Discussion and Consideration of Pay Application #9 – Miron Construction – Tiffin Recreation Center – Motion to Approve — K-3

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO PENNPAC PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Broad Form Named Insured “insured,” but only to the extent that person or organization qualifies as an “insured” under the Who The following is added to Section II - Covered Autos Is An Insured provision contained in Section II of the Liability Coverage, Paragraph A.1. Who Is An Coverage Form. Insured: This insurance does not apply unless the written contract or agreement has been executed or the d. (1) Any organization or subsidiary thereof which is permit has been issued prior to the “bodily injury” or a legally incorporated entity of which you own “property damage.” a financial interest of more than 50 percent of the voting stock on the effective date of this This insurance does not apply to the owner or any endorsement. one else from whom you hire or borrow a covered “auto.” (2) Paragraph I.d.(1) does not apply to “accident” or “loss” with respect to which an “insured” III. Temporary Substitute Autos – Physical Damage under this policy is also an “insured” under Coverage another policy or would be an “insured” under The following is added to Paragraph C. Certain such policy but for its termination or upon the Trailers, Mobile Equipment And Temporary exhaustion of its limits of insurance. Substitute Autos of Section I – Covered Autos: (3) Paragraph I.d.(2) does not apply to a policy If Physical Damage Coverage is provided by this written to apply specifically in excess of this coverage form, the following types of vehicles are policy. covered “autos” for Physical Damage Coverage: e. (1) Any organization you newly acquire or form, Any “auto” you do not own while used with the other than a partnership, joint venture or limited permission of its owner as a temporary substitute for liability company and over which you maintain a covered “auto” you own that is out of service ownership or majority interest, will qualify as a because of its: Named Insured if there is no other similar insurance available to that organization. a. Breakdown; b. Repair; (2) Coverage under Paragraph I.e.(1) is afforded c. Servicing; only until the 180th day after you acquire or d. “Loss”; or form the organization or the end of the policy e. Destruction period, whichever is earlier. Coverage does not apply to an “accident” or “loss” that results The coverage that applies is the same as the coverage from an “accident” that occurred before you provided for the vehicle being replaced. acquired or formed the organization. IV. Personal Effects Coverage II. Blanket Additional Insured The following is added to Section III - Physical Any person or organization, with whom you agree in Damage Coverage, Paragraph A. Coverage: a written contract, agreement or permit, to name as an 5. We will pay up to $1,000 for “loss” to wearing insured for Covered Autos Liability Coverage is an apparel and other personal effects which are: Includes copyrighted material of Insurance Services Office, Inc., with its permission. 71 1783 0520 Copyright, Insurance Services Office, Inc., 1993, 2001 Page 1 of 5