PROOF OF INSURANCE (2022) CLOSED----*- "10 SOCIFOR-131 DGONZALE
ACfJRL7° �,,,�,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMfPPlYYYY)
71912021
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 INSUREII AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 Ileu of such ondorsement s .
PRODUCER
C4RMICT
PHONE Exq; (626 799-7000 FAx 626 441-3233
(AfC,Nol:t
Bolton & Companyy
3475 E. Foothill 81vd., Suite 100
p%& . propcasualty@boltonco.com
Pasadena, CA 91107
IN SURERISI AFFORDING COVERAGE
NAIC #
INSURER A; Great American Insurance Co,
16691
INSURED
INSURER B : State Compensation Ins. Fund
36076
INSURER C :
Society for the Prevention of Cruelty to An imals, Los Angeles
INSURER D ;
5026 West Jefferson Blvd.
Los Angeles, CA 90016
INSURER E
INSURER F :
Cf)VRRAfzFC CFRTIRICATF NIIMRFR- REVISION NUIMRFR:
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.
INSR LTRTYPE
OF INSURANCE
ADDINSDL
SUBR
POLICY NUMBER
POLICY EFF
MMI
POL G E7SP
LIMITS
A
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE �X OCCUR
X
X
PAC322454614
711/2021
71112022
PREMISESDAMAGE TO RENru a
$ 1,000,000
MFDEXP (Any one arson
$ 20,000
PERSONAL & ADV INJURY
1,000,OOD
GENT AGOREGATELIMIT APPLIES PER:
POLICY JEC7 LOC
GENERAL AGGREGATE
2,000,0O0
PRODUCTS-COMP;CPAGG
2,000,000
ABUSE OR MOLEST
$ 1,000,000
OTHER
AUTOMOBILE LIABILITY
COMBA
(E&aC deyINGLE LIMIT
$ 1,000,000
BODILY INJURY Per erson
$
X ANY AUTO
CAP322454717
711/2021
71112022
BODILY INJURY Per acddent
OWNED SCHEDULED
SSW
AUTOS ONLY AUTOS
PaEaccIJ nt AMAGE
AUTOS ONLY AL1T05 ONLY
A
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 10,000,000
ExGE5S LIAB
CLAIMS -MADE
UMB32245481 B
7/1/2021
7/1/2022
AGGREGATE
DED X RETENTION$ 10,000
10,000,000
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
OFFICERfMEMBEREXCLUDED?ECUTiVE
(Mandatary in NH)
NIA
X
92388912021
71112021
7I112022
PER CTH-
TAT E
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 11000,000
E.L. DISEASE . POLICY LIMIT
1,000,000
$
If a s,describeunder
DSCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1 R1, Additional Remarks Schedule, may be attached If more space Is required)
Re: Operations of the Named Insured.
GL Additional Insured applies per CG89701114 attached, only if required by written contractlagreement.
GL and WC Waiver of Subrogation applies per CG89701114 & 1021742018 attached.
Additional Insured(s), City of El Segundo.
City of El Segundo
City Clerk's Office
Attn: Mona Shilling
350 Main Street
El Segundo, CA 90245
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
ACORD 26 (2016103) a 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
GREAT AMERICAN INS CO OF NY
CG 8 9 7 0 (Ed. 1 1114 )
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SIGNATURE GENERAL LIABILITY BROADENING ENDORSEMENT
This Endorsement modifies and is subject to the insurance provided under the following form:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following extension only applies in the event that no other specific coverage for the indicated loss
exposure is provided under this Policy. If other specific coverage applies, the terms, conditions and
limits of that Coverage are the exclusive coverage applicable under this Policy, unless otherwise noted in
this Endorsement. This is a summary of the various additional coverages and coverage modifications
provided by this Endorsement. For complete details on specific coverages, consult the actual policy
wording.
Coverage Description
Limit of Insurance
Page
Non -Owned Aircraft
Included
2
Non -Owned Watercraft
Included
2
Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock
Included
3
Medical Payments
$ 20,000
3
Damage to Premises Rented to You
$ 1,000,000
3
Supplementary Payments - Bail Bonds
$ 3,000
4
Supplementary Payments - Loss of Earnings
$ 1,000 per day
4
Newly Formed or Acquired Organizations
Included
4
Unintentional Failure to Disclose Hazards
Included
5
Knowledge of Occurrence, Claim or Suit
Included
5
Property Damage Liability - Elevators
Included
5
Property Damage Liability Borrowed Equipment
Included
5
Liberalization Clause
Included
6
Amendment of Pollution Exclusion (Premises)
Included
6
Limited Property Damage to Property of Others
$ 5,000
6
Additional Insured - Manager or Lessor of Premises
Included
7
CG 89 70 (Ed, 11114) (Page 1 of 12)
GREAT AMERICAN INS CO OF NY
Coverage Description
Limit of Insurance
Page
Additional Insured - Funding Sources
Included
7
Additional Insured - By Contract
Included
8
Primary and Non -Contributory Additional Insured Extension
Included
10
Additional Insureds - Protection of Your Limits
Included
10
Blanket Waiver of Transfer of Rights of Recovery Against Others
to Us (Subrogation)
Included
11
Property Damage Extension With Voluntary Payments
$ 1 ,0001$ 5,000
11
Who Is An Insured - Fellow Employee Extension - Management
Employees
Included
12
Broadened Personal and Advertising Injury
Included
12
A. Non -Owned Aircraft
Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property
Damage Liability, exclusion g. Aircraft, Auto or Watercraft does not apply to an aircraft provided:
1. it is not owned by any insured;
2. it is hired, chartered or loaned with a trained paid crew;
3. the pilot in command holds a currently effective certificate, issued by the duly constituted
authority of the United States of America or Canada, designating him or her a commercial or
airline pilot; and
4. it is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply if there is available to the Insured
other valid and collectible insurance, whether primary, excess (other than insurance written to apply
specifically in excess of this Policy), contingent or on any other basis, that would also apply to the
loss covered under this provision.
B. Non -Owned Watercraft
Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property
Damage Liability, subparagraph (2) of exclusion g. Aircraft, Auto or Watercraft is replaced by the
following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) less than 60 feet long; and
CG 89 70 (Ed. 11/14) (Page 2 of 12)
GREAT AMERICAN INS CO OF NY
(b) not being used to carry persons or property for a charge.
C. Bodily Injury - Mental Injury, Mental Anguish, Humiliation or Shock
Under SECTION V - DEFINITIONS, Definition 3. is replaced by the following:
3. "Bodily Injury" means physical injury, sickness, or disease, including death of a person. "Bodily
Injury" also means mental injury, mental anguish, humiliation, or shock if directly resulting from
physical injury, sickness, or disease to that person.
D. Medical Payments
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by
this Policy are amended as follows;
The Medical Expense Limit in paragraph 7, of SECTION III - LIMITS OF INSURANCE is replaced by
the following Medical expense Limit;
The Medical Expense Limit provided by this Policy shall be the greater of:
a. $ 20,000; or
b. the amount shown in the Declarations for Medical Expense Limit
This provision 7. is subject to all the terms of SECTION III - LIMITS OF INSURANCE.
E. Damage to Premises Rented to You
If Damage to Premises Rented to You is not otherwise excluded from this Coverage Part:
1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property
Damage Liability:
3. The last paragraph of paragraph 2. Exclusions is deleted in its entirety and replaced by the
following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke,
leakage from an automatic fire protection system or water to premises while rented to you
or temporarily occupied by you with permission of the owner. A separate Limit of
Insurance applies to this coverage as described in SECTION III - LIMITS OF INSURANCE.
However, this insurance does not apply to damage to premises while rented to you, or
temporarily occupied by you with the permission of the owner, caused by:
i. rupture, bursting, or operation of pressure relief devices;
ii. rupture or bursting due to expansion or swelling of the contents of any building or
structure, caused by or resulting from water;
iii. explosion of steam boilers, steam pipes, steam engines, or steam turbines; or
iv. flood
2. Paragraph 6. Under SECTION III - LIMITS OF INSURANCE is deleted in its entirety and
replaced with the following:
CG 89 70 (Ed. 11114) (Page 3 of 12)
GREAT AMERICAN INS CO OF NY
6. Subject to paragraph 5. above, the most we will pay under Coverage A for damages
because of "property damage" to any one premises, while rented to you, or in the case of
damage caused by fire, lightning, explosion, smoke, leakage from automatic fire protection
system or water while rented to you or temporarily occupied by you with the permission
of the owner, for all such damage caused by fire, lightning, explosion, smoke, leakage from
automatic fire protection systems or water proximately caused by the same event, whether
such damage results from fire, lightning, explosion, smoke, leakage from automatic fire
protection systems or water or any combination of the six, is the higher of $ 1,000,000 or
the amount shown in the Declarations for the Damage to Premises Rented to You Limit.
3. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, subsection 4. Other
Insurance, paragraph b. Excess Insurance where the words "Fire insurance" appear they are
changed to "insurance for fire, lightning, explosion, smoke, leakage from an automatic fire
protection system or water."
4. As regards coverage provided by this provision I. Damage to Premises Rented to You -
paragraph 9.a. of Definitions is replaced with the following:
9. a. a contract for a lease of premises. However, that portion of the contract for a lease of
premises that indemnifies any person or organization for damage by fire, lightning,
explosion, smoke, leakage from automatic fire protection systems or water to
premises while rented to you or temporarily occupied by you with the permission of
the owner is not an "insured contract";
F. Supplementary Payments
1. In the Supplementary Payments - Coverages A and B provision, paragraph 1.b. is replaced
with:
b. Up to $ 3,000 for the cost of bail bonds required because of accidents or traffic law
violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage
applies, We do not have to furnish these bonds.
2. Paragraph 1.d. is replaced by the following:
d. All reasonable expenses incurred by the Insured at our request to assist us in the
investigation or defense of the claim or "suit," including actual loss of earnings up to $
1,000 a day because of time off work.
G. Newly Formed or Acquired Organizations
Paragraph 3. of SECTION 11 - WHO IS AN INSURED is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
interest, 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 until the expiration of the policy period in
which the entity was acquired or formed by you;
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.
CG 89 70 (Ed. 11114) (Page 4 of 12)
GREAT AMERICAN INS CO OF NY
d. records and descriptions of operations must be maintained by the first named insured.
No person or organization is an insured with respect to the conduct of any current or past
partnership, joint venture or limited liability company that is not shown as a named insured in the
Declarations or qualifies as an insured under this provision.
H. Unintentional Failure to Disclose Hazards
Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to
Condition 6. Representations:
Failure of the .Insured to disclose all hazards existing as of the inception date of this Policy shall not
prejudice the insurance with respect to the coverage afforded by this Policy, provided such failure
or omission is not intentional on the part of the Insured.
I. Knowledge of Occurrence, Claim or Suit
Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to
Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit:
Knowledge of any occurrence, claim, or suit by any agent, servant or employee of the Named
Insured does not in itself constitute knowledge by the Insured unless notice of such injury, claim or
suit shall have been received by:
a. you, if you are an individual;
b. a partner, if you are a partnership
c, an executive officer or insurance manager, if you are a corporation.
J. Property Damage Liability - Elevators
1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property
Damage Liability, subparagraphs (3), (4) and (6) of exclusion j. Damage to Property do not
apply if such property damage results from the use of elevators.
2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS,
Condition 4. Other Insurance, paragraph b. Excess Insurance:
The insurance afforded by this provision of this Endorsement is excess over any property
insurance, whether primary, excess, contingent or on any other basis.
K. Property Damage Liability - Borrowed Equipment
1. Under paragraph 2. Exclusions of SECTION I - COVERAGE A - Bodily Injury and Property
Damage Liability, subparagraph (4) of exclusion j. Damage to Property does not apply to
"property damage" to borrowed equipment while not being used to perform operations at a job
site.
2. The following is added to SECTION IV - COMMERCIAL GENERAL LIABILITY Conditions,
Condition 4. Other Insurance, paragraph b. Excess Insurance:
The insurance afforded by this provision of this Endorsement is excess over any property
insurance, whether primary, excess, contingent or on any other basis.
CG 89 70 (Ed. 11114) (Page 5 of 12)
GREAT AMERICAN INS CO OF NY
L. Liberalization Clause
If we revise this Signature General Liability Broadening Endorsement to provide more coverage
without additional premium charge, your policy will automatically provide the coverage as of the
date the revision is effective in your state.
M. Amendment of Pollution Exclusion (Premises)
1. The following is added to paragraph (1)(a) of Exclusion f. of SECTION I - COVERAGE A -
Bodily Injury and Property Damage Liability:
(iv) "Bodily injury" or "property damage" arising out of the actual discharge, dispersal, seepage,
migration, release or escape of "pollutants."
As used in this Endorsement, the actual discharge, dispersal, seepage, migration, release or
escape of pollutants must;
(aa) commence on a clearly identifiable day during the policy period; and
(bb) end, in its entirety, within seventy-two (72) hours of the commencement of the
discharge, dispersal, seepage, migration, release or escape of "pollutants"; and
(cc) be discovered and reported to us within fifteen (15) days of the clearly identifiable day
that the discharge, dispersal, seepage, migration, release or escape of "pollutants"
commences; and
(dd) be neither expected nor intended from the standpoint of any insured; and
(ee) be unrelated to any previous discharge, dispersal, seepage, migration, release or
escape; and
(ff) not originate at or from a storage tank or other container, duct or piping which;
a. is below the surface of the ground or water; or
b. at any time has been buried under the surface of the ground or water and then is
subsequently exposed.
2. For the purposes of this coverage, the following is added to the definition of "property
damage" of SECTION V - DEFINITIONS and applies only as respects this coverage:
Land or water, whether below ground level or not, is not tangible property.
3. Coverage provided hereunder does not apply to any discharge, dispersal, seepage, migration,
release or escape that is merely threatened or alleged rather than shown to have actually
occurred.
N. Limited Property Damage to Property of Others
The following is added under SECTION 1 - SUPPLEMENTARY PAYMENTS - COVERAGES A and B:
3. We will pay up to $ 5,000 for loss to personal property of others while in the temporary care,
custody or control of an insured caused by any person participating in your organized activities.
For the purpose of this supplementary payment, loss shall mean damage or destruction but
does not include mysterious disappearance or loss of use. In the event of a theft, a police
report must be filed. This supplementary payment does not apply if:
a. coverage is otherwise provided by the Property Coverage part (if any) of this Policy; or
CG 89 70 (Ed. 11114) (Page 6 of 12)
GREAT AMERICAN INS CO OF NY
b. the loss is covered by any other insurance you have or by any insurance of such person
who causes such loss.
These payments will not reduce the Limits of Insurance.
O. Additional Insured - Manager or Lessor of Premises
1. SECTION II - WHO IS AN INSURED is amended to include as an additional insured any person
or organization from whom you lease or rent property and which requires you to add such
person or organization as an additional insured on this Policy under:
(a) a written contract; or
(b) an oral agreement or contract where a Certificate of Insurance showing that person or
organization as an additional insured has been issued;
but the written or oral contract or agreement must be an "insured contract," and,
(i) currently in effect or become effective during the term of this Policy; and
(II) executed prior to the "bodily injury," "property damage," "personal and advertising injury."
2. With respect to the insurance afforded to the Additional Insured identified in paragraph 1.
above, the following additional provisions apply;
(a) This insurance applies only with respect to the liability arising out of the ownership,
maintenance or use of that part of the premises leased to you.
(b) The Limits of Insurance applicable to the Additional Insured are the lesser of those
specified in the written contract or agreement or in the Declarations for this Policy and
subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance
applicable to the Additional Insured are inclusive of and not in addition to the Limits of
Insurance shown in the Declarations.
(c) In no event shall the coverages or Limits of Insurance in this Coverage Form be increased
by such contract.
(d) Coverage provided herein is excess over any other valid and collectible insurance available
to the Additional Insured whether the other insurance is primary, excess, contingent or on
any other basis unless a written contractual arrangement specifically requires this insurance
to be primary.
(e) This insurance applies only to the extent permitted by law.
3. This insurance does not apply to:
(a) Any "occurrence" or offense which takes place after you cease to be a tenant in that
premises,
(b) Structural alterations, new construction or demolition operations performed by or on behalf
of the Additional Insured.
P. Additional Insured - Funding Sources
1. SECTION If - WHO IS AN INSURED is amended to include as an additional insured any Funding
Source which requires you in a written contract to name the Funding Source as an additional
insured but only with respect to liability arising out of:
CG 89 70 (Ed. 11114) (Page 7 of 12)
GREAT AMERICAN INS CO OF NY
a. your premises; or
b. "your work" for such additional insured; or
c. acts or omissions of such additional insured in connection with the general supervision of
"your work"
and only to the extent set forth as follows:
a. The Limits of Insurance applicable to the Additional Insured are the lesser of those
specified in the written contract or agreement or in the Declarations for this Policy and
subject to all the terms, conditions and exclusions for this Policy. The Limits of Insurance
applicable to the Additional Insured are inclusive of and not in addition to the Limits of
Insurance shown in the Declarations.
b. The insurance afforded to the Additional Insured only applies to the extent permitted by law
c. If coverage provided to the Additional Insured is required by a contract or agreement, the
insurance afforded to such additional insured will not be broader than that which you are
required by the contract or agreement to provide for such additional insured.
d. In no event shall the coverages or Limits of Insurance in this Coverage Form be increased
by such contract,
Q. Additional Insureds - By Contract
1. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or
organization whom you have agreed to add as an additional insured in a written contract, written
agreement or permit. Such person or organization is an additional insured but only with respect
to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out
of:
a. your acts or omissions, or the acts or omissions of those acting on your behalf, in the
performance of your ongoing operations for the Additional Insured that are subject of the
written contract or written agreement provided that the "bodily injury" or "property damage
occurs, or the "personal and advertising injury" is committed, subsequent to the signing of
such written contract or written agreement; or
b. the maintenance, operation or use by you of equipment rented or leased to you by such
person or organization; or
c. the Additional Insureds financial control of you; or
d. operations performed by you or on your behalf for which the state or political subdivision
has issued a permit
However:
1. the insurance afforded to such additional insured only applies to the extent permitted by
law; and
2. if coverage provided to the Additional Insured is required by contract or agreement, the
insurance afforded to such additional insured will not be broader than that which you are
required by the contract or agreement to provide such additional insured.
With respect to paragraph 1.a. above, a person's or organization's status as an additional insured
under this Endorsement ends when:
CG 89 70 (Ed. 1 1114) (Page 8 of 12)
GREAT AMERICAN INS CO OF NY
(1) all work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed for or on behalf
of the Additional Insured(s) at the location of the covered operations has been completed;
or
(2) that portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
With respect to paragraph 1.b. above, this insurance does not apply to any "occurrence" which
takes place after the equipment rental or lease agreement has expired or you have returned
such equipment to the lessor.
The insurance provided by this Endorsement applies only if the written contract or written
agreement is signed prior to the "bodily injury" or "property damage."
We have no duty to defend an additional insured under this Endorsement until we receive
written notice of a "suit" by the Additional Insured as required in paragraph b. of Condition 2.
Duties in the Event of Occurrence, Offense, Claim or Suit under SECTION IV -
COMMERCIAL GENERAL LIABILITY CONDITION.
2. With respect to the insurance provided by
paragraph 2. Exclusions under SECTION I
Damage Liability:
This insurance does not apply to:
this Endorsement, the following are added to
COVERAGE A - Bodily Injury and Property
a. "Bodily injury" or "property damage" that occurs prior to your commencing operations at
the location where such "bodily injury" or "property damage" occurs.
b. "Bodily injury," "property damage" or "personal and advertising injury" arising out of the
rendering of, or failure to render, any professional architectural, engineering or surveying
services, including:
(1) the preparing, approving, or failing to prepare or approve, maps, shop drawings,
opinions, reports, surveys, field orders, change orders or drawings and specifications;
or
(2) supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other
wrongdoing in the supervision, hiring, employment, training or monitoring of others by that
Insured, if the "occurrence" which caused the "bodily injury" or "property damage," or the
offense which caused the "personal and advertising injury," involved the rendering of, or failure
to render, any professional architectural, engineering or surveying services.
c. "Bodily injury" or "property damage" occurring after:
(1) all work, including materials, parts or equipment furnished in connection with such
work, on the project (other than service, maintenance or repairs) to be performed for
or on behalf of the Additional Insured(s) at the location of the covered operations has
been completed; or
(2) that portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations for a principal as a part of the same
project.
CG 89 70 (Ed. 1 111 4) (Page 9 of 12 )
GREAT AMERICAN INS CO OF NY
d. Any person or organization specifically designated as an additional insured for ongoing
operations by a separate additional insured endorsement issued by us and made part of this
Policy.
3. With respect to the insurance afforded to these Additional Insureds, the following is added to
SECTION III - LIMITS OF INSURANCE:
If coverage provided to the Additional Insured is required by a contract or agreement, the most
we will pay on behalf of the Additional Insured is the amount of insurance:
a. required by the contract or agreement; or
b. available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This Endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
R. Primary and Non -Contributory Additional Insured Extension
This provision applies to any person or organization who qualifies as an additional insured under any
form or endorsement under this Policy.
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS
is amended as follows:
a. The following is added to paragraph a. Primary Insurance:
This insurance is primary to and will not seek contribution from any other insurance available to
an additional insured under your policy provided that:
(1) the Additional Insured is a named insured under such other insurance; and
(2) you have agreed in writing in a contract or agreement that this insurance would be primary
and would not seek contribution from any other insurance available to the Additional
Insured.
b. The following is added to paragraph b. Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental
contract or agreement, an equipment rental or lease contract or agreement or permit issued by
a state or political subdivision between you and an additional insured does not require this
insurance to be primary or primary and non-contributory, this insurance is excess over any
other insurance for which the Additional Insured is designated as a named insured.
Regardless of the written agreement between you and an additional insured, this insurance is
excess over any other insurance whether primary, excess, contingent or on any other basis for
which the Additional Insured has been added as an additional insured on other policies.
S. Additional Insureds - Protection of Your Limits
This provision applies to any person or organization who qualifie.s as an additional insured under any
form or endorsement under this Policy.
1. The following is added to Condition 2. Duties in the Event of Occurrence, Offense, Claim or
Suit:
An additional insured under this Endorsement will as soon as practicable:
CG 89 70 (Ed. 11114) (Page 10 of 12)
GREAT AMERICAN INS CO OF NY
a. give written notice of an "occurrence" or an offense that may result in a claim or "suit"
under this insurance to us;
b. tender the defense and indemnity of any claim or "suit" to all insurers whom also have
insurance available to the Additional Insured; and
c. agree to make available any other insurance which the Additional Insured has for a loss we
cover under this Coverage Part.
d. we have no duty to defend or indemnify an additional insured under this Endorsement until
we receive written notice of a "suit" by the Additional Insured.
2. The Limits of Insurance applicable to the Additional Insured are those specified in a written
contract or written agreement or the Limits of Insurance stated in the Declarations of this Policy
and defined in SECTION III - LIMITS OF INSURANCE of this Policy, whichever are less. These
limits are inclusive of and not in addition to the Limits of Insurance available under this Policy.
T, Blanket Waiver of Transfer of Rights of Recovery Against Others to Us (Subrogation)
Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added to
Condition 8. Transfer of Rights of Recovery Against Others to Us:
If required by a written contract or written agreement, we waive any right of recovery we may
have against a person or organization because of payment we make for injury or damage arising out
of your ongoing operations or "your work" done under a contract for that person or organization
and included in the "products -completed operations hazard" provided that the injury or damage
occurs subsequent to the execution of the written contract or written agreement,
U. Property Damage Extension with Voluntary Payments
1. The following is added to paragraph 1. Insuring Agreement of SECTION I - COVERAGE A -
Bodily Injury and Property Damage Liability:
At your request we will pay for "loss" to property of others caused by your business
operations for which this Policy provides liability insurance. Such payment will be made without
regard to your legal obligation to do so. The "loss" must occur during the policy period and
must take place in the "coverage territory."
2. With respect to the coverage afforded under paragraph 1. above, paragraph 2. Exclusions of
SECTION I - COVERAGES A - Bodily Injury and Property Damage Liability is amended as
follows:
Exclusions j.(3), j.(4), j.(5) and j.(6) are deleted.
3. As respects coverage afforded by this coverage, SECTION III - LIMITS OF INSURANCE is
replaced by the following:
Regardless of the number of insureds, claims made or "suits" brought or persons or
organizations making claims or bring "suits":
1. Subject to 2. Below, the most we will pay for one or more "loss" arising out of any one
"occurrence" is $ 1,000.
2. The aggregate amount we will pay for the sum of all "loss" in an annual period is $ 5,000.
This aggregate amount is part of and not in addition to the General Aggregate Limit
described in paragraph 2. of SECTION III - LIMITS OF INSURANCE.
CG 89 70 (Ed. 11114) (Page 11 of 12)
GREAT AMERICAN INS CO OF NY
V. Who Is an Insured - Fellow Employee Extension - Management Employees
1. The following is added to paragraph 2.a.(1) of SECTION II - WHO IS AN INSURED:
Paragraph (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury"
caused by an "employee" who is acting in a supervisory capacity for you. Supervisory capacity
as used herein means the "employee's" job responsibilities assigned by you, including the direct
supervision of other "employee" of yours. However, none of these "employees" are insureds
for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which
is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising
injury," caused in whole or in part by their intoxication by liquor or controlled substances.
This coverage is excess over any other valid and collectable insurance available to your
"employee,"
W. Broadened Personal and Advertising Injury
1, Unless "Personal and Advertising Injury" is excluded from this Policy, the following is added to
SECTION V - DEFINITIONS Item 14.;
h. mental injury, mental anguish, humiliation, or shock, if directly resulting from Items 14.a.
through 14.e.
CG 89 70 (Ed. 11/14) (Page 12 of 12)
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGATION
BLANKET BASIS
HOME OFFICE
SAN FRANCISCO EFFECTIVE JULY 1, 2021 AT 12.01 A.M.
ALL EFFECTIVE DATES ARE AND EXPIRING JULY 1, 2022 AT 12.01 A.M.
AT 12;01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
SPCALA
5026 W JEFFERSON BLVD
LOS ANGELES, CA 90016
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.
THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU
PERFORM WORT{ UNDER A WRITTEN CONTRACT THAT REQUIRES YOU
TO OBTAIN THIS AGREEMENT FROM US.
THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE
2.00% OF THE TOTAL POLICY PREMIUM.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCRIPTION
ANY PERSON OR ORGANIZATION
FOR WHOM THE NAMED INSURED
HAS AGREED BY WRITTEN
CONTRACT TO FURNISH THIS
WAIVER
BLANKET WAIVER OF
SUBROGATION
REP 04
9238891-21
RENEWAL
SC
3--23-54--
PAGE 1 OF
NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND
ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY
OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS IN THIS ENDORSEMENT,
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO:
;e:J� JULY 1, 2021
.-eg
2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO
SCIF FORM 10217 (REV,4-2018)
1
OLD DP 217