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Human Resources Department

Liability & Insurance

Sample Form 5: Additional Insured – Owners, Lessees Or Contractors – Completed Operations

Liability & Insurance 750

Name Of Additional Insured Person(s) Or Organization(s) -Not acceptable if left blank.  Must show exact name of the additional insured or “as required by contract”.
Location And Description Of Completed Operations -Not acceptable if left blank.  Must include project description unless the “by contract” language is used.  The location must be the location of the work, not our mailing address.
Section II - Who Is An Insured -The following endorsement protects us only if the contractor is doing work for us: Section II: Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard".