Sample endorsements and COI.pdf

POLICY NUMBER: INSERT POLICY NUMBER COMMERCIAL GENERAL LIABILITY

CG 202604 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED — DESIGNATED

PERSON OR ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

Information required to complete this Schedule, if not s’_a, will be shown in the Declarations.

a A. Section II — Who Is An Insured is ame include as an additional insured the erson( organization(s) shown in the Schedul I w respect to liability for “bodily injury”, “p e damage” or “personal and adv ng in caus d, in whole o r in part, by your s r omis ns or the acts or omissions of those tin r alt

1. In the performance of ngoi operations;

or

2. In connection with your prem es owned by or rented to you

However:

The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance:

If coverage provided to the additional insured i s required by a contract or agreement, the most we will pay on behalf of the a dditional insured is the amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits otlnsurance shown in the

Declaration.

Name Of Additional Insured Person(s) Or Organization(s):

City of Cape May , 643 Washington Street Cape May, NJ 08204

INSERT CONTRACT NUMBER AND CONTRACT TITLE

CG 20 260413 © Insurance Services Office, Inc., 2012 Page 1 of 1

COMMERCIAL GENERAL LIABILITY

CG 20 01 0413

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY -

OTHER INSURANCE CONDITION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

Other Insurance provision to the

Primary And Noncontributory Insurance

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

under such other insurance; and

The following is added to the Condition and supersedes any contrary:

(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

(1) The additional insured is a Named Insured

CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of I

J4CORO

CERTIFICATE OF LIABILITY INSURANCE

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 POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEE

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject U the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to th certificate holder in lieu of such endorsement(s).

PRODUCER CONTACT

AGENT INFO.

E-MAIL AODRESS:INSERr AGENT INFORMATION

INSERT NAME OF CONTRACTOR’S AGENT

INSURER(S) AFFORDING COVERAGE NAIC II

INSURER A INSERT INSURANCE COMPANY NAME AFFORDING COVERAGE

INSURED INSURER B INSERT INSURANCE COMPANY NAME AFFORDING COVERAGE

VENDORJCONTRACTOR’S INFORMATION INSURER C: INSERT INSUARANCE COMPANY NAME AFFORDING COVERAGE

INSURER 0:

INSURER E:

INSURER F:

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURE NAMED ABOVE FOR THE POLICY PERIOD INDICATED

NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT 0 HER DOCUMENT VJTH RESPECT TO WHICH THU CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES CRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOflJ MAY HAVE BEEN REDUCED BY PP LAIMS, NSR DDL IUBR POLICY EFFj UCY

LIMITSLTR — TYPE OF INSUR.ANCE POLICY NUMBER IMMIDDPYVYY’

tOCCURRENCE

$ 1,000.000COMMERCIAL GENERAL L!ABILITY

RLIATLD

J CLAIMS-MADE x OCCUR Ea occurrence) $ 100.000

INSERT POLICY NUMBER I T MED EXP(Myone person) $ 10.000

PERSONAL & ADO INJURY $ 1.000.000

GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000

PRO

POLICY H JECT h L

$jOTHER: —

COMNED SINGLE LIMII

$ .000.000lEa accident)

BODILY INJURY (Per person( $ANY AUTO %NSERT INSERT BODILY INJURY (Per accLdenl) $

AUTOMOBILELIABILITY

— jPYNU

PRODUCTS.COMPIOPAGG $1.000,000

DATE DATE HRUPERIYUMAAGE

ALL OWNED SCHEDULED

(Per accident) $I( HIRED AUTOS NON-OtMED

— AUTOS

INS T ER

EACH OCCURRENCE $ 2.000.000UMBRELLA LIAR L OCCUR

INSERT INSERT AGGREGATE $2,000,000

DATE DATE

SDED RETENTIONs

_TUTE

WORKERS COMPENSATION

ANY PR0PRIET0R’PARTNERIEXECUTIVE — NS T OLICY

EXCESS LIAB fl CMMADE

DATE DATE EL DISEASE- EA EMPLOYEE $ .000,000

AND EMPLOYERS LIABILITY EL EACH ACCIDENT $ 1.000.000

INSERT INSERT -_______OFFICEIMEMBER EXCLUDED’

(Mandaloiy in NH)

EL DISEASE- POLICY LIMIT $ ‘.000,000If yes, descrrbe under OFSCRIPTION OF OPFRATIONg below rEMPORARY DISABILITY

INSERT POLICY NUMBE INSERT DATE INSERT DATE

\DD1TIONAL INSURANCE,

IF RFQ — INSFRT P01 flY NI IMRFR

‘‘“ DATE

)ESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Renarirs schedule may be 3ttacd if more space .eq.jired) roject:lNSERTCONTRACTNUMBERANDCONTRACTTlTLE f.( LJ1Ac*

Dity of Cape May is named as Additional Insured, Primary and Non-ContribUtory Under General Liability by reqUited by wntten ContraCt as respect to: .

otioe of Cancellation or Non-renewal - 30 days, except for non-payment of premium 10 days.

I4f 7(( Q0..

CERTIFICATE HOLDER CANCELLATION

City of Cape May SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR

643 Washignton Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED II ACCORDANCE WITH THE POLICY PROVISIONS.Cape May, NJ 08204

AUTHORIZED REPRESENTATIVE

DATE (MM/DDP’YYY)

INSERT DATE

© 1968-2014 ACORD CORPORATION. All rights reserv