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POLICY NUMBER: 5268179 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations ANY PERSON OR ORGANIZATION WHOM YOU IPER THE CONTRACT OR AGREEMENT. BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. 1 Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. Section II - Who Is An Insured is amended to that which you are required by the contract include as an additional insured the person(s) or or agreement to provide for such additional organization(s) shown in the Schedule but only insured. I with respect to liability for "bodily injury", B. With respect to the insurance afforded to these "property damage" or "personal and advertising additional insureds, the following additional injury" caused, in whole or in part, by: exclusions apply: i 1. Your acts or omissions; or This insurance does not apply to "bodily injury" 2. The acts or omissions of those acting on or "property damage" occurring after: ; your behalf; 1. All work, including materials, parts or in the performance of your ongoing operations equipment furnished in connection with such 3 for the additional insured(s) at the location(s) work, on the project (other than service, maintenance or repairs) to be performed by designated above. or on behalf of the additional insured(s) at However: the location of the covered operations has r 1. The insurance afforded to such additional been completed; or insured only applies to the extent permitted 2. That portion of "your work" out of which by law; and the injury or damage arises has been put to 2. If coverage provided to the additional its intended use by any person or insured is required by a contract or organization other than another contractor or agreement, the insurance afforded to such suhcontractor engaged in performing additional insured will not be broader than operations for a principal as a part of the same project. CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 2 O