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POLICY NUMBER: 360-93-69 COMMERCIAL GENERAL LIABILITY <br /> CG20101219 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED - OWNERS, LESSEES OR <br /> CONTRACTORS - SCHEDULED PERSON OR <br /> ORGANIZATION <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> SCHEDULE <br /> Name Of Additional Insured Person(s) <br /> Or Organization(s) Locations Of Covered Operations <br /> PARTIES CONTRACTED FOR ADDITIONAL PER THE CONTRACT OR AGREEMENT <br /> INSURED STATUS <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these <br /> include as an additional insured the person(s) or additional insureds, the following additional <br /> organization(s) shown in the Schedule, but only exclusions apply: <br /> with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or <br /> damage" or "personal and advertising injury" "property damage" occurring after: <br /> caused, in whole or in part, by: <br /> 1. All work, including materials, parts or <br /> 1. Your acts or omissions; or equipment furnished in connection with such <br /> 2. The acts or omissions of those acting on your work, on the project (other than service, <br /> behalf; maintenance or repairs) to be performed by or <br /> in the performance of your ongoing operations for on behalf of the additional insured(s) at the <br /> the additional insured(s) at the location(s) location of the covered operations has been <br /> designated above. completed; or <br /> However: 2. That portion of "your work" out of which the <br /> 1. The insurance afforded to such additional injury or damage arises has been put to its <br /> intended use by any person or organization <br /> insured only applies to the extent permitted by other than another contractor or subcontractor <br /> law; and engaged in performing operations for a <br /> 2. If coverage provided to the additional insured is principal as a part of the same project. <br /> required by a contract or agreement, the <br /> insurance afforded to such additional insured <br /> will not be broader than that which you are <br /> required by the contract or agreement to <br /> provide for such additional insured. <br /> oR,N F RiskMougementDMslcrn <br /> a� REVIEWED&APPROVED BY. <br /> tq t�ceva�o <br /> — J Risk Management Specialist <br /> CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 <br />