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HomeMy WebLinkAboutHot Dog on a Stick; 2019-04-23;- STICK-(!) 0 T fl 0 ONA a:::::::-"" CUSTOMER CONTACT INFORMATION CITY OF CARLSBAD · Librarv & Cultural Arts\ Name Meaan Vanzandt / Heather Pizzuto Event Date Phone number 760~02-2089 / 760-602-2011 Serving Time Set Up Time Email menan.vanzandtl1i>cartsbadca.aov Guest Count Address of Event Billing Address Street 3096 Hardina St Street Dove Lane Citv Car1sbad City Carlsbad State, Zio CA 92008 State, Zio CA, 92011 Description Quantity Price Amount Combo Packages The Box (2 Stick Items, ChoiceofSmall Side) $ 9.00 Stick Items: Hot Dog on a stick-Turkey Hot Dog on a Stick-Beef Hot Dog on a Stick-Veggie Cheese on a Stick-American Cheese on a Stick.Pepper Jack Small Stdeltems: French Fries Funnel Cake Sticks (5 sticks/ order) A-la Carte Hot Doi! on a Stick-Turkev 100 s 3.00 Hot Doi! on a Stick-Beef $ 4.00 Hot Dog on a Stick-Veggie 40 $ 4.00 Cheese on a Stick-American 60 s 3.00 Cheese on a Stick-Pepper Jack s 3.00 French Fries 100 s 3.00 Funnel Cake Sticks (10 sticks/ order) s 3.00 Kettel Chips s 1.00 Fresh lemonade-16oz 100 $ 3.00 Fresh Lemonade-32oz s 5.00 Bottled Water s 2.00 Additional hour of serving time s 75.00 Credit Card Information Sub Total Name on Card Tax Rate Card Number Tax CW# Sub Total+ Tax Card Exoiration Labor Hours Billina Zio Code Amount Due SiQnature 11c:y.:,?> ,-=;t<AY~ :un:_.-n./\ lr~-rfY.,,CV A-P-~ u Hot Dog on a Stick -Catering'Contract The Hot Dog on a Stick Mini Booth is a self.<;ontained mobile restaurant that allows us to prepare hot dogs on a stick, cheese on a stick, fresh lemonade, and related items for your special event. 1. SITE SELECTION: Hot Dog on a Stick ("HOOS") reserves the right to pre-approve the location of the event and - will require the opportunity to inspect the site. The catering booth is a 5 fl by 5 ft canopy that will need about 5 to 10 feet behind the set up for our cookers and generator. When selecting a site make room accordingly. The generator does make some noise along with the output of some exhaust. A well ventilated area usually works best. HOOS will not be liable in any manner for damages or claims that arise if the site is not property ventilated. 5/3/19 5:15 om-6:45 om 4:00 PM 1775 $0.00 $300.00 $0.00 $160.00 $180.00 $0.00 $300.00 $0.00 $0.00 $300.00 $0.00 $0.00 $0.00 $1,240.00 0.0950 $117.80 $1 357.80 $0.00 $1,357.80 1. PAYMENT -*Prices subject to change. 2.1 DEPOSIT: A deposit of $500 or half of the total itemized order, whichever is greater, is required upon signing of this agreement. The receipt of your deposit will confirm the reservation. Until the deposit is received in full, HOOS has no obligation to hold your reservation. If you do not submit your itemized order at the time you execute this agreement, you must pay the difference, if any, between $500 and half of the total itemized order at the time you submit your order, as discussed in Section 2.3. 2.2 CANCELLATION: Deposits are non-refundable if you cancel this event less than fourteen (14) days from the event date. In order to receive a full refund on the deposit, you must provide a written notice of cancellation to HOOS Enterprises Catering (at the address listed below), and the notice of cancellation must be received by HOOS Enterprise Catering at least fourteen (14) days prior to the event date 2.3 PLACEMENT OF ORDER: You must provide your itemized order at least fourteen (14) days prior to the event date. After you provide your itemized order, you are permitted to purchase additional items and/or increase the quantity of any item(s) ordered by providing notice of the additional purchase(s) at least one day prior to the event date. However, once you provide your itemized order, you are not permitted to decrease the quantity of any items that you ordered. However, we may, but are not obligated to, permit you to modify your itemized order at least one day in advance of the event by reducing the quantity of one or more purchased items on the condition that you increase the quantity of one or more other items, so that the new overall total of items purchased (in dollars) is equal to or more than the original total order (in dollars). You will be charged for the final total of items purchased, even if you do not use or consume all of the items. We will only provide those products and supplies that you specifically order. 2.4 SELF-SUPPLY: If you wish. you may supplement or substitute HDOS's items, supplies, or equipment for your own. In the event you supplement or substitute any of HDOS's items, supplies, or equipment for your own, you acknowledge and agree that HOOS will not be held responsible for any costs or damage incurred in connection with your supplemented or substituted items, supplies, or equipment. You must provide HOOS with a written list of any items, supplies, or equipment you wish to substitute at least three (3) days prior to the date of the event. Any substitutions are subject to HOOS' written approval. There will be no reduction in price for any supplemented or substituted items. supplies, or equipment. The customer has agreed to provide. supplement or substitute the following items: coy,m•••~ 1 HOOS lnitals: ·"•' L Date:~ Date_~f/-ll/ 2.5 BALANCE DUE: Final payment must be made at the completion of your event by cash, electronic transfer, Visa, MasterCard, Discover, American Express or Company/School Authorized Check. No personal checks will be accepted. The catering crew will issue a final itemized bill indicating the amount of product used and the amount of total charges to be billed for services, less any deposits or prior payments. Please remember if your total amount sold is less than the minimum indicated above, you will be billed the minimum costs. Any extra items are forfeit or will be cooked up onsite and left for the customer/guests. All notices to be provided to HOOS under this agreement, as well as all payments via check, should be sent to the following address: HOOS Acquisition LLC 1644 Montebello Town Center Montebello. CA 90604 2.6 REFUNDS: In the event you give HOOS proper notice of cancellation entitling you to a refund, HOOS will issue a refund in the form of a written or electronic check made payable to you. 3. PROMOTIONAL MATERIAL 3.1 HOOS APPROVAL: All promotional materials containing the HOOS name or marks in any manner must be approved by the Hot Dog on a Stick Marketing department. Please email your design to HOOSCatering@gfgmanagement.com and HOOS will use all reasonable measures to notify you of HOOS' approval or disapproval within one business day of recei\/ing your proposed design. The material is deemed disapproved until you have received HOOS' written approval. You agree to conduct all marketing in a dignified manner and to conform to any standards and requirements HOOS specifies regarding use of the HOOS marks. HOOS reserves the right to require you to discontinue the use of any marketing materials containing HOOS' name or marks. Logo slicks or help with the design of the promotional material may be available. for a fee, upon request. You are not given any license to use the HOOS name or marl<s by entering into this agreement. 3.2 PHOTOGRAPH/MEDIA RELEASE AND WAIVER: HOOS reserves the right to take and pub6sh photographs, videos, and other forms of media of you and the event, for the purposes of promoting and advertising HOOS or for any other related , lawful purpose. This reservation of use includes but is not limited to publishing on the Internet and in e-mails, social media, magazines, pamphlets, advertisement fliers, and in whatever other print or digital media HOOS finds useful for such photographs, videos, and other forms of media. You waive the right to inspect or approve the finished product, in duding written or electronic copy, wherein your and/or your attendees· likeness appears. You and your attendees waive any right to compensation arising or related to the use of the photographs, videos, or other digital media. If HOOS uses your or your attendees· appearance at an event in any form of media, you may request that HOOS remove said media by providing us with written nolice which that specifies the: 0) pictures, videos, or other form of media at issue; and (ii) the individuals who wish to have their appearance removed. Notwithstanding the foregoing, HOOS acknowledges that depending on the type of event, the parties may "\\ \ ) be required to execute a confidentiality agreement that may modify or delete the terms in this Section 3.2. ~\}J 1'1uv · t ; ,.. , nh '' 1 R <I!><: · • e even . at>1e 11)"-imerme 4. INDEMNIFICATION REQUIREMENT: 4.1 Except to the extent such actions or claim arise out of the gross negligence or willful misconduct of HOOS, you agree to hold harmless, defend, and indemnify HOOS and HOOS' past. present and future affiliates, officers. directors, shareholders, managers, members, agents, attorneys, consultants, management companies, and employees against any claims, demands, fines. losses, costs, expenses 0nctuding, but not limited to, reasonable attorneys' fees, costs of investigation. settlement costs, and interest), liabmties, and damages (collectively, "Damages") arising directly or indirectly from, as a result of, or which in any way relate to the event. This Section 4.1 wiU survive after the completion of the event, and applies to Damages even if they exceed the limits of your insurance coverage. In no event shall HOOS be liable for punitive, exemplary, multiple, or consequential damages of any nature or for any reason whatsoever. reason whatsoever. 4.2 Except through its own actions. HOOS does not assume liability for any damages or loss whatsoever. No associate (employee) of HOOS has the authority to carry or increase its liability and statements made by an associate (employee) shall not be binding upon HOOS unless made in writing by an officer of HOOS. 4.5 INCIDENTAL CHARGES: HOOS may assess an incidental charge for additional expenses it incurs, which HOOS will charge to your credit card on file or add to the contract's final total. The expenses giving rise to such charges indude, without limitation: 0) all toll roads in getting to or returning from the event. Oi) parl<ing at the event, and (iii) any other unusual circumstances that HOOS may specify prior to executing this agreement. 4.6 Upon your request. HOOS will provide a certificate of insurance; however, if you or your chosen site require additional insurance, then HOOS reserves the right to charge an additional fee of $150.00. 5. FORCE MAJEURE: 5.1 Should events beyond the reasonable control of HOOS including, but not limited to, acts of God, fire, floods, earthquakes. severe weather conditions, war, strikes, government regulation, ciVJl disturbance, terrorism. disaster. disputes. accidents. vandalism, restrictions or regulations on travel, or any other comparable conditions occur. making ii illegal or impossible to fully perform under this agreement as the parties originally contracted, HOOS may terminate this contract without further liabmty of any nature, upon return of your deposit. 6. RIGHT TO RESCIND: 6.1 HOOS reserves the right, at any time, to unilaterally rescind this agreement and, or to deny service. even after the event has commenced, if any event is not conducted (or any personnel related to the event does not conduct themselves) in a manner consistent with the law abiding and wholesome family image of Hot Dog on a Stick, which 1-00S will decide in its sole discretion. 6.2~N: HDOS's unit cannot operate in the rain due to its use of hot oil. Therefore. in the event of rain, \"-~ 14 ,ill A:lptaee'their tents with~ largM'tood mck anO-J>rev1:m, 'Pooa msia tke . tr \} _ e do fyers from the ram 7. MISCELLANEOUS: This agreement constitutes the entire agreement between the parties and supersedes any and all prior offers. negotiations and agreements. Only a written agreement executed by both parties shall modify this agreement. If any provision of this agreement is declared invalid, the remaining provisions shall remain in full force and effect. The laws of the State of California shall govern this agreement. We hope this agreement will serve to acquaint you with the Hot Dog on a Stick Catering Mini Mobile Unit service and that you and your group will be as pleased with the service as HOOS is to bring it to you! I HAVE READ THE ABOVE AGREEMENT AND UNDERSTAND ITS TERMS. I WOULD NOT SIGN THIS AGREEMENT IF I DID NOT UNDERSTAND AND AGREE TO BE BOUND BY ITS TERMS. CUSTOMER: By: a:kan" J Pi 0~ HOOS: By: Print Name: Heather Pizzuto Print Name: Title: Libra & Cu ural Arts Director Title: Date: 4'2-Date: Approved as to Form: Celia A. Brewer, City Attorr;e;J v.1 ~ By: fll1 '-, ~ Assistant City Attorney Attest: i Q Barbara Engleson -/ f . / - By: __ ... AA.'"':;..a,. ... A __ .,__.._.,_:,{/..,;....a.l/\ ....... u_~;_...--1A,~~A ..... City Clerk I Page 1 of 1 ACORD• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 04/02/2019 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: Willis Insurance Services of Georgia, Inc. fA~~Nlt "•"· 1-877-945-7378 I FAX 1-888-467-2378 c/o 26 Century Blvd IA/C Nol: P.O. Box 305191 ifDA~~SS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Travelers Indemnity Company of America 25666 INSURED INSURER B: Travelers Indemnity Company of CT 25682 HDOS Acquisition, LLC DBA Hot Dog On A Stick INSURERC: Travelers Property Casualty Company of Ame 25674 5555 Glenridge Connector Ste 850 INSURERD: Atlanta, GA 30342 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER· W10816694 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. INSR ADDL SUBR 1 POLICY EFF /~~)-J%~, LTR TYPE OF INSURANCE m~n .. n,n POLICY NUMBER MM/DD/YYYYl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 f--~ CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence) $ 100,000 A MED EXP (Any one person) $ 5,000 -y 630-1L629216-TIA-18 08/21/2018 08/21/2019 PERSONAL & ADV INJURY $ 1,000,000 f-- GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 Fl □PRO-□LOC PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY ~~~~~~~~lNGLE LIMIT $ 1,000,000 -X ANY AUTO BODILY INJURY (Per person) $ B -OWNED -SCHEDULED y 810-1L933472-TCT-18 08/21/2018 08/21/2019 BODILY INJURY (Per accident) $ -AUTOS ONLY f--AUTOS HIRED NON-OWNED ;p~~~~~J;,';,fiAMAGE $ -AUTOS ONLY f--AUTOS ONLY $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ f-- EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION XI ~~fTuTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N C ANYPROPRIETOR/PARTNER/EXECUTIVE □ y E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A UB-1L933540-18 08/21/2018 08/21/2019 (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 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Date of Event: 5/3/10 Time of Event: 5:30 pm City of Carlsbad is included as an Additional Insured as respects to General Liability and Auto Liability. Waiver of Subrogation applies in favor of City of Carlsbad with respects to Workers Compensation as permitted by law. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Carlsbad AUTHORIZED REPRESENTATIVE 1200 Carlsbad Village Drive ~~ Carlsbad, CA 92008 © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID, 17725816 BATCH, 1137985 POLICY NUMBER: Y-630-IL629216-TIA-l 8 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 this 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. Broadened Named Insured B. Blanket Additional Insured -Broad Form Vendors C. Damage To Premises Rented To You • Perils of fire, explosion, lightning, smoke, water • Limit increased to $300,000 D. Blanket Waiver Of Subrogation E. Blanket Additional Insured -Owners, Managers Or Lessors Of Premises F. Blanket Additional Insured -Lessors Of Leased Equipment G. Incidental Medical Malpractice H. Personal Injury-Assumed By Contract I. Amended Bodily Injury Definition PROVISIONS A. BROADENED NAMED INSURED 1. The following is added to SECTION II -WHO IS AN INSURED: Any organization, other than a partnership or joint venture, over which you maintain owner- ship or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pe- riod that you no longer maintain ownership of, or majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION 11-WHO IS AN INSURED: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, unless reported in writing to us within 180 days. J. Bodily Injury To Co-Employees And Co-Volunteer Workers K. Aircraft Chartered With Crew L. Non-Owned Watercraft -Increased From 25 Feet To 50 Feet M. Increased Supplementary Payments • Cost of bail bonds increased to $2,500 • Loss of earnings increased to $500 per day N. Medical Payments -Increased Limit 0. Knowledge And Notice Of Occurrence Or Offense P. Unintentional Omission Q. Reasonable Force -Bodily Injury Or Property Damage B. BLANKET ADDITIONAL INSURED -BROAD FORM VENDORS The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: CG D4 58 0713 © 2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (6) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your prod- ucts"; or (7) "Your products" which, after distribution or sale by you, have been labeled or rela- beled or used as a container, part or in- gredient of any other thing or substance by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional insured specifically is scheduled by en- dorsement. C. DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I - COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABIL- ITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Para- graph 6. of Section Ill -Limits Of Insurance. This insurance 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 operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6. of SEC- TION 111-LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning smoke resulting from such fire, explosion, or lightning; or wa- ter. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; explosion; lightning; smoke resulting from such fire, ex- plosion, or lightning; water; or any combina- tion of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations of this Coverage Part for Damage To Prem- ises Rented To You Limit. Page 2 of 7 © 2013 The Travelers Indemnity Company. All rights reserved. CG D4 58 0713 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 3. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, ex- plosion, or lightning; or (5) Water. is not an "insured contract"; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED -OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" that: COMMERCIAL GENERAL LIABILITY a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have signed and executed that contract or agree- ment; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is com- mitted, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. BLANKET ADDITIONAL INSURED -LESSORS OF LEASED EQUIPMENT The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertis- ing injury" that: a. Is "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have CG D4 58 0713 © 2013 The Travelers Indemnity Company. All rights reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- ment; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Part, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "ad- vertising injury" caused by an offense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services" to a person. 2. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; c. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION 11-WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1 )(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "incidental medical services" by any of your "employees", other than an employed doctor. Any such "employees" providing or failing to provide "incidental medical services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I -COV- ERAGES -COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph 5. of SECTION Ill -LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in the providing or fail- ing to provide "incidental medical services" to any one person will be considered one "oc- currence". 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV -COM- MERCIAL GENERAL LIABILITY CONDI- , TIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of SECTION II -WHO IS AN INSURED. H. PERSONAL INJURY -ASSUMED BY CON- TRACT 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION I -COVERAGES -COVERAGE B PER- SONAL AND ADVERTISING INJURY LI- ABILITY: Page 4 of 7 © 2013 The Travelers Indemnity Company. All rights reserved. CG D4 58 0713 Includes copyrighted material of Insurance Services Office, Inc. with its permission. e. Contractual Liability "Personal injury" or "advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for damages because of "personal injury" assumed in a con- tract or agreement that is an "insured contract", provided that the "personal injury" is caused by an offense com- mitted subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable at- torneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this in- surance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAY- MENTS -COVERAGES A AND B: Notwithstanding the provisions of Paragraph 2.b.(2) of Section I -Coverage A -Bodily In- jury And Property Damage Liability or Para- graph 2.e. of Section I -Coverage B -Per- sonal and Advertising Injury Liability, such payments will not be deemed to be damages because of "bodily injury", "property damage" or "personal injury", and will not reduce the limits of insurance. 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS -COVER- AGES A AND B: d. The allegations in the "suit" and the in- formation we know about the "occur- rence" or offense are such that no conflict appears to exist between the interests of COMMERCIAL GENERAL LIABILITY the insured and the interests of the in- demnitee; 4. The following replaces the first subparagraph of Paragraph f. of the definition of "insured contract" in the DEFINITIONS Section: f. That part of any other contract or agree- ment pertaining to your business (includ- ing an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury," "property damage" or "per- sonal injury" to a third person or organiza- tion. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. I. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily in- jury" in the DEFINITIONS Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, including death resulting from any of these at any time. J. BODILY INJURY TO CO-EMPLOYEES AND CO-VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1) of SECTION 11-WHO IS AN INSURED: Paragraph (1 )(a) above does not apply to "bodily injury" to a co-"employee" in the course of the co- "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. K. AIRCRAFT CHARTERED WITH CREW The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I -COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. L. NON-OWNED WATERCRAFT 1. The following replaces Paragraph (2) of Ex- clusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I -COVERAGES -COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: CG D4 58 0713 © 2013 The Travelers Indemnity Company. All rights reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY (2) A watercraft you do not own that is: (a) Fifty feet long or less; and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTION II -WHO IS AN INSURED: Any person or organization that, with your ex- press or implied consent, either uses or is re- sponsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS -COVER- AGES A AND B of SECTION I -COVER- AGES: b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS -COVER- AGES A AND B of SECTION I -COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. N. MEDICAL PAYMENTS-INCREASED LIMIT The following replaces Paragraph 7. of SECTION Ill -LIMITS OF INSURANCE: 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C. for all medical expenses because of "bod- ily injury" sustained by any one person, and will be the higher of: (a) $10,000; or (b) The amount shown on the Declarations of this Coverage Part for Medical Expense Limit. 0. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV -COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II -Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture; (ii) A manager of any limited liability company; (iii) A trustee of any trust; or (iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as prac- ticable after any of the persons described in Paragraphs e.(1) or (2) above discov- Page 6 of 7 © 2013 The Travelers Indemnity Company. All rights reserved. CG D4 58 0713 Includes copyrighted material of Insurance Services Office, Inc. with its permission. ers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement. P. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional er- ror in, any information provided by you which we relied upon in issuing this policy will not prejudice COMMERCIAL GENERAL LIABILITY your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. Q. REASONABLE FORCE -BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I - COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the in- sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. CG D4 58 0713 © 2013 The Travelers Indemnity Company. All rights reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office, Inc. with its permission. -·-- o-iiiiii iiiiiii -= .,_ --"'.iiiiiiiiiiiii = ~ o- o::::::::: ~ TRAVELERS] · ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) -001 POLICY NUMBER: UB-1L933540-18-14-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. INCLUDING: TBD 005241 DATE OF ISSUE: 09-04-18 ST ASSIGN: PAGE 1 OFl