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Insurance Certificates 2018 InterWest Consulting Group
A� DATE (MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 08/15/2018 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(ies) must 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 lieu of such endorsement(s). PRODUCER CONTNAMME" Kathy Star IUSI Colorado, LLC Prof Liab PHONE 1 g00-873-8500 FAX P.O. Box 7050 c .Fxt.' WC. No'! (Englewood CO 80155 E-MAIL SS, INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:XL Specialty Insurance Comoanv 37885 INSURED INTERCON35 INSURER B:Travelers Indemnitv Comoanv of CT 25682 Interwest Consulting Group INSURER C: Travelers Property Cas. Co. of Amer 25674 P.O. Box 18330 Boulder CO 80308 INSURER D: INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 109453312 REVISION NUMBER: 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. 1NSR TYPE OF INSURANCE ;.W , . a'�nn POLICY EFF I POIJCY EXP LTR INSD WVD POLICY NUMBER (MMIDOIYYYYI IMMMDIYYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 6806H441235 11/14/2017 11/14/2018 EACH OCCURRENCE $1,000,000 _ CLAIMS -MADE XI OCCUR PREMISE Si [Eaoccurrennel $1,000.000 MED EXP (Any one Derson) $10.000 PERSONAL BADVINJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000.000 POLICY jE� � LOC PRODUCTS - COMP/OPAGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y Y BAOJ093233 11/14/2017 11/14/2018 CUMHINI=U.4'INULI=LiMi 1$ (Ea accident) 1.000.000 X ANY AUTO I BODILY INJURY (Per person) $ AUTOWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS x HIRED AUTOS N NON -OWNED PROPERTY DAMAGE $ AUTOS (Per accidernl C X UMBRELLA LIAR OCCUR Y Y CUP21`178249 11/14/2017 11/14/2018 ' EACH OCCURRENCE s4,000,000 EXCESS LIAR rd CLAIMS -MADE I AGGREGATE $4,000,000 DED I X I RETENTIONS 0 $ C WORKERS COMPENSATION UB8J034006 11/14/2017 11/14/2018 f PER OTH- AND EMPLOYERS' LIABILITY YIN Y X 1 STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ` E.L. DISEASE - EA EMPLOYEE $1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1.000.000 A Professional Liability Y DPR9919387 11/14/2017 11/14/2018 Per Claim $2,000,000 Pollution Liab Included Annual Aggregate $5,000,000 Claims Made DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and oompleted operations under General Liability' Designated Insured under Automobile Liability; and Additional Insured's under Umbrella / Excess Liability but only with respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability, Automobile Liability, Umbrella/Excess insurance applies on a primary and non-contrlbutory basis. A Blanket Waiver of Subrogation applies for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella I Excess Liability policy See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta CA 92253 AUTHOR= REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INTERCON35 LOC #: A�C7R® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED USI Colorado, LLC Prof Liab Interwest Consulting Group PP.O. Box 18330 POLICY NUMBER Boulder CO 80308 CARRIER I NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE provides excess coverage over the General Liability, Automobile Liability and Employers Liability. Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY Policy 86806H441235 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement mociies insurance provided under the following: COMMERCIAL GENERAL UABiLITY COVERAGE PART A. The following Is added to WHO IS AN INSURED (5ectlon ill: Any person or organization that you agree In a "contract or agreement requiring insurance' to in- clude as an additional insured an this Coverage Part, but only with respect to tiabHfly for 'bodily In- jury'. "property damage' or "personal Injury' caused, in whole or In pars, icy your acts or omis- sions or the acts or omissions of those acting on your behalf: e. In the performance of your ongoing opera- tions; b. in connection with premises owned by or rented to you; or c. in connection with "your work' and included within the 'produclwAmpteled operations hazard". Such person or organization does not qualify as an additional Irnured for'bodlfy injury', 'property damage' or 'personal Ir>jury" for which that per- son or organization has aswmad liability In a con- tract or agreement. The insurance provided to such additional insured Is limited as follows, d. This Insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically Is added by another endorsement to Ihis Cover- age Part. e. This Insurance does not apply to tie render ing of or feifure to render any 'professional services". f. The 6mlts of Insurance afforded Io the addi- tional Insured shall be the Omits which you agreed In that 'contract or agreement requir- ing Insurance' to provide for that additional Insured, or the Um b shown In the Declera- tons for this Coverage Part, whichever are less This endorsement does not Increase the Nmlts of insurance stated In the UMRS OF INSURANCE (Section III) for this Coverage Part B. The following Is added to Paragraph e. of 4. Other Insurance In COMMERCIAL GENERAL UABILITY CONDITIONS (Section IV); However, If you specfically agree in a "contract or agreement requiring insurance" that the Insurance provided to an additional Insured under Ibis Cov- erage Part must�pply on a primary basis, or a primary and non-CbAlrtbulmy basis, Mils insurance Is prkn ty to olher insurance that Is available to such additional Insured which covers such addl- Yonal Inured as a named Insured, and we wig not share wkh do other Inmence, pmvkkd OW- (1) The 'buddy injury" or 'property damage" for which coverage is sought occurs; and (2) The personal Injury' for which coverage is am*[ arfses out of an offense commfbed; after you have entered Into that "contract or agreement requiring Inwrance`. Sul this Insur- ance stilt is excess over valid and collectible other insurance, whether primary. excess, contingent or on any other basis, that Is available to the Insured when the marred is an additional Insured under any other Insurance. C. The fallowing Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL UABiL1TY COW DITIONS (Section M: We waive any rights of recovery we may have against any person or organization because of payments we make for 'bodffy Injury', "property damaw or personal Injury` arising out of 'your work' performed by you. or on your behalf, under a'contrad or agreement requiring I tstrance" with that person or organizaton. We waive time rights only where you have agreed to do so as part of the "contract or agreement requfifng Insur- ance' with such pawn or organization entered Into by you before, and In effed when, the 'bodily CG 03 8109 07 a 2007 the Tnvelam Coerpenles, bra Page 1 of 2 reduces Ow eopyd0hred m.rerw or teswmce services OMm he,. with Rs pem+lnlcn COMMERCIAL GENERAL LIABILITY injury' or *property damage" occurs. or the 'par- sorral injury' offense is committed. D. The fallmWng definition is added to DEFINITIONS (section 1): "Contract or agreement mqufring Insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured an this Cov- erage Part, provided that the "bodlty Injury" and 'property damage" occurs, and the "personal In- jury' Is caused by an offense committed: a. After you have entered Into lhal contract or agreement; b. While that part of the contract or agreement Is In effect; and c- Berare the end of the policy period Page Z of Z o 20117 the Tiewbn compenka, bm CG D3 8109 OT Induces the copy+IpMed malerlsl of lanrm s SwAM Offs, Jim. wth 15 pwrnh&lon Policy N6806H991235 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ R CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS XTEND ENDORSEMENT This endorsement modifies Insurance provided under the following• COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE Provisions A. — T. and V. of this endorsement bmaden coverage Provisions U. and W. of ftds endorsement may WWI coverage The following bit Is a general coverage description only Limitations and exclusions may apply to these coverages Reed all the PROVISIONS or this endorsement carefully to determine rights, dudes, and what is and Is not covered A. Broadened Named Insured B. Incidental Medial Malpractice C. Reasonable Force — Bodily injury Or Property Damage D. Non -Owned Watercraft — Increased To Up To 75 feet E. Aircraft Chartered With Crew F. Exlendon Of Coverage — Damage To Premises Rented To You G. Malicious Prosecution — Exception To Knowing Violation Of Wghts Of Mother Exclusion H. Medical Payments Link I. Increased Supplementary Payments J. Additional Insured — Owner, Manager Or Lessor Of Premises K. Additional insured —Lessor Of Leased Equipment L Additional Insured — State Or Political Subdivi- slona -- Permits Retailing To Premises M. Additional Insured — State Or Political Sobdivt- sions- Parmfta RNetinp To Operetians PROVISIONS A. BROADENED NAMED INSURED 1. The Named insured In hem 1. of the Com- mon Policy Declaradona is amended as far - low. The person or organization named in Item 1. of tine Common Porky Declarations aW any oWnJzatiam, ocher f m a pa*ttrsNp. joint venture. Hmiled ffabillty company or Inrst, of which you are the axle owner or in which you rnalrtetn the mafo* owrm hip inlertmt on the effective dale of the policy. However. N. Additional Insured — Archilect, Engineer Or Surveyor O. Who Is An Insured — Newly Acquired Or Formed Organt2atlons P. Who is An Ir=mW — Unnamed Partnershlp Or Joint Venture — Excess CL Per Project Genera) Aggregate Limit R. Knowledge And Notice Or Occurrence Or Offense S. Unintentional Omission T. Walver Of Transfer Of Rights Of Recovery Agafnsi Dthem To Us When Requited By Cort• tract Or Agreement U. Amended Bodily injury Definition V. Amended Insured Contract Defirdflan — Rallmad Easement W. Amended Property Damage Definition — TanglWe Property X. AtWtfanal Daftliom — Contract or Agreement Requiring Insurance coverage for any such additional organization will ),ease as of the data, If arty, during the policy period, that you no longer are the sole owner of, or maintain the )majority ownership interest IN aurh orasnitatiort. Z. This PrnvWan A. does mat apply to any per- son or orhan¢atkm for which ooversge Is ex- cluded by another endorsement to Uds Cov- erage Pert. 0. INCIDENTAL MEDICAL MALPRACTICE 1. The foillowlmg Is added to Paragraph 1.Insur- ing Agreement of COVERAGE A BODILY CG D3 7g 09 07 O 2Q07Tbr TrWdm Cot PW&16 Mrs Page 1 or 8 COMMERCIAL GENERAL LIABILITY INJURY AND PROPERTY DAMAGE LI- ABILITY in COVERAGES (Section Q. '8odlly irsJury' arising out of the rendering of. or (allure to render, "first aid" or "Good Sa- maritan services' to a person, other Ilan a co- employee" or 'volunteer workar*, will be deemed to be caused by an 'occurrence. For the purposes of determining the applice- ble limits of Insurance, any act or omission together with all related acts or omissions In the furnishing of the services to any one per- son will be deemed one 'occurrence". 2. As used in this Provision B.t a. 'Fkst efd' means medical or nursing ser- vice, Ireatment. advice or Instruction; the related furnishing of food or beverages; the furnishing or dispensing of drugs or medical supplies or appliances; b. "Good Samaritan services' means those medical services rendered or provided In an emergency and for which no remu- aaration Is demanded or received. 3. Paragraph 2.a.(1)(d) of WHO IS AN IN- SURED (Suction 11) does not apply to any of your employees% who are not employed as a doctor or nurse by you, but only wt& per- forming the services described In Paragraph 1. above and while acting within the scope of their employment by you. Any sudh'employ- eae rendering 'Good Samaritan services' will be deemed to be acting within the scope of their employment by you 4. The following exclusion Is added to Pus - graph 2. Exclusions of COVERAGE A BOD- ILY INJURY AND PROPERTY DAMAGE LIABILITY in COVERAGES (Section n: Sale of Pharmaceuticals 'Bodily Injury' or 'property damage' arfs- I ng out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by or with the knowledge or consent of the Insured. The Insurance provided by this Provision B. shalt be a>4r:ass over any valid and collectible other Irtsunhncs svaMabfe to tha insured, whether primary, axcesa, connngent or an any other baste. except for Insurance pur- chased specifically by you to apply In excess of the Limits of insurance shown In the Deda- radons for this Coverage Part C. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The Expected Or Intended Injury Exclusion in Paragraph 2. Exclusions of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY in COVERAGES (Section n Is de- leted and replaced by the following Expected Or Intended Injury Or Damage 'Bodily Irt)wyr• or "property damage' expected or intended from the standpoint of the insured This exclusion does not apply to 'bcdlly Injury' or 'property damage" resul8ng from the use of rea. sonable force to protect any person or property. D. NON -OWNED WATERCRAFT — INCREASED TO UP TO 75 FEET 1. The exception contained In Subparagraph (2) of the Aircref% Auto Or Watercraft Exclu. sloe in 2. Exclusions of COVERAGE A BODILY INJURY AND PROPERTY DAM. AGE LIABILITY In COVERAGES (Section n Is deleted and replaced by the followlrW (2) A watercraft you do not awn that Is. (a) Less than 75 feet long; and (b) Not being used to Carry parsons or piny for a charge; 2. Only as respects the Insurance provided by ills Provision D., WHO iS AN INSURED (Section 11) Is amended to include as an ia. sured any person who. with your expressed or Implied consent, either uses or Is respon- sible for the use of the watercraft. The Insurance provided by this Provision D. shall be excess over any valid and collectible other Insurance evallaMe to the insured, whether prk nary. excess, contingent or an arry other basis, except for Insurance peer- rhased apedfi=4 by you la apply to excess of the limits of Insurance shown kh the Deds. rations for this Coverage Part. E. AIRCRAFT CHARTERED WITH CREW 1. The following Is added to the exceptions con- tained In the Ahera% Auto Or Watercraft t xduslon in Paragraph 2. Exclusiona of COVERAGE A BODILY INJURY AND PROPEM DAMAGE LIABILITY in COV- ERAGES (Section 1): Aircraft chartered with crow. Inctudnig a pilot, to any Inured. Page 2 of 8 02W ThsTrzv4&s eomv,rhI bhh: CO 03 79 69 07 Z This Provision E. does not apply if the char. tered aircraft Is owned by any Insured 3. The Insurance provided by this Prayslon E. shall be excess over any vaild and collectible other Insurance available to the insured whellier primary, excess. contingent or an any other bask except for Insurance pur- chased specifically by you to apply In excess of the Lirr& of Insurance shown In the Deda- ratims for this Coverage Part. F. EXTENSION OF COVERAGE — DAMAGE TO PREMISES RENTED TO YOU 1. The last paragraph of COVERAGE A BOD- ILY INJURY AND PROPERTY DAMAGE LIABILITY in COVEERAGE$ (Section tj 1 deleted and replaced by the following. Exclusions c. through n. do not apply to dam- age bu premises while rented to you or lem- porarly occupied by you with permission of the owner caused by & Fire b. Explosion c. Lightning d. Smoke resulting from such Are, explo- sion, or ighWng; or e. Water. A separate tirnil of kmx mca applies to this coverage as described In LIMITS OF tN- SURANCE (Section Nlj 2. The Insurance under this Provision F. does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture. bursting, or operatlm of pres- sure relief devices; b. Rupture or bhsstlrhp due to expansion or awe ft or the conterb of any bugdng or structure. caused by or resulting from wa- ter; or c. Explosion of steam bolars. steam pipes, steam or%*=, or steam brbkhes. 3. Paragraph Q. or LIMITS OF INSURANCE (Section III) Is deleted arid replaced by the following: Subject to 5. above, the Damegv To Prom. Isas Rented To You Umft Is the most we will pay under Coverage A for the sum of all damages because of 'pmpwty damage' to COMMERCIAL GENERAL LIABILITY any one premises while rented to you. or temporadly occupied by you with permission of Use owner, caused by, fire; explosion; Ught- riing, smoke re3vlbnp Tram such fire, expla. slon. at iightrdng; or whaler. The Daruge To Premfsas Rented To You Limit will apply to all 'property danhaga proxhnaiely caused by the sane 'occrxrenca'. whether such dam- age results from: The; explosion. lightning, smoke resulting from such Are, explosion. or lightning, or water, or any combination of any of these rxuses The Damage To Premises Rented To You Limit wig be the hlgher of. a. $1.000,000; or b. The amount shown for The Damage To Premises Rented To You Limit In the Deciarallons for this Coverage ParL 4. Paragraph a. of the delinkion or'Inswed con. Irect' In DEFINITIONS (Section V) Is deleted and ropfaeed by the rollowing: a. A conrrac! for a lease of premises. How- ever, that portion of the contract for a tease of premises that indemnifies any person or organization for demege to premises white rented to you. or Tempo- rarlly occupied by you with permission of ihs owner, caused by: the, axploslon, 50; smoke resulting from such fire, explosion, or lightning; or water Is not an '4nsured aonlracr, 5. this Provision F. does not apply 9 coverage for Damage To Premises Rented To You of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY In COV- ERAOES (Beetkm Ij to excluded by smother endorsement to this Coverage Part- G. MALICIOUS PROSECUTION — EXCEPTION TO KNOWING VIOLATION OF RIGHTS OF AN- OTHER EXCLUBM The following Is added to the Knowing Violation Of Rlghts Of Another Exclusion In 2. Exclu- sions of COVERAGE B PERSONAL INJURY, ADVERTISING INJURY AND WEB SITE IN- JURY LIABL.ITY of the WEB XTEND IJABILI Y Endorsement This axciusbn does not apply io personal Injury' caused by maklaus prosreeudon. C G 03 79 09 07 0 200 The Trevehn Ca"Mm rna Page 3 of S COMMERCIAL. GENERAL LIABILITY H. MEDICAL PAYMENTS LIMIT The Medical Expense Limit shown in the Doctors liana for this Coverage Part is Increased to $10.000. I. INCREASED SUPPLEMENTARY PAYMENTS Paragraphs 1.b. and 1.d. of SUPPLEMENTARY PAYMENTS — COVERAGES A AND 13 In COV- ERAGES (Seatlon t) are amended as follows: 1. In Paragraph 1.b., the amount we will pay for The cost of bail bonds is Increased to $2500. 2- In Paragraph i.d., the amount we wit pay for loss of earnings Is Increased to $500 a day. J. ADDITIONAL INSURED —OWNER. MANAGER OR LESSOR OF PREMISES 1. WHO IS AN INSURED (Saation ti) Is amended to Include as an insured: Any person or organization that you have agreed In a contract or agreement to include as an additional Msured on this Coverage Part but: a. Only with respect to Uablilly► for "bodily In- jury' or 'properly damage that occurs, or 'personal injury- caused by an offense committed, after you have entered into that contract or agreement; and b. Only If the "bodily lrr)ury', -property dam- age' or 'personal injury' Is caused, in whole or In part, by acts or omissions of you or any person or organization per- forming operations an your behalf, and artsas out of fho ownership, maintenance or use or that pert of any premises teased to you under that conlrad or agreement. 2. The Ntaurance provided W such additional Insured under this Provision J. Is subjed to the following provhs9orrs: a. The i(mfta of Insiurance afforded to such addNlonal insured shaft be the tlnrits which you agreed to provide In the con- tract or agreement, or the ltmlts shown In the Declarations for this Covetag Part. whichever are loss; and b. The insurim afforded to such additional Insured does not apply to: (1) Any -bodily Injury` or -property dam- age that occurs, or 'personal Irrjttrt caused by an offense committed. af- ter you cease to be a lenient in that premLses: (2) Any sirmtural alterations, new can struction or demolition operations performed by or on behalf of such additional insured; or (3) Any premises for which coverage Is excluded by another endorsement to Dais Coverage Part. 3. This Provision J. does not apply on any bash to any person or organization for which coverage as on additional Insured specifically is added by another en- dorsement to this Coverage Part K. ADDITIONAL INSURED — LESSOR OF LEASED EQUIPMENT 1. WHO IS AN INSURED (Section iQ is amended to Include as an Insured: Any person or organization that you have agreed In a contract or agreement to fnalude as an additional Insured on Ihis Coverage Part, but, a. Only with respect to liability for ImMy in- jur)P or "properly damage that occurs, or personal Injury' caused by an offense committed, after you have entered into that contract or agreement; and b. Only N Use "bodily Injury', "Itmparty dam- age or 'personal Injury' is caused, in whole or In part. by acts or amicsions of you or any presort or orpanixatian per- forming operations on your behalf. in the maintenance. operation or use of equip- ment based to you by such addfdaral In- sured, 2- The Insurance provided to such additonal Insured under this Provision K. is subject to the fallowing provisions: a. The smite of Insurance afforded to such additional Insured eW be the Iindls which you agreed to provide in the con - bad or agrauxr ant. or fhe 11mits shown in the GvAamtlons for @ifs Coverage Part, whichever are less. and b. The Insurance afforded to such additional insured does not apply: (1) To any %odlly inbW cr 'pmparty damage- that occurs, or-perswo M. Jury' caused by an offense commit led, after the equipment Leese ex- phas: or Page 4 of 8 O 2007 ?tr TraNbrs Compa n m CO 03 TO 09 07 121 Ii the equipment Is teased with an operator 3. This Provision K. does not apply on any basis to any parson or organIzallon for which cov- erage as an additional insured specifically Is added by another endorsement to this Cov- erage Part L ADDITIONAL INSURED — STATE OR POLITI- CAL SUBONISIONS -- PERMITS RELATING TO PREMISES The following Is added to Paragraph 2. of WHO IS AN INSURED (Section Ili) to include as an Insured: Any state or political subdivision thal has Issued a permit in connection with prendses owned or oc. cupied by, or rented or loaned lo. you, but only with rasped (o 'badly lr*ai'', "Pmp9fty damage-. "personal "' or'advarilsing ir4ury' arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of adver- Uslrg. signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations for which that state or political subdivision has issued such permit. M. ADDITIONAL INSURED — STATE OR POI.TTI- CAL SUBDMSiONS — PERMITS RELATING TO OPERATIONS The followkV Is added to Paragraph 2. of WHO IS AN INSURED (Section i) to include as an insured - Arty slate or political subdivision that has Issued a permit, but orgy with .aspect to "bodily Injury*, 'properly damage",Injury' or'advertis- Ing injury' arising out of operations performed by you or on your behalf for which that stato or po- Ntieal subdivision has Issued such permit How- ever. no such slate or political subdivision is an insured for. COMMERCIAL GENERAL LIABILITY N. ADDITIONAL INSURED — ARCHITECT, ENGI- NEER OR SURVEYOR 1. The folio ng Is added to Paragraph 2. of WHO IS AN INSURQy 19ecllon Ili) to Include as an insured: Any architect, engineer or surveyor engaged by or for you that you agree In a "contract or agreement requiring komnce" to Include as an additlanal insured on this Coverage Part, but only with respect to liability for'boft in- jury', `property damage' or 'personal Injury" thal )s caused, in whole or In part, by acts or omissions of you or any parson or organize - lion acting on your behalf In connection with your promises or `your work'. L This Provision N. does not apply on any basis to any person or Gr$ardt9on for which cov- erage as an additional Insured speclkaity is added by another endorsement 10 this Cov- erage Part. O WHO 13 AN INSURED — NEWLY ACQUIRED OR FORMED ORGANiZATIONS 1. "Bodily btjuupl', `property damage'. "personal injury" or 'advartising injury' arising out of P. operall ms performed for that state or political subdivision: or 2. "Bodily injury" or 'properly damage" Included within the 'produde — completed operations hazanr. 1. Paragraph 4.a. Of WHO IS AN INSURED (Section 11) is deleted and replaced by the following. a. Coverage under this provision Is afforded only unfit the 180th day attar you acquire or form the argardW6W or the end of the Policy period. whichever is eaffier. Any such newly acquired or formed orgarka lion that you report In writing to us wlldn 180 days after you acquire or form the orgmintlon wig be covered under this Provision until the end of the policy Ne riod, even If there aka roots Than Igo days remaining until the and of the policy period: 2. This Provision 0. does not apply to any or- ganization for which coverage Is excluded by another endorsement to ibis Coverage Part. WHO 13 AN INSURED — UNNAMED PART. HJERSW OR JOiW VENTURE —DRESS 1. The test paragraph of WHO IS AN INSURED (Steilan 8) is deleted and replaced by the fa6owirtg: No person or organtrow Is an insured vdth respect to the conduct of any Burn mi or past perfrrership, joint venture or Hurdled uablllty company that to not shown as a Named in. sured In the Common Pocky DecWa8ons. CG 03 79 09 07 0 zw TMTraveivs corwpwAm Ire. Page 5 of 5 COMMERCIAL GENERAL LIABILITY However, this exclusion does not apply to your IhMAy with mopect to your conduct of the business of any current or past parUxr- ship or joint venture: a. That is not shown as a Named Insured In the Common Polcyy Declarations, and b. in which you are a member or partner where each and every one of your co - ventures In That joint venture Is an archi- tectural, engineering or surveying firm 2. This Provision P. does not apply to any per- son or organization for which coverage Is ex- cluded by another endorsement to this Cov- erage Part. 3. The Insurance provided by this Provision P. shah be excess over any valid and collecMe other Insurence, whether primary. excess, contingent or on any other basis. which Is available covering your liability with rasped to your conduct of the business of any current or past partnership cr joint venture that Is not shown as a Named Insured in the Common Policy Declarations and which is Issued to such partnership anoint venture. Q. PER PROJECT GENERAL AGGREGATE LIMIT 1. Paragraph 2. of LIMITS OF INSURANCE (Section Ill) Is defeled and replaced by the following: The General Aggregate Limit is the moat we will pay for the sum or: a. Damages under Coverage t3; and b. Damages from 'occummces' under Cov- erage A and for an medical expenses caused by aWdents under Coverage C which cannot be attributed only to opera bona at a single "protect". 2. The following is added to LIMITS OF IN- SURANCE (Section 1111): A separate Per Project General Aggregate Lill applies to each 'projeel' for all sums which the Insured becomes Iagelly obligated to pay as damages caused by "ocuoTances' under Coverage A and for all medical ex- penses cans" by acddents under Coverage C wNch can he ater bLOd only to operations at a single oprotacr. and that 8mit Is equal to the amount or the General Aggregate Limit shown in the Declarotlons for this Coverage Part. Any payments made under Coverage A for damages and under Coverage C for medical expenses shall reduce the Per Protect Gen- eral Aggregate LImR for that 'project", but shall not reduce: a. Any other Per Project General Aggregate Limit for any other wgiect; b. The General Aggregate Limit: or m The Products -Completed Operations Ag- gregele Limit. The limns shown in the Declarations for this Coverage Part for Each Occurrence. Dam- age To Premises R.enled To You and Medical Expense are also subjed to the Per Project General Aggregate LknR when the Per Pro- tect General Aggregate Limit apples. 3. As used In the Provision Q.: 'Project means an area away from pranwses owned by or rented to you at which you are performing operations pursuant to a contract or agreement For the purposes of delermin- Ing the applicable eggregate limit or Mnsnr- ance, each 'project that includes premises Involving the some or connecting lots, or premises whose connection Is Inlenrrpted only by a street, roadway, waterway or right of -way or a railroad shag be considered a sin gle "project'. R. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following b added to Paragraph 2. Duties In Th Event of Occurrence. Otfensg, Clahn Or Sul! of COMMERCIAL. GENERAL UABIUTY CONDMONS (Section ft Notice of an 'occurrence" or of an offense which may result In a claim must be given as soon as practicable after knowledge of the "occurrence" or offense has bean reported to you, one of your 'exea>fhve otifcers iff you are a corporation), one of your partners who is an individual Of you we e partnership), one of your managers or you ere a Rrrrited liability company). one of your trustees who Is an individual of you are a bust), or an 'employed' (such as an insurance. loss. Control or d* manager or administrator) designated by you to give such notica. Knowledge by any other'anrptayee' of an'occur. ronce or offense does not Imply that you also have such knowledge. Page 6 of e 0 2ao7 The Triwarers Canpe am trc. CG D3 79 09 07 Notice of an "occurrence' or of an offense %fth may result In a zlalm vAl be deemed to Ire given as soon as pracl cable 10 us It 11 Is given in good faith as soon as practicable to your workers' corrn- pensation, accident, or health Insurer This ap- plies only if you subsequently give notice of the "occurrence or offense to us as soon as practi- cable over you. one of your'execuGve officers" (II you are a corporation), one of your partners who Is an individual (H you era a partnership), one of your managers (if you are a limited ilabillty company), one at your trustees who Is an Individ- ual (if you ass a trust). of an'amployea" {such as an insurance, loss control or risk manager or ad- ministrator) designated by you to give such notice discovers that the 'occurrence' or offense may Involve this policy. S. UNiNTEITIONAL OMISSION 1. The following Is added to Paragraph 8. Rep- rasentatlons of COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): The unintentional omission of, or uninten. !tonal war in, any information provided by you which we relied upon In issuing this pol- icy shall not prejudice your fights under this Insurance. 2. Tlis Provision S. does not affect our right to tolled additional premium or to exercise our right of cancellation or nonranewal in a= dance with applicable insurance laws or mgu- latlons. T. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US WHEN REQUIRED BY CONTRACT OR AGRiBEMENT The following Is added to Paragraph 8. Transfer of Rights of Rewwry Against Oftnm to Us of COMMERCIAL GENERAL LIABILITY CONDI- TIONS (8ection M: We waive any rights of recovery we may have against any person or orpantmtkm because of payments we make for "bodily kVry". 'property damage. "personal injury" or'adverti tng hW arising out of: COMMERCIAL GENERAL LIABILITY 4. "Your products'. We waive these rights only where you have agreed to do so as part of a contract at "me- ment entered Into by you before, and In effect when, the 'bodNy Injury" or 'property damage occurs, or the 'personal 4ijury' offense or'advar- Nsing injury' offense Is committed U. AMENDED BODILY INJURY DEFINITION The dermillon of 'bodily injury' in DEFINITIONS (Section V) Is deleted and replaced by the follow- Ing 'Bodily lnjury" means: e. Physical harm, including sickness or disease. sustained by a person; b Mental anguish. Injury or Illness, or emotional distress resulting at any time from such physical harm. sickness or disease; or c. Cara, loss of services or death resulting at any time from such physkal harm, sickness or disease. V. AMENDED INSURES? CONTRACT DEFINITION — RAILROAD EASEMENT 1. Subparagraph c- of ile definition of'Insured contract In DEFINITIONS (Section V) is de- leted and replaced by the following: c. Any easement or r"Kwm agreement, x. Subparagraph 11(9) of the definition of 9n- suded contract" In DEFINITIONS (Section V) Is deleted. W. AMENDED PROPERTY DAMAGE DEFINITION --TANG13LE PROPERTY The definition of "property damage' In DERNI- TIONS (section V) Is detelad and replaced by the following: -Property damage• means: a. Physical Injury to tangible property. inr.Wng all rasutting icas of use of the[ property. All such loss of use shell be deemed to occur at the time of tha physical injury dW caused It. or 1. Prennises owned by you, temporarily occu- b. Loss of use of tangible property that is not pied by you with permission of the owner, or physically irfured. AN such loss of use shall [eased or rented to yar; be deemed to occur at tics line of the `ocau- rence` that caused It. 2 Ongoing elf. under contrrsd or you4 m nt For the purposes of this Insurance, tarrg[ble prop - your 6alneif. under a contract or agreement with that person or organization; arty does not Include data. 3. 'Your work"; or CO D3 TO 09 07 0 2W? MW TWWM Coepiea r= Page 7 of a COMMERCIAL GENERAL LIABILITY X The following definition is added to SECTION V — DEFLNITIONS: 'Contract or agreement requiring Insurance" means that part of any contract or agreement under which you are required to Include a parson or organization as an addiNanal insured on Ihis Coverage Fari, provided that the 'bodrffy Injury' and 'property damage- occurs, and the "personal injury' is reused by an rWansa committed. a. After you have entered into that contract or agreement; b. While that part of the contract or agreement Is In effect; and c. Berate the and of the policy period. Page a of a 0 ZG? The Travelers Cogxm m toe. CO D3 T9 09 07 Policy #BAOJ093233 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described In any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing Is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and Is not covered. A. BLANKET ADDCRONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS —INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED OMIT A. BLANKET ADDITIONAL INSURED The following Is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE - Any person or organization who Is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured Is an "insured" for Covered Autas Liability Coverage, but only for damages to which this Insurance applies and only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured provision contained in Section It. B. EMPLOYEE MIRED AUTO H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT —INCREASED LIMIT 1. WAIVER OF DEDUCTIBLE— GLASS J. PERSONAL PROPERTY K. AIRBAGS L AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. In B.S., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your 'employee" under a contract in an 'employee's' name, with your permission, while performing duties related to the conduct of your busi- ness. 1. The following Is added to Paragraph A.i., However, any "auto" that Is leased, hired, Who Is An insured, of SECTION II — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE: covered "auto". An 'employee" of yours Is an insured" while C. EMPLOYEES AS INSURED operating a covered "auto' hired or rented The following is added to Paragraph A.1., Who is under a contract or agreement In an 'am- An Insured, of SECTION II —COVERED AUTOS ployeWs' name, with your permission, while LIABILITY COVERAGE, CA T4 20 021 S O 2015 The Tnavatero Indemnity Company All rWft reserved. Page 1 of 3 includes copyrighted matartsl or insurance Services Office Inc with Its permisslorL COMMERCIAL AUTO Any "employee" of yours Is an 'insured" while us- ing a covered "auto" you don't own, hire or borrow In your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION It — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of ball bonds (in- cluding bonds for related traffic law vlola. dons) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION U — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses Incurred by the 'Insured" at our request, Including actual loss of earnings up to $500 a day be- cause of time off from work E. TRAILERS —INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a bad capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HiRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A-4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" era covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos' that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to arty one "auto" that you hire, rent or borrow Is the lesser of: (a) $50,0W: (b) The actual cash value of the damaged or stolen property as of the time or the 'loss"; or (c) The cost or repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depredation and physical condition will be made in determining actual cash value in the event of a total "loss% (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that Is hired, rented or bor- rowed with a driver, or (b) Any "auto" that Is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT The following replaces the first sentence In Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered 'auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT —INCREASED LIMIT Paragraph CA b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted I. WAIVER OF DEDUCTIBLE — GLASS The following Is added to Paragraph D. Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage If the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following Is added to Paragraph AA. Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE - Personal Property Coverage We will pay up to $4110 far "loss" to wearing ap- parel and other personal property which is, (1) Owned by an Insured", and (2) In or on your covered "auto". This coverage only applies In the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. Page 2 of 3 O 2015 The Travelers Indemnity Company IW rights reserved CA T4 20 0215 Includes copyriphied malarial or tnsurance Services ORics Inc with Its perrnlss on K. AIRBAGS The following is added to Paragraph 8.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.& does not apply to "loss" to one or more airbags In a covered "auto' you own that in- state due to a cause other than a cause of "loss' sal forth In Paragraphs A.i.b. and AA.c., but only: a. If that "auto' Is a covered 'auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not Intentionally Inflated. We will pay up to a maximum of $1,000 for any one 'loss". L AUTO LOAN LEASE GAP The following Is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown In the Schedule or Deefarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto' less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and COMMERCIAL AUTO (2) Any. (a) Overdue lease or loan payments at the time of the "loss•; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor, (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION 1V — BUSINESS AUTO CONDI- TIONS: 5. Transfer OF Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or 'Toss", pro- vided that the'accldent" or'foW arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated In such contract. CA T4 20 0215 62015 The Travelers Indemnily Company All rights reserved Page 3 of 3 Includes copyrighted matedal of Insurance Services office Inc wM Its permission TRAl1ELER5Aftk woRKERs ANCOMPENSATION ONE sorrea< 80=0 EMPLOYERS LIABILITY POLICY anTrma, Cr 06313 ENDORSEMENT WC 09 03 76 ( A) — 001 POLICY NUMBER: UBSJ034006 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an k4ury covered by this policy. We wilt not enforce our right against the perm or organization named In the Schedule. The additional premium for this endorsement shalt be 3 % of the California workers' compensation pre- mium. Schedule Person or Organization Job thmrlptlon AM URSCH OR ORORNIZATIOH FOR WilICH TER INBVRM HAS AM= BY WRIT17tai CONTRACT McUT PRIOR TO L099 TO FURNISH THIS WAIM. This endorsement changes the policy to which n Is elteched and Is effective on the date Issued unless otherwise (The Information below to required only when this endorsement Is Issued subsequent to preparation of the poncy.) Endorsement Effective Policy No. Endorsement No Insured Premtran Insurance company Couniars gi ed by DATE OF ISSUE: ST ASSIGN: Page 1 of 1 POLICY NUMBER: 680-62443.235 ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATIONMONRENEWAL PROVIDED BY US This endorsement modifies Insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of bays Notice of Cancellation: 3o NONRENEWAL: Number of Days Notice of Nonrenewal: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRRCT TEAT NOTICE OF CANCELLATION OR NOHRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IFs 1. YOU SEND us A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING TEE NAH6 AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST HAM INGU E) RECEIVES NOTICE FROM Us OF TUB CANCELLATION OR NONRiMEWAL OF THIS 2. WE INCBIVE SUCH WRITTEN REOMST AT LEAST 14 DAYS BEFORE T= BEGINNING OF THE APPLICABLE W MER OF DAYS SHOWN IN THIS SCiiSDDLE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN vxgaRsT FROM YOU To US. PROVISIONS: A. If we cancel this policy for any statutorily pemtit- ted reason other than nonpayment of premium and a number of days is shown for cancellation in the schedule above, we will mail notice of cancel - Won to the person or organization shown In the schedule above. We will mall such notice to the address shown in the schedule above at least the number of days shown for cancellation In the schedule above before the effective date of can- cellation POLICYI AND B. It we decide to not renew tMs poky for any stalu. torDy permitted reason, and a number of days is showin for nanrenewal In the schedulee above, we will mall notice of the nonrenewal to the person or organization shown In the schedule above. We wig mal such notice to the address shown In the schedule above at least the number of days shown for nonrenewal in the schedule above be- fore the expiration date. IL T4 00 12 09 0 2009 The Travelee indemnity Gorrqury Page Z of 1