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PROOF OF INSURANCE (2022) CLOSEDWILLIA1 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 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 endorsementisl. PRODUCER r tdt-a Iv-A;J0W P. 104 1 ca,xrrc = I ! 0. .._.. _..—._ .... Rohm Insurance Agency LLC PHONE�c3 " t N k:" 14 51. 2965 9 y714 516 2960 7 License #OK07568 C qt .,t 26 Plaza Square, Suite 200 yfrarraramins.Cam Orange, CA 92866........... iRRAGE NAIC_ .......... Indrwnll.. Co of CT 25682 INSURED Williams Pipeline Contractors, .._"" INSURERS Travelers Prop Cas Co of Amer 25674 " Inc. P.O. Box 951030 INSURER C ......_. .... .."" Mission Hills, CA 91395 INSURER D : INSURER A..: INSURER F : COVERAGES CERTIFICATE, NUMBER.- REVISION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SU POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - CLAIMS -MADE X OCCUR Y Y 4TCOOP102323TCT21 /01/202 022 DAMAGE STi) RENTED 300,00 � MEI�_EXP_(A�ane person}......,. �... . 5' 00 PERSONAL & ADV INJURY --- ............. $ 1,000,000 _.._..._.. — GEN'LAGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 POLICY„rv_..,I XI PiRg LOC JL � PRODUCTS,- COMP/OP AGG„ � $2000000' OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO 8104NO58682212SG 09/01/2021 09/01/2022 a sar OWNED SCHEDULED _ AUTOS ONLY AUOOTOS _BODILY,ItdJUFti .(F!e BODILY I{VJURY GPer aacidant, P3 „ „_"""_"" X HbR X_. AU'TOShI PeOm de tl AMAOE SONLY LIAROCCUR EACHOCCURRENCER CLAIMS -MADE L AGGREGATE $ RETENTION$ WORKE COMPENSATION WORKERS X PER OTH- T'�+TUTE E D LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE Y UB4J573465212SG 09/01/2021 09/01/2022....,,,EL EACH ACCIDENT 1,000,000 ICE PRIETOR/PARTNER/EXECUTIVE �'sntt EMBEREXCLUDED? st.in NH)„E N/A L. DISEASE - EA EMPLOYEE 1,000,000 If yes, describe unde „"$ ..._. .. 1,000,000 DE CRIPTION F P RATIONS below E L DI EASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: ON -CALL SEWER SYSTEMS MAINTENANCE AND REPAIR SERVICES PROJECT #ENG 21-26 CITY OF EL SEGUNDO ITS OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, PRIMARY &'NON-CONTRIBUTORY AND WAIVER OF SUBROGATION AS RESPECTS TO GENERAL LIABILITY PER ENDORSEMENTS ATTACHED, WORKERS COMPENSATION WAIVER OF SUBROGATION APPLIES PER ENDORSEMENT ATTACHED. ELSEGUN CITY OF EL SEGUNDO 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 REPRESENTAAT/TIVV�E ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved,. The ACORD name and logo are registered marks of ACORD ..-� WILLIA1 OP ID: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/20/2021 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 endors+ement(sL PRODUCER 2ohm Insurance Agency LLC -icense #OK07568 26 Plaza Square, Suite 200 :)range, CA 92866 INSURED Williams Pipeline Contractors, Inc. P.O. Box 951030 Mission Hills, CA 91395 COVE CERTIFIC&M b1UJ#BER: rra 714-516-2960 1 r' .,_..714-516-2965 'Travelers Incler ni(rw Co of Cf....._ .Travelers Prop Cas Co of Amer 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.�— .....TYPE OF INSURANCE........ POLICYNUMBER._ .._,.. ,. POLICY EFFPOLICY EXP .. .� .... LIMITS.............. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE _._.... X � occuR Y ' Y 4TCOOP182323TCT21 09/01/2021 09/01/2022 DAMAGE TO RENTED .R.fI,�9.3.F.tarC�i.._ P _ $----___._. 300,000 MED EXP..IAnL_anepersan) $ . 000 . ......--......, PERSONAL & ADV INJURY $ 1,000,000 — -------------- .... GENLAGGREGATE LIMIT APPLIES PER G_E_NERALAGGREGATE 2,000- $_ PR - POLICY C._ JEf LOC PRODUCTS - COMP/OP AGG 2 000 0 T14 R; B AUTOMOBILE LIABILITY A...,,, COMBINED SCNGLE LIMIT CF �kf lxll� ......' 1,000,000 $.._. .., ...., 111-1 ................ X ANYAUTO Y Y 8104NO58682212SG 09/01/2021 09/01/2022 BODILYINJURYTPerpersan)ww " OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident _ ZRS X AU" O �C Y .IE e sd nC AMAGE._ $ ..X ONLY U ._ .._ B X1 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE CUPBJ387414212S 09/01/2021!09/01/2022 AGGREGATE_. $ 1,000,000 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION X OTH T9TL!TF 1 ILITY Y / N AND ANY PROPRIEERMEMO R EXCLUDED ANY PROPRIETOR/PARTNER/EXECUTIVE LJ NIA Y UB4J573465212SG 09/01/2021 09/01/2022 m E L. EACH ACCIDENT $ 1,000,000 andatory in NH) E DISEASE EA EMPLOYEE $___ 1,000,000 If yyes, describe under . „_.,.PLOYEE OI A P 1 Y 1,000,000 DE CRIPTION OF P Tl NS below LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: PROJECT #PW 21-05 WATER MAIN IMPROVEMENTS ON GRAND AVENUE. CITY OF EL SEGUNDO ITS OFFICERS, OFFICIALS EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONALL INSURED„ PRIMARY 5, N614-CONTRIBUTORY AND WAIVER OF SUBROGATION AS RESPECTS TO GENERAL LIABILITY AND AUTO LIABILITY PER ENDORSEMENTS ATTACHED. WORKERS COMPENSATION WAIVER OF SUBROGATION APPLIES PER ENDORSEMENT ATTACHED. ELSEGUN CITY OF EL SEGUNDO 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. AUTHyO,RIIZZED REPRESENTATIVE Gam- o�_ 4aat "�__ OF ACORD 26 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NAMED INSURE[]: WILLIAMS PIPELINE CONTR/\CTORS, INC. POLICY NUMBER'�T��O�1��T�7�1 � COMMERCIAL GENERAL LIABILITY POLICY TERM: 09/01/2021 TO 09/01/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ��U�0n��K 8�� ~��nn�m��o ADDITIONAL o��U�N�� uo�m��D�J��(includes Prod ucts-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following ksadded 1wSECTION U|—WHO kS AN INSURED: Any person or organization that you agree in m written contract or agreement to include as an additional insured on this Coverage Part is on insuned, but only: a' With respect to liability for "bodily injury" or "property damage" that 000uoe' orfor "personal injury" caused by an offense that is comnmnitted, subsequent to the signing of that contract or agreement and while that pad of the contract or agreement ioineffect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor inthe performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person ororganization. The insurance provided tosuch additional insured is subject tothe following provisions: a' If the Limits of Insurance of this Coverage Pod shown inthe Declarations exceed the minimum |irnUs required by the written contract o, egreamnent, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation app|ims, the minimum limits required by the vvrd1mn contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the |inmdg of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "persona|inkury" arising out ofthe providing, or failure to pnovide, any professional architectural, engineering or surveying services, including: (a) The prepmhnQ, apprnving, or failing to prepare or mppn)ve, nnmps, shop dravvngs, opiniVno, nypmrts, surveyo, field orders or change ondens, or the prnparing, approvin0, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, imapection, architectural or engineering activities. (2) Any "bodily injury" or "property Uenomge^ caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such uovnne0e for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give uawritten notice assoon aspracticable of an "000unnnom^ or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses ofany injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. b. The insurance provided to such additional (2) Ifaclaim kamade or"suit'ksbrought against insured does not apply to: the additional insured: COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or"suUt"and the date received; and (b) Notify usmssoon mspracticable and see to itthat vvm receive written notice of the claim or''nuif'assoon aspracticable. (3) Immediately mend us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the ^muit', and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. Howevar, this condition does not m0aot whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured asdescribed inParagraph 4.. Other Insurance, of Section K%'— Cornnnmncia| General Liability Conditions. Page 2of2 @om10The Travelers Indemnity Company. All rights reserved, CG D246 04 19 NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY #4TCOOP182323TCT21POLICY TERM: DS01/2U21TODA01/2022 COMMERCIAL GENERAL LIABILITY PRIMARY & NON-CONTRIBUTORY c. Method Of Sharing |fall ofthe other insurance permits contribution byequal shares, wewill follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. |fany ofthe other insurance does not permit contribution by equal ehares, we will contribute by limits. Under this mnmthmd, each insurers share iobased onthe ratio ofits applicable limit of insurance to the total applicable limits of insurance ofall insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary bmsis, or m primary and non- contributory bmsio, this insurance is primary to other insurance that is available to such insured which covers such insured as anamed insured, and wowill not share with that other insurance, provided that: (1) The "bodily injury' pr"property damage" for which coverage kssought occurs; and (2) The "personal and advertising injury' for which coverage issought h; caused by an offense that is committed; subsequent to the signing of that contract or agreement byyou. 6' Premium Audit a. VVawill compute all premiums for this Coverage Part inaccordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium isadeposit premium only. At the dose of each audit period wmwill compute the earned premium for that period and send notice tuthe first Named Insured. The due date for audit and retrospective premiums isthe date shown asthe due date onthe bill. |fthe sum mf the advance and audit premiums paid for the policy period is greater than the earned pnennium, we will return the excess to the find Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send uncopies otsuch times aswmmay request. 6. Representations Byaccepting this po|ioy, you agree: a' The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made tous; and c. We haw issued this policy in n»||anma upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonnenevms(inaccordance with applicable insurance laws or regulations. 7. SeparationQfInsureds Except with respect to the Limits ofInsurance, and any rights or duties specifically assigned in this Coverage Part to the first Named |naurmd, this insurance applies: a- As if each Named Insured were the only Named Insured; and b. Separately toeach insured against whom claim ismade mr^suit'iebrought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part nfany payment we have made under this Coverage Part, those rights are transferred tous. The insured must donothing after loss toimpair them. Adour request, the insured will bring "muit'ortransfer those rights tousand help uaenforce them. 9. When We Do Not Renew kvedecide not to renew this Coverage Part, vewill mail ordeliver bxthe first Named Insured ohovml in the Declarations written notice of the nonnenevma| not less than 3Odays before the expiration date. If notice ismailed, proof of mailing will be sufficient proof of notice. SECTION V—DEFINUTYONS 1' 'AUvedisexent'means anotice that isbroadcast m published to the general public or specific market oagrnmnby about your goods, products or services for the purpose of attracting customers or supporters. For the purposes ofthis definition: a. Notices that are published include material placed on the Internet or on similar electronic means ofcommunication; and b. Regarding vmebsi1es, only that part of vmebode that is about your goods, products orservices for the purposes of attracting customers or supporters imconsidered anadvertisement. Page 16of21 m20nrThe Travelers Indemnity Company. All rights reoamou. CG T1 0002 19 Includes copyrighted material ofInsurance Services Office, Inc. with its permission. NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY NUMBER: 4TCOOP182323TCT21 POLICY TERM: 09/01/2021 TO 09/01/2022 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries — > B. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN INSURED: C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability — Railroads F. Damage To Premises Rented To You a. An organization other than a partnership, joint venture or limited liability company; or b. A trust; as indicated in its name or the documents that govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury", "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II — Who entity; or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products -completed operations hazard". CG D3 16 02 19 © 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b.Vfthe definition of "ncounenoo^ in the DEFINITIONS Section: b. An mot or omission committed in providing or failing to provide "incidental medical services", first mid or "Good Samaritan services" too pemeon, 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 If — WHO IS ANUNS0RED: Un|moo you are in the business or occupation nfproviding professional health care services, ParmQnypha(1)(m). (b). (c) and (d) above do not apply to "bodily injury" arising out of providing urfailing toprovide: (a) "Incidental medical services" by any of your "employees" who is a nuroe, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer wmrkans", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first mid 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 ofyour business. 3. The following nap|acmo the last sentence of Paragraph 6. of SECTION YVU — 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 mid or "Good Samaritan services" toany one person will bedeemed to beone "occurwenme" 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION K — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE Sale Of Pharmaceuticals "Bodily injury' m"property domage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge orconsent of, the insured. 5' The following is added to the DEFINITIONS "Incidental medical services" means: xu Medico, surgical, dental, |eborgtorV, x-ray or nursing service or treatment, advice or instTucUon, or the related furnishing of hx/d or beverages; or b. The furnishing or dispensing of drugs or mneUica|, dmnto(, or surgical supplies or appliances. 6. The following is added to Paragraph 4'b.. Excess Insurance, of SECTION UV — COMMERCIAL GENERAL LIABILITY This imsuomom is excess over any valid and collectible other inourancm, whether phmnary, excess, contingent oronany other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the e)dent not subject to Paragraph 2'e'(1) of Section || —VVhu Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer OfRights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: K the insured has agreed in m contract or agreement to waive that imsuned's right of recovery against any person or organization, we waive our right ofrecovery against such person or orgonizmdion, but only for payments we make because of: a' "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. E. CONTRACTUAL LIABILITY —RAILROADS <------ 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c' Any easement orlicense agreement; Page of 0 2017The Travelers Indemnity Company. All rights reserved. CG[3 16 02 19 COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(I) of the definition of "insured contract" in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D3 16 0219 0 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY NUMBER: 8104NO58682212SG POLICY TERM: 09/0112021 TO 09/01/2022 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I a 1IM12144--yAll This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COVERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — LIABILITY COV- ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — LI- ABILITY COVERAGE: The following is added to Paragraph c. in A.1., An "employee" of yours is an "insured" while Who Is An Insured, of SECTION 11 — LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" Any person or organization who is required under name, with your permission, while performing duties related to the conduct of your busi- a written contract or agreement between you and ness. that person or organization, that is signed and CA T3 53 06 09 Q 2009 The Travelers Companies, Inc. Page 1 of 4 Includes the copyrighted material of Insurance Services Office. Inc. with its permission. COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS The following replaces Subparagraph e. in Para- graph B.7., Policy Term, Coverage Territory, of SECTION IV — BUSINESS AUTO CONDITIONS: e. Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their house- holds. (1) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (a) You must arrange to defend the "insured" against, and investigate or settle any such claim or "suit" and keep us advised of all pro- ceedings and actions. (b) Neither you nor any other in- volved "insured" will make any settlement without our consent. (c) We may, at our discretion, par- ticipate in defending the "insured" against, or in the settlement of, any claim or "suit". (d) We will reimburse the "insured": (i) For sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "insured" pays with our consent, but only up to the limit described in Paragraph C., Limit Of Insurance, of SECTION II — LIABILITY COVERAGE; (ii) For the reasonable expenses incurred with our consent for your investigation of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit de- scribed in Paragraph C., Limit Of Insurance, of SECTION II — LIABILITY COVERAGE, Page 2 of 4 © 2009 The Travelers Companies, Inc. CA T3 53 06 09 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (2) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess contingent or on any other basis. (3) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (4) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL EFFECTS The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident' or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); CA T3 53 06 09 © 2009 The Travelers Companies, Inc. Page 3 of 4 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 © 2009 The Travelers Companies, Inc. CA T3 53 06 09 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. NAMED INSURED: WILLIAMS PIPELINE CONTRACTORS, INC. POLICY NUMBER: 8104NO58682212SG POLICY TERM: 09/01/2021 TO 09/01/2022 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A W-11 lot] 1] 0 A 9 11 Z ra , N 6191 • • This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.l.c., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION II. 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an addi- tional insured person or organization is the first named insured when the written contract or agreement between you and that person or or- ganization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy pe- riod, requires this insurance to be primary and non-contributory. CA T4 74 0215 0 2015 The Travelers Indemnity Company, All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 4T" WORKERS COMPENSATION TRAVELERS AND ONE TOMR SQUAU EMPLOYERS LIABILITY POLICY H9RTP01M, CT 06183 ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: UB4J573465212SG 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 mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. % of the California workers' compensation pre - 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 09/01/2021 Policy No. UB4J573465212SG Endorsement No. Insured WILLIAMS PIPELINE CONTRACTORS, INC. Premium Insurance Company Countersigned by TRAVELERS PROP CAS CO OF AMER DATE OF ISSUE: 08-20-2021 Page 1 of 1