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able io sureties as a defense in the jurisdiction of the suit
shall be applicable.

40, Notice to the Sursty, the Gumer or tha Contractor shell
ba mefled or defvered to tha eddress shown on the sigeralure

page.

44. When this Bond hes been fumished to comply with &
statutory or other legal requirement in the location where
the construction was to ba performed, any provision In Lhis
Bond condictng with seid statutory of legs! requirement
shall ba deemed deleted here from end provierons con-
forming to such statutory or other lagal requirement shail
be deamad i herein. The Intent ts that this
Sound shail be construsd as @ statutory bond and notes a
common law bond,

42 DEFINTIONS
42.4 Balance of ihe Contact Price: The totel amount
payable by the Owner to tha Cantracior under the

Construction Contract efter ef proper adjustments
have been mada, including allowance to the Con-

MODIFICATIONS TO THIS BOND ARE AS FOLLOWS:

frector of any emounts received or to be received by
the Ovmer in satiement of Insurance or other claims
for damages te which the Contractor is entited, reduced
by eff valid and proper made to of on

behalf of the Contractor undar the Gonsiruction Cone

12.2 Construction Contract The agreement between
the Owner and the Contractor identified on the sig-
nature page, including ell Contract Documents and
changes thereto.

412.3 Contractor Default. Failure of the Contractor,
which has neither baen remedied nor welved, to per-
form or otherwise to comply with the terms of the
Ceonstruciion Contract.

42.4 Owner Dafsuit: Failure of lhe Owner, which hes
neliher bean remedied nor waived, to pay the Con-
tractor as raquirad by the Construction Contract or to
perform and complete or comply with the other terms
theraof.

(Space is provided below for additional signaturas of added parties, olher than these appearing on the cover page.)

CONTRACTOR AS PRINCIPAL SURETY

Company: {Corporate Seal) 3 Campany: (Corporate Seal)
Signature: Signature:

Name and Title: Name and Title:

Address: Address:

AIA DOCUMENT ANZ PERFORMANE BCND AN PAYMENT BOND DECEMBER 1884 30, ALAO AV218984 3

TRE AMERICAN I{STITUTE OF ARCHITECTS, 1735 NEW TORIC AVE, HAW, WASHINOTON D.C. 22025

THIRD PRATING - RARCH 1657

Ne. BI-8085¢-el
POWER OF ATTORNEY
BERKLEY INSURANCE COMPANY
WILMINGTON, DELAWARE

NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully.

KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the “Company”}, a corporation duly
organized and existing under the laws of the State of Delaware, having its principal office in Greenwich, CT, has made, constituted
and appointed, and does by these presents make, constitute and appoint: Lisa J, Nolan; Christine M. McCusker; Chris Sharpes
Beatrice Lachance; James Harrison; Tara C, Dean; Jeffrey J. Schroeder; Eitzabeth A, Morrisseite; or Nicki A. Runcil of FIAL,

dnc. dba Cross Insurance - Manchester of Manchester, NH its true and lawful Attorney-in-Fact, to sign its name as surety only as
delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of
Financial Guaranty Insurance, providing that no single obligation shall exceed Gae Hundred Million and 00/100 U.S. Dollars
(U.5.3100,000,000.00), to the same extent as if such bonds had been duly executed and acknowledged by the regularly elected
officers of the Company at its principal office in their own proper persons.

This Power of Attorney shall be construed and enforced in accordance with, and governed by, the laws of the State of Delaware,
without giving effect te the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following
resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25, 2010:

RESOLVED, that, with respect to the Surety business written by Berkley Surety, ihe Chairman of the Board, Chief
Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant
Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein
to execute bonds, undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the
corporate seal of the Company to powers of attomey executed pursuant hereto; end said officers may remove any such
attomey-in-fact and revoke any power of attorney previously granted; and further

RESOLVED, that such power of attorney limits the acts of those named therein to the bonds, undertakings, recognizances,
or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the
manner and to the extent therein stated; and further

RESOLVED, that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and
further

RESOLVED, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any
power of attomey or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or
other suretyship obligation of the Company; and such signature and seal when so used shall have the same force and effect as
though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any
person or persons who shall ftave been such officer or officers of the Company, notwithstanding the fact that they may have
ceased to be such at the time when such instruments shall be issued.

IN WITNESS WHEREOF, the Company has ee ee and attested by ite appropriate officers and its

eorporate seal hereunto mI
Insurance Company
gu si tthe

eae asidet & Secretary he breton l

STATE OF CONNECTICUT }
} ssz
COUNTY OF FAIREIELD }

Sworn to before me, a Notary Public in the State of Connecticut, this ist day of a: 2020, by Ira S. Ledennan

respectively, of Berkley Insurance Company. MARA CRLNDBAKEH
CONNECTICUT
BMY COALMISSION EXPIRES

APH 2, BOR
CERTIFICATE
I, the undersigned, Assistent Secretary of BERELEY INSURANCE COMPANY, DO HEREBY CERTIFY that the foregoing is a
tue, correct and complete copy of the original Power of Attorney; that said Power of Attorney bas not been revoked or rescinded
thatthe authority of the Attomney-in-Pact set forth therein, who executed the bond or undertaking to which this Power of

bbe , otate 0. Connecticut

DATE (MM/DDAYYYY}

eo
ACORD CERTIFICATE OF LIABILITY INSURANCE oaios/2020

THIS CERTIFICATE 15 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(ies) 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 rights to the certificate holder in feu of such endorsement(s}.

PRODUCER CONTACT Judith George CIC.CPIW,CRIS
FIAI/Cross Insurance PHONE, exn, (603) 669-3218 TAG, no}: (603) 645-4331
1100 Elm Street Eibkess: igeorge@crossagency.com
(NSURER{S) AFFORDING COVERAGE NAIC #
Manchester NH 03101 INSURER A: S€#lective Insurance Co, of America 12572
INSURED INSURERB; Selective Insurance Co of Southeast 39926
Stephens-Marquis Associates, inc. INSURERC:
717 Daniel Webster Highway INSURER D:
INSURER E :
Merrimack NH 03054 INSURER F:
COVERAGES CERTIFICATE NUMBER: 19-20 Alllines REVISION NUMBER:
THIS 1S 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 HERE!N IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REQDUCED BY PAID CLAIMS.
ADSL SVER
Ne TYPE OF INSURANCE NSH wb POLICY NUMBER (MAIDDIYYYY) | GAMO DIRTY) Limtrs
><] COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000
AMA Ni
CLAIMS-MADE OCCUR PREMISES (Ea occurrence} g 500,000
— MED EXP (Any one person} $ 15,000
AT $2336788 07/09/2019 | 07/09/2020 | seaconataapvinjury |g 1,000,000
| GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g_ 2,000,000
|__| Power ier Loc propuCTSs-compioracs | s 2,200,000
OTHER: 8
COMBINED SINGLE Liat
AUTOMOBILE LIABILITY eo NOLE LIMIT s 1,000,006
>< Any AUTO BODILY INJURY (Per person) | $
[| OWNED SCHEDULED ;
A |__| AUTOS ONLY AUTOS $2336788 OF/01/2079 | 07/01/2020 | BoDiLy INJURY {Per accident) | §
HIRED NON-GWNED PROPERTY DAMAGE $
|_| AUTOS ONLY ALITOS ONLY | (Per accident)
Medical payments $ 5,000
[OS] UMARELLAUIAB | 3€! occur EACH OCCURRENCE s_ 2,000,000
A EXCESS LIAB CLAIMS-MADE $2336788 07/01/2019 | 07/01/2020 | sccrecate g 2,000,000
DED | | RETENTION § $
WORKERS COMPENSATION PER ‘OTA
AND EMPLOYERS’ LIABILITY YIN >[Sikure | [88 7000 000
B |SrrcERMEMBER EXCLUDED? NIA WC9059244 (3a.) MA NH RI 07/01/2019 | 07/01/2020 [EL EACH ACCIDENT $e
(Mandatory in NH} EL DISEASE-EAEMPLOvEE | 5 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLCY Limiy jg [000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 701, Additional Remarks Schedule, may be attached if more space is required}

Project: Nashua DPW Fue! Facility, Nashua, NH. The City of Nashua, NH is included as additional insured with respects to CGL and business auto policies
on a primary and non-contributory basis as required by written contract with named insured. Notice of cancellation to the certificate holder is 30 days, 10
days for non-payment, with respects to CGL, business auto and umbrella policies.

_CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREB IN

City of Nashua, NH ACCORDANCE WITH THE POLICY PROVISIONS,

229 Main Street

AUTHORIZED REPRESENTATIVE
NH 03060-2019

Nashua
© 1988-2015 ACORD CORPORATION. All rights reserved.

ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD

QQODOFS 2379445534

UAT OE TTA EA

ElitePac®
General Liability Extension Endorsement

COMMERCIAL GENERAL LIABILITY
CG 73 00 07 19
SUMMARY OF COVERAGES (including index)

This is a summary of the various additional coverages and coverage modifications provided by this
endorsement. No coverage is provided by this summary. Refer to the actual endorsement (Pages 3-through-9)
for changes affecting your insurance protection.

DESCRIPTION PAGE FOUND
Additional Insureds - Primary and Non-Contributory Provision Page 8
Blanket Additional insureds - As Required By Contract Page 5

* Owners, Lessees or Contractors (includes Architects, Engineers or Surveyors
® Lessors of Leased Equipment

* Managers or Lessors of Premises

* Mortgagees, Assignees and Receivers

e Any Other person or organization other than a joint venture

* Grantors of Permits

Broad Form Vendors Coverage Page 7
Damage To Premises Rented To You (Including Fire, Lightning or Explosion) Page 3
Electronic Data Liability ($100,000) Page 4
Employee Definition Amended Page 9
Employees As Insureds Modified Page 5
Employer's Liability Exclusion Amended (Not applicable in New York) Page 3
Incidental Malpractice Exclusion modified Page 7
Knowledge of Occurrence, Claim, Suit or Loss Page 7
Liberalization Clause Page 8
Mentai Anguish Amendment (Not applicable to New Yark) Page 9
Newly Formed or Acquired Organizations Page 5
Non- Owned Aircraft Page 3
Non-Owned Watercraft (under 60 feet} Page 3
Not-for-profit Members - as additional insureds Page 5
Personal And Advertising Injury - Discrimination Amendment (Not applicable in New York) Page 8
Products Amendment (Medical Payments) Page 4
Supplementary Payments Amended - Bail Bonds ($5,000) and Loss of Earnings ($1,000) Page 4
Two or More Coverage Parts or Policies Issued By Us Page 8
Unintentional Failure to Disclose Hazards Page 8
Waiver of Transfer of Rights of Recovery (subrogation} Page 8
When Two or More Coverage Paris of this Policy Apply to a Loss Page 3
Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG73 00 6119

Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 1 of 3

ee

HAM as qd IAF

THIS PAGE IS INTENTIONALLY LEFT BLANK.

Copyright, 2018 Selective Insurance Company of America. All rights reserved. CG 73 000119
includes copyrighted material of Insurance Services Office, inc., with its permission. Page 2 of 9

ee

QOODUFS 2379449585

HIG ESE TUT OM AE

ElitePac®
General Liability Extension Endorsement

COMMERCIAL GENERAL LIABILITY
CG 73 00 01 19

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies the insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART

The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be
amended as shown beiow. However, if (a) two or more Caverage Parts of this policy, or (b) two or more forms or
endorsements within the same Coverage Part apply to a loss, coverage provisian(s) with the broadest language
will apply, unless specifically stated otherwise within the particular amendment covering that loss.

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless

modified by the endorsement.

COVERAGES - Amendments

SECTION | - COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY

EXCLUSIONS
Employer's Liability Amendment

(This provision is not applicable in the State of New
York).

The foliowing is added to Exclusion e, Employer’s
Liability under COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY, 2. Exclusions:

This exclusion also does not apply to any
“temporary worker”.

Non-Owned Aircraft, Auto or Watercraft

A. Paragraph {2} of Exclusion g, Aircraft, Auto Or
Watercraft under COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE LIABILITY, 2. Exclus-
ions is deleted in its entirety and replaced with
the following:

(2) A watercraft you do not own that is:

{a} Less than 26 feet long and not being
used to carry persons or property for a
charge; or

(b) At least 26 feet, but less than 60 feet
long, and not being used fo carry per-
sons or properiy for a charge. Any
person is an insured who uses or is
responsible for the use of such water-
craft with your expressed or implied
consent. However, if the insured has any
other valid and collectible insurance for
“bodily injury” or “praperty damage”
that would be covered under this provi-
sion, or on any other basis, this cover-
age is then excess, and subject to
Condition 4, Other Insurance, b. Excess
Insurance under SECTION IV - COM-
MERCIAL GENERAL LIABILITY COND}-
TIONS.

Copyright, 2018 Selective Insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

B. The following is added ito Exclusion g. Aircraft,
Auto Or Watercraft under COVERAGE A BODILY
INJURY AND PROPERTY DAMAGE LIABILITY, 2.
Exclusions:

This exclusion does not apply to:

(6) Any aircraft, not owned or operaied by any
insured, which is hired, chartered or loaned
with a paid crew. However, if the insured
has any other valid and collectible insur-
ance for “bodily injury” or “property dam-
age” that would be covered under this
provision, or on any other basis, this cover-
age is then excess, and subject to Condition
4. Other Insurance, b. Excess Insurance
under SECTION IV - COMMERCIAL
GENERAL LIABILITY CONDITIONS.

Damage To Premises Rented to You

A. The last paragraph of Paragraph 2. Exclusions
under COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE is deleted in its entirety
and replaced with the following:

Exclusions «. through n. do not apply to damage
by fire, lightning or explosion to premises rented
to you or temporarily occupied by you with the
permission of the owner. A separate limit of
insurance applies to this coverage as described
in SECTION IIF- LIMITS OF INSURANCE.

CG 73 00017195
Page 3 of 9

FE EP Rk

OANice arnen ant

B. Paragraph 6, under SECTION Ill - LIMITS OF
INSURANCE is deleted in its entirely and
replaced with the following:

8. Subject to Paragraph 5, above, 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 caused by fire, lightning or
explosion, while rented te you or temporarily
occupied by you with permission of the
owner, for all such damage caused by fire,
lightning or explosion proximately caused by
the same event, whether such damage
results from fire, lightning or explasion or
any combination of the three, is the amount
shown in the Declarations for the Damage
To Premises Rented To You Limit.

Cc. Paragraph a, of Definition 9. “Insured contract”
under SECTION V - DEFINITIONS is deleted in its
entirety and replaced with the following:

a. A contract for a lease of premises. However,
that portion of the contract for a lease of
premises that indemnifies any person ar
organization for damage by fire, lightning or
explosion to premises while rented to you or
temporarily occupied by you with the per-
mission of the owner is not an “insured
contract";

Electronic Data Liability

4. Exclusion p. Access or Disclosure Of Confiden-
tial Or Personal Information And Data-related
Liability under COVERAGE A BODILY INJURY
AND PROPERTY DAMAGE LIABILITY, 2.
Exclusions is deleted in its entirety and replaced
by the following:

p. Access or Disclosure Of Confidential Or
Personal Information And Data-related
Liability
Damages arising out of:

(1) Any access to or disclosure of any
person’s or organization's contidential
or personal information, including
patents, trade secrets, processing
methods, customer fists, financial infor-
mation, credit card information or any
other type of nonpublic information; or

(2) The loss of, loss of use of, damage to,
corruption of, inability to access, or
inability to manipuiate “electronic data”
that does not result from physical injury
to tangible property.

Copyright, 2018 Selective Insurance Company of America. All rights reserved.
includes copyrighted material of Insurance Services Office, Inc., wiih its permission.

This exclusion applies even if damages are
claimed for notification costs, credii mon-
itoring expenses, forensic expenses, public
relatians expenses or any other loss, cost or
expense incurred by you or others arising
out of that which is described in Paragraph
(1) or (2) above.
B. The following paragraph is added to SECTION Ill

- LIMITS OF INSURANCE:

Subject to 5. above, the mosi we will pay under

COVERAGE A for “property damage” because of

all toss of “electronic data” arising out of any

one “occurrence” is a sub-limit of $100,000.

SECTION I|- COVERAGE C MEDICAL PAYMENTS
EXCLUSIONS
Any Insured Amendment
Exclusion a. Any Insured under COVERAGE C
MEDICAL PAYMENTS, 2. Exclusions is deleted in its
entirety and replaced with the following:
a. Any Insured

To any insured.

This exclusion does not apply to:

(1} “Not-for-profit members";

(2) “Golfing facility” members who are not paid

a fee, salary, or other compensation; or

(3) “Volunteer workers”.
This exclusion exception does not apply if
COVERAGE C MEDICAL PAYMENTS is excluded by
another endorsement to this Coverage Part.
Product Amendment

Exclusion f. Products-Campleted Operations Hazard
under COVERAGE C MEDICAL PAYMENTS, 2.
Exclusions is deleted in its entirety and replaced
with the following:

i. Praducts-Completed Operations Hazard

Included within the “products-completed opera-
tions hazard”.

This exclusion does act apply to “your products”
sold for use or consumption on your premises,
while such products are still on your premises.

This exclusion exception, does not apply if
COVERAGE C MEDICAL PAYMENTS is excluded by
another endorsement to this Coverage Part.

SECTION I[ - SUPPLEMENTARY PAYMENTS -
COVERAGES A AND B

Expenses For Bail Bands And Loss Of Earnings

A. Subparagraph i1.b. under SUPPLEMENTARY

PAYMENTS - COVERAGES A AND B is deleted

in its entirety and replaced with the following:

b. Up to $5,000 for cost of bail bonds required
because of accidents or traffic [aw violations
arising out of the use of any vehicle to which
Badily injury. Liability Coverage applies. We
do not have to furnish these bonds,

CG 73 00 6119
Page 4 of 9

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GOOODFS 23794495K6

FARO U UCSC A TE

B. Subparagraph i.d. under SUPPLEMENTARY
PAYMENTS - COVERAGES A AND B is deleted
in its entirety and replaced with the following:

d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
“suit”, including actual loss of earnings up to
$1,000 a day because of time off from work.

SECTION I - WHO IS AN INSURED - Amendments
Not-for-Profit Organization Members

The following paragraph is added to SECTION Ii -
WHO IS AN INSURED:

if you are an organization other than a partnership,
joint venture, or a limited fiability company, and you
are a not-for-profit organization, the following are
included as additional insureds:

4. Your officials:

Your trustees;

Your members:

Your board members;

Your commission members:

Your agency members;

Your insurance managers;

Your elective or appointed officers; and
9. Your “not-for-profit members”,

SN PnP eM

However only with respect fo their liability for your
activities or activities they perform on your behalf.

Employees As Insureds Modified

A. Subparagraph 2.a.(1Ka) under SECTION Il -
WHO IS AN INSURED does not apply to “bodily
injury” to a “temporary worker” caused by a co-
“employee” who is not a “temporary worker”.

B. Subparagraph 2.a.(2) under SECTION Ii - WHO
iS AN INSURED does not apply to “property
damage” fo the property of a “temporary
worker" or “volunteer worker" caused by a co-
“employee” who is not a “temporary worker" or
“volunteer worker”.

C. Subparagraph 2.a.(ifd} under SECTION I -
WHO IS AN INSURED does not apply to “bodily
injury” caused by cardio-pulmonary resuscita-
tion or first aid services administered by @ co-
“employee ”.

With respect to this provision only, Subparagraph

(1) of Exciusion 2. e. Employer's Liability under

SECTION I - COVERAGES, COVERAGE A BODILY

INJURY AND PROPERTY DAMAGE LIABILITY does

not apply.

Newly Formed Or Acquired Organizations

A. Subparagraph 3.a. under SECTION Il - WHO 1S
AN INSURED is deleted in its entirety and
replaced with the following:

Copyright, 2018 Selective Insurance Company of America. AH rights reserved.
includes copyrighted material of insurance Services Office, Inc., with its permission.

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, However,
COVERAGE A does not apply to “bodily
injury” or “property damage” that occurred
before you acquired or formed the argani-

Zation.
B. The following paragraph is added to
SECTION Ho - WHO iS AN INSURED,

Paragraph 3:

if you are engaged in the business of can-
struction of dwellings three stories or less in
height, or other buildings three stories or
less in height and less than 25,000 square
feet in area, you will also be an insured with
respect io “your work” only, for the period of
time described above, for your liability
arising out of the conduct of any partnership
or joint venture of which you are or were a
member, even if ihat partnership or joint
veniure is not shown as a Named Insured.
However, this provision only applies if you
maintain or maintained an interest of at
leasi fifty percent in that partnership or joint
venture for the period of that partnership or
joint venture.

This provision does not apply to any partnership or
joint venture that has been dissolved or otherwise
ceased to function for more than thirty-six months.

With respeci to the insurance provided by this
provision, Newly Formed or Acquired Organizations,
the folfowing is added to SECTION IV - COMMER-
CIAL GENERAL LIABILITY, Paragraph 4. Other
Insurance, Subparagraph b. Excess insurance:

The insurance provided by this provision, Newly
Formed or Acquired Organizations, is excess aver
any other insurance available to the insured,
whether primary, excess, contingent or on any other
basis.

{All other provisions of this section remain
unchanged)

Blanket Additional Insureds - As Required By
Contract

Subject to the Primary and Non-Centributory provi-
sion set forth in this endorsement, SECTION II -
WHO iS AN INSURED is amended to include as an
additional insured:

A. Owners, Lessees or Contractars/Architects,
Engineers and Surveyors

1. Any person or organization for whom you
are performing operations when you and
such person or organization have agreed in
a written contract, written agreement or
written permit that such person or organi-
zation be added as an additional insured on
your commercial general liability policy; and

CG 73 00 0119
Page 5 of §

TCIM RP AAs

annien (asia 907

2. Any other person or organization, including
any architects, engineers or surveyors not
engaged by you, whom you are required io
add as an additional insured under your
policy in the contract or agreement in
Paragraph 1. above:

Such person or organization is an additional
insured only with respect to liability for “bodily
injury", “property damage” or “personal and
advertising injury” caused, in whole or in part,
by:

a. Your acts or omissions; or

b. The acts of omissions of those acting on
your behalf;

in the performance of your ongoing operations
performed for the additional insured in Para-
graph 1., above.

However, this insurance does not appiy to:
"Bodily injury”, “property damage” or “personal
and advertising injury” arising out of the render-
ing of, or the failure fo render, any professional
architectural, engineering or surveying services
by or for you, including:

a, The preparing, approving, or failing to
prepare of approve, maps, shop
drawings, opinions, reports, surveys,
field orders, change orders or drawings
and specifications; and

b. Supervisory, inspection, architectural or
engineering activities.
Professional services do not include services
within construction means, methods, tech-
niques, sequences and precedures employed by
you in connection with your operations in your
capacity as a construction contracter.

A person or organization's status as an
additional insured under this endorsement ends
when your operations for the person or organi-
zation described in Paragraph 1. above are
completed.

Other Additional Insureds

Any of the following persons ar organizations
with whom you have agreed in a written
contract, written agreement or written permit
that such persons or organizations be added as
an additional insured on your commercial
general liability policy:

1. Lessors of Leased Equipment

Any person or organization from whom you
lease equipment, but only with respect to
liability for “bodily injury", “property dam-
age” or “personal and advertising injury"
caused, in whole or in part, by your
maintenance, operation or use of equipment
leased fo you by such person or organi-
zation.

Copyright, 2018 Selective Insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9

TACMREATOS FAP

With respect to the insurance afforded to
these additional insureds, this insurance
does not apply to any “occurrence” which
takes place after the equipment iease
expires.

Managers or Lessars of Premises

Any person or organization from whom you
lease premises, but only with respect to
liability arising out of the ownership,
maintenance or use of that part of the
premises leased to you.

This insurance does not apply to any
“occurrence” which takes place after you
cease to be a tenant of that premises.

Mortgagees, Assignees or Receivers

Any person or organization with respect to
their liability as mortgagee, assignee or
receiver and arising out of the ownership,
maintenance or use of your premises.

This insurance does not apply to any
“occurrence” which takes place after the
mortgage is satisfied, or the assignment or
receivership ends.

Any Person or Organization Other Than A
Joint Venture

Any person or organization (other than a
joint venture of which you are a member),
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 of
omissions of those acting on your behalf in
the performance of your ongoing operations
or in connection with property owned by

you.

State or Governmentai Agency or Palitical
Subdivision - Permits or Authorizations

Any state or governmental agency or
subdivision or political subdivision, but only
with respect to:

a. Operations performed by you or on your
behalf for which the state or govern-
mental agency or subdivision or political
subdivision has issued a permit or
authorization; or

b, The following hazards for which the
state or governmental agency or sub-
division or political subdivision has
issued a permit or authorization in
connection with premises you own, rent
or control and to which this insurance
applies:

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(4) The existence, maintenance, repair,
construction, erection or removal of
advertising signs, awnings, cano-
pies, cellar entrances, coai holes,
driveways, manholes, marquees,
hoist away openings, sidewalk
vaults, street banners or decora-
tions and similar exposures;

(2) The construction, erection or re-
moval of elevators; or

(3) The ownership, maintenance or use
of any elevators covered by this
insurance,

This insurance does not apply to:

{a} “Bodily injury" or “praperty
damage” arising out of opera-
tions performed for the federal
government, siate or munici-
pality; or

(b) “Bodily injury” or “property
damage" included within the
“products-completed operations
hazard”.

With respect to Paragraphs 2. through 4.,,
this insurance does not apply to structural
alterations, new construction or demolition
operations performed by or on behalf of
such person or organization.

The provisions of this coverage extension do not
apply unless the written contract or written agree-
ment has been signed by the Named insured or
written permit issued prior to the “bodily injury” or
“property damage” or “personal and advertising
injury”.

Broad Form Vendors Coverage

Subject to the Primary and Non-Contributory
provision set forth in this endorsement, SECTION Hl-
WHO IS AN INSURED is amended to include as an
additional insured any person or organization
(referred to below as vendor} for whom you have
agreed in a written contract or written agreement to
provide coverage as an additional insured under
your policy. Such person or arganization is an
additional insured only with respect to “bodily
injury" or “property damage” arising out of “your
products” which are distributed or sold in the
regular course of the vendor's business. However,
ihe insurance afforded the vendor does not apply to:

a. “Bodily injury" or “properly damage" for
which the vendor is obligated to pay
damages by reason of the assumption of
liability in a contract or agreement; however
this exclusion does not apply to liability for
damages that the vendor would have in the
absence of the contract or agreement;

b. Any express warranty unauthorized by you;

Copyright, 2018 Selective insurance Company of America. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.

ec. Any physical or chemical change in the
product made Intentionally by the vendor,

d, Repackaging, unless unpacked solely for
the purpose of inspection, demonstration,
testing, or the substitution of parts under
instructions from the manufacturer, and then
repackaged in the original container.

e. Any failure to make such inspections,
adjustments, tests or servicing as the
vendor has agreed fo make or normally
undertakes to make in the usual course of
business in connection with the sale of the
product; or

f. Products which, after distribution or sale by
you, have been labeled or re-labeled or
used as a container, part of ingredient of
any other thing or substance by or for the
vendor; however this insurance does nat
apply to any insured person or organization,
from who you have acquired such products,
or any ingredient, part or container, entering
into, accompanying or containing such
products.

The provisions of this coverage extension do not
apply unless the written contract or written agree-
ment has been signed by the Named Insured prior
to the “bodily injury” or “property damage”.
Incidental Malpractice

Subparagraph 2.a.(1}{d) under SECTION Il - WHO IS

AN INSURED is deleted in its entirety and replaced

with the following:

{d} Arising out of his or her providing or failing to
provide professional health care services.

This does not apply to nurses, emergency
medical technicians or paramedics if you are not
in the business or occupation of providing any
such professional services.

This also does not apply to “bodily injury”
caused by cardio-pulmonary resuscitation or
first aid services administered by a co-
“employee”.
This provision does not apply if you are a Social
Service or Senior Living risk.
SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS - Amendments

Knowledge Of Occurrence, Claim, Suit Or Lass

The following is added to Paragraph 2. Duties in the
Event of Occurrence, Offense, Claim or Suit under
SECTION IV - COMMERCIAL GENERAL LIABILITY
CONDITIONS:

The requirements under this paragraph do not apply
until after the “occurrence” or offense is known to:

4. You, if you are an individual:
2. A partner, if you are a partnership:

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