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Named Insured <br />Endorsement hiumber <br />Dr. Maureen Sassoon <br />Policy Symbol <br />Policy Number <br />Elfective Date of Endorsement <br />ECP <br />=07/0'112016to07/01/2097 <br />0710112016 <br />Issued 9y (Name of Insurance Company) <br />WastcheSter Surplus Lines Insurance Company <br />Insert tiro popsy number. The remainder pf the Information is W be 6ompteted only when this endorsement is issued subsequent tD the preparation & the policy. <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS <br />(PRIMARY AND NOWCONTRIBUTORY) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />CONTRACTOR'S POLLUTION LIABILITY COVERAGE <br />SCHEDULE: <br />Name of Person or Organization: <br />Any person or organization that is an owner of real property or personal property on which you are performing <br />operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of <br />such person or organization to you, wherein such request is made prior to commencement of operations. <br />(If no erAry aramears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />SECTION 11 -WHO IS AN INSURED is amended to include: <br />A. SECTION 11 - WHO IS AN INSURED is amended to include as an insured the person or organization shown In the <br />Schedule, but only with respect to liability arising out of your ongoing operations perforated for that Insured_ <br />B. With respect to the Insurance: afforded to these additional insureds, the following exclusion is added, <br />2. Exclusions <br />This insurance does not apply to bodily Injury or property damage occurring after: <br />(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other <br />than service, maintenance or repairs) to be performed by or an behalf of the additional insured(s) at the site of <br />the covered operations has been completed; or <br />(2) That partisan Qf your work out of which the injury or damage arises has been put to its intended use by any <br />person or organization other than another contractor or subcontractor engaged in performing operations for a <br />principal as a part of the same project. <br />C. The C=overage provided hereunder shall be primary and not contributing with any other insurance available to those <br />designated above under any other third party liability policy. <br />ENV -3101 (08-04) Includes copyrighted material of Insumnce Services (office, Inc. with its permission <br />Page 1 of 1 <br />