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G-1 APPENDIX GâPROPOSED ADDITIONAL INSURED ENDORSEMENT Additional Insured Endorsement The entity shown below is an Additional Insured under the Commercial General Liability Coverage (CGL) [or Commercial Auto or Builderâs Risk or Broad Form as may be applicable]Form: Department of X (and include address and contact information) As an additional insured, the foregoing entity is afforded all rights and coverages under the CGL [or Commercial Auto or Builderâs Risk or Broad Form as may be applicable] as the named insured with regard to the project described below, and in accordance with the State Specifications for such project: Describe Project and specifications The carrier issuing this endorsement further agrees that if any disputes arise between the entity described above and the insurance carrier issuing this endorsement and/or the Named Insured on the policy as to any duty to defend and/or indemnify the additional insured for claims arising out of the above-described project, such disputes shall be submitted to mediation within sixty (60) days after notification of the dispute if an agreement for resolution cannot be reached within thirty (30) days of resolution. The mediator chosen to mediate the dispute shall be chosen from the list of mediators kept by the federal court in the jurisdiction in which the dispute will be mediated.
