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PROOF OF INSURANCE (2022 - 2022) CLOSEDA�--�C 1 �® �V/� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 06/10/2021 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 Bannister & Associates Insurance Agency CA License #0691071 CONTACT NAME: Kerry Wakely PHONE FAX A/C No Ext: (714) 536-6086 A/C No: (714) 536-4054 E-MAIL ADDRESS: kerry@bai-ins.com 305 17th Street Huntington Beach CA 92648 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Depositors Insurance Company 42587 INSURED (310) 618-2600 Carter Services, Inc. INSURERB:AMCO Insurance Company 19100 INSURERC:security National Insurance Co 19879 INSURERD: 2807 Oregon Court, F3 INSURER E7 Torrance CA 90503 INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 6017 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Ix I OCCUR y ACP 3087747466 06/15/2021 06/15/2022 DA PREM SESOEa occurDence $ 1,000,000 MED EXP (Any one person) $ 51000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ 2,000,000 POLICY JJECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 lEmpl Benefits Liab $ 1,000,000 OTHER I AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ACP 3087747466 06/15/2021 06/15/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB X OCCUR ACP 3087747466 06/15/2021 06/15/2022 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ C WORKERS COMPENSATION Y/N AND EMPLOYERS' LIABILITY y SWC1335225 04/01/2021 04/01/2022 X STATUTE EERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N /A E.L. DISEASE - EA EMPLOYEE $ 11000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of E1 Segundo, its officials and employees are named as additional insureds with respects general liability policy limits. Primary and non-contributory wording applies with respects general liability policy limits. Waiver of subrogation applies with respects workers compensation policy limits. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo City Clerk AUTHORIZED REPRESENTATIVE 350 Main Street, Room 5 E1 Segundo CA 90245 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 POLICY NUMBER: ACP 3087747466 COMMERCIAL GENERAL LIABILITY CG 81 86 03 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTIONGARDsm GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: The following is a summary of the additional coverages provided by this endorsement. For complete details on a specific coverage, consult the endorsement contract language. 1. Additional Insureds Various additional insured extensions 2. Aggregate Limit Per Project 3. Blanket Waiver of Subrogation If required by written contract, insurer waives right of subrogation 4. Broad Form Named Insured 5. Broadened Definition of BI Definition includes mental anguish 6. Broadened Liability Coverage for Damage to "Your Product' and "Your Work" 7. Contractual Liability — Railroads Expanded definition of "insured contract" 8. Contractual Liability for Personal and Advertising Injury 9. Damage to Premises Rented to You Extends perils Limit: $1,000,000 10. Electronic Data Liability Limit: $100,000 11. Expected and Intended Injury 12. Incidental Medical Malpractice 13. Knowledge of Occurrence 14. Liberalization 15. Lost Key Coverage Occurrence Limit: $10,000 16. Newly Formed and Acquired Organizations 180 days 17. Non -owned Aircraft 18. Non -owned Watercraft Included for watercraft up to 51 ft 19. Supplementary Payments Increased bail bonds limit to $5,000 Increased daily loss of earnings limit to $1,000 per day 20. Unintentional failure to Disclose Hazard 21. Non -duplication of Benefits CG 81 86 03 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 7 with its permission. CG 81 86 03 19 1. Additional Insured — Automatic Status When granting the franchise or license Required In An Agreement Or Contract With ends. You d. Lessors of Leased Equipment — SECTION II — WHO IS AN INSURED is with respect to their liability for amended to include: "bodily injury", "property damage", or 1. Any person(s) or organization(s) whom you "personal and advertising injury", are required to add as an additional caused in whole or in part by your insured on this policy under a written maintenance, operation, or use of contract or written agreement, provided the equipment leased to you by such written contract or written agreement: person(s) or organization(s). This insurance does not apply to any (1) Is currently in effect or becomes "occurrence" which takes place after effective during the term or this the equipment lease expires. policy; and However, their status as additional (2) Was executed prior to the "bodily insured under this policy ends when injury," "property damage" or their lease, contract, or agreement "personal and advertising injury" with you for such leased equipment for which the additional insured expires. seeks coverage. e. Lessor of Land —with respect to The person or organization added as an liability arising out of the ownership, additional insured by this endorsement is an maintenance or use of that specific additional insured only with respect to liability part of the land leased to you and for: subject to the following additional 1. "Bodily injury" or "property damage" or exclusions: 2. "Personal and advertising injury"; This insurance does not apply to: due to: (1) Any "occurrence" which takes a. Controlling Interest — with respect place after you cease to be a to their liability arising out of: tenant in that premise; or (1) Their financial control of you; or (2) Structural alterations, new construction or demolition (2) Premises they own, maintain or operations performed by or on control while you lease or behalf of such additional occupy these premises. insured. This insurance does not apply to However, their status as additional structural alterations, new insured under this policy ends when construction and demolition you cease to be a tenant of such operations performed by or for such premises. additional insured. f. Managers or Lessors of Premises b. Co-owner of Insured Premises — —with respect to liability arising out with respect to the co -owner's of the ownership, maintenance, or liability as a co-owner of such use of that part of the premises you premises. own, rent, lease, or occupy. c. Grantor of Franchise or License This insurance does not apply to: Any person or organization that has (1) Any "occurrence" which takes granted you a franchise or license place after you cease to be a by written contract or agreement is tenant in that premises; or an additional insured, but only with respect to their liability as a grantor (2) Structural alterations, new con - of afranchise or license to you. struction, or demolition However, their status as additional operations performed by or on behalf the insured under this policy ends when person or organization. their contract or agreement with you Page 2 of 7 Includes copyrighted material of Insurance Services Office, Inc., CG 81 86 03 19 with its permission. CG 81 86 03 19 However, their status as additional This exclusion applies even insured under this policy ends when if the claims against any you cease to be a tenant of such insured allege negligence premises. or other wrongdoing in the g. Mortgagee, Assignee or Receiver supervision, hiring, — with respect to their liability as employment, training or mortgagee, assignee, or receiver monitoring of others by that and arising out of the ownership, insured, if the "occurrence" maintenance, or use of a premise which caused the "bodily by you. This insurance does not injury" or "property apply to structural alterations, new damage", or the offense construction or demolition which caused the "personal operations performed by or on and advertising injury", behalf of such additional insured. involved the rendering of, or h. Owners, Lessees, or Contractors failure to render, any professional, architectural, — with respect to liability for "bodily engineering, or surveying injury", "property damage", or services. "personal and advertising injury" caused in whole or in part, by: i. State or Political Subdivision — (1) Your acts or omissions; or Permits Relating to Premises with respect to the following (2) The acts or omissions of those hazards for which the state or acting on your behalf, in the political subdivision has issued a performance of your ongoing permit or authorization in operations performed for that connection with premises you own, additional insured, whether the rent, or control and to which this work is performed by you or on insurance applies. your behalf; or (1) The existence, maintenance, (3) "Your work" performed for that repair, construction, erection, or additional insured and included removal of advertising, signs, in the "products -completed awnings, canopies, cellar operations hazard." entrances, coal holes, drive - The insurance does not apply ways, manholes, marquees, to: hoist away openings, sidewalk (a) "Bodily injury", "property vaults, street banners, or damage", or "personal and decorations and similar advertising injury" arising exposures; or out of the rendering of or the (2) The construction, erection, or failure to render any removal of elevators; or professional architectural, (3) The ownership maintenance or engineering, or survey use of any elevators covered by services, including: this insurance. (i) The preparing, approv- This insurance does not apply to: ing, or failing to prepare or " ro 1 "Bodilyin ur "property () y p p y or approve maps, shop damage" or "personal or drawings, opinions, advertising injury" arising out of reports, survey, field operations performed for the orders, change orders, state or municipality; or or drawings and specifications; or (2) "Bodily injury" or "property (ii) Supervisory, inspection, damage" included within the "products-completed architectural or eon operations hazard". neering activities. CG 81 86 03 19 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 7 with its permission. CG 81 86 03 19 However, such state or political subdivision's status as additional insured under this policy ends when the permit ends. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. The insurance afforded to such additional insureds described in a.- i. above: (1) Only applies to the extent 5 permitted by law; and (2) Will not be broader than any coverage requirement in a contract or agreement to provide for such additional insured. 2. Aggregate Limit Per Project Under SECTION III — LIMITS OF INSURANCE, the following paragraph is added to Paragraph 2: The General Aggregate Limit under SECTION III LIMITS OF INSURANCE applies separately to each of your construction projects away from premises owned by or rented to you. 3. Blanket Waiver Of Subrogation Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" included in the "products completed operations hazard." However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: a. Is in effect or becomes effective during the term or this policy; and b. Was executed prior to loss. 4. Broad Form Named Insured Under SECTION II — WHO IS AN INSURED, the following is added to Paragraph 2: e. Any business entity incorporated or organized under the laws of the United State of America (including any State thereof), its territories or possessions, or Canada (including any Province thereof) in which the 6 Named Insured shown in the Declarations owns, during the policy period, an interest of more than fifty percent. If other valid collectible insurance is available to any business entity covered by this solely by reason of ownership by the Named Insured shown in the Declarations in excess of fifty percent, this insurance is excess over the other insurance, whether primary, excess, contingent, or on any other basis. Broadened Bodily Injury Definition (Mental Anguish) Under SECTION V — DEFINITIONS, Definition 3. "Bodily Injury" is replaced with: 3. "Bodily injury" means physical injury, sickness, or disease to a person and if arising out of the foregoing, mental anguish, mental injury, shock, or humiliation, including death at any time resulting therefrom. Broadened Liability Coverage for Damage to "Your Product" and "Your Work" Under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2. Exclusions is amended to delete exclusions k. and I. and replace them with the following: This insurance does not apply to: k. Damage to Your Product "Property damage" to "your product" arising out of it or any part of it except when caused by or resulting from: (1) Fire; (2) Smoke; (3) Collapse; or (4) Explosion. I. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products -completed operations hazard". This exclusion does not apply: (1) If the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor; or (2) If the cause of loss to the damaged work arises as a result of: (a) Fire; (b) Smoke; Page 4 of 7 Includes copyrighted material of Insurance Services Office, Inc., CG 81 86 03 19 with its permission. (c) Collapse; or (d) Explosion. Under SECTION III — LIMITS OF INSURANCE, the following paragraph is added: Subject to 6. above, $100,000 is the most we will pay under Coverage A for the sum of damages arising out of any one "occurrence" because of "property damage" to "your product' and "your work" that is caused by fire, smoke, collapse or explosion and is included within the "product -completed operations hazard". This sublimit does not apply to "property damage" to "your work" if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. 7. Contractual Liability — Railroads a. Under SECTION V — DEFINTIONS, the following replaces Paragraph c. of definition 9. "Insured Contract': c. Any easement or license agreement; b. Under SECTION V —DEFINITIONS, Paragraph f.(1) of definition 9. "Insured Contract' is deleted. 8. Contractual Liability for Personal and Advertising Injury Under SECTION I — COVERAGES, COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2. Exclusions is amended to delete exclusion e. Contractual Liability. This provision 8. does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 9. Damage to Premises Rented to You a. Under SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, the last paragraph of 2. Exclusions is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. b. Under SECTION III — LIMITS OF INSURANCE, Paragraph 6. is replaced with: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of CG 81 86 03 19 "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion, smoke or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. c. Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; 10. Electronic Data Liability a. Under SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following: This insurance does not apply to: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury." b. Under SECTION III — LIMITS OF INSURANCE, the following paragraph is added: Subject to paragraph 5. above, $100,000 is the most we will pay under Coverage A for all damages arising out of any one "occurrence" because of "property damage" that results from physical injury to tangible property and arises out of "electronic data". c. Under SECTION V — DEFINITIONS, the following definition is added: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media CG 81 86 03 19 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 7 with its permission. CG 81 86 03 19 which are used with electronically 12. Incidental Medical Malpractice Liability controlled equipment. a. Under SECTION II — WHO IS AN INSURED, d. Under SECTION V — DEFINITIONS, the Paragraph 2.a.(1)d. does not apply to definition of "property damage" is replaced nurses, emergency medical technicians or by the following for the purposes of the paramedics employed by you arising out of coverage provided by this endorsement his or her providing or failing to provide only: professional health care services, but only if 17. "Property damage" means: such healthcare services are within the a. Physical injury to tangible property, scope of their employment by you or are including all resulting loss of use of related to or arise out of the conduct of your that property. All such loss of use business. shall be deemed to occur at the b. This coverage does not apply if you are time of the physical injury that engaged in the business or occupation of caused it; providing professional health care services. b. Loss of use of tangible property 13. Knowledge Of An Occurrence that is not physically injured. All Under SECTION IV — COMMERCIAL such loss of use shall be deemed GENERAL LIABILITY CONDITIONS, the to occur at the time of the following is added to 2. Duties In The Event Of "occurrence" that caused it; or Occurrence, Offense, Claim Or Suit: c. Loss of, loss of use of, damage to, e. Knowledge of an occurrence, offense, claim corruption of, inability to access, or or suit by an agent or employee of any inability to properly manipulate insured shall not in itself constitute "electronic data," resulting from knowledge of the insured unless you, a physical injury to tangible property. partner, if you are a partnership; or an All such loss of "electronic data" executive officer or insurance manager, if shall be deemed to occur at the you are a corporation receives such notice of time of the "occurrence" that an occurrence, offense, claim or suit from caused it. the agent or employee. For the purposes of this insurance, f. The requirements in Paragraph b. will not be "electronic data" is not tangible considered breached unless there is property. knowledge of occurrence as outlined in e. If Electronic Data Liability is provided at a Paragraph e. above. higher limit by another endorsement 14. Liberalization attached to this policy, then the $100,000 limit provided by this Provision 10. If we revise this endorsement to provide more Electronic Data Liability is part of, and not coverage without additional premium charge, we in addition to, that higher limit. will automatically provide the additional coverage to all endorsement holders as of the day the 11. Expected or Intended Injury revision is effective in your state. Under SECTION I — COVERAGES, COVERAGE A — BODILIY INJURY AND PROPERTY DAMAGE LIABILITY, Exclusion a. is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 15. Lost Key Coverage a. Under SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, coverage is extended to include the following: If a customer's master or grand key, excluding electronic key card, is lost, damaged or stolen while in your care, custody or control we will pay the cost of replacing the keys, including the master lock and all keys used in the same lock, the cost of adjusting locks to accept the new keys, or the cost to replace the locks, whichever is less. Page 6 of 7 Includes copyrighted material of Insurance Services Office, Inc., CG 81 86 03 19 with its permission. b. Limit of Insurance — For the purpose of this coverage the most we will pay is $ 10,000 per "occurrence". 16. Newly Formed And Acquired Organizations a. Under SECTION II — WHO IS AN INSURED, in paragraph 3.a., 90th day is changed to 180th day. b. This provision does not apply if coverage for newly formed or acquired organizations is excluded either by the provisions of the Commercial General Liability Coverage Form or by any applicable endorsement. 17. Non -Owned Aircraft Under SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Exclusion g. does not apply to an aircraft provided: a. It is hired, chartered or loaned with a paid crew; b. It is not owned by an insured; c. The pilot in command holds a currently effective license for the particular aircraft being flown, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial airline pilot; and d It is not being used by the insured to carry persons or property for a charge. The following is added to SECTION IV, COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4. Other Insurance, paragraph b. Excess Insurance: This Non -Owned Aircraft insurance is excess over any other valid and collectible insurance whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis that would also apply to loss covered under this provision. 18. Non -Owned Watercraft Under SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph (2) of Exclusion g. is deleted and replaced with CG 81 86 03 19 the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used by the insured to carry persons or property for a charge. 19. Supplementary Payments Under SECTION SUPPLEMENTARY COVERAGES A AND 1.d. are replaced with: — COVERAGES, PAYMENTS — B Paragraphs 1.b and b. Up to $5,000 for 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. 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 from work. 20. Unintentional Failure To Disclose Hazard Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 6. Representations the following paragraph is added: d. Your failure to disclose all hazards or prior "occurrences" or offenses existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" or offenses is not intentional. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. 21. Non -Duplication of Benefits No one will be entitled to receive duplicate payments for the same elements of loss under any of the coverages provided by the Commercial General Liability Coverage form, this endorsement, or any other applicable endorsement. All terms and conditions of this policy apply unless modified by this endorsement. CG 81 86 03 19 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 7 with its permission. POLICY NUMBER: ACP 3087747466 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. 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 All terms and conditions of this policy apply unless modified by this endorsement. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 4/1/2021 Policy No. SWC1335225 Endorsement No. 0 Insured Carter Services, Inc. Premium $ 79,329 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84)