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POLICY NUMBER: BUSINESSOWNERS <br /> BP04020713 <br /> • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED-MANAGERS OR LESSORS <br /> OF PREMISES <br /> This endorsement modifies insurance provided under the following: <br /> BUSINESSOWNERS COVERAGE FORM <br /> SCHEDULE <br /> Designation Of Premises (Part Leased To You): <br /> 1502 Rucker Ave <br /> Everett <br /> WA <br /> 98201-2016 <br /> Name Of Person(s) Or Organization(s) (Additional Insured): <br /> COLLEEN SCANLAN <br /> 1502 RUCKER <br /> EVERETT, WA 98201 <br /> Additional Premium: $ <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> Section II -Liability is amended as follows: 1. Any "occurrence" that takes place after <br /> A. The following is added to Paragraph C. Who you cease to be a tenant in the premises <br /> Is An Insured: described in the Schedule. <br /> 3. The person(s) or organization(s) shown 2. Structural alterations, new construction <br /> in the Schedule is also an additional in- or demolition operations performed by or <br /> sured, but only with respect to liability for the person(s) or organization(s) des- <br /> arising out of the ownership, mainten- ignated in the Schedule. <br /> ance or use of that part of the premises C. With respect to the insurance afforded to <br /> leased to you and shown in the Schedule. these additional insureds, the following is <br /> However: added to Paragraph D. Liability And Medical <br /> a. The insurance afforded to such addi Expenses Limits Of Insurance: <br /> tional insured only applies to the ex- If coverage provided to the additional insured <br /> tent permitted by law; and is required by a contract or agreement, the <br /> b. If coverage provided to the addition- most we will pay on behalf of the additional <br /> al insured is required by a contract or insured is the amount of insurance: <br /> agreement, the insurance afforded to 1. Required by the contract or agreement; <br /> such additional insured will not be or <br /> broader than that which you are re- 2. Available under the applicable Limits Of <br /> quired by the contract or agreement Insurance shown in the Declarations; <br /> to provide for such additional in- whichever is less. <br /> sured. This endorsement shall not increase the ap- <br /> B. With respect to the insurance afforded to plicable Limits Of Insurance shown in the <br /> these additional insureds the following addi- Declarations. <br /> tional exclusions apply: <br /> This insurance does not apply to: <br /> BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 <br />