Client#: 1886055 123AACT
DATE (MM/DD/YYYY)
ACORD TM CERTIFICATE OF LIABILITY INSURANCE 9/22/2022
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).
CONTACT
PRODUCER NAME: Certificate Teams
McGriff Insurance Services PHONE FAX
(A/C, No, Ext): 770 267-4545 (A/C, No): 8663172202
216 South Broad Street E-MAIL
ADDRESS: certificatesga@mcgriff.com
Monroe, GA 30655 INSURER(S) AFFORDING COVERAGE NAIC #
770 267-4545 INSURER A : Union Insurance Company 25844
INSURED INSURER B : Technology Insurance Company 42376
A Action Janitorial Services Inc 37362
INSURER C : General Star Indemnity Company
A-Action New York, LLC
INSURER D :
Attn:Barbara Storey PO Box 1046
INSURER E :
Lithonia, GA 30058
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X X CPA444259043 06/01/2022 06/01/2023 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 500,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO-
X POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
COMBINED SINGLE LIMIT
A AUTOMOBILE LIABILITY X X CPA444259043 06/01/2022 06/01/2023 (Ea accident) $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE
X AUTOS ONLY X AUTOS ONLY (Per accident) $
$
A X UMBRELLA LIAB X OCCUR CPA444259043 06/01/2022 06/01/2023 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
DED X RETENTION $0 $
WORKERS COMPENSATION PER OTH-
B AND EMPLOYERS' LIABILITY
X TWC4140671 09/10/2022 09/10/2023 X STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? Y N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
C Excess auto IXG674928 07/28/2022 06/01/2023 $4,000,000 in excess of
liability only lead underlying carrier
Union Insurance Company
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
***See attached forms***
CLCG0060 (09/16) - General Liability Contractor's Ultra Plus Endorsement - Georgia
CLCG2012 (09/16) - Additional Insured - Owners, Lessees or Contractors - Completed Operations Coverage -
Automatic Status When Required in Construction Agreement With You
CLCG0114 (09/16) - Primary and Noncontributory - Other Insurance Condition (Additional Insured)
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
DeKalb County School District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1701 Mountain Industrial Blvd ACCORDANCE WITH THE POLICY PROVISIONS.
Stone Mountain GA 30083
AUTHORIZED REPRESENTATIVE
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S30667165/M30635730 JEF2
DESCRIPTIONS (Continued from Page 1)
AICA59 (05/15) - Commercial Automobile Expansion Endorsement
WC000313 (04/84) - Waiver of Our Right to Recover From Others Endorsement
** Workers Comp Information **
Proprietors/Partners/Executive Officers/Members Excluded:
Barbara Storey, Officer
Stanley Storey, Officer
SAGITTA 25.3 (2016/03) 2 of 2
#S30667165/M30635730
A Action Janitorial Services Inc
CPA444259043
COMMERCIAL GENERAL LIABILITY
CL CG 00 60 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
GENERAL LIABILITY CONTRACTOR'S ULTRA PLUS
ENDORSEMENT - GEORGIA
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SUMMARY OF COVERAGE EXTENSIONS
Provision Name of Extension Included or Limit
No. of Insurance
A. Medical Payments $10,000
B. Legal Liability - Damage To Premises Rented To You (Fire, Lightning, $500,000
Explosion, Smoke, Leakage From Automatic Fire Protection Systems)
C. Property Damage – Elevators Included
D. Non-Owned Watercraft (Increased to maximum length of less than 51 feet) Included
E. Coverage for Injury to Leased Workers Included
F. Supplementary Payments – Increased Limits
1. Bail Bonds $3,000
2. Loss of Earnings $1,000
G. Automatic Additional Insureds – Specified Relationships Included
H. Additional Insured - Owners, Lessees or Contractors - Automatic Status Included
I. Newly Formed Or Acquired Organization, Partnership Or Limited Liability Included
Company And Extended Period Of Coverage
J. Extended Property Damage $5,000 occurrence
$15,000 aggregate
K. Limited Contractors Professional Liability Included
L. Per Project Aggregate Limit $10,000,000
M. Location Aggregate Limit $10,000,000
N. Knowledge Of Occurrence Included
O. Unintentional Omission Or Unintentional Error In Disclosure Included
P. Waiver Of Transfer Of Rights Of Recovery Against Others Included
Q. Incidental Medical Malpractice Included
R. Expected or Intended Injury or Damage Included
S. Joint Venture/Partnership/Limited Liability Company Coverage Included
T. Mobile Equipment Redefined Included
U. Liberalization Clause Included
The above is a summary only. Please consult the specific provisions that follow for complete information on the
extensions provided.
__________________________________________________________________________________________
CL CG 00 60 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 7
with its permission
A. MEDICAL PAYMENTS a. $500,000; or
If SECTION I - COVERAGE C MEDICAL b. The Damage To Premises Rented
PAYMENTS is not otherwise excluded from this To You Limit shown in the
Coverage Part: Declarations,
1. The Medical Expense Limit provided by this is the most we will pay under Coverage
policy, subject to the terms of SECTION III - A for damages because of "property
LIMITS OF INSURANCE, shall be the greater damage" to premises while rented to
of: you, or in the case of damage by fire,
a. $10,000; or lightning, explosion, "smoke", or leakage
from automatic fire protective systems,
b. The Medical Expense Limit shown in the while rented to you or temporarily
Declarations of this Coverage Part. occupied by you with permission of the
B. LEGAL LIABILITY - DAMAGE TO PREMISES owner.
RENTED TO YOU (Fire, Lightning, Explosion, This limit will apply to all damage
Smoke, Or Leakage From Automatic Fire proximately caused by the same event,
Protective Systems) whether such damage results from fire,
If damage to premises rented to you under lightning, explosion, "smoke", leakage
Coverage A. is not otherwise excluded from this from automatic fire protective systems, or
policy or coverage part, the following provisions other covered causes of loss or any
applies: combination thereof.
1. Under Section I - Coverage A - Bodily 4. Subparagraph b.(1)(a)(ii) of Paragraph 4.
Injury And Property Damage Liability, the Other Insurance of Section IV -
last paragraph (after the exclusions) is Commercial General Liability Conditions
deleted and replaced by the following: is deleted and replaced by the following:
Exclusions c. through n. do not apply to dam- (ii) That is fire, lightning, explosion, "smoke"
age by fire, lightning, explosion, "smoke", or or leakage from automatic fire protective
leakage from automatic fire protective systems insurance for premises rented to
systems to premises while rented to you or you or temporarily occupied by you with
temporarily occupied by you with the permission of the owner;
permission of the owner. A separate limit of 5. Subparagraph a. of definition 9. "Insured
insurance applies to this coverage as contract" of Section V - Definitions is
described in Section III - Limits Of deleted and replaced by the following:
Insurance.
2. The paragraph immediately after a. A contract for a lease of premises.
Subparagraph j.(6) of Paragraph 2. However, that portion of the contract for
Exclusions of Section I - Coverage A - a lease of premises that indemnifies any
Bodily Injury And Property Damage person or organization for damage by
Liability is deleted and replaced by the fire, lightning, explosion, "smoke" or
following: leakage from automatic fire protective
systems to premises while rented to you
Paragraphs (1), (3) and (4) of this exclusion or temporarily occupied by you with
do not apply to "property damage" (other permission of the owner is not an
than damage by fire, lightning, explosion, "insured contract".
"smoke", or leakage from automatic fire
protective systems) to premises, including 6. As used in the Paragraph D. Legal Liability -
the contents of such premises, rented to you Damage To Premises Rented To You:
for a period of seven or fewer consecutive "Smoke" does not include smoke from
days. A separate limit of insurance applies to
agricultural smudging, industrial operations
Damage To Premises Rented To You as
or "hostile fire".
described in Section III - Limits Of
Insurance. C. PROPERTY DAMAGE - ELEVATORS
3. Paragraph 6. of Section III - Limits Of Under SECTION I - COVERAGE A.2. Exclusions
Insurance is deleted and replaced by the j. Damage To Property:
following: Paragraphs (3), (4), and (6) of this exclusion
6. Subject to Paragraph 5. above, the do not apply to the use of elevators.
greater of:
k. Damage To Your Product does not other provision of, or endorsement
apply to the use of elevators. added to, this policy.
D. NON-OWNED WATERCRAFT f. Only the following persons or
1. Subparagraph (2) of Exclusion 2.g. Aircraft, organizations are additional insureds
Auto Or Watercraft of Section I – Coverage under this endorsement, and cover-age
A- Bodily Injury And Property Damage provided to such additional insureds is
Liability: limited as provided herein:
(1) Managers Or Lessors Of Premises
A watercraft you do not own that is:
(a) Less than 51 feet long; and A manager or lessor of premises, but
only with respect to liability arising
(b) Not used to carry persons or out of the ownership, maintenance or
property for a charge. use of that part of the premises
E. COVERAGE FOR INJURY TO LEASED leased to you and subject to the
WORKERS following additional exclusions:
Under SECTION I - COVERAGE A.2. This insurance does not apply to:
Exclusions, (a) Any "occurrence" which takes
With respect to Exclusion 2.e. Employer's place after you cease to be a
Liability, the definition of "employee" in the tenant of that premises.
DEFINITIONS Section is replaced by the (b) Structural alterations, new
following: construction or demolition
"Employee" does not include a "leased worker" or operations performed by or on
a "temporary worker". behalf of such additional insured.
F. SUPPLEMENTARY PAYMENTS (2) Lessor of Leased Equipment
SECTION I -SUPPLEMENTARY PAYMENTS - Any person(s) or organization(s)
COVERAGES A AND B is amended as follows: from whom you lease equipment, but
only with respect to liability for "bodily
1. The limit of insurance in paragraph 1.b. for injury", "property damage" or
the cost of bail bonds is increased from $250 "personal and advertising injury"
to $3,000; and caused, in whole or in part, by your
2. The limit of insurance in paragraph 1.d. for maintenance, operation or use of
loss of earnings because of time off from equipment leased to you by such
work is increased from $250 to $1,000. person(s) or organization(s).
G. AUTOMATIC ADDITIONAL INSURED - A person’s or organization’s status
SPECIFIED RELATIONSHIPS as an additional insured under this
endorsement ends when their written
The following is added to Paragraph 2. of contract or written agreement with
SECTION II - WHO IS AN INSURED: you for such leased equipment ends.
e. Any person or organization described in
This insurance does not apply to any
paragraph f. below, whom you and such
"occurrence" which takes place after
person or organization have agreed in
the equipment lease expires.
writing in a contract or agreement that
such person or organization be added as H. ADDITIONAL INSURED - OWNERS, LESSEES
an additional insured on your policy. OR CONTRACTORS - AUTOMATIC STATUS
Such person or organization is an insured 1. SECTION II - WHO IS AN INSURED is
provided: amended to include as an additional insured
(1) The written contract, written any person or organi-zation to whom you are
agreement or permit is: obligated by written contract or written
agreement that such person or organization
(a) Currently in effect or becomes be added as an additional insured on your
effective during the policy period; policy. Such person or organization is an
and additional insured only with respect to liability
(b) Executed prior to an for "bodily injury", property damage" or
"occurrence" or offense to which this "personal and advertising injury" caused, in
insurance would apply. whole or in part, by:
(2) They are not specifically designated a. Your acts or omissions; or
as an additional insured under any
CL CG 00 60 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 7
with its permission
b. The acts or omissions of those acting on limits of insurance are inclusive of and not in
your behalf; addition to the limits of insurance shown in the
Declarations.
in the performance of your ongoing operations
for the additional insured. I. NEWLY FORMED OR ACQUIRED
ORGANIZATION, PARTNERSHIP OR LIMITED
A person's or organization's status as an
LIABILITY COMPANY AND EXTENDED
additional insured under this policy ends when
PERIOD OF COVERAGE
your operations for that additional insured are
completed. Paragraph 3. of Section II - Who Is An Insured is
2. With respect to the insurance afforded to deleted and replaced by the following:
these additional insureds, the following 3. Any organization you newly acquire or form,
additional exclusions apply: other than a joint venture, and over which you
This insurance does not apply to: maintain ownership or:
a. "Bodily injury", "property damage" or a. Majority interest of more than 50% if you
"personal and advertising injury" arising are a corporation;
out of the rendering of, or the failure to b. Majority interest of more than 50% as a
render, any professional architectural, general partner of a newly acquired or
engineering or surveying services, formed partnership; and/or
including:
c. Majority interest of more than 50% as an
(1) The preparing, approving, or failing to
owner of a newly acquired or formed
prepare or approve, maps, shop limited liability company;
drawings, opinions, reports, surveys,
field orders, change orders or will qualify as a Named Insured if there is no
drawings and specifications; or other similar insurance available to that
organization. However, for these
(2) Supervisory, inspection, architectural
organizations:
or engineering activities.
b. "Bodily injury" or "property damage" (i) Coverage under this provision is afforded only
occurring after: until the next anniversary date of this policy’s
effective date after you acquire or form the
(1) All work, including materials, parts or organization, partnership or limited liability
equipment furnished in connection company, or the end of the policy period,
with such work, on the project (other whichever is earlier;
than service, maintenance or repairs)
to be performed by or on behalf of the (ii) Section I - Coverage A - Bodily Injury And
additional insured(s) at the location of Property Damage Liability does not apply to
the covered operations has been "bodily injury" or "property damage" that
completed; or occurred before you acquired or formed the
organization, partnership or limited liability
(2) That portion of "your work" out of company;
which the injury or damage arises has
been put to its intended use by any (iii) Section I - Coverage B - Personal And
person or organization other than Advertising Injury Liability does not apply to
another contractor or subcontractor "personal and advertising injury" arising out of
engaged in per-forming operations for an offense committed before you acquired or
a principal as a part of the same formed the organization, partnership or limited
project. liability company;
3. With respect to the insurance afforded to (iv) Coverage applies only when operations of the
these additional insureds, SECTION III - newly acquired organization, partnership or
LIMITS OF INSURANCE is amended as limited liability company are the same or
follows: similar to the operations of insureds already
covered under this insurance;
(v) Coverage only applies for those limited liability
The limits applicable to the additional insured
companies who have established a date of
are those specified in the written contract or
formation as recorded within the filed state
agreement or the limits stated in the
articles of organization, certificates of
Declarations, whichever is less. If no limits are
formation or certificates of organization; and
specified in the written contract or agree-ment,
the limits applicable to the additional insured (vi) Coverage only applies for those partnerships
are those specified in the Declarations. The who have established a date of formation as
recorded within a written partnership ground or water, caused by and occurring
agreement or partnership certificate. during the use of mechanical equipment
for the purpose of grading land, paving,
J. EXTENDED PROPERTY DAMAGE
excavating, drilling, borrowing, filling,
The following is added to SECTION I - back-filling or pile driving.
COVERAGE A
1. For the purposes of this coverage section, K. LIMITED CONTRACTORS PROFESSIONAL
Exclusions j.(4) and (5) are deleted in their LIABILITY
entirety, and are replaced by the following:
The following exclusion is added to Paragraph 2.
(4) We will pay those sums that the insured Exclusions of SECTION I - COVERAGE A and
becomes legally obligated to pay as Paragraph 2. Exclusions of SECTION I -
damages because of "property damage" COVERAGE B:
to personal property of others while in the
1. This insurance does not apply to "bodily
care, custody and control of the insured
injury", "property damage" or "personal and
(5) That particular part of real property on advertising injury" arising out of the rendering
which you or any contractors or of or failure to render any professional
subcontractor working directly or indirectly services by you or on your behalf, but only
on your behalf are performing operations, with respect to either or both of the following
if the "property damage" arises out of operations:
those operations; or
a. Providing engineering, architectural or
2. The amount we will pay for damages is limited surveying services to others in your
to $5,000 per occurrence, $15,000 policy capacity as an engineer, architect or
aggregate. surveyor; and
3. The insurance provided by this endorsement b. Providing, or hiring independent
does not apply to "property damage" included professionals to provide engineering,
within the "products-completed operations architectural or surveying services in
hazard" or within the "explosion hazard", the connection with construction work you
"collapse hazard" or the "underground perform.
property damage hazard".
2. Subject to Paragraph 3. below, professional
4. A deductible of $250 per claim is applicable to services include:
this coverage part. The deductible does not
a. Preparing, approving, or failing to prepare
reduce the limit of insurance.
or approve, maps, shop drawings,
For purposes of the coverage provided by this opinions, reports, surveys, field orders,
endorsement the following definitions are added to change orders, or drawings and
SECTION V - DEFINITIONS: specifications; and
a. "Collapse hazard" includes structural b. Supervisory or inspection activities
property damage: and any resulting performed as part of any related
"property damage" to any property at any architectural or engineering activities.
time.
3. Professional services do not include services
b. "Explosion hazard" includes "property within construction means, methods,
damage" arising out of blasting or techniques, sequences and procedures
explosion. The "explosion hazard" does employed by you in connection with your
not include "property damage" arising out operations in your capacity as a construction
of the explosion of air or steam vessels, contractor.
piping under pressure, prime movers,
L. PER PROJECT AGGREGATE LIMIT
machinery or power transmitting
equipment. 1. Under Section III - Limits of Insurance the
General Aggregate Limit applies separately to
c. "Underground property damage hazard"
each of your construction projects away from
includes "underground property damage"
premises owned by or rented to the insured.
and any resulting "property damage" to
The most we will pay under this coverage
any other property at any time.
extension is $10,000,000 regardless of the
d. Underground property damage" means number of separate construction projects.
"property damage" to wires, conduits,
If a construction project away from premises
pipes, mains, sewers, tanks, tunnels, any
owned by or rented to the insured has been
similar property, and any apparatus used
abandoned, delayed, or abandoned and then
with them beneath the surface of the
restarted, or if the authorized contracting
CL CG 00 60 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 7
with its permission
parties deviate from plans, blueprints, However, the unintentional omission of, or
designs, specifications or timetables, the unintentional error in, any information given or
project will still be deemed to be the same provided by you shall not prejudice your rights
construction project. under this insurance.
M. LOCATION AGGREGATE LIMIT
This provision does not affect our right to
1. Under Section III - Limits of Insurance the collect additional premium or to exercise our
General Aggregate Limit applies separately to right of cancellation or non-renewal.
each of your "locations" owned by or rented to
you. The most we will pay under this coverage This provision does not apply to any known
extension is $10,000,000 regardless of the injury or damage which is excluded under any
number of separate locations. other provision of this policy.
2. Under Section V - Definitions, the following P. WAIVER OF TRANSFER OF RIGHTS OF
definition is added: RECOVERY AGAINST OTHERS
"Location" means premises involving the The following is added to Paragraph 8. Transfer
same or connecting lots, or premises whose Of Rights Of Recovery Against Others To Us of
connection is interrupted only by a street, Section IV - Commercial General Liability
roadway, waterway or right-of way of a Conditions:
railroad.
We waive any right of recovery we may have
N. KNOWLEDGE OF OCCURRENCE against any person or organization because of
The following is added to paragraph 2. Duties In payments we make for injury or damage arising
The Event Of Occurrence, Offense, Claim Or out of your ongoing operations or "your work" and
Suit of SECTION IV - COMMERCIAL GENERAL included in the "products-completed operations
LIABILITY CONDITIONS: hazard" when you have agreed in a written
contract or written agreement that any right of
e. A report of an "occurrence", offense, claim recovery are waived for such person or
or "suit" to: organization. This waiver applies only to the
(1) You, if you are an individual, person(s) or organization(s) agreed to in the
written contract or written agreement and is
(2) A partner, if you are a partnership,
subject to those provisions.
(3) An executive officer or insurance
This waiver does not apply unless the written
manager, if you are a corporation, or
contract or written agreement has been executed
(4) A manager, if you are a limited liability prior to the "bodily injury" or "property damage".
company;
However, if any person or organization is
is considered knowledge and requires you separately scheduled on a separate waiver of
to notify us of the "occurrence", offense, transfer of rights of recovery which is attached to
claim, or "suit" as soon as practicable. this policy, then this waiver does not apply.
f. We are considered on notice of an Q. INCIDENTAL MEDICAL MALPRACTICE
"occurrence", offense, claim or "suit" that
is reported to your Workers’
Compensation insurer for an event which 1. Paragraph 2.a.(1)(d) of Section II – Who Is
later develops into an "occurrence", An Insured does not apply to a physician,
offense, claim or "suit" for which there is nurse practitioner, physician assistant, nurse,
coverage under this policy. However, we emergency medical technician or paramedic
will only be considered on notice if you employed by you if you are not in the business
notify us as soon as you know the claim or occupation of providing medical,
should be addressed by this policy rather paramedical, surgical, dental, x-ray or nursing
than your Workers’ Compensation policy. services.
2. This provision is excess over any other valid
O. UNINTENTIONAL OMISSIONS OR and collectible insurance whether such
UNINTENTIONAL ERROR IN DISCLOSURE insurance is primary, excess, contingent or on
any other basis. Any payments by us will follow
The following is added to paragraph 6.
paragraph 4.b. of Section IV-Commercial
Representations of SECTION IV -
General Liability Conditions.
COMMERCIAL GENERAL LIABILITY
CONDITIONS:
R. EXPECTED OR INTENDED INJURY OR conduct of any current or past partnership,
DAMAGE joint venture or limited liability company that is
Exclusion 2.a. Expected Or Intended Injury of not shown as a Named Insured in the
Section I - Coverage A - Bodily Injury And Declarations.
Property Damage Liability is replaced entirely 3. As used in this endorsement, “consolidated
with the following: (wrap-up) insurance program“ (also known as
a. Expected Or Intended Injury an owner-controlled insurance program,
O.C.I.P.) means a construction, erection or
“Bodily injury” or “property damage” demolition project for which the prime
expected or intended from the standpoint contractor/project manager or owner of the
of the insured. This exclusion does not construction, erection or demolition project
apply to “bodily injury” or “property has secured general liability insurance
damage” resulting from the use of covering some or all of the contractors or
reasonable force to protect persons or subcontractors involved in the project,
property. sometimes referred to as an a Contractor
S. JOINT VENTURE / PARTNERSHIP / LIMITED Controlled Insurance Program (C.C.I.P.)
LIABILITY COMPANY COVERAGE T. MOBILE EQUIPMENT REDEFINED
1. The following is added to Section II - Who Is Sub-paragraph f.(1) of definition 12. “mobile
An Insured: equipment” of Section V - Definitions is entirely
4. You are an insured when you had an replaced by the following:
interest in a joint venture, partnership or (1) Equipment with a gross vehicle
limited liability company which terminated weight of 1,000 pounds or more and
or ended prior to or during this policy designed primarily for:
period, but only to the extent of your
(a) Snow removal;
interest in such joint venture, partnership
or limited liability company. (b) Road maintenance, but not
However, this coverage does not apply: construction or resurfacing; or
(c) Street cleaning;
a. Prior to the termination or end date of
any joint venture, partnership or U. LIBERALIZATION CLAUSE
limited liability company; The following is added to Section IV-
b. To a joint venture, partnership or Commercial General Liability Conditions:
limited liability company which is, or
ever was, insured under a If we adopt a mandatory attachment form change
“consolidated (wrap-up) insurance
which broadens coverage under this edition of the
program” (also known as an owner-
Commercial General Liability CG0001 for no
controlled insurance program,
additional charge, and those changes are
O.C.I.P.).
intended to apply to all insureds under this edition
2. With respect to the coverage provided by this of CG0001, that change will automatically apply to
section G. Joint Venture / Partnership / your insurance as of the date we implement the
Limited Liability Company Coverage, the change in your state. This liberalization clause
last Paragraph of Section II - Who Is An does not apply to changes implemented through
Insured is replaced by the following: introduction of a subsequent edition of the
Except as provided in 4. above, no person or Commercial General Liability form CG0001.
organization is an insured with respect to the
CL CG 00 60 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 7
with its permission
This page has been left blank intentionally.
A Action Janitorial Services Inc
CPA444259043
COMMERCIAL GENERAL LIABILITY
CL CG 20 12 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES, OR
CONTRACTORS - COMPLETED OPERATIONS COVERAGE
- AUTOMATIC STATUS WHEN REQUIRED IN
CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who is An Insured is amended to 3. The insurance provided to the additional in-
include as an additional insured any person or or- sured by this endorsement and by paragraph
ganization, but only when: f. of the definition of “insured contract” under
DEFINITIONS (Section V), as amended by
1. You have agreed in writing in a contract or
this endorsement, does not apply to “bodily
agreement that such person or organization
injury” or “property damage” beyond:
be added as an additional insured on your
policy except for a contractor/project man- a. The effective date of any deletion of, any
ager or owner of a construction project in removal of, or any non-continuance of,
which you are involved that is included in a this additional insured endorsement from
“consolidated (wrap-up) insurance program”; this policy, or
and
b. The period of time required by the written
2. Such written contract or written agreement contract or written agreement.
has been executed prior to the “bodily injury”
4. The insurance provided to the additional
or “property damage”.
insured does not apply to “bodily injury” or
B. The insurance provided to the additional insured “property damage” arising out of an archi-
by this endorsement is further limited as follows: tect’s, engineer’s or surveyor’s having ren-
dered or having failed to render any profes-
1. That person or organization is an additional
sional services, including, but not limited to:
insured only for liability for “bodily injury” or
“property damage”: a. The preparation, approval or the failure
to prepare or approve maps, shop draw-
a. Due to your negligence and specifically
ings, opinions, reports, surveys, field ord-
caused by “your work” for the additional
ers, change orders or drawings and spe-
insured which is the subject of the writ-
cifications; or
ten contract or agreement; and
b. Supervisory, inspection, architectural or
b. Included within the “products-completed
engineering activities.
operations hazard”.
This exclusion applies even if the claims
2. The Limits of Insurance applicable to the
against any insured allege negligence or
additional insured are those specified in the
other wrongdoing in the supervision, hiring,
written contract or written agreement, or in
employment, training or monitoring of others
the Declarations of this policy, whichever is
by that insured, if the "occurrence" which
less. These Limits of Insurance are inclusive
caused the "bodily injury" or "property dam-
of, and not in addition to, the Limits of
age", or the offense which caused the "pers-
Insurance shown in the Declarations.
onal and advertising injury", involved the ren-
dering of, or the failure to render, any
professional architectural, engineering or
surveying services.
CL CG 20 12 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 2
with its permission
C. With respect to the coverage provided under this (b) Giving directions or instructions,
endorsement, SECTION IV - COMMERCIAL or failing to give them, if that is
GENERAL LIABILITY CONDITIONS, is the primary cause of the injury or
amended as follows: damage; or
1. The following is added to the Duties In The (3) Under which the insured, if an archi-
Event of Occurrence, Offense, Claim or Suit tect, engineer or surveyor, assumes
Condition: liability for an injury or damage aris-
ing out of the insured's rendering or
As a condition precedent to coverage and/or
failure to render professional ser-
defense, an additional insured under this
vices, including those listed in (2)
endorsement must give us as soon as
above and supervisory, inspection,
practicable notice of an “occurrence” which
architectural or engineering activi-
may result in a claim or “suit” under this
ties.
insurance.
2. The following definition is added:
D. With respect to the coverage provided under this
endorsement, SECTION V - DEFINITIONS: is “Consolidated (wrap-up) insurance program”
changed as follows: means a construction, erection or demolition
project for which the prime contractor/project
1. The definition of “insured contract” is chang-
manager or owner of the construction project
ed by replacing paragraph f. of that definition
has secured general liability insurance cover-
with the following:
ing some or all of the contractors or sub-
“Insured contract” means: contractors involved in the project, otherwise
referred to as an Owner Controlled Insurance
f. That part of any other contract or agree-
Program (O.C.I.P.) or Contractor Controlled
ment pertaining to your business (in-
Insurance Program (C.C.I.P.)
cluding an indemnification of a munici-
pality in connection with work performed E. This endorsement does not provide coverage for
for a municipality) under which you as- liability resulting from the sole negligence of the
sume the tort liability of another party to additional insured.
pay for "bodily injury" or "property dam-
age" to a third person or organization,
provided the “bodily injury” or “property
damage” is specifically caused by “your
work” and included in the “products-
completed operations hazard”. Tort lia-
bility 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 op-
erations, within 50 feet of any rail-
road property and affecting any rail-
road bridge or trestle, tracks, road-
beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engin-
eer or surveyor for injury or damage
arising out of:
(a) Preparing, approving, or failing to
prepare or approve, maps, shop
drawings, opinions, reports, sur-
veys, field orders, change orders
or drawings and specifications;
or
CL CG 20 12 09 16 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 2
with its permission
A Action Janitorial Services Inc
CPA444259043
COMMERCIAL GENERAL LIABILITY
CL CG 01 14 09 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
<!-Bookmark:PRIMARY AND NONCONTRIB - OTHER INS_CL CG 01 14_09/16:EndBoomark-!>
(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.
CL CG 01 14 09 16 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1
with its permission
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313
(Ed. 04-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule . (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule .
Any person or organization as required by written contract 283 .00
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. TWC4140671 Endorsement No.
Insured A Action Janitorial Services Inc Premium$
Insurance Company
Countersigned by _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
WC 00 0313
(Ed. 04-84)
This page has been left blank intentionally.
A Action Janitorial Services Inc
COMMERCIAL AUTO
CPA444259043
AI CA 59 07 21
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE EXPANSION 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 modified
by endorsement.
SUMMARY OF COVERAGE EXTENSIONS
Provision Name of Extension Limit or
No. Included
A. Broadened Named Insured Included
B. Additional Insured by Contract or Agreement Including Primary and Included
Noncontributory Other Insurance Condition
C. Additional Insured- Employees Included
D. Extended Coverage- Bail Bonds $5,000
E. Extended Coverage- Loss of Earnings (Per Day) $1,000
F. Fellow Employee Coverage Included
G. Transportation Expense Due to Theft of a Covered Auto (Per Day/Maximum) $75/ $2,500
H. Extended Coverage - Air Bags Included
I. Auto Loan/Lease Gap Coverage Included
J. Glass Deductible Included
K. Extended Coverage - Electronic Equipment Included
L. Extended Coverage - Personal Effects $500
M. Towing And Labor (Gross Vehicle Weight of 20,000 lbs. or less) $100
N. Physical Damage Coverage - Hired “Autos” $125,000
1. Loss of use (Per Day/Maximum) $500/ $3,500
O. Rental Reimbursement Coverage $2,500
P. Drive Other Car Coverage Included
Q. Knowledge of Occurrence Included
R. Waiver of Subrogation By Contract or Agreement Included
S. Unintentional Omissions Included
T. Bodily Injury Re-defined Included
U. Employee Hired Auto 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.
AI CA 59 07 21 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 6
with its permission.
A. BROADENED NAMED INSURED additional insured(s) is the lesser of:
a. The Limits of Insurance specified in
The Named Insured shown in the Declarations is the written contract or agreement
amended to include: described above; or
b. The Limits of Insurance shown in the
Any organization, other than a joint venture, over Declarations.
which you maintain ownership or majority interest
of more than 50%, unless that organization is an This provision shall not increase the Limit
“insured” under any other automobile policy or of Insurance shown in the Declarations
would be an “insured” under such a policy but for in this policy or coverage part.
the exhaustion of its Limit of Insurance, however;
5. The following changes are made to
Paragraph 5. Other Insurance of B.
1. Coverage under this provision is afforded only General Conditions under Section IV –
until the next anniversary date of this policy's Business Auto Conditions:
effective date after you acquire or form the a. The following is added to Paragraph 5.a.:
organization or the end of the policy period,
whichever is earlier. If required by the written contract or
agreement described above, the
insurance afforded to the additional
2. Coverage does not apply to "bodily injury" or insured under this provision will be
"property damage" that occurred before you primary to, and will not seek contribution
acquired or formed the organization. from, the additional insured’s own
insurance.
B. ADDITIONAL INSURED BY CONTRACT OR b. Paragraph 5.c. is deleted in its entirety.
AGREEMENT INCLUDING PRIMARY AND
NONCONTRIBUTORY OTHER INSURANCE 6. Paragraph A.1.c. under Section II -
Covered Autos Liability Coverage is
CONDITION deleted in its entirety.
The following is added to Section II – Covered 7. The definition of "insured contract" under
Section V – Definitions is amended to add
Autos Liability Coverage, Paragraph A.1.:
the following:
An "insured contract" does not include that
When you have agreed in a written contract part of any contract or agreement: That
or agreement to include a person or pertains to the ownership, maintenance or
organization as an additional insured, such use of an "auto" and which indemnifies a
person or organization is included as an person or organization for other than the
"insured" subject to the following: vicarious liability of such person or
1. Such person or organization is an organization for "bodily injury" or "property
additional insured only to the extent such damage" caused by your operation or use of
person or organization is liable for "bodily a covered "auto".
injury" or "property damage" because of
the conduct of an "insured" under However, a person or organization is an
Paragraphs a. or b. under Paragraph A.1. additional "insured" under this provision only
Who Is An Insured of Section II – Covered to the extent such person or organization is not
Autos Liability Coverage, caused by an named as an "insured" by separate
"accident" and resulting from the endorsement to this policy.
ownership, maintenance or use of a
covered "auto". C. ADDITIONAL INSURED - EMPLOYEES
2. The written contract or agreement
described above must have been Section II- Covered Autos Liability Coverage,
executed prior to the "accident" that Paragraph A.1.b.(2) is deleted and replaced by
caused the "bodily injury" or "property
damage" and be in effect at the time of the following:
such "accident".
(2) Your employee or agent if the covered “auto”
3. The insurance afforded to any such
additional insured does not apply to any is owned by that employee or a member of his
"accident" beyond the period of time or her household, but this exclusion does not
required by the written contract or apply if the covered "auto” is being used in
agreement described above. your business or your personal affairs.
4. The most we will pay on behalf of such
AI CA 59 07 21 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 6
with its permission.
D. EXTENDED COVERAGE - BAIL BONDS H. EXTENDED COVERAGE - AIRBAGS
Section II – Covered Autos Liability Coverage, Section III – Physical Damage Coverage,
Paragraph A.2.a.(2) is deleted and replaced by Paragraph B.3.a. does not apply to the unintended
the following: discharge of an airbag. Coverage is excess over
any other collectible insurance or warranty
(2) Up to $5,000 for cost of bail bonds (including specifically designed to provide coverage.
bonds for related traffic law violations)
required because of an “accident” we cover. I. AUTO LOAN/LEASE GAP COVERAGE
We do not have to furnish these bonds.
The following is added to Section III – Physical
E. EXTENDED COVERAGE - LOSS OF EARNINGS Damage Coverage, Paragraph C.:
Section II – Covered Autos Liability Coverage, 4. In the event of a total “loss” to a covered
Paragraph A.2.a.(4) is deleted and replaced by “auto”, we will pay any unpaid amount due on
the following: the lease or loan for a covered “auto”, less:
(4) All reasonable expenses incurred by the a. The amount under the Physical Damage
“insured” at our request, including actual loss coverage section of the policy; and
of earnings up to $1,000 a day because of
time off from work. b. Any:
F. FELLOW EMPLOYEE COVERAGE (1) Overdue or any deferred lease/loan
payments at the time of the “loss”,
Section II – Covered Autos Liability Coverage, (2) Financial penalties imposed under a
Paragraph B.5. does not apply. lease for excessive use, abnormal
wear and tear or high mileage;
G. COVERAGE EXTENSION AS A (3) Security deposits not returned by the
CONSEQUENCE OF THEFT OF AN “AUTO” lessor;
(4) Costs for extended warranties, Credit
1. Transportation Expense Life Insurance, Health, Accident or
Disability Insurance;
Section III – Physical Damage Coverage, (5) Carry-over balances from previous
Paragraph A.4.a. is deleted and replaced by loans or leases.
the following:
Coverage provided under this extension will be
a. We will also pay up to $75 per day to a excess over any other collectible insurance
maximum of $2,500 for temporary including, but not limited to, any coverage
transportation expense incurred by you provided by or purchased from the lessor or any
because of the total theft of a covered financial institution.
“auto” that has a Gross Vehicle Weight of
20,000 lbs. or less. We will pay only for J. GLASS DEDUCTIBLE
those covered “autos” for which you carry
either Comprehensive or Specified The following is added to Section III – Physical
Causes of Loss Coverage. We will pay for Damage Coverage, Paragraph D.:
temporary transportation expenses
incurred during the period beginning 48 3. Any Comprehensive Coverage deductible
hours after the theft and ending, shown in the Declarations does not apply to
regardless of the policy’s expiration, when “loss” when you elect to patch or repair glass
the covered “auto” is returned to use or we rather than replace.
pay for its “loss”.
We will also pay reasonable and
necessary expenses to facilitate the
return of the stolen “auto” to you.
AI CA 59 07 21 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 6
with its permission.
K. EXTENDED COVERAGE - ELECTRONIC N. PHYSICAL DAMAGE COVERAGE - HIRED
EQUIPMENT “AUTOS”
You may extend the Comprehensive, Specified
The following is added to Section III - Physical Causes of Loss and Collision coverages provided
Damage Coverage, Paragraph A.4.: on your owned “autos” to any “auto” you lease,
rent, hire or borrow from someone other than your
c. Physical Damage coverage on a covered employees or partners or members of their
“auto” also applies to “loss” to any electronic households. Any "auto" you lease, hire, rent or
equipment that receives or transmits audio, borrow is deemed to be a covered "auto" you own.
visual or data signals and that is not designed However, any "auto" that is leased, hired, rented
solely for the reproduction of sound. This or borrowed with a driver is not a covered "auto".
coverage applies only if the equipment is
permanently installed in the covered “auto” at Coverage provided here is subject to the following:
the time of “loss” or the equipment is
removable from a housing unit which is 1. This extension is only available for “autos” you
permanently installed in the covered “auto” at lease, hire, rent or borrow for less than 30
the time of the “loss”, and such equipment is consecutive days.
designed to be solely operated by use of the
power from the “auto’s” electrical system, in or 2. The most we will pay in any one “loss” is the
upon the covered “auto”. least of $125,000, the actual cash value of the
“auto” or the cost to repair or replace the
We will pay with respects to a covered “auto” “auto”, except that such amount will be
for “loss” to antennas and other accessories reduced by a deductible to be determined as
necessary for use of the electronic equipment. follows:
However, this does not include tapes, records
or discs. The deductible shall be equal to the amount of
the highest deductible shown for any owned
L. EXTENDED COVERAGE - PERSONAL “auto” of the same classification for that
EFFECTS coverage. In the event there is no owned
“auto” of the same classification, the highest
The following is added to Section III – Physical deductible for any owned “auto” will apply for
Damage Coverage, Paragraph A.4.: that coverage.
d. Physical Damage Coverage on a covered 3. Coverage provided under this extension will:
“auto” may be extended to “loss” to your
personal property or, if you are an individual, a. Be excess over any other collectible
the personal property of a family member, that insurance you have;
is in the covered “auto” at the time of “loss”.
b. Pay, in addition to the limit set forth in N.2.
The most we will pay for any one “loss” under above, up to $500 per day, not to exceed
this coverage extension is $500. $3,500 per “loss” for:
M. TOWING AND LABOR (1) Any costs or fees associated with the
“loss” to a hired “auto”; and
Section III – Physical Damage Coverage, (2) Loss of use, provided it is the
Paragraph A.2. is deleted and is replaced by the consequence of an “accident” for
following: which you are legally liable, and as a
result of which a monetary loss is
We will pay up to $100 for towing and labor costs sustained by the leasing or rental
incurred each time a covered “auto” with both concern.
Comprehensive and Collision Coverage and that
is a private passenger type, light truck or medium Paragraphs 1 through 3 above do not apply if
truck is disabled. However, the labor must be separate Hired Auto Physical Damage Coverage
performed at the place of disablement. is indicated in the Declarations.
AI CA 59 07 21 Includes copyrighted material of Insurance Services Office, Inc., Page 4 of 6
with its permission.
O. RENTAL REIMBURSEMENT COVERAGE P. DRIVE OTHER CAR COVERAGE
1. We will pay for rental reimbursement expenses 1. Your Covered Autos Liability Coverage, Auto
incurred by you for the rental of an "auto" Medical Payments, Uninsured and
because of "loss" to a covered "auto". Underinsured Motorists Coverage, and
Payment applies in addition to the otherwise Physical Damage Coverage is extended to
applicable amount of each coverage you any private passenger type “auto” you hire,
have on a covered "auto". No deductibles borrow or do not own while being used by or
apply to this coverage. This coverage is only in the care, custody or control of the following
available to those covered “autos” involved in persons:
a “loss” and Physical Damage is provided to a. You, if you are designated in the
the covered “auto”. Declarations as an individual.
b. Your partners or members, if you are
2. We will pay only for those expenses incurred designated in the Declarations as a
during the policy period beginning 24 hours partnership or joint venture;
after the "loss" and ending, regardless of the c. Your members or managers, if you are
policy's expiration, with the lesser of the designated in the Declarations as a
following; limited liability company;
d. Your executive officers, if you are
a. The number of days reasonably required designated in the Declarations as an
to repair or replace the covered "auto". If organization other than an individual,
"loss" is caused by theft, this number of partnership, joint venture or limited liability
days is added to the number of days it company;
takes to locate the covered "auto" and e. The spouse of any person named in P.1.a.
return it to you, or through P.1.d. while a resident of the
same household.
b. When the total amount paid under this
coverage extension reaches $2,500. 2. The following “autos” are not covered:
3. Our payment is limited to the lesser of the a. Any “auto” owned by a person named in
following amounts: P.1.a. through P.1.d. or by any member of
his or her household.
a. Necessary and actual expenses incurred. b. Any “auto” used by a person named in
b. Not more than $75 per day. P.1.a. through P.1.d. while working in the
business of selling, servicing, repairing or
4. We will pay up to an additional $300 for the parking “autos”.
reasonable and necessary expenses you
incur to remove your materials and equipment 3. The most we will pay for the total of all
from the covered “auto” and replace such damages under Covered Autos Liability
materials and equipment on the rental “auto”. Coverage, Auto Medical Payments,
Uninsured and Underinsured Motorists
5. This coverage does not apply while there are Coverage is the LIMIT OF INSURANCE for
spare or reserve “autos” available to you for each Coverage shown in the Declarations as
your operations. applicable to owned “autos”.
6. If “loss” results from the total theft of a covered 4. Our obligation to pay for, repair, return or
“auto” of the “private passenger type”, we will replace damaged or stolen property under
pay under this coverage only that amount of Physical Damage Coverage, will be reduced
your rental reimbursement expenses which is by a deductible equal to the amount of the
not already provided for under the Physical largest deductible shown for any owned
Damage Coverage Extension. private passenger type “auto” applicable to
that coverage. If there are no owned
private passenger type “autos”, the
deductible shall be $100 for Comprehensive
Coverage and $250 for Collision Coverage.
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with its permission.
Q. KNOWLEDGE OF OCCURRENCE S. UNINTENTIONAL OMISSIONS
The following is added to Section IV - Business The following is added to Section IV- Business
Auto Conditions, Paragraph A.2.: Auto Conditions, Paragraph B.2.:
d. Notice of an "accident" or "loss" will be We will not deny coverage under this policy if you
considered knowledge of yours only if fail to disclose all hazards existing as of the
reported to you, if you are an individual, a inception date of the policy, provided such failure
partner, an executive officer or an employee is not intentional.
designated by you to give us such notice.
e. Notice of an "accident" or "loss" to your T. BODILY INJURY REDEFINED
Workers Compensation insurer, for an event Section V- Definitions, Paragraph C. is deleted
which later develops into a claim for which and replaced by the following:
there is coverage under this policy, shall be
considered notice to us, but only if we are C. "Bodily injury" means bodily injury, disability,
notified as soon as you know that the claim sickness, or disease sustained by a person,
should be addressed by this policy, rather including death resulting from any of these at
than your Workers Compensation policy. any time. "Bodily injury" includes mental
anguish or other mental injury resulting from
f. Your rights under this policy shall not be "bodily injury".
prejudiced if you fail to give us notice of an
"accident" or "loss", solely due to your U. EMPLOYEE HIRED AUTO
reasonable and documented belief that the
event is not covered by this policy. 1. Changes In Liability Coverage
The following is added to the Who Is An
The following is added to Section IV- Business Insured provision:
Auto Conditions, Paragraph A.2.b.: An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
(6) Knowledge of the receipt of documents contract or agreement in an "employee's"
concerning a claim or “suit” will be considered name, with your permission, while performing
knowledge of yours only if receipt of such duties related to the conduct of your
documents is known to you, if you are an business.
individual, a partner, an executive officer, or 2. Changes In General Conditions
an employee designated by you to forward
Paragraph 5.b. of the Other Insurance
such documents to us.
Condition is replaced by the following:
R. WAIVER OF SUBROGATION BY CONTRACT For Hired Auto Physical Damage Coverage,
OR AGREEMENT the following are deemed to be covered
"autos" you own:
The following is added to Section IV-Business 1. Any covered "auto" you lease, hire,
Auto Conditions, Paragraph A.5.: rent or borrow; and
2. Any covered "auto" hired or rented by
The Transfer Of Rights Of Recovery Against your "employee" under a contract in
Others To Us Condition does not apply to any that individual "employee's" name, with
person(s) or organization(s) for whom you are your permission, while performing
required to waive subrogation with respect to the duties related to the conduct of your
coverage provided under this Coverage Form, but business.
only to the extent that subrogation is waived: However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
1. Under a written contract or agreement with covered "auto".
such person(s) or organization(s); and
2. Prior to the “accident” or the “loss”.
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with its permission.