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HomeMy WebLinkAboutSANTA ANA ELKS LODGE 794 BANQUET FACILITYINSURANv L uR FILE WORK NIAY PROCEED UNTIEE NSU{IAI EXPIRES CLERK OF COUNCIL DATE: u) (YASMIA VA4V&x)FA Santa Ana Public Works Agency Employee Retreat N-2022-136 The Client agrees to the following policies below for the event date and time specified on this contract. A deposit is required to guarantee the date and time for all clients utilizing the Santa Ana Elks Lodge 794 Banquet oFacility. A provisional booking of one date can be held for up to 3 days, after at which time the Santa Ana Elks Lodge 794 has full discretion to release the date. t- '-4 The Client is required to make a deposit of $500,00 to secure the booking; of which $250.00 is non-refundable. The Santa Ana Elks Lodge 794 reserves the right to withhold all or part of the initial deposit if any substantial damages are made to the facility or outside property; in addition to additional charges incurred the day of the event. Cancellation Policy: Cancellation within 30 days of your scheduled event will result in the forfeit of 50% of the Client's deposit. Food Policy: All food and beverage arrangements MUST be provided by the Santa Ana Elks Lodge 794 (no outside food/or beverages including Alcohol). Any food provided buffet or sit-down style, not consumed during the event, will not be permitted to leave the premises, per the health code. Meals are served promptly as set forth on the Banquet Event Order. A two (2) hour maximum is allowed for Food Service. Menu & Guests Count: Any menu changes, special requests and guaranteed number of guests must be confirmed 7 days prior to the scheduled event. Absolutely no reductions in the guaranteed guest count will be accepted less than one (1) week prior to the scheduled event. The Santa Ana Elks Lodge 794 reserves the right to substitute any food that may become unavailable in the market or that exceed reasonable market price. And will make the best effort to notify the Client of such substitution(s) if time allows. Bar Service: Santa Ana Elks Lodge 794 offers a full bar service, including cash, tab, and open bar options. Events requesting a cash or tab bar will be assessed a $125.00 per bartender fee. Guests should acknowledge the right of our bartenders to suspend the serving of alcohol to any persons in order to ensure responsible drinking. The Client shall comply with all applicable local and state liquor laws, and further agrees that neither Client or Client's guests will request or serve alcoholic beverages to a minor or any persons who are intoxicated. The Santa Ana Elks Lodge 794 forbids any alcoholic beverages to be brought onto the premises. Decoration: Santa Ana Elks Lodge 794 will provide white table linens, white napkin linens, glassware, plate ware, and silverware for all events. In addition to the use of audio-visual equipment and microphone and podium. The Client will have access to the event venue at least 2 hours prior to the start time of the event to decorate. Should Client need additional time, there will be an additional charge of $150.00 per hour. The Banquet Manager must approve all additional decorations or displays brought onto the premises in advance. The use of confetti, rose petals, birdseed, glitter, feathers, fog, sparklers, pyrotechnics and smoke machines, are strictly prohibited and will result in a loss of initial deposit. Nothing can be stapled or taped to any walls or surfaces. Personal Belongings: Santa Ana Elks Lodge 794 will not be held responsible for the loss or damage of any personal belongings of the Client or guests of Client. Security: Security is required for all events 200+ guests. At a cost to the Client of $250.00. Liability Insurance: The Grand Lodge requires that each event is covered by our Insurance Company at a cost to the Client of $295.00. We can not use the Clients company or make any exceptions to this policy. Damage: Because the Client is responsible for their guests and vendors; prior to the event the Banquet Captain, Banquet Manager or General Manager will walk the event area and Lodge to insure there is no visible damage. If agreed, the Client will sign and date below that everything was in perfect order. %JIA _ . Client Signature Date (walk through) Banquet Captain, Banquet Manager Condition After the event we will re walkthe premises to ensure all areas are still in perfect order and damage free. The Client will be responsible for the cost to repair any damaged or missing items caused by guests or vendors. Banquet Captain, Banquet Manager, General Manager Client Signature Condition Final payment: Final payment for the guaranteed number of guests must be paid in full by check, credit or cash. All additional charges, including charges for additional guests above your guaranteed count, shall be paid immediately following dinner. A Banquet Manager will verify the number of guests in attendance for each function. I, YASMIN VAZQUEZ (PUBLIC WORKS AGENCY EMPLOYEE RETREAT), agree to the above referenced polices in this contract_ Client Name(s): Client Address: Client Contact: Type of Function: Date of Function: Room Rented: YASMIN VAZQUEZ (PUBLIC WORKSAGENCY EMPLOYEE RETREAT) `i(Li' ! 0g—ggZ.j (cell) EMPLOYEE RETREAT TUESDAY, MAY 17, 2022 YVAZQUEZ@SANTA-ANA.ORG (Email) Time of Event: 10 AM — 2 PM '/I Room Rental Fee: WAIVED Signature: La.i, WG1 c2, Date: (!5-11� 22- GRAND BALLROOM Banquet Manager Signature: P Date: xFJ N-2022-136 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: d�W�(t I Daisy Gome Clerk of the Lneil APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By- Briad& Salvatierra Deputy City Attorney RECOMMENDED FOR APPROVAL: Nabil Saba, PE Executive Director Public Works Agency CITY OF SANTA ANA Kristine Ridge City Manager SANTA ANA ELKS LODGE 794 -exxvirz I n/L(G ,4 a � SANTA ANA ELKS LODGE 794 1751 S. Lyon Street Santa Ana, CA 92705 FINAL HEADCOUNT - 5/6/2022 BANQUET EVENT ORDER Date Booked: JOHN MOORE, General Manager 794iohnmoore(@amail.com MARIA BISBEE, Dir of Banquets 794ba na uets@email.com Office:(714) 547-7794 Name of Event: PUBLIC WORKS AGENCY EMPLOYEE ELK MEMBER MICHAEL, MURRIETA-OR RETREAT Date of Event: TUESDAY, MAY 17, 2022 Client: YASMIN VAZQUEZ Time of Event: 10:00 AM - 2:00 PM Phone: 714-308-4927 Type of Event: Email: YVAZQUEZ@SANTA-ANA.ORG Room: GRAND BALLROOM Address: MMURRIETA@SANTA-ANA.ORG Number of Guest: 250 City, State, Zip: Santa Ana, CA 92701 Meal Time: 12:00 PM SIGNATURE OF APPROVAL Meal Type: BUFFET DATE U 5/9/2022 (,V MENU QUANTITY @ COST TOTAL GREEN SALAD W/RANCH AND ITALIAN DRESSINGS, CHICKEN ALFREDO, MEAT LASAGNE, SPECIAL VEGAN: PASTA W/OLIVE OIL, GARLIC, VEGETABLES, FRESH FRUIT, 250 $ 38.50 $ 9,625.00 CHEESECAKE, GARLIC BREAD, ICED TEA, COFFEE, SOFT BEVERAGES, WATER $ 9,625.00 GRAND BALLROOM TO BE SET FOR SEATING OF 260 - 26 ROUND TABLES OF 10, WHITE LINEN AND NAPKIN, LONG TABLE JUST INSIDE ROOM FOR CHECK -IN W/WHITE LINEN AND 2 CHAIRS AND ANY OTHER TABLES NEEDED, PODIUM/MICROPHONE, USE OF AV EQUIPMENT, TABLE #S NEEDED SUB -TOTAL FOOD $ 9,625.00 MANDATORY FEES ROOM RENTAL GRAND BALLROOM (FEE $1,200.00) 1 WAIVED WAIVED WAIVED BARTENDER (FEE $125.00 EACH) LIABILITY INSURANCE (Fee $295.00) WAIVED WAIVED WAIVED SECURITY (1) (Fee $250.00) N/A N/A N/A SUB -TOTAL MANDATORY FEES $ - ADDITIONAL AMENITIES LABOR FEE 1 $ 250.00 $ 250.00 $ 250.00 SUB -TOTAL ADDITIONAL AMENITIES $ 250.00 GFATUITY21% INCLUSIVE CA SALES TAX9.25% INCLUSIVE TOTAL BEO $ 9,875.00 A $500.00 DEPOSIT IS REQUIRED TO SECURE YOUR DATE FULLY REFUNDABLE 1 WEEK AFTER YOUR EVENT ,DEPOSIT DATE RECEIVED Final Payment Due On: MONDAY, MAY 17, 2022 Certificate of Liability Insurance Due on: WAIVED 2022 BEO D - PUB WORKS - EMPLOYEE RETREAT JCII I Id ILI Id IVI. uignany signea Dy,amamna ivi. I a,.,h,.rr _--1 Lambert Date: 2022.03.16 09:20:35 -07'00' BENS&PR-01 RT N DAT128/2D/YYYY) 2/26/zozz ,�`oRo CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER License # OM10410 Armstrong/Robitaille/Riegle Business and Insurance Solutions 1500 Quail St, Suite #100 Newport Beach, CA 92660 CONTACT NAME: PHONE FAX (949) 381-7700 ruc, No :(949 861-9429 WAVE . arrinfo@aleragroup.com INSURER(SI AFFORDING COVERAGE NAIC # INSURERA: Great American Insurance Co. 16691 INSURED INSURER B: Insurance Co Of the West 27847 INSURER C Benevolent & Protective Order of Elks #794 INSURER 0: 1751 S. Lyon St Santa Ana, CA 92705 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMRF_R- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSD SUBR MD POLICY NUMBER POLICY EFF POLICY MP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X PAC395275100 5129/2021 5/29/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTPREMISES (Es IED memiel $ 1,000,000 10,000 MED EXP (Any one enum PERSONAL&ADV INJURYk$2,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY❑ PROLOC GENERALAGGREGATE PRODUCTS-COMP/OP AGGOTHERA AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUTOS ONLY PAC395275100 5129/2021 5/2912022 EOMBINED SINGLE LIMIT otcklimll BODILY INJURY Per erson BODILY INJURY Per accident X Perac (cant AMAGE $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE UMB395275200 5/29/2021 5/29/2022 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DEO I X I RETENTION$ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTNE WE.L.FICER/MEMBER EXCLUDED? (Mandatory in NH) IF yes, describe under DESCRIPTION OF OPERATIONS below NIA WSD506302200 12/5/2021 12I5/2022 X PER OTH- UIEER EACH ACCIDENT 1,000,g0g $ E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 A A Abuse & Molestation Abuse & Molestation PAC395275100 PAC395275100 5129/2021 5129/2021 5/29/2022 5/29/2022 Each Abuse Limit Aggregate Limit 1,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Santa Ana is included as Additional Insured as respects General Liability per the attached forms. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE RNLMw�1IadDlsldmL lL y t: Y REmEwEC&APPRovEDBY, ACORD 25 (2016103) 01988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Management Supervisor b"l " Ub/UU/ZUZI . HAL; 3JbIOZ/Dl UU liKtAl AMtKIUAN INb"UKANUt LoUMF'ANY *D/B* 121126296 255044 CG 89 70 (Ed. 11/14) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT This Endorsement modifies and is subject to the insurance provided under the following form: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following extension only applies in the event that no other specific coverage for the indicated loss exposure is provided under this Policy. If other specific coverage applies, the terms, conditions and limits of that Coverage are the exclusive coverage applicable under this Policy, unless otherwise noted in this Endorsement. This is a summary of the various additional coverages and coverage modifications provided by this Endorsement. For complete details on specific coverages, consult the actual policy wording. Coverage Description Limit of Insurance Page Non -Owned Aircraft Included 2 Non -Owned Watercraft Included 2 Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Included 3 Medical Payments $ 20,000 3 Damage to Premises Rented to You $ 1,000,000 3 Supplementary Payments - Bail Bonds $ 3,000 4 Supplementary Payments - Loss of Earnings $ 1,000 per day 4 Newly Formed or Acquired Organizations Included 4 Unintentional Failure to Disclose Hazards Included 5 Knowledge of Occurrence, Claim or Suit Included 5 Property Damage Liability - Elevators Included 5 Property Damage Liability - Borrowed Equipment Included 5 Liberalization Clause Included 6 Amendment of Pollution Exclusion (Premises) Included 6 Limited Property Damage to Property of Others $ 5,000 6 Additional Insured - Manager or Lessor of Premises Included 7 RWRWeMwgv�ntDb{ime REVIEWED6APPRovm Br Risk Management Supervisor CG 89 70 (Ed. 11/14) (Pane 1 of 12) Jl - Ub/Ud/LUZ1 " t-AU JUOZ101 UU UKtA I AMtKIUAN INJUKANUt I:VMYANY *D/B* 121126296 255044 Coverage Description Limit of Insurance Page Additional Insured - Funding Sources Included 7 Additional Insured - By Contract Included 8 Primary and Non -Contributory Additional Insured Extension Included 10 Additional Insureds - Protection of Your Limits Included 10 Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Included 11 Property Damage Extension With Voluntary Payments $ 1,000/$ 5,000 11 Who Is An Insured - Fellow Employee Extension - Management Employees Included 12 Broadened Personal and Advertising Injury Included 12 A. Non -Owned Aircraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided: 1. it is not owned by any insured; 2. it is hired, chartered or loaned with a trained paid crew; 3. the pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating him or her a commercial or airline pilot; and 4. it is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the Insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this Policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. Non -Owned Watercraft Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) less than 60 feet long; and CG 89 70 (Ed. 11/141 (Pace 2 of 12) a ®'. w.kr nMdan ItuF wm S/WreovmBy. Si.wcwl�a Lu�.Ge�X — Risk Management Supendsor Jl " Ub/UU/ZUZI - F'Al: :SybZ/5l UU UKtAI AMtKILAN INJUKANI;t GUMFANY *D/B* 121126296 255044 (b) not being used to carry persons or property for a charge. C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from physical injury, sickness, or disease to that person. D. Medical Payments If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this Policy are amended as follows: The Medical Expense Limit in paragraph 7. of SECTION III - LIMITS OF INSURANCE is replaced by the following Medical expense Limit: The Medical Expense Limit provided by this Policy shall be the greater of: a. $ 20,000; or b. the amount shown in the Declarations for Medical Expense Limit This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE. E. Damage to Premises Rented to You If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part: 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: 3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Limit of Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. However, this insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with the permission of the owner, caused by: i. rupture, bursting, or operation of pressure relief devices; ii. rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; iii. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or iv. flood 2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: ,s3 R EwmS,•��•F�MPROvO)eBY7. , ,' Ruk 5A g Super ery ^o CG 89 70 (Ed. 11/14) (Pane 3 of 12) W " UD/U`J/ZUZI " VAI: J`JbZ/bl UU UKtAl AMtKII:AN INJUKANUL GUMVANY *D/B* 121126296 255044 6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection system or water while rented to you or temporarily occupied by you with the permission of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water proximately caused by the same event, whether such damage results from fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water or any combination of the six, is the higher of $ 1,000,000 or the amount shown in the Declarations for the Damage to Premises Rented to You Limit. 3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire protection system or water." 4. As regards coverage provided by this provision I. Damage to Premises Rented to You - paragraph 9.a. of Definitions is replaced with the following: 9. a. a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, leakage from automatic fire protection systems or water to premises while rented to you or temporarily occupied by you with the permission of the owner is not an "insured contract'; F. Supplementary Payments 1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced with: b. Up to $ 3,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the Insured at our request to assist us in the investigation or defense of the claim or "suit," including actual loss of earnings up to $ 1,000 a day because of time off work. G. Newly Formed or Acquired Organizations Paragraph 3. of SECTION II - WHO IS AN INSURED is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a named insured if there is no other similar insurance available to that organization. However: a. coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. coverage A does not apply to "bodily injury" or property damage that occurred before you acquired or formed the organization; and c. coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. R4kMw*9wwtDMskn M� b+*W `�� Risk Management Supervisor CG 89 70 (Ed. 11/14) (Pane 4 of 12) J7 ' Lo/U`J/ZUZI ' VAL; 3`J*Z/01 UU UKtAl AMtKIUAN INSUKANGt UL)WANY *D/B* 121126296 255044 d. records and descriptions of operations must be maintained by the first named insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a named insured in the Declarations or qualifies as an insured under this provision. H. Unintentional Failure to Disclose Hazards Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 6. Representations: Failure of the Insured to disclose all hazards existing as of the inception date of this Policy shall not prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure or omission is not intentional on the part of the Insured. I. Knowledge of Occurrence, Claim or Suit Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named Insured does not in itself constitute knowledge by the Insured unless notice of such injury, claim or suit shall have been received by: a. you, if you are an individual; b. a partner, if you are a partnership c. an executive officer or insurance manager, if you are a corporation. J. Property Damage Liability - Elevators 1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraphs (3), (4) and (6) of exclusion j. Damage to Property do not apply if such property damage results from the use of elevators. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. K. Property Damage Liability - Borrowed Equipment 1. Under paragraph 2. Exclusions of SECTION 1 - COVERAGE A - Bodily Injury and Property Damage Liability, subparagraph (4) of exclusion j. Damage to Property does not apply to "property damage" to borrowed equipment while not being used to perform operations at a job site. 2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions, Condition 4. Other Insurance, paragraph b. Excess Insurance: The insurance afforded by this provision of this Endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. 12tinEWED &APPROVED Br ��'' Ruk Management Supevkw CG 89 70 (Ed. 11/14) (Paae 5 of 12) Sl - U0/UU/ZUZI " NAI:;JUOZr bl UU UKtAI AMtKII:AN INJUKANI:t UUMF'ANY *D/B* 121126296 255044 L. Liberalization Clause If we revise this Signature General Liability Broadening Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the date the revision is effective in your state. M. Amendment of Pollution Exclusion (Premises) 1. The following is added to paragraph (1)(a) of Exclusion f. of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: (iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage, migration, release or escape of "pollutants." As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or escape of pollutants must: (aa) commence on a clearly identifiable day during the policy period; and (bb) end, in its entirety, within seventy-two (72) hours of the commencement of the discharge, dispersal, seepage, migration, release or escape of "pollutants"; and (cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day that the discharge, dispersal, seepage, migration, release or escape of "pollutants" commences; and (dd) be neither expected nor intended from the standpoint of any insured; and (as) be unrelated to any previous discharge, dispersal, seepage, migration, release or escape; and (ff) not originate at or from a storage tank or other container, duct or piping which: a. is below the surface of the ground or water; or b. at any time has been buried under the surface of the ground or water and then is subsequently exposed. 2. For the purposes of this coverage, the following is added to the definition of "property damage" of SECTION V - DEFINITIONS and applies only as respects this coverage: Land or water, whether below ground level or not, is not tangible property. 3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration, release or escape that is merely threatened or alleged rather than shown to have actually occurred. N. Limited Property Damage to Property of Others The following is added under SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A and B: 3. We will pay up to $ 5,000 for loss to personal property of others while in the temporary care, custody or control of an insured caused by any person participating in your organized activities. For the purpose of this supplementary payment, loss shall mean damage or destruction but does not include mysterious disappearance or loss of use. In the event of a theft, a police report must be filed. This supplementary payment does not apply if: Is a. coverage is otherwise provided by the Property Coverage part (if an „e_ R41 MarugnnvdDhi9un 9' REvi EvrEo fi MrRov®liv: �'. Risk Management Supervisor CG 89 70 (Ed. 11/14) (Pane 6 of 12) W - U0/UV/LUL1 " t AU 35VOZt5l UU liKtAl AMtKIUAN INtiUKANUt UUMF'ANY *D/B* 121126296 255044 b. the loss is covered by any other insurance you have or by any insurance of such person who causes such loss. These payments will not reduce the Limits of Insurance. O. Additional Insured - Manager or Lessor of Premises 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization from whom you lease or rent property and which requires you to add such person or organization as an additional insured on this Policy under: (a) a written contract; or (b) an oral agreement or contract where a Certificate of Insurance showing that person or organization as an additional insured has been issued; but the written or oral contract or agreement must be an "insured contract," and, (i) currently in effect or become effective during the term of this Policy; and (ii) executed prior to the "bodily injury," "property damage," "personal and advertising injury." 2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1. above, the following additional provisions apply: (a) This insurance applies only with respect to the liability arising out of the ownership, maintenance or use of that part of the premises leased to you. (b) The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. (c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. (d) Coverage provided herein is excess over any other valid and collectible insurance available to the Additional Insured whether the other insurance is primary, excess, contingent or on any other basis unless a written contractual arrangement specifically requires this insurance to be primary. (e) This insurance applies only to the extent permitted by law. 3. This insurance does not apply to: (a) Any "occurrence" or offense which takes place after you cease to be a tenant in that premises. (b) Structural alterations, new construction or demolition operations performed by or on behalf of the Additional Insured. P. Additional Insured - Funding Sources 1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any Funding Source which requires you in a written contract to name the Funding Source as an additional insured but only with respect to liability arising out of: — Risk Management Supervisor CG 89 70 (Ed. 11/14) (Pace 7 of 12) J7 " Ub/UU/ZUZI " F'Al: JU0Z/01 UU UKtA I AMtKIUAN INSUKANUt UUMYANY *D/B* 121126296 255044 a. your premises; or b. "your work" for such additional insured; or c. acts or omissions of such additional insured in connection with the general supervision of "your work" and only to the extent set forth as follows: a. The Limits of Insurance applicable to the Additional Insured are the lesser of those specified in the written contract or agreement or in the Declarations for this Policy and subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations. b. The insurance afforded to the Additional Insured only applies to the extent permitted by law c. If coverage provided to the Additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased by such contract. Q. Additional Insureds - By Contract 1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of: a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the Additional Insured that are subject of the written contract or written agreement provided that the "bodily injury" or "property damage occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or b. the maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or c. the Additional Insureds financial control of you; or d. operations performed by you or on your behalf for which the state or political subdivision has issued a permit However: 1. the insurance afforded to such additional insured only applies to the extent permitted by law; and 2. if coverage provided to the Additional Insured is required by contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide such additional insured. With respect to paragraph 1.a. above, a person's or organization's status as an additional insured under this Endorsement ends when: R4kMcruq�enedl%tsWa RenEwEn 6 MPRovm Dr MWIF �F Gc+*�enX Risk Management Supemw CG 89 70 (Ed. 11/14) (Pane 8 of 12) b"I " Ub/UVIZUZI " YAU JU0Zr01 UU UKtA I AMtKIUAN INJUKANUt UUMNANY *D/B* 121126296 255044 (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this Endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage." We have no duty to defend an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured as required in paragraph b. of Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITION. 2. With respect to the insurance provided by this Endorsement, the following are added to paragraph 2. Exclusions under SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: This insurance does not apply to: a. 'Bodily injury" or "property damage" that occurs prior to your commencing operations at the location where such "bodily injury" or "property damage" occurs. b. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: (1) the preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the "occurrence" which caused the "bodily injury" or "property damage," or the offense which caused the "personal and advertising injury," involved the rendering of, or failure to render, any professional architectural, engineering or surveying services. c. 'Bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed for or on behalf of the Additional Insured(s) at the location of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. vEDBv- ,''j ReviEwm> DNlsimt 5A,.,u.x&k ulkw Ruk Management Supervisor CG 89 70 (Ed. 11/14) (Paae 9 of 12) 1l - Ub/UU1ZUZI - NAL; J`UbZ/bl UU UKtAI AMtKII;AN INJUKANI;t UUMNANY *D/B* 121126296 255044 d. Any person or organization specifically designated as an additional insured for ongoing operations by a separate additional insured endorsement issued by us and made part of this Policy. 3. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the Additional Insured is required by a contract or agreement, the most we will pay on behalf of the Additional Insured is the amount of insurance: a. required by the contract or agreement; or b. available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This Endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. R. Primary and Non -Contributory Additional Insured Extension This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to paragraph a. Primary Insurance: This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) the Additional Insured is a named insured under such other insurance; and (2) you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the Additional Insured. b. The following is added to paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the Additional Insured is designated as a named insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the Additional Insured has been added as an additional insured on other policies. S. Additional Insureds - Protection of Your Limits This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this Policy. 1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit: An additional insured under this Endorsement will as soon as practicable: DMdmi ,' REREVIEWED &APPROVED BY. of t'�"" Ruk Management Supervisor CG 89 70 (Ed. 11/141 (Paae 10 of 12) A"7 " 1Jb11JU/Z1JZI " YAL; JUbZ/b1 UU IJKtAI AMt KIL:AN INSUKANGt UUMYANY *D/B* 121126296 255044 a. give written notice of an 'occurrence" or an offense that may result in a claim or "suit' under this insurance to us; b. tender the defense and indemnity of any claim or "suit' to all insurers whom also have insurance available to the Additional Insured: and c. agree to make available any other insurance which the Additional Insured has for a loss we cover under this Coverage Part. d. we have no duty to defend or indemnify an additional insured under this Endorsement until we receive written notice of a "suit' by the Additional Insured. 2. The Limits of Insurance applicable to the Additional Insured are those specified in a written contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy and defined in SECTION III - LIMITS OF INSURANCE of this Policy, whichever are less. These limits are inclusive of and not in addition to the Limits of Insurance available under this Policy. T. Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation) Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to Condition 8. Transfer of Rights of Recovery Against Others to Us: If required by a written contract or written agreement, we waive any right of recovery we may have against a person or organization because of payment we make for injury or damage arising out of your ongoing operations or "your work" done under a contract for that person or organization and included in the "products -completed operations hazard" provided that the injury or damage occurs subsequent to the execution of the written contract or written agreement. U. Property Damage Extension with Voluntary Payments 1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A - Bodily Injury and Property Damage Liability: At your request we will pay for "loss" to property of others caused by your business operations for which this Policy provides liability insurance. Such payment will be made without regard to your legal obligation to do so. The "loss" must occur during the policy period and must take place in the 'coverage territory." 2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of SECTION I - COVERAGES A - Bodily Injury and Property Damage Liability is amended as follows: Exclusions j.(3), j.(4), j.(5) and j.(6) are deleted. 3. As respects coverage afforded by this coverage, SECTION III - LIMITS OF INSURANCE is replaced by the following: Regardless of the number of insureds, claims made or "suits" brought or persons or organizations making claims or bring "suits": 1. Subject to 2. Below, the most we will pay for one or more "loss" arising out of any one "occurrence" is $ 1,000. 2. The aggregate amount we will pay for the sum of all "loss" in an annual period is $ 5,000. This aggregate amount is part of and not in addition to the General Aggregate Limit described in paragraph 2. of SECTION III - LIMITS OF INSURANCE. R4kMcn;enmttxrlslmt RenEWEo&APPRov®Br. ��ec (a+rt�rn�7 �� Risk Management Supervisor CG 89 70 (Ed. 11/14) (Pace 11 of 12) Jl " Ub/U`J/ZUZI ' YAI: JUOZ/bl UU UKtAI AMtKIUAN INA"UKANI:t UUW"ANY *D/B* 121126296 255044 V. Who Is an Insured - Fellow Employee Extension - Management Employees 1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED: Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, including the direct supervision of other "employee" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury," caused in whole or in part by their intoxication by liquor or controlled substances. This coverage is excess over any other valid and collectable insurance available to your "employee." W. Broadened Personal and Advertising Injury 1. Unless "Personal and Advertising Injury" is excluded from this Policy, the following is added to SECTION V - DEFINITIONS Item 14.: h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a. through 14.e. ;¢ R Ewm Rov®Br Risk Management Supem or CG 89 70 (Ed. 11/14) (Pane 12 of 12)