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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