Agreement - Dibble CM, LLC

City of Chandler — Regular Meeting (2021-12-09)

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10/11/2021
Farmer Woods Group
919 North 1st Street
Phoenix
AZ
85004
Alena Avnukov
(602)264-0566
(602)277-4706
alena-avnukov@leavitt.com
Dibble CM, LLC
7878 n 16th St
Ste 300
Phoenix
AZ
85020-4660
Acadia Insurance Company
031325
Continental Western Insurance Company
010804
Argonaut Insurance Company
19801
21/22 CPKG
A
X
X
X
X
Y
CPA454132719
1/27/2021
1/27/2022
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
Employee Benefits
1,000,000
A
X
X
Y
CPA454132719
1/27/2021
1/27/2022
1,000,000
Underinsured motorist BI single limit
1,000,000
B
X
X
X
10,000
X
Y
CUA454132819
1/27/2021
1/27/2022
5,000,000
C
Error and Ommissions
121AE016780900
2/28/2021
2/28/2022
Each Claim/Aggregate
2,000,000
D
Cyber Liability
AXIS-P-06677161
06/12/2021
06/12/2022
Per Claim/Aggregate
3,000,000
RE: #WA1521.453 Fire Station 10 well site improvements Phase II
City of Chandler, , its officers, officials, agents, representatives, subconsultants and consultant &
employees are additional insured as required in a written contract per forms CLCG0443 09/16 (on going),
CLCG2023 09/16(com ops), CLCL0114 09/16(Primary non contributory) & CLCA2014 10/13(AI Auto), Waiver of
Subrogation as required in a written contract per forms CLCG0443 09/16(GL) & CLCA2014 10/13(Auto)
attached. Excess follows form. Seperation of Insureds (Severability Clause) provided per the CG0001 04/13
attached.
City of Chandler
Public Works & Utilities Dept
P.O. Box 4008
Mail Stop 407
Chandler, AZ  85244-4008
Paula.brown@chandleraz.gov
Alena Avnukov/AIAVNU
Y
The ACORD name and logo are registered marks of ACORD
CERTIFICATE HOLDER
© 1988-2014 ACORD CORPORATION.
All rights reserved.
ACORD 25 (2014/01)
AUTHORIZED REPRESENTATIVE
CANCELLATION
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
LOC
JECT
PRO-
POLICY
GEN'L AGGREGATE LIMIT APPLIES PER:
OCCUR
CLAIMS-MADE
COMMERCIAL GENERAL LIABILITY
PREMISES (Ea occurrence)
$
DAMAGE TO RENTED
EACH OCCURRENCE
$
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
PRODUCTS - COMP/OP AGG
$
$
RETENTION
DED
CLAIMS-MADE
OCCUR
$
AGGREGATE
$
EACH OCCURRENCE
$
UMBRELLA LIAB
EXCESS LIAB
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES  (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
INSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
LIMITS
PER
STATUTE
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
$
$
$
ANY PROPRIETOR/PARTNER/EXECUTIVE
If yes, describe under
DESCRIPTION OF OPERATIONS below
(Mandatory in NH)
OFFICER/MEMBER EXCLUDED?
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y / N
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED
SCHEDULED
HIRED AUTOS
NON-OWNED
AUTOS
AUTOS
AUTOS
COMBINED SINGLE LIMIT
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
$
$
$
$
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.
INSD
ADDL
WVD
SUBR
N / A
$
$
(Ea accident)
(Per accident)
OTHER:
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.  THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT:  If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed.  If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement.  A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
INSURED
PHONE
(A/C, No, Ext):
PRODUCER
ADDRESS:
E-MAIL
FAX
(A/C, No):
CONTACT
NAME:
NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
INSURER(S) AFFORDING COVERAGE
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INS025 (201401)

COMMERCIAL GENERAL LIABILITY 
CL CG 20 23 09 16 
 
THIS ENDORSEMENT CHANGES THE POLICY.  PLEASE READ IT CAREFULLY. 
 
 
CL CG 20 23 09 16
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
Page 1 of 2
 
ADDITIONAL INSURED – OWNERS, LESSEES OR 
CONTRACTORS – COMPLETED OPERATIONS: 
AUTOMATIC STATUS 
 
This endorsement modifies insurance provided under the following: 
 
COMMERCIAL GENERAL LIABILITY COVERAGE PART 
 
A. Additional Insured(s) 
 
1. Section II – Who Is An Insured is amended 
to include as an additional insured any 
person or organization for whom you have 
agreed to add as an additional insured on 
your policy in a written contract or written 
agreement, but only with respect to liability 
for “bodily injury” or “property damage” 
caused, in whole or in part, by “your work” 
performed for that additional insured and 
included 
in 
the 
“products-completed 
operations hazard”. 
 
2. The insurance afforded to such additional 
insured(s) described in Paragraph 1. above 
is subject to each of the following additional 
provisions: 
 
a. The coverage provided to the additional 
insured by this endorsement does not 
apply to “bodily injury” or “property 
damage” beyond: 
 
(1) The period of time required by the 
written contract or written agreement 
described in Paragraph 1. above, or 
10 years from the date of the 
completion of “your work” described 
in Paragraph 1. above, whichever is 
less; or 
 
(2) Two years from the date of the 
completion of “your work” described 
in Paragraph 1. above, if the written 
contract or written agreement does 
not specify the period of time. 
 
b. The insurance afforded to the additional 
insured(s) only applies to the extent 
permitted by law. 
 
c. The written contract or written agreement 
must have been executed prior to when 
the “bodily injury” or “property damage” 
occurs. 
 
d. The following is added to Section III – 
Limits Of Insurance: 
 
The most we will pay on behalf of the 
additional insured(s) is the amount of 
insurance: 
 
(1) Required by the written contract or 
written 
agreement 
described 
in 
Paragraph 1. above; or 
 
(2) Available under the applicable Limits 
of 
Insurance 
shown 
in 
the 
Declarations 
of 
this 
policy 
or 
coverage part; 
 
whichever is less. 
 
This endorsement shall not increase the 
applicable Limits of Insurance shown in 
the 
Declarations 
of 
this 
policy 
or 
coverage part. 
 
B. Professional Liability Exclusion 
 
With respect to coverage provided by this 
endorsement, the following exclusion is added to 
Paragraph 2. Exclusions of Section I – 
Coverage A – Bodily Injury And Property 
Damage Liability: 
 
This insurance does not apply to “bodily injury” or 
“property damage” arising out of:

Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
CL CG 20 23 09 16
 
Professional Liability 
 
Having rendered or having failed to render any 
professional 
architectural, 
engineering 
or 
surveying services, including: 
 
1. The preparation, approval, or failure to 
prepare or approve, maps, shop drawings, 
opinions, reports, surveys, field orders, 
change 
orders 
or 
drawings 
and 
specifications; or 
 
2. Supervisory, 
inspection, 
architectural 
or 
engineering activities. 
 
This exclusion applies even if the claims against 
any 
insured 
allege 
negligence 
or 
other 
wrongdoing 
in 
having 
supervised, 
hired, 
employed, trained or monitored others by that 
insured, if the “occurrence” which caused the 
“bodily injury” or “property damage” involved the 
rendering of or the failure to render any 
professional 
architectural, 
engineering 
or 
surveying services. 
 
C. Duties In Event Of Occurrence, Claim Or Suit 
 
With respect to the coverage provided by this 
endorsement, the following replaces Paragraphs 
2.a. and 2.b. of Section IV – Commercial 
General Liability Conditions: 
 
a. You and any additional insured must see to it 
that we are notified as soon as practicable of 
an “occurrence” which may result in a claim.  
To the extent possible, notice should include: 
 
(1) How, when and where the “occurrence” 
took place; 
 
(2) The names and addresses of any injured 
persons and witnesses; and 
 
(3) The nature and location of any injury or 
damage arising out of the “occurrence”. 
 
b. If a claim is made or “suit” is brought against 
any insured, the insured must: 
 
(1) Immediately record the specifics of the 
claim or “suit” and the date received; and 
 
(2) Notify us as soon as practicable. 
 
The insured must see to it that we receive 
written notice of the claim or “suit” as soon as 
practicable.

COMMERCIAL GENERAL LIABILITY 
CL CG 04 43 09 16 
 
THIS ENDORSEMENT CHANGES THE POLICY.  PLEASE READ IT CAREFULLY. 
 
CL CG 04 43 09 16
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
Page 1 of 8
 
CONTRACTORS GENERAL LIABILITY  
ULTRA ENDORSEMENT  
 
This endorsement modifies insurance provided under the following: 
 
COMMERCIAL GENERAL LIABILITY COVERAGE PART 
 
SUMMARY OF COVERAGE EXTENSIONS 
 
Provision
Name Of Coverage Extension 
Included or Limit 
of Insurance 
A. 
Miscellaneous Additional Insureds 
Included 
B. 
Aggregate Limits Of Insurance For Construction Projects: 
 
 
1.  Single Construction Project Aggregate Limit (Away From Premises) 
Equal To General 
Aggregate Limit 
 
2.  Cap For All Damages From All Ongoing Construction Projects 
$5,000,000 
C. 
Expected Or Intended Injury Or Damage 
Included 
D. 
Joint Venture / Partnership / Limited Liability Company Coverage 
Included 
E. 
Knowledge Of Occurrence 
Included 
F. 
Legal Liability – Damage To Premises Rented To You (Fire, Lightning, 
Explosion, Smoke, Or Leakage From Automatic Fire Protective Systems) 
Included 
G. 
Medical Payments 
$10,000 
H. 
Mobile Equipment Redefined 
Included 
I. 
Newly Formed Or Acquired Organizations – Extended Period Of Coverage 
Included 
J. 
Non-Owned Watercraft (Increased to maximum length of less than 51 feet) 
Included 
K. 
Supplementary Payments – Increased Limits: 
 
 
1.  Bail Bonds 
$3,000 
 
2.  Loss Of Earnings 
$1,000 
L. 
Unintentional Omission Or Unintentional Error In Disclosure 
Included 
M. 
Waiver Of Subrogation 
Included 
 
The above is a summary only.  Please consult the specific provisions that follow for complete information on the 
extensions provided. 
 
The provisions of the Commercial General Liability 
Coverage Part apply except as otherwise provided in 
this endorsement.  This endorsement applies only if 
such Coverage Part is included in this policy. 
 
A. MISCELLANEOUS ADDITIONAL INSUREDS 
 
1. Section II – Who Is An Insured is amended 
to include as an insured any person or 
organization (referred to as additional insured 
below) described in Paragraphs A.1.c.(1) 
through A.1.c.(4) below when you and such 
person or organization have agreed in writing 
in a contract or agreement that such person 
or organization be added as an additional 
insured on your policy, provided that: 
a. The written contract or written agreement 
is: 
 
(1) Currently in effect or becoming 
effective during the term of this 
policy; and 
 
(2) Fully executed by you and the 
additional insured prior to the “bodily 
injury”, “property damage” or “per-
sonal and advertising injury”. 
 
b. The insurance afforded by this provision 
does not apply to any person or organi-
zation included as an additional insured

Page 2 of 8
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
CL CG 04 43 09 16
 
by a separate endorsement issued by us 
and made a part of this policy or 
coverage part. 
 
c. Only the following persons or organi-
zations are additional insureds under this 
provision, 
with 
coverage 
for 
such 
additional insureds limited as provided 
herein: 
 
(1) Managers Or Lessors Of Premises 
 
A manager or lessor of premises but 
only with respect to liability arising 
out of the ownership, maintenance or 
use of that part of the premises 
leased to you and subject to the 
following additional exclusions: 
 
This insurance does not apply to: 
 
(a) Any “occurrence” which takes 
place after you cease to be a 
tenant in that premises. 
 
(b) Structural alterations, new con-
struction or demolition operations 
performed by or on behalf of 
such additional insured. 
 
(2) Lessor Of Leased Equipment 
 
Any person or organization from 
whom you lease equipment but only 
with respect to liability for “bodily 
injury”, 
“property 
damage” 
or 
“personal 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. 
 
A person’s or organization’s status 
as an additional insured under this 
endorsement ends when their written 
contract or written agreement with 
you for such leased equipment ends. 
 
This insurance does not apply to any 
“occurrence” which takes place after 
the equipment lease expires. 
 
(3) Controlling Interest 
 
Any person(s) or organization(s) with 
a controlling interest in the Named 
Insured, but only with respect to their 
liability arising out of: 
 
(a) Their financial control of you; or 
 
(b) Premises they own, maintain or 
control while you lease or occupy 
these premises. 
 
This insurance does not apply to 
structural 
alterations, 
new 
con-
struction or demolition operations 
performed by or for such additional 
insured. 
 
(4) Owners Or Contractors For Whom 
You 
Are 
Performing 
Ongoing 
Operations 
 
(a) Any person or organization for 
whom 
you 
are 
performing 
operations but only with respect 
to liability for “bodily injury”, 
“property damage” or “personal 
and advertising injury” caused, in 
whole or in part, by: 
 
(i) Your acts or omissions; or 
 
(ii) The acts or omissions of 
those acting on your behalf: 
 
in the performance of your 
ongoing 
operations 
for 
the 
additional insured. 
 
A 
person’s 
or 
organization’s 
status as an additional insured 
under this provision ends when 
your 
operations 
for 
that 
additional insured are completed. 
 
(b) With respect to the insurance 
afforded 
to 
these 
additional 
insureds, the following additional 
exclusions apply: 
 
(i) “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: 
 
(1.1) 
The 
preparing, 
approving, or failing 
to 
prepare 
or 
approve, maps, shop 
drawings, 
opinions, 
reports, 
surveys,

CL CG 04 43 09 16
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
Page 3 of 8
 
field orders, change 
orders or drawings 
and 
specifications; 
or 
 
(1.2) 
Supervisory, inspec-
tion, architectural or 
engineering 
activities. 
 
This exclusion applies even 
if the claims against any 
insured allege negligence or 
other 
wrongdoing 
in 
the 
supervision, hiring, employ-
ment, training or monitoring 
of others by that insured, if 
the 
“occurrence” 
which 
caused the “bodily injury” or 
“property damage”, or the 
offense which caused the 
“personal 
and 
advertising 
injury”, 
involved 
the 
rendering of or the failure to 
render 
any 
professional 
architectural, engineering or 
surveying services. 
 
(ii) “Bodily injury” or “property 
damage” occurring after: 
 
(1.1) 
All work, including 
materials, parts or 
equipment furnished 
in connection with 
such work, on the 
project (other than 
service, 
mainten-
ance or repairs) to 
be performed by or 
on 
behalf 
of 
the 
additional insured(s) 
at the location of the 
covered 
operations 
has been completed; 
or 
 
(1.2) 
That portion of “your 
work” out of which 
the injury or damage 
arises has been put 
to its intended use 
by any person or 
organization 
other 
than another con-
tractor 
or 
sub-
contractor engaged 
in performing opera-
tions for a principal 
as a part of the 
same project. 
 
2. With respect to coverage provided by this 
Provision 
A. 
Miscellaneous 
Additional 
Insureds, the following additional provisions 
apply: 
 
a. Any insurance provided to an additional 
insured designated under Paragraphs 
A.1.c.(1) through A.1.c.(4) above does 
not apply: 
 
(1) To “bodily injury” or “property dam-
age” included within the “products-
completed operations hazard”; or 
 
(2) To “bodily injury”, “property damage” 
or “personal and advertising injury” 
arising out of the sole negligence of 
such additional insured. 
 
b. The insurance afforded to such additional 
insured only applies to the extent 
permitted by law. 
 
c. The insurance afforded to such additional 
insured will not be broader than that 
which you are required to provide by the 
written contract or written agreement. 
 
3. With respect to the insurance afforded to the 
additional insureds within this Provision A. 
Miscellaneous Additional Insureds, the 
following is added to Section III – Limits Of 
Insurance: 
 
The most we will pay on behalf of the 
additional insured is the amount of insurance: 
 
a. Required by the written contract or 
written agreement; or 
 
b. Available under the applicable Limits of 
Insurance shown in the Declarations; 
 
whichever is less. 
 
This endorsement shall not increase the 
applicable Limits of Insurance shown in the 
Declarations. 
 
B. AGGREGATE LIMITS OF INSURANCE FOR 
CONSTRUCTION PROJECTS 
 
1. For all sums which the insured becomes 
legally obligated to pay as damages caused

Page 4 of 8
Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
CL CG 04 43 09 16
 
by 
“occurrences” 
under 
Section 
I 
– 
Coverage A, and for all medical expenses 
caused by accidents under Section I – 
Coverage C, which can be attributed only to 
ongoing operations at construction projects 
away from premises owned by or rented to 
the insured: 
 
a. The most we will pay will be capped at 
$5,000,000, regardless of the number of: 
 
(1) “Occurrences”; 
 
(2) Insureds: 
 
(3) Claims made or “suits” brought; 
 
(4) Persons or organizations making 
claims or bringing “suits”; or 
 
(5) Separate construction projects. 
 
b. Subject to Paragraph B.1.a. above: 
 
(1) A 
separate 
Single 
Construction 
Project General Aggregate Limit 
applies to each construction project 
away from premises owned by or 
rented to the insured, and that limit is 
equal to the amount of the General 
Aggregate 
Limit 
shown 
in 
the 
Declarations. 
  
(2) The 
Single 
Construction 
Project 
General Aggregate Limit is the most 
we will pay for the sum of all 
damages 
under 
Section 
I 
– 
Coverage 
A, 
except 
damages 
because 
of 
“bodily 
injury” 
or 
“property damage” included in the 
“products-completed 
operations 
hazard”, and for medical expenses 
under Section I – Coverage C 
regardless of the number of: 
 
(a) Insureds; 
 
(b) Claims made or “suits” brought; 
or 
 
(c) Persons or organizations making 
claims or bringing “suits”. 
 
(3) Any payments made under Section I 
– Coverage A for damages or under 
Section I – Coverage C for medical 
expenses shall reduce the Single 
Construction Project General Aggre-
gate 
Limit for that construction 
project away from premises owned 
by or rented to the insured.  Such 
payments 
shall 
not 
reduce 
the 
General Aggregate Limit shown in 
the Declarations nor shall they 
reduce any other Single Construction 
Project General Aggregate Limit for 
any 
other 
separate 
construction 
project away from premises owned 
by or rented to the insured. 
 
(4) The limits shown in the Declarations 
for Each Occurrence, Damage To 
Premises 
Rented 
To 
You 
and 
Medical Expense continue to apply.  
However, instead of being subject to 
the General Aggregate Limit shown 
in the Declarations, such limits will 
be subject to the applicable Single 
Construction 
Project 
General 
Aggregate Limit. 
 
2. For all sums which the insured becomes 
legally obligated to pay as damages caused 
by 
“occurrences” 
under 
Section 
I 
– 
Coverage A, and for all medical expenses 
caused by accidents under Section I – 
Coverage C, which cannot be attributed only 
to ongoing operations at a single construction 
project away from premises owned by or 
rented to the insured: 
 
a. Any payments made under Coverage A 
for damages or under Coverage C for 
medical expenses shall reduce the 
amount available under the General 
Aggregate 
Limit 
or 
the 
Products-
Completed Operations Aggregate Limit, 
whichever is applicable; and 
 
b. Subject to Paragraph B.1.a. above, such 
payments shall not reduce any Single 
Construction Project General Aggregate 
Limit. 
 
3. When coverage for liability arising out of the 
“products-completed operations hazard” is 
provided, 
any 
payments 
for 
damages 
because of “bodily injury” or “property 
damage” included in the “products-completed 
operations hazard” will reduce the Products-
Completed Operations Aggregate Limit, and 
not reduce the General Aggregate Limit nor 
the Single Construction Project General 
Aggregate Limit. 
 
4. If a single construction project away from 
premises owned by or rented to the insured 
has 
been 
abandoned, 
delayed, 
or 
abandoned and then restarted, or if the

CL CG 04 43 09 16
Includes copyrighted material of Insurance Services Office, Inc. 
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Page 5 of 8
 
authorized contracting parties deviate from 
plans, blueprints, designs, specifications or 
timetables, the project will still be deemed to 
be the same construction project. 
 
5. If endorsement CG 25 03, Designated 
Construction Project(s) General Aggregate 
Limit (or a similar construction project(s) 
aggregate endorsement) is also a part of this 
policy or coverage part, the most we will pay 
for the total of: 
 
a. All sums which the insured becomes 
legally obligated to pay as damages 
caused by “occurrences” under Section I 
– Coverage A; and 
 
b. All 
medical 
expenses 
caused 
by 
accidents under Section I – Coverage 
C, 
 
which can be attributed only to ongoing 
operations at: 
 
(1) Any 
construction 
project(s) 
designated in such CG 25 03 
endorsement (or in a similar such 
construction 
project(s) 
aggregate 
endorsement); 
 
(2) Any construction project(s) to which 
the 
provisions 
of 
Provision 
B. 
Aggregate Limits Of Insurance For 
Construction 
Projects 
in 
this 
endorsement apply; and/or 
 
(3) Any construction project(s) to which: 
 
(i) The provisions of Provision B. 
Aggregate Limits Of Insurance 
For Construction Projects in 
this endorsement; and 
 
(ii) The provisions of such CG 25 03 
endorsement (or a similar such 
construction project(s) aggregate 
endorsement) 
 
both apply, 
 
is subject to Paragraph B.1.a. above. 
 
6. The provisions of Section III – Limits Of 
Insurance not otherwise modified by this 
endorsement shall continue to apply as 
stipulated. 
 
C. EXPECTED 
OR 
INTENDED 
INJURY 
OR 
DAMAGE 
 
Exclusion 2.a. Expected Or Intended Injury of 
Section I – Coverage A – Bodily Injury And 
Property Damage Liability is deleted and 
replaced by the following: 
 
a. Expected Or Intended Injury Or Damage 
 
“Bodily injury” or “property damage” expected 
or intended from the standpoint of the 
insured.  This exclusion does not apply to 
“bodily injury” or “property damage” resulting 
from the use of reasonable force to protect 
persons or property. 
 
D. JOINT VENTURE / PARTNERSHIP / LIMITED 
LIABILITY COMPANY COVERAGE 
 
1. The following is added to Section II – Who 
Is An Insured: 
 
4. You are an insured when you had an 
interest in a joint venture, partnership or 
limited liability company which terminated 
or ended prior to or during this policy 
period, but only to the extent of your 
interest in such joint venture, partnership 
or limited liability company. 
 
However, this coverage does not apply: 
 
a. Prior to the termination or end date 
of any joint venture, partnership or 
limited liability company; 
 
b. If there is other valid and collectible 
insurance purchased specifically to 
insure the joint venture, partnership 
or limited liability company; or 
 
c. To a joint venture, partnership or 
limited liability company which is, or 
ever 
was, 
insured 
under 
a 
“consolidated (wrap-up) insurance 
program” (also known as an owner-
controlled 
insurance 
program, 
OCIP). 
 
2. With respect to the coverage provided by this 
Provision D. Joint Venture / Partnership / 
Limited Liability Company Coverage, the 
last Paragraph of Section II – Who Is An 
Insured is replaced by the following: 
 
Except as provided in 4. above, no person or 
organization is an insured with respect to the

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Includes copyrighted material of Insurance Services Office, Inc. 
with its permission 
CL CG 04 43 09 16
 
conduct of any current, or past partnership, 
joint venture or limited liability company that 
is not shown as a Named Insured in the 
Declarations. 
 
3. As used in this endorsement, “consolidated 
(wrap-up) insurance program” (also known 
as an owner-controlled insurance program, 
OCIP) means a construction, erection or 
demolition project for which the prime 
contractor/project manager or owner of the 
construction, erection or demolition project 
has 
secured 
general 
liability 
insurance 
covering some or all of the contractors or 
subcontractors 
involved 
in 
the 
project, 
sometimes referred to as a Contractor 
Controlled Insurance Program (CCIP). 
 
E. KNOWLEDGE OF OCCURRENCE  
 
Paragraph 2.a. Duties In The Event Of 
Occurrence, Offense, Claim Or Suit of Section 
IV – Commercial General Liability Conditions 
is deleted and replaced by the following: 
 
a. You must see to it that we are notified as 
soon as practicable of an “occurrence” or an 
offense which may result in a claim only 
when the “occurrence” or offense is known 
to: 
 
(1) You, if you are an individual; 
 
(2) A partner, if you are a partnership; 
 
(3) A manager, if you are a limited liability 
company; or 
 
(4) An “executive officer” or the “employee” 
designated by you to give such notice, if 
you are an organization other than a 
partnership or limited liability company. 
 
To the extent possible, notice should include: 
 
(i) How, when and where the “occur-rence” 
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 “occur-rence” 
or offense. 
 
F. LEGAL LIABILITY – DAMAGE TO PREMISES 
RENTED TO YOU (Fire, Lightning, Explosion, 
Smoke Or Leakage From Automatic Fire 
Protective Systems) 
 
If damage to premises rented to you is not 
otherwise excluded from this policy or coverage 
part, then the following provisions apply: 
 
1. Under Section I – Coverage A – Bodily 
Injury And Property Damage Liability the 
last paragraph (after the exclusions) is 
deleted and replaced by the following: 
 
Exclusion c. through n. do not apply to 
damage by fire, lightning, explosion, “smoke”, 
or leakage from automatic fire protective 
systems to premises while 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. 
 
2. The paragraph immediately after Subpara-
graph j.(6) of Paragraph 2. Exclusions of 
Section I – Coverage A – Bodily Injury 
And Property Damage Liability is deleted 
and replaced by the following: 
 
Paragraphs (1), (3) and (4) of this exclusion 
do not apply to “property damage” (other 
than damage by fire, lightning, explosion, 
“smoke” and leakage from automatic fire 
protective systems) to premises, including 
the contents of such premises, rented to you 
for a period of seven or fewer consecutive 
days.  A separate limit of insurance applies to 
Damage To Premises Rented To You as 
described in Section III – Limits Of 
Insurance. 
 
3. Paragraph 6. of Section III – Limits Of 
Insurance is deleted and replaced by the 
following: 
 
6. Subject to Paragraph 5. above, the 
greater of: 
 
a. $300,000; or 
 
b. The Damage To Premises Rented 
To 
You 
Limit 
shown 
in 
the 
Declarations; 
 
is the most we will pay under Coverage 
A for damages because of “property 
damage” to premises while rented to you,

CL CG 04 43 09 16
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with its permission 
Page 7 of 8
 
or in the case of damage by fire, 
lightning, explosion, “smoke” or leakage 
from automatic fire protective systems, 
while rented to you or temporarily 
occupied by you with permission of the 
owner. 
 
This limit will apply to all damage 
proximately caused by the same event, 
whether such damage results from fire, 
lightning, explosion, “smoke”, leakage 
from automatic fire protective systems, or 
other covered causes of loss or any 
combination thereof. 
 
4. Subparagraph b.(1)(a)(ii) of Paragraph 4. 
Other 
Insurance 
of 
Section 
IV 
– 
Commercial General Liability Conditions 
is deleted and replaced by the following: 
 
(ii) That is fire, lightning, explosion, 
“smoke”, or leakage from automatic 
fire protective systems insurance for 
premises 
rented 
to 
you 
or 
temporarily occupied by you with 
permission of the owner; 
 
5. Subparagraph a. of Definition 9. “Insured 
contract” of Section V – Definitions is 
deleted and replaced by 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, explosion, “smoke”, or 
leakage from automatic fire protective 
systems to premises while rented to you 
or temporarily occupied by you with 
permission of the owner is not an 
“insured contract”. 
 
6. As used in this Provision F. Legal Liability – 
Damage To Premises Rented To You: 
 
“Smoke” does not include smoke from 
agricultural smudging, industrial operations 
or “hostile fire”. 
 
 
G. MEDICAL PAYMENTS 
 
 
If Coverage C – Medical Payments is not 
otherwise excluded from this policy or coverage 
part, the Medical Expense Limit is changed, 
subject to the terms of Section III – Limits Of 
Insurance, to the greater of: 
 
a. $10,000; or 
 
b. The Medical Expense Limit shown in the 
Declarations. 
 
H. MOBILE EQUIPMENT REDEFINED 
 
Subparagraph f.(1) of Definition 12. “Mobile 
equipment” of Section V – Definitions is deleted 
and replaced by the following: 
 
(1) Equipment with a gross vehicle weight of 
1,000 pounds or more and designed primarily 
for: 
 
(a) Snow removal; 
 
(b) Road maintenance, but not construction 
or resurfacing; or 
 
(c) Street cleaning; 
 
I. 
NEWLY 
FORMED 
OR 
ACQUIRED 
ORGANIZATIONS – EXTENDED PERIOD OF 
COVERAGE 
 
Paragraph 3. of Section II – Who Is An Insured 
is deleted and replaced by the following: 
 
3. Any organization you newly acquire or form, 
other than: 
 
(i) A partnership, joint venture, or limited 
liability company; or 
 
(ii) An organization excluded either by the 
provisions of this policy or coverage part, 
or by endorsement, 
 
and over which you maintain ownership or 
majority interest of more than 50% will qualify 
as a Named Insured if there is no other 
similar 
insurance 
available 
to 
that 
organization.  However: 
 
a. Coverage under this provision is afforded 
only until the next anniversary date of 
this policy’s effective date after you 
acquire or form the organization or the 
end of the policy period, whichever is 
earlier; 
 
b. Section I – Coverage A – Bodily Injury 
And Property Damage Liability does 
not apply to “bodily injury” or “property 
damage” 
that 
occurred 
before 
you 
acquired or formed the organization; and

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CL CG 04 43 09 16
 
c. Section I – Coverage B – Personal 
And Advertising Injury Liability does 
not apply to “personal and advertising 
injury” 
arising 
out 
of 
an 
offense 
committed before you acquired or formed 
the organization. 
 
J. NON-OWNED WATERCRAFT 
 
 
Subparagraph (2) of Exclusion 2.g. Aircraft, 
Auto Or Watercraft of Section I – Coverage A 
– Bodily Injury And Property Damage Liability 
is deleted and replaced by the following: 
 
(2) A watercraft you do not own that is: 
 
(a) Less than 51 feet long; and 
 
(b) Not being used to carry persons or 
property for a charge; 
 
K. SUPPLEMENTARY PAYMENTS – INCREASED 
LIMITS 
 
Section I – Supplementary Payments – 
Coverages A And B is changed as follows: 
 
1. The limit shown in Paragraph 1.b. for the 
cost of bail bonds is changed from $250 to 
$3,000; and 
 
2. The limit shown in Paragraph 1.d. for loss of 
earnings because of time off from work is 
changed from $250 a day to $1,000 a day. 
 
L. UNINTENTIONAL 
OMISSION 
OR 
UNINTENTIONAL ERROR IN DISCLOSURE 
 
The following provision is added to Paragraph 6. 
Representations of Section IV – Commercial 
General Liability Conditions: 
 
However, the unintentional omission of, or the 
unintentional error in, any information given or 
provided by you shall not prejudice your rights 
under this insurance. 
 
This provision does not affect our right to collect 
additional premium or to exercise our right of 
cancellation or non-renewal. 
 
M. WAIVER OF SUBROGATION 
 
Paragraph 8. Transfer Of Rights Of Recovery 
Against Others To Us of Section IV – 
Commercial General Liability Conditions is 
amended by the addition of the following: 
 
Notwithstanding anything to the contrary in the 
previous paragraph, we waive any right of 
recovery we may have against a person or 
organization because of payments we make for 
injury or damage arising out of your ongoing 
operations or “your work” included in the 
“products-completed operations hazard”, if: 
 
a. Such operations or work were done under a 
written 
contract 
or 
written 
agreement 
between 
you 
and 
such 
person 
or 
organization that contained a provision 
requiring such waiver; and 
 
b. Such written contract or written agreement 
was: 
 
(1) Made prior to the covered injury or 
damage; and 
 
(2) In effect at the time of the covered injury 
or damage. 
 
This waiver applies only with respect to such 
person or organization.

COMMERCIAL GENERAL LIABILITY 
CL CG 01 14 09 16 
 
THIS ENDORSEMENT CHANGES THE POLICY.  PLEASE READ IT CAREFULLY. 
 
 
CL CG 01 14 09 16
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Page 1 of 1
 
PRIMARY AND NONCONTRIBUTORY –  
OTHER INSURANCE CONDITION 
(ADDITIONAL INSURED) 
 
This endorsement modifies insurance provided under the following: 
 
COMMERCIAL GENERAL LIABILITY COVERAGE PART 
 
Paragraph (v) is added to Paragraph (1)(a) of Paragraph b. Excess Insurance under Paragraph 4. Other 
Insurance of Section IV – Commercial General Liability Conditions, as follows: 
 
(1) This insurance is excess over: 
 
(a) Any of the other insurance, whether primary, excess, contingent or on any other basis: 
 
(v) That is available to any person or organization who has been added as an additional insured to this 
policy by endorsement. 
 
However, with respect to an additional insured added by endorsement for liability caused, in whole or in 
part: 
 
1. By your acts or omissions, or the acts or omissions of those acting on your behalf: 
 
(a) In the performance of your ongoing operations; or 
 
(b) In connection with your premises; 
 
2. By your maintenance, operation or use of equipment leased to you by such person or organization; 
or 
 
3. By “your work” performed for that additional insured and included in the “products-completed 
operations hazard”; 
 
this insurance shall be primary to and will not seek contribution from the additional insured’s own 
insurance if you and such additional insured have agreed prior to loss in a written contract or written 
agreement, in effect during this policy period, that this insurance be primary and noncontributory as 
respects liability described in Subparagraph (1)(a)(v)1., (1)(a)(v)2. or (1)(a)(v)3. above.  However, this 
insurance, in all cases, is excess over any other liability insurance available to the additional insured to 
which such person or organization has been added as an additional insured.

COMMERCIAL AUTO
CL CA 20 14 10 13
THIS ENDORSEMENT CHANGES THE POLICY.  PLEASE READ IT CAREFULLY.
CL CA 20 14 10 13
Includes copyrighted material of Insurance Services Office,  Inc.,
with its permission.
Page 1 of 7
BUSINESS AUTO ULTRA PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
SUMMARY OF COVERAGE EXTENSIONS
Paragraph
No.
Name Of Extension
Limit or
Included
A.
Included
B.
Airbags Coverage Extension
Included
C.
Employees As Insureds
Included
D.
Hired Auto Physical Damage Coverage (Limited)
$65,000
E.
Employee Hired Autos (Limited)
$65,000
F.
Knowledge Of Accident, Claim, Suit, Or Loss
Included
G.
Limited Fellow Employee Coverage
Included
H.
Limited Loan/Lease Gap Coverage
$1,500
I.
Limited Rental Reimbursement Coverage
45 Days
Sublimits:
1. $75 Maximum Rental Expenses Per Day
2. $3,375 Maximum Rental Expenses Because Of Loss To Any
One Covered "Auto"
3. $15,000 Maximum Rental Expenses Because Of All "Loss"
To All Covered "Autos" In Any One Policy Period.
J.
Newly Formed Or Acquired Organizations
Included
K.
Supplementary Payments
Increased Limits:
1. Bail Bonds
$3,000
2. Loss Of Earnings (Per Day)
$1,000
L.
Towing And Labor Coverage Extension
$75
M.
Waiver Of Subrogation By Contract Or Agreement
Included
The above is a summary only.  Please consult the specific provisions that follow for complete information on the
extensions provided.  If there is a conflict between this summary and the endorsement provisions that follow, the
endorsement provisions shall prevail.
CPA4541327

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with its permission.
CL CA 20 14 10 13
A.
ADDITIONAL INSURED BY CONTRACT OR
AGREEMENT
1.
The Who Is an Insured provision for Cov-
ered Autos Liability Coverage is changed
to add as an additional insured any person
or organization when you and such person
or organization have agreed in writing in a
contract or agreement that such person or
organization be added as an additional in-
sured on your policy, subject to the following
additional provisions
a.
Such person or organization is an addi-
tional insured only with respect to their
vicarious legal responsibility for
by
an "accident" and resulting from your
ownership, maintenance or use of a
x-
tent of that liability.
b.
Such person or organization is not an
additional insured for any
owned by, hired from, or borrowed from
such person or organization or a mem-
ber of such person's household.
c.
Such written contract or agreement
must be executed prior to, and be in ef-
d.
Paragraph H.
n-
tained in
Section V
Definitions
is
changed to add sub-paragraph d. to the
end of that definition, as follows:
that part of any contract or agreement:
d.
That pertains to the
ownership,
which indemnifies a person or or-
ganization for other than the vicari-
ous liability of such person or organ-
by an "accident"
and resulting from your ownership,
maintenance or use of a covered
2.
None of the following shall be an additional
insured under this endorsement:
a.
b.
m-
for
3.
Paragraph A.1. Who Is An Insured con-
tained in Section II
Covered Autos Lia-
bility Coverage, is changed to delete sub-
paragraph c.
4.
The additional insured Is not required to pay
for any premiums stated in the policy or
earned from the policy.  Any return premium
shall be payable to you.
5.
You are authorized to act for the additional
insured in all matters pertaining to this in-
surance.
6.
The additional insured will retain any right of
recovery as a claimant under this policy.
B.
AIRBAGS COVERAGE EXTENSION
Exclusion B.3.a. contained in Section III
Physical Damage Coverage does not apply to
the 
unintended 
discharge 
of 
an 
airbag.
However, coverage is excess over any other
collectible insurance or warranty specifically
designed to provide coverage.
C.
EMPLOYEES AS INSUREDS
The following is added to the Section II
Cov-
ered Autos Liability Coverage, Paragraph A.1.
Who Is An Insured provision:
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.
However, the insurance provided by this pro-
vision, C. Employees As Insureds, does not
apply if separate Employees As Insured cov-
erage (or any similar or equivalent coverage)
has been provided by a separate endorsement
issued by us and made a part of this policy or
coverage part.
D.
HIRED AUTO PHYSICAL DAMAGE COV-
ERAGE (LIMITED)
Covered
Autos Liability Coverage
in this policy or
coverage part, then such Physical Damage
Coverage that is provided in this policy or
or borrow, subject to the following additional
provisions:
1.
This extension for Hired Auto Physical
Damage
Coverage (Limited)
does not
apply to:
a.
borrow that is a land vehicle that would
qualify under the definition of "mobile
equipment" 
under 
this 
policy 
or
coverage part if it were not subject to a
compulsory or financial responsibility
law or other motor vehicle insurance law
where it is licensed or principally
garaged;

CL CA 20 14 10 13
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with its permission.
Page 3 of 7
b.
Any "auto" you lease, hire, rent or bor-
row from any of your "employees", part-
ners (if you are a partnership), members
(if you are a limited liability company) or
members of their households; or
c.
borrow:
(1) For a period of more than 30 days;
or
(2) With a driver.
2.
Physical Damage Coverage
The Physical Damage Coverage provided
will be:
(a) With respect to Other Than Collision
coverage:
(1) Comprehensive Coverage if any
this coverage under this policy or
coverage part; or,
(2) Specified Causes Of Loss Coverage
if, under this coverage part or policy,
has this coverage and no other
Comprehensive Coverage; and
(b)
owned by you has this coverage under
this policy or coverage part.
3.
Limit Of Insurance
be the lesser of:
a.
The actual cash value of the damaged
"loss";
b.
The cost to repair or replace the
property of like kind and quality; or
c.
$65,000,
except that such amount will be reduced by
a deductible as determined by paragraph
D.4. below.
4.
Deductible
Our obligation to pay for, repair, return or
replace such damaged or stolen covered
will be reduced by a deductible
for each coverage afforded under D.2.(a)
and D.2.(b) above equal to the amount of
the largest deductible applicable for that
you.  However, no deductible will apply to
5.
Loss Of Use
under 
this 
extension
D. 
Hired 
Auto
Physical Damage Coverage (Limited), and
subject to the coverages provided under
paragraph D.2. Coverage above, we will
also pay expenses for loss of use of such
dditional
provisions:
a.
written rental contract or agreement;
b.
Such 
loss 
of 
use 
is 
a
direct
this extension D. Hired Auto Physical
Damage Coverage (Limited):
(1)
responsible; and
(2) As a result of which the leasing or
rental entity sustains a monetary
loss;
c.
The most we will pay for any expenses
for loss of use is $300 per day, subject
to a maximum of $2,100l; and
d.
Paragraph b. Loss Of Use Expenses
of Paragraph 4. Coverage Extensions
of Paragraph A. Coverage contained in
Section 
III
Physical 
Damage
Coverage does not apply.
6.
Other Insurance
Coverage under this extension D. Hired
Auto 
Physical 
Damage 
Coverage
(Limited) will be excess over any other valid
and collectible insurance available to the
afforded if any physical damage coverage is
Item Four
Schedule Of Hired Or Borrowed Covered
Auto Coverage
And Premiums
in the
Business Auto Declarations in this policy
or coverage part (or which would have been
provided except for the application of an
exclusion).
E.
EMPLOYEE HIRED AUTOS (LIMITED)
1.
Cov-
ered Autos Liability Coverage in this poli-
cy or coverage part, then the following pro-
vision applies:

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CL CA 20 14 10 13
Changes In Covered Autos Liability Cov-
erage
The following is added to the Who Is An In-
sured Provision:
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
written contract in an "employee's" name,
with your permission, while performing du-
ties related to the conduct of your business.
However, this extension does not apply to:
a.
Any "auto" that is hired or rented with a
driver;
b.
period of more than 30 days;
c.
"Mobile equipment", or
d.
a land
vehicle that would qualify under the def-
inition of "mobile equipment" under this
policy or coverage part if it were not
subject to a compulsory or financial re-
sponsibility law or other motor vehicle
insurance law where it is licensed or
principally garaged.
2.
If hired "autos" are covered "autos" for
Physical Damage Coverage in this policy
or coverage part, then the following provi-
sions apply:
a.
Changes in General Conditions
Paragraph 5.b. of the Other Insurance
Condition of Section IV
Business Au-
to Conditions is replaced by the follow-
ing:
For Hired Auto Physical Damage Cov-
erage, the following 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 "employee" under a written
contract in an "employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business.
However, none of the following are cov-
ered "autos:
(i)
Any "auto" that is leased, hired
rented or borrowed with a driver;
(ii)
for a period of more than 30
days;
(iii) "Mobile equipment", or
(iv) Any other land vehicle that
would qualify under the defini-
tion of "mobile equipment" un-
der this policy or coverage part
if it were not subject to a com-
pulsory or financial responsibility
law or other motor vehicle in-
surance law where it is licensed
or principally garaged.
b.
Limit Of Insurance
will be the lesser of:
(1) The actual cash value of the
time of the "loss";
(2) The cost to repair or replace the
property of like kind and quality; or
(3) $65,000,
3.
Any insurance afforded by this provision E.
Employee Hired Autos (Limited) does not
apply if separate Employees Hired Autos
coverage (or any similar or equivalent cov-
erage) has been provided by a separate en-
dorsement issued by us and made a part of
this policy or coverage part.
F.
KNOWLEDGE OF ACCIDENT, CLAIM, SUIT,
OR LOSS
Sub-paragraph a. contained in Paragraph A.2.
Duties In The Event Of Accident, Claim, Suit
or Loss, of Section IV
Business Auto
Conditions is replaced by the following:
a.
In the event of "accident", claim, "suit" or
"loss", you must give us or our authorized
representative prompt notice of the "acci-
dent" or "los
1.
You, if you are an individual;
2.
A partner, if you are a partnership;
3.
A manager, if you are a limited liability
company; or
4.
designated by you to give such notice, if
you are an organization other than a
partnership or a limited liability compa-
ny.
Include:
(1) How, when and where the "accident" or
"loss" occurred;
(2) The "insured's" name and address; and

CL CA 20 14 10 13
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Page 5 of 7
(3) To the extent possible, the names and
addresses of any injured persons and
witnesses.
G. LIMITED FELLOW EMPLOYEE COVERAGE
Paragraph 5. Fellow Employee of Paragraph B.
Exclusions contained in Section II
Covered
Autos Liability Coverage is replaced by the
following:
5.
Fellow Employee
a.
"Bodily injury" to any fellow "employee"
of the "insured" arising out of and in the
course of the fellow "employee's" em-
ployment or while performing duties re-
lated to the conduct of your business; or
b.
The spouse, child, parent, brother or sis-
ter of that fellow "employee" as a con-
sequence of Paragraph a. above.
However, this exclusion does not apply to
Such coverage is excess over any other
collectible insurance, and
Paragraph
5.
Other Insurance of Paragraph B. General
Conditions under Section IV
Business
Auto Conditions is changed accordingly.
Any insurance provided by this provision G.
Limited Fellow Employee Coverage does not
apply if separate Fellow Employee Coverage
(or any similar or equivalent coverage) has
been provided by a separate endorsement is-
sued by us and made a part of this policy or
coverage part.
As used in this provision, "executive officer"
means a person holding any of the officer
positions created by your charter, constitution,
by-laws 
or 
any 
other 
similar 
governing
document.
H.
LIMITED LOAN/LEASE GAP COVERAGE
Paragraph 4. Coverage Extensions of Para-
graph A. Coverage contained in Section III
Physical Damage Coverage is amended to add
the following:
I
v-
long-term leased by you for a period of 12 con-
secutive months or longer, we will pay any un-
paid amount due on your loan or lease for such
o the following addition-
al provisions:
1.
We will only pay the lesser of:
a.
The sum of such unpaid amount, less
(1) The amount paid under the Physi-
cal Damage Coverage Section of
the policy or coverage part; and
(2) Any:
(a) Overdue loan/lease payments at
(b) Financial penalties imposed un-
der a lease for excessive use,
abnormal wear and tear or high
mileage;
(c) Security deposits not returned
by the Lessor;
(d) Costs for extended warranties,
Credit Life Insurance, Health,
Accident or Disability Insurance
purchased with the loan or
lease; and
(e) Carry-over balances from previ-
ous loans or leases; or
b.
$1,500.
2.
This
that is a land vehicle that would qualify
under the definition of "mobile equipment"
under this policy or coverage part if it were
not subject to a compulsory or financial
responsibility law or other motor vehicle
insurance law where it is licensed or
principally garaged;
3.
The 
insurance 
afforded 
for
Limited
Loan/Lease Gap Coverage in this exten-
sion endorsement does not apply if
separate Loan/Lease Gap Coverage is
endorsement issued by us and made a
part of this policy or coverage part.
I.
LIMITED RENTAL REIMBURSEMENT COV-
ERAGE
We will pay for rental reimbursement expenses
following additional provisions:
1.
As used in this Rental Reimbursement
Coverage provisio
motor 
vehicle,
"trailer"
or 
semitrailer
designed for travel on public roads.
a.

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CL CA 20 14 10 13
b.
Any other land vehicle that would qualify
under the definition of "mobile equip-
ment" under this policy or coverage part
if it were not subject to a compulsory or
financial responsibility law or other
motor vehicle insurance law where it is
licensed or principally garaged.
2.
Payment applies in addition to the otherwise
applicable amount of each coverage you
3.
No deductible applies to this coverage.
4.
We will pay only for those expenses incurred
during the policy period beginning 24 hours
expiration date of the policy, with the lesser
of the following number of days:
a.
The 
number 
of 
days 
reasonably
required to repair or replace the covered
b.
45 days
5.
Our payment is limited to the lesser of the
following amounts:
a.
Necessary 
and 
actual 
expenses
incurred.
b.
The maximum rental expenses shown
below:
(1) $75 any one day;
(2) $3,375 because of "loss" to any one
covered "auto";
(3) $15,000 because of all "loss" to all
covered autos in any one policy
period.
6.
This coverage does not apply while there
are
for your operations.
7.
Paragraph a. Transportation Expenses of
Paragraph
4.
Coverage Extension
of
Paragraph
A.
Coverage
contained 
in
Section III
Physical Damage Coverage,
does not apply and is entirely deleted.
8.
The insurance afforded for Limited Rental
Reimbursement 
Coverage
in 
this
extension endorsement does not apply if
separate Rental Reimbursement Coverage
is issued by us as an endorsement and
made a part of this policy or coverage
part.
J.
NEWLY FORMED OR ACQUIRED ORGANI-
ZATIONS
The Named Insured shown in the Business Auto
Declarations 
is 
amended 
to 
include 
any
organization you newly form or acquire, other
than:
(i)
a partnership, joint venture, or limited
liability company; or
(ii) an organization excluded either by the
provisions of this Coverage Part, or by
endorsement,
and over which you maintain ownership or
majority interest of more than 50%, subject to
the following additional provisions:
1.
This insurance does not apply to any newly
formed or acquired organization that is an
but for its termination or the exhaustion of its
Limit of Insurance.
2.
Coverage under this provision does not
apply to injury, damage,
that occurred before you formed or acquired
the organization.
3.
Coverage under this provision is afforded
only until the next anniversary date of this
form the organization, or the end of the poli-
cy period, whichever is earlier.
K.
SUPPLEMENTARY 
PAYMENTS
IN-
CREASED LIMITS
The following changes are made to the Para-
graph a. Supplementary Payments of Para-
graph 2. Coverage Extensions of Paragraph
A. Coverage contained in Section II
Covered
Autos Liability Coverage:
1.
The limit shown in Subparagraph (2) for the
cost of bail bonds is changed from $2,000 to
$3,000.
2.
The limit shown in Subparagraph (4) for all
reasonable expenses incurred at our re-
quest, including actual loss of earnings be-
cause of time off work, is changed from
$250 to $1,000 per day.
L.
TOWING 
AND 
LABOR 
COVERAGE 
EX-
TENSION
Paragraph
2. 
Towing
of 
Paragraph
A.
Coverage
under
Section 
III
Physical
Damage Coverage is entirely replaced by the
following:
both
Comprehensive 
Coverage 
and 
Collision
Coverage in this policy or coverage part, we will
pay up to $75 for towing and labor costs
senger
following additional provisions:
1.
The labor must be performed at the place of
disablement;

CL CA 20 14 10 13
Includes copyrighted material of Insurance Services Office,  Inc.,
with its permission.
Page 7 of 7
2.
This coverage does not apply to stolen
3.
p
Physical Damage
Towing And Labor coverage shown under
Item 
Two
of 
the
Business 
Auto
Declarations in this policy or coverage part,
the most we will pay for each covered
disablement is the greater of:
a.
The limit shown under Item Two in the
Declarations, or
b.
$75
4.
As used in this coverage:
a.
-
wheel auto of the private passenger or
station wagon type; and
b.
-up or panel
truck, sport utility vehicle or similar
(GVW) of 11,000 pounds or less.
Gross Vehicle Weight (GVW) is the
maximum loaded weight for which a
by the manufacturer.
M. WAIVER OF SUBROGATION BY CONTRACT
OR AGREEMENT
The following is added to Paragraph
A.5.
Transfer Of Rights Of Recovery Against
Others To Us
contained in
Section IV
Business Auto Conditions:
Notwithstanding anything to the contrary in the
previous paragraph, we waive any right of
recovery we may have against a person or
organization because of payments we make for
arising out of the operation, maintenance, use,
you and such person or organization have
agreed in writing in a contract or agreement to
waive such right of recovery, provided:
1.
Such written contract or agreement was:
a.
Made prior to the covered injury or
damage; and
b.
In effect at the time of the covered injury
or damage; and
2.
The injury or damage arises out of the oper-
ations contemplated by such written contract
or agreement.
This waiver applies only to such person or
organization designated in such written contract
or agreement.

COMMERCIAL GENERAL LIABILITY
 
CG 00 01 04 13
 
CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 1 of 16
 
COMMERCIAL GENERAL LIABILITY COVERAGE FORM 
 
Various provisions in this policy restrict coverage. 
Read the entire policy carefully to determine rights, 
duties and what is and is not covered.  
Throughout this policy the words "you" and "your" 
refer to the Named Insured shown in the Declarations, 
and any other person or organization qualifying as a 
Named Insured under this policy. The words "we", 
"us" and "our" refer to the company providing this 
insurance.  
The word "insured" means any person or organization 
qualifying as such under Section II – Who Is An 
Insured.  
Other words and phrases that appear in quotation 
marks have special meaning. Refer to Section V –
Definitions.  
SECTION I – COVERAGES  
COVERAGE A – BODILY INJURY AND PROPERTY 
DAMAGE LIABILITY  
 1. Insuring Agreement  
 
a. We will pay those sums that the insured 
becomes legally obligated to pay as damages 
because of "bodily injury" or "property damage" 
to which this insurance applies. We will have 
the right and duty to defend the insured against 
any "suit" seeking those damages. However, 
we will have no duty to defend the insured 
against any "suit" seeking damages for "bodily 
injury" or "property damage" to which this 
insurance does not apply. We may, at our 
discretion, investigate any "occurrence" and 
settle any claim or "suit" that may result. But:  
 
(1) The amount we will pay for damages is 
limited as described in Section III – Limits 
Of Insurance; and  
 
(2) Our right and duty to defend ends when we 
have used up the applicable limit of 
insurance in the payment of judgments or 
settlements under Coverages A or B or 
medical expenses under Coverage C.  
No other obligation or liability to pay sums or 
perform acts or services is covered unless 
explicitly provided for under Supplementary 
Payments – Coverages A and B.  
 
b. This insurance applies to "bodily injury" and 
"property damage" only if:  
 
(1) The "bodily injury" or "property damage" is 
caused by an "occurrence" that takes place 
in the "coverage territory"; 
 
(2) The "bodily injury" or "property damage" 
occurs during the policy period; and 
 
(3) Prior to the policy period, no insured listed 
under Paragraph 1. of Section II – Who Is 
An Insured and no "employee" authorized 
by you to give or receive notice of an 
"occurrence" or claim, knew that the "bodily 
injury" or "property damage" had occurred, 
in whole or in part. If such a listed insured 
or authorized "employee" knew, prior to the 
policy period, that the "bodily injury" or 
"property damage" occurred, then any 
continuation, change or resumption of such 
"bodily injury" or "property damage" during 
or after the policy period will be deemed to 
have been known prior to the policy period. 
 
c. "Bodily injury" or "property damage" which 
occurs during the policy period and was not, 
prior to the policy period, known to have 
occurred 
by 
any 
insured 
listed 
under 
Paragraph 1. of Section II – Who Is An Insured 
or any "employee" authorized by you to give or 
receive notice of an "occurrence" or claim, 
includes 
any 
continuation, 
change 
or 
resumption of that "bodily injury" or "property 
damage" after the end of the policy period.  
 
d. "Bodily injury" or "property damage" will be 
deemed to have been known to have occurred 
at the earliest time when any insured listed 
under Paragraph 1. of Section II – Who Is An 
Insured or any "employee" authorized by you to 
give or receive notice of an "occurrence" or 
claim: 
 
(1) Reports all, or any part, of the "bodily injury" 
or "property damage" to us or any other 
insurer; 
 
(2) Receives a written or verbal demand or 
claim for damages because of the "bodily 
injury" or "property damage"; or 
 
(3) Becomes aware by any other means that 
"bodily injury" or "property damage" has 
occurred or has begun to occur. 
 
e. Damages because of "bodily injury" include 
damages 
claimed 
by 
any 
person 
or 
organization for care, loss of services or death 
resulting at any time from the "bodily injury".  
<!-Bookmark:COMMERCIAL GENERAL LIABILITY COVERAGE FORM_CG 00 01_04/13:EndBoomark-!>

Page 2 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 2. Exclusions  
This insurance does not apply to:  
 
a. Expected Or Intended Injury  
"Bodily injury" or "property damage" expected 
or intended from the standpoint of the insured. 
This exclusion does not apply to "bodily injury" 
resulting from the use of reasonable force to 
protect persons or property.  
 
b. Contractual Liability  
"Bodily injury" or "property damage" for which 
the insured is obligated to pay damages by 
reason of the assumption of liability in a 
contract or agreement. This exclusion does not 
apply to liability for damages:  
 
(1) That the insured would have in the absence 
of the contract or agreement; or  
 
(2) Assumed in a contract or agreement that is 
an "insured contract", provided the "bodily 
injury" 
or 
"property 
damage" 
occurs 
subsequent to the execution of the contract 
or agreement. Solely for the purposes of 
liability assumed in an "insured contract", 
reasonable attorneys' fees and necessary 
litigation expenses incurred by or for a party 
other than an insured are deemed to be 
damages because of "bodily injury" or 
"property damage", provided:  
 
(a) Liability to such party for, or for the cost 
of, that party's defense has also been 
assumed in the same "insured contract"; 
and  
 
(b) Such attorneys' fees and litigation 
expenses are for defense of that party 
against a civil or alternative dispute 
resolution proceeding in which damages 
to which this insurance applies are 
alleged.  
 
c. Liquor Liability  
"Bodily injury" or "property damage" for which 
any insured may be held liable by reason of:  
 
(1) Causing or contributing to the intoxication of 
any person;  
 
(2) The furnishing of alcoholic beverages to a 
person under the legal drinking age or 
under the influence of alcohol; or  
 
(3) Any statute, ordinance or regulation relating 
to the sale, gift, distribution or use of 
alcoholic beverages.  
This exclusion applies even if the claims 
against any insured allege negligence or other 
wrongdoing in: 
 
(a) The supervision, hiring, employment, 
training or monitoring of others by that 
insured; or 
 
(b) Providing 
or 
failing 
to 
provide 
transportation 
with 
respect 
to 
any 
person that may be under the influence 
of alcohol; 
if the "occurrence" which caused the "bodily 
injury" or "property damage", involved that 
which is described in Paragraph (1), (2) or (3) 
above.  
However, this exclusion applies only if you are 
in the business of manufacturing, distributing, 
selling, 
serving 
or 
furnishing 
alcoholic 
beverages. For the purposes of this exclusion, 
permitting 
a 
person 
to 
bring 
alcoholic 
beverages on your premises, for consumption 
on your premises, whether or not a fee is 
charged or a license is required for such 
activity, is not by itself considered the business 
of selling, serving or furnishing alcoholic 
beverages.  
 
d. Workers' Compensation And Similar Laws  
Any obligation of the insured under a workers' 
compensation, 
disability 
benefits 
or 
unemployment compensation law or any 
similar law. 
 
e. Employer's Liability  
"Bodily injury" to:  
 
(1) An "employee" of the insured arising out of 
and in the course of:  
 
(a) Employment by the insured; or  
 
(b) Performing duties related to the conduct 
of the insured's business; or  
 
(2) The spouse, child, parent, brother or sister 
of that "employee" as a consequence of 
Paragraph (1) above.  
This exclusion applies whether the insured 
may be liable as an employer or in any other 
capacity and to any obligation to share 
damages with or repay someone else who 
must pay damages because of the injury. 
This exclusion does not apply to liability 
assumed by the insured under an "insured 
contract".

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 3 of 16
 
 
f. Pollution  
 
(1) "Bodily injury" or "property damage" arising 
out of the actual, alleged or threatened 
discharge, dispersal, seepage, migration, 
release or escape of "pollutants": 
 
(a) At or from any premises, site or location 
which is or was at any time owned or 
occupied by, or rented or loaned to, any 
insured. However, this subparagraph 
does not apply to: 
 
(i) "Bodily injury" if sustained within a 
building and caused by smoke, 
fumes, vapor or soot produced by or 
originating from equipment that is 
used to heat, cool or dehumidify the 
building, or equipment that is used to 
heat water for personal use, by the 
building's occupants or their guests; 
 
(ii) "Bodily injury" or "property damage" 
for which you may be held liable, if 
you are a contractor and the owner 
or lessee of such premises, site or 
location has been added to your 
policy as an additional insured with 
respect to your ongoing operations 
performed for that additional insured 
at that premises, site or location and 
such premises, site or location is not 
and never was owned or occupied 
by, or rented or loaned to, any 
insured, other than that additional 
insured; or 
 
(iii) "Bodily injury" or "property damage" 
arising out of heat, smoke or fumes 
from a "hostile fire"; 
 
(b) At or from any premises, site or location 
which is or was at any time used by or 
for any insured or others for the 
handling, storage, disposal, processing 
or treatment of waste;  
 
(c) Which are or were at any time 
transported, handled, stored, treated, 
disposed of, or processed as waste by 
or for:  
 
(i) Any insured; or  
 
(ii) Any person or organization for whom 
you may be legally responsible; or 
 
(d) At or from any premises, site or location 
on which any insured or any contractors 
or subcontractors working directly or 
indirectly on any insured's behalf are 
performing operations if the "pollutants" 
are brought on or to the premises, site 
or location in connection with such 
operations by such insured, contractor 
or 
subcontractor. 
However, 
this 
subparagraph does not apply to:  
 
(i) "Bodily injury" or "property damage" 
arising out of the escape of fuels, 
lubricants or other operating fluids 
which are needed to perform the 
normal 
electrical, 
hydraulic 
or 
mechanical functions necessary for 
the operation of "mobile equipment" 
or its parts, if such fuels, lubricants 
or other operating fluids escape from 
a vehicle part designed to hold, store 
or receive them. This exception does 
not apply if the "bodily injury" or 
"property damage" arises out of the 
intentional discharge, dispersal or 
release of the fuels, lubricants or 
other operating fluids, or if such 
fuels, lubricants or other operating 
fluids are brought on or to the 
premises, site or location with the 
intent that they be discharged, 
dispersed or released as part of the 
operations being performed by such 
insured, contractor or subcontractor; 
 
(ii) "Bodily injury" or "property damage" 
sustained within a building and 
caused by the release of gases, 
fumes or vapors from materials 
brought 
into 
that 
building 
in 
connection with operations being 
performed by you or on your behalf 
by a contractor or subcontractor; or 
 
(iii) "Bodily injury" or "property damage" 
arising out of heat, smoke or fumes 
from a "hostile fire". 
 
(e) At or from any premises, site or location 
on which any insured or any contractors 
or subcontractors working directly or 
indirectly on any insured's behalf are 
performing operations if the operations 
are to test for, monitor, clean up, 
remove, contain, treat, detoxify or 
neutralize, or in any way respond to, or 
assess the effects of, "pollutants".

Page 4 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 
(2) Any loss, cost or expense arising out of 
any:  
 
(a) Request, demand, order or statutory or 
regulatory requirement that any insured 
or others test for, monitor, clean up, 
remove, contain, treat, detoxify or 
neutralize, or in any way respond to, or 
assess the effects of, "pollutants"; or  
 
(b) Claim or suit by or on behalf of a 
governmental authority for damages 
because of testing for, monitoring, 
cleaning 
up, 
removing, 
containing, 
treating, detoxifying or neutralizing, or in 
any way responding to, or assessing the 
effects of, "pollutants".  
However, this paragraph does not apply to 
liability for damages because of "property 
damage" that the insured would have in the 
absence of such request, demand, order or 
statutory or regulatory requirement, or such 
claim or "suit" by or on behalf of a 
governmental authority. 
 
g. Aircraft, Auto Or Watercraft  
"Bodily injury" or "property damage" arising out 
of 
the 
ownership, 
maintenance, 
use 
or 
entrustment to others of any aircraft, "auto" or 
watercraft owned or operated by or rented or 
loaned to any insured. Use includes operation 
and "loading or unloading".  
This exclusion applies even if the claims 
against any insured allege negligence or other 
wrongdoing 
in 
the 
supervision, 
hiring, 
employment, training or monitoring of others by 
that insured, if the "occurrence" which caused 
the "bodily injury" or "property damage" 
involved the ownership, maintenance, use or 
entrustment to others of any aircraft, "auto" or 
watercraft that is owned or operated by or 
rented or loaned to any insured. 
This exclusion does not apply to:  
 
(1) A watercraft while ashore on premises you 
own or rent;  
 
(2) A watercraft you do not own that is:  
 
(a) Less than 26 feet long; and  
 
(b) Not being used to carry persons or 
property for a charge;  
 
(3) Parking an "auto" on, or on the ways next 
to, premises you own or rent, provided the 
"auto" is not owned by or rented or loaned 
to you or the insured;  
 
(4) Liability assumed under any "insured 
contract" for the ownership, maintenance or 
use of aircraft or watercraft; or  
 
(5) "Bodily injury" or "property damage" arising 
out of:  
 
(a) The 
operation 
of 
machinery 
or 
equipment that is attached to, or part of, 
a land vehicle that would qualify under 
the definition of "mobile equipment" if it 
were not subject to a compulsory or 
financial responsibility law or other 
motor vehicle insurance law where it is 
licensed or principally garaged; or 
 
(b) The operation of any of the machinery 
or equipment listed in Paragraph f.(2) or 
f.(3) 
of 
the 
definition 
of 
"mobile 
equipment".  
 
h. Mobile Equipment  
"Bodily injury" or "property damage" arising out 
of:  
 
(1) The transportation of "mobile equipment" by 
an "auto" owned or operated by or rented or 
loaned to any insured; or  
 
(2) The use of "mobile equipment" in, or while 
in practice for, or while being prepared for, 
any prearranged racing, speed, demolition, 
or stunting activity.  
 
i. War  
"Bodily injury" or "property damage", however 
caused, arising, directly or indirectly, out of: 
 
(1) War, including undeclared or civil war; 
 
(2) Warlike action by a military force, including 
action in hindering or defending against an 
actual 
or 
expected 
attack, 
by 
any 
government, sovereign or other authority 
using military personnel or other agents; or 
 
(3) Insurrection, rebellion, revolution, usurped 
power, or action taken by governmental 
authority in hindering or defending against 
any of these. 
 
j. Damage To Property  
"Property damage" to:  
 
(1) Property you own, rent, or occupy, including 
any costs or expenses incurred by you, or 
any other person, organization or entity, for 
repair, 
replacement, 
enhancement, 
restoration or maintenance of such property 
for any reason, including prevention of 
injury to a person or damage to another's 
property;  
 
(2) Premises you sell, give away or abandon, if 
the "property damage" arises out of any 
part of those premises;  
 
(3) Property loaned to you;

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 5 of 16
 
 
(4) Personal property in the care, custody or 
control of the insured;  
 
(5) 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; or  
 
(6) That particular part of any property that 
must be restored, repaired or replaced 
because 
"your 
work" 
was 
incorrectly 
performed on it.  
Paragraphs (1), (3) and (4) of this exclusion do 
not apply to "property damage" (other than 
damage by fire) to premises, including the 
contents of such premises, rented to you for a 
period of seven or fewer consecutive days. A 
separate limit of insurance applies to Damage 
To Premises Rented To You as described in 
Section III – Limits Of Insurance. 
Paragraph (2) of this exclusion does not apply 
if the premises are "your work" and were never 
occupied, rented or held for rental by you.  
Paragraphs (3), (4), (5) and (6) of this 
exclusion do not apply to liability assumed 
under a sidetrack agreement.  
Paragraph (6) of this exclusion does not apply 
to "property damage" included in the "products-
completed operations hazard".  
 
k. Damage To Your Product  
"Property damage" to "your product" arising out 
of it or any part of it.  
 
l. Damage To Your Work  
"Property damage" to "your work" arising out of 
it or any part of it and included in the "products-
completed operations hazard".  
This exclusion does not apply if the damaged 
work or the work out of which the damage 
arises was performed on your behalf by a 
subcontractor.  
 
m. Damage To Impaired Property Or Property 
Not Physically Injured  
"Property damage" to "impaired property" or 
property that has not been physically injured, 
arising out of:  
 
(1) A 
defect, 
deficiency, 
inadequacy 
or 
dangerous condition in "your product" or 
"your work"; or  
 
(2) A delay or failure by you or anyone acting 
on your behalf to perform a contract or 
agreement in accordance with its terms.  
This exclusion does not apply to the loss of use 
of other property arising out of sudden and 
accidental physical injury to "your product" or 
"your work" after it has been put to its intended 
use.  
 
n. Recall Of Products, Work Or Impaired 
Property  
Damages claimed for any loss, cost or 
expense incurred by you or others for the loss 
of use, withdrawal, recall, inspection, repair, 
replacement, adjustment, removal or disposal 
of:  
 
(1) "Your product";  
 
(2) "Your work"; or  
 
(3) "Impaired property";  
if such product, work, or property is withdrawn 
or recalled from the market or from use by any 
person or organization because of a known or 
suspected defect, deficiency, inadequacy or 
dangerous condition in it.  
 
o. Personal And Advertising Injury 
"Bodily injury" arising out of "personal and 
advertising injury". 
 
p. Electronic Data 
Damages arising out of the loss of, loss of use 
of, damage to, corruption of, inability to access, 
or inability to manipulate electronic data.  
However, this exclusion does not apply to 
liability for damages because of "bodily injury". 
As used in this exclusion, 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, cells, data processing 
devices or any other media which are used 
with electronically controlled equipment. 
 
q. Recording And Distribution Of Material Or 
Information In Violation Of Law 
"Bodily injury" or "property damage" arising 
directly or indirectly out of any action or 
omission that violates or is alleged to violate: 
 
(1) The Telephone Consumer Protection Act 
(TCPA), including any amendment of or 
addition to such law;  
 
(2) The CAN-SPAM Act of 2003, including any 
amendment of or addition to such law;  
 
(3) The Fair Credit Reporting Act (FCRA), and 
any amendment of or addition to such law, 
including the Fair and Accurate Credit 
Transactions Act (FACTA); or

Page 6 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 
(4) Any 
federal, 
state 
or 
local 
statute, 
ordinance or regulation, other than the 
TCPA, CAN-SPAM Act of 2003 or FCRA 
and their amendments and additions, that 
addresses, prohibits, or limits the printing, 
dissemination, 
disposal, 
collecting, 
recording, 
sending, 
transmitting, 
communicating or distribution of material or 
information. 
Exclusions c. through n. do not apply to damage 
by fire to premises while rented to you or 
temporarily occupied by you with permission of the 
owner. A separate limit of insurance applies to this 
coverage as described in Section III – Limits Of 
Insurance.  
COVERAGE B – PERSONAL AND ADVERTISING 
INJURY LIABILITY  
 1. Insuring Agreement  
 
a. We will pay those sums that the insured 
becomes legally obligated to pay as damages 
because of "personal and advertising injury" to 
which this insurance applies. We will have the 
right and duty to defend the insured against 
any "suit" seeking those damages. However, 
we will have no duty to defend the insured 
against any "suit" seeking damages for 
"personal and advertising injury" to which this 
insurance does not apply. We may, at our 
discretion, investigate any offense and settle 
any claim or "suit" that may result. But:  
 
(1) The amount we will pay for damages is 
limited as described in Section III – Limits 
Of Insurance; and  
 
(2) Our right and duty to defend end when we 
have used up the applicable limit of 
insurance in the payment of judgments or 
settlements under Coverages A or B or 
medical expenses under Coverage C.  
No other obligation or liability to pay sums or 
perform acts or services is covered unless 
explicitly provided for under Supplementary 
Payments – Coverages A and B. 
 
b. This insurance applies to "personal and 
advertising injury" caused by an offense arising 
out of your business but only if the offense was 
committed in the "coverage territory" during the 
policy period.  
 2. Exclusions  
This insurance does not apply to:  
 
a. Knowing Violation Of Rights Of Another 
"Personal and advertising injury" caused by or 
at the direction of the insured with the 
knowledge that the act would violate the rights 
of another and would inflict "personal and 
advertising injury". 
 
b. Material Published With Knowledge Of 
Falsity 
"Personal and advertising injury" arising out of 
oral or written publication, in any manner, of 
material, if done by or at the direction of the 
insured with knowledge of its falsity.  
 
c. Material Published Prior To Policy Period 
"Personal and advertising injury" arising out of 
oral or written publication, in any manner, of 
material whose first publication took place 
before the beginning of the policy period.  
 
d. Criminal Acts 
"Personal and advertising injury" arising out of 
a criminal act committed by or at the direction 
of the insured. 
 
e. Contractual Liability 
"Personal and advertising injury" for which the 
insured has assumed liability in a contract or 
agreement. This exclusion does not apply to 
liability for damages that the insured would 
have in the absence of the contract or 
agreement. 
 
f. Breach Of Contract 
"Personal and advertising injury" arising out of 
a breach of contract, except an implied 
contract to use another's advertising idea in 
your "advertisement". 
 
g. Quality Or Performance Of Goods – Failure 
To Conform To Statements 
"Personal and advertising injury" arising out of 
the failure of goods, products or services to 
conform with any statement of quality or 
performance made in your "advertisement". 
 
h. Wrong Description Of Prices 
"Personal and advertising injury" arising out of 
the wrong description of the price of goods, 
products 
or 
services 
stated 
in 
your 
"advertisement".

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 7 of 16
 
 
i. Infringement Of Copyright, Patent, 
Trademark Or Trade Secret 
"Personal and advertising injury" arising out of 
the 
infringement 
of 
copyright, 
patent, 
trademark, trade secret or other intellectual 
property rights. Under this exclusion, such 
other intellectual property rights do not include 
the use of another's advertising idea in your 
"advertisement". 
However, this exclusion does not apply to 
infringement, 
in 
your 
"advertisement", 
of 
copyright, trade dress or slogan. 
 
j. Insureds In Media And Internet Type 
Businesses 
"Personal and advertising injury" committed by 
an insured whose business is: 
 
(1) Advertising, broadcasting, publishing or 
telecasting; 
 
(2) Designing or determining content of web 
sites for others; or 
 
(3) An Internet search, access, content or 
service provider.  
However, this exclusion does not apply to 
Paragraphs 14.a., b. and c. of "personal and 
advertising 
injury" 
under 
the 
Definitions 
section. 
For the purposes of this exclusion, the placing 
of frames, borders or links, or advertising, for 
you or others anywhere on the Internet, is not 
by 
itself, 
considered 
the 
business 
of 
advertising, 
broadcasting, 
publishing 
or 
telecasting. 
 
k. Electronic Chatrooms Or Bulletin Boards 
"Personal and advertising injury" arising out of 
an electronic chatroom or bulletin board the 
insured hosts, owns, or over which the insured 
exercises control. 
 
l. Unauthorized Use Of Another's Name Or 
Product 
"Personal and advertising injury" arising out of 
the unauthorized use of another's name or 
product in your e-mail address, domain name 
or metatag, or any other similar tactics to 
mislead another's potential customers. 
 
m. Pollution 
"Personal and advertising injury" arising out of 
the actual, alleged or threatened discharge, 
dispersal, seepage, migration, release or 
escape of "pollutants" at any time.  
 
n. Pollution-related 
Any loss, cost or expense arising out of any:  
 
(1) Request, demand, order or statutory or 
regulatory requirement that any insured or 
others test for, monitor, clean up, remove, 
contain, treat, detoxify or neutralize, or in 
any way respond to, or assess the effects 
of, "pollutants"; or  
 
(2) Claim or suit by or on behalf of a 
governmental 
authority 
for 
damages 
because of testing for, monitoring, cleaning 
up, 
removing, 
containing, 
treating, 
detoxifying or neutralizing, or in any way 
responding to, or assessing the effects of, 
"pollutants".  
 
o. War 
"Personal and advertising injury", however 
caused, arising, directly or indirectly, out of: 
 
(1) War, including undeclared or civil war; 
 
(2) Warlike action by a military force, including 
action in hindering or defending against an 
actual 
or 
expected 
attack, 
by 
any 
government, sovereign or other authority 
using military personnel or other agents; or 
 
(3) Insurrection, rebellion, revolution, usurped 
power, or action taken by governmental 
authority in hindering or defending against 
any of these. 
 
p. Recording And Distribution Of Material Or 
Information In Violation Of Law 
"Personal 
and 
advertising 
injury" 
arising 
directly or indirectly out of any action or 
omission that violates or is alleged to violate: 
 
(1) The Telephone Consumer Protection Act 
(TCPA), including any amendment of or 
addition to such law;  
 
(2) The CAN-SPAM Act of 2003, including any 
amendment of or addition to such law;  
 
(3) The Fair Credit Reporting Act (FCRA), and 
any amendment of or addition to such law, 
including the Fair and Accurate Credit 
Transactions Act (FACTA); or 
 
(4) Any 
federal, 
state 
or 
local 
statute, 
ordinance or regulation, other than the 
TCPA, CAN-SPAM Act of 2003 or FCRA 
and their amendments and additions, that 
addresses, prohibits, or limits the printing, 
dissemination, 
disposal, 
collecting, 
recording, 
sending, 
transmitting, 
communicating or distribution of material or 
information.

Page 8 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
COVERAGE C – MEDICAL PAYMENTS  
 1. Insuring Agreement  
 
a. We will pay medical expenses as described 
below for "bodily injury" caused by an accident:  
 
(1) On premises you own or rent;  
 
(2) On ways next to premises you own or rent; 
or  
 
(3) Because of your operations; 
provided that:  
 
(a) The 
accident 
takes 
place 
in 
the 
"coverage territory" and during the policy 
period;  
 
(b) The expenses are incurred and reported 
to us within one year of the date of the 
accident; and  
 
(c) The 
injured 
person 
submits 
to 
examination, 
at 
our 
expense, 
by 
physicians of our choice as often as we 
reasonably require.  
 
b. We will make these payments regardless of 
fault. These payments will not exceed the 
applicable limit of insurance. We will pay 
reasonable expenses for:  
 
(1) First aid administered at the time of an 
accident;  
 
(2) Necessary medical, surgical, X-ray and 
dental 
services, 
including 
prosthetic 
devices; and  
 
(3) Necessary 
ambulance, 
hospital, 
professional nursing and funeral services.  
 2. Exclusions  
We will not pay expenses for "bodily injury":  
 
a. Any Insured 
To any insured, except "volunteer workers".  
 
b. Hired Person 
To a person hired to do work for or on behalf of 
any insured or a tenant of any insured.  
 
c. Injury On Normally Occupied Premises 
To a person injured on that part of premises 
you own or rent that the person normally 
occupies.  
 
d. Workers' Compensation And Similar Laws 
To a person, whether or not an "employee" of 
any insured, if benefits for the "bodily injury" 
are payable or must be provided under a 
workers' compensation or disability benefits 
law or a similar law.  
 
e. Athletics Activities 
To a person injured while practicing, instructing 
or participating in any physical exercises or 
games, sports, or athletic contests.  
 
f. Products-Completed Operations Hazard 
Included 
within 
the 
"products-completed 
operations hazard".  
 
g. Coverage A Exclusions 
Excluded under Coverage A. 
SUPPLEMENTARY PAYMENTS – COVERAGES A 
AND B  
 1. We will pay, with respect to any claim we 
investigate or settle, or any "suit" against an 
insured we defend:  
 
a. All expenses we incur.  
 
b. Up to $250 for cost of bail bonds required 
because of accidents or traffic law violations 
arising out of the use of any vehicle to which 
the Bodily Injury Liability Coverage applies. We 
do not have to furnish these bonds.  
 
c. The cost of bonds to release attachments, but 
only for bond amounts within the applicable 
limit of insurance. We do not have to furnish 
these bonds.  
 
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 $250 a 
day because of time off from work.  
 
e. All court costs taxed against the insured in the 
"suit". However, these payments do not include 
attorneys' fees or attorneys' expenses taxed 
against the insured.  
 
f. Prejudgment interest awarded against the 
insured on that part of the judgment we pay. If 
we make an offer to pay the applicable limit of 
insurance, we will not pay any prejudgment 
interest based on that period of time after the 
offer.

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 9 of 16
 
 
g. All interest on the full amount of any judgment 
that accrues after entry of the judgment and 
before we have paid, offered to pay, or 
deposited in court the part of the judgment that 
is within the applicable limit of insurance.  
These payments will not reduce the limits of 
insurance.  
 2. If we defend an insured against a "suit" and an 
indemnitee of the insured is also named as a party 
to the "suit", we will defend that indemnitee if all of 
the following conditions are met:  
 
a. The "suit" against the indemnitee seeks 
damages for which the insured has assumed 
the liability of the indemnitee in a contract or 
agreement that is an "insured contract";  
 
b. This 
insurance 
applies 
to 
such 
liability 
assumed by the insured;  
 
c. The obligation to defend, or the cost of the 
defense of, that indemnitee, has also been 
assumed by the insured in the same "insured 
contract";  
 
d. The allegations in the "suit" and the information 
we know about the "occurrence" are such that 
no conflict appears to exist between the 
interests of the insured and the interests of the 
indemnitee;  
 
e. The indemnitee and the insured ask us to 
conduct and control the defense of that 
indemnitee against such "suit" and agree that 
we can assign the same counsel to defend the 
insured and the indemnitee; and  
 
f. The indemnitee:  
 
(1) Agrees in writing to:  
 
(a) Cooperate with us in the investigation, 
settlement or defense of the "suit";  
 
(b) Immediately send us copies of any 
demands, notices, summonses or legal 
papers received in connection with the 
"suit";  
 
(c) Notify any other insurer whose coverage 
is available to the indemnitee; and  
 
(d) Cooperate with us with respect to 
coordinating other applicable insurance 
available to the indemnitee; and  
 
(2) Provides us with written authorization to:  
 
(a) Obtain records and other information 
related to the "suit"; and  
 
(b) Conduct and control the defense of the 
indemnitee in such "suit".  
So long as the above conditions are met, 
attorneys' fees incurred by us in the defense of 
that indemnitee, necessary litigation expenses 
incurred by us and necessary litigation expenses 
incurred by the indemnitee at our request will be 
paid 
as 
Supplementary 
Payments. 
Notwithstanding the provisions of Paragraph 
2.b.(2) of Section I – Coverage A – Bodily Injury 
And Property Damage Liability, such payments will 
not be deemed to be damages for "bodily injury" 
and "property damage" and will not reduce the 
limits of insurance.  
Our obligation to defend an insured's indemnitee 
and to pay for attorneys' fees and necessary 
litigation expenses as Supplementary Payments 
ends when we have used up the applicable limit of 
insurance in the payment of judgments or 
settlements or the conditions set forth above, or 
the 
terms of 
the 
agreement 
described in 
Paragraph f. above, are no longer met. 
SECTION II – WHO IS AN INSURED  
 1. If you are designated in the Declarations as:  
 
a. An individual, you and your spouse are 
insureds, but only with respect to the conduct 
of a business of which you are the sole owner.  
 
b. A partnership or joint venture, you are an 
insured. Your members, your partners, and 
their spouses are also insureds, but only with 
respect to the conduct of your business.  
 
c. A limited liability company, you are an insured. 
Your members are also insureds, but only with 
respect to the conduct of your business. Your 
managers are insureds, but only with respect 
to their duties as your managers.  
 
d. An organization other than a partnership, joint 
venture or limited liability company, you are an 
insured. Your "executive officers" and directors 
are insureds, but only with respect to their 
duties as your officers or directors. Your 
stockholders are also insureds, but only with 
respect to their liability as stockholders.  
 
e. A trust, you are an insured. Your trustees are 
also insureds, but only with respect to their 
duties as trustees.

Page 10 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 2. Each of the following is also an insured:  
 
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. However, none of these 
"employees" 
or 
"volunteer 
workers" 
are 
insureds for:  
 
(1) "Bodily injury" or "personal and advertising 
injury":  
 
(a) To you, to your partners or members (if 
you are a partnership or joint venture), 
to your members (if you are a limited 
liability company), to a co-"employee" 
while in the course of his or her 
employment or performing duties related 
to the conduct of your business, or to 
your other "volunteer workers" while 
performing duties related to the conduct 
of your business;  
 
(b) To the spouse, child, parent, brother or 
sister 
of 
that 
co-"employee" 
or 
"volunteer worker" as a consequence of 
Paragraph (1)(a) above;  
 
(c) For which there is any obligation to 
share damages with or repay someone 
else who must pay damages because of 
the injury described in Paragraph (1)(a) 
or (b) above; or  
 
(d) Arising out of his or her providing or 
failing to provide professional health 
care services.  
 
(2) "Property damage" to property:  
 
(a) Owned, occupied or used by;  
 
(b) Rented to, in the care, custody or 
control of, or over which physical control 
is being exercised for any purpose by;  
you, any of your "employees", "volunteer 
workers", any partner or member (if you are 
a partnership or joint venture), or any 
member (if you are a limited liability 
company).  
 
b. Any person (other than your "employee" or 
"volunteer worker"), or any organization while 
acting as your real estate manager.  
 
c. Any person or organization having proper 
temporary custody of your property if you die, 
but only:  
 
(1) With respect to liability arising out of the 
maintenance or use of that property; and  
 
(2) Until your legal representative has been 
appointed.  
 
d. Your legal representative if you die, but only 
with 
respect 
to 
duties 
as 
such. 
That 
representative will have all your rights and 
duties under this Coverage Part.  
 3. Any organization you newly acquire or form, other 
than a partnership, joint venture or limited liability 
company, and over which you maintain ownership 
or majority interest, will qualify as a Named 
Insured if there is no other similar insurance 
available to that organization. However:  
 
a. Coverage under this provision is afforded only 
until the 90th day after you acquire or form the 
organization or the end of the policy period, 
whichever is earlier;  
 
b. Coverage A does not apply to "bodily injury" or 
"property damage" that occurred before you 
acquired or formed the organization; and  
 
c. Coverage B does not apply to "personal and 
advertising injury" arising out of an offense 
committed before you acquired or formed the 
organization.  
No person or organization is an insured with respect 
to the conduct of any current or past partnership, joint 
venture or limited liability company that is not shown 
as a Named Insured in the Declarations.  
SECTION III – LIMITS OF INSURANCE  
 1. The Limits of Insurance shown in the Declarations 
and the rules below fix the most we will pay 
regardless of the number of:  
 
a. Insureds;  
 
b. Claims made or "suits" brought; or  
 
c. Persons or organizations making claims or 
bringing "suits".  
 2. The General Aggregate Limit is the most we will 
pay for the sum of:  
 
a. Medical expenses under Coverage C;  
 
b. Damages under Coverage A, except damages 
because of "bodily injury" or "property damage" 
included in the "products-completed operations 
hazard"; and  
 
c. Damages under Coverage B.

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 11 of 16
 
 3. The Products-Completed Operations Aggregate 
Limit is the most we will pay under Coverage A for 
damages because of "bodily injury" and "property 
damage" included in the "products-completed 
operations hazard".  
 4. Subject to Paragraph 2. above, the Personal And 
Advertising Injury Limit is the most we will pay 
under Coverage B for the sum of all damages 
because of all "personal and advertising injury" 
sustained by any one person or organization.  
 5. Subject to Paragraph 2. or 3. above, whichever 
applies, the Each Occurrence Limit is the most we 
will pay for the sum of:  
 
a. Damages under Coverage A; and  
 
b. Medical expenses under Coverage C  
because of all "bodily injury" and "property 
damage" arising out of any one "occurrence".  
 6. Subject to Paragraph 5. above, the Damage To 
Premises Rented To You Limit is 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 by fire, 
while rented to you or temporarily occupied by you 
with permission of the owner.  
 7. Subject to Paragraph 5. above, the Medical 
Expense Limit is the most we will pay under 
Coverage C for all medical expenses because of 
"bodily injury" sustained by any one person.  
The Limits of Insurance of this Coverage Part apply 
separately to each consecutive annual period and to 
any remaining period of less than 12 months, starting 
with the beginning of the policy period shown in the 
Declarations, unless the policy period is extended 
after issuance for an additional period of less than 12 
months. In that case, the additional period will be 
deemed part of the last preceding period for purposes 
of determining the Limits of Insurance.  
SECTION IV – COMMERCIAL GENERAL LIABILITY 
CONDITIONS  
 1. Bankruptcy  
Bankruptcy or insolvency of the insured or of the 
insured's estate will not relieve us of our 
obligations under this Coverage Part.  
 2. Duties In The Event Of Occurrence, Offense, 
Claim Or Suit  
 
a. You must see to it that we are notified as soon 
as practicable of an "occurrence" or an offense 
which may result in a claim. To the extent 
possible, notice should include:  
 
(1) How, when and where the "occurrence" or 
offense took place;  
 
(2) The names and addresses of any injured 
persons and witnesses; and  
 
(3) 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 
any insured, you must:  
 
(1) Immediately record the specifics of the 
claim or "suit" and the date received; and  
 
(2) Notify us as soon as practicable.  
You must see to it that we receive written 
notice of the claim or "suit" as soon as 
practicable.  
 
c. You and any other involved insured must:  
 
(1) Immediately 
send 
us 
copies 
of 
any 
demands, notices, summonses or legal 
papers received in connection with the 
claim or "suit";  
 
(2) Authorize us to obtain records and other 
information;  
 
(3) Cooperate with us in the investigation or 
settlement of the claim or defense against 
the "suit"; and  
 
(4) Assist us, upon our request, in the 
enforcement of any right against any 
person or organization which may be liable 
to the insured because of injury or damage 
to which this insurance may also apply.  
 
d. No insured will, except at that insured's own 
cost, voluntarily make a payment, assume any 
obligation, or incur any expense, other than for 
first aid, without our consent.  
 3. Legal Action Against Us  
No person or organization has a right under this 
Coverage Part:  
 
a. To join us as a party or otherwise bring us into 
a "suit" asking for damages from an insured; or  
 
b. To sue us on this Coverage Part unless all of 
its terms have been fully complied with.  
A person or organization may sue us to recover on 
an agreed settlement or on a final judgment 
against an insured; but we will not be liable for 
damages that are not payable under the terms of 
this Coverage Part or that are in excess of the 
applicable limit of insurance. An agreed settlement 
means a settlement and release of liability signed 
by us, the insured and the claimant or the 
claimant's legal representative.

Page 12 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 4. Other Insurance  
If other valid and collectible 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 
Paragraph b. below applies. If this insurance is 
primary, our obligations are not affected unless 
any of the other insurance is also primary. 
Then, we will share with all that other 
insurance 
by 
the 
method 
described 
in 
Paragraph c. below.  
 
b. Excess Insurance  
 
(1) This insurance is excess over:  
 
(a) Any of the other insurance, whether 
primary, excess, contingent or on any 
other basis:  
 
(i) That is Fire, Extended Coverage, 
Builder's Risk, Installation Risk or 
similar coverage for "your work";  
 
(ii) That is Fire insurance for premises 
rented 
to 
you 
or 
temporarily 
occupied by you with permission of 
the owner;  
 
(iii) That is insurance purchased by you 
to cover your liability as a tenant for 
"property 
damage" 
to 
premises 
rented 
to 
you 
or 
temporarily 
occupied by you with permission of 
the owner; or 
 
(iv) If 
the 
loss 
arises 
out 
of 
the 
maintenance or use of aircraft, 
"autos" or watercraft to the extent not 
subject to Exclusion g. of Section I – 
Coverage A – Bodily Injury And 
Property Damage Liability.  
 
(b) Any other primary insurance available to 
you 
covering 
liability 
for 
damages 
arising 
out 
of 
the 
premises 
or 
operations, 
or 
the 
products 
and 
completed operations, for which you 
have been added as an additional 
insured. 
 
(2) When this insurance is excess, we will have 
no duty under Coverages A or B to defend 
the insured against any "suit" if any other 
insurer has a duty to defend the insured 
against that "suit". If no other insurer 
defends, we will undertake to do so, but we 
will be entitled to the insured's rights 
against all those other insurers.  
 
(3) 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: 
 
(a) The total amount that all such other 
insurance would pay for the loss in the 
absence of this insurance; and  
 
(b) The total of all deductible and self-
insured amounts under all that other 
insurance. 
 
(4) We will share the remaining loss, if any, 
with any other insurance that is not 
described 
in 
this 
Excess 
Insurance 
provision and was not bought specifically to 
apply in excess of the Limits of Insurance 
shown in the Declarations of this Coverage 
Part.  
 
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 insurer 
contributes equal amounts until it has paid its 
applicable limit of insurance or none of the loss 
remains, whichever comes first.  
If any of the other insurance does not permit 
contribution by equal shares, we will contribute 
by limits. Under this method, each insurer's 
share is based on the ratio of its applicable 
limit of insurance to the total applicable limits of 
insurance of all insurers.  
 5. Premium Audit  
 
a. We will compute all premiums for this 
Coverage Part in accordance with our rules 
and rates.  
 
b. Premium shown in this Coverage Part as 
advance premium is a deposit premium only. 
At the close of each audit period we will 
compute the earned premium for that period 
and send notice to the first Named Insured. 
The due date for audit and retrospective 
premiums is the date shown as the due date 
on the bill. If the sum of the advance and audit 
premiums paid for the policy period is greater 
than the earned premium, we will return the 
excess to the first Named Insured.  
 
c. The first Named Insured must keep records of 
the 
information 
we 
need 
for 
premium 
computation, and send us copies at such times 
as we may request.  
 6. Representations  
By accepting this policy, you agree:  
 
a. The statements in the Declarations are 
accurate and complete;

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 13 of 16
 
 
b. Those 
statements 
are 
based 
upon 
representations you made to us; and  
 
c. We have issued this policy in reliance upon 
your representations.  
 7. Separation Of Insureds  
Except with respect to the Limits of Insurance, and 
any rights or duties specifically assigned in this 
Coverage Part to the first Named Insured, this 
insurance applies:  
 
a. As if each Named Insured were the only 
Named Insured; and  
 
b. Separately to each insured against whom claim 
is made or "suit" is brought.  
 8. Transfer Of Rights Of Recovery Against Others 
To Us  
If the insured has rights to recover all or part of 
any payment we have made under this Coverage 
Part, those rights are transferred to us. The 
insured must do nothing after loss to impair them. 
At our request, the insured will bring "suit" or 
transfer those rights to us and help us enforce 
them.  
 9. When We Do Not Renew  
If we decide not to renew this Coverage Part, we 
will mail or deliver to the first Named Insured 
shown in the Declarations written notice of the 
nonrenewal not less than 30 days before the 
expiration date.  
If notice is mailed, proof of mailing will be sufficient 
proof of notice.  
SECTION V – DEFINITIONS  
 1. "Advertisement" means a notice that is broadcast 
or published to the general public or specific 
market segments about your goods, products or 
services for the purpose of attracting customers or 
supporters. For the purposes of this definition: 
 
a. Notices that are published include material 
placed on the Internet or on similar electronic 
means of communication; and 
 
b. Regarding web sites, only that part of a web 
site that is about your goods, products or 
services 
for 
the 
purposes 
of 
attracting 
customers or supporters is considered an 
advertisement. 
 2. "Auto" means: 
 
a. A land motor vehicle, trailer or semitrailer 
designed for travel on public roads, including 
any attached machinery or equipment; or 
 
b. Any other land vehicle that is subject to a 
compulsory or financial responsibility law or 
other motor vehicle insurance law where it is 
licensed or principally garaged. 
However, 
"auto" 
does 
not 
include 
"mobile 
equipment".  
 3. "Bodily injury" means bodily injury, sickness or 
disease sustained by a person, including death 
resulting from any of these at any time.  
 4. "Coverage territory" means:  
 
a. The United States of America (including its 
territories and possessions), Puerto Rico and 
Canada;  
 
b. International waters or airspace, but only if the 
injury or damage occurs in the course of travel 
or transportation between any places included 
in Paragraph a. above; or  
 
c. All other parts of the world if the injury or 
damage arises out of:  
 
(1) Goods or products made or sold by you in 
the territory described in Paragraph a. 
above; 
 
(2) The activities of a person whose home is in 
the territory described in Paragraph a. 
above, but is away for a short time on your 
business; or  
 
(3) "Personal and advertising injury" offenses 
that take place through the Internet or 
similar electronic means of communication; 
provided the insured's responsibility to pay 
damages is determined in a "suit" on the merits, in 
the territory described in Paragraph a. above or in 
a settlement we agree to.  
 5. "Employee" 
includes 
a 
"leased 
worker". 
"Employee" does not include a "temporary 
worker".  
 6. "Executive officer" means a person holding any of 
the officer positions created by your charter, 
constitution, bylaws or any other similar governing 
document.  
 7. "Hostile 
fire" 
means 
one 
which 
becomes 
uncontrollable or breaks out from where it was 
intended to be. 
 8. "Impaired property" means tangible property, other 
than "your product" or "your work", that cannot be 
used or is less useful because:  
 
a. It incorporates "your product" or "your work" 
that is known or thought to be defective, 
deficient, inadequate or dangerous; or  
 
b. You have failed to fulfill the terms of a contract 
or agreement;  
if such property can be restored to use by the 
repair, replacement, adjustment or removal of 
"your product" or "your work" or your fulfilling the 
terms of the contract or agreement.

Page 14 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
 9. "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 
organization 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 
operations 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 
indemnification 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 railroad property and 
affecting any railroad bridge or trestle, 
tracks, road-beds, tunnel, underpass or 
crossing;  
 
(2) That indemnifies an architect, engineer or 
surveyor 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, 
engineer 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 supervisory, inspection, 
architectural or engineering activities.  
10. "Leased worker" means a person leased to you by 
a labor leasing firm under an agreement between 
you and the labor leasing firm, to perform duties 
related to the conduct of your business. "Leased 
worker" does not include a "temporary worker".  
11. "Loading or unloading" means the handling of 
property:  
 
a. After it is moved from the place where it is 
accepted for movement into or onto an aircraft, 
watercraft or "auto";  
 
b. While it is in or on an aircraft, watercraft or 
"auto"; or  
 
c. While it is being moved from an aircraft, 
watercraft or "auto" to the place where it is 
finally delivered;  
but "loading or unloading" does not include the 
movement of property by means of a mechanical 
device, other than a hand truck, that is not 
attached to the aircraft, watercraft or "auto".  
12. "Mobile equipment" means any of the following 
types of land vehicles, including any attached 
machinery or equipment:  
 
a. Bulldozers, farm machinery, forklifts and other 
vehicles designed for use principally off public 
roads;  
 
b. Vehicles maintained for use solely on or next to 
premises you own or rent;  
 
c. Vehicles that travel on crawler treads;  
 
d. Vehicles, 
whether 
self-propelled 
or 
not, 
maintained primarily to provide mobility to 
permanently mounted:  
 
(1) Power cranes, shovels, loaders, diggers or 
drills; or  
 
(2) Road construction or resurfacing equipment 
such as graders, scrapers or rollers;  
 
e. Vehicles not described in Paragraph a., b., c. 
or d. above that are not self-propelled and are 
maintained primarily to provide mobility to 
permanently 
attached 
equipment 
of 
the 
following types:  
 
(1) Air compressors, pumps and generators, 
including 
spraying, 
welding, 
building 
cleaning, geophysical exploration, lighting 
and well servicing equipment; or  
 
(2) Cherry pickers and similar devices used to 
raise or lower workers;  
 
f. Vehicles not described in Paragraph a., b., c. 
or d. above maintained primarily for purposes 
other than the transportation of persons or 
cargo.

CG 00 01 04 13 
© Insurance Services Office, Inc., 2012
Page 15 of 16
 
However, self-propelled vehicles with the 
following 
types 
of 
permanently 
attached 
equipment are not "mobile equipment" but will 
be considered "autos":  
 
(1) Equipment designed primarily for:  
 
(a) Snow removal;  
 
(b) Road maintenance, but not construction 
or resurfacing; or  
 
(c) Street cleaning;  
 
(2) Cherry pickers and similar devices mounted 
on automobile or truck chassis and used to 
raise or lower workers; and  
 
(3) Air compressors, pumps and generators, 
including 
spraying, 
welding, 
building 
cleaning, geophysical exploration, lighting 
and well servicing equipment. 
However, "mobile equipment" does not include 
any land vehicles that are subject to a compulsory 
or financial responsibility law or other motor 
vehicle insurance law where it is licensed or 
principally garaged. Land vehicles subject to a 
compulsory or financial responsibility law or other 
motor vehicle insurance law are considered 
"autos". 
13. "Occurrence" 
means 
an 
accident, 
including 
continuous or repeated exposure to substantially 
the same general harmful conditions.  
14. "Personal and advertising injury" means injury, 
including consequential "bodily injury", arising out 
of one or more of the following offenses:  
 
a. False arrest, detention or imprisonment;  
 
b. Malicious prosecution;  
 
c. The wrongful eviction from, wrongful entry into, 
or invasion of the right of private occupancy of 
a room, dwelling or premises that a person 
occupies, committed by or on behalf of its 
owner, landlord or lessor;  
 
d. Oral or written publication, in any manner, of 
material that slanders or libels a person or 
organization or disparages a person's or 
organization's goods, products or services; 
 
e. Oral or written publication, in any manner, of 
material that violates a person's right of 
privacy;  
 
f. The use of another's advertising idea in your 
"advertisement"; or 
 
g. Infringing upon another's copyright, trade dress 
or slogan in your "advertisement".  
15. "Pollutants" mean any solid, liquid, gaseous or 
thermal irritant or contaminant, including smoke, 
vapor, soot, fumes, acids, alkalis, chemicals and 
waste. Waste includes materials to be recycled, 
reconditioned or reclaimed. 
16. "Products-completed operations hazard":  
 
a. Includes all "bodily injury" and "property 
damage" occurring away from premises you 
own or rent and arising out of "your product" or 
"your work" except:  
 
(1) Products that are still in your physical 
possession; or  
 
(2) Work that has not yet been completed or 
abandoned. However, "your work" will be 
deemed completed at the earliest of the 
following times:  
 
(a) When all of the work called for in your 
contract has been completed.  
 
(b) When all of the work to be done at the 
job site has been completed if your 
contract calls for work at more than one 
job site.  
 
(c) When that part of the work done at a job 
site has been put to its intended use by 
any person or organization other than 
another contractor or subcontractor 
working on the same project.  
Work that may need service, maintenance, 
correction, repair or replacement, but which 
is otherwise complete, will be treated as 
completed.  
 
b. Does not include "bodily injury" or "property 
damage" arising out of:  
 
(1) The transportation of property, unless the 
injury or damage arises out of a condition in 
or on a vehicle not owned or operated by 
you, and that condition was created by the 
"loading or unloading" of that vehicle by any 
insured;  
 
(2) The 
existence 
of 
tools, 
uninstalled 
equipment 
or 
abandoned 
or 
unused 
materials; or  
 
(3) Products or operations for which the 
classification, listed in the Declarations or in 
a policy Schedule, states that products-
completed operations are subject to the 
General Aggregate Limit.  
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 use of tangible property that is not 
physically injured. All such loss of use shall be 
deemed 
to 
occur 
at 
the 
time 
of 
the 
"occurrence" that caused it.  
For the purposes of this insurance, electronic data 
is not tangible property.

Page 16 of 16 
© Insurance Services Office, Inc., 2012
CG 00 01 04 13
 
As used in this definition, 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, cells, data processing 
devices or any other media which are used with 
electronically controlled equipment. 
18. "Suit" means a civil proceeding in which damages 
because of "bodily injury", "property damage" or 
"personal and advertising injury" to which this 
insurance applies are alleged. "Suit" includes:  
 
a. An arbitration proceeding in which such 
damages are claimed and to which the insured 
must submit or does submit with our consent; 
or  
 
b. Any 
other 
alternative 
dispute 
resolution 
proceeding in which such damages are 
claimed and to which the insured submits with 
our consent.  
19. "Temporary worker" means a person who is 
furnished to you to substitute for a permanent 
"employee" on leave or to meet seasonal or short-
term workload conditions.  
20. "Volunteer worker" means a person who is not 
your "employee", and who donates his or her work 
and acts at the direction of and within the scope of 
duties determined by you, and is not paid a fee, 
salary or other compensation by you or anyone 
else for their work performed for you. 
21. "Your product":  
 
a. Means:  
 
(1) Any goods or products, other than real 
property, manufactured, sold, handled, 
distributed or disposed of by:  
 
(a) You;  
 
(b) Others trading under your name; or  
 
(c) A 
person 
or 
organization 
whose 
business or assets you have acquired; 
and  
 
(2) Containers (other than vehicles), materials, 
parts or equipment furnished in connection 
with such goods or products.  
 
b. Includes: 
 
(1) Warranties or representations made at any 
time with respect to the fitness, quality, 
durability, performance or use of "your 
product"; and 
 
(2) The providing of or failure to provide 
warnings or instructions.  
 
c. Does not include vending machines or other 
property rented to or located for the use of 
others but not sold.  
22. "Your work":  
 
a. Means:  
 
(1) Work or operations performed by you or on 
your behalf; and  
 
(2) Materials, parts or equipment furnished in 
connection with such work or operations.  
 
b. Includes: 
 
(1) Warranties or representations made at any 
time with respect to the fitness, quality, 
durability, performance or use of "your 
work"; and  
 
(2) The providing of or failure to provide 
warnings or instructions.

INSR
ADDL SUBR
LTR
INSR WVD
DATE (MM/DD/YYYY)
PRODUCER
CONTACT
NAME:
FAX
PHONE
(A/C, No):
(A/C, No, Ext):
E-MAIL
ADDRESS:
INSURER A :
INSURED
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF
POLICY EXP
TYPE OF INSURANCE
LIMITS
(MM/DD/YYYY) (MM/DD/YYYY)
COMMERCIAL GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE
NAIC #
Y / N
N / A
(Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE
$
DAMAGE TO RENTED
$
PREMISES (Ea occurrence)
CLAIMS-MADE
OCCUR
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
$
PRO-
OTHER:
LOC
JECT
COMBINED SINGLE LIMIT
$
(Ea accident)
BODILY INJURY (Per person)
$
ANY AUTO
OWNED
SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS ONLY
AUTOS
AUTOS ONLY
HIRED
PROPERTY DAMAGE
$
AUTOS ONLY
(Per accident)
$
OCCUR
EACH OCCURRENCE
$
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
$
PER
OTH-
STATUTE
ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS below
POLICY
NON-OWNED
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE    EXPIRATION   DATE    THEREOF,    NOTICE   WILL   BE   DELIVERED   IN
ACCORDANCE   WITH   THE   POLICY   PROVISIONS.
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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
CERTIFICATE HOLDER
CANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016/03)
ACORDTM
CERTIFICATE OF LIABILITY INSURANCE
Property & Casualty Ins Co of Hartford
10/13/2021
Greyling Ins. Brokerage/EPIC
3780 Mansell Rd. Suite 370
Alpharetta, GA  30022
Trudy Henry
770-552-4225
866-550-4082
aceccertificates@greyling.com
Dibble & Associates Consulting
7878 N. 16th St., Ste. 300
Phoenix, AZ  85020
34690
21-22
A
N
20WEGAC0MAS
11/01/2021 11/01/2022 X
1,000,000
1,000,000
1,000,000
Re: Dibble CM, Chandler Project No. WA1521.453, Fire Station Well Site Improvements
Waiver of Subrogation is applicable where required by written contract & allowed by law.
Should any of the above described policies be cancelled by the issuing insurer before the expiration date
thereof, 30 days' written notice (except 10 days for nonpayment of premium) will be provided to the
Certificate Holder.
City of Chandler
Public Works & Utilities Department
P.O. Box 4008, Mail Stop 407
Chandler, AZ  85244-4008
1 of 1
#S2934856/M2891865
DIBBASSOC
Client#: 53946
KTRU1