2016-10-07_REVISION - C1981025

• Permit No: C1981025
• IBM Index Class Name: Revision
• Doc Date: 10/7/2016
• Doc Name: Certificate of Insurance
• From: J. E. Stover & Associates, Inc.
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: CCW
• Email Name: JRS
• Media Type: D
• Archive: No

(a) All work, including materials, parts
or equipment furnished in
connection with such work, on the
project (other than service,
maintenance or repairs) to be
performed by or on behalf of the
additional insured(s) at the location
of the covered operations has been
completed; or
(b) That portion of "your work" out of
which the injury or damage arises
has been put to its intended use by
any person or organization other
than another contractor or
subcontractor engaged in
performing operations for a
principal as a part of the same
project.
j. Any Grantor of Licenses to you, but only
with respect to their liability as grantor of
licenses to you.
Their status as additional insured under
this endorsement ends when:
1. The license granted to you by such
person(s) or organization(s) expires; or
2. Your license is terminated or revoked
by such person(s) or organization(s)
prior to expiration of the license as
stipulated by the contract or
agreement.
k. Any Grantor of Franchise, but only with
respect to their liability as grantor of a
franchise to you.
I. Any Co-owner of Insured Premises, but
only with respect to their liability as co-
owner of any insured premises.
m. Any Concessionaires Trading Under Your
Name, but only with respect to their liability
as a concessionaire trading under your
name.
3. Any insurance provided to any additional
insured does not apply to "bodily injury",
"property damage" or "personal and advertising
injury" arising out of the sole negligence or
willful misconduct of the additional insured or its
agents, "employees" or any other
representative of the additional insured.
4. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits of Insurance:
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
J. COVERAGE FOR INJURY TO CO -EMPLOYEES
AND/OR YOUR OTHER VOLUNTEER WORKERS
Section II — Who is an Insured, paragraph 2.a. (1)
is amended to add the following:
e. Paragraphs (a), (b), and (c) do not apply to
your "employees" or "volunteer workers" with
respect to "bodily injury" to a co -"employee" or
other "volunteer worker".
Damages owed to an injured co -"employee" or
"volunteer worker" will be reduced by any
amount paid or available to the injured co -
"employee" or "volunteer worker" under any
other valid and collectible insurance.
K. HEALTH CARE SERVICE PROFESSIONALS AS
INSUREDS - INCIDENTAL MALPRACTICE
Section II — Who is an Insured, paragraph 2.a. (1)
(d) is amended as follows:
This provision does not apply to Nurses,
Emergency Medical Technicians, or Paramedics
who provide professional health care services on
your behalf.
However this exception does not apply if you are in
the business or occupation of providing any such
professional services.
L. NEWLY FORMED OR ACQUIRED ORGANIZATIONS
Section II — Who Is An Insured, paragraph 3.a. is
replaced by the following:
3.a. Coverage under this provision is afforded until
the end of the policy period.
This provision does not apply if newly formed or
acquired organizations coverage is excluded either
by the provisions of the Coverage Form or by
endorsements.
M. DAMAGE TO PREMISES RENTED TO YOU
Section III — Limits of Insurance, paragraph 6. is
replaced by the following:
Subject to 5.a. above, the Damage To Premises
Rented To You Limit, or $500,000, whichever is
higher, is the most we will pay under Coverage A
for damages because of "property damage" to any
one premises, while rented to you, or in the case of
damage by fire, smoke or leakage from automatic
protection systems, while rented to you or
temporarily occupied by you with permission of the
owner.
If coverage provided to any additional insured N. MEDICAL PAYMENTS — INCREASED LIMITS
is required by a contract or agreement, the Section III — Limits of Insurance, paragraph 7. is
most we will pay on behalf of the additional replaced by the following:
insured is the amount of insurance:
7. Subject to paragraph 5. above, the Medical
a. Required by the contract or agreement; or Expense Limit is the most we will pay under
b. Available under the applicable Limits of Coverage C for all medical expenses because
Insurance shown in the Declarations; of "bodily injury" sustained by any one person,
whichever is less. and will be the higher of:
(a) $10,000; or
CG7578(5-15) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 5 of 6