December
(3).
10. 8.
9. 6.
7. 1.
5. 4.
3. 2.
Named Insured:
Policy Effective Date:
Policy Expiration Date:
This endorsement effective: 12:01 A.M.
Policy No:
Amendatory Endorsement
In consideration of the premium shown below, it is hereby understood and agreed this endorsement is attached to and forms part of the above policy and is effective as shown above. This endorsement amends only the changes which are indicated by check in the box immediately preceding such change:
Policy is
Item(s) listed below are the policy schedule.
Name of Insured is amended as shown below.
Insured mailing address is amended as shown below.
Policy term is amended to:
Endorsement No is null and void
Description of item(s) is amended as shown below.
Limit of Liability is as shown below.
Policy Reinstated
Other, as shown below
Prime Mechanical Service, Inc.; Prime Mechanical Inc DBA: R H Tinney 01/03/2022
01/03/2023
03/30/2022
E812271 Great American E & S Insurance Company forms a part of
Amended Form GLE 20 10 07 04 – Additional Insured – Owners, Lessees or Contractors – Scheduled Person or Organization, entity amended as requested
$ 0.00 Premium
Breakdown:
$ 0.00 Terrorism Premium
$ 0.00 Grand Total
Issue Date: 04/06/2022 Authorized Representative
ENDORSEMENT NO. 8
POLICY NUMBER: E812271 COMMERCIAL GENERAL LIABILITY
GLE 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 FORM with
broadening endorsement and pollution LIABILITY coverage
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s): Location(s) Of Covered Operations
The City of Alameda, its City Council, boards and commissions, officers & employees, agents & volunteers are additional insured for work done on their behalf by the named insured
950 W. Mall Square
Alameda, CA 94501
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II - 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) desig-
nated above.
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.
GLE 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1