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POLICY NUMBER: 5268179 COMMERCIAL GENERAL LIABILITY <br /> CG 20 10 04 13 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED - OWNERS, LESSEES OR <br /> CONTRACTORS - SCHEDULED PERSON OR <br /> ORGANIZATION <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> SCHEDULE <br /> Name Of Additional Insured Persona) <br /> Or Organization(s) Locatlonis) Of Covered Operations <br /> ANY PERSON OR ORGANIZATION WHOM YOU PER THE CONTRACT OR AGREEMENT. <br /> ! BECOME OBLIGATED TO INCLUDE AS AN <br /> ADDITIONAL INSURED AS A RESULT OF ANY <br /> CONTRACT OR AGREEMENT YOU HAVE <br /> ENTERED INTO. <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations <br /> A. Section II - Who Is An Insured is amended to that which you are required by the contract <br /> include as an additional insured the person(s) or or agreement to provide for such additions' <br /> organization(s) shown in the Schedule, but only insured. <br /> with respect to liability for "bodily injury", B. With respect to the insurance afforded to these <br /> "property damage" or "personal and advertising additional insureds, the following additions <br /> injury" caused, in whole or in part, by: exclusions apply* <br /> 1. Your acts or omissions; or This insurance does not apply to "bodily injury" <br /> 2. The acts or omissions of those acting on or "property damage" occurring after. <br /> your behalf; 1. All work, including materials, parts or <br /> in the performance of your ongoing operations equipment furnished in connection with such <br /> for the additional insured(s) at the locationis) work, on the project (other than service. <br /> designated above. maintenance or repairs) to be performed by <br /> or on behalf of the additional insured(s) at <br /> However: the location of the covered operations has <br /> 1. The insurance afforded to such additional been completed, or <br /> insured only applies to the extent permitted 2. That portion of 'your work" out of which <br /> by law; and the injury or damage arises has been put to <br /> 2. If coverage provided to the additional its intended use by any person or <br /> insured is required by a contract or organization other than another contractor or <br /> agreement, the insurance afforded to such subcontractor engaged in performing <br /> additional insured will not be broader than operations for a principal as a part of the <br /> same project. <br /> CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 I7 <br />