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DocuSign Envelope ID: B66ED176-593F-4958-AB56-22425F84AFF6 <br />Attachment Goae: UJJ�PLU8 Uertiticate 11J: 1-166 431 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED BY CONTRACT OR AGREEMENT <br />PRIMARY BASIS <br />This endorsement modifies insurance provided under the following Coverage Form: <br />COMMERCIAL GENERAL LIABILITY <br />PRODUCTS/COMPLETED OPERATIONS <br />LIABILITY LIQUOR LIABILITY <br />POLLUTION LIABILITY <br />This endorsement changes the policy effective on the inception date of the policy unless another endorsement <br />effective date is indicated below. <br />SCHEDULE <br />Name of Additional Insured Person(s) or Organization(s): <br />As required by written contract or agreement when such written contract or <br />agreement is executed prior to an occurrence, offense or loss to which this <br />endorsement applies, but only for the limits agreed to in such contract or the <br />Limits of Liability provided by this policy, whichever is less. Any individually <br />scheduled additional insureds shall not be construed to override nor negate this <br />blanket additional insured. <br />Designated Project, Location, or Work of Covered Operations: <br />escribecl person(s) <br />As per written contract or agreement with the above described persons) or <br />organization(s) <br />CHANGES <br />SECTION II - WHO IS AN INSURED is amended to include: <br />4. The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written <br />contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional <br />Insured subject to the below: <br />a. Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such <br />Additional Insured is liable for "bodily injury", "property damage" or "personal and advertising injury" <br />caused by your acts or omissions while actively engaged in the performance of your ongoing operations <br />involving the project(s), locations(s), or work designated in the Schedule and as specified in the contract <br />between you and the above scheduled Additional Insured(s). <br />b. The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: <br />(1) If the "occurrence" or offense takes place subsequent to the execution and effective date of such <br />written contract: and, <br />(2) While such written contract is in force, or until the end of the policy period, which ever occurs first. <br />c. How Limits Apply to Additional Insured(s) <br />The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: <br />(1) The limits of insurance specified in the written contract or written agreement; or, <br />(2) The Limits of Insurance provided by the Coverage Form. <br />SNGL 023 1209 Safety National Casualty Corporation Page 1 of 2 <br />