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HomeMy WebLinkAboutCMAP - Insurance CertificateA ® DATE(MM /DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 10/6/2011 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 Newport Beach, CA 92660 949- 756 -0271 a Fax 949- 756 -2713• License No. OC36861 INSURED: PROGRAM INSURER(S) AFFORDING COVERAGE A/C. NAIC # 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY MM DD/YY DD/YY) LIMITS LTR INSR WVD ( ) (MM • GENERAL LIABILITY X PAC 1000001 00 09/29/11 09/29/12 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED _ $1 000,00 0 X COMMERCIAL GENERAL LIABILITY - PREMISES (Ea Occurrence) „ - CLAIMS MADE il OCCUR MED EXP (Any one person) _ N_ /A _ _$11000,000 GLDED: Al' 000 PERSONAL &ADVINJURY ,- GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGG_REGATEmm NA* _ X POLICY PRO- LOC PRODUCTS- COMP /OPAGG. $1,000,000 • AUTOMOBILE LIABILITY PAC 1000001 00 09/29/11 09/29/12 COMBINED SINGLE LIMIT lEaAccidentt _ $1,000 000 - ANY AUTO BODILY INJURY ( Per person) _ ALL OWNED AUTOS BODILY INJURY (Per accident) -� "` PROPERTY DAMAGE SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS AUTO DED: $1,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE CLAIMS AGGREGATE EXCESS LIAB DEDUCTIBLE RETENTION KER MPEISATION we srATU- oTH- AND EMPLOYERS LIABILITY Y/N TORY LIMITS ER ,_.,,,,..H V______�.�_ .._......— ......�_ ANY PROPRIETORY /PARTNER /EXECUTIVE N/A ACCIDENT E.L. EACH ACCIDENT OFFICER I MEMBER EXCLUDED? (MANDATORY IN NH) IF YES, DESCRIBE E.L. DISEASE - EA EMPLOYEE �E. UNDER DESCRIPTION OF OPERATIONS BELOW L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES (Attach Acord 101, Additional Remarks Schedules, If more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS TO INSURED's OPERATIONS. THE CITY OF GILROY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS INSURANCE. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©2008 ACORD CORPORATION. All rights reserved. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA ST. ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRESEjNTATIVE ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©2008 ACORD CORPORATION. All rights reserved. A CO 1' AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. COMMUNITY MEDIA ACCESS PARTNERSHIP POLICY NUMBER 5055 SANTA TERESA BLVD. PAC 1000001 00 GILROY, CA 95020 CARRIER NAIC# ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29/11 innITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, — FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Companyby mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. I ne -- name — g.— ey,-- i-- -- -- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission DATE (MMIDOlYYYY) A � ® CERTIFICATE OF LIABILITY INSURANCE 10/6/2011 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 Newport Beach, CA 92660 949- 756 -0271• Fax 949 - 756 -2713• License No. OC36861 INSURER(S) AFFORDING COVERAGE NO: NAIC p COMMUNITY MEDIA ACCESS PARTNERSHIP INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO. __23140.,,, -, __.,_. 5055 SANTA TERESA BLVD. INSURER B: GILROY, CA 95020 INSURER C: INSURER D: _-.._.._... ._ .......... ._..- ............ .. _ - INSURER E: ._............. ..._ .... .........__....._ ......... ..... INSURER F: "NOTIGICATE NUMBER' 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 LTR TYPE OF INSURANCE ADDL INSR sUBR WVD POLICY NUMBER POLICY EF (MMIDD/YY) MM/D P (MIDD/YY) LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X PAC 1000001 00 09/29/11 09/29/12 EACH OCCURRENCE $1,000,000 DAMA RENT D'_- PREMISES Ea Occurcence $1 ��� 000 CLAIMS MADE OCCUR MED EXP (Any one person) N/A PERSONAL & ADV INJURY $1_,000,000 GL DED: $1,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA* _ PRODUCTS- COMP /OPAGG. $1,000,000 POLICY PRO- LOC • AUTOMOBILE LIABILITY PAC 1000001 00 09/29/11 99/29/12 COMBINED SINGLE LIMIT _. lEa. AccidEDl1_.._______— _......._._ $1 000 000 ... � ___._...__...._.. _ ANY AUTO BODILY INJURY( Per person) BODILY INJURY (Per accident) ALL OWNED AUTOS PROPERTY DAMAGE - SCHEDULEDAUTOS X HIRED AUTOS X NON -OWNED AUTOS AUTO DED: $1,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE. - AGGREGATE EXCESS LIAB CLAIMS DEDUCTIBLE - _.- ..__.— .„....M..,._d._. RETENTION WORKERS COMPENSATION WC STATU• OTH- AND EMPLOYERS LIABILITY Y/N _ TO ER RY LIMITS ANY PROPRIETORY /PARTNER /EXECUTIVE OFFICER IME MBER EXCLUDED? N/A E.L. EACH ACCIDENT .._�,.. _ ...._....._ ................_,.. ..........__.__.,..._...,...-- (MANOATORY IN NH) IF YES, DESCRIBE E.L. DISEASE - EA EMPLOYE E E.L. DISEASE - POLICY LIMIT UNDER DESCRIPTION OF OPERATIONS BELOW DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES (Attach Acord 101, Additional Remarks Schedules, If more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS TO INSURED's OPERATIONS. THE CITY OF GILROY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS INSURANCE. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. vcrTrnr - -- - - - --- -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA ST. ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRES TATIVE AGENCY CUSTOMER ID: LOC #: ACO ® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 L ---- AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. COMMUNITY MEDIA ACCESS PARTNERSHIP POLICY NUMBER 5055 SANTA TERESA BLVD. PAC 1000001 00 GILROY, CA 95020 CARRIER NAIC# ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29111 hininITInNAI REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Companyby mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. reserved. ,negl— name —logo re..yi>—u -..wr... THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission A o ® CERTIFICATE OF LIABILITY INSURANCE DATE 9/26/2012 (MM/DDIYYYY) 9/26/2012Y) 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 NAME: PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN Alliant Insurance Services, Inc. PHONE: �. PHONE: M� 1301 Dove St., Suite 200 SUBR WVD ! No Newport Beach, CA 92660 E -MAIL ADDRESS: ...__ .. 949 - 756 -0271 • Fax 949 - 756 -2713• License No. OC36861 PRODUCER: X m __.... CUSTOMER ID # 09/29/12 m•M, INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER:µ EACH OCCURRENCE INSURERS) AFFORDING COVERAGE NAIC # COMMUNITY MEDIA ACCESS PARTNERSHIP INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 5055 SANTA TERESA BLVD. L -139 GILROY, CA 95020 INSURER B: COMMERCIAL GENERAL LIABILITY INSURER C: ................ ............................... .............................................................................. ............._................. ............................... PREMISES (Ea Occurrence) INSURER D: .............................................................................................................................................................................................................. ............................... INSURER E: .............................................................................................................................................................................................................. ............................... INSURER F: N/A CnVG0A1GPS CERTIFICATE NIIMRFR• RFVISIAN NIIMRFR- 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YY) POLICY P (MM /DD/YY) LIMITS A GENERAL LIABILITY X PAC 1000082 01 09/29/12 09/29/13 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea Occurrence) $1,000,000 CLAIMS MADE ] OCCUR _ MED EXP (Any one person) N/A GL DED: $1 000 PERSONAL & ADV INJURY _$1,000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA* PRODUCTS- COMP /OPAGG. $1,000,000 POLICY PRO- LOC A AUTOMOBILE LIABILITY PAC 1000082 01 09/29/12 09/29/13 EaAccid nt) INGLE LIMIT $11000,000 ANY AUTO BODILY INJURY ( Per person) m� _.. ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE Per Accident) X HIRED AUTOS X NON -OWNED AUTOS AUTO DED: $1,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS DEDUCTIBLE RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY Y/N TCRY LIMITS ER ANY PROPRIETORY /PARTNER /EXECUTIVE OFFICER / MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT ...... ..................._........___ W W W (MANDATORY IN NH) IF YES, DESCRIBE E.L. DISEASE - EA EMPLOYEE UNDER DESCRIPTION OF OPERATIONS BELOW E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES (Attach Acord 101, Additional Remarks Schedules, If more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE S RESPECTS TO INSURED's OPERATIONS. THE CITY OF GILROY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS INSURANCE. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. rs= wTrcrrn-rs= sanr nl=w rnlurFr I ATI"N ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©2008 ACORD CORPORATION. All rights reserved. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA ST. ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRES TATIVE Q ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©2008 ACORD CORPORATION. All rights reserved. A CORD® AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. COMMUNITY MEDIA ACCESS PARTNERSHIP POLICY NUMBER 5055 SANTA TERESA BLVD. L -139 PAC 1000082 01 GILROY, CA 95020 i CARRIER NAIC# ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29/12 4DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE - - - -� - .. ..... _ ...... _ ....... ----------------------- --------------------------------------------------------------------- ..-------------- - ._ ..... .--- -- --------------- - — Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Companyby mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. i ne AUQKU name ana logo are registerea marKs or AcUKU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page I of I its permission