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PROOF OF INSURANCE (2021 - 2022) CLOSEDDATE (MMIDDIYYYY) ,q (t1pY....• )RV CERTIFICATE OF LIABILITY INSURANCE 01r1412021 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 CONTACT Baker Romero & Associates Insurance Brokers, Inc. NAME; Christine R Sousa 750 Terrado Plaza #238 iA/Cc Npa EXI); (626)332-2258 jA°� No): (626)339-9921 EODRE CovinaCA 91723 ADixFss'' cltrist'inB bakerromero.com, , License #: OG22790 INSURED C & J Technical Solutions and Services, Inc. 4000 Vallley Blvd Suite 103 INSURERS) AFFORDING COVERAGE NAIC # INSURERA: Travelers Property Casualty 25674 INSURERB: AssuredPartners -Auto DB 25674 INSURER C: Lloyds of London POLICY X PrdCb• JI INSURER D : Westchester Surplus Lines Insurance Company 10172 R E, Walnut, CA 91789 I INSURE,: RF: COVERAGES CERTIFICATE NUMBER: 00002819-4642434 REVISION NUMBER: 248 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. ILLTRR TYPE OF INSURANCE INSta SNIUVD POLICY EFF POLICY EXP ! D POLICY NUMBER ( POLICY f POLICY LIMITS A XI COMMERCIAL GENERAL LIABILITY Y Y 680-6H929173-21-47 02/02/2021 02/0212022 EACH OCCURRENCE $ 1,000,000 — " DAMAGE 1'G� RENTED CLAIMS -MADE U OCCURPREMISF.S_1, F.e_orr.tarrenr,Pj $ 1,000,000 1 MED EXP (Any one Derson) $ 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A.M. Best Ratings: Travelers Property Casualty Company of America (A++ XV); Project: EI Segundo Park Vista Senior Living Center— Plumbing Upgrade, EI Segundo, CA. CITY, its officials, and employees are Named as additional insureds under said insurance coverage and such insurance will be deemed "primary" such that any other insurance that may be carried by CITY will be excess thereto.The following applies to the Additional Insured(s): Blanket Forms attached herewith: Blanket Addtional Insured CGD3810915; Coverage Xtend Endorsement CGD3790116, includes Waiver of Subrogation.Worker's Compenastion Waiver of Subrogation included per form WC990376. (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLA'TIO'N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Arianne Bola, Abola@elsegundo.org ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (CRS) ©1988-2015 ACOAD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by CRS on January 14, 2021 at 03:50PM PERSONAL & ADV INJURY $ 1,,0,00,,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PrdCb• JI ] LOC ,PRODUCTS-COMPIOPA GG $ 2,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE B LIABILITY1 5,000,000 680-6H929173-21-47 02/02/2021 1 02/02/2022 ((Ea gc�,clhlenll INR;I.F� 1.IP.fuT $ 1,000,000 „AUTOMOBILE ANY AUTO IS 1 BODILY INJURY (Per person) $ OWNED P SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY � „ (Per aGDidPn)i , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A.M. Best Ratings: Travelers Property Casualty Company of America (A++ XV); Project: EI Segundo Park Vista Senior Living Center— Plumbing Upgrade, EI Segundo, CA. CITY, its officials, and employees are Named as additional insureds under said insurance coverage and such insurance will be deemed "primary" such that any other insurance that may be carried by CITY will be excess thereto.The following applies to the Additional Insured(s): Blanket Forms attached herewith: Blanket Addtional Insured CGD3810915; Coverage Xtend Endorsement CGD3790116, includes Waiver of Subrogation.Worker's Compenastion Waiver of Subrogation included per form WC990376. (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLA'TIO'N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Arianne Bola, Abola@elsegundo.org ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (CRS) ©1988-2015 ACOAD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by CRS on January 14, 2021 at 03:50PM I $ A UMBRELLA LIAR OCCUR Y Y CUP -31342535S -21-47S-21-47 02102/2021 0210212022 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE 1 5 5,000,000 I DFD X RFTENT�ON $ 0 Product/Co. Ops IS 5,000,000 WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY Y UB-OK197920-21-47-G PER OiH- ozns/2oz1 o2nslzozz X STATUTE �R Z ANY PROPRIETOR/PARTNER/EXECUTIVE NIA OFFICER/MEMBER EXCLUDED? E EACH ACCIDENT 1 $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE', $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE -POLICY LIMIT I $ 1,000,000 C Prof. Liab.$10K Died. ANE158927820 08101/2020 06/0112021 $21M Each Claim $2M Aggregate D 1 Enviornmental Liab. G71760285002 11121/2020 11/2112021 $11M Each Claim $2M aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) A.M. Best Ratings: Travelers Property Casualty Company of America (A++ XV); Project: EI Segundo Park Vista Senior Living Center— Plumbing Upgrade, EI Segundo, CA. CITY, its officials, and employees are Named as additional insureds under said insurance coverage and such insurance will be deemed "primary" such that any other insurance that may be carried by CITY will be excess thereto.The following applies to the Additional Insured(s): Blanket Forms attached herewith: Blanket Addtional Insured CGD3810915; Coverage Xtend Endorsement CGD3790116, includes Waiver of Subrogation.Worker's Compenastion Waiver of Subrogation included per form WC990376. (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLA'TIO'N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Arianne Bola, Abola@elsegundo.org ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE (CRS) ©1988-2015 ACOAD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by CRS on January 14, 2021 at 03:50PM AGENCY CUSTOMER ID: 00002819 LOC #: .......� A R� ADDITIONAL REMARKS SCHEDULE Page 2 of 2 ........_ ... AGENCY NAMED INSURED Baker, Romero & Associates Insurance Brokers, Inc. C & J Technical Solutions and Services, Inc. POLICY NUMBER N/A CARRIER NAIC CODE .w.,..w........................................ ......................... ........................................ ....... ... Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance _.............................................._............... ..., m (continued from Description of Operations) Workers Comp: John Jolly ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CRS on January 14, 2021 at 03:50PM Policy Number: 680-61-1929173-21-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. R.,.k .. ... This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage 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, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. L This insurance does not apply to the rendering of or failure to render any "Professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liabirity required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section 111 — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations 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 occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period. whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured 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. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the 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 available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs: and (2) The "personal injury" for which coverage is sought arises out of an offense committed: after you have signed that "written contract requiring Insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary. excess, contingent or on any other 'basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 8109 15 0 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted materiel or insurance Services Otfice, Inc., vAth Its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to Include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2215 The Travelers Indemnity Company. All rights reserved. CG D3 8109 15 Includes the copyrighted material of Insurance Services ice, 'Inc., vAth its permission Policy Number: 680-6H929173-21-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. M A [OIL M�► This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following replaces Paragraph b.(3) of the definition of "products -completed operations hazard° in the DEFINITIONS Section: (3) Products or operations for which the classification, listed in the Declarations. in a polity Schedule or in our manual of rules, states that the products -completed operations are subject to the General Aggregate Limit. CG D3 09 02 19 ® 2017 The Travelers Indemnity company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. Policy Number: 680-6H929173-21-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTE,ND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS 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. Non -Owned Watercraft — 75 Feet Long Or Less H. Blanket Additional Insured — Governmental B. Who Is An Insured — Unnamed Subsidiaries Entities — Permits Or Authorizations Relating To Premises C. Who Is An Insured — Retired Partners. Members. Directors And Employees D. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees, Co - Volunteer Workers And Retired Partners, Members, Directors And Employees E. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional Insured —Controlling Interest G. Blanket Additional Insured — Mortgagees, Assignees. Successors Or Receivers PROVISIONS A. NON -OWNED WATERCRAFT — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g.. Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less: and (b) Not being used to carry any person or property for a charge: I. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations J. Incidental Medical Malpractice K. Medical Payments — Increased Limit L Amendment Of Excess Insurance Condition — Professional Liability M. Blanket Waiver Of Subrogation —When Required By Written Contract Or Agreement N. Contractual Liability — Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less: and (2) Not being used to cant' any person or property for a charge: B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION 11— WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: 2. The following replaces Paragraph 2.e. of a. You are the sole owner of, or maintain an SECTION 11— WHO IS AN INSURED: ownership interest of more than 50% in, such e. Any person or organization that, with subsidiary on the first day of the policy your express or implied consent, either period; and CG D3 79 0219 ® 2017 The Travelers Indemnity Comparry. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office. Inc, wllh Ile permission. COMMERCIAL GENERAL LIABILITY 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°x6 in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED — RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any person who is your retired partner, member, director or "employee" that is performing services for you under your direct supervision, but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no such retired partner, member, director or "employee" is an insured for: (1) "Bodily injury": (a) To you, to your current partners or members (if you are a partnership or joint venture), to your current members (N you are a limited liability company) or to your current directors; (b) To the spouse, child, parent, brother or sister of that current partner, member or director as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. 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 first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or "employees" 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. (2) "Personal injury": (a) To you, to your current or retired partners or members (if you are a partnership or joint venture), to your current or retired members (if you are a limited liability company), to your other current or retired directors or "employees" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent. brother or sister of that current or retired partner, member, director, "employee" or "volunteer worker" as a consequence of Paragraph (2)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (2)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (3) "Property damage" to property: (a) Owned. occupied or used by; or (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your retired partners. members or directors, your current or retired "employees" or "volunteer workers". any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. Page 2 of 6 ® 2017 The Travelers indemnity Company. All rights reserved. CG D3 79 0219 Includes copyrighted material or insurance SeMces Office, Inc, with its permission. D. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a current or retired co - "employee" while in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" or retired partners, members or directors while performing duties related to the conduct of your business. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION 11— WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture. and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However. a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it: or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization. if you report such organization in writing to us within 180 days after you acquire or form it: b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such COMMERCIAL GENERAL LIABILITY organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. F. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" that arises out of: a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTIO N II —WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. G. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee. successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury". "property damage" or "personal and advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is "personal and advertising injury" caused by an offense that is committed. CG D3 79 0219 ® 2017 The Travelers IndemnW company. All rights reserved. Page 3 of 6 Includes copyrighted material of insurance Services Ofllos, Inc, with Its permission. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily Injury" or "property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement Is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. H. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTiiTIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you 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 the existence, ownership, use, maintenance, repair, construction. erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION 11— 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 damagee" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury". "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". J. 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, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page 4 of b Q 2017 The "travelers indemnity Company. AAI rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. occupational therapist or occupational therapy assistant, physical therapist or speech-language pathologist; 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 S. 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 Phannaceuticals "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. S. 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 4.1b.. 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, COMMERCIAL GENERAL LIABILITY 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. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph S. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. and will be the higher of: a. $10,000; or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L. AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY The following is added to Paragraph 4.b.. Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance, whether primary. excess, contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss is not subject to the professional services exclusion of Coverage A or Coverage B. M. BLANKET WAIVER OF SUBROGATION — WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT 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 written 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 signing of that contract or agreement. CG D3 79 0219 ® 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of insurance Servicos Qiiioe, Inc. with its pertNssion. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" In the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph C(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 0 2017 The Trawlers Indemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted materiel of Insurance Services Office, Inc. with (Is permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-6H929173-21-47 ISSUE DATE:12/18/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE — LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ 4,000,000 (Other Than Projects and Products -Completed Operations) Designated Location Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) Designated Project Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) General Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) Designated Projects: Each "project" for which you have agreed, in a written contract which is in effect during this policy period, to provide a separate General Aggregate Limit, provided that the contract is signed by you before the "bodily injury" or "property damage" occurs. Designated Locations: All locations listed in Item 3. of in any Master Pac Account Exposure policy. PROVISIONS the Common Policy Declarations or Endorsement included in this 1. The General Aggregate Limit (Other Than 1. The Limits of Insurance shown in the Products -Completed Operations) shown in the Declarations or the Schedule — Limits Of Declarations is replaced by the Limits of Insurance And Designated Projects And Insurance shown in the Schedule — Limits Of Locations, whichever apply, and the rules Insurance And Designated Projects And below fix the most we will pay regardless of Locations. the number of: 2. The following replaces Paragraph 1. of SECTION a. Insureds: III — LIMITS OF INSURANCE: b. Claims made or "suits" brought; CG D4 69 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. Persons or organizations making claims under Coverage B. Instead, the or bringing "suits"; or General Aggregate Limit described in d. "Projects" or "locations". Paragraph 2.d. below applies to such damages. 3. The following replaces Paragraph 2. of SECTION III — LIMITS OF INSURANCE: (5) Any payments made for damages or 2. a. The Total Aggregate Limit shown in the medical expenses to which the Designated Project Aggregate Limit Schedule — Limits Of Insurance And applies will reduce the Designated Desi 9 Hated Projects And Locations is the Project Aggregate Limit for the most we will pay for the sum of all applicable "project". Such payments amounts under the Designated Location will not reduce the Total Aggregate Aggregate Limit and all amounts under Limit, the General Aggregate Limit the General Aggregate Limit. This described in Paragraph 2.d. below, includes: the Designated Project Aggregate (1) Damages under Coverage A, except Limit for any other "project" or the damages because of "bodily injury" or Designated Location Aggregate Limit. "property damage" included in c. Subject to the Total Aggregate Limit the "products -completed operations described in Paragraph 2.a. above, the hazard"; Designated Location Aggregate Limit (2) Damages under Coverage B; and shown in the Schedule — Limits Of (3) Medical expenses under Coverage C. Insurance And Designated Projects And Locations applies and is further subject to b. The Designated Project Aggregate Limit 9 1all of the following provisions: shown in the Schedule — Limits Of Insurance And Designated Projects And (1) The Designated Location Aggregate Locations applies and is further subject to Limit is the most we will pay for the all of the following provisions: sum of: (1) The Designated Project Aggregate (a) Damages under Coverage A Limit is the most we will pay for the because of "bodily injury" and sum of: "property damage" caused by "occurrences"; and (a) Damages under Coverage A because of "bodily injury" and (b) Medical expenses under "property damage" caused by Coverage C for "bodily injury" "occurrences`; and caused by accidents; (b) Medical expenses under that can be attributed only to Coverage C for "bodily injury" operations at a single "location". caused by accidents; (2) The Designated Location Aggregate that can be attributed only to Limit applies separately to each operations at a single "project". 'location". (2) The Designated Project Aggregate (3) The Designated Location Aggregate Limit applies separately to each Limit does not apply to damages "project'. because of "bodily injury" or "property (3) The Designated Project Aggregate damage" included in the "products - Limit does not apply to damages completed operations hazard". because of "bodily injury" or "property "products- Instead, the Products -Completed Operations Aggregate Limit damage" included in the described in Paragraph 3. below completed operations hazard". Instead, the Products -Completed applies to such damages. Operations Aggregate Limit (4) The Designated Location Aggregate described in Paragraph 3. below Limit does not apply to damages applies to such damages. under Coverage B. Instead, the (4) The Designated Project Aggregate General Aggregate Limit described in Limit does not apply to damages Page 2 of 3 ® 2017 The Travelers Indemnity Company. All rights reserved. CG D4 69 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or medical expenses to which the Designated Location Aggregate Limit applies will reduce: (a) The Total Aggregate Limit; and (b) The Designated Location Aggregate Limit for the applicable "location". Such payments will not reduce the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit or the Designated Location Aggregate Limit for any other "location". d. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the General Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The General Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences", and medical expenses under Coverage C for "bodily injury" caused by accidents, that cannot be attributed only to operations at a single "project" or a single "location"; and (b) Damages under Coverage B. (2) The General Aggregate Limit does not apply to damages for "bodily injury" or "property damage" included in the "products -completed oper- ations hazard". Instead, the Products -Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (3) Any payments made for damages or medical expenses to which the COMMERCIAL GENERAL LIABILITY General Aggregate Limit applies will reduce: (a) The Total Aggregate Limit; and (b) The General Aggregate Limit. Such payments will not reduce the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 4. The following replaces Paragraph 3. of SECTION III — LIMITS OF INSURANCE: 3. The Products -Completed Operations Aggre- gate Limit shown in the Declarations is the most we will pay under Coverage A for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard". Any payments made for such damages will not reduce the Total Aggregate Limit, the General Aggregate Limit, the Designated Project Aggregate Limit for any "project' or the Designated Location Aggregate Limit for any "location". 5. The following is added to the DEFINITIONS Section: "Location" means any designated location shown in the Schedule — Limits Of Insurance And Designated Projects and Locations that is owned by or rented to you. For the purposes of determining the applicable aggregate limit of insurance, each "location" that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "location". "Project" means any designated project shown in the Schedule — Limits Of Insurance And Designated Projects And Locations that is away from premises owned by or rented to you and at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes a premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered a single "project". CG D4 69 02 19 m 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted materiel of Insurance Services Office, Inc. with its permission. .�„ �, �, WORKERS COMPENSATION f AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-OK197920-21-47-G 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 2.00 % of the California workers' compensation pre- mium. Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule ENGINEERS Job Description 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by, DATE OF ISSUE: 12-18-20 ST ASSIGN: Page 1 of 1