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HomeMy WebLinkAboutFlagship Facility Services - Insurance CertificateAR °® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F6/9/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF IN 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: Susan Stockdale Woodruff - Sawyer & Co. PHONE 415- 391 - 2141x6426 FAX 4I5- 989 -9923 50 California Street, Floor 12 San Francisco CA 94111 en RIF,Q. sstockdale(a)wsandco.com - ... -J ArPUKU1K{i LVVERAGE NAIL INSURERA:Zurich American Insurance Company 116535 INSURED FLAGENT -01 INSURERB:American Zurich Insurance Company 140142 Flagship Facility Services, Inc. INSURER Mutual Insurance Company 123043 1050 N. Fifth Street San Jose, CA 95112 INSURER D: KtVI,IUN 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR GL0829847716 7/1/2017 7/1/2018 EACH OCCURRENCE $1,000,000 DAMAGE T R NTE .PREMISES Ea. occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO- ❑ JECT LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 5K Comp -Sche X 5K Coll -Sche BAP829847816 7/1/2017 7/1/2018 (''0,1.' N N LIMIT Eident $1,000,000 X BODILY INJURY (Per person) $ X X BODILY INJURY (Per accident) $ PRO E TY DAMAGE Per accident $ X $ C B X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE NIA 100005243908 WC829803618 7/1/2016 7/1/2017 7!1/2017 ]/1/2018 EACH OCCURRENCE $25,000,0.00 AGGREGATE $25;000,000 DED I RETENTION S. WORKERS COMPENSATION AND EMPLOYERS' UASILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) H es, descr be under DESCRIPTION OF OPERATIONS below X PER TATUTE OTH S ER - $ E .L. EACH .ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Gilroy, its officers, employees, agents, council members & other representatives are included as Additional'' Insureds with respect to General Liability as required by written contract per attached endorsements. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. -- ---• -� 1L° •� � I ne Hwrcu name and logo are registered marks of ACORD POLICY NUMBER: 610824847716 ' COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNE-RS, LESSEES OR COWRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or O anization s Locations Of Covered Operations CITY? GIL OY ITJ OFFICI =RR� EMPLOYEES - AGENTS COUNCIL M MBERS 8: O`T'HER REPRESENTATIVES THE CITY OF GILROY, ITS OFFICERS. EMPLOYEES, AGENTS. 7g51 �� SANNA STREET CouNC1 V.bM@ERE & OTHER REPRESENTATIVES ARE INCLUDED AS ADDITICNAL INSUREDS WITH REPECT TO GENERAL LIABILITY GILROY. CA 95020 AS REQUIRED BY WRITTEN CONTRACT. information required to complete this Schedule if not shown above will be shown -in the Declarations A. Section It — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 0413 C Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Urnits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured Is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever Is less. This endorsement shall not Increase the applicable limits of Insurance shown In the Declaratlons. Page -2 of 2 0 Insurance Services Offte, Inc., 2012 CG 20 10 04 13 -T AcoREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI� 6/26/2014 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 pollcy(les) 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 endorseme s . PRODUCER ' NAME: .. Susan Stockdale Woodruff Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 PHONE I FAX - - ac Ne - - E-MAIL INSURERS AFFORDING COVERAGE. NAIL 0 EACH OCCURRENCE INSURER A Zurich American Insurance Company 165'As $1,000,000 INSURED FLAGENT -01 INSURER B American Zurich Insurance Company $0142 INSUMC:Libedy Mutual Insurance Company 23043 Flagship Facility Services Inc. 1050 North 5th Street San Jose, CA 95112 INSURER D: GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY PRO LOC PRODUCTS- COMP /OP AGG $2,000,000 INSURER E : A INSURER F • LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS 5K Comp Sche X 5K Coll -Sche COVERAGES CERTIFICATE NUMBER: 1423225599 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 U D POLICY NUMBER POLICY MMIDD .YY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR GLOB29847713 /1/2014 /1/2015 EACH OCCURRENCE $1,000,000 DAMAGE To RE PREMISES (Ea ocwiience $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2;000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 17 POLICY PRO LOC PRODUCTS- COMP /OP AGG $2,000,000 $ A LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS 5K Comp Sche X 5K Coll -Sche BAP829847813 /1/2014 /1/2015 Ea accident $1,000,000 OAUTIOMOBILE BODILY INJURY (Per person) -$ BODILY INJURY (Per acc dent) $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE 100005243906 /1/2014 /1/2015 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATIO AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR /PARTNER/EXECUTIVE OFFICERMIEMBER EXCLUDED? (Mandatory In NH) If yes,.deaonbe under DESCRIPTION OF OPERATIONS below N /A VVC829803615 /1/2014 /1/2015 X WC STATU- I JOTH - - E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,0 DESCRIPTION. OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) The City of Gilroy, its officers and employees are included as Additional Insureds with respect to General Liability as required by written contract per attached CG 2010 07 -04. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE -.WILL BE DELIVERED IN ACCORDANCE 14M THE POLICY PROVISIONS. ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:GLO829847713 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) City of Gilroy Its Officers and FImployees 7351 Rosanna Street Gilroy, Ca 95020 Information required to complete this Schedule. if not A. Section 11 — Who Is An Insured Is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily Injury", "properly damage" or "personal and advertising injury" caused. In whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. Of Covered e City of Gilroy, its officers and ployees are included as Additional aureds with respect to General ability as required by written retract per attached CO 2010 07 -04. will be shown in B. With respect to the insurance afforded to these additional Insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, Including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CO 2010 07 04 0 ISO Properties, Inc.,. 2004 Page 1 of 1 AClJR�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDIYYYY) 6/28/2013 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 Woodruff- Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 CONTACT NAME: Susan Stockdale PHONE 41 - 1- 41x 2 Ac No:415- 989 -9923 E -MAIL - DDR.ss:sstockdaleawsandco.com INSURERS AFFORDING COVERAGE NAIC # /1/2014 INSURER A :Z rl h American Insurance Company _ 1 DAMAGE TO RENTED PREMISES Ea occurrence INSURED FLAGENT -01 INSURER B :Am rican Zurich Insurance Company 40142 INSURER C: i I lnsu[ance Company 4 Flagship Facility Services, Inc. 1050 North 5th Street San Jose, CA 95112 INSURER D GENERAL AGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG INSURER E: INSURER F: A AUTOMOBILE COVERAGES CERTIFICATE NUMBER: 615107200 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 EFF MM /DD/YYYY ) POLICY EXP (MM/DD/YYYY1 LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y GL0829847712 /1/2013 /1/2014 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP /OP AGG $2,000,000 _ $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS BAP829847812 /1/2013 71112014 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE 100005243905 /1/2013 /1/2014 EACH OCCURRENCE $25,000,000 AGGREGATE $25,000,000 DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 0829803614 /1/2013 /1/2014 X WC STATU- OTH- LIMI TS FIR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Gilroy, its officers and employees are included as Additional Insureds with respect to General Liability as required by written contract per attached U -GL- 1175 -C CW form. t,r_K I Ir-KiA I C MULLJCK t ANUr_LLA I IUN City of Gilroy 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE(/�,,/,n/ ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD �' u�ffe. f' Additional Insured — Automatic — Owners, Lessees Or ZURICH' Contractors Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add9, Prem Return Prem. GLOS29847712 07/01/2013 07/01/2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section 11— Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under Section I - Coverage A - Bodily Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, and resulting directly from your ongoing operations or "your work" as included in the "products- completed operations hazard ", which is the subject of the written contract or written agreement, performed for the additional insured person or organization. C. However, regardless of the provisions of Paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. E. The additional insured must see to it that: 1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not U -GL- 1175 -C CW (07110) Page 1 of 2 apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non - contributory. F. For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non - contributory with respect to any other policy upon which the additional insured is a Named Insured. In that event, we will not seek contribution from any other such insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence ", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. All other terms and conditions of this policy remain unchanged. t1- GL- 1 175 -C CW (07/10) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission.