GENERAL50446

• Permit No: C1981046
• IBM Index Class Name: General Documents
• Doc Date: 4/27/1990
• Doc Name: BID RN-COAL MINES-3 SUNLIGHT MINE RECLAMATION PROJECT
• From: MLRD
• To: DIV OF PURCHASING
• Permit Index Doc Type: RECLAMATION PROJECTS
• Media Type: D
• Archive: No

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POLICY NUMBER GSP 1 19671 COMMERCIAL GENERAL LIABILITY
NAP1E INSURED: DBA CUKRI' COl;STRUCTION EFFECTIVE DATE: 4/20/90
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED-OWNERS, LESSEES or
CONTRACTORS (Form A)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization (Additional Insured): Location of
STATE OF COLORADO Covered Operations
CO
Premium Basis Rates Advance Premium
Bodily Injury and (Per
Property Damage Liability Cost 31000 of cost) S
IF ANY SUBJECT TO AUDIT
Total Advance Premium b
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
1. WHO IS AN INSURED (Section II) is amended to
include as an insured [he person or organization
(called "additional insured") shown in the Sched-
ule but only with respect to liability arising out of:
A. "Your work" for the additional insureds} at
the location designated above, or
B. Acts or omissions of the additional insureds)
in connection with their general supervision
of "your work" at the location shown in the
Schedule.
2. With respect to the insurance afforded these addi-
tionalinsureds. tnefollowing additional provisions
apply:
A. None of the exclusions under Coverage A,
except exclusons (a). (d). (e), (t), (h2). (i).
and (m), apply to this insurance.
B. Additional Exclusions. This insurance does
not apply to:
(1) "Bodily injury" or "property damage"
for which the additional insureds) are
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 additional
insureds) would have in the absence of
the contract or agreement.
(2) "Bodily injury" or "property damage"
occurring after:
(a) All work on the pro(ect (other than
service, maintenance, or repairs) to
be performed by or on behalf of the
additional insureds) at the site of the
covered operations has been com-
pleted; 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 an-
other contractor or subcontractor
engaged in performing operations for
a principal as a part of the same
project.
(3) "Bodily infury" or "property damage"
arising out of any act or omission of the
additional insureds) or any of their em-
ployees. other than the general supervi-
sion of work performed for the additional
insureds) by you.
(4) "Property damage" to:
(a) Property owned, used or occupied by
or rented to the additional insured(s);
(b) Property inthe care.custody,orcon-
trol of the additional insureds) or
over which the additional msured(s)
are for any purpose exercising phys-
ical control; or
(c) "Your work" for the additional in-
sured(s).
CG 20 09 11 85 Copyright, Insurance Services Office, Inc., 1984 ^
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