HomeMy WebLinkAboutG.E. JOHNSON CONSTRUCTION COMPANY INC - INSURANCE CERTIFICATEPStLWtBf Jt
IMA of Colorado, Inc.
1550 17th Street
Suite 600
Denver, CO 80202
Electronic Service Requested
ALL FOR AADC 80,0
2657 1.4517 AB 0.490
City of Fort Collins 54
PO BOX 58❑
FORT COLLINS, CO 80522-0580
2011 MOM
1Aon] /.4.11i7
If you have questions regarding the content of this document, Please contact -
the Producer/Agent listed on the certificate of insurance. -
cc:
The data included in this notice and in the attached document is confidential to Ebix BPO
and the party responsible for bringing you this information.
Certificate Delivery by Certiticat"Now - www.ConfirmNet.Com - 877.669.8600
P5W*2=)2
GE Johnson Construction Company, Inc.
Policy Number: DTC0067OC7011ND11
Effective: 10/01/2011 - 10/01/2012
COMMERCIAL GENERAL LIABILITY
b. "Bodily injury" or "property damage" in-
cluded In the "products -completed opera-
tions hazard".
I. OTHER INSURANCE CONDITION
A. COMMERCIAL GENERAL LIABILITY CON-
DITIONS (Section IV), paragraph 4. (Other
Insurance) Is deleted and replaced by the fol-
lowing:
4. Otherinsurance
If valid and collectible "other insurance" is
available to the insured for a loss we
cover under Coverages A or B of this
Coverage Part, our obligations are limited
as follows:
a. Primary Insurance
This insurance is primary except
when b. below applies. If this insur-
ance is primary, our obligations are
not affected unless any of the "other
insurance" is also primary. Then, we
will share with all that "other insur-
ance" by the method described in c.
below.
b. Excess Insurance
This insurance is excess over any of
the - "other insurance", whether pri-
mary, excess, contingent or on any
other basis:
(1) That is Fire, Extended Coverage,
Builder's Risk, Installation Risk,
or similar coverage for "your
work';
(2) That is Fire insurance for prem-
ises rented to you or temporarily
occupied by you with permission
of the owner,
(3) That is insurance purchased by
you to cover your liability as a
tenant for "property damage" to
premises rented to you or tempo-
rarily occupied by you with per-
mission of the owner; or
(4) If the loss arises out of the main-
tenance or use of aircraft,
"autos", or watercraft to the ex-
tent not subject to Exclusion g. of
Section I — Coverage A — Bodily
Injury And Property Damage Li-
ability; or
(5) That is available to the insured
when the insured is an additional
insured under any other policy,
including any umbrella or excess
policy.
When this insurance is excess, we
will have no duty under Coverages A
or B to defend the insured against
any "suit" if any provider of "other In-
surance" has a duty to defend the in-
sured against that "suit". If no pro-
vider of "other insurance" defends,
we will undertake to do so, but we will
be entitled to the insured's rights
against all those providers of "other
insurance".
When this insurance is excess over
"other insurance", we will pay only
our share of the amount of the loss, if
any, that exceeds the sum of:
(1) The total amount that all such
"other insurance" would pay for
the loss in the absence of this in-
surance; and
(2) The total of all deductible and
self -insured amounts under that
"other insurance".
We will share the remaining loss, if
any, with any "other insurance" that is
not described in this Excess Insur-
ance provision.
c. Method Of Sharing
If all of the "other insurance" permits
contribution by equal shares, we will
follow this method also. Under this
approach each provider of insurance
contributes equal amounts until it has
paid Its applicable limit of insurance
or none of the loss remains, which-
ever comes first.
If any of the "other insurance" does
not permit contribution by equal
shares, we will contribute by limits.
Under this method, the share of each
provider of insurance is based on the
ratio of its applicable limit of insur-
ance to the total applicable limits of
insurance of all providers of insur-
ance.
B. The following definition is added to DEFINITIONS
(Section V):
"Other insurance":
a. Means insurance, or the funding of losses,
that is provided by, through or on behalf of:
Page 4 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D316 07 04
Y52iM2MIM12
GE Johnson Construction Company, Inc.
Policy Number: DTC00670C7011ND11
Effective: 10/01/2011 - 10/01/2012
(1) Another insurance company;
(2) Us or any of our affiliated insurance com-
panies, except when the Non cumulation
of Each Occurrence Limit section of
Paragraph 5 of LIMITS OF INSURANCE
(Section III) or the Non cumulation of Per-
sonal and Advertising Injury limit sections
of Paragraph 4 of LIMITS OF INSUR-
ANCE (Section III) applies;
(3) Any risk retention group;
(4) Any self-insurance method or program,
other than any funded by you and over
which this Coverage Part applies; or
(5) Any similar risk transfer or risk manage-
ment method.
b. Does not include umbrella insurance, or ex-
cess insurance, that you bought specifically to
apply in excess of the Limits of Insurance
shown on the Declarations of this Coverage
Part.
J. INCREASED SUPPLEMENTARY PAYMENTS
Paragraphs 1.b. and 1.d. of SUPPLEMENTARY
PAYMENTS — COVERAGES A AND B (Section I
— Coverages) are amended as follows:
1. In paragraph 1.b., the amount we will pay for
the cost of bail bonds is increased to $2500.
2. In paragraph 1.d., the amount we will pay for
loss of earnings is increased to $500 a day.
K. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
1. The following Is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section
IV), paragraph 2. (Duties In The Event of Oc-
currence, Offense, Claim or Suit):
Notice of an "occurrence" or of an offense
which may result in a claim must be given as
soon as practicable after knowledge of the
"occurrence" or offense has been reported to
you, one of your "executive officers" (if you
are a corporation), one of your partners who
is an individual (if you are a partnership), one
of your managers (if you are a limited liability
company), or an "employee" (such as an in-
surance, loss control or risk manager or ad-
ministrator) designated by you to give such
notice.
Knowledge by any other "employee" of an
"occurrence" or offense does not imply that
you also have such knowledge.
COMMERCIAL GENERAL LIABILITY
2. Notice of an "occurrence" or of an offense
which may result in a claim will be deemed to
be given as soon as practicable to us if it is
given in good faith as soon as practicable to
your workers' compensation insurer. This ap-
plies only if you subsequently give notice of
the "occurrence" or offense to us as soon as
practicable after you, one of your "executive
officers" (if you are a corporation), one of your
partners who is an individual (if you are a
partnership), one of your managers (If you are
a limited liability company), or an "employee"
(such as an insurance, loss control or risk
manager or administrator) designated by you
to give such notice discovers that the "occur-
rence" or offense may involve this policy.
3. This Provision K. does not apply as respects
the specific number of days within which you
are required to notify us in writing of the
abrupt commencement of a discharge, re-
lease or escape of "pollutants" that causes
"bodily injury" or "property damage" which
may otherwise be covered under this policy.
L. UNINTENTIONAL OMISSION
The following is added to COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS (Section IV),
paragraph 6. (Representations):
The unintentional omission of, or unintentional
error in, any information provided by you which
we relied upon in issuing this policy shall not
prejudice your rights under this insurance. How-
ever, this Provision L. does not affect our right to
collect additional premium or to exercise our right
of cancellation or nonrenewal in accordance with
applicable state insurance laws, codes or regula-
tions.
M. PERSONAL INJURY — ASSUMED BY CON-
TRACT
1. The following is added to Exclusion e. (1) of
Paragraph 2., Exclusions of Coverage B.
Personal Injury, Advertising Injury, and
Web Site Injury Liability of the Web XTEND
Liability endorsement:
Solely for the purposes of liability assumed in
an "insured contract", reasonable attorney
fees and necessary litigation expenses In-
curred by or for a party other than an Insured
are deemed to be damages because of "per-
sonal injury" provided:
(a) Liability to such party for, or for the cost
of, that party's defense has also been as-
CG D316 07 04 Copydght, The Travelers Indemnity Company, 2004 Page 5 of 6
0
P52 0 2&*2
GE Johnson Construction Company, Inc.
Policy Number: DTC00670C701IND/1
Effective: 10/01/2011 - M01/2012
COMMERCIAL GENERAL LIABILITY
sumed in the same "insured contract"; N. BLANKET ADDITIONAL INSURED — LESSOR
and
OF LEASED EQUIPMENT
(b) Such attorney fees and litigation ex-
WHO IS AN INSURED (Section II) Is amended to
penses are for defense of that party
Include as an insured any person or organization
against a civil or alternative dispute reso-
(referred to below as "additional Insured") with
lution proceeding in which damages to
whom you have agreed in a written contract, exe-
which this insurance applies are alleged.
cuted before the "bodily Injury" or "property dam-
2. Paragraph 2.d. of SUPPLEMENTARY PAY- .
age" occurs or the "personal injury" or "advertis-
MENTS — COVERAGES A AND B (Section I
ing injury' offense Is committed, to name as an
— Coverages) is deleted and replaced by the
additional insured, but only with respect to their li-
following:
ability for "bodily injury", "property damage", "per-
d. The allegations in the "suit" and the in-
sonal Injury" or "advertising injury" caused, in
whole or in part, by your acts or omissions in the
formation we know about the "occur-
rence" or offense are such that no conflict
maintenance, operation or use of equipment
appears to exist between the interests of
leased to you by such additional insured, subject
to the following provisions:
the insured and the Interests of the in-
demnitee;
1. Limits of Insurance. The limits of insurance
3. The third sentence of Paragraph 2 of SUP-
afforded to the additional Insured shall be the
limits which you agreed to provide in the writ-
PLEMENTARY PAYMENTS — COVERAGES
ten contract, or the limits shown on the Decla-
A AND B (Section I — Coverages) is deleted
rations, whichever are less.
and replaced by the following:
Notwithstanding the provisions of Paragraph
2. The insurance afforded to the additional in -
"bodily
2.b.(2) of Section I — Coverage A— Bodily In-
sured does not apply to any injury" or
"property "personal
jury And Property Damage Liability, or the
damage" that occurs, or
injury„ "advertising advertising injury° caused by an of -
provisions of Paragraph 2.e.(1) of Section 1—
fense which is committed, after the equipment
Coverage B — Personal Injury, Advertising In-
- . lease expires..
jury And Web Site Injury Liability, such pay-
.
ments will not be deemed to be damages for
3. The insurance afforded to the additional in -
"bodily injury" and °property damage°, or
sured is excess over any valid and collectible
damages for "personal injury", and will not re-
"other insurance" available to such additional
duce the limits of insurance.
insured, unless you have agreed in the writ-
4. This provision M. does not apply if coverage
ten contract that this insurance must be pri-
"other
for "personal injury" liability is excluded by
mary to, or non-contributory with, such
insurance".
endorsement.
Page 6 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D316 07 04
N
19
rr
P51b Qft1]
P/NMAA COL
ASSURANCE
INSURED:
G.E. Johnson Construction Co.
25 North Cascade , Suite 400
Colorado Springs, CO 80903
ENDORSEMENT: Blanket Waiver of Subrogation
7501 E Lowry Blvd
Denver, CO 80230-7006
Phone: (303) 361-4000 / (800) 873-7242
Fax: (303) 361-5000 / (888) 329-2251
NCCI #: WC000313B
Policy #: 4048587
AGENT:
IMA of Colorado, Inc
1550 17th Street
Suite 600
Denver, CO 80202
(303) 534-4567
We have the right to recover our payments from anyone liable for any injury covered by this policy. We will not
enforce our right against the person or organization named in the schedule. This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the schedule.
SCHEDULE
To any person or organization when agreed to under a written contract or agreement, as defined
above and with the insured, which is in effect and executed prior to any loss.
Effective Date: October 1, 2011 Expires on October 1, 2012
Pinnacol Assurance has issued this endorsement October 3, 2011.
Nicholas Furness
Underwriter
Pimxtl A rawe' 7501 E Lowry Bhd' Denver, GO 80230
Pape 1 of 1 ISA - E temei / BAP Record Ore 10V=11 11:03:12 4098587 Updated: 0SN92007 353E
N
z
W
PSEblleExeaE
0
A� "
°10
CERTIFICATE OF LIABILITY INSURANCE
07/ 0° 1
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: U the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to
the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer Fights to the
certificate holder In lieu of such endorsement(s).
PRODUCER 1-303-534-4567
INA of Colorado, Inc.
CONTACT
NAME:
PNONE FAX
NC No
��
WRLE
1550 17th Street
Suite 600
Deaver, CO 80202
INSURE S AFFORDING COVERAGE
NAIC0
INSURER A: TRAVELERS IND CO (Travelers Insurance
25658
INSURED
G.B. Johnson Construction Company, Inc.
Attn: Accounts Payable
INSURER B: TRAVELERS PROP CAB CO OF AMER (Traveler
25674
INSURER C: ANERICAN GUAR fi LIAB IH9 (Zurich
26247
INSURER O: ZURICH AMER INS CO (Pinnacol)
16535
25 North Cascade Avenue, Suite 400
INSURER E: PINNACOL ASSUR
41190
Colorado Springs, CO 80903
INSURER F :
COVFRAGFS CFRTIFICATF NUIMRFR• 23540414 RFVIRInN NIIMRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE
ABBE
INSR
SUa
POLICY NUMBER
POLICY EFF
POLICY EXP
LIMITS
A
GENERAL LIABILITY
DTC00670C701IND11
10/01/1
10/01/12
EACH OCCURRENCE
$ 1,000,000
Y COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
DAMAGE TORENTED
PREMISES Ea ocwn
$ 1,000,000
MED EXP (Any ore prawn)
$ 5,000
Y PD Deductible: $25,000
PERSONAL 4 ADV INJURY
f 1,000,000
X
Annual Agg Ded:100,000
GENERAL AGGREGATE
$2,000,000
GENL AGGREGATE LIMIT APPLIES PER
PRODUCTS - COMPIOP AGG
$2,000,000
POLICY X PRO- ELT Z LOC
S
B
AUTOMOBILE
LIABILITY
IYTO10067OC701TIL11
COMBINED SINGLE LIMIT
Ea accident
1, 000,000
BODILY INJURY(Par prawn)-
_ _
E-
ANYAUTO — _ _ _ _
_
- _ _
_ —
__ _
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY(Per arudwt)
$
X
HIRED AUTOS X NON -OWNED
AUTOS
PROPERTY DAMAGE
Per accident
S
$
C
X
UMBRELLALIAB
E
OCCUR
AUC931908400
10/01/1
10/01/12
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
EXCESS LIAR
CLAIMS -MADE
DELI I I RETENTIONS
S
D
E
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPMETORIPARTNERE.XECLmVE YIN
OFFICEREMBER EXCLUDED? O
M
NIA
NC463293201- CA ONLY
4048587- CO ONLY
10/O1/1
10/01/1
10/O1/12
10/01/12
X WCSTATU- 0T14
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE - EA EMPLOYEE
X 100,000
(Mandatory In NN)
If yes deaaibe under
DESCRIPTION OF OPERATIONS below
I
E.L. DISEASE -POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Athch ACORD 101, Addmond Remade Schadula, 8 moan pew M npulnd)
Re: All Operations.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Fort Collins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 580 r
ORLM REPRESENTATIVE /^/j
Fort Collins, CO 80522-0000 //,#
I USA a/�//\
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
heatherTe
23540414
n
N
7
UJ
SUPPLEMENT TO CERTIFICATE OF INSURANCE
DATE
10/07/2011
NAME OF INSURED: G.B. Johnson construction Company, Inc.
Attn: Accounts Payable
Additional Descdotion of Operations/Rematks from Page 1:
Additional Information:
Contractors Professional E Pollution Liability: Policy #PCB184954601
Insurer: Great American Insurance Company Bff. Dates: 10/01/11 - 10/01/12
$5,000,000 Bach Claim Limit; $6,000,000 Aggregate Limit; $50,000 Deductible
SUPP (05/04)
PS26 2W)2
G.E. Johnson Construction Company, Inc.
Policy Number: DT810WIOC701TIL11
Effective: 10/01/2011 - 1N01=12
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi-
sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form,
SCHEDULE
Name of Person(s) or Organizatlon(s):
ANY PERSON OR ORGANIZATION THAT YOU ARE
REQUIRED TO INCLUDE AS AN ADDITIONAL
INSURED ON THIS COVERAGE FORM IN A
WRITTEN CONTRACT OR AGREEMENT THAT IS
SIGNED AND EXECUTED BY YOU BEFORE THE
"BODILY INJURY" OR "PROPERTY DAMAGE"
OCCURS AND THAT IS_IN EFFECT DURING
THE POLICY PERIOD
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to the endorsement.)
Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent
that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section
11 of the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1
P326 28 2
G.E. Johnson Construction Company, Inc. Policy Number: DTC0067OC7011ND11 Effective: 10/01/2011 - 10/01/2012
COMMERCIAL GENERAL LIABILITY m
u.
0
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS) UJ
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED — (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and
b) if, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the Independent acts
or omissions of such person or organization.
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring Insurance", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease -the limits of insurance described in
Section III — Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury', "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, including:
i. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ti. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products -completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the and of the period of time for
which the "written contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that Is
available to the additional insured for a loss we
cover under this endorsement. However, if the
'written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non-contributory basis,
this insurance is primary to "other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2
PUNKUMW
G.E. Johnson Construction Company, Inc.
Policy Number: DTC0067OC701IND11 Effective: 10/01/2011 - 10/01/2012
COMMERCIAL GENERAL LIABILITY
I. How, when and where the "occurrence"
or offense took place;
Ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
I. Immediately record the specifics of the
claim or "suit" and the date received; and
If. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit' as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit', cooperate
with us in the investigation or settlement of
the claim or defense against the "suit", and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional Insured by
this endorsement is primary to "other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional In-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the policy period.
Page 2 of 2 m 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
G.E. Johnson Construction Company, Inc. Policy Number: DTC00670C701IND11 Effective: 10/01/2011 - 10/01/2012
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRIPTION OF COVERAGE — Provisions A.-H. and J.-N, of this endorsement broaden coverage,
and provision I. of this endorsement may limit coverage. The following listing is a general coverage description
only. Limitations and exclusions may apply to these coverages. Read all the PROVISIONS of this endorsement
carefully to determine rights, duties, and what is and is not covered.
A. Broadened Named Insured
B. Extension of Coverage — Damage To Premises
Rented To You
• Perils of fire, explosion, lightning, smoke, water
• Limit increased to $300,000
C. Blanket Waiver of Subrogation
D. Blanket Additional Insured — Managers or Lessors
of Premises
E. Incidental Medical Malpractice
F. Extension of Coverage — Bodily Injury
G. Contractual Liability — Railroads
PROVISIONS
A. BROADENED NAMED INSURED
1. The Named Insured in Item 1. of the Declara-
tions Is as follows:
The person or organization named in Item 1.
of the Declarations and any organization,
other than a partnership, joint venture or lim-
ited liability company, of which you maintain
ownership or in which you maintain the major-
ity interest on the effective date of the policy.
However, coverage for any such additional
organization will cease as of the date, if any,
during the policy period, that you no longer
maintain ownership of, or the majority interest
in, such organization.
2. WHO IS AN INSURED (Section II) Item 4.a.
is deleted and replaced by the following:
a. Coverage under this provision is afforded
only until the 18Oth day after you acquire
or form the organization or the end of the
policy period, whichever is earlier.
H. Additional Insured — State or Political Subdivisions
I. Other Insurance Condition
J. Increased Supplementary Payments
• Cost of bail bonds increased to $2,500
• Loss of earnings increased to $500 per day
K. Knowledge and Notice of Occurrence or Offense
L. Unintentional Omission
M. Personal Injury —Assumed by Contract
N. Blanket Additional Insured —Lessor of Leased
Equipment
3. This Provision A. does not apply to any per-
son or organization for which coverage is ex-
cluded by endorsement.
B. EXTENSION OF COVERAGE — DAMAGE TO
PREMISES RENTED TO YOU
1. The last paragraph of COVERAGE A. BOD-
ILY INJURY AND PROPERTY DAMAGE LI-
ABILITY (Section I — Coverages) is deleted
and replaced by the following:
Exclusions c. through n. do not apply to dam-
age to premises while rented to you, or tem-
porarily occupied by you with permission of
the owner, caused by:
a.. Fire;
b. Explosion;
c. Lightning;
d. Smoke resulting from such fire, explosion,
or lightning; or
e. Water.
A separate limit of insurance applies to this
coverage as described in Section III Limits Of
Insurance.
CG D3 16 07 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 6
m
0
0
P52 W2W 2
G.E. Johnson Construction Company, Inc. Policy Number: DTC00670C701IND11 Effective: 10/01/2011 - 10/01/2012
COMMERCIAL GENERAL LIABILITY
2. This insurance does not apply to damage to 5. This Provision B. does not apply if coverage
premises while rented to you, or temporarily for Damage To Premises Rented To You of
occupied by you with permission of the COVERAGE A. BODILY INJURY AND
owner, caused by: PROPERTY DAMAGE LIABILITY (Section I —
a. Rupture, bursting, or operation of pres- Coverages) is excluded by endorsement.
sure relief devices; C. BLANKET WAIVER OF SUBROGATION
b. Rupture or bursting due to expansion or
swelling of the contents of any building or
structure, caused by or resulting from wa-
ter;
c. Explosion of steam boilers, steam pipes,
steam engines, or steam turbines.
3. Paragraph 6. of LIMITS OF INSURANCE
(Section III) is deleted and replaced by the
following:
Subject to 5. above, the Damage To Prem-
ises Rented To You Limit is the most we will
pay under COVERAGE A. for the sum of all
damages because of "property damage" to
any one premises while rented to you, or
temporarily occupied by you with permission
of the owner, caused by: fire; explosion; light-
ning; smoke resulting from such fire, explo-
sion, or lightning; or water. The Damage To
Premises Rented To You Limit will apply to all
"property damage" proximately caused by the
same "occurrence", whether such damage
results from: fire; explosion; lightning; smoke
resulting from such fire, explosion, or light-
ning; or water; or any combination of any of
these causes.
The Damage To Premises Rented To You
Limit will be the higher of:
a. $300,000; or
b. The amount shown on the Declarations
for Damage To Premises Rented To You
Limit.
4. Paragraph a. of the definition of "insured con-
tract" (DEFINITIONS — Section V) is deleted
and replaced by the following:
a. A contract for a lease of premises. How-
ever, that portion of the contract for a
lease of premises that indemnifies any
person or organization for damage to
premises while rented to you, or tempo-
rarily occupied by you with permission of
the owner, caused by: fire; explosion;
lightning; smoke resulting from such fire,
explosion, or lightning; or water, is not an
"Insured contract";
We waive any right of recovery we may have
against any person or organization because of
payments we make for injury or damage arising
out of: premises owned or occupied by or rented
or loaned to you; ongoing operations performed
by you or on your behalf, done under a contract
with that person or organization; "your work"; or
"your products". We waive this right where you
have agreed to do so as part of a written contract,
executed by you before the "bodily injury" or
"property damage" occurs or the "personal injury"
or "advertising injury" offense is committed.
D. BLANKET ADDITIONAL INSURED — MANAG-
ERS OR LESSORS OF PREMISES
WHO IS AN INSURED (Section II) is amended to
include as an insured any person or organization
(referred to below as "additional insured") with
whom you have agreed in a written contract, exe-
cuted before the "bodily Injury" or "property dam-
age" occurs or the °personal injury" or "advertis-
ing injury" offense is committed, to name as ail
additional Insured, but only with respect to liability
arising out of the ownership, maintenance or use
of that part of any premises leased to you, subject
to the following provisions:
I. Limits of Insurance. The limits of insurance
afforded to the additional insured shall be the
limits which you agreed to provide in the writ-
ten contract, or the limits shown on the Decla-
rations, whichever are less.
2. The insurance afforded to the additional in-
sured does not apply to:
a. Any "bodily Injury" or "property damage"
that occurs, or "personal Injury" or "adver-
tising Injury" caused by an offense which
is committed, after you cease to be a ten-
ant in that premises;
b. Any premises for which coverage is ex-
cluded by endorsement; or
c. Structural alterations, new construction or
demolition operations performed by or on
behalf of such additional Insured.
3. The insurance afforded to the additional in-
sured is excess over any valid and collectible
Page 2 of 6 Copyright, The Travelers Indemnity Company, 2004 CG D316 07 04
i
P526 2V,2
GE Johnson Construction Company, Inc.
_ Policy Number: DTCOD67OC7011ND1I
Effective: 10/01/2011 - 10/01/2012
"other insurance" available to such additional
insured, unless you have agreed in the writ-
ten contract that this insurance must be pri-
mary to, or noncontributory with, such "other
insurance".
E. INCIDENTAL MEDICAL MALPRACTICE
1. The following is added to paragraph 1. Insur-.
ing Agreement of COVERAGE A. — BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
ITY (Section I — Coverages):
"Bodily injury' arising out of the rendering of,
or failure to render, the following will be
deemed to be caused by an "occurrence":
a. Medical, surgical, dental, laboratory, x-ray
or nursing service, advice or instruction,
or the related furnishing of food or bever-
ages;
b. The furnishing or dispensing of drugs or
medical, dental, or surgical supplies or
appliances;
c. First aid; or
d. 'Good Samaritan services." As used in
this Provision E., "Good Samaritan ser-
vices" are those medical services ren-
dered or provided in an emergency and
for which no remuneration is demanded
or received.
2. Paragraph 2.a.(1)(d) of WHO IS AN IN-
SURED (Section 11) does not apply to any
registered nurse, licensed practical nurse,
emergency medical technician or paramedic
employed by you, but only while performing
the services described in paragraph 1. above
and while acting within the scope of their em-
ployment by you. Any "employees" rendering
'Good Samaritan services" will be deemed to
be acting within the scope of their employ-
ment by you.
3. The following exclusion is added to paragraph
2. Exclusions of COVERAGE A. — BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
ITY (Section 1— Coverages):
(This insurance does not apply to:) "Bodily in-
jury" or "property damage" arising out of the
willful violation of a penal statute or ordinance
relating to the sale of pharmaceuticals com-
mitted by or with the knowledge or consent of
the insured.
4. For the purposes of determining the applica-
ble limits of insurance, any act or omission
COMMERCIAL GENERAL LIABILITY
together with all related acts or omissions in
the furnishing of the services described in
paragraph 1. above to any one person will be
deemed one "occurrence".
5. This Provision E. does not apply if you are in
the business or occupation of providing any of
the services described in paragraph 1. above.
6. The insurance provided by this Provision E.
shall be excess over any valid and collectible
"other insurance" available to the insured,
whether primary, excess, contingent or on
any other basis, except for insurance that you
bought specifically to apply in excess of the
Limits of Insurance shown on the Declara-
tions of this Coverage Part.
F. EXTENSION OF COVERAGE — BODILY IN-
JURY
The definition of "bodily injury" (DEFINITIONS —
Section V) is deleted and replaced by the follow-
ing:
"Bodily injury" means bodily injury, mental an-
guish, mental injury, shock, fright, disability, hu-
miliation, sickness or disease sustained by a per-
son, including death resulting from any of these at
any time.
G. CONTRACTUAL LIABILITY —RAILROADS
1. Paragraph c. of the definition of "insured con-
tract" (DEFINITIONS — Section V) is deleted
and replaced by the following:
c. Any easement or license agreement;
2. Paragraph L(1) of the definition of "insured
contract" (DEFINITIONS — Section V) is de-
leted.
H. ADDITIONAL INSURED — STATE OR POLITI-
CAL SUBDIVISIONS — PERMITS
WHO IS AN INSURED (Section II) is amended to
include as an insured any state or political subdi-
vision, subject to the following provisions:
1. This insurance applies only when required to
be provided by you by an ordinance, law or
building code and only with respect to opera-
tions performed by you or on your behalf for
which the state or political subdivision has is-
sued a permit.
2. This insurance does not apply to:
a. "Bodily injury," "property damage," "per-
sonal injury" or "advertising injury" arising
out of operations performed for the state
or political subdivision; or
CG D316 07 04 Copyright, The Travelers Indemnity Company, 2004 Page 3 of 6
m
r
0
O