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PROOF OF INSURANCE (2021) CLOSEDWILLIA1 O A �^ I DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 00I19V200 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. this certificate does not confer rights to the certificate holder in lieu of such endorsem in policies may require an endorsement. A statement on If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain PRODUCER g y 714-516-2960 PHO ACT'.. Lisa 714-516-296 Ybarra N�ent s). Rohm Insurance 26 Plaza Square, Suite 200LC a ss lytic 4 Oro—Iimins:corrt License #OK07568 FAX Ney;714..5..... . Orange, CA 92866 16 2965 aNsrarf Indemnity CO avEapE raAl,�„ __ .. _ ER,A:Travelers of CT 25682 Williams Pipeline Contractors,ra ..._... ,.. Inc. � _)�rsu�a=,R � I'ro�r Cas Co of Amer ....... 12567""4 INSUREDTravelers P.O. Box 1120 tkSUq" Somis, CA 93066 I,NSURER D INSURER _-- ... 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, I R -UPI TYPECOMMERCIAL POLIC� _-ppPPO ��E I II�IMPtt9�✓YyxJ LIMIT....m.. A X COM CE' Ya YNUMBER ,.....IS.. 1 Atlt�.., E ERAL LIABILITY 00 EAC occuR Y y coaPle' 323TCT20 09/01/Z020 09/01/2021 ��° ) p30 ,0 CLAIMS -MADE 1 X , �,O0Q PEHSON _ _.. 1,000 000 ..,...., , ....,, F4P;. � ACrV rN.rUiiY I S ... X01000 PEN AOiaREwh7E LIMIT APPLIES PER: GFNEFil1i AGGREC ATk a 2,000,000 POLICYPRo- Loc 46-66- ;_X,QCY JECT PYiaCYi)GfS.,COMP.OPAGG S v B AUTOMOBILE LIABILITY COMBINED�SINGLE LIMIT i 1,000,000 X ANY AUTO ( ) --,. 0104 C .- � AUTOS ONLY AUTOS N06000220� 0910112021 E1Ot7ILY,,,INJURk"�afr amen, ,. LED 12 O BOOM Y IN DUI<Y 1 ar aiccld�nr OWNED � SCHEDULED - ) � a X,I A�SONLY X. A9JTN00'PW asxiL^Rdenp$ANAGE w�4 ... B X LLA Ufif}ti0'� AB X UMBRELLA accuR Aar? REN E S UAB .. , "0, .� ....... 1,000,000 OI'I cLAIMs MAGE l �I OUP0J30741420 09/01 /2020 09/01/2021 I OED X � RETENTIONS 111,0001 S B wo r�P tABIu7Y Y I UB4J57346520 09/01/2020 09/0172021 X E� ATU t l r{ " �° ANY PR'OP'RIETORMARTUOEO'XECUTIVE '" N (A Y -. _ S - . .. 1"000,000 ,._- AN. UMOME AE Ac iD NT COMPENSATION PER ry In I SEAL EA EMPLOWF,E, 1,000,000 DISEASE -POLICY LIMIT I . 4f tis, d'escnbe ur+de+' - Im I, �crl.�, . . _ S ...__. ,. ; I o :sc:RlPrIr�N ori OPERATIONS belle ' 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE PROJECT #PW 19-17 ON-CALL SEWER EMERGENCY SYSTEMS REPAIR SERVICES PROJECT CITY OF EL SEGUNDO ITS OFFICIALS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, PRIMARY & NON-CONTRIBUTORY AND WAIVER OF SUBROGATION AS RESPECTS TO GENERAL LIABILITY PER ENDORSEMENTS ATTACHED, WORKERS COMPENSATION WAIVER. OF SUBROGATION APPLIES PER ENDORSEMENT ATTACHED. CERTIFICATE HOLDER CANCELLATION ELSEGUN A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE .,a - 44_-_%_ ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ,,... WILLIA1 QEJQ; LA CERTIFICATE OF LIABILITY INSURANCEI DATE(MM/DD/YYYY) II 08/19/2020 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)1. PRODUCER CRNT Rohm Insurance Agency LLC PHONE Ext FAx 714-516-2960 �_�Y�a•r .Ilea rr2860 (cq,r+� Npi.714-516'-2988 License #OK07568 g y ) I714a 16-296 raS r a N1....... ,.......... 26 Plaza Square, Suite 200 �ply���;,_ y Orange, CA 92866 N. ^ R_ J 9 �. A_ I _AFFORmINr c y R ra INAURFR A Travelers ln+derr�rli Co of CTE � iNAIC // � 682 INSURED Williams Pipeline Contractors, u,�gsuRRR A, Prop, 5674 Travelers Pro Cas Co 0 Inc. P.O. Box 1120 INSURER c Somis, CA 93066 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, MAY HAVE BEEN REDUCED BY PAID CLAIMS iEXCLUSIONS AND CONDITIONS H IADD�R LIMITS SHOWN ... �1MdDf5tYYYj)1 (oLRCY E%f� LIMITS 1tl000,000 TIONS OF SUCH _ TYPE OF INSURANCE NUMBER J POLE M7DDNYY'YJ.w.f —._. RAL LIABILITY EACH OrCtIRRENCE $ A L. ... -- CLAIMS MADE 300 000 - OCCUR Y Y COOP182323TCT20 09101/20201' 09101/2021 DAuAOE To' RENTED COMMERCIAL GENE X ' GEN'L,AGGR,E',GATE LIMIT APPLIES PER: 5,000 l_ I POLICY „ XEUT LOC 1,,000„000 OTHER' 2,000,000 B AUTOMOBILE LIABILITY 2000,00 X ANY AUTO i8104NO5868220 OWNED SCHEDULED 1,0,0.0 AUTOS ONLY AUTOS .0...00 ._ -- A.?05 f7N iY X „ AUTOS ONLY ........... B X X. C UM13RELLALIAB X OCCUR ESS LIMAII AB CUPSJ38741420 -- DEC......i X,..i R'9mTENTIONS'CLAIMS-MAD WORKERS COMPENSATION 0 1,000,00o D EMPLOYERS' LIABILITY Y d N Y U134.157346520 ANY PROPRIETOR/PARTNER/EXECUTIVE NIA FCe11 Eat ....' --- - ry in N )EXCLUDED S�arJarsary, in NH) 1 ,000,000 If S, dcGcrlbe unoer . 1,000,000 D 'SCRIP"T ON OF OPERAr'IONS below, 1,000,000 MED EXP 5,000 PERSONAI.. & ADV INJURY S 1,,000„000 .... 2,000,000 — S - 92OMP! AGC, 2000,00 IS COMBINED CMBINEDI.I.M......I.1....... 1,0,0.0 �SINGLE .0...00 ._ 09/01/2020 09/01/2021 80PIL NJLIRY(Fq!9.grxcr,l Y.(dsmpr ac lalrenh')....:"� ........... Pq iERTY D AMAGE iF er 4 cidq nIl 109/01 .GGREGATE 0 1,000,00o /2021 A 09/01/2020/ ... GPI w000 1,000,000, S X1 PER OTH- - 5TAZOTF .........;.(m . I I --- - 09/0112020 09101/2021 E L EACH S 1 ,000,000 ,ACCIDE: E L Q�IPrSI I r+,EwP�crYEl,,, . 1,000,000 E L DISEASE -PoLIC ' YLIMIr s 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PROJECT NO,: PW 19.16 ON-CALL WATER SYSTEMS REPAIR SERVICES PRO.IECT. CITY OF EL SEGUNDO ITS OFFICIALS, AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, PRIMARY S NON-CONTRIBUTORY AND WAIVER OF SUBROGATION AS RESPECTS TO GENERAL LIABILITY PER ENDORSEMENT'S ATTACHED. WORKERS COMPENSATION WAIVER OF SUBROGATION APPLIES PER ENDORSEMENT ATTACHED. CERTIFICATE HOLDER CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 ACORD 25 (2016/03) ELSEGUN 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 1 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY NUMBER: COOP182323TCT20 COMMERCIAL GENERAL LIABILITY POLICY TERM: 09/01/2020 TO 09/01/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such 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 or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury" or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) If a claim is made or "suit" is brought against insured does not apply to: the additional insured: CG D2 46 04 19 © 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) 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. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. Page 2 of 2 © 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY #COOP182323TCT20 POLICY TERM: 09/01/2020 TO 09/01/2021 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an 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 insured which covers such 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 occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. PRIMARY & NON-CONTRIBUTORY a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY NUMBER: COOP182323TCT20 COMMERCIAL GENERAL LIABILITY POLICY TERM: 09/01/2020 TO 09/01/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTENC ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 this 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 coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries > B. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability — Railroads < F. Damage To Premises Rented To You The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, B. joint venture or limited liability company, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or a. An organization other than a partnership, joint venture or limited liability company; or b. A trust; as indicated in its name or the documents that govern its structure. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury", "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II — Who entity; or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products -completed operations hazard". CG D3 16 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury' arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. E. CONTRACTUAL LIABILITY — RAILROADS el 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; Page 2 of 3 © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of "premises premises is rented to you, if you rent such damage in the DEFINITIONS Section: premises for a period of seven or fewer consecutive days. "Premises damage" means "property damage" to: CG D3 16 0219 © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. TRAVELERS �, WORKERS COMPENSATION ,: AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: UB4J57346520 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 2 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE 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 09/01/2020 Policy No. UB4J57346520 Endorsement No. Insured WILLIAMS PIPELINE CONTRACTORS, INC. Premium Insurance Company Countersigned by TRAVELERS PROP CAS CO OF AMER DATE OF ISSUE: 08-19-2020 Page 1 of 1