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HomeMy WebLinkAboutAPEX PAVEMENT SOLUTIONS INC - INSURANCE CERTIFICATE 2022-2023SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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 endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 2/1/2023 CCIG 155 Inverness Drive West Englewood CO 80112 303-799-0110 303-799-0156 info@thinkccig.com License#:45339 Selective Insurance Company of 12572 TGPRESS-01 Pinnacol Assurance 41190ApexPavementSolutions,Inc. Tendit Group LLC 7979 E.Tufts Ave Suite 1500 Denver CO 80237 SiriusPoint Specialty Insuranc 16820 1243714745 A X 1,000,000 X 500,000 10,000 1,000,000 2,000,000 X X S2503737 11/5/2022 11/5/2023 2,000,000 A 1,000,000 X X X S2503737 11/5/2022 11/5/2023 A X X 10,000,000S250373711/5/2022 11/5/2023 X 0 B X40316092/1/2023 11/1/2023 1,000,000 1,000,000 1,000,000 A C Leased/Rented Equipment Pollution S2503737 CPPLS00025960 11/5/2022 11/5/2022 11/5/2023 11/5/2023 Limit Retention $10,000 $1,000,000 Occ/Agg:$2,000,000 As required by written contract or written agreement,City of Fort Collins,its officers,agents and employees are included as Additional Insured for ongoing and completed operations under General Liability and Automobile Liability on a primary and non-contributory basis.As required by written contract or written agreement,a Waiver of Subrogation in favor of the Additional Insured applies to General Liability,Automobile Liability and Workers’Compensation.Umbrella coverage is Follow Form to General Liability,Automobile Liability and Workers Compensation/Employers Liability. City of Fort Collins Purchasing Division Fort Collins CO 80522 Contracting, Installation, Service and Repair General Liability Extended ElitePac® Endorsement COMMERCIAL GENERAL LIABILITY CG 79 88 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. BLANKET ADDITIONAL INSUREDS a. Ongoing Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed under that contract, agreement, or permit when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of your ongoing operations. If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of your ongoing operations, then such person or organization is an additional insured only with respect to “bodily injury”, “property damage” or “personal and advertising injury” caused in whole or in part by your ongoing operations performed under that contract, agreement, or permit. b. Completed Operations SECTION II — WHO IS AN INSURED is amended to include as an additional insured: 1. Any person or organization for whom you are performing or have performed operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above; Such person or organization is an additional insured only with respect to their liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard” when that contract, agreement, or permit requires the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 79 88 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 3 If the written contract, written agreement, or written permit does not require that the additional insured be added with respect to liability arising out of “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”, then such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by “your work” performed under that contract, agreement, or permit and included in the “products-completed operations hazard”. c. The coverages provided in Paragraphs a. and b. do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury”, “property damage” or “personal and advertising injury”. d. Exclusions (1) With respect to the insurance afforded to additional insureds under a. Ongoing Operations the following is added to 2. Exclusions under SECTION I — COVER- AGE A — BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY : This insurance does not apply to “bodily injury”, “property damage”, or “personal and advertising injury” occurring after: (a) 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 site of the covered operations has been completed; or (b) 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 contrac- tor or subcontractor engaged in perform- ing operations for a principal as a part of the same project. (2) With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations, the following is added to 2. Exclusions under SECTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAM AGE LIABILITY: This insurance does not apply to: “Bodily injury”, “property damage”, or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. e. Conditions With respect to the insurance afforded to these additional insureds under a. Ongoing Operations and b. Completed Operations the following is added to Paragraph 4. Other Insurance, a. Primary Insurance under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary and will not contribute with any other insurance available to an additional insured under this coverage part provided that: (1) The additional insured is a Named Insured under such other insurance. (2) You have agreed in a written contract, written agreement or written permit to include that additional insured on your General Liability policy on a primary and/or non-contributory basis. 2. PROPERTY DAMAGE CARE, CUSTODY OR CONTROL The following is added to Exclusion j. under SECTION I — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Paragraphs (4) and (5) do not apply for the limited purpose of providing the coverage and sub-limits of liability as set forth below. We will pay those sums that the insured becomes legally obligated to pay as damages arising out of “property damage” to: (1) Personal property in the care, custody or control of the insured; and Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 79 88 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 3 (2) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the “property damage” arises out of those operations. The most we will pay under (1) and (2) above in any one “occurrence” or for all damages during any one policy period is a sub-limit of $100,000. These limits are included in and not in addition to the Limits of Insurance shown in the Declarations of the Commercial General Liability Policy. Our right and duty to defend the insured against any “suit” for damages under (1) and (2) above ends when we have used up the applicable sub-limit of liability in the payment of judgments or settlements under it. 3. OTHER INSURANCE AMENDMENT — SUPPLE- MENTAL COVERAGE FOR INSURED’S INVOLVE- MENT IN A CONSOLIDATED (WRAP-UP) IN SUR- ANCE PROGRAM OR SIMILAR PROJECT The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDI- TIONS, Paragraph 4. Other Insurance b. Excess Insurance (1)(a): (v) That is covered by a consolidated (wrap-up) or similar insurance program provided by the prime contractor/project manager or owner of the construction project in which you are involved for your ongoing operations or operations included within the “products-completed operations hazard”, unless such consolidated (wrap-up) or similar program is specifically excluded from coverage on this policy. 4. FELLOW EMPLOYEE EXTENSION Under SECTION II — WHO IS AN INSURED Para- graphs 2.a. and 2.a. (1) are replaced by the following: a. Your “volunteer workers” only while performing duties related to the conduct of your business, or your “employees”, other than either your “executive officers” (if you are an organization other than a partnership, joint venture, or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. The Employers Liability exclusion (SECTION I — COVERAGES; COVERAGE A, exclusion e.) does not apply to this provision. However, none of these “employees” or “volunteer workers” are insureds for: (1) “Bodily injury” or “personal and advertising injury”: (a) Arising out of his or her providing or failing to provide professional health care services. 5. CONTRACTUAL LIABILITY (RAILROADS) Definition 9. Insured Contract is amended as fol- lows: Paragraph c. is deleted in its entirety and replaced with the following: Any easement or license agreement; Paragraph f.(1) is deleted in its entirety. 6. CONTRACTUAL LIABILITY AMENDMENT — (PERSONAL AND ADVERTISING INJURY) If it is required in a written contract, written agreement or written permit with the insured that any contractual liability exclusion for Personal Injury be removed from the policy, then Exclusion e. Contractual Liability under COVERAGE B PERSONAL AND ADVERTISING INJURY, 2. Exclusions is deleted in its entirety and replaced with the following: e. Contractual Liability “Personal and advertising Injury” for which the insured has assumed liability in a contract or agreement arising out of an “advertisement”. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement” 7. WAIVER OF GOVERNMENTAL IMMUNITY We will waive, both in the adjustment of claims and in the defense of “suits” against the insured, any governmental immunity of the insured, unless the insured requests in writing that we not do so. Waiver of immunity as a defense will not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. 8. DAMAGE TO PREMISES RENTED TO YOU The Limit of Insurance for Damage To Premises Rented To You is increased to $1,000,000. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 79 88 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 3 ElitePac® General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 01 19 SUMMARY OF COVERAGES (including index) This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-9) for changes affecting your insurance protection. DESCRIPTION PAGE FOUND Additional Insureds - Primary and Non-Contributory Provision Page 8 Blanket Additional Insureds - As Required By Contract Page 5 • Owners, Lessees or Contractors (includes Architects, Engineers or Surveyors • Lessors of Leased Equipment • Managers or Lessors of Premises • Mortgagees, Assignees and Receivers • Any Other person or organization other than a joint venture • Grantors of Permits Broad Form Vendors Coverage Page 7 Damage To Premises Rented To You (Including Fire, Lightning or Explosion) Page 3 Electronic Data Liability ($100,000) Page 4 Employee Definition Amended Page 9 Employees As Insureds Modified Page 5 Employer’s Liability Exclusion Amended (Not applicable in New York) Page 3 Incidental Malpractice Exclusion modified Page 7 Knowledge of Occurrence, Claim, Suit or Loss Page 7 Liberalization Clause Page 8 Mental Anguish Amendment (Not applicable to New York) Page 9 Newly Formed or Acquired Organizations Page 5 Non-Owned Aircraft Page 3 Non-Owned Watercraft (under 60 feet) Page 3 Not-for-profit Members - as additional insureds Page 5 Personal And Advertising Injury - Discrimination Amendment (Not applicable in New York) Page 8 Products Amendment (Medical Payments) Page 4 Supplementary Payments Amended - Bail Bonds ($5,000) and Loss of Earnings ($1,000) Page 4 Two or More Coverage Parts or Policies Issued By Us Page 8 Unintentional Failure to Disclose Hazards Page 8 Waiver of Transfer of Rights of Recovery (subrogation) Page 8 When Two or More Coverage Parts of this Policy Apply to a Loss Page 3 Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 THIS PAGE IS INTENTIONALLY LEFT BLANK. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 9 ElitePac® General Liability Extension Endorsement COMMERCIAL GENERAL LIABILITY CG 73 00 01 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. However, if (a) two or more Coverage Parts of this policy, or (b) two or more forms or endorsements within the same Coverage Part apply to a loss, coverage provision(s) with the broadest language will apply, unless specifically stated otherwise within the particular amendment covering that loss. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. COVERAGES - Amendments SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY EXCLUSIONS Employer’s Liability Amendment (This provision is not applicable in the State of New York). The following is added to Exclusion e. Employer’s Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion also does not apply to any “temporary worker”. Non-Owned Aircraft, Auto or Watercraft A. Paragraph (2) of Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclus- ions is deleted in its entirety and replaced with the following: (2) A watercraft you do not own that is: (a) Less than 26 feet long and not being used to carry persons or property for a charge; or (b) At least 26 feet, but less than 60 feet long, and not being used to carry persons or property for a charge. Any person is an insured who uses or is responsible for the use of such watercraft with your expressed or implied consent. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. B. The following is added to Exclusion g. Aircraft, Auto Or Watercraft under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions: This exclusion does not apply to: (6) Any aircraft, not owned or operated by any insured, which is hired, chartered or loaned with a paid crew. However, if the insured has any other valid and collectible insurance for “bodily injury” or “property damage” that would be covered under this provision, or on any other basis, this coverage is then excess, and subject to Condition 4. Other Insurance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS. Damage To Premises Rented to You A. The last paragraph of Paragraph 2. Exclusions under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE is deleted in its entirety and replaced with the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 9 B. Paragraph 6. under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and replaced with the following: 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 or explosion, while rented to you or temporarily occupied by you with permission of the owner, for all such damage caused by fire, lightning or explosion proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of the three, is the amount shown in the Declara- tions for the Damage To Premises Rented To You Limit. C. Paragraph a. of Definition 9. “Insured contract” under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: 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 or explosion to premises while rented to you or temporarily occupied by you with the permission of the owner is not an “insured contract”; Electronic Data Liability A. Exclusion p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is deleted in its entirety and replaced by the following: p. Access or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: (1) Any access to or disclosure of any person’s or organization’s confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information or any other type of nonpublic information; or (2) The loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate “electronic data” that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. B. The following paragraph is added to SECTION III - LIMITS OF INSURANCE: Subject to 5. above, the most we will pay under COVERAGE A for “property damage” because of all loss of “electronic data” arising out of any one “occurrence” is a sub-limit of $100,000. SECTION I - COVERAGE C MEDICAL PAYMENTS EXCLUSIONS Any Insured Amendment Exclusion a. Any Insured under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: a. Any Insured To any insured. This exclusion does not apply to: (1) “Not-for-profit members”; (2) “Golfing facility” members who are not paid a fee, salary, or other compensation; or (3) “Volunteer workers”. This exclusion exception does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. Product Amendment Exclusion f. Products-Completed Operations Hazard under COVERAGE C MEDICAL PAYMENTS, 2. Exclusions is deleted in its entirety and replaced with the following: f. Products-Completed Operations Hazard Included within the “products-completed operations hazard”. This exclusion does not apply to “your products” sold for use or consumption on your premises, while such products are still on your premises. This exclusion exception, does not apply if COVERAGE C MEDICAL PAYMENTS is excluded by another endorsement to this Coverage Part. SECTION I - SUPPLEMENTARY PAYMENTS - COVERAGES A AND B Expenses For Bail Bonds And Loss Of Earnings A. Subparagraph 1.b. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 B. Subparagraph 1.d. under SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is deleted in its entirety and replaced with 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 from work. SECTION II - WHO IS AN INSURED - Amendments Not-for-Profit Organization Members The following paragraph is added to SECTION II - WHO IS AN INSURED: If you are an organization other than a partnership, joint venture, or a limited liability company, and you are a not- for-profit organization, the following are included as additional insureds: 1. Your officials; 2. Your trustees; 3. Your members; 4. Your board members; 5. Your commission members; 6. Your agency members; 7. Your insurance managers; 8. Your elective or appointed officers; and 9. Your “not-for-profit members”. However only with respect to their liability for your activities or activities they perform on your behalf. Employees As Insureds Modified A. Subparagraph 2.a.(1)(a) under SECTION II - WHO IS AN INSURED does not apply to “bodily injury” to a “temporary worker” caused by a co-“employee” who is not a “temporary worker”. B. Subparagraph 2.a.(2) under SECTION II - WHO IS AN INSURED does not apply to “property damage” to the property of a “temporary worker” or “volunteer worker” caused by a co-“employee” who is not a “temporary worker” or “volunteer worker”. C. Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED does not apply to “bodily injury” caused by cardio-pulmonary resuscitation or first aid services administered by a co-“employee”. With respect to this provision only, Subparagraph (1) of Exclusion 2. e. Employer’s Liability under SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY does not apply. Newly Formed Or Acquired Organizations A. Subparagraph 3.a. under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. However, COVERAGE A does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization. B. The following paragraph is added to SECTION II - WHO IS AN INSURED, Paragraph 3: If you are engaged in the business of con- struction of dwellings three stories or less in height, or other buildings three stories or less in height and less than 25,000 square feet in area, you will also be an insured with respect to “your work” only, for the period of time described above, for your liability arising out of the conduct of any partnership or joint venture of which you are or were a member, even if that partnership or joint venture is not shown as a Named Insured. However, this provision only applies if you maintain or maintained an interest of at least fifty percent in that partnership or joint venture for the period of that partnership or joint venture. This provision does not apply to any partnership or joint venture that has been dissolved or otherwise ceased to function for more than thirty-six months. With respect to the insurance provided by this provision, Newly Formed or Acquired Organizations, the following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY, Paragraph 4. Other Insurance, Subparagraph b. Excess Insurance: The insurance provided by this provision, Newly Formed or Acquired Organizations, is excess over any other insurance available to the insured, whether primary, excess, contingent or on any other basis. (All other provisions of this section remain unchanged) Blanket Additional Insureds - As Required By Contract Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured: A. Owners, Lessees or Contractors/Architects, Engineers and Surveyors 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your commercial general liability policy; and Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 2. Any other person or organization, including any architects, engineers or surveyors not engaged by you, whom you are required to add as an additional insured under your policy in the contract or agreement in Paragraph 1. above: Such person or organization is an additional insured only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: a. Your acts or omissions; or b. The acts of omissions of those acting on your behalf; in the performance of your ongoing operations performed for the additional insured in Paragraph 1., above. However, this insurance does not apply to: “Bodily injury”, “property damage” or “personal and advertising injury” arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services by or for you, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifi- cations; and b. Supervisory, inspection, architectural or engineering activities. Professional services do not include services within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. A person or organization’s status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. Other Additional Insureds Any of the following persons or organizations with whom you have agreed in a written contract, written agreement or written permit that such persons or organizations be added as an additional insured on your commercial general liability policy: 1. Lessors of Leased Equipment Any person or organization from whom you lease equipment, but only with respect to liability for “bodily injury”, “property damage” or “per- sonal and advertising injury” caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any “occurrence” which takes place after the equipment lease expires. 2. Managers or Lessors of Premises Any person or organization from whom you lease premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to any “occur- rence” which takes place after you cease to be a tenant of that premises. 3. Mortgagees, Assignees or Receivers Any person or organization with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to any “occurrence” which takes place after the mortgage is satisfied, or the assignment or receivership ends. 4. Any Person or Organization Other Than A Joint Venture Any person or organization (other than a joint venture of which you are a member), 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 the acts of omissions of those acting on your behalf in the performance of your ongoing operations or in connection with property owned by you. 5. State or Governmental Agency or Political Subdivision - Permits or Authorizations Any state or governmental agency or subdivision or political subdivision, but only with respect to: a. Operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization; or b. The following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9 (1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; (2) The construction, erection or removal of elevators; or (3) The ownership, maintenance or use of any elevators covered by this insurance. This insurance does not apply to: (a) “Bodily injury” or “property damage” arising out of operations performed for the federal government, state or municipality; or (b) “Bodily injury” or “property damage” included within the “products- completed operations hazard”. With respect to Paragraphs 2. through 4., this insurance does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured or written permit issued prior to the “bodily injury” or “property damage” or “personal and advertising injury”. Broad Form Vendors Coverage Subject to the Primary and Non-Contributory provision set forth in this endorsement, SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) for whom you have agreed in a written contract or written agreement to provide coverage as an additional insured under your policy. Such person or organization is an additional insured only with respect to “bodily injury” or “property damage” arising out of “your products” which are distributed or sold in the regular course of the vendor’s business. However, the insurance afforded the vendor does not apply to: a. “Bodily injury” or “property damage” for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement; however this exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or f. Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for the vendor; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or con- taining such products. The provisions of this coverage extension do not apply unless the written contract or written agreement has been signed by the Named Insured prior to the “bodily injury” or “property damage”. Incidental Malpractice Subparagraph 2.a.(1)(d) under SECTION II - WHO IS AN INSURED is deleted in its entirety and replaced with the following: (d) Arising out of his or her providing or failing to provide professional health care services. This does not apply to nurses, emergency medical technicians or paramedics if you are not in the business or occupation of providing any such professional services. This also does not apply to “bodily injury” caused by cardio-pulmonary resuscitation or first aid services administered by a co-“employee”. This provision does not apply if you are a Social Service or Senior Living risk. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS - Amendments Knowledge Of Occurrence, Claim, Suit Or Loss The following is added to Paragraph 2. Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: The requirements under this paragraph do not apply until after the “occurrence” or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 3. An “executive officer” or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; or 5. Your elected or appointed officials, officers, mem bers, trustees, board members, commission mem bers, agency members, or your administrator or your insurance manager if you are an organization other than a partnership, joint venture, or limited liability company. Primary and Non-Contributory Provision The following is added to Paragraph 4. Other Insur- ance, b. Excess Insurance under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is primary to and we will not seek contribution from any other insurance available to an additional insured under this policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in a written contract, written agreement or written permit that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. Unintentional Failure To Disclose Hazards The following is added to Paragraph 6. Representations under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: However, if you should unintentionally fail to disclose any existing hazards in your representations to us at the inception date of the policy, or during the policy period in connection with any additional hazards, we shall not deny coverage under this Coverage Part based upon such failure to disclose hazards. Waiver Of Transfer Of Rights Of Recovery The following is added to Paragraph 8. Transfer of Rights Of Recovery Against Others To Us under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: We will waive any right of recovery we may have against a person or organization because of payments we make for “bodily injury” or “property damage” arising out of your ongoing operations or “your work” done under a written contract or written agreement and included in the “products-completed operations hazard”, if: 1. You have agreed to waive any right of recovery against that person or organization in a written contract or written agreement; 2. Such person or organization is an additional insured on your policy; or 3. You have assumed the liability of that person or organization in that same contract, and it is an “insured contract”. The section above only applies to that person or organization identified above, and only if the “bodily injury” or “property damage” occurs subsequent to the execution of the written contract or written agreement. Liberalization The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: If we revise this Coverage Part to provide more coverage without additional premium charge, subject to our filed company rules, your policy will automatically provide the additional coverage as of the day the revision is effective in your state. Two or More Coverage Parts or Policies Issued By Us (This provision is not Applicable in the state of New York or Wisconsin). The following condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: It is our intention that the various coverage parts or policies issued to you by us, or any company affiliated with us, do not provide any duplication or overlap of coverage. We have exercised diligence to draft our coverage parts and policies to reflect this intention. However, if the facts and circumstances that will respond to any claim or “suit” give rise to actual or claimed duplication or overlap of coverage between the various coverage parts or policies issued to you by us or any company affiliated with us, the limit of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limit under this coverage, or any one of the other coverage forms or policies. This condition does not apply to any Excess or Umbrella policy issued by us specifically to apply as excess insurance over this coverage part or policy to which this coverage part is attached. SECTION V - DEFINITIONS Discrimination (This provision does not apply in New York). A. The following is added to Definition 14. “Personal and advertising injury”: “Personal and advertising injury” also means “discrimination” that results in injury to the feelings or reputation of a natural person, however only if such “discrimination” or humiliation is: 1. Not done by or at the direction of: a. The insured; or Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 9 b. Anyone considered an insured under SECTION II - WHO IS AN INSURED; 2. Not done intentionally to cause harm to another person. 3. Not directly or indirectly related to the em- ployment, prospective employment or termi- nation of employment of any person or persons by any insured. 4. Not arising out of any “advertisement” by the insured. B. The following definition is added to SECTION V - DEFINITIONS: “Discrimination” means: a. Any act or conduct that would be considered discrimination under any applicable federal, state, or local statute, ordinance or law; b. Any act or conduct that results in disparate treatment of, or has disparate impact on, a person, because of that person’s race, religion, gender, sexual orientation, age, disability or physical impairment; or c. Any act or conduct characterized or interpreted as discrimination by a person based on that person’s race, religion, gender, sexual orienta- tion, age, disability or physical impairment. It does not include acts or conduct characterized or interpreted as sexual intimidation or sexual harass- ment, or intimidation or harassment based on a person’s gender. Electronic Data The following definition is added to SECTION V - DEFINITIONS: “Electronic data” means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cell, data processing devices or any other media which are used with electronically controlled equipment. For the purpose of the Electronic Data Liability coverage provided by this endorsement, Definition 17. “Property damage” is deleted in its entirety and replaced by the following: 17. “Property damage” means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate “electronic data”, resulting from physical injury to tangible property. All such loss of “electronic data” shall be deemed to occur at the time of the “occurrence” that caused it. For the purpose of the Electronic Data Liability coverage provided by this endorsement, “electronic data” is not tangible property. Employee Amendment Definition 5. “Employee” under SECTION V - DEFINI- TIONS is deleted in its entirety and replaced by the following: 5. “Employee” includes a “leased worker”, or a “temporary worker”. If you are a School, “Employee” also includes a student teacher. Golfing Facility The following definition is added to SECTION V - DEFINITIONS: “Golfing facility” means a golf course, golf club, driving range, or miniature golf course. Mental Anguish Amendment (This provision does not apply in New York). Definition 3. “Bodily injury” under SECTION V - DEFINITIONS is deleted in its entirety and replaced with the following: 3. “Bodily injury” means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish resulting from any bodily injury, sickness or disease sustained by a person. (In New York, mental anguish has been determined to be “bodily injury”). Not-for-profit Member The following definition is added to SECTION V - DEFINITIONS: “Not-for-profit member” means a person who is a member of a not-for-profit organization, including clubs and churches, who receives no financial or other compensation. Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 00 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 ElitePac® Commercial Automobile Extension COMMERCIAL AUTO CA 78 09 11 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. AMENDMENTS TO SECTION II - LIABILITY COVER- AGE A. If this policy provides Auto Liability coverage for Owned Autos, the following extensions are applica- ble accordingly: NEWLY ACQUIRED OR FORMED ORGANIZA- TIONS The following is added to SECTION II, A.1. - Who Is An Insured: Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no similar insurance available to that organi- zation. However: 1. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; 2. Coverage does not apply to “bodily injury” or “property damage” resulting from an “accident” that occurred before you acquired or formed the organization. No person or organization is an “insured” with re- spect to the conduct of any current or past partner- ship, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. EXPENSES FOR BAIL BONDS AND LOSS OF EARNINGS Paragraphs (2) and (4) of SECTION II, A.2.a. - Supplementary Payments are deleted in their entirety and replaced with the following: (2) Up to the Limit of Insurance shown on the ElitePac Schedule for the cost of bail bonds (in- cluding bonds for related traffic law violations) required because of an “accident” covered under this policy. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the “insured” at our request. This includes actual loss of earnings because of time off from work, which we will pay up to the Limit of Insurance shown on the ElitePac Schedule. EMPLOYEE INDEMNIFICATION AND EMPLOY- ER’S LIABILITY AMENDMENT The following is added to SECTION II, B.4. - Exclusions: This exclusion does not apply to a “volunteer work- er” who is not entitled to workers compensation, disability or unemployment compensation benefits. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion, SECTION II, B.5. - is deleted in its entirety. CARE, CUSTODY OR CONTROL AMENDMENT The following is added to SECTION II, B.6. - Exclusions: This exclusion does not apply to property owned by anyone other than an “insured”, subject to the follow- ing: 1. The most we will pay under this exception for any one “accident” is the Limit of Insurance stat- ed in the ElitePac Schedule; and 2. A per “accident” deductible as stated in the ElitePac Schedule applies to this exception. B. If this policy provides Auto Liability coverage for Owned Autos or Non-Owned Autos, the following extension is applicable accordingly: LIMITED LIABILITY COMPANIES The following is added to SECTION II, A.1. - Who Is An Insured: If you are a limited liability company, your members and managers are “insureds” while using a covered “auto” you don’t own, hire or borrow during the course of their duties for you. BLANKET ADDITIONAL INSUREDS - As Required By Contract The following is added to SECTION II, A.1. - Who Is An Insured: Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 Any person or organization whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional “insured” on your policy. Such person or organization is an additional “insured” only with respect to liability for “bodily injury” or “property damage” caused, in whole or in part, by your owner- ship, maintenance or use of a covered “auto”. This coverage shall be primary and non-contributory with respect to the additional “insured”. This provision only applies if: 1. It is required in the written contract, written agreement or written permit identified in this sec- tion; 2. It is permitted by law; and 3. The written contract or written agreement has been executed (executed means signed by a named insured) or written permit issued prior to the “bodily injury” or “property damage”. C. If this policy provides Auto Liability coverage for Non- Owned Autos, the following extension is applicable accordingly: EMPLOYEES AS INSUREDS If this policy provides Auto Liability coverage for Non-Owned Autos, the following is added to SECTION II, A.1. - Who Is An Insured: Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow in your business or your personal affairs. An “employee” of yours is an “insured” while operat- ing an “auto” hired or rented under a contract or agreement in that “employee’s” name with your per- mission, while performing duties related to the con- duct of your business. AMENDMENTS TO SECTION III - PHYSICAL DAMAGE COVERAGE If this policy provides Comprehensive, Specified Causes of Loss or Collision coverage, the following extensions are applicable for those “autos” for which Comprehen- sive, Specified Causes of Loss or Collision coverage is purchased: TOWING AND LABOR SECTION III, A.2. - Towing is deleted in its entirety and replaced with the following: We will pay all reasonable towing and labor costs up to the maximum Limit of Insurance shown on the ElitePac Schedule per tow each time a covered “Private Passen- ger Auto”, “Social Service Van or Bus” or “Light Truck” is disabled and up to the maximum Limit of Insurance per tow each time a covered “Medium Truck”, “Heavy Truck” or “Extra Heavy Truck” is disabled. For labor charges to be eligible for reimbursement the labor must be performed at the place of disablement. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. GLASS BREAKAGE DEDUCTIBLE The following is added to SECTION III, A.3. - Glass Breakage - Hitting A Bird Or Animal - Falling Objects or Missiles: If damaged glass is repaired rather than replaced, no deductible will apply for such repair. This extension does not apply to Emergency Services Organizations and Governmental Entities. ADDITIONAL TRANSPORTATION EXPENSES SEC- TION III, A.4.a. - Transportation Expenses is deleted in its entirety and replaced with the following: We will pay up to the maximum Limit of Insurance shown on the ElitePac Schedule for temporary transportation expenses that you incur because of any “loss” to a cov- ered “auto”, but only if the covered “auto” carries the coverages and meets the requirements described in 1. or 2. below: 1. We will pay temporary transportation expenses for total theft of a covered “auto”. We will only pay for such expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy’s expiration, when the covered “auto” is re- turned to use or we pay for its “loss”. 2. For “loss” other than total theft of a covered “auto” under Comprehensive or Specified Causes of Loss Coverage, or for any “loss” under Collision Coverage to a covered “auto”, we will only pay for those tem- porary transportation expenses incurred during the policy period beginning 24 hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the number of days reasonably required to repair or replace the covered “auto” or 30 days. Paragraph 2. of this extension does not apply while there are spare or reserve “autos” available to you for your operations. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO PHYSICAL DAMAGE COVERAGE The following is added to SECTION III, A.4. - Coverage Extensions: Physical Damage coverage is hereby extended to apply to Physical Damage “loss” to “autos” leased, hired, rent- ed or borrowed without a driver. We will provide cover- age equal to the broadest coverage available to any covered “auto” shown in the Declarations. But, the most we will pay for “loss” to each “auto” under this coverage extension is the lesser of: Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 1. The Limit of Insurance stated in the ElitePac Sched- ule; or 2. The actual cash value of the damaged or stolen property as of the time of the “loss”; or 3. The actual cost of repairing or replacing the dam- aged or stolen property with other property of like kind and quality. A part is of like kind and quality when it is of equal or better condition than the pre- accident part. We will use the original equipment from the manufacturer when: (a) The operational safety of the vehicle might otherwise be impaired; (b) Reasonable and diligent efforts to locate the appropriate rebuilt, aftermarket or used part have been unsuccessful; or (c) A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost. For each leased, hired, rented or borrowed “auto” our obligation to pay “losses” will be reduced by a deductible equal to the highest deductible applicable to any owned “auto” for that coverage. No deductible will be applied to “losses” caused by fire or lightning. SECTION IV, B.5. Other Insurance Condition, Para- graph 5.b. is deleted in its entirety and replaced by the following: For Hired Auto Physical Damage Coverage, the follow- ing are deemed to be covered “autos’” you own: 1. Any covered “auto” you lease, hire, rent, or borrow; and 2. Any covered “auto” hired or rented by your “em- ployee” under a contract or agreement in that “employee’s” name, with your permission, while performing duties related to the conduct of your business. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO LOSS OF USE COVERAGE The following is added to SECTION III, A.4. - Coverage Extensions: We will pay expenses for which you are legally responsi- ble to pay up to the Limit of Insurance shown on the ElitePac Schedule per “accident” for loss of use of a leased, hired, rented or borrowed “auto” if it results from an “accident”. This coverage extension does not apply to Emergency Services Organizations, Governmental Entities, and Schools. AUTO LOAN/LEASE GAP COVERAGE (Not Applica- ble in New York) The following is added to SECTION III, A.4. - Coverage Extensions: In the event of a total “loss” to a covered “auto” we will pay any unpaid amount due on the lease or loan for a covered “auto”, less: 1. The amount paid under the Physical Damage Cover- age Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of “loss”; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear, high mileage or similar charges; c. Security deposits not refunded by the lessor or financial institution; d. Costs for extended warranties, credit life, health, accident, or disability insurance purchased with the loan or lease; and e. Carry-over balances from previous leases or loans. You are responsible for the deductible applicable to the “loss” for the covered “auto”. PERSONAL EFFECTS The following is added to SECTION III, A.4. - Coverage Extensions: If this policy provides Comprehensive Coverage for a covered “auto” you own and that covered “auto” is stolen, we will pay up to the Limit of Insurance shown on the ElitePac Schedule, without application of a deducti- ble, for lost personal effects that were in the covered “auto” at the time of theft. Personal effects do not include jewelry, tools, money, or securities. This coverage is excess over any other collectible insurance. AIRBAG COVERAGE The following is added to SECTION III, B.3.a. - Exclu- sions: Mechanical breakdown does not include the accidental discharge of an airbag. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. EXPANDED AUDIO, VISUAL, AND DATA ELEC- TRONIC EQUIPMENT COVERAGE SECTION III, B.4. - Exclusions This exclusion does not apply to the following: 1. Global positioning systems; 2. “Telematic devices”; or 3. Electronic equipment that reproduces, receives or transmits visual or data signals and accessories used with such equipment, provided such equipment is: Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 a. Permanently installed in or upon the covered “auto” at the time of the “loss”; b. Removable from a housing unit that is perma- nently installed in the covered “auto” at the time of the “loss”; c. Designed to be solely operated by use of power from the “auto’s” electrical system; or d. Designed to be used solely in or upon the covered “auto”. For each covered “loss” to such equipment, a deductible of $50 shall apply, unless the deductible otherwise appli- cable to such equipment is less than $50, at which point the lower deductible, if any, will apply. COMPREHENSIVE DEDUCTIBLE - LOCATION TRAC KING DEVICE The following is added to SECTION III, D. - Deductible: Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 50% for any “loss” caused by theft if the covered “auto” is equipped with a location tracking device and that device was the sole method used to recover the “auto”. PHYSICAL DAMAGE LIMIT OF INSURANCE SECTION III, C. - Limit Of Insurance is deleted in its entirety and replaced with the following: The most we will pay for a “loss” in any one “accident” is the lesser of: 1. The actual cash value of the damaged or stolen property as of the time of the “loss”; or 2. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. AMENDMENTS TO SECTION IV - BUSINESS AUTO CONDITIONS DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The following is added to SECTION IV, A.2.a. - Duties In The Event Of Accident, Claim, Suit Or Loss: The notice requirements for reporting “accident” claim, “suit” or “loss” information to us, including provisions related to the subsequent investigation of such “acci- dent”, claim, “suit” or “loss” do not apply until the “accident”, claim, “suit” or “loss” is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. An executive officer or insurance manager, if you are a corporation; 4. Your members, managers or insurance manager, if you are a limited liability company; 5. Your elected or appointed officials, trustees, board members or your insurance manager, if you are an organization other than a partnership, joint venture or limited liability company. But, this section does not amend the provisions relating to notification of police or protection or examination of the property that was subject to the “loss”. WAIVER OF SUBROGATION SECTION IV, A.5. - Transfer Of Rights Of Recovery Against Others To Us is deleted in its entirety and replaced with the following: We waive any right of recovery we may have against any person or organization because of payments we make for “bodily injury” or “property damage” resulting from the ownership, maintenance or use of a covered “auto” but only when you have assumed liability for such “bodily injury” or “property damage” in an “insured con- tract”. In all other circumstances, if a person or organiza- tion to or for whom we make payment under this Cover- age Form has rights to recover damages from another, those rights are transferred to us. MULTIPLE DEDUCTIBLES The following is added to SECTION IV, A. - Loss Conditions: If a “loss” from one event involves two or more covered “autos” and coverage under Comprehensive or Specified Causes of Loss applies, only the highest applicable deductible will be applied. CONCEALMENT, MISREPRESENTATION OR FRAUD The following is added to SECTION IV, B.2. - Conceal- ment, Misrepresentation Or Fraud: If you should unintentionally fail to disclose any existing hazards in your representations to us prior to the incep- tion date of the policy or during the policy period in connection with any newly discovered hazards, we will not deny coverage under this Coverage Form based upon such failure. POLICY PERIOD, COVERAGE TERRITORY SECTION IV, B.7. - Policy Period, Coverage Territory is deleted in its entirety and replaced with the following: Under this Coverage Form, we cover “accidents” and “losses” occurring: a. During the policy period shown in the Declarations; and b. Within the “Coverage Territory”. Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 We also cover “loss” to or “accidents” involving a cov- ered “auto” while being transported between any of these places. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US - DEDUCTIBLES The following is added to SECTION IV, B.8. - Two Or More Coverage Forms Or Policies Issued By Us: If a “loss” covered under this Coverage Form also in- volves a “loss” to other property resulting from the same “accident” that is covered under this policy or another policy issued by us or any member company of ours, only the highest applicable deductible will be applied. AMENDMENTS TO SECTION V - DEFINITIONS BODILY INJURY INCLUDING MENTAL ANGUISH (Not Applicable in New York) The definition of bodily injury is deleted in its entirety and replaced by the following: “Bodily injury” means bodily injury, sickness, or disease sustained by a person, including death resulting from any of these. “Bodily injury” includes mental anguish resulting from bodily injury, sickness or disease sus- tained by a person. ADDITIONS TO SECTION V - DEFINITIONS COVERAGE TERRITORY “Coverage Territory” means: 1. The United States of America (including its territories and possessions), Canada and Puerto Rico; and 2. Anywhere in the world, except for any country or jurisdiction that is subject to trade or other economic sanction or embargo by the United States of America, if a covered “auto” is leased, hired, rented, or borrowed without a driver for a period of 30 days or less, and the insured’s responsibility to pay “dam- ages” is determined in a “suit” on the merits in and under the substantive law of the United States of America (including its territories and possessions), Puerto Rico, or Canada, or in a settlement we agree to. If we are prevented by law, or otherwise, from defending the “insured” in a “suit” brought in a location described in Paragraph 2. above, the insured will conduct a defense of that “suit”. We will reimburse the “insured” for the rea- sonable and necessary expenses incurred for the de- fense of any such “suit” seeking damages to which this insurance applies, and that we would have paid had we been able to exercise our right and duty to defend. EXTRA HEAVY TRUCK “Extra Heavy Truck” means a truck with a gross vehicle weight rating of 45,001 pounds or more. HEAVY TRUCK “Heavy Truck” means a truck with a gross vehicle weight rating of 20,001 pounds to 45,000 pounds. LIGHT TRUCK “Light Truck” means a truck with a gross vehicle weight rating of 10,000 pounds or less. MEDIUM TRUCK “Medium Truck” means a truck with a gross vehicle weight rating of 10,001 pounds to 20,000 pounds. PRIVATE PASSENGER AUTO “Private Passenger Auto” means a four-wheel “auto” of the private passenger or station wagon type. A pickup, panel truck or van not used for business is included within the definition of a “private passenger auto”. SOCIAL SERVICE VAN OR BUS “Social Service Van or Bus” means a van or bus used by a government entity, civic, charitable or social service organization to provide transportation to clients inci- dental to the social services sponsored by the organiza- tion, including special trips and outings. TELEMATIC DEVICE “Telematic Device” includes devices designed for the collection and dissemination of data for the purpose of monitoring vehicle and/or driver performance. This in- cludes Global Positioning System technology, wireless safety communications and automatic driving assistance systems, all integrated with computers and mobile com- munications technology in automotive navigation sys- tems. VOLUNTEER WORKER “Volunteer worker” means a person who performs busi- ness duties for you, for no financial or other compensa- tion. Copyright, 2017 Selective Insurance Company of America. All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 Copyright, 2021 Selective Insurance Company of America. All rights reserved. CXL 456 06 22 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US — BLANKET BASIS (WAIVER OF SUBROGATION) COMMERCIAL UMBRELLA LIABILITY CXL 456 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL UMBRELLA LIABILITY COVERAGE PART A. The following is added to Paragraph M. Transfer Of Rights Of Recovery Against Others To Us under SECTION IV — CONDITIONS: We will waive any right of recovery against a person or organization because of payments we make under this Commercial Umbrella Liability Coverage Part. This waiver applies only if the insured has agreed in a written contract or written agreement to: 1. Either: a. Waive any right of recovery against that person or organization; or b. Assume the liability of that person or organ- ization pursuant to a written contract or written agreement that qualifies as an “insured contract”; 2. And: a. Include such person or organization as an additional insured on your Commercial Umbrella Liability Coverage Part; and b. The “underlying insurance” contains a sub- stantially similar waiver of recovery rights. Such waiver by us applies only to the person or organization identified above and only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. B. The following Definition is added to SECTION V — DEFINITIONS: “Insured contract” means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organ- ization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an “insured contract”; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition oper- ations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indem - nification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for “bodily injury” or “property damage” to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies a railroad for “bodily injury” or “property damage” arising out of construction or demolition operations, within 50 feet of any rail- road property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or sur- veyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engi- neer or surveyor, assumes liability for an injury or damage arising out of the insured’s rendering or failure to render professional services, including those listed in (2) above and supervi- sory, inspection, architectural or engineering activities.