HomeMy WebLinkAboutCertificate of Insurance 10.26.2023Client#: 1635640
MATRICON2
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDNM)
10/26/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer any rights to the certificate holder In lieu of such endorsement(s).
PRODUCER
USI Insurance Services, LLC
2375 E. Camelback Road, Suite 250
Phoenix, 85016
877 468-65511 6
CONTACT
NAME: Christine Torrance
AICNNo Ext): 602 666-4830 FAX
(A/C, No):610 537-2283
E-MAIL
ADDRESS: Christine.torrance@usi.com
INSURER(S) AFFORDING COVERAGE NAIC#
INSURER A: Sentinel Insurance Company Ltd. 11000
INSURED
Matrix Consulting Group, Ltd
1650 S Amphlett Blvd, Ste 213
San Mateo, CA 94402
INSURER B: Hartford - WC Multiple Issuing Cos 00914
INSURER C: Swiss Re Corp Solutions America Ins Co 29874
INSURER : Twin City Fire Insurance Company 29459
69SBAR00849
8/08/2023
INSURER E:
INSURER F:
PREMISES Ea occurrence $1,000,000
COVERAGES CERTIFICATE NUMBER: REVISION NLIMRFR-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
NSR
W /D
POLICY NUMBER
POLICY EFF
MM/DDIrYYYY
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
X
X
69SBAR00849
8/08/2023
08/08/2024
EAACHH OCCCURRRENCE s2,000,000
PREMISES Ea occurrence $1,000,000
MED EXP (Any one person) $10,000
PERSONAL &ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY 51JECOT FILOC
GENERAL AGGREGATE $4,000,000
PRODUCTS - COMP/OP AGG $4,000,000
$
OTHER:
A
AUTOMOBILE
LIABILITY
X
X
59SBAR00849
$/08/2023
08/08/2024
COMBINED SINGLE LIMIT
(EaO accident $2,000,000
BODILY INJURY (Per person) $
ANY AUTO
X
OWNED SCHEDULED
AUTOS ONLY AUTOS
NON -OWNED
HIRED ONLY Ix AUTOS ONLY
BODILY INJURY (Per $
( )
PROPERTY DAMAGE
Per accident $
A
X
UMBRELLA LIAB
X
OCCUR
69SBAR00849
8/08/2023
08/08/2024
EACH OCCURRENCE s3,000,000
EXCESS LIAB
CLAIMS -MADE
AGGREGATE s3,000,000
DED I X RETENTION $10,000
$
B
WORKERS COMPENSATIONX
AND EMPLOYERS' LIABILITYSTA
ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N
OFFICER/MEMBER EXCLUDED? F
N / A
59WECAB6SO4
08/08/202$
0$/08/202
X PER oTH-
UTE ER
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1,000,000
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT $1,000,000
C
Cyber Liability
C4LTK141409CYBER20
10/04/2023
10104/2024
$2,000,0001$5,000 ret
D
Professional Liab
69PG029737223
8/08/2023
r
08/0812024
$2,000,0001$3,000,000
$10,000 ded/ea claim
—
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: 2023 Pathway Fee Nexus Study
General Liability, including completed operations, and Hired & Non -Owned Auto Liability include an
automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder,
only when there is a written contract or written agreement between the named insured and the certificate
holder and with regard to work performed by or on behalf of the named insured. General Liability, Hired &
(See Attached Descriptions)
Town of Los Altos Hills
26379 Fremont Rd.
Los Altos Hills, CA 94022
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Cc)1! MR -2015 ACORn r0RP0RATIr1N All rinhfa raen—hell
ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
#842400383/M42201670 AFCZP
DESCRIPTIONS (Continued from Page 1)
Non -Owned Auto Liability and Workers Compensation provide a blanket Waiver of Subrogation in favor of the
same, when required by written contract. General Liability and Hired & Non -Owned Auto Liability contain a
special endorsement with "Primary and Non -Contributory" wording, when required by written contract. This
form is subject to any/all respective policy provisions.
Additional Insured: The Town of Los Altos Hills, its elective and appointed officers, employees, and
volunteers.
Workers Compensation Issuing Company:
Hartford Casualty Insurance Co. / NAIC 29424
Qrw1 1 1 40.0 �,Cwl VIua) Z OT L
#S42400383/M42201670
BUSINESS LIABILITY COVERAGE FORM
2. Applicable To Medical Expenses Coverage
We will not pay expenses for "bodily injury":
a. Any Insured
To any insured, except "volunteer workers".
b. Hired Person
To a person hired to do work for or on behalf
of any insured or a tenant of any insured.
c. Injury On Normally Occupied Premises
To a person injured on that part of
premises you own or rent that the person
normally occupies.
d. Workers' Compensation And Similar
Laws
To a person, whether or not an
"employee" of any insured, if benefits for
the "bodily injury" are payable or must be
provided under a workers' compensation
or disability benefits law or a similar law.
e. Athletics Activities
To a person injured while practicing,
instructing or participating in any physical
exercises or games, sports or athletic
contests.
f. Products -Completed Operations Hazard
Included with the "products -completed
operations hazard".
g. Business Liability Exclusions
Excluded under Business Liability Coverage.
C. WHO IS AN INSURED
1. If you are designated in the Declarations as:
a. An individual, you and your spouse are
insureds, but only with respect to the
conduct of a business of which you are the
sole owner.
b. A partnership or joint venture, you are an
insured. Your members, your partners, and
their spouses are also insureds, but only with
respect to the conduct of your business.
c. A limited liability company, you are an
insured. Your members are also insureds,
but only with respect to the conduct of your
business. Your managers are insureds, but
only with respect to their duties as your
managers.
d. An organization other than a partnership,
joint venture or limited liability company, you
are an insured. Your "executive officers" and
directors are insureds, but only with respect
to their duties as your officers or directors.
Your stockholders are also insureds, but only
with respect to their liability as stockholders.
Matrix Consulting Group, Ltd
Policy Number: 59SBAR00849
e. A trust, you are an insured. Your trustees
are also insureds, but only with respect to
their duties as trustees.
2. Each of the following is also an insured:
a. Employees And Volunteer Workers
Your "volunteer workers" only while
performing duties related to the conduct of
your business, or your "employees", other
than either your "executive officers" (if you
are an organization other than a
partnership, joint venture or limited liability
company) or your managers (if you are a
limited liability company), but only for acts
within the scope of their employment by
you or while performing duties related to
the conduct of your business.
However, none of these "employees" or
"volunteer workers" are insureds for:
(1) "Bodily injury" or "personal and
advertising injury":
(a) To you, to your partners or
members (if you are a partnership
or joint venture), to your members
(if you are a limited liability
company), or to a co -"employee"
while in the course of his or her
employment or performing duties
related to the conduct of your
business, or to your other
"volunteer workers" while
performing duties related to the
conduct of your business;
(b) To the spouse, child, parent,
brother or sister of that co -
"employee" or that "volunteer
worker" as a consequence of
Paragraph (1)(a) above;
(c) For which there is any obligation
to share damages with or repay
someone else who must pay
damages because of the injury
described in Paragraphs (1)(a) or
(b) above; or
(d) Arising out of his or her providing
or failing to provide professional
health care services.
If you are not in the business of
providing professional health care
services, Paragraph (d) does not apply
to any nurse, emergency medical
technician or paramedic employed by
you to provide such services.
(2) "Property damage" to property:
(a) Owned, occupied or used by,
Page 10 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
(b) Rented to, in the care, custody or
b. Coverage under this provision does not
control of, or over which physical
apply to:
control is being exercised for any
(1) "Bodily injury" or "property damage"
purpose by you, any of your
that occurred; or
"employees", "volunteer workers",
any partner or member (if you are
(2) "Personal and advertising injury"
a partnership or joint venture), or
arising out of an offense committed
any member (if you are a limited
before you acquired or formed the
liability company).
organization.
b. Real Estate Manager
4. Operator Of Mobile Equipment
Any person (other than your "employee" or
With respect to "mobile equipment" registered in
"volunteer worker"), or any organization
your name under any motor vehicle registration
while acting as your real estate manager.
law, any person is an insured while driving such
c. Temporary Custodians Of Your
equipment along a public highway with your
Property
permission. Any other person or organization
Any person or organization having proper
responsible for the conduct of such person is
temporary custody of your property if you
also an insured, but only with respect to liability
die, but only:
arising out of the operation of the equipment, and
only if no other insurance of any kind is available
(1) With respect to liability arising out of the
to that person or organization for this liability.
maintenance or use of that property; and
However, no person or organization is an insured
(2) Until your legal representative has
with respect to:
been appointed.
a. "Bodily injury" to a co -"employee" of the
d. Legal Representative If You Die
person driving the equipment; or
Your legal representative if you die, but
b. "Property damage" to property owned by,
only with respect to duties as such. That
rented to, in the charge of or occupied by
representative will have all your rights and
you or the employer of any person who is
duties under this insurance.
an insured under this provision.
e. Unnamed Subsidiary
5. Operator of Nonowned Watercraft
Any subsidiary and subsidiary thereof, of
yours which is a legally incorporated entity
of which you own a financial interest of
more than 50% of the voting stock on the
effective date of this Coverage Part.
The insurance afforded herein for any
subsidiary not shown in the Declarations
as a named insured does not apply to
injury or damage with respect to which an
insured under this insurance is also an
insured under another policy or would be
an insured under such policy but for its
termination or upon the exhaustion of its
limits of insurance.
3. Newly Acquired Or Formed Organization
Any organization you newly acquire or form,
other than a partnership, joint venture or
limited liability company, and over which you
maintain financial interest of more than 50% of
the voting stock, will qualify as a Named
Insured if there is no other similar insurance
available to that organization. However:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier; and
With respect to watercraft you do not own that
is less than 51 feet long and is not being used
to carry persons for a charge, any person is an
insured while operating such watercraft with
your permission. Any other person or
organization responsible for the conduct of
such person is also an insured, but only with
respect to liability arising out of the operation
of the watercraft, and only if no other
insurance of any kind is available to that
person or organization for this liability.
However, no person or organization is an
insured with respect to:
a. "Bodily injury" to a co -"employee" of the
person operating the watercraft; or
b. "Property damage" to property owned by,
rented to, in the charge of or occupied by
you or the employer of any person who is
an insured under this provision.
6. Additional Insureds When Required By
Written Contract, Written Agreement Or
Permit
The person(s) or organization(s) identified in
Paragraphs a. through f. below are additional
insureds when you have agreed, in a written
Form SS 00 08 04 05 Page 11 of 24
BUSINESS LIABILITY COVERAGE FORM
contract, written agreement or because of a
permit issued by a state or political
subdivision, that such person or organization
be added as an additional insured on your
policy, provided the injury or damage occurs
subsequent to the execution of the contract or
agreement, or the issuance of the permit.
A person or organization is an additional
insured under this provision only for that
period of time required by the contract,
agreement or permit.
However, no such person or organization is an
additional insured under this provision if such
person or organization is included as an
additional insured by an endorsement issued
by us and made a part of this Coverage Part,
including all persons or organizations added
as additional insureds under the specific
additional insured coverage grants in Section
F. — Optional Additional Insured Coverages.
(e) Any failure to make such
inspections, adjustments, tests or
servicing as the vendor 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;
(f) Demonstration, installation,
servicing or repair operations,
except such operations performed
at the vendor's premises in
connection with the sale of the
product;
(g) Products which, after distribution
or sale by you, have been labeled
or relabeled or used as a
container, part or ingredient of any
other thing or substance by or for
the vendor; or
a. Vendors
(h) "Bodily injury" or "property
Any person(s) or organization(referred to
damage" arising out of the soles)
below as vendor), but only with respect to
negligence of the vendor for its
"bodily injury" or "property damage" arising
own acts or omissions or those of
out of "your products" which are distributed
its employees or anyone else
or sold in the regular course of the vendor's
acting on its behalf. However, this
business and only if this Coverage Part
exclusion does not apply to:
provides coverage for "bodily injury" or
(i) The exceptions contained in
"property damage" included within the
Subparagraphs (d) or (f); or
"products -completed operations hazard".
(ii) Such inspections, adjustments,
(1) The insurance afforded to the vendor
tests or servicing as the vendor
is subject to the following additional
has agreed to make or normally
exclusions:
undertakes to make in the usual
This insurance does not apply to:
course of business, inconnection
with the distribution
(a) "Bodily injury" or "property
or sale of the products.
damage" for which the vendor is
(2) This insurance does not apply to any
obligated to pay damages by
insured person or organization from
reason of the assumption of
whom you have acquired such products,
liability in a contract or agreement.
or any ingredient, part or container,
This exclusion does not apply to
entering into, accompanying or
liability for damages that the
containing such products.
vendor would have in the absence
of the contract or agreement;
b. Lessors Of Equipment
(b) Any express warranty
(1) Any person or organization from
unauthorized by you;
whom you lease equipment; but only
(c) Any physical or chemical change
with respect to their liability for "bodily
"property
in the product made intentionally
injury", damage" or
"personal
by the vendor;
and advertising injury"
caused, in whole or in part, by your
(d) Repackaging, except when
maintenance, operation or use of
unpacked solely for the purpose of
equipment leased to you by such
inspection, demonstration, testing,
person or organization.
or the substitution of parts under
instructions from the manufacturer,
and then repackaged in the
original container;
Page 12 of 24 Form SS 00 08 04 05
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to any
"occurrence" which takes place after
you cease to lease that equipment.
c. Lessors Of Land Or Premises
(1) Any person or organization from
whom you lease land or premises, but
only with respect to liability arising out
of the ownership, maintenance or use
of that part of the land or premises
leased to you.
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) Any 'occurrence" which takes
place after you cease to lease that
land or be a tenant in that
premises; or
(b) Structural alterations, new
construction or demolition
operations performed by or on
behalf of such person or
organization.
d. Architects, Engineers Or Surveyors
(1) Any architect, engineer, or surveyor, but
only with respect to liability for "bodily
injury", "property damage" or "personal
and advertising injury" caused, in whole
or in part, by your acts or omissions or
the acts or omissions of those acting on
your behalf.
(a) In connection with your premises;
or
(b) In the performance of your
ongoing operations performed by
you or on your behalf.
(2) With respect to the insurance afforded
to these additional insureds, the
following additional exclusion applies:
This insurance does not apply to
"bodily injury", "property damage" or
"personal and advertising injury"
arising out of the rendering of or the
failure to render any professional
services by or for you, including:
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
BUSINESS LIABILITY COVERAGE FORM
e. Permits Issued By State Or Political
Subdivisions
(1) Any state or political subdivision, but
only with respect to operations
performed by you or on your behalf for
which the state or political subdivision
has issued a permit.
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
(a) 'Bodily injury", "property damage"
or "personal and advertising
injury" arising out of operations
performed for the state or
municipality; or
(b) 'Bodily injury" or "property damage"
included within the "products -
completed operations hazard".
f. Any Other Party
(1) Any other person or organization who
is not an insured under Paragraphs a.
through e. above, but only with
respect to liability for "bodily injury",
"property damage" or "personal and
advertising injury" caused, in whole or
in part, by your acts or omissions or
the acts or omissions of those acting
on your behalf:
(a) In the performance of your
ongoing operations;
(b) In connection with your premises
owned by or rented to you; or
(c) In connection with "your work" and
included within the "products -
completed operations hazard", but
only if
(i) The written contract or written
agreement requires you to
provide such coverage to
such additional insured; and
(ii) This Coverage Part provides
coverage for "bodily injury" or
"property damage" included
within the "products -
completed operations hazard".
(2) With respect to the insurance afforded
to these additional insureds, this
insurance does not apply to:
"Bodily injury", "property damage" or
"personal and advertising injury"
arising out of the rendering of, or the
failure to render, any professional
architectural, engineering or surveying
services, including:
Form SS 00 08 04 05 Page 13 of 24
BUSINESS LIABILITY COVERAGE FORM
(a) The preparing, approving, or
failure to prepare or approve,
maps, shop drawings, opinions,
reports, surveys, field orders,
change orders, designs or
drawings and specifications; or
(b) Supervisory, inspection,
architectural or engineering
activities.
The limits of insurance that apply to additional
insureds are described in Section D. — Limits
Of Insurance.
How this insurance applies when other
insurance is available to an additional insured
is described in the Other Insurance Condition
in Section E. — Liability And Medical Expenses
General Conditions.
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named Insured in
the Declarations.
D. LIABILITY AND MEDICAL EXPENSES
LIMITS OF INSURANCE
1. The Most We Will Pay
The Limits of Insurance shown in the
Declarations and the rules below fix the most
we will pay regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
2. Aggregate Limits
The most we will pay for:
a. Damages because of "bodily injury" and
"property damage" included in the
"products -completed operations hazard" is
the Products -Completed Operations
Aggregate Limit shown in the
Declarations.
b. Damages because of all other "bodily
injury", "property damage" or "personal
and advertising injury", including medical
expenses, is the General Aggregate Limit
shown in the Declarations.
This General Aggregate Limit applies
separately to each of your "locations"
owned by or rented to you.
"Location" means premises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway or right-of-way of a
railroad.
This General Aggregate limit does not
apply to "property damage" to premises
while rented to you or temporarily
occupied by you with permission of the
owner, arising out of fire, lightning or
explosion.
3. Each Occurrence Limit
Subject to 2.a. or 2.b above, whichever
applies, the most we will pay for the sum of all
damages because of all "bodily injury",
"property damage" and medical expenses
arising out of any one "occurrence" is the
Liability and Medical Expenses Limit shown in
the Declarations.
The most we will pay for all medical expenses
because of "bodily injury" sustained by any
one person is the Medical Expenses Limit
shown in the Declarations.
4. Personal And Advertising Injury Limit
Subject to 2.b. above, the most we will pay for
the sum of all damages because of all
"personal and advertising injury" sustained by
any one person or organization is the Personal
and Advertising Injury Limit shown in the
Declarations.
5. Damage To Premises Rented To You Limit
The Damage To Premises Rented To You
Limit is the most we will pay under Business
Liability Coverage for damages because of
"property damage" to any one premises, while
rented to you, or in the case of damage by fire,
lightning or explosion, while rented to you or
temporarily occupied by you with permission of
the owner.
In the case of damage by fire, lightning or
explosion, the Damage to Premises Rented To
You Limit applies to all damage proximately
caused by the same event, whether such
damage results from fire, lightning or explosion
or any combination of these.
6. How Limits Apply To Additional Insureds
The most we will pay on behalf of a person or
organization who is an additional insured
under this Coverage Part is the lesser of:
a. The limits of insurance specified in a
written contract, written agreement or
permit issued by a state or political
subdivision; or
b. The Limits of Insurance shown in the
Declarations.
Such amount shall be a part of and not in
addition to the Limits of Insurance shown in
the Declarations and described in this Section.
Page 14 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
If more than one limit of insurance under this
(1) Immediately send us copies of any
policy and any endorsements attached thereto
demands, notices, summonses or
applies to any claim or "suit", the most we will pay
legal papers received in connection
under this policy and the endorsements is the
with the claim or "suit";
single highest limit of liability of all coverages
applicable to such claim or "suit". However, this
(2) Authorize us to obtain records and
paragraph does not apply to the Medical Expenses
other information;
limit set forth in Paragraph 3. above.
(3) Cooperate with us in the investigation,
The Limits of Insurance of this Coverage Part apply
settlement of the claim or defense
"suit";
separately to each consecutive annual period and to
against the and
any remaining period of less than 12 months, starting
(4) Assist us, upon our request, in the
with the beginning of the policy period shown in the
enforcement of any right against any
Declarations, unless the policy period is extended
person or organization that may be
after issuance for an additional period of less than 12
liable to the insured because of injury
months. In that case, the additional period will be
or damage to which this insurance
deemed part of the last preceding period for purposes
may also apply.
of determining the Limits of Insurance.
d. Obligations At The Insured's Own Cost
E. LIABILITY AND MEDICAL EXPENSES
No insured will, except at that insured's own
GENERAL CONDITIONS
cost, voluntarily make a payment, assume
any obligation, or incur any expense, other
1. Bankruptcy
than for first aid, without our consent.
Bankruptcy or insolvency of the insured or of
e. Additional Insured's Other Insurance
the insured's estate will not relieve us of our
If we cover a claim or "suit" under this
obligations under this Coverage Part.
Coverage Part that may also be covered
2. Duties In The Event Of Occurrence,
by other insurance available to an
Offense, Claim Or Suit
additional insured, such additional insured
a. Notice Of Occurrence Or Offense
must submit such claim or "suit" to the
You or any additional insured must see to
other insurer for defense and indemnity.
it that we are notified as soon as
However, this provision does not apply to
practicable of an "occurrence" or an
the extent that you have agreed in a
offense which may result in a claim. To
written contract, written agreement or
the extent possible, notice should include:
permit that this insurance is primary and
(1) How, when and where the "occurrence"
non-contributory with the additional
or offense took place;
insured's own insurance.
(2) The names and addresses of any
f. Knowledge Of An Occurrence, Offense,
injured persons and witnesses; and
Claim Or Suit
(3) The nature and location of any injury
Paragraphs a. and b. apply to you or toany
or damage arising out of the
additional insured only when such
"occurrence",
occurrence or offense.
offense, claim or "suit" is
known to:
b. Notice Of Claim
(1) You or any additional insured that is
If a claim is made or "suit" is brought
an individual;
against any insured, you or any additional
(2) Any partner, if you or an additional
insured must:
insured is a partnership;
(1) Immediately record the specifics of the
"suit"
(3) Any manager, if you or an additional
claim or and the date received;
insured is a limited liability company;
and
(2) Notify us as soon as practicable.
(4) Any "executive officer" or insurance
manager, if you or an additional
You or any additional insured must see to
insured is a corporation;
it that we receive a written notice of the
"suit"
(5) Any trustee, if you or an additional
c
claim or as soon as practicable.
insured is a trust; or
c. Assistance And Cooperation Of The
(6) Any elected or appointed official, if you
Insured
or an additional insured is a political
You and any other involved insured must:
subdivision or public entity.
Form SS 00 08 04 05 Page 15 of 24
BUSINESS LIABILITY COVERAGE FORM
This Paragraph f. applies separately to
you and any additional insured.
3. Financial Responsibility Laws
a. When this policy is certified as proof of
financial responsibility for the future under
the provisions of any motor vehicle
financial responsibility law, the insurance
provided by the policy for "bodily injury"
liability and "property damage" liability will
comply with the provisions of the law to
the extent of the coverage and limits of
insurance required by that law.
b. With respect to "mobile equipment" to
which this insurance applies, we will
provide any liability, uninsured motorists,
underinsured motorists, no-fault or other
coverage required by any motor vehicle
law. We will provide the required limits for
those coverages.
4. Legal Action Against Us
No person or organization has a right under
this Coverage Form:
a. To join us as a party or otherwise bring us
into a "suit" asking for damages from an
insured; or
b. To sue us on this Coverage Form unless
all of its terms have been fully complied
with.
A person or organization may sue us to recover
on an agreed settlement or on a final judgment
against an insured; but we will not be liable for
damages that are not payable under the terms of
this insurance or that are in excess of the
applicable limit of insurance. An agreed
settlement means a settlement and release of
liability signed by us, the insured and the
claimant or the claimant's legal representative.
5. Separation Of Insureds
Except with respect to the Limits of Insurance,
and any rights or duties specifically assigned
in this policy to the first Named Insured, this
insurance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom
a claim is made or "suit" is brought.
6. Representations
a. When You Accept This Policy
By accepting this policy, you agree:
(1) The statements in the Declarations
are accurate and complete;
(2) Those statements are based upon
representations you made to us; and
(3) We have issued this policy in reliance
upon your representations.
b. Unintentional Failure To Disclose
Hazards
If unintentionally you should fail to disclose
all hazards relating to the conduct of your
business at the inception date of this
Coverage Part, we shall not deny any
coverage under this Coverage Part
because of such failure.
7. Other Insurance
If other valid and collectible insurance is
available for a loss we cover under this
Coverage Part, our obligations are limited as
follows:
a. Primary Insurance
This insurance is primary except when b.
below applies. If other insurance is also
primary, we will share with all that other
insurance by the method described in c.
below.
b. Excess Insurance
This insurance is excess over any of the
other insurance, whether primary, excess,
contingent or on any other basis:
(1) Your Work
That is Fire, Extended Coverage,
Builder's Risk, Installation Risk or
similar coverage for "your work";
(2) Premises Rented To You
That is fire, lightning or explosion
insurance for premises rented to you
or temporarily occupied by you with
permission of the owner;
(3) Tenant Liability
That is insurance purchased by you to
cover your liability as a tenant for
"property damage" to premises rented
to you or temporarily occupied by you
with permission of the owner;
(4) Aircraft, Auto Or Watercraft
If the loss arises out of the maintenance
or use of aircraft, "autos" or watercraft to
the extent not subject to Exclusion g. of
Section A. — Coverages.
(5) Property Damage To Borrowed
Equipment Or Use Of Elevators
If the loss arises out of "property
damage" to borrowed equipment or
the use of elevators to the extent not
subject to Exclusion k. of Section A. —
Coverages.
Page 16 of 24 Form SS 00 08 04 05
(6) When You Are Added As An
Additional Insured To Other
Insurance
That is other insurance available to
you covering liability for damages
arising out of the premises or
operations, or products and completed
operations, for which you have been
added as an additional insured by that
insurance; or
(7) When You Add Others As An
Additional Insured To This
Insurance
That is other insurance available to an
additional insured.
However, the following provisions
apply to other insurance available to
any person or organization who is an
additional insured under this Coverage
Part:
(a) Primary Insurance When
Required By Contract
This insurance is primary if you
have agreed in a written contract,
written agreement or permit that
this insurance be primary. If other
insurance is also primary, we will
share with all that other insurance
by the method described in c.
below.
(b) Primary And Non -Contributory
To Other Insurance When
Required By Contract
If you have agreed in a written
contract, written agreement or
permit that this insurance is
primary and non-contributory with
the additional insured's own
insurance, this insurance is
primary and we will not seek
contribution from that other
insurance.
Paragraphs (a) and (b) do not apply to
other insurance to which the additional
insured has been added as an
additional insured.
When this insurance is excess, we will
have no duty under this Coverage Part to
defend the insured against any "suit" if any
other insurer has a duty to defend the
insured against that "suit". If no other
insurer defends, we will undertake to do
so, but we will be entitled to the insured's
rights against all those other insurers.
Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
When this insurance is excess over other
insurance, we will pay only our share of
the amount of the loss, if any, that
exceeds the sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, if any, with
any other insurance that is not described in
this Excess Insurance provision and was not
bought specifically to apply in excess of the
Limits of Insurance shown in the
Declarations of this Coverage Part.
c. Method Of Sharing
If all the other insurance permits
contribution by equal shares, we will follow
this method also. Under this approach,
each insurer contributes equal amounts
until it has paid its applicable limit of
insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method, each
insurer's share is based on the ratio of its
applicable limit of insurance to the total
applicable limits of insurance of all insurers.
8. Transfer Of Rights Of Recovery Against
Others To Us
a. Transfer Of Rights Of Recovery
If the insured has rights to recover all or
part of any payment, including
Supplementary Payments, we have made
under this Coverage Part, those rights are
transferred to us. The insured must do
nothing after loss to impair them. At our
request, the insured will bring "suit" or
transfer those rights to us and help us
enforce them. This condition does not
apply to Medical Expenses Coverage.
b. Waiver Of Rights Of Recovery (Waiver
Of Subrogation)
If the insured has waived any rights of
recovery against any person or
organization for all or part of any payment,
including Supplementary Payments, we
have made under this Coverage Part, we
also waive that right, provided the insured
waived their rights of recovery against
such person or organization in a contract,
agreement or permit that was executed
prior to the injury or damage.
Page 17 of 24
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED
3. Additional Insured - Grantor Of Franchise
COVERAGES
WHO IS AN INSURED under Section C. is
If listed or shown as applicable in the Declarations,
amended to include as an additional insured
one or more of the following Optional Additional
the person(s) or organization(s) shown in the
Insured Coverages also apply. When any of these
Declarations as an Additional Insured -
Optional Additional Insured Coverages apply,
Grantor Of Franchise, but only with respect to
Paragraph 6. (Additional Insureds When Required
their liability as grantor of franchise to you.
by Written Contract, Written Agreement or Permit)
4. Additional Insured - Lessor Of Leased
of Section C., Who Is An Insured, does not apply
Equipment
to the person or organization shown in the
a. WHO IS AN INSURED under Section C. is
Declarations. These coverages are subject to the
amended to include as an additional
terms and conditions applicable to Business
insured the person(s) or organization(s)
Liability Coverage in this policy, except as
shown in the Declarations as an Additional
provided below:
Insured — Lessor of Leased Equipment,
1. Additional Insured - Designated Person Or
but only with respect to liability for "bodily
Organization
injury", "property damage" or "personal
WHO IS AN INSURED under Section C. is
and advertising injury" caused, in whole or
amended to include as an additional insured
in part, by your maintenance, operation or
the person(s) or organization(s) shown in the
use of equipment leased to you by such
Declarations, but only with respect to liability
person(s) or organization(s).
for "bodily injury", "property damage" or
b. With respect to the insurance afforded to
"personal and advertising injury" caused, in
these additional insureds, this insurance
whole or in part, by your acts or omissions or
does not apply to any 'occurrence" which
the acts or omissions of those acting on your
takes place after you cease to lease that
behalf:
equipment.
a. In the performance of your ongoing
5. Additional Insured - Owners Or Other
operations; or
Interests From Whom Land Has Been
b. In connection with your premises owned
Leased
by or rented to you.
a. WHO IS AN INSURED under Section C. is
2. Additional Insured - Managers Or Lessors
amended to include as an additional
Of Premises
insured the person(s) or organization(s)
a. WHO IS AN INSURED under Section C. is
shown in the Declarations as an Additional
amended to include as an additional insured
Insured —Owners Or Other Interests From
the person(s) or organization(s) shown in the
Whom Land Has Been Leased, but only
Declarations as an Additional Insured -
with respect to liability arising out of the
Designated Person Or Organization; but only
ownership, maintenance or use of that part
with respect to liability arising out of the
of the land leased to you and shown in the
ownership, maintenance or use of that part of
Declarations.
the premises leased to you and shown in the
b• With respect to the insurance afforded to
Declarations.
these additional insureds, the following
b. With respect to the insurance afforded to
additional exclusions apply:
these additional insureds, the following
This insurance does not apply to:
additional exclusions apply:
(1) Any 'occurrence" that takes place
This insurance does not apply to:
after you cease to lease that land; or
(1) Any 'occurrence" which takes place
(2) Structural alterations, new
after you cease to be a tenant in that
construction or demolition operations
premises; or
performed by or on behalf of such
(2) Structural alterations, new
person or organization.
construction or demolition operations
6. Additional Insured - State Or Political
performed by or on behalf of such
Subdivision — Permits
person or organization.
a. WHO IS AN INSURED under Section C. is
amended to include as an additional
insured the state or political subdivision
shown in the Declarations as an Additional
Page 18 of 24 Form SS 00 08 04 05
BUSINESS LIABILITY COVERAGE FORM
Insured — State Or Political Subdivision -
(e) Any failure to make such
Permits, but only with respect to
inspections, adjustments, tests or
operations performed by you or on your
servicing as the vendor has agreed
behalf for which the state or political
to make or normally undertakes to
subdivision has issued a permit.
make in the usual course of
b. With respect to the insurance afforded to
business, in connection with the
these additional insureds, the following
distribution or sale of the products;
additional exclusions apply:
(f) Demonstration, installation,
This insurance does not apply to:
servicing or repair operations,
(1) "Bodily injury", "property damage" or
except such operations performed
"personal and advertising injury"
at the vendor's premises in
arising out of operations performed for
connection with the sale of the
the state or municipality; or
product;
(2) "Bodily injury" or ;;property damage"
(g) Products which, after distribution
included in the product -completed
or sale by you, have been labeled
operations" hazard.
or relabeled or used as a
7. Additional Insured —Vendors
container, part or ingredient of any
other thing or substance by or for
a. WHO IS AN INSURED under Section C. is
the vendor; or
amended to include as an additional
(h) "Bodily injury" or "property
insured the person(s) or organization(s)
damage" arising out of the sole
(referred to below as vendor) shown in the
negligence of the vendor for its
Declarations as an Additional Insured -
own acts or omissions or those of
Vendor, but only with respect to "bodily
its employees or anyone else
injury" or "property damage" arising out of
acting on its behalf. However, this
"your products" which are distributed or
exclusion does not apply to:
sold in the regular course of the vendor's
business and only if this Coverage Part
(i) The exceptions contained in
provides coverage for "bodily injury" or
Subparagraphs (d) or (f); or
"property damage" included within the
(ii) Such inspections,
"products -completed operations hazard".
adjustments, tests or servicing
b. The insurance afforded to the vendor is
as the vendor has agreed to
subject to the following additional exclusions:
make or normally undertakes
(1) This insurance does not apply to:
to make in the usual course ofbusiness, in connection with
(a) "Bodily injury" or "property
the distribution or sale of the
damage" for which the vendor is
products.
obligated to pay damages by
(2) This insurance does not apply to any
reason of the assumption of
insured person or organization from
liability in a contract or agreement.
whom you have acquired such
This exclusion does not apply to
products, or any ingredient, part or
liability for damages that the
container, entering into,
vendor would have in the absence
accompanying or containing such
of the contract or agreement;
products.
(b) Any express warranty
8. Additional Insured — Controlling Interest
unauthorized by you;
WHO IS AN INSURED under Section C. is
(c) Any physical or chemical change
amended to include as an additional insured
in the product made intentionally
the person(s) or organization(s) shown in the
by the vendor;
Declarations as an Additional Insured —
(d) Repackaging, unless unpacked
Controlling Interest, but only with respect to
solely for the purpose of inspection,
their liability arising out of:
demonstration, testing, or the
a. Their financial control of you; or
substitution of parts under
instructions from the manufacturer,
b. Premises they own, maintain or control
and then repackaged in the original
while you lease or occupy these premises.
container;
Form SS 00 08 04 05 Page 19 of 24
BUSINESS LIABILITY COVERAGE FORM
This insurance does not apply to structural
The limits of insurance that apply to additional
alterations, new construction and demolition
insureds are described in Section D. — Limits Of
operations performed by or for that person or
Insurance.
organization.
How this insurance applies when other insurance
9. Additional Insured — Owners, Lessees Or
is available to an additional insured is described in
Contractors — Scheduled Person Or
the Other Insurance Condition in Section E. —
Organization
Liability And Medical Expenses General
a. WHO IS AN INSURED under Section C. is
Conditions.
amended to include as an additional
G. LIABILITY AND MEDICAL EXPENSES
insured the person(s) or organization(s)
DEFINITIONS
shown in the Declarations as an Additional
Insured — Owner, Lessees Or Contractors,
1. "Advertisement" means the widespread public
but only with respect to liability for "bodily
dissemination of information or images that
injury", "property damage" or "personal
has the purpose of inducing the sale of goods,
and advertising injury" caused, in whole or
products or services through:
in part, by your acts or omissions or the
a. (1) Radio;
acts or omissions of those acting on your
(2) Television;
behalf:
(3) Billboard;
(1) In the performance of your ongoing
(4) Magazine;
operations for the additional
insured(s); or
(5) Newspaper;
(2) In connection with "your work"
b. The Internet, but only that part of a web
performed for that additional insured
site that is about goods, products or
and included within the "products-
services for the purposes of inducing the
completed operations hazard", but
sale of goods, products or services; or
only if this Coverage Part provides
c. Any other publication that is given
coverage for "bodily injury" or
widespread public distribution.
"property damage" included within the
However, "advertisement" does not include:
products -completed operations
hazard".
a. The design, printed material, information
b. With respect to the insurance afforded to
or images contained in, on or upon the
packaging or labeling of any goods or
these additional insureds, this insurance
products; or
does not apply to "bodily injury", "property
damage" or "personal an advertising
b. An interactive conversation between or
injury" arising out of the rendering of, or
among persons through a computer network.
the failure to render, any professional
2. "Advertising idea" means any idea for an
architectural, engineering or surveying
"advertisement".
services, including:
3. "Asbestos hazard" means an exposure or
(1) The preparing, approving, or failure to
threat of exposure to the actual or alleged
prepare or approve, maps, shop
properties of asbestos and includes the mere
drawings, opinions, reports, surveys,
presence of asbestos in any form.
field orders, change orders, designs or
4. "Auto" means a land motor vehicle, trailer or
drawings and specifications; or
semi -trailer designed for travel on public
(2) Supervisory, inspection, architectural
roads, including any attached machinery or
or engineering activities.
equipment. But "auto" does not include
10. Additional Insured — Co -Owner Of Insured
"mobile equipment".
Premises
5. 'Bodily injury" means physical:
WHO IS AN INSURED under Section C. is
a. Injury;
amended to include as an additional insured
b. Sickness; or
the person(s) or Organization(s) shown in the
Declarations as an Additional Insured — Co -
C. Disease
Owner Of Insured Premises, but only with
sustained by a person and, if arising out of the
respect to their liability as co-owner of the
above, mental anguish or death at any time.
premises shown in the Declarations.
6. "Coverage territory" means:
Page 20 of 24 Form SS 00 08 04 05
a. The United States of America (including its
territories and possessions), Puerto Rico
and Canada;
b. International waters or airspace, but only if
the injury or damage occurs in the course
of travel or transportation between any
places included in a. above;
c. All other parts of the world if the injury or
damage arises out of:
(1) Goods or products made or sold by you
in the territory described in a. above;
(2) The activities of a person whose home
is in the territory described in a.
above, but is away for a short time on
your business; or
(3) "Personal and advertising injury"
offenses that take place through the
Internet or similar electronic means of
communication
provided the insured's responsibility to pay
damages is determined in the United States of
America (including its territories and
possessions), Puerto Rico or Canada, in a
"suit" on the merits according to the
substantive law in such territory, or in a
settlement we agree to.
7. "Electronic data" means information, facts or
programs:
a. Stored as or on;
b. Created or used on; or
c. Transmitted to or from
computer software, including systems and
applications software, hard or floppy disks,
CD-ROMS, tapes, drives, cells, data
processing devices or any other media which
are used with electronically controlled
equipment.
8. "Employee" includes a "leased worker".
"Employee" does not include a "temporary
worker".
9. "Executive officer" means a person holding
any of the officer positions created by your
charter, constitution, by-laws or any other
similar governing document.
10. "Hostile fire" means one which becomes
uncontrollable or breaks out from where it was
intended to be.
11. "Impaired property" means tangible property,
other than "your product" or "your work", that
cannot be used or is less useful because:
a. It incorporates "your product" or "your work"
that is known or thought to be defective,
deficient, inadequate or dangerous; or
BUSINESS LIABILITY COVERAGE FORM
b. You have failed to fulfill the terms of a
contract or agreement;
if such property can be restored to use by:
a. The repair, replacement, adjustment or
removal of "your product" or "your work";
or
b. Your fulfilling the terms of the contract or
agreement.
12. "Insured contract" means:
A contract for a lease of premises.
However, that portion of the contract for a
lease of. premises that indemnifies any
person or organization for damage by fire,
lightning or explosion to premises while
rented to you or temporarily occupied by
you with permission of the owner is
subject to the Damage To Premises
Rented To You limit described in Section
D. — Liability and Medical Expenses Limits
of Insurance.
b. A sidetrack agreement;
C. Any easement or license agreement,
including an easement or license
agreement in connection with construction
or demolition operations on or within 50
feet of a railroad;
d. Any obligation, as required by ordinance,
to indemnify a municipality, except in
connection with work for a municipality;
e. An elevator maintenance agreement; or
f. That part of any other contract or
agreement pertaining to your business
(including an indemnification of a
municipality in connection with work
performed for a municipality) under which
you assume the tort liability of another
party to pay for "bodily injury" or "property
damage" to a third person or organization,
provided the "bodily injury" or "property
damage" is caused, in whole or in part, by
you or by those acting on your behalf.
Tort liability means a liability that would be
imposed by law in the absence of any
contract or agreement.
Paragraph f. includes that part of any
contract or agreement that indemnifies a
railroad for "bodily injury" or "property
damage" arising out of construction or
demolition operations within 50 feet of any
railroad property and affecting any railroad
bridge or trestle, tracks, road -beds, tunnel,
underpass or crossing.
However, Paragraph f. does not include
that part of any contract or agreement:
Form SS 00 08 04 05 Page 21 of 24
BUSINESS LIABILITY COVERAGE FORM
(1) That indemnifies an architect,
engineer or surveyor for injury or
damage arising out of:
(a) Preparing, approving or failing to
prepare or approve maps, shop
drawings, opinions, reports,
surveys, field orders, change
orders, designs or drawings and
specifications; or
(b) Giving directions or instructions,
or failing to give them, if that is the
primary cause of the injury or
damage; or
(2) Under which the insured, if an
architect, engineer or surveyor,
assumes liability for an injury or
damage arising out of the insured's
rendering or failure to render
professional services, including those
listed in (1) above and supervisory,
inspection, architectural or
engineering activities.
13. "Leased worker" means a person leased to
you by a labor leasing firm under an
agreement between you and the labor leasing
firm, to perform duties related to the conduct of
your business. "Leased worker" does not
include a "temporary worker".
14. "Loading or unloading" means the handling of
property:
a. After it is moved from the place where it is
accepted for movement into or onto an
aircraft, watercraft or "auto";
b. While it is in or on an aircraft, watercraft or
"auto"; or
c. While it is being moved from an aircraft,
watercraft or "auto" to the place where it is
finally delivered;
but "loading or unloading" does not include the
movement of property by means of a mechanical
device, other than a hand truck, that is not
attached to the aircraft, watercraft or "auto".
15. "Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
a. Bulldozers, farm machinery, forklifts and
other vehicles designed for use principally
off public roads;
b. Vehicles maintained for use solely on or
next to premises you own or rent;
c. Vehicles that travel on crawler treads;
d. Vehicles, whether self-propelled or not, on
which are permanently mounted:
(1) Power cranes, shovels, loaders,
diggers or drills; or
(2) Road construction or resurfacing
equipment such as graders, scrapers
or rollers;
e. Vehicles not described in a., b., c., or d.
above that are not self-propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the
following types:
(1) Air compressors, pumps and
generators, including spraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment; or
(2) Cherry pickers and similar devices
used to raise or lower workers;
f. Vehicles not described in a., b., c., or d.
above maintained primarily for purposes
other than the transportation of persons or
cargo.
However, self-propelled vehicles with the
following types of permanently attached
equipment are not "mobile equipment" but
will be considered "autos":
(1) Equipment, of at least 1,000 pounds
gross vehicle weight, designed
primarily for:
(a) Snow removal;
(b) Road maintenance, but not
construction or resurfacing; or
(c) Street cleaning;
(2) Cherry pickers and similar devices
mounted on automobile or truck
chassis and used to raise or lower
workers; and
(3) Air compressors, pumps and
generators, including spraying,
welding, building cleaning,
geophysical exploration, lighting and
well servicing equipment.
16. "Occurrence" means an accident, including
continuous or repeated exposure to substantially
the same general harmful conditions.
17. "Personal and advertising injury" means injury,
including consequential "bodily injury", arising
out of one or more of the following offenses:
a. False arrest, detention or imprisonment;
b. Malicious prosecution;
Page 22 of 24 Form SS 00 08 04 06
C. The wrongful eviction from, wrongful entry
into, or invasion of the right of private
occupancy of a room, dwelling or
premises that the person occupies,
committed by or on behalf of its owner,
landlord or lessor;
d. Oral, written or electronic publication of
material that slanders or libels a person or
organization or disparages a person's or
organization's goods, products or services;
e. Oral, written or electronic publication of
material that violates a person's right of
privacy;
f. Copying, in your "advertisement", a
person's or organization's "advertising
idea" or style of "advertisement'
g. Infringement of copyright, slogan, or title of
any literary or artistic work, in your
"advertisement"; or
h. Discrimination or humiliation that results in
injury to the feelings or reputation of a
natural person.
18. "Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
19. "Products -completed operations hazard";
a. Includes all "bodily injury" and "property
damage" occurring away from premises
you own or rent and arising out of "your
product" or "your work" except:
(1) Products that are still in your physical
possession; or
(2) Work that has not yet been completed
or abandoned. However, "your work"
will be deemed to be completed at the
earliest of the following times:
(a) When all of the work called for in
your contract has been completed.
(b) When all of the work to be done at
the job site has been completed if
your contract calls for work at
more than one job site.
(c) When that part of the work done at
a job site has been put to its
intended use by any person or
organization other than another
contractor or subcontractor
working on the same project.
BUSINESS LIABILITY COVERAGE FORM
Work that may need service, maintenance,
correction, repair or replacement, but
which is otherwise complete, will be
treated as completed.
The "bodily injury" or "property damage"
must occur away from premises you own
or rent, unless your business includes the
selling, handling or distribution of "your
product" for consumption on premises you
own or rent.
b. Does not include "bodily injury" or
"property damage" arising out of:
(1) The transportation of property, unless
the injury or damage arises out of a
condition in or on a vehicle not owned
or operated by you, and that condition
was created by the "loading or
unloading" of that vehicle by any
insured; or
(2) The existence of tools, uninstalled
equipment or abandoned or unused
materials.
20. "Property damage" means:
a. Physical injury to tangible property,
including all resulting loss of use of that
property. All such loss of use shall be
deemed to occur at the time of the
physical injury that caused it; or
b. Loss of use of tangible property that is not
physically injured. All such loss of use
shall be deemed to occur at the time of
"occurrence" that caused it.
As used in this definition, "electronic data" is
not tangible property.
21. "Suit" means a civil proceeding in which
damages because of "bodily injury", "property
damage" or "personal and advertising injury"
to which this insurance applies are alleged.
"Suit" includes:
a. An arbitration proceeding in which such
damages are claimed and to which the
insured must submit or does submit with
our consent; or
b. Any other alternative dispute resolution
proceeding in which such damages are
claimed and to which the insured submits
with our consent.
22. "Temporary worker" means a person who is
furnished to you to substitute for a permanent
"employee" on leave or to meet seasonal or
short-term workload conditions.
23. "Volunteer worker" means a person who:
a. Is not your "employee";
Form SS 00 08 04 05 Page 23 of 24
BUSINESS LIABILITY COVERAGE FORM
b. Donates his or her work;
c. Acts at the direction of and within the
scope of duties determined by you; and
d. Is not paid a fee, salary or other
compensation by you or anyone else for
their work performed for you.
24. "Your product":
a. Means:
(1) Any goods or products, other than real
property, manufactured, sold, handled,
distributed or disposed of by:
(a) You;
(b) Others trading under your name;
or
(c) A person or organization whose
business or assets you have
acquired; and
(2) Containers (other than vehicles),
materials, parts or equipment
furnished in connection with such
goods or products.
b. Includes:
(1) Warranties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of "your product"; and
(2) The providing of or failure to provide
warnings or instructions.
c. Does not include vending machines or
other property rented to or located for the
use of others but not sold.
25. "Yourwork":
a. Means:
(1) Work or operations performed by you
or on your behalf; and
(2) Materials, parts or equipment
furnished in connection with such work
or operations.
b. Includes:
(1) Warranties or representations made at
any time with respect to the fitness,
quality, durability, performance or use
of "your work'; and
(2) The providing of or failure to provide
warnings or instructions.
Page 24 of 24 Form SS 00 08 04 05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Policy Number: 59 WEC AB6SO4 Endorsement Number:
Effective Date: 08/08/23 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: MATRIX CONSULTING GROUP LTD
1650 S AMPHLETT BLVD STE 213
SAN MATEO CA 94402
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
Any person or organization for whom you are required by contract or agreement to obtain this waiver from us.
Endorsement is not applicable in KY, NH, NJ or for any MO construction risk
Countersigned by
Authorized Representative
Form WC 00 03 13 Printed in U.S.A.
Process Date: 06/29/23 Policy Expiration Date: 08/08/24