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r <br /> r <br /> 98-C9-R412-4 010978 CMP-4860 <br /> Page 1 of 1 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> Stan f.A <br /> (: <br /> ..,v..»<. CMP-4860 ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION <br /> ga. This endorsement modifies insurance provided under the following: <br /> BUSINESSOWNERS COVERAGE FORM <br /> SCHEDULE <br /> Policy Number: 98-C9-R412-4 <br /> Named Insured: <br /> BUTTERS,ROBERT <br /> 1909 HEWITT AVE APT 4 <br /> EVERETT WA 98201-3177 <br /> Name And Address Of Additional Insured Person Or Organization: <br /> THE CITY OF EVERETT,ITS <br /> OFFICERS EMPLOYEES AND AGENTS <br /> 2930 WETMORE AVE STE 8-A <br /> EVERETT WA 98201-4044 <br /> 1. SECTION II —WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an <br /> additional insured, any person or organization shown in the Schedule, but only with respect to liability <br /> for"bodily injury', "property damage" or"personal and advertising injury" caused, in whole or in part, <br /> by: <br /> a. Premises And Ongoing Operations <br /> Your acts or omissions or the acts or omissions of those acting on your behalf: <br /> (1) In connection with your premises; or <br /> (2) In the performance of your ongoing operations; or <br /> b. Products-Completed Operations <br /> "Your work" performed for that additional insured and included in the"products-completed opera- <br /> tions hazard". <br /> 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a <br /> "suit" brought for damages for which you are provided coverage. <br /> 3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any <br /> insurance carried by the additional insured shall be noncontributory with respect to coverage provid- <br /> ed by you. <br /> There will be no refund of premium in the event this endorsement is cancelled. <br /> All other policy provisions apply. <br /> CMP-4860 <br /> ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 <br /> Includes copyrighted material of Insurance Services Office,Inc,with its permission <br />