Orange County NC Website
DocuSign Envelope ID: 1BF58F80-D11334CM-BBBC-42D02CE07015 <br /> COMMERCIAL GENERAL LIABILITY <br /> POLICY NUMBER: <br /> III 2CN0165-21245 <br /> M IRKEV EVANSTON INSURANCE COMPANY <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> BLANKET ADDITIONAL INSURED <br /> This endorsement modifies insurance provided under the following <br /> COMMERCIAL GENERAL LIABILITY COVERAGE FORM <br /> PRODUCTS/COMPLETED OPERATIONS COVERAGE FORM <br /> LIQUOR LIABILITY COVERAGE FORM <br /> PROFESSIONAL LIABILITY COVERAGE FORM <br /> Please refer to each coverage form to determine which terms are defined. Words shown in quotations on this endorse- <br /> ment may or may not be defined in all coverage forms. <br /> SCHEDULE <br /> Person or Entity: Any person or organization to whom you are obligated by valid written contract to provide such <br /> coverage. <br /> Additional Premium: $ (Check box if fully earned.®) <br /> Included <br /> WHO IS AN INSURED is amended to include the person or entity shown in the Schedule above as an Additional Insured <br /> under this insurance, but only as respects negligent acts or omissions of the Named Insured and only as respects any <br /> coverage not otherwise excluded in the policy. Our agreement to accept an Additional Insured provision in a contract is <br /> not an acceptance of any other provisions of the contract or the contract in total. <br /> When coverage does not apply for the Named Insured, no coverage or defense shall be afforded to the Additional In- <br /> sured. <br /> No coverage shall be afforded to the Additional Insured for injury or damage of any type to any "employee" of the Named <br /> Insured or to any obligation of the Additional Insured to indemnify another because of damages arising out of such injury <br /> or damage. <br /> All other terms and conditions remain unchanged. <br /> MEGL 0009-01 04 11 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 <br /> with its permission. <br />