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Illinois BUSINESSOWNERS LIABILITY <br />Casualty SL AI 04 0914 <br />Company <br />A Mutual Insurance Company <br />POLICY NUMBER: BP38698 EFFECTIVE DATE FOR THIS ENDORSEMENT: June 9, 2016 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR <br />SUBDIVISIONS OR POLITICAL SUBDIVISIONS - PERMITS OR AUTHORIZATIONS <br />RELATING TO PREMISES <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS LIABILITY COVERAGE FORM <br />SCHEDULE <br />State Or Governmental Agency Or Subdivision Or Political Subdivision: <br />City of South Bend - Board of Public Works <br />227 West Jefferson <br />1316 County City Building <br />South Bend, IN 46601 <br />A. The following is added to Section C. Who Is An Insured in the Businessowners Liability Coverage Form: <br />4. Any state or governmental agency or subdivision or political subdivision designated in the Schedule of this <br />endorsement is also an insured, subject to the following additional provision: <br />This insurance applies only with respect to the following hazards for which the state or governmental agency or <br />subdivision or political subdivision has issued a permit or authorization in connection with "premises° you own, <br />rent, or control and to which this insurance applies: <br />a. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, <br />canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist -away openings, sidewalk <br />vaults, street banners, or decoration and similar exposures; <br />b. The construction, erection, or removal of elevators; or <br />c. The ownership, maintenance, or use of any elevators covered by this insurance. <br />B. The following is added to Section D. Liability, Medical Expenses And Merchandise Withdrawal Expenses Limits <br />Of Insurance: <br />9, The Limits Of Insurance for the person or organization designated in the Schedule of this endorsement are those <br />specified in the ordinance, contract or agreement with you, if applicable, or in this Coverage Form, whichever is <br />less. These Limits Of Insurance are inclusive of and are not in addition to the Limits Of Insurance shown in the <br />Declarations. <br />BL At 04 09 14 Original Page 1 of 2 <br />Includes copyrighted material of Insurance Services Office, Inc. with its permission. <br />