PERMFILE113020

• Permit No: C1992080
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: APPENDIX 3-3 CERT OF INSURANCE
• Media Type: D
• Archive: No

pOLICY NUMBER:
THIS ENDORSEAENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 03 00 11 85
DEDUCTIBLE LIABILITY INSURANCE
• endorsement modifies Insurance provided under the folloring:
COIMERCIAL GENERAL LIABILITY COYERAGE PART
PRODUCTS/COMPLETED OPERAT10N5 LIABILITY COVERAGE PART
Corerape
6odity Injury Liability
Property Demege Liability
SCHEDULE
Aenunt and Bests of Deductible
S per claim
S per occurrenee
S 500 per cle im
f 2500 per occurrence
bodily Injury Ltebi llty end Property f per claim
Damage Liability Combined S Der occurrence
(If no entry appears above, Information required to complete this endorsement rill be shown in the Decleretions es
:ppltteble to this endorsement.)
APPLICATION OP ENDORSEMENT (Enter bel or any limitations on the application of this endorsement. if no limitation is
entered, the deductibles apply to damages for all 'bodily injury' end 'property damage', however, ceused):-
1. Our obligation under the Bod11y Injury Liebtlity and
Property Damage Liability Coverages to pay damages on your
behalf applies only to the amount of damages in excess of
any deductible amounts stated in the Schedule above es
eppltteble to such coverages, end the 11m1ts of Insurance
applicable to 'each occurrence' for such coverages r111 be
reduced by the emouni of such deductible. 'Aggregate' limits
for such coverages shall not be reduced by the application
• of such deductible amount.
2. The deductible amounts stated 1n tfie Schedule apply es
follows:
A. PER CUIM BASIS -- if the deductible is on a 'per
claim' basis, the deductible amount appl tes:
1. Under the Bod11y injury Liebtlity or Property
Damage Li eb111ty Coverage, respectively:
e. To ell demeges because of 'bodily injury'
sustained by one person, or
b. To all demeges because of 'property
damage' sustained by one person or
orgeni zetton,
es the result of any one "occurrence'.
2. Under Bodily Injury Liability and Property
Damage Liability Coverage combined to all damages
because of 'botlily injury' and 'property damage'
sustained by one person or orgenizetion es the
result of any one 'occurrence".
B. PER OCCURRENCE BASIS -- if the deductible is on e
'per occurrence' basis, the deductible amount eppl ies:
•
Fotm No. CG 03 00 11 85
1. Under the Bodily Injury Liability or Property
Demege Liability Coverage, respectively:
a. To ell damages because of 'bodily Injury'
es the result of any one "occurrence', or
b. To all damages because of 'property
damage' as the result of any one
'occurrence'.
regardless of the number of persons or
organizatt ons rho sustain damages because of that
'occurrence'.
2. Under Bodily injury L1ab111ty and Property
Damage Liebtlity Coverage combined to ell demeges
because of 'bodily injury" end 'property damage'
es the result of any one 'occurrence' regardless
of the number of persons or organizations rho
sustain demeges because of that °occu rrence".
3. The terms of this insurance, including those
with respect to:
(a) Our right end duty to defend any 'suits'
seekf ng Those damages; and
(b) Ycur duties in the event of an
'occurrence", cla tm, or suit apply
irrespective of the epplicatlon of the
deductible amount.
4. We may pay any part or all of the deductible
amount to effect settlement of any claim or suit
and, upon notification of the action taken, you
shell promptly reimburse us for such pert of the
deductible amount es has been paid by us.
Copyright Insurance Services Office, Inc