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PROOF OF INSURANCE (2020 - 2021) CLOSEDTHIS IS TO C'ERTIFI" THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANN' REQUIRENIEN'1','1'ERNI Oil CONDITION OF ANN' CONTRACTOR OTHER DOC'UN1ENT WITH RESPECT TO WHICH I HIS CERTIFICATE N1A1 BE ISSUED OR N1A1 PERTAIN, THE INSURANCE AFFORDED BI"THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL I HE TERNIS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LINIFFS SHOWN NIAI' HAVE BEEN REDUCED BN' PAID C'LAIN1S. USSR TYPE OF INSURANCE ADDL SUER POLIC]' NUMBER POLICYEFF POLICYEXP LIMITS FUR INSD WYD (NIMIDD/I'I'I']') (MM/11DA11 I') COMMERCIAL GENERAL LIABILITY CLAIMS MADE yo,yOCCUR A GENT AGGREGA'T'E LIMIT APPLIES PER: POLICY PROJECT V LOC DATE (MM/DD/]']']']') $300,000.00 CERTIFICATE OF LIABILITY INSURANCE E.L. EACH ACCIUEN .AN]' AU'T'O $10,000.00 A OWNED AU'T'OS SCHEDULED ONLY 04/09/2020 THIS C'ER'T'IFIC'ATE IS ISSUED AS A MATTER OF I.NFORNIATION ONLIAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. I HIS CERTIFICATE DOES NOT AFFIRNIATINVELI OR NEGATWELN' AMEND, EXTEND OR ALTER THE CON'ERAGE AFFORDED BN" 1'HE POLICIES BELOW.I HIS C'ER'TIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE'IANTEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE Oil PRODUCER, AND THE CERTIFICATE HOLDER 02/26/2021 IMPOR'TAN'T: H the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. H 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 I CON'TAC'T' NAME: FounderShield, LLC I PHONE (.A/C No. Ext): 646-854-1058 I FAX (.A/C No): 119 W 24th Street, 3rd Floor I E-MAIL ADDRESS: coilufoundershield.com New Pork, New Pork, 10011 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: CONTINENTAL CASUALTY CO (CNA) 20443 INSURED I INSURER B: AXIS INSURANCE COMPANY 37273 INSURER C: UNDERWRITERS A'1' LLOYD'S LONDON (SCALE) AA -1122000 Sl'lllR'1'ech 1100 Manhattan Ave. I INSURER D: Manhattan Beach, California, 90266 I INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO C'ERTIFI" THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANN' REQUIRENIEN'1','1'ERNI Oil CONDITION OF ANN' CONTRACTOR OTHER DOC'UN1ENT WITH RESPECT TO WHICH I HIS CERTIFICATE N1A1 BE ISSUED OR N1A1 PERTAIN, THE INSURANCE AFFORDED BI"THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL I HE TERNIS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LINIFFS SHOWN NIAI' HAVE BEEN REDUCED BN' PAID C'LAIN1S. USSR TYPE OF INSURANCE ADDL SUER POLIC]' NUMBER POLICYEFF POLICYEXP LIMITS FUR INSD WYD (NIMIDD/I'I'I']') (MM/11DA11 I') COMMERCIAL GENERAL LIABILITY CLAIMS MADE yo,yOCCUR A GENT AGGREGA'T'E LIMIT APPLIES PER: POLICY PROJECT V LOC OTHER $300,000.00 AU'T'OMOBILE LIABILITY E.L. EACH ACCIUEN .AN]' AU'T'O $10,000.00 A OWNED AU'T'OS SCHEDULED ONLY $4,000,000.00 �r HIRED .AU'T'OS ,�t ]�r NON -OWNED AU'T'OS ONLY ONLY UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE WORKERS C'ONIPENSATION AND ENIPLOYERS LIABILITI' ANAP ROPRIE'1'Oli/1'AII'I :NEREXECU'1'INV YIN OFFIC'ERMEMBER EXCLUDED? N (Mandatory in NH) N/ A If ves, describe under DESC'RIP'TION OF OPERATIONS below B Cyber Liability,Errors & Omissions C Directors & Officers .A Property B6020975247 02/26/2020 02/26/2021 EACH OCCURRENCE $2,00000.00 DAMAGE TO RENTED $300,000.00 PREMISES (Ea occurrence) E.L. EACH ACCIUEN MED EXP (Any one person) $10,000.00 PERSONAL &.ADV [NJ UR]' $2,000,000.00 GENERAL AGGREGATE $4,000,000.00 PRODUCTS - COMP/OP AGG $2,000,000.00 01/05/2021 S COMBINED SINGLE LIMIT $1,000,000.00 (Ea accident) BODILY INJURI' (Per person) B6020975247 02/26/2020 02/26/2021 B011IL]' 1NJURI' (Per accident) PROPERTY DAMAGE (Per accident) 11-001-000067109-02 01/05/2020 B118OD201043/049 01/05/2020 B6020975247 02/26/2020 Each occurence Aggregate DESCRIPTION OF OPERATIONS / LOC'A'TIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is included as an Additional Insured on the above referenced policy where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of EI Segundo 'THEREOF, NO'TIC'E WILL BE DELIVERED IN .ACCORD ANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 'The ACORD name and logo are registered marks of ACORD PER STATUTE OTHER E.L. EACH ACCIUEN E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICI' LIMIT 01/05/2021 $ 2.000,000 per occ $2.000.000 in agg 01/05/2021 $ 1.000,000 per occ $1.000.000 in agg 02/26/2021 $ 23814.00 BIT $500 deductible DESCRIPTION OF OPERATIONS / LOC'A'TIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Certificate Holder is included as an Additional Insured on the above referenced policy where required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANN OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of EI Segundo 'THEREOF, NO'TIC'E WILL BE DELIVERED IN .ACCORD ANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 'The ACORD name and logo are registered marks of ACORD SB146932F CNA (Ed. 6-16) BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS TABLE OF CONTENTS 1. Blanket Additional Insured Provisions A. Additional Insured — Blanket Vendors B. Miscellaneous Additional Insureds, C. Additional Provisions Pertinent to Additional Insured Coverage, 1. Primary — Noncontributory orovision 2. Definition of "written contract."' 11, Liabilitv Extension Coveraggs, A. Bodilv Iniury — Expanded Definition B. Broad Knowledae of Occurrence ...... ....... C. Estates, Leoal Representatives and Spouses D. Legal Liabllity — Damacae to Premises E. Personal and Advertisin InJury — Discrimination or Humiliation V F. Personal and AdvertisinoIWry — Broadened Eviction G. Waiver of Subrooation - Blanket I. BLANKET ADDITIONAL INSURED PROVISIONS A. ADDITIONAL INSURED — BLANKET VENDORS Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a "written contract" to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; SB146932F (6-16) Page 1 of 7 Copyright, CNA All Rights Reserved, SB146932F CNA (Ed. 6-16) e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. orf.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if "bodily injury" or "property damage" included within the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. B. MISCELLANEOUS ADDITIONAL INSUREDS 1. Who Is An Insured is amended to include as an insured any person or organization (called additional insured) described in paragraphs 3.a. through 3.j. below whom you are required to add as an additional insured on this policy under a "written contract.": 2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide the additional insured with: a. A higher limit of insurance than required by such "written contract"; b. Coverage broader than required by such "written contract" and in no event greater than that described by the applicable paragraph a. through k. below; or c. Coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard." But this paragraph c. does not apply to the extent coverage for such liability is provided by .<a paragraph 3.j. below. Any coverage granted by this endorsement shall apply only to the extent permitted by law. 3. Only the following persons or organizations can qualify as additional insureds under this endorsement: a. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) such person or organization's financial control of you; or (2) Premises such person or organization owns, maintains or controls while you lease or occupy these premises; provided that the coverage granted to such additional insureds does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. SB146932F (6-16) Page 2 of 7 Copyright, CNA All Rights Reserved. CNA SB146932F (Ed. 6-16) b. Co-owner of Insured Premises A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co-owners liability for "bodily injury", "property damage" or "personal and advertising injury" as co-owner of such premises. c. Grantor of Franchise Any person or organization that has granted a franchise to you, but only with respect to such person or organization's liability for "bodily injury", "property damage", or "personal and advertising injury" as grantor of a franchise to you. d. Lessor of Equipment Any person or organization from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by your maintenance; operation or use of such equipment, provided that the "occurrence" giving rise to such bodily injuryor property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. e. Lessor of Land Any person or organization from whom you lease land, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of that specific part of the land leased to you, provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such "personal and advertising injury", takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. f. Lessor of Premises An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the ownership, maintenance or use of such part of the premises leased to you, and provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense giving rise to such personal and advertising injury", takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. g. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or receiver's liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. h. State or Political Subdivisions A state or government agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such government agency or subdivision or political subdivision's liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of: (1) The following hazards in connection with premises you own, rent, or control and to which this insurance applies: (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or SB146932F (6-16) Page 3 of 7 (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance or use of any elevators covered by this insurance; or Copyright, CNA All Rights Reserved. SB146932F CNA (Ed. 6-16) (2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted by this paragraph does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or government agency or subdivision or political subdivision; or (b) "Bodily injury" or "property damage" included within the "products -completed operations hazard." With respect to this provision's requirement that additional insured status must be requested under a "written contract", we will treat as a "written contract" any governmental permit that requires you to add the governmental entity as an additional insured. I. Trade Show Event Lessor With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization .whom you are required to include as an additional insured, but only with respect to such person or organization's liability for "bodily injury", "property damage", or "personal and advertising injury" cause by: a. Your acts or omissions; or b. Acts or omissions of those acting on your behalf; in the performance of your ongoing operations at the trade show premises during the trade show event. j. Other Person or Organization Any person or organization who is not an additional insured under paragraphs a. through i. above. Such additional insured is an insured solely for "bodily injury", "property damage" or "personal and advertising injury" for which such additional insured is liable because of your acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: (1) For "bodily injury," "property damage," or "personal and advertising injury" arising out of the rendering or failure to render any professional services; (2) For "bodily injury" or "property damage" included in the "products -completed operations hazard." But this provision (2) does not apply to such "bodily injury" or "property damage" if: (a) It is entirely due to your negligence and specifically results from your work for the additional insured which is the subject to the "written contract'; and (b) The "written contract" requires you to make the person or organization an additional insured for such "bodily injury" or "property damage"; or (3) Who is afforded additional insured coverage under another endorsement attached to this policy. C. ADDITIONAL PROVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE With respect only to additional insured coverage provided under paragraphs A. and B. above: 1. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add the following to the Condition entitled Other Insurance: This insurance is excess of all other insurance available to an additional insured whether primary, excess, contingent or on any other basis. However, if a "written contract" requires that this insurance be either primary or primary and noncontributing, then this insurance will be primary and non-contributory relative solely to insurance on which the additional insured is a named insured. 2. Under Liability and Medical Expense Definitions, the following definition is added: "Written contract" means a written contract or agreement that requires you to make a person or organization an additional insured on this policy, provided the contract or agreement: a. Is currently in effect or becomes effective during the term of this policy; and b. Was executed prior to: SB146932F (6-16) Page 4 of 7 Copyright, CNA All Rights Reserved. l - A_L_A,� (1) The "bodily injury" or "property damage"; or (2) The offense that caused the "personal and advertising injury'; for which the additional insured seeks coverage. II.. LIABILITY EXTENSION COVERAGES SB146932F (Ed. 6-16) It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. A. Bodily Injury – Expanded Definition Under Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deleted and replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical injury, sickness or disease. B. Broad Knowledge of Occurrence Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following: Paragraphs a. and b. above apply to you or to any additional insured only when such "occurrence," offense, claim or "suit" is known to: (1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph applies separately to you and any additional insured. C. Estates, Legal Representatives and Spouses The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative or spouse outside the scope of such person's capacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. D. Legal Liability – Damage To Premises Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is replaced by the following: k. Damage To Property "Property damage" to: 1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of SB146932F (6-16) Page 5 of 7 Copyright, CNA All Rights Reserved. CNA GB146832F such property for any raoson, including prevention ofinjury bo o person ordamage to another's 2. Premises you ueU. Qkm away or abandon, if the "property damage" ohuum out of any pod of those premises; 3. Property loaned toyou; 4. Personal property inthe care, custody orcontrol ufthe insured; §. That particular part ofany real property on which you or any contractors or subcontractors working directly or indirectly in your behalf are performing operations, if the "property damage" arises out of those operations; or 6. That particular pad of any property that must be nmmtoved, repaired or replaced because "your work" was incorrectly performed onit. Paragraph 2 of this exclusion does not apply if the premises are ''your wnrk" and were never onoupied, rented orheld for rental by you. Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire or explosion) topremises: (1) rented to you: (2) temporarily occupied byyou with the permission ofthe owner, or (3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D — Liability and Medical Expenses Limits of Insurance. Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the "produds'nomp|eted operations hazard," 2. Under B. 2xclwsione, 1. Applicable to Business Liability Coverage, the following paragraph added, and replaces the similar pamaQmsph, if any, beneath paragraph (14) of the exclusion entitled ' Personal and Advertising injury: Exclusions c, d e, f, gM ik, 1, and o, donot apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. 3. The first Paragraph Premises Rented TmYou Limit ofthe section entitled Liability And Medical Expenses Limits OfInsurance isreplaced bythe following: � The most we will pay under Business Liability fordamagesbecause cf" ' to any one pmemimes, while mon1od to yyou;or ��mp�ma/temporarilyoccupied by you with the permission' ~ `� damage" owner, including contents of such premises rented to you for period of 7 or fewer consecutive days, is the Damage to Premises Rented bzYou limit shown inthe Declaration. E. PmrmonayandAdvedisTng|njury—DiscdmhnatbnmmrHumi|iaton 1. Under Liability and Nled|co| Expenses DmOn|dons, the definition of "personal and advertising injury' is amended boadd the following: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only ifsuch discrimination orhumiliation is: (1) Not done intentionally byoratthe direction of: (a) The insured; or 8B146932F(6'16) Page Gcf7 Copyright, CNA All Rights Reserved. CNA SB146932F (Ed. 6-16) (b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. 2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising injury is amended to add the following additional exclusions: (15) Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. (16) Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any insured. (17) Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. 3. This provision (Personal and Advertising Injury — Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. F. Personal and Advertising Injury - Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of 'Personal and advertising injury" is amended to delete Paragraph c. and replace it with the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord or lessor. G. Waiver of Subrogation — Blanket We waive any right of recovery we may have against: a. Any person or organization with whom you have a written contract that requires such a waiver. All other terms and conditions of the Policy remain unchanged. SB146932F (6-16) Page 7 of 7 Copyright, CNA All Rights Reserved. CHUBB® ISSUING COMPANY Workers' Compensation ACE AMERICAN INSURANCE COMPANY NCCI CARRIER CODE and Employers Liability 12165 Insurance Policy Information Page POLICY NUMBER F New 0 Renewal ❑ Rewrite Symbol: WLR Number: C6 61 86 16 7 PREVIOUS POLICY NO. F Individual Partnership ❑ Association Symbol: WLR Number: C65539421 0 Corporation ❑ Joint Venture F Other Legal Entity Item 1. TRINET GROUP, INC. Inter/Intrastate ID No.: Named L/C/F SPIDR TECH, INC Insured 9000 TOWN CENTER PARKWAY Federal Employer ID No.: 953359658 BRADENTON FL 34202 Mailing Address Employer's ID No.: PIIC CODE: 7372 For other named insured see Extension of Information Page — Schedule of Named Insured, WC 99 99 99 A For other workplaces see Extension of Information Page — Schedule of Other Workplaces, WC 99 99 99 B Item 2. Policy period: From 07-01-2019 To 07-01-2020 12:01 A.M., standard time at the named insured's mailing address. Item 3A. Workers' Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here: CA Item 3B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 2,000,000 each accident Bodily Injury by Disease $ 2,000,000 policy limit Bodily Injury by Disease $ 2,000,000 each employee Item 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT ND,OH,WA,WY, AND STATES DESIGNATED IN ITEM 3.A Item 3D. This Policy includes these endorsements and schedules: See schedule of Forms and Endorsements WC999999D Item 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE —CLASSIFICATIONS If indicated here, interim ad'ustments of premium will be made: F-1Semi-Annually[� Quarterly ❑ Monthly PRODUCER NAME AND MAILING ADDRESS USI INSURANCE SERVICES LLC 2601 SOUTH BAYSHORE DRIVE 16TH FLOOR SUITE 1600 COCONUT GROVE FL 33133 PRODUCER CODE: Z05455 13-3771734 DAU MARKETING OFFICE: DALLAS BRANCH ISSUE DATE: 06/25/2019 Minimum Premium collected in CA $ Total Estimated Premium $ Deposit Premium $ Authorized Representative WC 00 00 01A (05/88) Copyright 1987 National Council on Compensation Insurance INSURED COPY