Casey Tree COI 1-5 - February 12, 2024 - DCSD Board Meeting Archive

DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 05/09/2023
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 rights to the certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER
NAME: Teresa Beckett
PHONE FAX
CGM INSURANCE AGENCY, INC. (A/C, No, Ext): (678) 674-4229 (A/C, No): (888) 491-3723
E-MAIL
1201 W Peachtree ST NW ADDRESS: tbeckett@cgmins.com
STE 2300 INSURER(S) AFFORDING COVERAGE NAIC #
Atlanta GA 30309-3453 INSURER A : GREENWICH INS CO 22322
INSURED INSURER B : XL INS AMER INC 24554
Casey Tree Experts, Inc INSURER C : CAPITOL SPECIALTY INS CORP 10328
4135 Arcadia Industrial Cir SW INSURER D :

INSURER E :
Lilburn GA 30047-2906 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 INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 5,000
A x NPC-1003621-03 05/05/2023 05/05/2024 PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident) $ 1,000,000
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED
B AUTOS ONLY AUTOS NBA-1003622-0 05/05/2023 05/05/2024 BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000
A EXCESS LIAB CLAIMS-MADE NEC-6006124-03 05/05/2023 05/05/2024 AGGREGATE $ 5,000,000
DED RETENTION $ PR/COMP OPS AGG $ 5,000,000
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $

Pollution Liability Each Pollution Incident $1,000,000
C EV20210176-03 02/28/2023 02/28/2024 Pollution Accregate $2,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
PRoject Name: IRB 16-752-026 Tree Cutting and Trimming Services
Certificate holder is named as Additional Insured

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Dekalb County School District and
The Dekalb County Board Of Education AUTHORIZED REPRESENTATIVE
1780 Montreal Rd
Tucker GA 30084
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: Q-40096 COMMERCIAL GENERAL LIABILITY
CG 20 10 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following additional
organization(s) shown in the Schedule, but only exclusions apply:
with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or
damage" or "personal and advertising injury" "property damage" occurring after:
caused, in whole or in part, by: 1. All work, including materials, parts or
1. Your acts or omissions; or equipment furnished in connection with such
2. The acts or omissions of those acting on your work, on the project (other than service,
behalf; maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
in the performance of your ongoing operations for location of the covered operations has been
the additional insured(s) at the location(s) completed; or
designated above.
2. That portion of "your work" out of which the
However: injury or damage arises has been put to its
1. The insurance afforded to such additional intended use by any person or organization
insured only applies to the extent permitted by other than another contractor or subcontractor
law; and engaged in performing operations for a
2. If coverage provided to the additional insured is principal as a part of the same project.
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.

CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2
C. With respect to the insurance afforded to these 2. Available under the applicable limits of
additional insureds, the following is added to insurance;
Section III – Limits Of Insurance: whichever is less.
If coverage provided to the additional insured is This endorsement shall not increase the
required by a contract or agreement, the most we applicable limits of insurance.
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or

Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19
POLICY NUMBER: Q-40096 COMMERCIAL GENERAL LIABILITY
CG 20 37 12 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following is added to
organization(s) shown in the Schedule, but only Section III – Limits Of Insurance:
with respect to liability for "bodily injury" or If coverage provided to the additional insured is
"property damage" caused, in whole or in part, by required by a contract or agreement, the most we
"your work" at the location designated and will pay on behalf of the additional insured is the
described in the Schedule of this endorsement amount of insurance:
performed for that additional insured and included 1. Required by the contract or agreement; or
in the "products-completed operations hazard".
2. Available under the applicable limits of
However: insurance;
1. The insurance afforded to such additional whichever is less.
insured only applies to the extent permitted by
law; and This endorsement shall not increase the
applicable limits of insurance.
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.

CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
POLICY NUMBER: XIC 421 1013

" "

! !

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

COVERAGE DESCRIPTION

'.103#3:6$45+565' 650*:4+%#-#.#)'
*04 //463'&
30#&03./463'&
.1-0:''4 4/463'&4
&&+5+0/#-/463'&:0/53#%5 )3''.'/503'3.+5
.1-0:''+3'& 6504
611-'.'/5#3:#:.'/54
.'/&'&'--08.1-0:''9%-64+0/
*:4+%#-#.#)'07'3#)'
'/5#-'+.$634'.'/5
953#91'/4'<30#&'/'&07'3#)'
'340/#-(('%5407'3#)'
'#4'#1
-#44'1#+3< #+7'3('&6%5+$-'
*:4+%#-#.#)'07'3#)'95'/4+0/4
&&+5+0/#-3#/41035#5+0/91'/4'
+3'& 650*:4+%#-#.#)'
64+/'44 6500/&+5+0/4
05+%'(%%633'/%'
#+7'3(6$30)#5+0/
/+/5'/5+0/#-#+-63'0+4%-04'#;#3&4
3+.#3:/463#/%'
0&+-:/,63:'&'(+/'&
95'/&'&#/%'--#5+0/0/&+5+0/

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
'.103#3:6$45+565' 650*:4+%#-#.#)'

< , '35#+/ 3#+-'34 0$+-' 26+1.'/5 /& '.103#3: 6$45+565'
6504 is changed by adding the following:

If Physical Damage coverage is provided by this Coverage Form, the following types of vehicles are also
covered “autos” for Physical Damage coverage:

Any “auto” you do not own while used with the permission of its owner as a temporary substitute for
a covered “auto” you own that is out of service because of its:

# Breakdown;

$ Repair;

% Servicing;

& “Loss”; or

' Destruction.

*04 //463'&

< " 07'3#)' *0 4 / /463'& is
changed by adding the following:

30#&03./463'&

For any covered “auto”, any subsidiary, affiliate or organization, other than a partnership or joint
venture, as may now exist or hereafter be constituted over which you assume active management
or maintain ownership or majority interest, provided that you notify us within ninety (90) days from
the date that any such subsidiary or affiliate is acquired or formed and that there is no similar
insurance available to that organization. However, coverage does not apply to “bodily injury” or
“property damage” that occurred before you acquired or formed the organization.

.1-0:''4 4/463'&4

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.

&&+5+0/#-/463'&:0/53#%5 )3''.'/53'3.+5

Any person or organization with whom you have agreed in writing in a contract, agreement or
permit, to provide insurance such as is provided under this policy, provided that the “bodily injury”
or “property damage” occurs subsequent to the execution of the written contract, agreement or
permit.

.1-0:''+3'& 6504

An “employee” of yours is an “insured” while operating an “auto” hired or rented under a contract or
agreement in that “employee’s” name, with your permission, while performing duties related to the
conduct of your business.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 2 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
< '/'3#-0/&+5+0/4 5*'3/463#/%'$
is replaced with the following:

$ For Hired Auto Physical Damage Coverage, the following are deemed to be covered
“autos” you own:

Any covered “auto” you lease, hire, rent or borrow; and

Any covered “auto” hired or rented by your “employee” under a contract in that
individual “employee’s” name, with your permission, while performing duties
related to the conduct of your business.

However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered
“auto”.

611-'.'/5#3:#:.'/54

< " 07'3#)' 07'3#)' 95'/4+0/4 #
611-'.'/5#3:#:.'/54 is changed as follows:

Item is deleted and replaced by the following:

Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required
because of an "accident" we cover. We do not have to furnish these bonds.

Item is deleted and replaced by the following:

All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings
up to $500 a day because of time off from work.

.'/&'&'--08.1-0:''9%-64+0/

< " 9%-64+0/4 '--08.1-0:'' does not
apply.

The insurance provided under this Provision is excess over any other collectible insurance.

*:4+%#-#.#)'07'3#)'

<" 07'3#)' is changed by adding the following:

'/5#-'+.$634'.'/5

# We will pay for rental reimbursement expenses incurred by you for the rental of an “auto”
because of “loss” to a covered “auto”. Payment applies in addition to the otherwise
applicable amount of each coverage you have on a covered “auto”. No deductibles apply
to this coverage.

$ We will pay only for those expenses incurred during the policy period beginning twenty-four
(24) hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser
of the following number of days:

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
The number of days reasonably required to repair or replace the covered “auto”. If
“loss” is caused by theft, this number of days is added to the number of days it
takes to locate the covered “auto” and return it to you.

Thirty (30) days.

% Our payment is limited to the lesser of the following amounts:

Necessary and actual expenses incurred.

$50 any one day per private passenger “auto”;
$100 any one day per truck;
$1,500 any one period per private passenger “auto”;
$3,000 any one period per truck; or
Higher limits if shown elsewhere in this policy.

& This coverage does not apply while there are spare or reserve “autos” available to you for
your operations.

' If “loss” results from the total theft of a covered “auto” of the private passenger type, we will
pay under this coverage only that amount of your rental reimbursement expenses which is
not already provided for under the Physical Damage Coverage Extension.

953#91'/4'<30#&'/'&07'3#)'

We will pay for the expense of returning a stolen covered “auto” to you.

'340/#-(('%5407'3#)'

If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that
“auto” is stolen, we will pay, without application of a deductible, up to $500 for “personal effects”
stolen from the “auto”.

As used in this endorsement, “personal effects” means tangible property that is worn or carried by
an “insured”. “Personal effects” does not include tools, jewelry, money or securities.

'#4'#1

In the event of a total “loss” to a covered “auto” shown in the Declarations, we will pay any unpaid
amount due on the lease or loan for a covered “auto”, less:

# The amount paid under the Physical Damage Coverage Section of the policy; and

$ Any:

Overdue lease/loan payments at the time of the “loss”;

Financial penalties imposed under a lease for excessive use, abnormal wear and
tear or high mileage;

Security deposits not returned by the lessor;

Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability
Insurance purchases with the loan or lease; and

Carry-over balances from previous loans or leases.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 4 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
-#44'1#+3< #+7'3('&6%5+$-'

No deductible applies to glass damage if the glass is repaired rather than replaced.

*:4+%#-#.#)'07'3#)'95'/4+0/4

<" 07'3#)' 07'3#)'95'/4+0/4 is amended by
the following:

&&+5+0/#-3#/41035#5+0/91'/4'

'%5+0/4 # and$ are amended to provide a limit of $50 per day and a maximum limit of $1,000.

+3'& 650*:4+%#-#.#)'

The following section is added:

Any “auto” you lease, hire, rent or borrow is deemed to be a covered “auto” for physical damage
coverage. The most we will pay for each covered “auto” is the lesser of:

the actual cash value;

the cost for repair or replacement; or

$50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage
Coverage.

For each covered “auto” a deductible of $100 for Comprehensive Coverage and $1,000 for
Collision Coverage will apply.

64+/'44 6500/&+5+0/4

< 0440/&+5+0/4 is changed by the following:

05+%'(%%633'/%'

'%5+0/<65+'4/*'7'/5( %%+&'/5-#+.6+53044# is changed by adding the
following:

If you report an injury to an “employee” to your workers’ compensation carrier and if it is
subsequently determined that the injury is one to which this insurance may apply, any failure to
comply with this condition will be waived if you provide us with the required notice as soon
thereafter as practicable after you know or reasonably should have known that this insurance may
apply.

#+7'3(6$30)#5+0/

'%5+0/ 3#/4('3 ( +)*54 ( '%07'3: )#+/45 5*'34 0 4 is changed by adding the
following:

However, this Condition does not apply to any person(s) or organization(s) with whom you have a
written contract, but only to the extent that subrogation is waived prior to the “accident” or the “loss”
under such contract with that person or organization.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
< '/'3#-0/&+5+0/4 is changed by the following:

/+/5'/5+0/#-#+-63'0+4%-04'#;#3&4

The following condition is added:

Your unintentional failure to disclose all hazards as of the inception date of the policy shall not
prejudice any insured with respect to the coverage afforded by this policy.

3+.#3:/463#/%'

0/&+5+0/ 5*'3/463#/%' is changed by adding the following:

For any covered “auto” this insurance shall apply as primary and not contribute with any other
insurance where such requirement is agreed in a written contract executed prior to a “loss”.

0&+-:/,63:'&'(+/'&

< “Bodily injury” is replaced by the following:

“Bodily injury” means bodily injury, sickness or disease sustained by a person including mental anguish,
mental injury, shock, fright or death resulting from any of these at any time.

95'/&'&#/%'--#5+0/0/&+5+0/

"03. #/%'--#5+0/$ is replaced by the following:

The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before
the effective date of cancellation if we cancel for any other reason.

All other terms and conditions of this policy remain unchanged.

XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 6 of 6
May not be copied without permission.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
&200(5&,$/*(1(5$//,$%,/,7<
&*

7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//<

35,0$5<$1'121&2175,%8725<±
27+(5,1685$1&(&21',7,21

7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ

&200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57
/,4825/,$%,/,7<&29(5$*(3$57
352'8&76&203/(7('23(5$7,216/,$%,/,7<&29(5$*(3$57

7KH IROORZLQJ LV DGGHG WR WKH 2WKHU ,QVXUDQFH <RXKDYHDJUHHGLQZULWLQJLQDFRQWUDFWRU
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DGGLWLRQDOLQVXUHG
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DQ DGGLWLRQDO LQVXUHG XQGHU \RXU SROLF\ SURYLGHG
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XQGHUVXFKRWKHULQVXUDQFHDQG

&* ,QVXUDQFH6HUYLFHV2IILFH,QF 3DJHRI

ENDORSEMENT #

This endorsement, effective 12:01 a.m. , forms a part of

Policy No. issued to

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

XL Plus Endorsement

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The
following listing is a general coverage description only. Limitations and exclusions may apply
to these coverages. Read this endorsement carefully to determine rights, duties, and what is
and is not covered.
A. Reasonable Force – Bodily Injury or Property Damage
B. Damage To Premises Rented To You Extension
● Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion,
vandalism, leakage from fire extinguishing equipment or water damage
● Limit increased to $300,000
C. Aircraft Chartered with Crew
D. Non-Owned Watercraft
E. Personal and Advertising Injury – Assumed by Insured Contract
F. Increased Supplementary Payments
● Cost for bail bonds increased to $5,000
● Loss of earnings increased to $1,000 per day
G. Broadened Named Insured
H. Blanket Additional Insured – Managers or Lessors of Premises
I. Blanket Additional Insured – Lessor of Leased Equipment
J. Injury to Co-Employees and Co-Volunteer Workers
K. Knowledge and Notice of Occurrence or Offense
L. Unintentional Omission
M. Liberalization
N. Blanket Waiver of Subrogation
O. Incidental Medical Malpractice Injury
P. Extension of Coverage – Bodily Injury
Q. Coverage Territory
Form XIL 436 1208 © 2008, XL America, Inc. Page 1 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
A. REASONABLE FORCE – BODILY INJURY OR PROPERTY DAMAGE
Exclusion a. Expected Or Intended Injury of Part 2., Exclusions of Coverage A. Bodily Injury
And Property Damage Liability of Section I – Coverages is deleted in its entirety and replaced
by the following:

[This insurance does not apply to:)

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.

B. DAMAGE TO PREMISES RENTED TO YOU EXTENSION
1. The last paragraph of 2. Exclusions of Coverage A. Bodily Injury And Property Damage
Liability of Section I - Coverages is deleted in its entirety and replaced by the following:
Exclusions c. through n. do not apply to damages to premises while rented to you, or
temporarily occupied by you with permission of the owner, caused by fire, lightning,
explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire
extinguishing equipment or water damage. A separate limit of insurance applies to this
coverage as described in Section III- Limits of Insurance.
2. This insurance does not apply to damage to premises while rented to you, or temporarily
occupied by you with permission of the owner, caused by:
a. Rupture, bursting, or operation of pressure relief devices;
b. Rupture or bursting due to expansion or swelling of the contents of any building or
structure, caused by or resulting from water; or
c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines.
3. Paragraph 6. of Section III- Limits of Insurance is deleted in its entirety and replaced by the
following:
6.a. 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 temporarily occupied by you with permission of
the owner, caused by fire, explosion, lightning, smoke, aircraft or vehicle, riot or civil
commotion, vandalism, leakage from fire extinguishing equipment or water damage.
The Damage To Premises Rented To You Limit will apply to all damage proximately
caused by the same “occurrence”, whether such damage results from fire, explosion,
lightning, smoke, aircraft or vehicle or riot or civil commotion, vandalism, leakage from
fire extinguishing equipment or water damage or any combination of any of these.
b. The Damage to Premises Rented to You Limit will be the higher of:
(1) $300,000; or
(2) The amount shown on the Declarations for Damage to Premises Rented to You
Limit.

Form XIL 436 1208 © 2008, XL America, Inc. Page 2 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
4. Paragraph 9.a. of the definition of “insured contract” under Section V- Definitions, is deleted
in its entirety and replaced by the following:
[“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, lightning,
explosion, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from
fire extinguishing equipment or water damage to premises while rented to you, or
temporarily occupied by you with the permission of the owner is not an “insured
contract”.
5. This Article B. does not apply if coverage for Damage to Premises Rented to You of
Coverage A. Bodily Injury And Property Damage Liability of Section I – Coverages is
excluded by endorsement.

C. AIRCRAFT CHARTERED WITH CREW
1. The following is added to the exceptions contained in Exclusion g., Aircraft, Auto or
Watercraft in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage of
Section I – Coverages:
[This exclusion does not apply to:)
Aircraft chartered with crew to any insured.
2. This Article C. does not apply if the chartered aircraft is owned by any insured.
3. The insurance provided by this Article C. shall be excess over any valid and collectible
insurance available to the insured, whether primary, excess, contingent or on any other
basis, except for insurance purchased specifically by you to be excess of this policy.

D. NON-OWNED WATERCRAFT
1. The exception contained in Subparagraph (2) of Exclusion g. Aircraft. Auto or Watercraft
in Part 2., Exclusions of Coverage A. Bodily Injury And Property Damage Liability of
Section I – Coverages is deleted in its entirety and replaced by the following:
(2) A watercraft you do not own that is:
(a) 50 feet long or less; and
(b) Not being used to carry persons or property for a charge;
2. This Article D. applies to any person who, with your expressed or implied consent, either
uses or is responsible for the use of the watercraft.
3. This insurance provided by this Article D. shall be excess over any other valid and
collectible insurance available to the insured, whether primary, excess, contingent or on
any other basis, except for insurance purchased specifically by you to be excess of this
policy.

E. PERSONAL AND ADVERTISING INJURY – ASSUMED BY INSURED CONTRACT
1. Exclusion e. Contractual Liability in Part 2., Exclusions of Coverage B. Personal And
Advertising Injury Liability of Section I – Coverages is deleted in its entirety and replaced
by the following:

Form XIL 436 1208 © 2008, XL America, Inc. Page 3 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
[This insurance does not apply to:)

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:
1. That the insured would have in the absence of the contract or agreement; or
2. Assumed in a written contract or agreement that is an “insured contract”; provided the
“personal and advertising injury” is caused by an offense which occurs subsequent to
the execution of the contract or agreement.
2. Subparagraph f. of the definition of “insured contract” Section V.- Definitions is deleted in its
entirety and replaced by the following:
f. That part of any other contract or agreement pertaining to your business, including an
indemnification of a municipality in connection for work performed for a municipality,
under which you assume the tort liability of anther party to pay for “bodily injury”,
“property damage” or “personal and advertising injury” to a third party or organization.
Tort liability means a liability that would be imposed by law in the absence of any
contract or agreement.
2. This Article E. does not apply if Coverage B. Personal And Advertising Injury Liability is
excluded by endorsement.

F. INCREASED SUPPLEMENTARY PAYMENTS
Subparagraphs 1. b. and d. of Supplementary Payments – Coverages A And B of Section I -
Coverages are amended as follows:
1. In Subparagraph b., the amount we will pay for the cost of bail bonds is increased up to
$5,000.
2. In Subparagraph d., the amount we will pay for a loss of earnings is increased up to
$1,000 a day.

G. BROADENED NAMED INSURED
1. The Named Insured in Item 1. of the Declarations is as follows:
The person or organizations named in Item 1. of the Declarations and any organization,
other than a partnership or joint venture, over which you maintain ownership or majority
interest on the effective date of the policy. However, coverage for any such organization
will cease as of the date that you no longer maintain ownership of, or majority interest in,
such organization.
2. This Article G. does not apply to any person or organization for which coverage is excluded
by endorsement.

Form XIL 436 1208 © 2008, XL America, Inc. Page 4 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
H. BLANKET ADDITIONAL INSURED – MANAGERS OR LESSORS OF PREMISES
1. Section II-Who Is An Insured is amended to include as an insured any person or
organization with whom you have agreed in a written contract executed prior to loss (an
“additional insured”), but only with respect to liability arising out of the ownership,
maintenance or use of that part of any premises leased to you, subject to the following
provisions:
a. Limits of Insurance. The Limits of Insurance afforded to the “additional insured” shall
be the limits you agreed to provide, or the limits shown on the Declarations, whichever
is less.
b. The insurance afforded to the “additional insured” does not apply to:
(1) Any “occurrence” that takes place after you cease to be a tenant in that premises;
(2) Any premises for which coverage is excluded by endorsement; or
(3) Structural alterations, new construction or demolition operations performed by or
on behalf of such “additional insured”.
2. The insurance afforded to the “additional insured” is excess over any valid and collectible
insurance available to such “additional insured”, unless you have agreed in a written
contract for this insurance to apply on a primary or contributory basis.

I. BLANKET ADDITIONAL INSURED – LESSOR OF LEASED EQUIPMENT
1. Section II-Who Is An Insured is amended to include an “additional insured” (as defined in
Article H. above), but only with respect to their liability arising out of maintenance, operation
or use by you of equipment leased to you by such “additional insured”, subject to the
following provisions:
a. Limits of Insurance. The Limits of Insurance afforded to the “additional insured” shall
be the limits which you agreed to provide, or the limits shown on the Declarations,
whichever is less.
b. The insurance afforded to the “additional insured” does not apply to:
(1) Any “occurrence” that takes place after the equipment lease expires; or
(2) “Bodily injury” or “property damage” arising out of the sole negligence of such
additional insured.
2. The insurance provided to the “additional insured” is excess over any valid and collectible
insurance available to such “additional insured”, unless you have a written contract for this
insurance to apply on a primary or contributory basis.

J. INJURY TO CO-EMPLOYEES AND CO-VOLUNTEER WORKERS
1. Section II- Who Is An Insured is amended to include your “employees” as insureds with
respect to “bodily injury” to a co-“employee" in the course of the co-”employee’s”
employment by you, or to your “volunteer workers” while performing duties related to the
conduct of your business, provided that this coverage for your “employees” does not
apply to acts outside the scope of their employment by you or while performing duties
unrelated to the conduct of your business.

Form XIL 436 1208 © 2008, XL America, Inc. Page 5 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
2. Section II – Who Is An Insured is amended to include your “volunteer workers” as
insureds with respect to “bodily injury” to a co-“volunteer worker” while performing duties
related to the conduct of your business, or to your “employees” employment by you,
provided that this coverage for your “volunteer workers” does not apply while performing
duties unrelated to the conduct of your business.

K. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE
The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or
Suit of the Section IV - Commercial General Liability Conditions:
Notice of an “occurrence” or of an offense which may result in a claim under this insurance
shall be given as soon as practicable after knowledge of the “occurrence” or offense has
been reported to any insured listed under Paragraph 1. of Section II-Who Is An Insured or
any “employee” (such as insurance, loss control, risk manager or administrator) designated
by you to give such notice.

Knowledge of any other “employee(s)” of an “occurrence” or of an offense does not imply that
you also have such knowledge.
Notice shall be deemed prompt if given in good faith as soon as practicable to your workers
compensation insurer. This applies only if you subsequently give notice to us as soon as
practicable after any insured listed under Paragraph 1. of Section II – Who Is An Insured or
an “employee” (such as an insurance, loss control, or risk manager or administrator)
designated by you to give such notice discovers that the “occurrence”, offense or claim may
involve this policy.

L. UNINTENTIONAL OMISSION

The following is added to Paragraph 6., Representations, of Section IV- Commercial General
Liability Conditions:
The unintentional omission of, or unintentional error in, any information provided by you shall
not prejudice your rights under this insurance. However, this Article L. does not affect our
right to collect additional premium or to exercise our right of cancellation or nonrenewal in
accordance with applicable state insurance laws or regulations.

M. LIBERALIZATION
The following is added to Section IV-Commercial General Liability Conditions:
Liberalization
After the issuance of this policy, if we adopt a change in our forms or rules which would
broaden the coverage provided by any form that is a part of this policy without a premium
charge, the broader coverage will apply to this policy. This extension is effective upon the
approval of such broader coverage in your state.

Form XIL 436 1208 © 2008, XL America, Inc. Page 6 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
N. BLANKET WAIVER OF SUBROGATION
The following is added to Section IV-Commercial General Liability Conditions:
Waiver of Subrogation
We waive any right of recovery we may have against any person or organization because of
payments we make for injury or damage arising out of premises owned or occupied or rented
or loaned to you; ongoing operations performed by you or on your behalf, done under a
contract with that person or organization; “your work”; or “your products”. We waive this right
where you have agreed to do so as part of a written contract, executed by you prior to loss.

O. INCIDENTAL MEDICAL MALPRACTICE INJURY
1. For insurance applicable to this Article O, the definition of “bodily injury” in Section V -
Definitions is amended to include, “Incidental Medical Malpractice Injury”.
2. The following definition is added to Section V- Definitions:
“Incidental medical malpractice injury” means “bodily injury”, mental anguish, sickness or
disease sustained by a person, including death resulting from any of these at any time,
arising out of the rendering of, or failure to render, the following services:
a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or
instruction, or the related furnishing of food or beverages;
b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or
appliances;
c. First aid; or
d. “Good Samaritan Services”. As used in this Article O., “Good Samaritan Services” are
those medical services rendered or provided in an emergency and for which no
remuneration is demanded or received.
3. Paragraph 2.a.(1)(d) of Section II -Who Is An Insured does not apply to any registered
nurse, licensed practical nurse, emergency medical technician or paramedic employed by
you, but only while performing the services described in Paragraph 2. above and while
acting within the scope of their employment by you. Any “employees” rendering “Good
Samaritan Services” will be deemed to be acting within the scope of their employment by
you.
4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. – Bodily
Injury And Property Damage Liability of Section I – Coverages:
[This insurance does not apply to:)
Willful Violation of Penal Statute
Liability arising out of the willful violation of a penal statute or ordinance relating to the
sale of pharmaceuticals by or with the knowledge or consent of the insured.
5. For the purposes of determining the applicable Limits of Insurance, any act or omission,
together with all related acts or omissions in the furnishing of services described in
Paragraph 2.a. through 2.d. above to any one person, will be considered one “occurrence”.
6. This Article O. does not apply if you are in the business or occupation of providing any of
the services described in Paragraph 2. above.

Form XIL 436 1208 © 2008, XL America, Inc. Page 7 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
7. The insurance provided by this Article O. shall be excess over any other valid and
collectible insurance available to the insured, whether primary, excess, contingent or on
any other basis, except for insurance purchased specifically by you to be excess of this
policy.

P. EXTENSION OF COVERAGE – BODILY INJURY
The definition of “bodily injury” Section V- Definitions is deleted in its entirety and replaced by
the following:
3. “Bodily injury” means bodily injury, mental anguish, mental injury, shock, fright, disability,
humiliation, sickness or disease sustained by a person, including death resulting from
any of these at any time.

Q. COVERAGE TERRITORY
The definition of “coverage territory” Section V- Definitions is deleted in its entirety and
replaced by the following:
4. “Coverage territory” means anywhere in the world.
This insurance does not apply to:
a. “bodily injury” or “property damage” that takes place; or
b. “personal and advertising injury” caused by an offense committed
outside the United States of America (including its possessions and territories),
Canada and Puerto Rico, unless a “suit” on the merits (to determine the insured’s
responsibility to pay damages to which this insurance applies) is brought in the
United States of America (including its possessions and territories), Canada or
Puerto Rico.
This insurance does not apply to damage, loss, cost or expenses in connection with any
“suit” brought outside the United States of America (including its possessions and
territories), Canada or Puerto Rico.

Form XIL 436 1208 © 2008, XL America, Inc. Page 8 of 8
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

Agenda Item