All Subcontractors. Re: Exhibit C - Certificate of Insurance Requirements (Page 1 of 9) Project: Project #:

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1 To: All Subcontractors Re: Exhibit C - Certificate of Insurance Requirements (Page 1 of 9) Project: Project #: Documents included in this insurance requirement package: Insurance Schedule (Pages 2-3) Sample Certificate showing General, Automobile, Excess & Worker s Compensation (Pages 4-5) Sample Certificate showing Installation Floater, In Transit, Temporary Storage (Page 6) Sample Additional Insured Endorsement CG2010(1185) (Page 7) Sample Additional Insured Endorsement CG2010(1001) and CG2037(1001) (Pages 8-9) Please submit to our office your Certificate of Insurance for the above referenced project. J.K. Scanlan Company, LLC requires each subcontractor have General Liability, Automobile Liability, Umbrella/Excess Liability and Worker s Compensation. Please endorse J. K. Scanlan Company, LLC, the Owner, and all other parties as required by the written contract with J. K. Scanlan Company, LLC, as Additional Insureds on the General Liability, Automobile and Umbrella/Excess liability policies on a primary and non-contributing basis and shall be for the duration of the contract including the Completed Operations period. See sample Certificate pages 5-6 under Description of Operations for specific wording. Please note that J. K. Scanlan Company now requires all subcontractors to submit with their certificates of insurance additional insured endorsement forms. Exhibit C Insurance Requirements will explain the additional insured endorsements and includes samples. Address for Owner of Project: Failure to provide Additional Insured Status shall result in J. K. Scanlan Company, LLC purchasing an Owner s & Contractor s Protective Liability Policy (OCP) on behalf of the subcontractor. The premium for this policy will be back-charged to your contract. Please also list NAME OF PROJECT on your certificate. This information is required by J.K. Scanlan Company, LLC on all projects. Your signed subcontract and Certificate of Insurance must be in this office before you may proceed with work on this project

2 INSURANCE SCHEDULE The Subcontractor, at its own expense, shall purchase and maintain in full force and effect, such insurance in a company or companies lawfully authorized to do business in the jurisdiction in which the Project is located, insurance policies as outlined below. Such policies shall protect the Contractor from claims that may arise out of or result from the Subcontractor s (or anyone directly or indirectly employed by the Subcontractor) operations performed under the Contract. The Subcontractor shall be required to provide Certificates of Insurance, and, upon demand, any policy or endorsement, evidencing the following coverage: 1. Insurance covering claims under workers compensation, disability benefits, and other similar employee benefit acts. Insurance also covering claims for damages because of bodily injury, occupational disease or sickness, or death of his/her employees with the following limits: Workers Compensation: Statutory. Employer s Liability: Bodily Injury by Accident (per Accident): $ 1,000,000 Bodily Injury by disease (per Employee): $ 1,000,000 Bodily Injury by Disease (Policy Limit); $ 1,000, Commercial General Liability insurance, which shall include: blanket contractual liability insuring the indemnification obligations of this Agreement; broad form property damage liability; and personal injury liability coverage extensions. Such policy shall not exclude X, C, U exposures. Commercial general liability policy shall include products and completed operations liability. Further, products and completed operations liability shall be maintained in full force and effect for a period of three (3) years following final completion of the Work. All coverage required under commercial general liability should be provided on an occurrence form with the following minimum limits: (Per Project Aggregate) Each Occurrence $ 1,000,000 Personal & Advertising Injury $ 1,000,000 Products/Completed Operations Aggregate $ 2,000,000 General Aggregate (Per Project) $ 2,000,000 Fire Damage $ 100,000 Medical Exp. $ 5,000 The required limits may be satisfied by a combination of a primary policy and an excess or umbrella policy. 3. Umbrella form Excess liability coverage with limits of not less than $5,000,000 per occurrence, covering all work performed by the Subcontractor under this Contract. 4. Automobile Liability with limits of at least $1,000,000 per occurrence combined single limit for Bodily Injury and Property Damage Liability including coverage for all owned, nonowned, and hired automobiles. A compulsory Massachusetts automobile policy is acceptable for vehicles registered in Massachusetts only. 5. Contractor s Equipment Coverage on an All Risk basis, covering physical damage to all tools and equipment, all materials to be installed into the project and apply to materials in transit or in temporary storage, including automotive equipment used by the Subcontractor with limits at least high enough to provide for replacement of items critical to Project efforts.

3 6. Such other kinds of insurance as may be required by the Contractor or by the General Contract Documents, each such policy to be in the amount stipulated in the General Contract Documents unless a different amount is hereinafter designated or is otherwise prescribed in writing by the Contractor. 7. If any operations performed within the scope of this Contract require the use of any aircraft or watercraft (owned or unowned), Subcontractor shall maintain liability insurance satisfactory to the Contractor and the Owner. 8. J. K. Scanlan Company, LLC, the Owner, and all other parties as required by the written contract with JK Scanlan shall be named as Additional Insured on the General Liability, Automobile and Excess Liability (Umbrella) policies. General Liability Additional Insured status shall be specifically provided by Additional Insured Form CG2010 (1185), OR CG2010 (1001) AND CG2037 (1001), or the carrier equivalent to these ISO form edition dates, and shall apply on a primary and non-contributing basis before any other Insurance or self-insurance, including any deductible, maintained by, or provided to, the additional insureds, and shall be for the duration of the contract, including the Completed Operations Period. All policies shall be endorsed to waive all Rights of Subrogation in favor of J. K. Scanlan Company, LLC and Owner, and any other party as required by the written contract. 30 days notice of cancellation shall be provided to J. K. Scanlan Company LLC, except 10 days notice for cancellation due to nonpayment of premium. Failure to provide Additional Insured status shall result in J. K. Scanlan Company purchasing an Owner s & Contractor s Protective Liability Policy (OCP) on behalf of the subcontractor. The premium for this policy will be back-charged to your contract.

4 DATE (MM/DD/YYYY) 2/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Insurance Agency Name & Address INSURED Subcontractor Name Subcontractor Address City, MA X ANY AUTO X ALL OWNED AUTOS X HIRED AUTOS X CERTIFICATE OF LIABILITY INSURANCE CONTACT NAME: PHONE Jane Smith (A/C, No, Ext): FAX (A/C, No): INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :A Insurance Company INSURER B :B Insurance Company INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) A GENERAL LIABILITY Y Y /1/2015 1/1/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $5,000 X XCU PERSONAL & ADV INJURY $1,000,000 X Contractual GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY X PRO- JECT LOC $ A AUTOMOBILE LIABILITY Y Y /1/2015 1/1/2016 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 B B X UMBRELLA LIAB EXCESS LIAB SCHEDULED AUTOS NON-OWNED AUTOS X OCCUR Y Y CLAIMS-MADE ABCDEFG 1/1/2015 1/1/2016 LIMITS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED RETENTION $ $ WORKERS COMPENSATION Y ZXWC /1/2016 1/1/2016 X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project Name: JK Scanlan Company LLC, the Owner, and all other parties as required by the written contract with JK Scanlan, are included as Additional Insureds on a primary and noncontributory basis where required by written contract, with respect to the Automobile, General Liability and Umbrella/Excess Liability policies. A Waiver of Subrogation applies in favor of the additional insureds where required by written contract with respect to the Workers Compensation, Automobile, General Liability and Umbrella/Excess Liability policies. Additional Insured endorsements See Attached... CERTIFICATE HOLDER JK Scanlan Company, LLC Falmouth Technology Park 15 Research Road East Falmouth MA CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

5 AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Insurance Agency POLICY NUMBER NAMED INSURED Subcontractor Name Subcontractor Address City, MA CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE are issued on the ISO Endorsement CG /85 OR CG /01 AND CG / days notice of cancellation or material modification will be provided to JK Scanlan Company LLC. ACORD 101 (2008/01) 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

6 DATE (MM/DD/YYYY) 2/27/2014 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY Insurance Agency Name & Address City, State Zip EVIDENCE OF PROPERTY INSURANCE PHONE (A/C, No, Ext): COMPANY A Insurance Company FAX (A/C, No): CODE: AGENCY CUSTOMER ID #: INSURED Subcontractor Name Subcontractor Address City, MA ADDRESS: SUB CODE: LOAN NUMBER EFFECTIVE DATE 1/1/2014 EXPIRATION DATE 1/1/2015 THIS REPLACES PRIOR EVIDENCE DATED: POLICY NUMBER IM CONTINUED UNTIL TERMINATED IF CHECKED PROPERTY INFORMATION LOCATION/DESCRIPTION THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE INFORMATION Scheduled Equipment Unscheduled Equipment Leased and Rented Equipment Installation Floater Limit In Transit Temporary Storage COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE DEDUCTIBLE Limit Limit Limit $1,000,000 $1,000,000 $1,000,000 Deductible Deductible Deductible $1,000 $1,000 $1,000 REMARKS (Including Special Conditions) Project Name: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAME AND ADDRESS JK Scanlan Company, LLC Falmouth Technology Park 15 Research Road East Falmouth MA MORTGAGEE LOSS PAYEE LOAN # AUTHORIZED REPRESENTATIVE ADDITIONAL INSURED ACORD 27 (2009/12) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

7 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. Name of Person or Organization: SCHEDULE JK Scanlan Company LLC, the Owner and all other parties as required by the written contract with JK Scanlan Company LLC. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 D

8 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: JK Scanlan Company LLC, the Owner and all other parties as required by the written contract with JK Scanlan Company LLC. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG ISO Properties, Inc., 2000 Page 1 of 1 D

9 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: JK Scanlan Company LLC, the Owner and all other parties as required by the written contract with JK Scanlan Company LLC. Location And Description of Completed Operations: Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products-completed operations hazard". CG ISO Properties, Inc., 2000 Page 1 of 1 D

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