3b. ShepCo Paving COI - February 9, 2026 - DCSD Board Meeting Archive

DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/12/2025
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).
PRODUCER CONTACT
NAME:
Yates, LLC PHONE FAX
2800 Century Parkway NE (A/C, No, Ext): 404-633-4321 (A/C, No): 404-633-1312
E-MAIL
Suite 300 ADDRESS: certs@yatesins.com
Atlanta GA 30345- INSURER(S) AFFORDING COVERAGE NAIC #

INSURER A : Amerisure Insurance Company 19488
SHEPPA01-C
INSURED INSURER B : Amerisure Mutual Insurance Company 23396
Shepco Paving Inc.
INSURER C : Travelers Property Casualty Co of America 25674
4080 McGinnis Ferry Rd
Bldg 200 Suite 203 INSURER D :
Alpharetta GA 30005 INSURER E :

INSURER F :
COVERAGES CERTIFICATE NUMBER: 231638957 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
A X COMMERCIAL GENERAL LIABILITY CPP2112585860601 8/1/2025 8/1/2026 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 100,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000

POLICY X JECT
PRO-
LOC PRODUCTS - COMP/OP AGG $ 2,000,000

OTHER: $
A COMBINED SINGLE LIMIT $ 1,000,000
AUTOMOBILE LIABILITY CA21125850601 8/1/2025 8/1/2026 (Ea accident)
X ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
NON-OWNED
X HIRED
AUTOS ONLY
X AUTOS ONLY
PROPERTY DAMAGE
(Per accident) $
$
B X UMBRELLA LIAB X OCCUR CU21125870602 8/1/2025 8/1/2026 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000
X RETENTION $ $
DED 0
PER OTH-
B WORKERS COMPENSATION WC21125880602 8/1/2025 8/1/2026 X STATUTE ER
AND EMPLOYERS' LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE
N E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? 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 Leased/Rented Equipment 660-6Y824196-TIL-24 8/1/2025 8/1/2026 All Risk/$2,500 Ded. $400,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Subject to policy terms, conditions, forms, and exclusions, the insurance coverage afforded by the policies above include the following when required by written
contract for the certificate holder and/or entities listed below: Blanket Additional Insured in regards to General Liability for ongoing and completed operations,
Automobile Liability, Umbrella Liability; Blanket Primary and Non-Contributory in regards to General Liability and Umbrella Liability; Blanket Waiver of
Subrogation in regards to General Liability, Automobile Liability, Umbrella Liability, and Workers Compensation. Blanket Thirty (30) day notice of cancellation in
regards to General Liability, Automobile Liability, Umbrella Liability, and Workers Compensation. Per Project Aggregate applies to the General Liability when
required by written contract.

Forms:
See Attached...
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
1780 Montreal Rd AUTHORIZED REPRESENTATIVE
Tucker GA 30084

© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
AGENCY CUSTOMER ID: SHEPPA01-C
LOC #:

ADDITIONAL REMARKS SCHEDULE Page 1 of 1

AGENCY NAMED INSURED
Yates, LLC Shepco Paving Inc.
4080 McGinnis Ferry Rd
POLICY NUMBER Bldg 200 Suite 203
Alpharetta GA 30005
CARRIER NAIC CODE

EFFECTIVE DATE:

ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
CG7324 0323 - Contractor’s Blanket Additional Insured Endorsement – Form A
CG7049 0417 - Contractors General Liability Extension Endorsement
CA7115 1109 - Advantage Commercial Automobile Broad Form Endorsement
CUDS7102 0414 – Schedule of Underlying Insurance
CU0001 0413 - Commercial Liability Umbrella Coverage Form
CU7467 0323 - Additional Insured - Primary/Non-Contributory Coverage when Required by Written Contract, Written Agreement, or Certificate of Insurance
CU2401 0918 – Waiver of Transfer of Rights of Recovery Against Others to Us
WC000313 (Ed. 4-84) – Waiver of Our Right to Recover from Others Endorsement
WC990645 0714 – Notice of Cancellation or Renewal - Third Party
IL7066 0714 – Notice of Cancellation, Nonrenewal or Material Change – Third Party

Project: ITB 24-548 Asphalt, Paving, Striping & Overlay

Entities: Dekalb County School District and Dekalb County Board of Education

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CONTRACTORS GENERAL LIABILITY EXTENSION ENDORSEMENT

TABLE OF CONTENTS Page
1. Additional Definitions 9
2. Aggregate Limits Per Location 7
3. Aggregate Limits Per Project 7
4. Blanket Contractual Liability - Railroads 3
5. Broadened Bodily Injury Coverage 11
6. Broadened Knowledge Of Occurrence 8
7. Broadened Legal Liability Coverage For Landlord's Business Personal Property 8
8. Broadened Liability Coverage For Damage To Your Product And Your Work 10
9. Broadened Who Is An Insured 3
10. Co-Employee Bodily Injury Coverage for Managers, Supervisors, Directors or Officers 4
[see provision 9, Broadened Who Is An Insured, paragraph 2.a.(1)]
11. Contractual Liability - Personal And Advertising Injury 3
12. Damage To Premises Rented To You - Specific Perils and Increased Limit 7
13. Designated Com eted Projects - Amended Limits of Insurance 11
14. Extended Notice Of Cancellation And Nonrenewal 9
15. Incidental Malpractice Liability 7
16. Increased Medical Payments Limit And Reporting Period 7
17. Mobile Equipment Redefined 9
18. Nonowned Watercraft And Nonowned Aircraft (Hired, Rented Or Loaned With Paid Crew) 3
19. Product Recall Expense 2
20. Property Damage Liability - Alienated Premises 2
21. Property Damage Liability- Elevators And Sidetrack Agreements 2
22. Property Damage Liability- Property Loaned To The Insured Or Personal Property In The Care, 2
Custody And Control Of The Insured
23. Reasonable Force - Bodily Injury or Property Damage 10
24. Sup ementary Payments 3
25. Transfer Of Rights (Blanket Waiver Of Subrogation) 9
26. Unintentional Failure To Disclose Hazards 8

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CG 70 49 0417 Page 1 of 11
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Under SECTION I - COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, paragraph 2.
EXCLUSIONS, provisions 1. through 6. of this endorsement are excess over any valid and collectible insurance
(including any deductible) available to the insured, whether primary, excess or contingent (SECTION IV -
COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance is changed accordingly).
Provisions 1. through 6. of this endorsement amend the policy as follows:
1. PROPERTY DAMAGE LIABILITY - ALIENATED PREMISES
A. Exclusion j. Damage to Property, paragraph (2) is deleted.
B. The following paragraph is also deleted from Exclusion j. Damage to Property:
Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied,
rented or held for rental by you.
2. PROPERTY DAMAGE LIABILITY- ELEVATORS AND SIDETRACK AGREEMENTS
A. Exclusion j. Damage to Property, paragraphs (3), (4), and (6) do not apply to the use of elevators.
B. Exclusion k. Damage to Your Product does not apply to:
1. The use of elevators; or
2. Liability assumed under a sidetrack agreement.
3. PROPERTY DAMAGE LIABILITY - PROPERTY LOANED TO THE INSURED OR PERSONAL PROPERTY
IN THE CARE, CUSTODY AND CONTROL OF THE INSURED
A. Exclusion j. Damage to Property, paragraphs (3) and (4) are deleted.
B. Coverage under this provision 3. does not apply to "property damage" that exceeds $25,000 per
occurrence or $25,000 annual aggregate.
4. PRODUCTRECALLEXPENSE
A. Exclusion n. Recall Of Products, Work Or Impaired Property does not apply to "product recall
expenses" that you incur for the "covered recall" of "your product". This exception to the exclusion does
not apply to "product recall expenses" resulting from:
1. Failure of any products to accomplish their intended purpose;
2. Breach of warranties of fitness, quality, durability or performance;
3. Loss of customer approval or any cost incurred to regain customer approval;
4. Redistribution or replacement of "your product", which has been recalled, by like products or
substitutes;
5. Caprice or whim of the insured;
6. A condition likely to cause loss, about which any insured knew or had reason to know at the
inception of this insurance;
7. Asbestos, including loss, damage or clean up resulting from asbestos or asbestos containing
materials;
8. Recall of "your product(s)" that have no known or suspected defect solely because a known or
suspected defect in another of "your product(s)" has been found.
B. Under SECTION Ill - LIMITS OF INSURANCE, paragraph 3. is replaced in its entirety as follows and
paragraph 8. is added:
3. The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of:

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Page 2 of 11 CG 70 49 0417
a. Damages under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY
because of "bodily injury" and "property damage" included in the "products-completed
operations hazard" and
b. "Product recall expenses".
8. Subject to paragraph 5. above [of the CGL Coverage Form], $25,000 is the most we will pay for all
"product recall expenses" arising out of the same defect or deficiency.
5. NONOWNED WATERCRAFT AND NONOWNED AIRCRAFT (HIRED, RENTED OR LOANED WITH PAID
CREW)
Exclusion g. Aircraft, Auto or Watercraft, paragraph (2) is deleted and replaced with the following:
[This exclusion does not apply to:]
(2) A watercraft you do not own that is:
(a) Less than 75 feet long; and
(b) Not being used to carry any person or property for a charge;
Exclusion g. Aircraft, Auto or Watercraft, paragraph (6) is added as follows:
[This exclusion does not apply to:]
(6) An aircraft you do not own, provided that:
(a) The pilot in command holds a currently effective certificate issued by the duly constituted authority of
the United States of America or Canada, designating that person as a commercial or airline transport
pilot;
(b) The aircraft is rented to you with a trained, paid crew; and
(c) The aircraft is not being used to carry any person or property for a charge.
6. BLANKET CONTRACTUAL LIABILITY - RAILROADS
Under SECTION V - DEFINITIONS, paragraph c. of "Insured Contract" is deleted and replaced by the
following:
c. Any easement or license agreement;
'Under SECTION V - DEFINITIONS, paragraph f.(1) of "Insured Contract" is deleted.
7. CONTRACTUAL LIABILITY-PERSONAL AND ADVERTISING INJURY
Under SECTION I - COVERAGE B., paragraph 2. Exclusions, paragraph e. Contractual Liability is deleted.
8. SUPPLEMENTARY PAYMENTS
Under SECTION I-SUPPLEMENTARY PAYMENTS- COVERAGES A AND B, paragraphs 1.b. and 1.d.
are deleted and replaced with the following:
b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the
use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these
bonds.
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense
of the claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work.
9. BROADENED WHO IS AN INSURED
SECTION II - WHO IS AN INSURED is deleted and replaced with the following:
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business
of which you are the sole owner.

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CG 70 49 0417 Page 3 of 11
b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses
are also insureds, but only with respect to the conduct of your business.
c. A limited liability company, you are an insured. Your members are also insureds, but only with
respect to the conduct of your business. Your managers are insureds, but only with respect to their
duties as your managers.
d. An organization other than a partnership, joint venture or limited liability company, you are an
insured. Your "executive officers" and directors are insureds, but only with respect to their duties as
your officers or directors. Your stockholders are also insureds, but only with respect to their liability
as stockholders.
e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as
trustees.
2. Each of the following is also an insured:
a. Your "volunteer workers" only while performing duties related to the conduct of your business, or
your "employees," other than either your "executive officers," (if you are an organization other than a
partnership, joint venture or limited liability company) or your managers (if you are a limited liability
company), but only for acts within the scope of their employment by you or while performing duties
related to the conduct of your business. However, none of these "employees" or "volunteer workers"
are insured for:
(1) "Bodily injury" or "personal and advertising injury":
(a) To you, to your partners or members (if you are a partnership or joint venture), to your
members (if you are a limited liability company), to a co-"employee" while in the course of
his or her employment or performing duties related to the conduct of your business, or to
your other "volunteer workers" while performing duties related to the conduct of your
business;
(b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker"
as a consequence of paragraph (1)(a) above;
(c) For which there is any obligation to share damages with or repay someone else who must
pay damages because of the injury described in paragraphs (1)(a) or (b) above; or
(d) Arising out of his or her providing or failing to provide professional health care services
except as provided in provision 10. of this endorsement.
Paragraphs (1)(a), (1)(b) and (1)(c) above do not apply to your "employees" who are:
(i) Managers;
(ii) Supervisors;
(iii) Directors; or
(iv) Officers;
with respect to "bodily injury" to a co-"employee".
(2) "Property damage" to property:
(a) Owned, occupied or used by;
(b) Rented to, in the care, custody or control of, or over which physical control is being
exercised for any purpose by
you, any of your "employees," "volunteer workers", any partner or member (if you are a
partnership or joint venture), or any member (if you are a limited liability company).
b. Any person (other than your "employee" or "volunteer worker"), or any organization while acting as
your real estate manager.
c. Any person or organization having proper temporary custody of your property if you die, but only;

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Page 4 of 11 CG 70 49 0417
(1) With respect to liability arising out of the maintenance or use of that property; and
(2) Until your legal representative has been appointed.
d. Your legal representative if you die, but only with respect to duties as such. That representative will
have all your rights and duties under this Coverage Form.
e. Your subsidiaries if:
(1) They are legally incorporated entities; and
(2) You own more than 50% of the voting stock in such subsidiaries as of the effective date of this
policy.
If such subsidiaries are not shown in the Declarations, you must report them to us within 180 days of
the inception of your original policy.
f. Any person or organization, including any manager, owner, lessor, mortgagee, assignee or receiver
of premises, to whom you are obligated under a written contract to provide insurance such as is
afforded by this policy, but only with respect to liability arising out of the ownership, maintenance or
use of that part of any premises or land leased to you, including common or public areas about such
premises or land if so required in the contract.
However, no such person or organization is an insured with respect to:
(1) Any "occurrence" that takes place after you cease to occupy or lease that premises or land; or
(2) Structural alterations, new construction or demolition operations performed by or on behalf of
such person or organization.
g. Any state or political subdivision but only as respects legal liability incurred by the state or political
subdivision solely because it has issued a permit with respect to operations performed by you or on
your behalf.
However, no state or political subdivision is an insured with respect to:
(1) "Bodily injury", "property damage", and "personal and advertising injury" arising out of
operations performed for the state or municipality; or
(2) "Bodily injury" or "property damage" included within the "products-completed operations
hazard."
h. Any person or organization who is the lessor of equipment leased to you to whom you are obligated
under a written contact to provide insurance such as is afforded by this policy, but only with respect
to their liability arising out of the maintenance, operation or use of such equipment by you or a
subcontractor on your behalf with your permission and under your supervision.
However, no such person or organization is an insured with respect to any "occurrence" that takes
place after the equipment lease expires.
i. Any architect, engineer, or surveyor engaged by you under a written contract but only with respect to
liability arising out of your premises or "your work."
However, no architect, engineer, or surveyor is an insured with respect to "bodily injury," "property
damage," or "personal and advertising injury" arising out of the rendering of or the failure to render
any professional services by or for you, including:
(1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports,
surveys, change orders, designs or specifications; or
(2) Supervisory, inspection, or engineering services.
This paragraph i. does not apply if a separate Additional Insured endorsement providing liability
coverage for architects, engineers, or surveyors engaged by you is attached to the policy.
If the written contract, written agreement, or certificate of insurance requires primary and non-contributory
coverage, the insurance provided by paragraphs f. through i. above will be primary and non-contributory

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CG 70 49 0417 Page 5 of 11
relative to other insurance available to the additional insured which covers that person or organization as
a Named Insured, and we will not share with that other insurance.
3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability
company and over which you maintain ownership or majority interest, will qualify as a Named Insured if
there is no other similar insurance available to that organization. However:
a. Coverage under this provision is afforded until the end of the policy period.
b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired
or formed the organization.
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed
before you acquired or formed the organization.
d. Coverage A does not apply to "product recall expense" arising out of any withdrawal or recall that
occurred before you acquired or formed the organization.
4. Any person or organization (referred to below as vendor) with whom you agreed under a written contract
to provide insurance is an insured, but only with respect to "bodily injury" or "property damage" arising out
of "your products" that are distributed or sold in the regular course of the vendor's business.
However, no such person or organization is an insured with respect to:
a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of
the assumption of liability in a contract or agreement. This exclusion does not apply to liability for
damages that the vendor would have in the absence of the contract or agreement.
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in "your product" made intentionally by the vendor;
d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or
the substitution of parts under instructions from the manufacturer, and then repackaged in the
original container;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to
make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of "your products";
f. Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of "your product";
g. "Your products" which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor.
h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts
or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion
does not apply to:
(1) The exceptions contained in subparagraphs d. or f.; or
(2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale
of the products.
This paragraph 4. does not apply to any insured person or organization from which you have acquired
"your product", or any ingredient, part, or container, entering into, accompanying or containing "your
product". This paragraph 4. also does not apply if a separate Additional Insured endorsement, providing
liability coverage for "bodily injury" or "property damage" arising out of "your product" that is distributed or
sold in the regular course of a vendor's business, is attached to the policy.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
venture or limited liability company that is not shown as a Named Insured in the Declarations.

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10. INCIDENTAL MALPRACTICE LIABILITY
As respects provision 9., SECTION II -WHO IS AN INSURED, paragraph 2.a.(1)(d) does not apply to any
nurse, emergency medical technician or paramedic employed by you to provide medical or paramedical
services, provided that you are not engaged in the business or occupation of providing such services, and
your "employee" does not have any other insurance that would also cover claims arising under this provision,
whether the other insurance is primary, excess, contingent or on any other basis.
Under SECTION II - LIMITS OF INSURANCE, provisions 11. through 14. of this endorsement amend the policy as
follows:
11. AGGREGATE LIMITS PER PROJECT
The General Aggregate Limit applies separately to each of your construction projects away from premises
owned by or rented to you.
12. AGGREGATE LIMITS PER LOCATION
The General Aggregate Limit applies separately to each of your locations, but only when required by written
contract, written agreement or certificate of insurance. As respects this provision 12., your locations are
premises you own, rent or use involving the same or connecting lots or premises whose connection is
interrupted only by a street, roadway, waterway or right-of-way of a railroad. However, your locations do not
include any premises where you, or others acting on your behalf, are performing construction operations.

13. INCREASED MEDICAL PAYMENTS LIMIT
A. SECTION Ill - LIMITS OF INSURANCE, paragraph 7., the Medical Expense Limit, is subject to all of the
terms of SECTION Ill - LIMITS OF INSURANCE and is the greater of:
1. $10,000;or
2. The amount shown in the Declarations for Medical Expense Limit.
B. This provision 13. does not apply if COVERAGE C MEDICAL PAYMENTS is excluded either by the
provisions of the Coverage Form or by endorsement.
14. DAMAGE TO PREMISES RENTED TO YOU - SPECIFIC PERILS AND INCREASED LIMIT
A. The word fire is changed to "specific perils" where it appears in:
1. The last paragraph of SECTION I - COVERAGE A, paragraph 2. Exclusions;
2. SECTION IV, paragraph 4.b. Excess Insurance.
B. The Limits of Insurance shown in the Declarations will apply to all damage proximately caused by the
same event, whether such damage results from a "specific peril" or any combination of "specific perils."
C. The Damage To Premises Rented To You Limit described in SECTION Ill - LIMITS OF INSURANCE,
paragraph 6., is replaced by a new limit, which is the greater of:
1. $1,000,000; or
2. The amount shown in the Declarations for Damage To Premises Rented To You Limit.
D. This provision 14. does not apply if the Damage To Premises Rented To You Limit of SECTION! -
COVERAGE A is excluded either by the provisions of the Coverage Form or by endorsement.
E. "Specific Perils" means fire; lightning; explosion; windstorm or hail; smoke; aircraft or vehicles; riot or civil
commotion; vandalism; leakage from fire extinguishing equipment; weight of snow, ice or sleet; or "water
damage".
"Water damage" means accidental discharge or leakage of water or steam as the direct result of the
breaking or cracking of any part of a system or appliance containing water or steam.
15. BROADENED LEGAL LIABILITY COVERAGE FOR LANDLORD'S BUSINESS PERSONAL PROPERTY
Under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2.

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Exclusions, j. Damage to Property, the first paragraph following paragraph (6) is deleted and replaced with
the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to
a landlord's business personal property that is subject to, or part of, a premises lease or rental agreement with
that landlord.
The most we will pay for damages under this provision 15. is $10,000. A $250 deductible applies.
Under SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, provisions 16. through 18. of this
endorsement amend the policy as follows:
16. BROADENED KNOWLEDGE OF OCCURRENCE
Under 2. Duties In The Event Of Occurrence, Offense, Claim, Or Suit, paragraph a. is deleted and replaced
and paragraphs e. and f. are added as follows:
a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense,
regardless of the amount, which may result in a claim. Knowledge of an "occurrence" or an offense by
your "employee(s)" shall not, in itself, constitute knowledge to you unless one of your partners, members,
"executive officers", directors, or managers has knowledge of the "occurrence" or offense. To the extent
possible, notice should include:
(1) How, when and where the "occurrence" or offense took place;
(2) The names and addresses of any injured persons and witnesses; and
(3) The nature and location of any injury or damage arising out of the "occurrence" or offense.
e. If you report an "occurrence" to your workers compensation carrier that develops into a liability claim for
which coverage is provided by this Coverage Form, failure to report such an "occurrence" to us at the
time of the "occurrence" shall not be deemed a violation of paragraphs a., b., and c. above. However,
you shall give written notice of this "occurrence" to us as soon you become aware that this "occurrence"
may be a liability claim rather than a workers compensation claim.
f. You must see to it that the following are done in the event of an actual or anticipated "covered recall" that
may result in "product recall expense":
(1) Give us prompt notice of any discovery or notification that "your product" must be withdrawn or
recalled. Include a description of "your product" and the reason for the withdrawal or recall;
(2) Cease any further release, shipment, consignment or any other method of distribution of like or
similar products until it has been determined that all such products are free from defects that could
be a cause of loss under the insurance.
17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
Paragraph 6. Representations is deleted and replaced with the following:
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accurate and complete;
b. Those statements are based upon representations you made to us;
c. We have issued this policy in reliance upon your representations; and
d. This policy is void in any case of fraud by you as it relates to this policy or any claim under this
policy.
We will not deny coverage under this Coverage Form if you unintentionally fail to disclose all hazards
existing as of the inception date of this policy. You must report to us any knowledge of an error or
omission in the description of any premises or operations intended to be covered by this Coverage Form
as soon as practicable after its discovery. However, this provision does not affect our right to collect
additional premium or exercise our right of cancellation or nonrenewal.

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18. TRANSFER OF RIGHTS (BLANKET WAIVER OF SUBROGATION)
Paragraph 8. Transfer of Rights Of Recovery Against Others To Us is deleted and replaced with the
following:
8. If the insured has rights to recover all or part of any payment we have made under this Coverage Form,
those rights are transferred to us. The insured must do nothing after loss to impair them. At our request,
the insured will bring "suit" or transfer those rights to us and help us enforce them. However, if the
insured has waived rights to recover through a written contract, or if "your work" was commenced under a
letter of intent or work order, subject to a subsequent reduction to writing with customers whose
customary contracts require a waiver, we waive any right of recovery we may have under this Coverage
Form.
19. EXTENDED NOTICE OF CANCELLATION AND NONRENEWAL
Paragraph 2.b. of A. Cancellation of the COMMON POLICY CONDITIONS is deleted and replaced with the
following:
b. 60 days before the effective date of the cancellation if we cancel for any other reason.
Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 9. When We Do Not
Renew is deleted and replaced with the following:
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured
shown in the Declarations written notice of the nonrenewal not less than 60 days before the
expiration date.
If notice is mailed, proof of mailing will be sufficient proof of notice.
20. MOBILE EQUIPMENT REDEFINED
Under SECTION V - DEFINITIONS, paragraph 12. "Mobile equipment", paragraph f. (1) does not apply to
self-propelled vehicles of less than 1,000 pounds gross vehicle weight.
21. ADDITIONAL DEFINITIONS
1. SECTION V - DEFINITIONS, paragraph 4. "Coverage territory" is replaced by the following definition:
"Coverage territory" means anywhere in the world with respect to liability arising out of "bodily injury,"
"property damage," or "personal and advertising injury," including "personal and advertising injury"
offenses that take place through the Internet or similar electronic means of communication provided the
insured's responsibility to pay damages is determined in a settlement to which we agree or in a "suit" on
the merits, in the United States of America (including its territories and possessions), Puerto Rico and
Canada.
2. SECTION V - DEFINITIONS is amended by the addition of the following definitions:
"Covered recall" means a recall made necessary because you or a government body has determined that
a known or suspected defect, deficiency, inadequacy, or dangerous condition in "your product" has
resulted or will result in "bodily injury" or "property damage".
"Product Recall expenses" mean only reasonable and necessary extra costs, which result from or are
related to the recall or withdrawal of "your product" for:
a. Telephone and telegraphic communication, radio or television announcements, computer time and
newspaper advertising;
b. Stationery, envelopes, production of announcements and postage or facsimiles;
c. Remuneration paid to regular employees for necessary overtime or authorized travel expense;
d. Temporary hiring by you or by agents designated by you of persons, other than your regular
employees, to perform necessary tasks;
e. Rental of necessary additional warehouse or storage space;

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CG 70 49 0417 Page 9 of 11
f. Packaging of or transportation or shipping of defective products to the location you designate; and
g. Disposal of "your products" that cannot be reused. Disposal expenses do not include:
(1) Expenses that exceed the original cost of the materials incurred to manufacture or process
such product; and
(2) Expenses that exceed the cost of normal trash discarding or disposal, except as are necessary
to avoid "bodily injury" or "property damage".
22. REASONABLE FORCE - BODILY INJURY OR PROPERTY DAMAGE
Under SECTION I - COVERAGE A., paragraph 2. Exclusions, subparagraph a. Expected Or Intended
Injury is deleted and replaced with the following:
[This insurance does not apply to:]
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This
exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force
to protect persons or property.
23. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK
A. Under SECTION I - COVERAGE A., paragraph 2. Exclusions, exclusion k. Damage to Your Product
and exclusion I. Damage to Your Work are deleted and replaced with the following:
[This insurance does not apply to:]
k. Damage to Your Product
"Property damage" to "your product" arising out of it or any part of it, except when caused by or
resulting from:
(1) Fire;
(2) Smoke:
(3) "Collapse"; or
(4) Explosion.
For purposes of exclusion k. above, "collapse" means an abrupt falling down or caving in of a
building or any part of a building with the result that the building or part of the building cannot be
occupied for its intended purpose.
I. Damage to Your Work
"Property damage" to "your work" arising out of it or any part of it and included in the
"products-completed operations hazard". This exclusion does not apply:
(1) If the damaged work or the work out of which the damage arises was performed on your behalf
by a subcontractor; or
(2) If the cause of loss to the damaged work arises as a result of:
(a) Fire;
(b) Smoke;
(c) "Collapse"; or
(d) Explosion.
For purposes of exclusion I. above, "collapse" means an abrupt falling down or caving in of a
building or any part of a building with the result that the building or part of the building cannot be
occupied for its intended purpose.
B. The following paragraph is added to SECTION Ill - LIMITS OF INSURANCE:

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11
Subject to 5. above [of the CGL Coverage Form], $100,000 is the most we will pay under Coverage A for
the sum of damages arising out of any one "occurrence" because of "property damage" to "your product"
and "your work" that is caused by fire, smoke, collapse or explosion and is included within the
"product-completed operations hazard". This sublimit does not apply to "property damage" to "your work"
if the damaged work, or the work out of which the damage arises, was performed on your behalf by a
subcontractor.
24. BROADENED BODILY INJURY COVERAGE
Under SECTION V - DEFINITIONS, the definition of "bodily injury" is deleted and replaced with the following:
3. "Bodily injury"
a. Means physical:
(1) Injury;
(2) Disability;
(3) Sickness; or
(4) Disease;
sustained by a person, including death resulting from any of these at any time.
b. Includes mental:
(5) Anguish;
(6) Injury;
(7) Humiliation;
(8) Fright; or
(9) Shock;
directly resulting from any "bodily injury" described in paragraph 3.a.
c. All "bodily injury" described in paragraph 3.b. shall be deemed to have occurred at the time the
"bodily injury" described in paragraph 3.a. occurred.
25. DESIGNATED COMPLETED PROJECTS -AMENDED LIMITS OF INSURANCE
When a written contract or written agreement between you and another party requires project-specific limits of
insurance exceeding the limits of this policy;
A. for "bodily injury" or "property damage" that occurs within any policy period for which we provided
coverage; and
B. for "your work" performed within the "products-completed operation hazard"; and
C. for which we previously issued Amendment Of Limits Of Insurance (Designated Project Or Premises) CG
71 94 either during this policy term or a prior policy term; and
D. that designated project is now complete;
the limits of insurance shown in the CG 71 94 schedule will replace the limits of insurance of this policy for the
designated project and will continue to apply for the amount of time the written contract or written agreement
requires, subject to the state statute of repose for the project location. These limits are inclusive of and not in
addition to the replaced limits.

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Agenda Item