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PROOF OF INSURANCE (2021) CLOSEDDATE(MM/DD/YYYY)
ACCOREY CERTIFICATE OF LIABILITY INSURANCE
a5(11212020
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 have ADDITIONAL INSURED provisions or 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 Patriot Risk & Insurance Services INAME.'C"`
2415 Campus Drive, Suite #200 tAsCNN ExI)' (949) 48&7900 FAX No): (949) 486-7950
Irvine, CA 92612 E'.MAIL
ADDRESS°
INSURE'RIS) AFFORDING COVERAGE NAIC #
www.patrisk com OK07568 INSURER A: Travelers Property Casualty Company of America 25674
INSURED INSURER B: Travelers Indemnity Company of CT '. 25682
Federal TechnoCo,gy Solutions, Inc.
1828 R'a'ilroad Street INSURER C:
Corona CA 92880 INSURER D;
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 55437078 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 ED
PAID CLAIMS,
NSR! TYPE OF INSURANCE ADDL SUBR POLICY CFF POLICY EXP LIMITS
LTR INs2 wvn POLICY NUMBER IMM(DDFYYYY'i IMMMDIYYYY'r
A w,�' COMMERCIAL GENERAL LIABILITY ✓ �/ ZLP61N09657 13/1/2020 3/1/2021 EACH OCCURRENCE 51,000„000
6NhW3r W N"nGD
CLAIMS -MADE ✓ OCCUR PRE,Mti✓u'Sl-.., x: ,l+lxxvrrer$500,000
GEN'L AGGREGATE LIMIT APPLIES PER:
$10,000
...,,,
POLICY ✓ Iy"",ECRO„p
I __
GENERAL AGGREGATE
OTHER.
PRODUCTS - COMPIOPAGG
AUTOMOBILE LIABILITY
✓ ✓ BA1N566591
✓
ANY AUTO
$1,000,000,.
'OWNED
SCHEDULED
$
AUTOS ONLY
AUTOS
PROPERTY DAMAGE �
HIRED
NON -OWNED
.., . .
AUTOS ONLY 'w"�
AUTOS ONLY
A
UMBRELLA LAB
✓ OCCUR CUP11\734216
EXCESS LAB
CLA.MRvIS-MADE
OEO RETE,NrIONS,
A I WORKERS COMPENSATION _ / UB1 N593335
!AND EMPLOVE'RS`'LIABIL�I'TY YIN
IAN YPROPRtETCOOPIARTNE RIE,XECUTIVE
TOFF%C'E,R'rM�IEh'IBEf7'EX(;,LLIf�ED� ❑ NIA
IManidatory 41 NH'.)
If yes describe under
DESCRIPTION OF OPERATIONS below
MED EXP (Any one pefson y
$10,000
PERSONAL & ADV INJURY
S1,000,000
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMPIOPAGG
$2,000,,000
$
3/1/2020 3/1/2021 CONIBI�''�OSINGLF13MIT
$1,000,000,.
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE �
$
fiPav 'r7Cx:n�14�9'NC,I
.., . .
$
3/1/2020 3/1/2021 EACH OCCURRENCE $4,000,000
AGGREGATE $4,,000,000
i$
3/1/2020 3/1/2021 ✓ STATUTE ERH I
E L EACH ACCIDENT $1,000,000
E L DISEASE - EA EMPLOYEE, $ 1,000,00Q
E L DISEASE - POLICY LIMIT S1,000,000
p DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: All California Operations as required by written contract
City of EI Segundo is named as additional insured with respect to liability as required by written contract. Coverage is primary and non contributory.
Waiver of Subrogation applies. See attached endorsements
"30 -day notice of cancellation / 10 -days for non-payment of premium.
Joseph L i l l i o
,+I Vuw.m ,ruu.ail iVill¢+u"cla:wmdn,rrq,t V�',
CERTIFICATE HOLDER CANCE''LLATI'ON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
IN'(ormatlo'n Systems Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
C'tyyof EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
5t? Main Street
EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE � w
Dave Jacobson
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
55137078 1 20/21 GL/AUTO/UN,9/WC 1 Dena Kurtz 1 5/12/2020 2:06:98 PN (PDT) I Page 1 of 10
ZLP61NO9657
COMMERCIAL GENERAL LIABILITY
Federal Technology Solutions, Inc
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED — (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization.
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section III — Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury", "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, including:
M21
The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products -completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that is
available to the additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non-contributory basis,
this insurance is primary to "other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
0 2005 The St. Paul Travelers Companies, Inc.
'�51;707W 1 20,`21 GL%AUTO,UMS,Wr I De— xurr.z I 5,'12,13020 2L 0c,;46 0m (Por) I Page 2 of LO
Page 1 of 2
,7L
COMMERCIAL GENERAL LIABILITY
I. How, when and where the 'occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the 'occurrence" or
offense.
b) If a claim is made or "suit' is brought against
the additional insured, the additional insured
must:
I. Immediately record the specifics of the
claim or "suit' and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit' as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit', cooperate
with us in the investigation or settlement of
the claim or defense against the "suit', and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit' to
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to 'other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the policy period
0 2005 The St. Paul 'Travelers Companies, Inc. CG D2 46 08 05
5543j16 1 "'0/21 G1.,'A1JTC7,`f1M9/Wil I De— Ku - ( !1::72620 2.0610 PM (POT) I rag,, 3 of 10
Federal Technology Solutions, Inc
GENERAL PURPOSE ENDORSEMENT POLICY NUMBER: ZLP61NO9657
ISSUE DATE: 03/01/2020
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COD425 (07-08) - OTHER INSURANCE ADDITIONAL INSUREDS PRIMARY AND
NONCONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE
This endorsement modifies insurance provided under the following:
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
OTHER INSURANCE - ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH
RESPECT TO CERTAIN OTHER INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 4. a., Primary Insurance, of SECTION
IV - COMMERCIAL GENERAL LIABILITY CONDITIONS:
However, if you specifically agree in a written contractor agreement that
the insurance afforded to an additional insured under this Coverage Part
must apply on a primary basis, or a primary and non-contributory basis,
this insurance is primary to other insurance that is available to such
additional insured which covers such additional insured as a named
insured, and we will not share with that other insurance, provided that:
(1) The "bodily injury" or "property damage" for which coverage is sought
is caused by an "occurrence" that takes place; and
(2) The "personal injury" or "advertising injury" for which coverage is
sought arises out of an offense that is committed; subsequent to the
signing and execution of that contract or agreement by you.
CG D4 25 07 08
2008 The Travelers Companies, Inc.
Page 1 of 1
,7L
CO T8 01 08 18 Page 1 of 1
Federal Technology Solutions, Inc
POLICY NUMBER: ZLP61 N09657
COMMERCIAL GENERAL LIABILITY
ISSUE DATE: 5n2>202&
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or or-
ganizations) shown in the Schedule, but only with
respect to liability for "bodily injury" or "property dam-
age" 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 in-
sured and included in the "products -completed opera-
tions hazard".
u7L
CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1
BA1N566591
Federal Technology Solutions, Inc,
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED
B. BLANKET ADDITIONAL INSURED
C. EMPLOYEE HIRED AUTO
D. EMPLOYEES AS INSURED
E. SUPPLEMENTARY PAYMENTS —INCREASED
LIMITS
F. HIRED AUTO — LIMITED WORLDWIDE COV-
ERAGE — INDEMNITY BASIS
G. WAIVER OF DEDUCTIBLE — GLASS
PROVISIONS
A. BROAD FORM NAMED INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II — COVERED AUTOS
LIABILITY COVERAGE:
Any organization you newly acquire or form dur-
ing the policy period over which you maintain
50% or more ownership interest and that is not
separately insured for Business Auto Coverage.
Coverage under this provision is afforded only un-
til the 180th day after you acquire or form the or-
ganization or the end of the policy period, which-
ever is earlier.
B. BLANKET ADDITIONAL INSURED
The following is added to Paragraph c. in A.1.,
Who Is An Insured, of SECTION II — COVERED
AUTOS LIABILITY COVERAGE:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that is signed and
executed by you before the "bodily injury" or
"property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional insured is an "insured" for Covered Autos
Liability Coverage, but only for damages to which
H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF
USE — INCREASED LIMIT
I. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES — INCREASED LIMIT
J. PERSONAL PROPERTY
K. AIRBAGS
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
M. BLANKET WAIVER OF SUBROGATION
N. UNINTENTIONAL ERRORS OR OMISSIONS
this insurance applies and only to the extent that
person or organization qualifies as an "insured"
under the Who Is An Insured provision contained
in Section II.
C. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A.1.,
Who Is An Insured, of SECTION II — COV-
ERED AUTOS LIABILITY COVERAGE:
An "employee" of yours is an "insured" while
operating an "auto" hired or rented under a
contract or agreement in an "employee's"
name, with your permission, while performing
duties related to the conduct of your busi-
ness.
2. The following replaces Paragraph b. in B.S.,
Other Insurance, of SECTION IV — BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own:
(1) Any covered "auto" you lease, hire,
rent or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in
an "employee's" name, with your
CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
COMMERCIAL AUTO
permission, while performing duties
(a) With respect to any claim made or "suit"
related to the conduct of your busi-
brought outside the United States of
ness.
America, the territories and possessions
However, any "auto" that is leased, hired,
of the United States of America, Puerto
rented or borrowed with a driver is not a
Rico and Canada:
covered "auto".
(i) You must arrange to defend the "in -
D. EMPLOYEES AS INSURED
sured" against, and investigate or set -
tie any such claim or "suit" and keep
The following is added to Paragraph A.1., Who Is
us advised of all proceedings and ac -
An Insured, of SECTION II —COVERED AUTOS
tions.
LIABILITY COVERAGE:
(ii) Neither you nor any other involved
Any "employee" of yours is an "insured" while us-
"insured" will make any settlement
ing a covered "auto" you don't own, hire or borrow
without our consent.
in your business or your personal affairs.
(iii) may, at our discretion, participate
E. SUPPLEMENTARY PAYMENTS — INCREASED
in defending the "insured" against, or
in
LIMITS
in the settlement of, any claim or
1. The following replaces Paragraph A.2.a.(2),
"suit".
of SECTION II — COVERED AUTOS LIABIL-
(iv) We will reimburse the "insured" for
ITY COVERAGE:
sums that the "insured" legally must
(2) Up to $3,000 for cost of bail bonds (in-
pay as damages because of "bodily
cluding bonds for related traffic law viola-
injury" or "property damage" to which
tions) required because of an "accident"
this insurance applies, that the "in -
we cover. We do not have to furnish
sured" pays with our consent, but
these bonds.
only up to the limit described in Para -
2. The following replaces Paragraph A.2.a.(4),
graph C., Limits Of Insurance, of
of SECTION II — COVERED AUTOS LIABIL-
SECTION II — COVERED AUTOS
ITY COVERAGE:
LIABILITY COVERAGE.
(4) All reasonable expenses incurred by the
(v) We will reimburse the "insured" for
"insured" at our request, including actual
the reasonable expenses incurred
loss of earnings up to $500 a day be-
with our consent for your investiga-
cause of time off from work.
tion of such claims and your defense
the "insured" against any such
F. HIRED AUTO — LIMITED WORLDWIDE COV-
"suit", but only up to and included
"s
ERAGE —INDEMNITY BASIS
within the limit described in Para -
The following replaces Subparagraph (5) in Para-
graph C., Limits Of Insurance, of
graph B.7., Policy Period, Coverage Territory,
SECTION 11 — COVERED AUTOS
of SECTION IV — BUSINESS AUTO CONDI-
LIABILITY COVERAGE, and not in
TIONS:
addition to such limit. Our duty to
(5) Anywhere in the world, except any country or
make such payments ends when we
jurisdiction while any trade sanction, em-
have used up the applicable limit of
bargo, or similar regulation imposed by the
insurance in payments for damages,
United States of America applies to and pro-
settlements or defense expenses.
hibits the transaction of business with or
(b) This insurance is excess over any valid
within such country or jurisdiction, for Cov-
and collectible other insurance available
ered Autos Liability Coverage for any covered
to the "insured" whether primary, excess,
"auto" that you lease, hire, rent or borrow
contingent or on any other basis.
without a driver for a period of 30 days or less
(c) This insurance is not a substitute for re -
and that is not an "auto" you lease, hire, rent
quired or compulsory insurance in any
or borrow from any of your "employees",
country outside the United States, its ter -
partners (if you are a partnership), members
ritories and possessions, Puerto Rico and
(if you are a limited liability company) or
Canada.
members of their households.
Page 2 of 4 6 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15
Includes copyrighted material of Insurance Services office, Inc. with its permission.
You agree to maintain all required or
compulsory insurance in any such coun-
try up to the minimum limits required by
local law. Your failure to comply with
compulsory insurance requirements will
not invalidate the coverage afforded by
this policy, but we will only be liable to the
same extent we would have been liable
had you complied with the compulsory in-
surance requirements.
(d) It is understood that we are not an admit-
ted or authorized insurer outside the
United States of America, its territories
and possessions, Puerto Rico and Can-
ada. We assume no responsibility for the
furnishing of certificates of insurance, or
for compliance in any way with the laws
of other countries relating to insurance.
G. WAIVER OF DEDUCTIBLE —GLASS
The following is added to Paragraph D., Deducti-
ble, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered "auto" will apply to
glass damage if the glass is repaired rather than
replaced.
H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF
USE — INCREASED LIMIT
The following replaces the last sentence of Para-
graph A.4.b., Loss Of Use Expenses, of SEC-
TION III —PHYSICAL DAMAGE COVERAGE:
However, the most we will pay for any expenses
for loss of use is $65 per day, to a maximum of
$750 for any one "accident".
I. PHYSICAL DAMAGE — TRANSPORTATION
EXPENSES — INCREASED LIMIT
The following replaces the first sentence in Para-
graph A.4.a., Transportation Expenses, of
SECTION III — PHYSICAL DAMAGE COVER-
AGE:
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
ered "auto" of the private passenger type.
J. PERSONAL PROPERTY
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III — PHYSICAL
DAMAGE COVERAGE:
Personal Property
We will pay up to $400 for "loss" to wearing ap-
parel and other personal property which is:
(1) Owned by an "insured"; and
COMMERCIAL AUTO
(2) In or on your covered "auto".
This coverage applies only in the event of a total
theft of your covered "auto".
No deductibles apply to this Personal Property
coverage.
K. AIRBAGS
The following is added to Paragraph B.3., Exclu-
sions, of SECTION III — PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to "loss" to one or
more airbags in a covered "auto" you own that in-
flate due to a cause other than a cause of "loss"
set forth in Paragraphs A.1.b. and A.1.c., but
only:
a. If that "auto" is a covered "auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one "loss".
L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
LOSS
The following is added to Paragraph A.2.a., of
SECTION IV — BUSINESS AUTO CONDITIONS:
Your duty to give us or our authorized representa-
tive prompt notice of the "accident" or "loss" ap-
plies only when the "accident" or "loss" is known
to:
(a) You (if you are an individual);
(b) A partner (if you are a partnership);
(c) A member (if you are a limited liability com-
pany);
(d) An executive officer, director or insurance
manager (if you are a corporation or other or-
ganization); or
(e) Any "employee" authorized by you to give no-
tice of the "accident" or "loss".
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — BUSINESS AUTO CONDI-
TIONS:
S. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract
signed and executed prior to any "accident"
or "loss", provided that the "accident" or "loss"
arises out of operations contemplated by
CA T3 53 02 15 ® 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4
Includes copyrighted material of Insurance Services Office. Inc. with its permission.
COMMERCIAL AUTO
such contract. The waiver applies only to the
person or organization designated in such
contract.
N. UNINTENTIONAL ERRORS OR OMISSIONS
The following is added to Paragraph B.2., Con-
cealment, Misrepresentation, Or Fraud, of
SECTION IV — BUSINESS AUTO CONDITIONS:
The unintentional omission of, or unintentional
error in, any information given by you shall not
prejudice your rights under this insurance. How-
ever
owever this provision does not affect our right to col-
lect additional premium or exercise our right of
cancellation or non -renewal.
JL
Page 4 of 4 ® 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
AW WORKERS COMPENSATION
TRAVELERSJ AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 ( A) — 001
POLICY NUMBER: U61 N593335
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WAIVER)
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule.
The additional premium for this endorsement shall be 3 % of the California workers' compensation pre-
mium.
Schedule
Person or Organization Job Description
ANY PERSON OR ORGANIZATION FOR
WHICH THE NAMED INSURED HAS
AGREED BY WRITTEN CONTRACT
EXECUTED PRIOR TO LOSS TO
FURNISH THIS WAIVER.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise
stated.
(The information below is required only when this endorsement is issued subsequent to preparation of
the policy.)
Endorsement Effective 3/1/2020 Policy No. UB 1 N593335 Endorsement No.
Insured Federal Technology Solutions, Inc. Premium
Insurance Company Countersigned by
Travelers Property Casualty Company of America t7
DATE OF ISSUE: 3/1/2020 ST ASSIGN: Page 1 of 1