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HomeMy WebLinkAboutABM ONSITE SERVICES-WEST, INC. 2B-2014r:ify of San i a '- Clerk of the Council AGREEMENT TERMINATION FORM COTC Office Use Only Please complete this form when the attached agreement and all CITY Or SANTA ANA amendments (if any) are no longer in effect. CLERK Or COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with Ad5M No. P,-aC�t4—\O(p was completed on '?jl /) LP and final payment has been made. (List all amendments. Use space below if needed.) A--aQ Iq-Mln' 0 I Revised 08-23-10 Department: �? F- A Phone/Ext.:,� Signature: o" Date: S1 141 L � A-2014-106-01 MAYOR Miguel A. PaIldo MAYOR PRO TEM r.0 Vincent F. Sairmlento COUNCILMEMBERS Angelica Arnezrua P. David Berravides Michele Martinez Roman Rayne Sal Tlnajero EXPIRES DAFE: I f 1 6 —6 CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 * P.O. Box 1988 M-23 Santa Ana, California 92702 MM.santa-ana.om May 26, 2015 ABNI Onsite Services — West, Inc. Attn: Arnold Klauber, Senior Vice President 165 Technology Drive, Suite 100 Irvine, CA 92618 Re-, Extension of Agreement No, A-2014-106 Dear Mr. Klauber: Pursuant to Section 4 ( 'Tcrm") of Agreement No. A-2014406, entered into by ABM Onsite Services — West, hie, and the City of Santa Ana, dated June 1, 2014, as amended by First Amendment No. A-2015-009, the time period of the Agreement is hereby extended for an additional one (1) year period, from June 1, 2015 to May 31, 2016. The insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. Sincerely' Gerardo Monet Executive Director of Pa ks, Recreation and Community Services Agency APPROVED AS TO FORM: Sonia R, Carvalho City Attorney n�i in M. f� istant City - Attorney cc: Clerk of the Council CffY OF SANTA ANA David Cavazos Cit "mann ATTEST: Maria D. Hirizar Clerk of the Council SANTA ANA CITY COUNCIL Miguel A. Puddr, Vincent F. Sermonic, 1 Mirtarle Nerriner AnqrocaAmazcva P David Senavides Roman Rayne Sat Tmajan, Mayor MaM Pro Tem, Wads Ward 2 t i Word 3 Wad 4 1 Ward 5 T Ward 6 6AMU� �n-- 1234de / T ® A� " CERT !LATE OF LIABILITY INSUR ICE DATE (MMIDDIYYYY) 10/27/2014 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(les) must 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 endorsement(s). PRODUCER Commercial Lines - (415) 541 -7900 Wells Fargo Insurance Services USA, Inc. - CA Lich: OD08408 CONTACT NAME: PHONE FAX AIC-N.. EW, _ A/C NO EMAIL ADDRESS: AFFORDING COVERAGE NAIC0 45 Fremont Street, Suite 800 _ INSURERA _ ACE American Insurance Company 22667 San Francisco, CA 94105 -2259 INSURED INSURER B: ACE Property and Casualty Ins. Co. 20699 ABM Onslte Services— West, Inc. INSURER C: $ 2,0Dg000 an ABM Industries Incorporated Company INSURER D; INSURER E: _ 1775 The Exchange SE, Suite 600 INSURER F: Atlanta, GA 30339 COVERAGES CERTIFICATE NUMBER: 8333639 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE AUDL D SU BR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY F-171 OCCUR CLAIMS -MADE XSLG27339177 11101/2014 11/0112015 EACH OCCURRENCE $ 2,000,000 DAMAGE T -RENTED PREMISES (Ea occurrence ) $ 2,0Dg000 MED EXP(Any one person) $ Excluded X $1000, 000 SIR X _ XCU _ PERSONAL B ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY El PRO LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 _ $ OTHER: A AUTOMOBILE LIABILITY ISAH08829779 11/01!2014 11/01/2015 COMBINED SINGLE LIMIT _tEa accident)-, $ s,DOO,DOo x BODILY INJURY (Per person) $ ANY AUTO x ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Paraccident) $ _ x PROPERTY DAMAGE Per accident) $ NON -OWNED HIRED AUTOS x AUTOS ___ B X UMBRELLA LIAR I x IOCCUR XOOG27636184 11101/2014 11/01/2015 E_ACH OCCURRENCE $ 5,000,000 _ AGGREGATE $ 5,000,000 EXCESS LIAB_ CLAIMS -MADE _ DED x RETENTION $ 25,000 $ '4 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/ PARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) N I A WCUC48138378 CA_$1000,000 SIR OH WA OR IL MI - $500K SIR 11/01/2014 11/01/2015 x PER OTH- STATUTE _ -.. ____ER E.L. EACHAC_CIDENT $ 1,000,000 E.L. DI_ti_EASE -EA EMPLOYEE 1 000,000 $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ 1.000,000 $ A Professional Liability G23645233009 11101/2014 11/01/2015 $5,000, 000 Each claim $5,000,000 Aggregate $1,000,000 Retention DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Addltlenal Remarks Schedule, may be attached If more space Is required) Job #3733 Jobsite: Parks, Recreation & Community Services Agency City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA. City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds as respects general liability as required by written contract with the Named Insured. If required by the written contract or agreement with said additional insureds, this insurance shall be primary insurance to any other insurance available to said insured covering the same loss. Such other insurance available to said additional insureds shall be excess to and non - contributing to this insurance. Thirty (30) days written notice of cancellation or non - renewal shall be given to the additional insured(s) in the event of cancellation of the general liability, automobile liability, workers' compensation and umbrella policy(ies). City of Santa Ana Attn: Silvia Cuevas 20 Civic Center Plaza m -23 Santa Ana, CA 92701 Reviewed by: Silvia Cuevas PRCSAIAdmin' 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. gr L 006R11 The ACORD name and logo are registered marks of ACORD © 1988.2014 ACORD CORPORATION. All rights reserved. ACORD25(2014 /01) 11111111111111111111 IN 11! 11 IN 11111111111111111111111111111111111111111111111111111 •cvaornzorootneelovorvwmeio• NON - CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS Named insured Endorsement Number ABM Industries Incorporated 4 Policy Symbol Policy Number policy Period 9flactive Date of Endoreemant XSL I G27339177 1'1/01/2014 to 11/0112015 Issued ey (Name at nsurance DampabY) ACE American Insurance Company Insert the policy number. The remainder of the Information Is to be colnpleled only when 7ma wdomeme l Is Issued aubsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization Additional Insured Endorggmgnt Any additional insured with whom you have agreed to provide such non- contributory Insurance, pursuant to and as required under a written contract executed prior to the date of loss (if no Information /a filled In, the schedule shall read., "All persons or entities added as additional Insureds through an endorsement with the term "Additional Insured' In the title) For organizations that are listed In the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following Is added to Section IVA: If other insurance Is available to an Insured we cover under any of the endorsements listed or described above (the "Additional Insured ") for a loss we cover under this policy, this insurance will apply to such loss and we will not seek contribution from the other Insurance available to the Additional Insured. Your "retained limit" Will applies to such lose, and we will only pay the Additional Insured for the "ultimate net loss" in excess of the "retained limit" shown In the Declarations of this policy. -�, � — Authorized Agent Reviewed by °° S Xa -20288 (oetos) PRCS�� Amin Page i of 1 OOfi319 IIII I IIIIIIIII IN 11111111111 N 11111111111111111111111111111111111111111111111111 aa1 tllamtleelm /O6OIOIO ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS Named Insured ABM Industries Incorporated Endorsement Number Any person or organization wham you have agreed 8 Pol oy ymbol Polloy Number Policy Period Effect va Data ❑t Endorsement XSt 027339177 11/01/2014 To 11/01/2016 Issued By (Name of Insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name Of Additional Inaurad Peraonia) Or Organlzatlon(a) Location And Daearlptlan Of Completed Operations Any person or organization wham you have agreed All locations where you perform work for such to Include as an additional Insured under a written additional insured pursuant to any such written contract, provided such contract required a CO2037 contract, equivalent and was executed prior to the date of loss, infamallon required to complete this schedule. If not shown above, will ba shown in the peoWretione, A. Section II —Who Is An Insured Is amended to Include as an additional Insured the person(s) or Drganization(s) shown In the Schedule, but onty with respect to liability for "bodily injury" or "property damage" caused, In whole or In part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional Inaurad and Included in the "products- completed operations hazard ". 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 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. B. 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 available under the applicable Limits of Insurance shown in the Declarations. This endorsement shall not Increase the applicable Limits of Insurance shown In the Declarations. RevleWed by' oil ..�. PR�SAIr,dmm MS -27302 (11/13) Copyright 2011 M F Authorized Representative Page 1 of 1 rovaoiaze,sn, e"e,oame,mmmo- ADDITIONAL INSURED • OWNERS, LESSEES OR CONTRACTORS • SCHEDULED PERSON OR ORGANIZATION Nomad Iiisured ABM Industries Incorporated Endorsement Number Any Owner, Lessee or Contractor whom you have 9 Policy symbol Policy Number Policy Perlo Effective Date of Endorsement XSL 627338177 11/01/2014 TO 11101/2015 Issued By (Name of insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name Ol Addlftonel Insured Psrsontsl Or Orgareatlon(s) Loostlonts) Or Covered Operations Any Owner, Lessee or Contractor whom you have All locations where you are performing operations agreed to Include as an additional Insured under a for such additional Insured pursuant to any such written contract, provided such contract required a written contract. CG2010 equivalent and was executed prior to the date of loss. Information required to complete this Schedule, If not shown above, will be shown In the setlarattcns. A. Section it — Who is An Insured Is amended to Include as an additional Insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for "bodily Injury ", "property damage" or "personal and advertising injury" caused, In whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional Insured(s) at the location(s) designated above. 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 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. B. With respect to the insurance afforded to these additional Insureds, the following additional exclusions apply: This insurance does not apply to "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 by 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 then another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the Insurance afforded to these additional Insureds, the following Is added to Section 111 — 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 available under the applicable Limits of Insurance shown in the Declarations. This endorsement shall not Increase the applicable Limits of Insurance shown In the Declarations. MS -27303 (11113) Copyright 2011 Im Page 1 of 2 Reviewed by: ��0l411 Silvia Cuevas oosz,o PRCSAIAdmin. IIII I I I VIII III II III III III II IIII I VIIIIII I II cracrnz"rootoas,ovoa,oro,o,o• ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Reviewed by' Silvia Cuevas QRCSAIAdmin. MS -27303 (11/13) Gopy0gh12011 m �L Who zed Repreaentadve Page 2 of 2 oos..I 1111111111111111111111111 HillHEIN111llllll1Hil Hill 1111 III I11111Hill11 1111 bU1A29,U0 U96,66,U80,6,6,6 123485 CERTIFICATE, OF LIABILITY INSURANCE DATE (MMIDDJYYYY) 10/26/2015 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 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 endorsement(s). PRODUCER CONTACT NAME: Commercial Lines - (415) 541 -7900 PHONE tALQ fAQ f&U;___,_.__ -� Wells Fargo Insurance Services USA,. Inc. - CA Lic#: OD08408 E -MAIL ADDRESS: 45 Fremont Street, Suuke $00 INSURER(S) AFFORDING COVERAGE NAIC # San Francisco, CA 94105 -2259 INSURER A: ACE American Insurance Company j 22667 INSURED _ INSURER B. ACE Property and Casualty Ins. Co 1 20699 ABM Onslte Services —West, Inc. _ INSURER C; an ABM Industries Incorporated Company - -.— _._ _.......... _...__._ -_ INSURER D ; 1775 The Exchange SE, Suite 600 INSURER E: Atlanta, GA 30339 INSURER F ; rnVPanr:FC r I=RTIFIC'ATF NUMRFR- 9722820 REVISION NUMRER� See below 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 . -_. LTR '.� TYPE OF INSURANCE AD DL SU 3_R I POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY XS LG2.7401028 11/01/2015 11/01/2016 EACH OCCURRENCE S 2,000 000 .... CLAIMS -MADE X OCCUR 6 "I • C7AVAC TO RENTED PREMISES Ea occurrence S 2,Q09 QflQ X $1,000 000 SIR v ed y d� 6:a'+' � � MED EXP (Any one person) S Excluded _..._...,....... L.m. XCU PERSONAL 8 AOW VNJURY S 2.000.000 GEN "L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 PRO X POLICY JECT LOC _..... rr9� V r� _ PRODUCTS - COMPIOP AGG 15 _ 2.OQfl.(7flQ _ y Il4 Ok OTHER: A, AUTOMOBILE LIABILITY 11/01/2015 11/01/2016 COMBINED SINGLE LIMIT j $ 6,000,000 Ea ancidenL, 14�� ---, It X ANY AUTO tl BODILY INJURY (Per person) j S x ALL OWNED SCHEDULED BODILY _... BODILY INJURY (Per aecpdent) $ AUTOS AUTOS X NON -OWNED PROPERTY DAMAGE X HIRED AUTOS AUTOS Pie ;accident) r B x UMBRELLA LIAB X OCCUR 1110112015 11101/2016 EACH OCCURRENCE 3 5,000 000 EXCESS LIAB CLAIMS -MADE AGGREGATE S 5.000.000 DED , X RETENTION $ 25 „000 __.._ $ A WORKERS COMPENSATION WCUC48593537 11401/2015 11/01/2016 X ��gr�1E ERH_ AND EMPLOYERS' LIABILITY Y I N _ 1 MANY PROP RIETORIPARTNERIEXECUTIVE CA - $1,000,000 SIR ..00©,00© E.L. EACH ACCIDENT ;*p .- .........._ ._ .- .._m..— —. IManda ofry in NH) EXCLUDED? N N f A CH WA OR IL MI - $500K SIR r 1,0f5Q 000 EI L. DISEASE - EA EMPLOYEE � OOQ 000 Me ycs, describe under DESCRIPTION OF OPERATIONS astlow E.L. DISEASE - POLICY LIMIT $ A Professional Liability 623645233009 I 7101/2015 7/01/2016 $5,fl00,000 Each claim $5,000,000 Aggregate 'f $1 000,000 Retention DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 109, Addlllonal Remarks schedule, may be attached it more space is required) ,lob #3733 Jobsite: Parks, Recreation & Community Services Agency City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA. City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds as respects general liability as required by written contract with the Named Insured. If required by the written contract or agreement with said additional insureds, this insurance shall be primary insurance to any other insurance available to said insured covering the same loss. Such other insurance available to said additional insureds shall be excess to and non - contributing to this insurance. Thirty (30) days written notice of cancellation or non- renowal shall be given to the additional insured(s) in the event of cancellation of the general liability, automobile liability, workers` compensation and umbrella pofcy(ies). (CERTIFICATE MULDER UANCUtLL.A 1 IlL N City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Silvia Cuevas ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza m-23 Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD O 1985 -2014 ACORD CORPORATION, All rights reserved. ACRD 25 (2014/01) 111111111111 1111111 1111111 X111111 11111 11111 11111 1 1111111111111111111111 11111111111111 &5A�66G�1,51�21�6,, rvl�' Named Insured ABM Industries Incorporated Endorsement Number 3 Policy Symboi Policy Number Policy Period Effective Date of Endorsement XSL �G27401028 111/01/2015 TO 11101/2016 Issued By (Name of Insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) I Or Organization(s) I All persons or entities added as an Additional Insured through an endorsement with the term 'Additional Insured' in the title but only if such non-contributory coverage is required by & written contract signed by the Named Insured prior to loss. For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IVA: If other valid and collectible insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional insured") for a loss we cover under this policy, this insurance will apply to such loss and is primary, meaning that we will not seek contribution from the other insurance available to the Additional Insured. Your "retained limit" still applies to such lose, and we will only pay the Additional Insured for the "ultimate not loss" in excess of the "retained limit" shown in the Declarations of this policy. Autft(l-rized Representative MS-27347 1113 Copyright 20119% Page 1 of 'I 'CY805A2GY002115f0T06tG?0/W0' ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION THIS ENDORSEMENT CHANGES, THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS COMMERCIAL GENERAL LIABILITY POLICY ANE5DIMM Nome OfAdditional Insured Person(s) Or organization(s) Locatlon(s) Of Covered Operations Any Owner, Lessee or Contractor whom you have All locations where you are performing operations agreed to include as an additional insured under a for such additional insured pursuant to any such written contract, provided such contract required a written contract. CG201 0 equivalent and was executed prior to the date of loss. Information required to complete this Schedule, if not shown a"Ve. Will be shown in the Declarations. A. Section 11 — Who is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but Only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above, However: I. 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 a contract or agreement, the insurance affordedi 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, an the project (other than service, maintenance or repairs) to be performed by 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. C. 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 available under the applicable Limits of Insurance shown in the Declarations, This endorsement shalt not increase the applicable Limits of Insurance shown in the Declarations. MS-27303 (11 /13) Em ? ed Page I of 2 Copyright 2011 IM f 111111111111111 IN 11111111111111111111111111111111111 111�1 1111111111111 CYBU A21(YC42a1�t9�ffeUlUUf�' �M Authorized RepresentetIve MS- 27303 (11/13) Copyright 2011 Im Page 2 of InIVIVI111IIIVYIIIIIINIII11I111IIYIIVRBBIRIMVIIIIIIA1111 ...._. Named Insured industries incorporated tn�cir­s`e­ me n t Nurn b e r 8 Any person or organization whore you have agreed Policy Policy Number Policy Period Effective Date of Endorsement XSL I 627401028 11 /01 /2015 TO 11/01/2016 contract, provided such contract required a CG2037 contract. Issued By (Name of Insurance G—Oriii5-6n—y—) loss ACE American Insurance Company I WormationreclO red to complete this Schedule, if not shown above, will be shown in the DeclaraLons, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS COMMERCIAL GENERAL LIABILITY POLICY SCHEDULE Name Of Additional Insured Porsonla) Or Organizatlon(s) Location And E)esorkptlon of Completeo operations Any person or organization whore you have agreed All locations where you perform work for such to include as an additional insured under a written additional insured pursuant to any such written contract, provided such contract required a CG2037 contract. equivalent and was executed prior to the date of loss I WormationreclO red to complete this Schedule, if not shown above, will be shown in the DeclaraLons, A. Section III —Who Is An Insured is amended to include as an additional insured the persori(s) or organization(s) Shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by '.your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -co mp leted operations hazard". However: 11. 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 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, B. 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 available under the applicable Limits of Insurance shown in the Declarations. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Authorized Representative C6 MS-27302 (11113) Copyright 2011 M. Page 1 of I 111111111111111111111111111111111 IN 111111111111111111111111111! 1111111111 P11 1111111111111 W011.0011'