HomeMy WebLinkAboutMGT OF AMERICA CONSULTING, LLCINSURANCE NOT ON FILE A-2018-193
WORK MAY N_Qj PROCEED
CLERK OF COUNCIL
DATE:SEP 1 2 2018 FIRST AMENDMENT TO CONSULTANT
AGREEMENT WITH MGT OF AMERICA CONSULTING, LLC
THIS FIRST AMENDMENT TO AGREEMENT is entered into this 21st day of August 2018, by
and between MGT of America, LLC, the parent company of MGT of America Consulting, LLC
("Consultant"), and the City of Santa Ana, a charter city and municipal corporation duly organized
and existing under the Constitution and laws of the State of California ("City").
RECITAL
A. On September 19, 2017, the City entered into Agreement #A-2017-251 with Consultant to
prepare applicable State Mandated Cost Reimbursement claims for the term of September 19,
2017 through September 18, 2018. The current. term of the Agreement is still in effect and
allows for a one-year option to extend the term.
B. The Agreement is a continuance of services initially provided under Agreement A-2016-199,
pursuant to RIP 13-035. Included within the services requested under the RFI` and
Agreement A-2016-199 were fees and rates for annual claims under SB 90.
C. In preparing the draft for Agreement A-2017-251, the parties inadvertently did not include
reference for services provided for State Mandated Cost Reimbursement claims under SB 90.
D hi accordance with the Umus, and conditions of the Agreement, the parties desire to amend
the Scope of Services and the Compensation amount of the Agreement to reflect services
provided by the Consultant to cover costs incurred for State Mandated Cost Reimbursement
claims under SB 90,
E. The City also recognizes the change in the Consultant's reorganization of its corporate
structure that occurred on November 17, 2017, The City shall refer to the Consultant, for the
purpose of this Agreement, as MGT of America Consulting, LLC, effective as of the date of
this First Amendment.
THE PARTIES THEREFORE AGREE:
I, Section 1, SCOPE OF SERVICES, shall be amended to include the attached Exhibit B
as an additional scope of services to this Agreement.
2. Section 2, COMPENSATION, shall be amended to increase the annual sum, as detailed
in the attached invoices attached hereto as Exhibit C. The total costs for the services
provided in Exhibit C shall not exceed $11,400. The total amount to be expended under
the amended terms of this Agreement shall not exceed $56,525.
Except as hereinabove modified in this First Amendment, the terms and conditions of said Agreement
remain uncharged and in full force and effic&
Page 1 of 2
IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the
Agreement the date and year first above written.
ATTEST:
MARIA D. HUIZAR
Clerk of the Council
APPROVED AS TO FORM:
Sonia R. Carvalho, City Attorney
By: T mars o osian
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
entm
Chief of Police
CITY OF SANTA ANA
' /,� .�
UL GO 1NE 1 _
City Manager "
MGT OF AMERICA CONSULTING, LLC
Page 2 of 2
Exhibit B
Description of Scope/ Services to be performed by the Consultant
A. Prepare and submit cost claims for FY 2016-2017 in in accordance with the
annual claiming instructions and deadlines provided by the State (February 15,
2018)
B. Facilitate department interviews to document and understand how the City
complies with each eligible mandate reimbursement program
C. Prepare and submit other new or first-time cost claims pursuant to the State
Controller's Office (SCO) claiming instructions which are issued in accordance
with parameters and guidelines received from the Commission on State
Mandates and mailed to local agencies during the fiscal year
D. Prepare all eligible City claims that exceed the State minimum of $1,000. Review
the claims for completeness, propriety and eligibility of costs
E. Discuss any edits with appropriate City member, provide completed claims to
City for review and signature by no later than three weeks prior to State claiming
deadlines
F. File/ deliver the executed claims with the SCO prior to claiming deadline(s)
G. Provide assistance to the City in responding to inquiries about and/ or defending
the claims filed by the City that are audited or desk reviewed by the Office of the
State Controller
H. Monitor the general payment status of all claims submitted and still due on behalf
of the City/ County pursuant to SB 90 claims due from the State
I. Assist the City with any claims filed by MGT of America that are audited by the
SCO
J. Provide on- going support and status updates related to the anticipated changes
in the claiming process arena of state government
7116/2018
INVOICE
Invoice for FSW I FY18 I City of Santa Ana I SB90 I FY17 ICA 18624 1 MGT of America Consulting, LLC
Exhibit C
Project: FSW I FY18 1 City of Santa Ana I SB90
FY17 I CA 1 8624
Invoice #32085 due October 07, 2017
STATUS: Late (282 days over)
ISSUE DATE: September 07, 2017
PAYMENT SCHEDULE: Net 30
STATEMENT OF SERVICES
TITLE
Annual SB 90 Claiming
MESSAGE
++* M G T
CONSULTING GROUP
TO: City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Attn:JasmineYu, CPA
Sr. Accountant
jyu@santa-ana.org
FROM: MGT of America Consulting,
LLC
4320 West Kennedy, Suite 200, Tampa FL
33609
PHONE: 813-327-4717
Employer Identification Number: 81-0878597
SUBTOTAL
$2,850.00
Fixed Fee $2,850.00
Total $2,850.00
First quarterly invoice for State Mandate Cost Claiming (SB 90) services provided during FY 17-18 fiscal year
Jul -Aug -Sep 2017
Terms: Total amount due within 30 days of invoice date. A service charge of 1 1/2% per month will be assessed on any unpaid balance over 60 days.
https://mgteonsulting.mavenlink.com/invoices/2940595 1l1
7/16/2018
Invoice for FSW I FY18 I City of Santa Ana I SB901 FY17 ICA 18624 1 MGT of America Consulting, LLC
INVOICE
Project: FSW I FY18 I City of Santa Ana SB90
FY17 I CA 1 8624
I nvo ice #32775 due January 28, 2018
STATUS: Late (169 days over)
ISSUE DATE: December 29, 2017
PAYMENT SCHEDULE: Net 30
STATEMENT OF SERVICES
TITLE
Annual SB 90 Claiming
Q2 SB 90 services, for 2016-17 actual claims due 2/15/18.
Terms: Total amount due within 15 days of invoice date. A service charge of 1 1/2% per
month will be assessed on any unpaid balance over 60 days.
+m`1* MGT
CONSUIT[NG Gflt1UP
TO: City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Attn: jasmine Yu, CPA
Sr. Accountant
jyu@santa-ana.org
FROM: MGT of America Consulting,
LLC
4320 West Kennedy, Suite 200, Tampa Fl -
33609
PHONE: 813-327-4717
Employer Identification Number: 81-0878597
AMOUNT
$2,850.00
https://mgtconsulting.mavenlink.com/invoices/3310215 1/1
7/16/2018
Invoice for FSW I FY18 I City of Santa Ana I SB90 I FY17 ICA 18624 1 MGT of America Consulting, LLC
INVOICE
Project: FSW I FY18 1 City of Santa Ana SB90
FY17 I CA 18624
Invoice #33298 due April 25, 2018
STATUS: Late (82 days over)
ISSUE DATE: March 26, 2018
PAYMENT SCHEDULE: Net 30
STATEMENT OF SERVICES
TITLE
Annual SB 90 Claiming
MESSAGE
l MGT
CONSULTING GROUP
TO: City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Attn: Jasmine Yu, CPA
Sr. Accountant'.
jyu@santa-ana.org
FROM: MGT of America Consulting,
LLC
4320 West Kennedy, Suite 200, Tampa FL
33609
PHONE: 813-327-4717 1
Employer Identification Number: 81-0878597
AMOUNT
$2,850.00
Fixed Fee $2,850.00
Total $2,850.00
3rd quarterly invoice for State Mandate Cost Claiming (SB 90) services provided during FY 17-18 fiscal year
Jan -Feb -Mar 2018
Terms: Total amount due within 30 days of invoice date.
https:/Imgtconsulting.mavenlink.com/invoices/3636315 1l1
7/16/2018
NVOICE
Invoice for FSW I FY18 I City of Santa Ana I SB90 I FY17 ICA 18624 1 MGT of America Consulting, LLC
Project: FSW I FY18 I City of Santa Ana I SB90
FY17 I CA 18624
Invoice #33434 due May 30, 2018
STATUS; Late (47 days over)
ISSUE DATE: April 30, 2018
PAYMENT SCHEDULE: Net 30
STATEMENT OF SERVICES
TITLE
Annual SB 90 Claiming
MESSAGE
49'1 MGT
CONSULTING GROUP
TO: City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Attn: jasmine Yu, CPA
Sr. Accountant
jyu@santa-ana.org
FROM: MGT of America Consulting,
LLC
4320 West Kennedy, Suite 200, Tampa Fl -
33609
L33609
PHONE: 813-327-4717
Employer Identification Number: 81-0878597
AMOUNT
$2,850.00
Fixed Fee $2,850.00
i
Total $2,850.00
4th quarterly invoice for State Mandate Cost Claiming (SB 90) services provided during FY 17-18 fiscal year
Apr -May -Jun 2018
Tents: Total amount due within 30 days of invoice date.
https://mgtconsulting.mavenlink.com/invoices/3767125 1l1
Itvsru CERTIFICATE OF LIABILITY INSURANCE
DATE (MhIIDDIYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICq TE301 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 1110 certificate holder Is an ADDITIONAL INSURED, the policy(lee) ,at have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, 00110111 policies may require an endorsement. A statement on
tills an IFlcaa does not confer rights 10 the. Certificate holderin III r,r—eh o,.,,,..o,,........,_,
g r)acy, Inc.
FL 32317
INSURED MGTOF-1
MGT of America, LLC
MGT of America Consulting, LLC
3800 Esplanade Way Ste 210
Tallahassee FL 32311
r-rtlmr THAI IME POLICIES OF INSURANCE LISTEL
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURAN
EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. I.I NUTR eNnm,
IN6R
I,Tft
1YPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
E
X
OLAIMS�MAOE X❑ OCCUR
X--
E -X lir
GEN'L
AGGREGATE LIMIT APPLIES PER',
X _
POLICY rJ jEOT [ LOC
OTHER'.
E
AU'
rOMOSILELIABILITY
ANY AU 10
OVVNGD SCHEDULED
AUTOS gNLV AUTOS
X
NON OWNED
AM US ONLY UTOSONLY
X
�X.
A -XV Rating
A
X
UMERELLALIAR X OCCUR
X
EXCESS LIAB CLAIMS -MADE
DED X RETENTION 10,000
B
WORXERSCOMPENSATION
C
AND EMPLOYERS' LIABILITY
YIN
ANY PRUPRIFTDRIPAR I NER/EXECUTIVE
OFFICI RIMEMBER E%CUMEw ❑ N
(MandEWry In NRI
If y.e, d..rh. under
DESCRIPTION OF OPERATIONS b,eo
D
Pmfesslanal Llahlllly(E&OI
Claima-Mede Form
715/95 Retro Date/A++XV
Y
Y
IA
V I N 1105638880
UNUITION OF ANY CONTRACT OR OTHER DOCUMENT WITH
E AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB
MAY HAVE BEEN REDUCED BY PAID CLAIMS,
7/112017 1 7/112018
BODILY INJURY (Per
EODILY INJURY ran,
EACH
ECT TO WHICH THIS
TO ALL THE; TERMS,
2,600,000
5,000,U00
UeeGNu91UN OF OPERATIONS I LOCATIONS I VEHICLES (ACORD'101, AddidInnl Remarks Rchedule, may he attached if more apaee is required)
Umbrella: A XV Rating, All Other Workers' Comp & CA Workers' Comp: A -XV Rating. ,y
CA- Workers' comp Employers Liability Limits: tQEVIEWEU,..- rr�,�
$1,000,000 Each Accident Y 9 y r I )11'() y,
$1000,000 Disease Policy Limit a Mararet'IIIfrrat51:44pat, ct,71,2017
$1,000,000 Disease Each Employee
Cyber Liability, Continental Casualty Company -Limits of Liability $1,000,000/$1,0OQ000 Retention $10,000 Reto Date 3/30/2017-Clalms
Made Effective 3/30/17 - 3/30/2018
City of Santa Ane
20 Civic Center Plaza (M-30)
P.O. Box 1068
Santa Ana CA 92702-1088
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 26 2016/08 The ACORD name <�., � r OUlau UUNYURATION. All
( ) and logo are registered marks of ACORD
AUTOMOBILE ADDITIONAL INSURED & WAIVER OF SUBROGATION
I- Me Is An Insured
Tho- following wa "insureds
a. You for any covered "nut,)",
b. Anyone ciao while using with your permission a covered "auto' you own, hire or borraw except;
(1) Tho awaror or anyone alga fano whom YOU hire or borrow a cnverad "aura'". Phis axaeptiaar dare
not apply if tile covered "auto" Is a "trailer" Connected to a SOcovred sero" you own.
household.
(o) Your "ornployaa'° if the covered "cut is owned by that"employco" or a member of his or her
(3) Sorueone using a covered "auto' while he Wr sba is working in a bushtcss of aell ing, servicteR,
repatriu$° parking or stnrbtg "autos" unlcsa that businass is yuma.
(4) Anyone adrar than your "employees", parincrs (if you are a parnrurship), anambers (if you w'e a
1invitedliabilityered auto oraleasoC�ar Gorrnwer or coy or their"ornploycea", while morin$ pruparty,
to or hon a covered "auto",
(s)erpaHnar(ifYou are ainlorrahip),oranromhar(tfyouoroaInheredliabilityaompauyjfora
cnver«1 "nolo"' owned by bin ahm• ar a mewnber of his or her household.
a. Anyone liable for the conduct of an °'insured" described above but only 4'o the extant of Wet liability.
Provides "additional
inauruf'slatus
S. Transfer Elf Rights Of Recovery Agalast oth Pro fa Us
ffmyperson or arg'ad"din" to ar for whom we make payment under. this Coverage Fomr has rights to
refnver damage, frown another, those rights we.Irn chuI ed to am. That person ve ageSoulgFrntl [I moor is
do
overyth og neeescary to secure our rights
^anti
i least dooathing atter "accident" or "loss" to impair them.
01 cy tOmMiCaglypermf—is ....-
waiver of suhranation J
CEIIE t Mercer a t5 (pt8'fy..
Puniness Auto Policy
MGT Of America Coneulting, LLC Policy 2093563501
a,
C
Owned Autos You Acquire After The policy
"aging
1. if Symbols 1, 2, a, 4, 4, 4 or 14 oro entorad nerd
10 a COvoroge In Item Two of the Declarations,
then you have Overage for 'autos' that you
acqulrO of U's typo descnbod tar the vemalnder
of the policy period.
2. Bill, tl symbol T is entered next to a coverage in
item T"O Of the Beolorallons, an 'avec' you
SOON will be a covered 'auto' lot that
ocveregeonly l;
e. We already cover all °aulos' that you own
for That coverage or II raplacoa en 'auto'
You Previously owned thal had ihot
coverage; and
Is. You tell us wihln e4 days after You acquire
it that you want us to cover it tar Thal
coverage.
COdain rraltara, 1110111016 E'quiPmarn And
Temporary SW"thurg Aufos
if Llabllly Coverage Is provided by fill$ Coverage
Form, the following typas of vehicles are also
covered autos, for Uablley Coverage:
1. 'Trailers' with a load capacity of 2,000 pounds
ar less designed primarily for travel On public
roads.
2. 'Mobpa 04ulpmani' whte using carried or towed
by a covarod °auto,'
3. Any 'auto" you to not own whle used with ")a
Permission 61 Its
owner
substitute fora cove red own artthart Is
DWI of service because of fta,
a.
Breakdown;
b.
Repair;
C,
Servicing;
d.
'Lass•; or
e,
DaAlruolton.
SEC99[rff R•-LIASILfTy COVERAGE
A. Covarrage
WO will PAY all sums an 'Insured' legally mugl pay
ea 4IMS908 bscause of 'bodily injury' or 'pmp$dy
damage' le which this Inautance applies, caused by
On 'accident' and msulling from the ownarehlp,
matnlsnanca or use of a covered *auto. -
We will also pay Oil SUMO an'Jore rad' legally must
pOY ac A 'Covered polkdkm coat or expense' is
which Uses tn"11410 APPllss, caused by an
'ecotdunt' and mau0ing from the ownership,
an'"ReancA Or use of covered 'autos" However.
we will only pay for the 'covarod pollution cast or
axpe1180' 11 UsOrg W allhar'bodlly injury" or -Property
damage' 10 Which this IngurOnng Applies that Is
caused by the some'acckgnV
We have the right and duly Is defend Any 'Insured'
ngalnat a 'suit' asking for ouch damages or a
'Covered pollution cost or expense.' However, we
havO no duly to defend any insured, Agalnat a'Suit,
$$eking damages kw 'bodily inlurY' or 'property
damage, or a 'covered pollutlon meat or expanse' to
which NO Insurance does not apply. We may
tnveatlgam and calla any claim or 'out,' as we
consider tle
code when the Liability Coverage Limit of Insurato defend or nce
has been exhauatad by payment of judgments or
soblamant$,
I. Who le An Inaurod
The following Org'irfaurede';
G. You for any covered -Auto,-
Is. Anyone else while using with your
permlealun a covered 'auto, vow Own, hire
or borrow except:
(1) The Owner ar anyone else team whom
You hire or borrow a covered 'auto '
Thlo exdmtalon does not apply If the
covered 'auto' Is a 'Irapa?' connected
to a covered 'auto, you Own.
(2) Your'Amplopee' d the Cowered "sum^ is
owned by that "emPloyoe' or a member
Of his or her househOlrL
($I GOIROalm using a covered 'auto• while
I's or she Is working In a business of
culling, sowlcing, rapaidng, parking or
eloring'autos' unless that business is
youre.
(4) Anyone other than your 'emplayeeg,'
meners mbers (it you Are aia
YOU ere alimited Uablltry
+
uornPAny), Or a Mesa or borrower or
Any of their 'employees,, while moving
Property to on from a Covated'aalo
(6) A por nor (It you aro a partnership), or a
member (it you era 2 limited liability
company) for a Coyorad 'auto' owned
by him or her or s member al Its or her
houAohald.
C. Anyone 110biu for the conduct of an
'Insured' desoribad above but only to the
040M of that liability,
2. Coyotes" padanOlaro
e. Supplementary Paymenla
Ws will pay (Or #10 'Insured';
(1) All expenegawe Inca?.
(2) Up to $2,1100 for Gaal of ball bonds
(Including bolds for felatad mason tow
ul"10011s) fequlrad beonuga of an
ACoiOsnt' we "VOL We do not have 10
lurnlah deaac bonds,
(s) The cast of hcnda to eslesga
atrechmanle In any "Ault' agsinsl thin
'Inuurod' we defend, but anly lot bond
amounts within our Urnit of lnaur
page 2 of 91 Copyright, ISO propsdios, Igo., 2025
once.
CA j44-0103 off `-
REVIEWED'
By Margaret Meerer at 5:44 pm, Oct 31} 2017
2uelness Auto policy
MGTof America Cououl.ting, LLC Policy 2099569501
CA 00 0103 oft
(1) Promptly notirythapnlVcaIfrho covered
'auto' Or any of Its equipment logician.
(2) Take all reasonable slops to protect Ora
covered 'auto' from further damage,
Also keep a record of your expenses for
ooneldamll0n In rho s$fti m8n1 of the
claim.
(a) Permit tie to Inspect the onvorod'autw
and records proving the foss, before Its
repair of dlsposlllan.
(4) Agree to oxaminmldis undar oath al
our request and glue us a signed
statement of Your answers.
3. LOP) Action Against U8
NO ono may bring A legal action against us
under this ooveraga Form until:
C There has 1180" full compliance with all the
farms of this COverage Form; and
Is. Undor Liability COv04198� we agree In
10 iting PAY Orr at the ns
an until IhlBamount of that ob obligation
has finally been determined by judgment
after trial. No one hap the right under INS
Palley to bring us Into en amlon 10
de18171tke the'Insurad's' liability,
4, LoespsynMd—phyalcaloamegaCOverogaai
Al our option we may:
A. Pay for. repair or replace damaged orsingon
proporty;
6. Rearm the etolOn PrOPeny, at our expense,
We Will pay for any damage that results to
the'aUIO' from the Ill or
C Take all Or any pad of the dernaged or
stolen proPO* at On agreed or appraised
value.
II we Pay for ate'loss; Our Payment will Include
sin$ H pMI"blfi 98188 IAx tar the damaged or
6. Transfer Of Rights Of Recovery Against
Others To us
If Any person or arganixetlon to M for whom we
make peymOOl under this Covurage Form hes
rights to Mover damages from Arwtiter, those
rights are trarmferrod to us, That parsonor
arganizahon must do ovatything nagaaeary ro
sacura our rights and nival do nothing after
'aacidenl' er "loss' to Impair lhom,
B. O"ten l Conditions
I. Benknrplcy
Bankruptcy or insolvency or 09e'insurad' or the
Insurad's' estate will not relieve JAB Of any
obligations under this Coverage Form,
2. COncaalmard, kllmsiarresentallon or Fraud
This COvarago Farm Is vold In any 0090 of trend
Ivy You at any time as II rutatas to this Coverage A�j�
Copyright, ISO PropOr110s, inc, 2005 �v D
23
Tof 11
F!EVIEZO
argaret Mercer at 5.44 pm, 0cf 31, 201,]-
SECTION IV— BUSINESS AUTO CONDITHO NS
Tho following conditions apply In addillon to the
COmmon Policy Condlilona:
A. Loneandhions
1. A"M eal Far Marcell Gemaga Loan
If You and we dfeapraO On the amount of 'Inas,'
either MAY demand an approloill of the 'loa s., In
Ih4 avant, each party will select a earn Want
appralear. The two Appraises will soiwl 4
competent and Impartial umpire The appraisers
will state separate l the actual cash value slid
amount of 'loan." It They tall to
agroa, they will
BOOM their dvolon000 to the umpire. A
decision agreed to by any two will be binding.
Each party Will:
A, pay Ica chosen appralaor„and
b, Bear the other expanBa9 of the appraisal
and umplra aquaffy.
If we submit to an appraisal, we will still retain
our right to deny Il Balm.
2. Olives In The Event Of Accident, ell
Suit
Or Loos
We have ne duty to provide coverage under this
polls y unless there has been full compliance
with a following duties:
A- In the event Of 'AWdent' claim, -mull' or
'leas,' you must give us nr our sefnan;atl
("presentative prompt notice of the
'scalds”? Or'tues.' Include:
(1) Now, when and where the'aooidOnP Or
'loss' ocounad;
(2t Tie'Insured's' name and addrous; and
13) TO the extent possible, the names and
addresses Of any injured persona and
wlmSaAaa.
It, Additionally, you and any other involved
Insured' must:
(1) Aosuma no obligation, make no
PaymentrIncur without
our cones t FOO Mit at rho
Cost.
am
(2) IrnmadlOtoig Bond us copies of any
request, damand, order, "floe,
9eMrnens or leg®l paper received
OOhcnr"Ing
WAR
the Balm or %ul
(3) COOPON118 With us In the imrestlgnion
craw
or soalemani of the claim or dotenaa
against the •sur
14) Authorize us to obtain medical records
or other Padinont inionamdon,
(o) Submit 10 examination, at our expenso,
by Physicians of our chole a, as often as
we reasonably ragdira.
O, If there 19'1098' to a Mounted 'eula' or Its
aqulPrnsnl you Mimi also do tha forowing:
CA 00 0103 oft
(1) Promptly notirythapnlVcaIfrho covered
'auto' Or any of Its equipment logician.
(2) Take all reasonable slops to protect Ora
covered 'auto' from further damage,
Also keep a record of your expenses for
ooneldamll0n In rho s$fti m8n1 of the
claim.
(a) Permit tie to Inspect the onvorod'autw
and records proving the foss, before Its
repair of dlsposlllan.
(4) Agree to oxaminmldis undar oath al
our request and glue us a signed
statement of Your answers.
3. LOP) Action Against U8
NO ono may bring A legal action against us
under this ooveraga Form until:
C There has 1180" full compliance with all the
farms of this COverage Form; and
Is. Undor Liability COv04198� we agree In
10 iting PAY Orr at the ns
an until IhlBamount of that ob obligation
has finally been determined by judgment
after trial. No one hap the right under INS
Palley to bring us Into en amlon 10
de18171tke the'Insurad's' liability,
4, LoespsynMd—phyalcaloamegaCOverogaai
Al our option we may:
A. Pay for. repair or replace damaged orsingon
proporty;
6. Rearm the etolOn PrOPeny, at our expense,
We Will pay for any damage that results to
the'aUIO' from the Ill or
C Take all Or any pad of the dernaged or
stolen proPO* at On agreed or appraised
value.
II we Pay for ate'loss; Our Payment will Include
sin$ H pMI"blfi 98188 IAx tar the damaged or
6. Transfer Of Rights Of Recovery Against
Others To us
If Any person or arganixetlon to M for whom we
make peymOOl under this Covurage Form hes
rights to Mover damages from Arwtiter, those
rights are trarmferrod to us, That parsonor
arganizahon must do ovatything nagaaeary ro
sacura our rights and nival do nothing after
'aacidenl' er "loss' to Impair lhom,
B. O"ten l Conditions
I. Benknrplcy
Bankruptcy or insolvency or 09e'insurad' or the
Insurad's' estate will not relieve JAB Of any
obligations under this Coverage Form,
2. COncaalmard, kllmsiarresentallon or Fraud
This COvarago Farm Is vold In any 0090 of trend
Ivy You at any time as II rutatas to this Coverage A�j�
Copyright, ISO PropOr110s, inc, 2005 �v D
23
Tof 11
F!EVIEZO
argaret Mercer at 5.44 pm, 0cf 31, 201,]-
Blanket Additional Insured . Owners, Lessees or
Contractors - with Products -Completed
Operations Coverage Endorsement
This endorsement madfles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It Is understood and agreed as follows:
I. The WHO IS AN INSURED section is amended to add as an insured any person or organization whom the
Named Insured N required by written contract to add as an additlonal Insured on this coverage part, Including
any such person up organization, If any, speoiflcally set forth on the Schedule attachment to thisendorsement.
However, such person or organization is an Insured only with respect to such person or organization's liability
for:
A. unless paragraph B. below applies,
1. bodily Injury, property damage, or personal and advertising Injury caused In whole or in past by the
ants or ornlsslons by or on behalf of the Named Insured and In the perfurrrancs of such Named
Insured's ongoing operations as specified in such written contract; or
2. bodily Injury or property damage caused in whole or In part by your work and Included In the
products -completed operations hazard, and only If
a. file writtan contract requires the Nam ad Insured to provide the additional Insured such coverage;
and
b. this coverage part provides such coverage.
B. bodily Injury, property damage, or personal and advertising Injury arising out of your work described In
such written contract, but only if:
1. thls coverage part provides coverage for bodily Injury or property damage Included within the
products completed operations hazard; and
2. the written contract specifically requires the Named Insured to provide addition@[ insured coverage
under the 11.85 or 10.01 edition of 043201 U or the 10.01 edition of CO2037,
It. Subject always to the terms and conditions of this policy, Including the limits of Insurance, the Insurer will not
provide such additional insured with:
A. coverage broader than required by the written contraot, or
S, a higher II It of Insurance than required by the written contract.
III. Tho Insurance granted by Ihis ornamental to the additional Insured does nut apply to bodily injury, property
damage, or personal and advertising Injury arising out of:
A. the pandering of, or the failure to randar, any professional architectural, enginefli or surveying services,
including:
1. the preparing, approving, or falling to prepare or approve maps, shop drawings, opinions, reports,
survsys, field orders, change orders or drawings and specfficatlons; and
2. superv]scry, Inspection, architectural or engineering activities; or
B. any premises or work for which the additional Insured is specifically listed as an eddilional insured on another
endorsement attached to this coverage part.
IV, Notwithstanding anything to the contrary In the section entitled COMMERCIAL GENERAL LIABILITY
CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of oil other Insurance available
to the additional insured whether on a annual al excess, contingent or any other basis, However, If this insurance
Page 1 of 2 reuey ran: 5095130327
Endorsement No:
Insured Name: MGT of Ametica Consul¢i,ns, LII EffactiveDift 07/01/2017
Cppyrtghl CNA Alf Rights Reserved, Includes Oepyrighled meledal Of IntlerenCe Seryll nrgce, Inc., w,lh Its ponli MI
[REVIETEDBy MarMercer at 5:44 pm;.Oct 39,1017'
CNA
Blanket Additional Insured - Owners, Lessees or
Contractors - with Products -Completed
Operations Coverage Endorsement
Is required by written contract to be primary and non-contributory, this Insurance will be primary and non,
contributory relative solely to insurance an which the additional Insured Is a norred Insured,
V. Solely with respect 10 Via insurance granted by this endorsement, the section emitted COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
The Condition entitled Duties In The Event of Occurrence, offense, Claim or Suit Is amended with the
addition of the following:
Any additional Insured pursuant to this andarsernent will as soon as practicable;
1, give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim;
2, except as provided In Paragraph IV, of this endorsement, agree to make available any other Insurance
the additional Insured has for any 1088 covered under this coverage part;
3. send the Insurer copies of at[ legal papers received, and otherwise cooperate with the Insurer in the
Investigation, defense, or settlement of the claim; and
4. tender the defense and indemnity of arty claim to any other Insurer or self insurer whose Polley or
program applies to a loss that the Insurer covers under this coverage part. However, If Ilia written
contract requires tilts insurance to be pnmoryand non-oontrlbutory, this paragraph (4) does net apply to
Insurance on which the additional Insured is a named insured,
The insurer has no duty to defend or indemnify an additional Insured under this endorsement until the Insurer
recelves wrillen notice of a claim from the additional Insured,
VI. Solely with respect to the Insurance granted by this endorsement, the section entitled DEFINITIONS is amended
to add the following definition;
Written contract means a written contract or written agreement that requires the Named Insured to make a
person or organization an additional Insured on this coverage part, provided the contract or agreement:
A. is currently in effector baronies effective during the term at this polloy; and
B. was executed prior to:
I, the bodily Injury or property damage; or
2. the offense that caused the personal and advertising injury
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible bylaw.
All other terns and conditions of the Policy remain unchanged.
nes enaor8emanr, w tich farms a part e4 and is forstlar ment to the Policy Issued by he designated Insurers, takes
effect on the effective dale of said Policy at ilia hour stated In said Palley, unless another effective date Is shown
below, and expires eaneurrentiv with said Pnaov_
CNA751TIgXX(1.15) .—.._`...—_...._.._..—_....�.,._........__._..._.,__.—...�.__.W._..
Page 2 of 2 Polley No:
Endorsement No:
insured Name: Effaollve Data:
a'opyrtlehl CNA All Rights RNssrvsd. Inuluden ceRYHnhietl msl2%8l of lnsuraneg aer4cus Of%,, Ire., wth ns-samllg5inn,
LREV'1v
aret Mercer at 5:44 pm;l7c�zQff
_ CNA
General Liability Extension Endorsement
It In understood and agreed that into endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE
PART as follows. It any other endorsement attached to thla pollcy amends any provision also amended by this
endorsement, then that other endorsement controls with respect to such provision, and the changes made by thin
endorsement with respect to such provlslon do net apply.
_..,.._...._____.__.__------ – ....._..�
"TABLE OF CONTENTS
1. Additional insureds
r
2, Additional Insured • Primary And Non -Contributory To Additional Insurad's Insurance
a, Bodily Injury –ExpandedOefinition . —
4. Broad Knowledge of Oceurrenost Notice of Occurrence
6. Broad Named Inaurad'"'�—'�
6. Estates, Legal Representatives and Spouses._.-..._...._.._—_-.__'""'--'
7e Expected Or Intended Injury – Exception for Reasonable Force
6, In Rem Actions —
9, incidental Health Care Malpractice Coverage
16. Joint VentureaYPartnershiplLimited Liability Companies
11, Legal Llatsiilty– Oamage To Premises
12. Medical Payments
13, Non -awned Aircraft Coverage
14,Non•owned Watercraft
16. Personal And Advertisjng Injury–Discrimination or Humiliation —
16, Personal And Advertising Injury -Contractual Liability
17, Property Damage -Elevators �µ __,_._ —•._ _ _
.,w.16. Supplementary Payments
1g. Unintentional FallureToDisclose Hazards
26. We or of Subrogatlon –Blanket
CNA74670Xx(1-15)�._' pnlicyNo; 5095136327
Page 1 of 13 Endorsement No;
Insured Name; MGT of Americ®0oosul.cing, LLC Elfective0ate: 07/01/241.7 `
ICopyttaht CNA All Tshls neanNed. Innludep cppyrfohmd mnlernxl of Imranno aarelras 0mee, Inc., Will Its pamlepion. G"
ffWS�0101,eP Mercer at 5:44
CNA_�_,..._. General Liability Extension Endorsement
1, ADDITIONAL INSUREDS
a. WHO IS AN INSURED Is amended to include as an Insured any parson or organization described in
paragraphs A. through K, below whom a Named Insured Is required to add as an additional Insured an this
Coverage Part under a written contract or written agreement, provided such contract or agreemonk
(1) Is currently in effect or becomes effective during the term of this Coverage part; and
(2) was executed prior to:
(a) the bodily Injury or property damage; or
(b) the offense that caused the personal and advertising Injury,
for which such additional insured seeks coverage,
b, However, subject always to the terms and condltlons of this policy, including the limits of Insurance, the
Insurer will not provide such additional insured with:
(1) a higher limit of insurance than required bysuch contractor agreement; or
(2) coverage broader Than required by such Contract or agreement, and In no event broader than that
described by the applicable paragraph A, through K. below.
Any coverage granted by this endorsement shall apply only to flhe extant permissible by law.
A, Controlling Interest
Any person or organization with a conlralling Interest in a Named Insured, but only with respect to such
person or organization's liability for bodily Injury, property damage or personal and advertising Injury
orlsing out of:
1. such person or organization's financial control of a Named Insured; or
2. premises such person or organlzellon owns, maintains or controls wltlla a Named insured leases or
occupies such premises;
provided that the coverage •granted by this paragraph does net apply to structural alterations, new
construction or demolition operations performed by, on behalf of, or for such additional Insured.
B. Co-owner of Insured Premises
A oo-owner of a premises cc -owned by a Named Insured and coverall ander this Insurance but only with
respect to much ro-owner's liability for bodily Injury, property damage or personal and advertising Injury
as co-owner of such premises.
C. Grantor of Franchise
Any person or organizatlon that has granted a franchise to a Named Insured, but only with respect to such
person or organization's liability for bodily Injury, property damage or personal and advertising injury as
grantor of a franchise to the Named Insured,
D. Lessor of Equipment
Any person or organization from whom a Named Insured losses equlpment, but only with respect to liability
for bodily Injury, property damage or personal and advertising injury paused. In whole or In part, by the
Named insured's maintenance, operation or ties of such equipment, provided that the occurrence giving
Nae to such bodily injury, property damage or the offense giving rise to such personal and advertising
Injury takes place prior to the termination of such lease.
E.. Lessor cf Land
Any poeon or organization from whom a Named Insured looses land but only with respect to liability for
—bo di irv(ury, Property demaga or ,personal and advartislnn�Injur)r .arisi o If of the ownorsiair�,
CMA74879XX (1-t,5) �
P Palley Na.
Page 2 of 98 Endorsement No:
Data;
Insured Name: Effective Datr`\
Capyrlyel GNA All riigh[a Reserved, inrluc9ea capyrlelrte0 maladai or In4urpnc®Services biflca, Inn„ uili ILq parm7sslnn
REViEWE�� ,
ay Margaret Mercer at 5:44 pnr, pct 71, 20f7.
D
General Liability Extension Endorsement
malmonance or use of such land, provided that the occurrence giving rise to such bodily injury or property
damage, or the offense giving rise to such personal and advertising injury, takes place prior to the
termination of such leas, The coverage granted by this paragraph does net apply to structural alterations,
new construction or demolition operations performed by, on behalf of, or for such additional Insured.
P. Lessor of Promises
An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate
manager, but only with respect to Ilability for bodily injury, property damage or personal and advertising
injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named
Insured, and provided that the occurrence giving rise to such bodily Injury, property damage or the
offense giving rise to such personal and advertising injury takes place prier to the termination of such
lease. The coverage granted by this paragraph does not apply to structural alterations, naov construction or
demolition operations performed by, on behalf of, or for such additional Insured,
G. Mortgagee, Assignee or Receiver
A mortgagee, assignee or mooivor of promises but only with respect to such mortgagee, assignee or
receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the
Named Insured's ownership, maintenance, or use of a promises by a Named Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by, on behalf of, nr for such additional Insured.
H. State or Governmental Agency or Subdivision or Polilioul Subdivisions —Permits
A state or governmental agency or subdivision or political subdivision that has Issued a permit or
authorization, but only with respect to such state or governmental agency or subdivision or polftioal
subdivision's Ilabiilty for bodily Injury, property damage or personal and advertising injury arising out of,
1, the following hazards in connection with premises a Named Insured owns, rents, or copiruls and to
which Ihis insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advsalsing signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, holstaway openings,
sidewalk vauils, street banners, or decorations and similar axposurae; or
b. the construction, erection, or removal of elevators; or
c, the ownership, maintenance or use of any elevators covered by th[s Insurance; or
2. the permitted or authorized operations performed by a Named Inevred or an a Named Insured's
behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations
performed for the state or goveromanlal agency or subdivision or poliftal subdivision; or
b. Bodily Injury or property damage included wilhln the produots-comploted operations hazard.
With respect to this provision's requirement that additional Insured status must be requested under a written
contract or agreement, the Insurer will treat as a mitten contract any governmental permit that requires the
Named Insured to add the governmental entity os an additional Insured.
1. Trade Show Event Lessor
1. With respect to a Named Insured's participation In a trade show event as an exhibitor, presenter or
displayer, any person or organization whom the Named Insured Is required to Include as an additional
insured, but only with respect to such person or organization's liability for bodily injury, property
damage or personal and advertising injury caused by,
CN
__A7AA7_._
gkX (1.19) Policy No;
Page 3 of 13 Endorsement No:
Effective Date:
Insured Names
Cvg�yal®ht CNh NI ralghisRnsarcaa. Includes avpytlghted motorial of lri a m* Sarvicss office, Inc., with Its a9mvlsslan.
E
EVIEWE Margarot Meroer at 9144 pm, Oct �M17
CMA
General Liability Extension Endorsement
a. the Named Insured's sots or emiesions; or
b, the acle or omissions of those acting on the Named Insured's behalf,
In the performance of the Named Insured's ongoing operations at the trade show event premises during
the trade show event.
2. The coverage granted by this paragraph does not eppiy tc bodily Injury or property damage Included
within the products -completed operations hazard.
J. Vendor
Any person or organization bill only with respect to such person or organization's Ilabllity for bodily Injuryor
property damage arising out of your products which are distributed or sold In the regular course of such
person or organization's business, provided that:
1, The coverage granted by this paragraph does not apply to:
B. bodily Injury or property damage for which such person or organization is obligated 10 pay
damages by reason of the assumption of liability in a contract or agreement unless such liability
exists in the absence of the contract or agreement;
Is any express warranty unauthorized by the Named Insured;
o, any physical or chemical change In any product made intentiandly by such person or organization;
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 any inspections, adjustments, tests or servicing that such person or organization
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;
t. demonstration, hnstalladon, servicing or repair operations, except such operations performed at the
such person or organization's premises in connection with the sale of a product;
U. products which, after distribution or sale by the Named insured, have been labeled or relabeled or
used as a container, part or Ingredient of any other thing or substance by or for such person or
organization; or
h. bodily injury or property damage arising out of the sole negligence of such person or organization
for its own acts or omissions ur these of Its employees or anyone else noting an Its behalf, However,
this exclusion does not apply to:
(1) the exceptions contained in Subparagraphs d. or f, above; or
(2) ouch inspections, adjustments, tests or servicing as such person or organization has agreed with
the Named Insured to make or normally undertakes to make in the usual course of business, In
connection with the distribution or sale of the products.
2. This paragraph J. does not apply to any insured person or organization, from whom the Named Insured
has acquired such produwa, nor to any ingradient, part or container, entering int), accompanying or
containing such products.
3, This Paragraph J. also does not apply:
a. to any vendor specifically scheduled as an addlllenal Insured by endorsement to this Coverage part;
It. to any of your products for which coverage is excluded by endorsement to this Coverage part; nor
o. if bodily injury or property damage included within the prcducts•conrpleted operations hazard
Is excluded by endorsement to this Coverage part.
page h of 13
Insured Name:
e
Copyright CNA All RIghie Reserved,
Endorsement No:
Effective Date:
Includes copyrighted material of osunmum ser,laes olfcc, Inc., Kim Itu porcnlsamn. �'/" - �h".. I �✓ t,d !
REVIEWS
By Margaret Marcor at 6:44 pm, Oct 51, 201T.
General Liability Extension Endorsement
K. Other Person Or Organization
Any person or organization who Is not an additional Insured under Paragraphs A. through J. above. Such
additional Insured is an Insured solely for bodily Injury, property damage or personal and advertising
Injury for which such additional insured Is liable because of the Named Insured's acts or omissions.
The coverage granted by this paragraph does not apply to any person or organlzatiom
1, for bodily injury, property damage, or personal and advertising Injury arising out of the rendering or
fallurs to render any professional sarvice;
2. for bodily Injury or property damage included within the products•oomplated operatdons hazard; nor
3, whc Is specifically scheduled as an additional Insured an another endorsement to this Coverage Part,
ADDITIONAL INSURED -PRIMARY AND NONCONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE
A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section Is
amended to add the following paragraph;
If the Named Insured has agreed in writing In a contract or agreement that this Insurance Is primary and
non-contri'outory relative to an addltlonal Insured's own Insurance, then this insurance is primary, and the
Insurer will not seek contribution from that other Insurance. For the purpose of this Provision 2., the
additional Insured's own Insurance moans Insurance on which the additional Insured Is a named Insured.
a, With respect to persons or organizations that qualify as additional Insureds pursuant to paragraph I.K. of this
endorsement, the following sentence is added to the paragraph above:
Otherwise, and notwithstanding anything to the contrary elsewhere In this Condition, the Insurance provided
to such person or organization is excess of any other insurance available to such person or organization.
BODILY INJURY — EXPANDED DEFINITION
Under DEFINITIONS the definition of bodily injury is deleted and replaced by the following:
Bodily Injury means physical Injury, sickness or disease sustained by a person, including death, humiliation,
shock, mental anguish or mental uhjury sustained by that parson at any time which results as a consequence of
the physical injury, sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is
amended to add the following:
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer's authorized representative notice of an
occurrence, offense or oiaim only when the occurrence, offense or claim Is known to a natural person
Named Insured, to a partner, executive officer, manager or member of a Named Insured, or to an
employee designated by any of the above to give such notice.
B. NOTICE OF OCCURRENCE
The Named Insured's rights under this Coverage Part will not be prejudiced if the Named insured falls to
give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named
Insured's reasenable belief that the bodily Injury or property damage is not covered under this Coverage
Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the
Insurer as soon as the Named Insured is aware that this Insurance may apply to such occurrence, offense
at claim,
IL BROAD NAMED INSURED
WHO IS AN INSURED is amended to delete its
UNA7457DXX (1 -1 B)
Page 5 of 13
3. In Its entirety and replace It with the
Policy No:
Endorsement No:
Effective Date:
insured Name:
Cepyriaht CNA All Rights Reserved. Insludss copydghod material or insurance samoos orrm, Inc., with its pmmfacion. .' l c -
By
vrewe® Maraaror Mercer of 5:44
4 pm, OcC31, 2017:-
CNA
_ General Liability Extension
.,._. Y Endorsement
3. Pursuant to the limitations described In Paragraph 4. below, any organization In which a Named Insured has
management control;
a. on the effective date of this Coverage Part; or
b. by reason of a Named Insured creating or acquiring the organization during the policy period,
qualifies so a Named Insured, provided that there Is no other similar liability Insurance, whether primary,
contributory, excess, contingent or otherwise, which provides coverage to such organization, or which would
have provided coverage but for the exhaustion of Its limit, and without regard to whether its coverage Is
broader or narrower than that provided by this Insurance,
But this BROAD NAMED INSURED provision does not apply to:
(a) any partnership, limited liability company or joint venture; or
(b) any organization for which coverage Is excluded by another endorsement attached to this Coverage
Part,
For the purpose of this provision, management control means:
A. owning Interests representing more than 60% of the voting, appointment ar designation power for the
selection of a majority of the Board of Directors of a corporadon; or
B, having the right, pursuant to a written trust agreement, to protect, control the use of, encumber or
transfer or sell property held by a trust.
4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3, above, this
Insurance does not apply to:
a. bodily Injury or property damage that first occurred prior to the date of management control, or that
first occurs after monagament control ceases; nor
b. personal or advertising Injury caused by an offenso that first occurred prior to the date of
manaoament control or thatfirst Occurs after management central anasoe.
5. "the Insurance providod by this Coverage Part applies to Named Insureds when trading under their own
names or under such other trading names or doing -business -as names (dba) as any Named insured should
choose to employ.
e, ESTATES, LEGAL REPRESENTATIVES, AND SPOUSES
The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under
this policy, provided, however, coverage Is afforded to such estates, heirs, legal represonlatives, and spouses
only for claims arising Solely out of their capacity or status as such and, in the case of a spouse, where such
claim seeks damages Prom marital community property, jointly held property or property transferred from such
naturai person Insured to such spouse. No coverage fa provided for any act, error or emission of an estate, heir,
legal representative, or spouse outside the scope of such persona capacity or status as such, provided however
that tha spouse of a natural person Named Insured and the spouses of members or partners of joint venture or
partnership Named Insureds are Insureds with respect to such spouses, acts, errors or omissions In the
conduct of the Named Insured's business.
7. EXPECTED OR INTENDED INJURY—EXCEPTION FOR REASONABLE FORCE
Under COVERAGES, Coverage A — Bodily Injury And Property Damage Liability, the paragraph entitled
Exclusions Is amended to delete the exclusion entitled Expected or IntendedInjury and replace It with the
following:
This Insurance does not apply to:
Expected or intended Injury
Fags 6 of 13 Policy No:
Endorsement No:
Insured Name: Effoctive Date:
Copydahl CNA All rights tinoweU. Includes rapyrlghfetl motertol nP lRsuraa4w aervfcen utiles, "o, Will Its rl®nnisslan. /l
L:RE!VIEret Mower at 5:44 pm, pct 31, 2017'
General Liability Extension Endorsement
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
persons or properly. the use of reasonable faros to protect
tr. IN REM ACTION'S
A quasi in rem action against any vessel owned or operated by cr for the Named Insured, or chartered by or far
the Named Insured, will be treated In the same manner as though tho action were in porsapam against the
Named Insured.
9, INCIDENTAL HEALTHCARE MALPRACTICE COVERAGE
Solely with respect to bodily Injury that arises out of a healthcare Incident:
A. Under COVERAGES, Coverage A — Bodily Injury And property Damage Liability, the Insuring
Agreement Is amended to replace Paragraphs 1.b.(1j and 1,6,(2) with the following;
Is. This Insurance apptiso to bodily Injury provided that the professional hoalih cars services are incidental
to the Named Inaured's primary business purpose, and only it:
(1) such bodily Injury Is caused by an occurrence that lakes place In the coverage territory,
(2) the bodily injury first occurs during the policy period. All bodily injury arising from an
occurrence will be deemed to have Occurred at the time of the first act, error, or amisaion that Is
part of the occurrence; and
B. Under COVERAGES, Coverage A — Bodily Injury And Property Damage Liability, the paragraph entitled
Exclusions Is amended to:
h add the following to the Employers Llablllty exclusion;
This axclusiun appllas only If the bodily Injury arising from a health care Incident is covered by other
Ilebillly Insurance avallable to the Insured (or which would have been available but for exhaustion Of Its
ilmfts),
It. delete the exclusion entitled Contractual Liability and replace It with the following:
This insuranco does not apply to;
Contractual Liability
the Insured's actual or alleged liability under any oral or written contract or egreemant, Including but not
limited to express warranties or guarantees.
11L add the following addttional exclusions
This Insurance does not apply to:
Discrimination
any actual or alleged discrimination, humiliation or harassment, Including but riot limited to claims based
an an individual's race, creed, color, age, gander, national Origin, religion, disabillly, marital status or
sexual Orientation,
Dishonesty or Crime
Any actual Or alleged dishonest, criminal or malicious act, error or omission.
MOdioaralMedicald Fraud
any actual Or alleged violation of law with respect to Medicare, Medicald, Tnaaro or any similar federal,
state Or local governmental program.
Services Excluded by Endorsement
Page i Of 13
Insured Name: EiiettVeDaie:
Copyright CNA Ali nlghla n®anrved, roludoo oupyrigh[ea metadal of hltlarenpe aervlcea 4xiaa,. 1910., with Ile pami alah.
REVIEW
By Margaret Mercer It 5:44 pm, Oct 9r, 201Z
General Liability Extension Endorsement
Any health care Incident for which coverage is excluded by endorsement,
C, UEMNITIONS Is smanded to:
I. add the following definitions:
Health care incident means an act, error or anieslon by the Named Insuroda employees or
volunteer workers In the rendering of:
e, professional healthcare services an behalf of the Named Insured or
b. Good Samaritan services rendered In an emergency and for which no payment is demanded or
received,
Professional health care services means any health care services or the related furnishing of food,
beverages, medical supplies or appliances by the following providers In their capacity as such but solely
to the extent they are duly licensed as required:
a. Physician;
b. Nurse;
a. Nurse practitioner;
d. Emergency medical technlclan
a. Paramedic;
C Dentist;
g, Physical theraplst;
h. Psychologist;
1. Speech therapist;
j. Other allied health professional; or
Professional health care services does not include any services rendered In oonneetlart with human
clinical trials or product testing.
11. delete the definition of occurrence and replace d with the following:
Occurrence means a health care Incident. All acts, errors or omissions that are logically connaoted by
any common fact, circumstance, situation, transaction, event, advice or decision will be considered to
constitute a single occurrence;
Ili, amend the definition of Insured to:
a. addthefollowing:
• the Named Insured's employees are Insureds with respect to:
(1) bodily injury to a co -employee while In the course of the co-employeo's employment by
the Named Insured or while performing duties related to the conduct of the Named
Insured's business; and
(2) bodily Injury Ia a volunteer worker while performing duties related to the conduct of the
Named Insured's business;
when such bodily Injury arises out of a health care Incident.
• the Named Insured's volunteer workers ere Insureds with respect to:
GNA74879XX (1.16) - -- Policy No:
Page a of 13 Endorsement Na:
Insured Name:
Effective Data:
ppp
anpYrigM CNA All Rl0nlp neservea. inclutlar: copynphtetl material al Insurance 9ervians arHea, Enc., vAth Hn permissEan. l-
REVIEWS
By Margaret Mercer at 5144 pin; Oct 31, 2017
CNA
General Liability Extension Endorsement,
(1) bodily Injury to a co•,voluntser worker white performing duties related to the conduct of the
Named Insured's business; and
(2) bodily injury to an employee while in the course of lho employee's employment by the
Named Insured or while performing duties related to the conduct of the Named Insured's
business;
when such bodily Injury arises out of a health care Incident.
Is. delete Subparagraph& (a), (b), (c) and (d) of Paragraph 2.a.(1) of WHO JS AN INSURED.
c, add the following;
Insured does not Include any physician while acting In his or her capacity as such.
D, The Other Insurance condition Is amended to delete Paragraph b.(1) In its entirety and replace It with the
following:
Otherinsurance
b. Excess Insurance
(1) To the extent this insurance applies, It Is excess over any other Insurance, self Insurance or risk
transfer Instrument, whether primary, excess, contingent or on any other basis, except for insurance
purchased specifically by the Nam ad Insured to be excess of this coverage.
10. JOiNT VENTURES 1 PARTNERSHIP 1 LIMITED LIABILITY COMPANIES
WHO IS AN INSURED Is amended to delete Its last paragraph and replace It with the following:
No person or organization Is an Insured with respect to the conduct of any current or past partnership, joint
venture or Ihnited liability company that Is not shown as a Named Insured in the Declarations, except that If the
Named Insured was a Joint venturer, partner, or member of a limited liability company sort such Joint venture,
partnership or limited liability company terminated prior to or during the policy period, such Named insured is
an Insured with respect to its interest in such joint venture, partnership or limited liability company but only to ilia
extent that:
a. any offense giving rise to personal and advertising Injury occurred prior to such termination date, and the
personal and advertising injury arising out of such offense first occurred after such lerminatlon date;
b. the bodily Injury or property damage first occurred after such termination date; and
c. there is no other valid and collectible insurance purchased specifically to Insure the partnership, joint venture
or llmiked iiabIlAy company.
11, LEGAL LIABILITY— DAMAGE TO PREMISES
A. Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions Is amended to delete the first paragraph Immediately following subparagraph (e) of the Damage
to property exclusion and replace it with the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to property damage (other than damage by Flre) to
premises ranted to the Named Insured or temporarily ooeuplod by thu Named Insured win the permission
of the owner, nor to the contents of premises rented to the Named Insured for a period of 7 or fewer
consecutive days. A separate limit of insurance applies to Damage To Promises Rented To You as
described In LIMITS OF INSURANCE,
S. Under COVERAGES, Coverage A— Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions Is amended to delete its last paragraph and replace it with the fallowing;
CNA74879XX(1AB) -- _.-`--"'�"'.�` Policy No:
Page g of 13 Endorsement No;
Effective Date:
Insured Name; �/'� p
Cnppigbt CNA NI Rion% Reserved. Include¢ capynyhted MOW11 of Insurance eervleas or5ce, Ina, uifh Its pe mlaiinn +� ry'��. I V A L;kt
lC V
��u��wE ,
By Margaret Mereer at 5:44 pm, Oc�31,',200177
General Liability Extension Endorsement
Exclusions o, through n, do not apply to damage by fire to premises while rented to a Named Insured or
temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of
premises rented to a Named Insured fur a period of 7 or fewer consecutive days,
A separate limit of insuranoe applies to this coverage as described In the LIMITS OF INSURANCE Socifolt,
C. LIMITS OF INSURANCE Is amended to delete paragraph 6. (the Darl To premises Rented To You
Limit) and replace It with the following:
S. Subject to Paragraph S, above, (the Each Occurrence UnAlt), the Damage'ro Premises Rented To You
Limit Is the most the Insurer will pay under COVERAGE A for damages because of property damage
to:
a any one premises while rented to a Named Insured or temporarily 000upied by a Named Insured
With the permission of the owner; and
b. contents of such promises if the promises is rented to the Named insured for a period of 7 or fewer
oonsocutive days,
The Damage To Promises Rented To You Limit Is $200,000. unlaas a higher Damage to Premises
Reacted to Yes Limit Is ehown In the Declarations,
D. The Other Insurance Condition Is amended to delete Paragraph b,(1)(a)(li), and replace it with the
following:
(II) That Is property Insurance for premises rented to a Named Insured, for prandses temporarily occupied
by the Named Insured with the permission of the owner; or for personal property of others in the Named
Insurad's care, Custody or control;
E. This Provision 11, does hal apply If liability for damage to premises rented to a Named insured Is excluded
by another endorsement attached to this Coverage part.
12, MEDICAL PAYMENTS
A. LIMITS OF INSURANCE Is amended to delete Paragraph 7. (the Milftal Expense Limit) and replace It with
the following:
7. Subject to Paragraph 6, above (the Each Occurrence Limit), the Medical Expense Limit is the most the
Insurer will pay under Coverage C - Medical payments for all medical expenses because of bodily
injury sustained by any one parson. The Medical Expense Limit Is the greater or:
(1) $16,000 unlesa a different amount is shown here: ; or
(2) the amount shown In the Declarations for Medical Expense Limit,
B. Under COVERAGES, Coverage C .,. Medical Payments, the Insuring Agreement is amended to replace
Paragraph 1,043)(b) with the following:
(b) The expenses are incurred and reported to the Insurer within three years of the data of the accident; and
13. NON -OWNED AIRCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended as follows:
The exclusion entitled Aircraft, Auto or Watercraft Is amended to add the following;
This exclusion does not apply to An aircraft not owned by any Named Insured, provided that;
1. 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;
2. the aircraft is rented with a trained, paid crew to the Named lnsurad; and
r.n y ry i at Policy No:
Pagee 1 70 0 oof f 1 13 Endorsement No;
Insured Name; Effective Date: f 1
Gusynght GNA. All meai
ghls Rayea. Includes copyriehletl malarial of asaoranca aeNlna9 OfOce, Inc, with Its hermpsslon,1 l (D
LREVIINEargaret Marcor at :44pra, ct31,2017
General Liability Extension Endorsement
3, the airoraft Is nut being used to carry persons or property for a charge,
14, NON•OWNED WATERCRAFT
Under COVERAGE* Coverage A — Bodily Injury and Property Damage Liability, the paragraph endtiad
Exclusions is amended to delete subparagraph (2) of the exclusion entitled Alraraft, Auto or Watercraft, and
replace It with the following.
This exclusion does not apply to:
(2) a watercraft that Is not owned by any Named Insured, provided the watercraft Is:
(a) lass than 79 feet long; and
(b) not being Lead to carry persons or property for a charge,
15. PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION
A. Under DEFINITIONS, the definition of personal and advertising Injury Is amended to add the following tort;
01scrim1nation or hurnIllation that results In Injury to the feelings or reputation of a natural person.
D. Under COVERAGES, Coverage B — Personal and Advertising injury Liability, the paragraph entitled
Exctuslons is amended to:
1. delete the Exniuslon entitled Knowing Violation Of Rights Of Another and replace It with the following:
This insurance does not apply to:
Knowing, Violation of Rights of Another
Personal and advertising Injury caused by or at the direction of the Insured with the knowledge that
the Oct would violate the rights at' another end would inflict personal and advertising Injury. This
exclusion shall not Opply to discriminadon or humiliation that results In Injury to the feelings or reputation
of a natural person, but only If such discrimination or humiliation Is not done intend ly by or at the
direction of:
(a) the Named Insured; or
(b) any executive officer, director, stockholder, partner, member or manager (If the Named Insured Is
a limited liability c(rnpany) of the Named Insured.
2. add the following exclusions:
This Insurance does not apply to:
Employment Related Discrimination
discrimination or humiliation directly orindlrectiy related to the employment, prospective employment,
past employment or termination of employment of any person by any Insured.
Prari Related Discrimination
discrimination or humlllalort arising out of the sale, rental, lease or sub•loesa or praspeotivo sale, rental,
lease or sub -lease of any room, dwalling or premises by or at the direction of any Insured.
Notwithstanding the above, there is no coverage for fines or penalties IOVlad or iarl by a governmental entity
because of discrimination,
The coverage provided by this PERSONAL AND ADVERTISING INJURY --DISCRIMINATION OR
HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely
train
Provision 1, ADDITIONAL INSUREDS of this andoreement; or
Page 11 of 13 ruos.y rvu:
Endorsement No:
Effective Date:
nsurod Nome; ■ In_1�
QoPVriylll CNA All ntghta nesarveq. Included rapydghleq maledpl or Insurance 6nwices OPouu, inc, uAth Its Parrvrtaelan �`jf� 4
REV/EWE 1
Sy Margaret Mercer at 5:44 pm, Oct 91, 2617Y-
NA --
General Liability Extension Endorsement
• attachment of an addlUona] Insured endorsement 10 this Coverage part.
is, PERSONAL AND ADVERTISING INJURY • CONTRACTUAL LIABILITY
A. Under COVERAGES, Coverage 8 -personal and Advertising Injury Liability, the paragraph entitled
Exclusions Is amended to delete the exclusion entitled Contractual Liability and replace Vt with tVte
following:
This Insurance does not apply to:
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 sgreomsnt; or
(2) assumed In a contract or agreement that is an Insured contract provided the offense that caused such
personal or advertising Injury first occurred subsequent to the execution of such Insured contract.
Solely for the purpose of liability assumed In an Insured contract, reasonable attorney fees and
necessary litigation expenses incurred by or for a party other than an Insured are deemed to be
damages because of personal and advertising injury provided;
(a) liability to such party for, or for the cost of, that party's defonse has siso been assumed In such
Insured contract; end
(b) such attorney fees and llligation expenses are for defense of such party against a civil or alternative
dispute resolutlan proceeding In which covered damages rare alleged.
B. Solely for the purpose of the coverage provided by this paragraph, DEFINITIONS 6s amended to delete the
definition of insured contract In Its entirely, and replace it with the following;
Insured contract means that pan of a written contract or written agreement pertaining to tits Named
Insured's business under which the Named Insured assumes the tort liability of another, party to pay for
personal or advertising Injury arising out or the offense of false arrest, detention or Imprisonment. Tort
liability means a liability that would be Imposed by law in the absence of any contract or agreement.
G. Solely for the purpose of the coverage provided by this paragraph, line following changes are made to the
Section sntitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B;
I. Paragraph 2.d. Is replaced by the fallowing:
d. The allegatlono in the suit and the inforrnallon the Insurer knows about the offense alleged In such
suit are such that no conflict appears to exist between the interests of the Insured and the interests
of the Indemnitee;
2. The first unnumbered paregraph beneath paragraph 21.(2)(b) Is deleted and replaced by the fellowing;
So long as the above conditions are met, attorneys fees Incurred by the Insurer In the defense of that
Indemnitee, necessary litigation expenses Incurred by the Insurer, and necessary litigation expenses
Incurred by the Indemnitoo at the Insurer's raquest will be paid as defense costs. Notwithstanding the
Provisions of Paragraph e.(2) of the Contractual Liability exclusion (as amended by this Endorsement),
such payments wilt not he deemed to be damages for personal and advertising Injury and will not
reduce the limits of insurance.
0. This PERSONAL AND ADVERTISING INJURY . LIMITED CONTRACTUAL LIABILITY Provision does not
apply if Coverage 8 _Personal and Adverttsing Injury Liability Is excluded by another endorsement
attached to this Coverage part.
Pogo 12 of 18 Policy No:
Endorsement No!
Insured Name Effective Date; r(
Capydght CMA Atl nights nasarved. Imcludns crpydgh(ad nisledal of InSurdpae Sarvicea ORca, Ina., with Its pa, r l6slen �lTj` 1 ' all
REVIEWEI9 V C l
By Margaret Mercer at 5.44 p., 00 31, 2017_
CNA
General Liability Extension Endorsement
17, PROPERTY DAMAGE —ELEVATORS
A. Under COVERAGES, Coverage A -- Bodily Injury and Property Damage Liability, the paragraph enlitied
Exclusions Is amended such that the Damage to Your Product Exclusion and subperagraphs J3),(4) and
16) of the Damage to Property Exclusion do not apply to property damage that results from the use of
elevators,
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision,
the Other Insurance condltions is amended to add the following paragraph:
This insurance Is excess over any of the other Insurance, whether primary, excess, contingent or on any
other basis that is Property Insurance covering property of others damaged from the use of elevators,
1S. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows
A. Paragraph i.b. Is amended to delete the $250 limit shown for the cost of ball bonds and replace it with a
$5,000, limit; and
S. Paragraph 1.d, Is emended to delete the limit of $250 shown for dally loss of earnings and replace It with a
$1,000, Ilmit.
19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentdonaliy Pails to disclose all existing hazards at the Inception date of the Named
Insured"s Coverage Part, the Insurer will not deny covorag�s under this Coverage Part because of such failure,
20, WAIVER OF SUBROGATION . BLANKET
Under CONDITIONS, the Transfer Of Rights Of Recovery Against others To Us Condition is amended 10 add
the following:
The Insurer wolves any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of:
1. tha Named Ineured's angcing eporatforis; or
2, your work Included in the PfOducts�complated operations hazard.
However, this waiver applies only when the Named Insured has agreed In writing to waive such right% of
recovery in a written ooniraol or written agreement, and only if Duch comrsol or agreement:
1. Is in effect or becomes e4ectivo during the term of this Coverage Part; and
2. was executed prior to the bodliy injury, property damage or personal and advertising Injury giving rise
to the claim.
All othor terms avid uund1lons of the Pnlloy remain unchanged.
-fids endorsement, which forms a part of and Is for atteoh ant to lige Policy Issued by ihs des(gnated Insurers,
lakes effect on the effective date of said Paltry at the hour stated in said Policy, unless another affective date is
shown below, and exnlras cnnnlermnkiv with _,id o,.u,.,.
UNrwrnarancli n t �.-PoIlcyNa:
Page 18 of 13 Endorsement No:
Insured Name: ElYoctive Date:
Capydgla CNA All nights Reserved Include%copyriyhtW maledal al Insolence Sarvines ovice, Inc., wshhillaLM_
pennlsaorl,
4ret Mercer lis pm, Oct 31, 2017-
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC tltl 03 13
(Ed, 484)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover cur payments from anyone liable for on 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 beneRit anyone not named m the Schedule,
Schedule
ANY PERSON OR ORGANIZATION ON WHOSE BEHALF YOU ARE REQUIRED TO OBTAIN
THIS WAIVER Cr OUR RIGHT TO RECOVER FROM UNDER WRITTEN CONTRACT
OR AGREEMENT. NOT APPLICABLE IN KANSAS.
This oodarsement changes tha Polley to which it Is attached and Is adactive on the date Issued timina8 otherwise atatotl.
(The Information below I$ required onto When this endorsement Ia Issued eubesquant to preparation of the pollryj
Endom menl Elraative 07/01/2017 Pollcy No, 301.1086712 (ALI othar&ndoraement No.
Inewod MGT of Ametice Coasulting, id'C PremBam
Insurance Company Valley T+or:ge Ins. Co. Ccuntersiyned by
WO 00 0313
(Ed. 4-154) Cppydght5089Ned onalCouncil unComparsutenInsurance.
( .� �L
L�a� .>
Margaret Mercer at 5:44 pm; Oct 31, 2077:
�� of Amar�Sna„ Consuleingr,,,_I_LC ,_•_„,��«
Policy 5011 D86788 CA
6.18160-13
(Ed, 11197)
WORKERS" COMPOM111014 AM EMPLOYERS° RIASILITY NSMANGE POLICY
KANKET WAIVER OF OUR RIGHT TO RECO:VER. FROM OTHERS
We mtdorsement chanes the patioy W wMah It Is aftaol%d
illsrood UO RATI Ons Wullrraa' Ca RpaneaUan lrmuranae Q. Reooaary From OWN and Pon TWO Emptayam'
Llabll>ly {neuri mn H. Recovery From OUw m are amended by adding thu following;
We wlN not enforce our sight W ranover agelnel pereana Or organfratfons, 71ts agresmani appltaa only to ft extant that
you podorin wotk under a wridton conftaot than raeulraayou toobtaht We ag(aamant Isom us.)
PREIt11UM CHAKQE-
Tha ohatgo WIN be an amoutt to whlahyou and wa agree that le a peroontago of the total slandard premium for California
expaautd, Tha amount Is
61•19160-B Page I of f
jEd,111d1)
aviEwI�
Say Nfargsrer Mercer ei 5,44 pm, Ocf 3n2017