2012-09-10_GENERAL DOCUMENTS - C1984065

• Permit No: C1984065
• IBM Index Class Name: General Documents
• Doc Date: 9/10/2012
• Doc Name: Email Regardng Insurance Certificate attached
• From: Jim Stover
• To: DRMS
• Permit Index Doc Type: Insurance
• Email Name: ZTT
• Email Name: DIH
• Media Type: D
• Archive: No

COMMERCIAL_ GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION -
VICARIOUS LIABILITY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE"
Name of Person or Organization:
Project:
Location of Project:
"If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.
A. SECTION 11 —WHO 1S AN INSURED is amended
to include as an additional insured the person or
organization shown in the Schedule, but only with
respect to "bodily injury", "property damage" or
"personal and advertising injury" caused, in whole,
by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf in the performance of your ongoing
operations for the additional insured at the
location designated above.
B. With respect to the insurance afforded to this
additional insured, the following exclusions apply:
This insurance does not apply to:
"Bodily injury ", "property damage" or "personal
and advertising injury" resulting from any act
or omission by, or willful misconduct of the
additional insured shown in the Schedule,
whether the sole or a contributing cause of the
loss. The coverage afforded to the additional
insured is limited solely to the additional
insured's "vicarious liability" that is a specific
and direct result of your conduct.
"Vicarious liability" as used in this
endorsement means liability that is imposed
on the additional insured solely by virtue of its
relationship with you, and not due to any act
or omission of the additional insured.
2. This insurance does not apply to "bodily
injury" or "property damage" occurring after:
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 insure(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.
CG7480(6-05) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 1