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PROOF OF INSURANCE (2022) CLOSEDDATE(MM/DDIYYYY) ACC>R" CERTIFICATE OF LIABILITY INSURANCE 111110/12/2021 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 CONTACT NAME Direct All Inquiries to Email Arthur J. Gallagher Risk Management Services, Inc. ..,,.,,.... PHONE - FAX 300 S. Riverside Plaza, Suite 1500 WC-001AeX4l,. --- _ E MAIL Chicago IL 60606 a;gp8g s Chl_Certaficates@ajg.com INSURER(S) AFFORDING COVERAGE I NAIC# INSURER A; Arch Insurance Company 11150 INSURED ARTHJGA113 INSURERS Arch Indemnl Insurance Company 30830 y Gallagher Benefit Services, Inc. INSURERC ACE Pro erl & Casualt Insurance Co 20699 Y P.. Koff & Associates m.... ..P, _ .... 2835 Seventh Street INSURERD 1_,r Berkeley CA 94710 INSURER E INSURER F . COVERAGES CERTIFICATE NUMBER:387954975 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. ILTR �.-,,.. , ,TYPE OF INSURANCE ._. ,. �ADDL�SbBR� , .-........ POLICY NUMBER �..... MMIDDYIYEIF PO lYEY'r""q" _..., -___._._._. .. ... ........ LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 41GPP4938414 10/1/2021 10H/2022 EACH OCCURRENCE $2,000,000 OCCUR ...... CLAIMS -MADE ��(. ,. ._ � � litLN I L(3._._ ..._ i%MhGEi(�Bpsce�rrcw) $1,000,000 MEDIEIXP�Aoy one person) $ 10 000 ( .. �� PERSONAL & ADV INJURY ` $ 2.000,000 ...., IT APPLIES PER: � N"L AGGREGATELIMIT $ 4,OOD,000 GENERALA , POLICY JECT �, LOG iPRODUCTSGGREGATE COMP/OPAGG $4000,000 A AUTOMOBILE LIABILITY Y 41CAB4938314 O0/11//2021 2 O'O"NIMNEDSINGLEUM1T $5,000000 ()ppeJ (MA) `X ANY AUTO .A 11021,0/1/2022 41C114939014 01 BODILY INJURY (Per person) ; $ I OWNED j SCHEDULED BODILY INJURY (Per accident) $ X AUTOS ONLY ,_._ !AUTOS HIRED NON -OWNED ;.mF'PdOF"ERl'"f DAMAiii: --- i ... $ ....,,[ AUTOS ONLY ._-XAUTOS ONLY C X UMBRELLA LIAB X OCCUR XEU G46820149 005 10/1/2021 10/1/2022 EACH OCCURRENCE $ 10 000 000 EXCESS LIAB CLAIMS MADE, AGGREGATE $ 10,000,000 V _..is l DED j X I RETENTION $ ( I, A WORKERS COMPENSATION y 41WCI4938114 10/1/2021 I 10/1/2022 �X PEROTH E ER 1 ® AND EMPLOYERS' LIABILITY Y� (AOS) Mo CI0501914 NY, TX, CA, KY 10/1 /2021 10/1 /2022 ACCIDENT $1,000,000 EL EACH A A YPR PRIET ER EXCTNER/E ECUTIVE N NIA I ----- Mandato m NH (Mandatory ) ,E EA EMPLOYEE $ 1,000,000 I � E L DISEASE If yes, describe under DESCRIPTION OF OPERATIONS below 1 4 I I E , DISEASE - POLICY LIMIT I $ 1,000,000 � I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) General Liability, General Aggregate Per Location Subject to $10 Mil Policy aggregate. Cit of El Segundo, its officers, officials„ employees & volunteers are Additional Insureds as respects General Liability policy pursuant to and subject to the be po ucy"s terms, definitions, conditions and exclusions, The Insurance provided in the General Liability is primary and any, other Insurance shall excess only, and not contributing. Waiver of Subrogalion applies to additional Insureds„ as respects General Liability, Auto Liability and Workers Cornpensation policies pursuant to and Subject to the policy's terms„ definitions, conditions and exclusions. 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 El Segundo 350 Main Street AUTHORIZED REPRESENTATIVE El Segundo CA 90245 r Via. ; ✓"""gym- r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDrrNY) 10/12/2021 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 NAM1E.. Arthur J. Gallagher Risk Management Services, Inc. PHONE X()" 312-704-0100 FAz i Arc Na 312 803 744 300 S. Riverside Plaza, Suite 1500 Chicago IL 60606 A DR.ESs ........ INSURERS AFFORDING COVERAGE .L...L,.,., .._.... .................. NAIC # .................. ---- ... --- INSURER Indian Harbor Insurance Company ... _ 36940 ... ,.,, INSURE ....---.._.._ ..... ,,,,,,, ....,...,... ------------------------- ..... ... .... D APTHJGA111 INSURER,B LEXI9-gl.n Insurance Company_ ., 19437 Arthur J. Gallagher & Co. and its subsidiaries INsur� rlc., Beazley Insurance ny„ CompaInc 37540 2850 West Golf Road Rolling Meadows, IL 60008 JN§YRER4 ________ ________ INSURER E — ................---- ----------------- ----- .. ,......,..,, �. ...,...., INSURER F . COVERAGES CERTIFICATE NUMBER:700522489 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. .�.... .....,.. -. ...U�iI�, ,,..,. .. _._ ,,.,.,...,.�... YNSR TYPE OFINSURANCE......... LTR POLICY NUMBER , _.. LIMIT,,,.....,�,. .... .-- . ...m,,... POLICY EFF POLICY EXP MMIIDDIYYYY MMILDIC0 YY S COMMERCIAL GENERAL LIABILITY CO.. "r EACH OCCURRENCE f $ r --------------.. CLAIMS-MADE OCCUR P_SFS (u aor RFM . $ _ ...... (� oneurre�sGe) $..MED EXP.Any p.............9n) I $... .. _.._. I I PERSONAL & ADV INJURY $ ENL.AGGREGATELIMIT APPLIES PER: I j-GENERAL AGGREGATE $. PRO � I POLICY JF.CT LOC .,.. i PRODUCTS COMP/0P AGG $ I $ OTHER, AUTOMOBILE LIABILITY ? COaMBIINdEADI,EWE E LIMn 1 $ .... .... em..... ............. I ANY AUTO [ BODILY INJURY (Per person) , $ J I OWNED I�.................I SCHEDULED j 1 J ., ..... ) �, .. BODILY INJURY Per ac f ( cadent $ AUTOS ONLY ! _ AUTOS ) ..........- HIRED I NON -OWNED i x DAMAGE 1 $ AUTOS ONLY t................. AUTOS ONLY "s Per arJwrM(b ....... ....................-------------- l.m...... UMBRELLA LIAB OCCUR €EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MA AGGREGATE $ ......... ........ ...... ...... ... .., I. -DE, DE RETENTION $ $ WORKERS COMPENSATION t PER 1 . OTT - ix I STATUTEER AND EMPLOYERS' LIABILITY Y/N ®' ". OPRIETNH/PARTNER/EXECUTIVE - E L EACCIDENT $ ACN —� OFFICERIMEMBER EXCLUDED? L N / A (Mandatory'1) ly E L DISEASE EA EMPLOYEE $ ............... ...... .. .. m..,,,,,,a .. _._........ If yes, describe under DESCRIPTION OF OPERATIONS below f �...... E L DISEASE - POLICY LIMIT $ A CyberLrObility MTP903416503 5/1/2021 1 5/1/2022 Aggregate/PerClaim: $25.000,000 B ExcessGyberLiability 012505866 9/1/2021 5/1/2022 ' C Excess Cyhker Liability V2933A210501 5/1/2021 5/1I2022 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage extends to: Gallagher Benefit services, Inc Koff & Associates 2835 Seventh Street Berkeley, CA 94710 CERTIF 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. 'E.D REPRESENTATIVE _,2«-/ © 19BB-2015 ACORD CORPORATION. All rlgnts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD a DATE (MM/DD/YYYY) ..raiC"RO CERTIFICATE OF LIABILITY INSURANCE -- 10/12/2021 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 CONTACT NAME . .. _........ Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 300 S. Riverside Plaza, Suite 1500 (�/�,.(t EXt) ,312 704 0100 - (A/c NPt;,,,:12 803 7443 MML Chicago IL 60606 INSURER(S) AFFORDING COVERAGE I NAIC # INSURED Arthur J. Gallagher & Co. and its subsidiaries 2850 West Golf Road Rolling Meadows, IL 60008 11 INSURER A: Lexington Insurance Company 93 INSURER B XL SpeClalty Ill.IISUranCe Compa INSURER C Underwriters at Llovd's London rnvcnnrce rFRTICIrATI= Ml IMRFR• AOA1A7RR1; RFVISIAN NIIMRFR- 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. _ ...... . ....... BR' POLICY E F i POLICY TYPE OF INSURANCE i l POUC�N _ _ LIMITS LTR K NUMBER M /YYYX 1 MMIDDIYKKK 1 COMMERCIAL GENERAL LIABILITY t EACH OCCURRENCE Is . rSAMA�L'YC7 IYLNYf=i� CLAIMS -MADE I I OCCUR w=PREMISES,(Ea occurrence,) s....-,,,,,,, .......... -.-. .., MED EXP Any one person) � $ PERSONAL & ADV INJURY $ „.. ,..1 N'LAGGREGATELIMITAPPLIESPER: i GENERAL AGGREGATE PR49 POLICY JEµO-El LOC PRODUCTS COMP/OP AGG $ OTHER " AUTOMOBILE LIABILITY i COMBINED 'SINGLELIIMn' j Ea [LBde $ t)l ........., . ANY AUTO I; i BODILY INJURY (Per person) $ --I OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED j PROPERTY D $ POPERlent� ? AUTOS ONLY AUTOS ONLY....... Q..„. a -- PE I -_ ......... ...... -... (� UMBRELLA LIAB I. IS OCCUR EACH OCCURRENCE -.-. - e...-.!. EXCESS LIAB CLAIMS MADE! 1 AGGREGATE I,,,,,,,,, ., -.- DED ... RETENTION$.... .................... .. % j S WORKERS COMPENSATION - ' PER i OT H f f f STATUTE ER AND EMPLOYERS' LIABILITY YIN .. .. -- ....... ANYPROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ,NIA E L. DISEASE EA EMPLOYEEI S - If es, describe under DESCRIPTION OF OPERATIONS below f E,L- DISEASE - POLICY LIMIT S A ; Errors & Omissions 016030323 9/29/2021 J 10/1 /2022 Per Claim/Aggregate $12.000.000 B Excess Errors & Omissions ELU177899-21 9/29/2021 10/1/2022 Per Claim/Aggregate $10,000.000 C Excess Errors & Omissions B1262FI0121921 9/29/2021 10/1/2022 PerClaim/Aggregate $13 000,000 DESCRIPTION OF OPERATIONS ILOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Crime -Employee Dishonesty - 9/1/2021 - 9/1/2022 - Federal Insurance Company - Policy #81326283 - $15,000,000 Aggregate Coverage extends to: GallagherBenefit Services, Inc Koff & Associates 2835 Seventh Street Berkeley, CA 94710 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 El Segundo 350 Main Street AUTH'O REDREPRESENTATIVE El Segundo CA 90245 U 19BB-ZU15 ACUKD CUKPUKA I IUN. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: ARTHJGA113 NEW YORK CONSTRUCTION DATE(MMIDDIYYYY) AC"R" " CERTIFICATE OF LIABILITY INSURANCE ADDENDUM lli4w�°" 10/12/2021 THIS ADDENDUM SUMMARIZES SOME OF THE POLICY PROVISIONS IN THE REFERENCED INSURANCE POLICIES AND IS ISSUED AS A MATTER OF INFORMATION ONLY; IT CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. ALL TERMS, EXCLUSIONS AND CONDITIONS IN THE ACTUAL POLICY SHOULD BE CONSULTED FOR A MORE DETAILED ANALYSIS OF COVERAGE, AS THIS ADDENDUM DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES. AGENCYmmmmmmmmmmmITIT NAMED INSURED(5) POLICY NUMBER g g EFFE1. Arthur J Gallagher & Co. and its SUbSIdlarle5 Arthur J. Gallagher Risk Management Services Inc CTIVE DATE CARRIER NAIC CODE ADDENDUM INFORMATION CERTIFICATE NUMBER:698147665 KtVI511LIN NUMt3hK: A. Insurer FlAdmitted / authorized 1-1 Excess line or free trade zone B. General Liability (GL) policy form CI ISO / ISO modified Other C. Specific operations excluded or restricted (GL policy) Location: Type of construction: E-1 Building height: ElClassifications [see attached declarations / endorsement] ElDesignated work [see attached endorsement] D. Additional insured endorsement (GL policy) CG 20 10 a CG 20 26 CG 20 32 CG 20 33 CG 20 37 CG 20 38 Other: #: Title: E. According to the terms of this GL policy, the additional insured has primary and noncontributory coverage EYes No and71no other option is available with this insurer F. Additional insured will receive advance notice if insurer cancels (GL policy) [�] Yes E ] No and no other option is available with this insurer G. Blanket contractual liability located in the "insured contract" definition (Section V, Number 9, Item f. in the ISO CGL policy) is removed or restricted Yes and no other option is available with this insurer No changes made H. "Insured contract" exception to the employers liability exclusion is removed or modified (GL policy) 1.1 Yes and ❑ no other option is available with this insurer ONO changes made I. GL policy (including endorsements) does not cover the additional insured for claims involving injury to employees of the named insured or subcontractors (not workers' compensation) Yes and q � no other option is available with this insurer No changes made ACORD 855 NY (2014/05) Attach to ACORD 25 U 2014 ACORD GUKPUKA I IUN. All ngnts reservea. The ACORD name and logo are registered marks of ACORD Ar;FNCV CIISTnMFR In. ARTH_lrA113 AUUtNUUM INI-UKMAIIUN J. Earth movement, excavation or explosion / collapse / underground property damage is excluded or restricted (GL policy) 1-1 Yes and ❑ no other option is available with this insurer ❑ No changes made K. Insured vs. insured suits (cross liability in the ISO CGL policy) are excluded or restricted (other than named insured vs. named insured) ] Yes and F—Ino other option is available with this insurer ❑ No changes made L• Property damage to work performed by subcontractors (exception to the "damage to your work" exclusion in the ISO CGL policy) is excluded or restricted Yes and no other option is available with this insurer No changes made M. Excess / umbrella policy is primary and non-contributory for additional insureds Yes, by specific policy provision Yes, by endorsement L..... I No and ❑ no other option is available with this insurer � -.2 / _,�E- AUTHORIZED REPRESENTATIVE SIGNATURE 10/12/2021 DATE (MM/DDNYYY) ACORD 855 NY (2014/05) Page 2 of 2 COMMERCIAL GENERAL LIABILITY CG2001 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY ANID NONCONTRI BUTORY OTHR INSURANCE CONDITION 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 Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance avaiiable 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. CG 20 01 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQOUR LIABILITY FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person or organization who is required under a written contract with you to be included as an insured under this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. All other terms and conditions of this policy remain unchanged. Endorsement Number: Policy Number: 41GPP4938414 Named Insured: ARTHUR J GALLAGHER & COMPANY This endorsement is effective on the inception date of this Policy unless otherwise stated herein Endorsement Effective Date: 10/01/2021 00 GL0596 00 04 10 Page 1 of 1 POLICY NUMBER: .41GPP4938414 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVES. OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE The following is added to Paragraph 8. Transfer Of Fights Of every Against Others To Us of Section IV — Conffons: We waive any right of recover we may have against the person or organixataon shown in the Schedule above bece,�use o payments we make for injury or damage arising out Of your ongoing operations or ""your work"' done under a contract with that person or organisation and included in the °"products- cornpleted operations hazard", TNs waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 (p Insurance Services Office, Inc., 2008 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Concitions, A. - Loss Conditions, 5. - Transfer of Fights of Recovery Against Others to Us, is amended by the addition of the following: However, we will waive any right of recovery we have against any person or organization with whom you have entered into a contract or agreement because of payments we make under this Coverage Form arising out of an "accident" or 'loss" if: (1) The "accident" or 'loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization: and (2) The contract or agreement was entered into prior to any "accident" or 'loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees of the person or organization, and we reserve our rights or lien to be reimbursed from any recovered funds obtained by any injured employee. All other terms and conditions of the Policy remain unchanged Endorsement Number: Policy Number: 41CAB4938314 Named Insured: ARTHUR J . GALLAGHER & COMPANY This endorsement is effective on the inception date of this policy unless otherwise stated herein. Endorsement Effective Date: 10/01/2021 00 CA0080 00 04 08 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 POLICY NUMBER: 41WCI4938114 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE ANY PERSON OR ORGANIZATION WHERE WAIVER OF OUR RIGHT TO RECOVER IS REQUIRED BY WRITTEN CONTRACT WITH SUCH PERSON OR ORGANIZATION PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF THE LOSS. 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 ,10/01/2021 Policy No.41WCI4938114 Endorsement No. Insured ARTHUR J. GALLAGHER & COMPANY Insurance Company ARCH INSURANCE COMPANY Countersigned By DATE OF ISSUE: Premium $ INCL . 19M National Council on Compensation Insurance.