Loading...
PROOF OF INSURANCE (2022) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 Wright, Finnegan & Carter Insurance Associates 23001 La Palma Ave, Ste 100 Yorba Linda, CA 92887 License #: Ok93616 INSURER A : INSURED Stephen Doreck Equipment Rentals, Inc.. DBA Doreck Construction 9075 Telegraph Road Pico Rivera, CA 90660 COVERAGES CERTIFICATE NUMBER: 00001603-5360434 Savannah Herrera (7141283-1999 AFFORDING COVERAGE REVISION NUMBER: 127 NAIC 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 ADDL0fk _.�... _ POLICY NUMBER pOLICY.EFF POI.IY EXP,. LIMITS L A X. COMMERCIAL GENERAL LIABILITY Y Y CO-720OP538-TCT-21 03/01/2021 03/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR ENTE PR �ES(Ea O Rurrorr.Ah , $ 300O0O MED EXP ('Anj2M person $ 5,000 Contractual Liao X Pollution Liab PERSONAL&ADVINJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 O0O 000 POLICY III JEO - LOC PRODUCTS -COMP/OP AGG _._._................-........._..........._..--..._ $ 2000000 11 GTH'ER, I I Pollution $ 2,000.000 , Y Y 810-8L58787A-21-26-G 03/01/2021 03101/2022 COMBINED CTBAUTOMOBILELIABILITY m.$-- IT1,0(0 , " ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ ..............._--------- HIRED NON -OWNED ti7 f C�Ai iAkE $ AUTOS ONLY AUTOS ONLY Per aoddlen8k PI1y Damage $ B UMBRELLA LIAB - OCCUR X, CUP-2J30069A-21-26 03/01/2021 03/01/2022 EACH OCCURRENCE $ 5,0001000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5 000 OOO $ DED RETENTION $ 10000 B WORKERS COMP NA IOIN Y UB-OK312895-21-26-G 03/01/2021 03/01/2022 X PTEpJIJT TH- _ -, Pr,_ AND ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N / A E,L, DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I "IT"mm�"IT""�""-"""" E„L,. DISEASE - POLICY LIMIT $ 1,000,000 B Install Floater QT-660-2G410825-TIL-21 08/18/2021 08/18/2022 Ded 1,000 350,000 B Equip Rented From QT-660-2G410825-TIL-21 08/18/2021 0 /18/2022 ACV 130,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Pollution Policy Westchester Surplus Lines Ins NAIC # 10172 Policy #G27153136008 Eff Date 03/01/2021 through 03/01/2022 $2,000,000.00. NEW RESIDENTIAL EXCLUSION FOR GENERAL LIABILITY POLICY. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 360 MAIN STREET El Segundo, CA 90245 AUTHORVEOREPRESENTATIVE SAH ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by SAH on 12/01/2021 at 01:13PM AGENCY CUSTOMER ID: 00001603 LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED Wright, Finnegan & Carter Insurance Associates Stephen Doreck Equipment Rentals, Inc. DBA Doreck Construction POLICY NUMBER N/A CARRIER Multiple Carriers NAIC CODE EFFECTIVE DATE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by SAH on December 01, 2021 at 01:13PM Policy: CO-720OP538-TCT-21 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 11— WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, joint venture or limited liability company, that is not shown as a Named Insured in the 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 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, B. BLANKET ADDfflONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS 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 If deemed 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. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you Will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence", pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of. a. "Bodily injury" or "property damage" that oocurs; or b. "Personal and advertising injury" caused by an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY —RAILROADS INJURY AND PROPERTY DAMAGE LIABILIITY: 1. The following replaces Paragraph c, of the Sale Of Phanttaceuticals definition of "insured contract" in the "Bodily injury' or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 © 2017 The Travelers Indemnity Company, All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Paragraph f.(1) of the defiNtion of "insured contract"' in the DEFINITIONS section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replace the definition of "premises damage"' in the DEFINITIONS Section'. "Premises darna !" me" "property damage" to: COMMERCIAL GENERAL LIABILITY a. Any premises while rented to you or temporarily occupied by you with pe"ission of the owneri 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. Q 2017 The Travelers Indermity Company. All rights reserved. (sage 3 of 3 Includes copyrighfied material of insurance SeNces 09ce, Inc,, wdh its permission. Policy: CO-720OPS38-TCT-21 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS The following is added to SECTION 11—WHO IS AN INSURED: Any person or organization that you agree in a Written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract 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 or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written 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 limits of insurance described in Section III — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings; opinions; reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury" or "property damage" caused by "your work' and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. C. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" 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 of any 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) If a claim is made or "suit' is brought against insured does not apply to: the additional insured: CG D2 46 0419 © 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send 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 "suit', 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. However, this condition does not affect 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 as described in Paragraph 4., Other Insurance, of Section IV —Commercial General Liability Conditions. Page 2 of 2 © 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 POLICY NUMBER: CO-720OP538-TCT-21 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 03-01-2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY R[ k g1L This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN GENERAL AGGREGATE A WRITTEN CONTRACT WHICH IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS. GENERAL AGGREGATE LIMIT.; PROVIDED THAT, THE CONTRACT IS SIGNED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION 1), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule above: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2. The Designated Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A-, except damages because of "bodily injury" or "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number oF: 9. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations malting claims or bringing "suits". 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project" shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Project General Ag- gregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION 1), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: CG D2 1101 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Ag- gregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Project General Aggregate Limit C. Part 2. of SECTION III' — LIMITS OF INSURANCE is deleted and replaced by the following: 2. The General Aggregate Limit is the most we Will pay for the sum of: a. Damages underCoverage B; and b. Damages from "occurrences" under COVERAGE A (SECTION 1) and for all medical expenses caused by accidents under COVERAGE C (SECTION 1) which cannot be attributed only to operations at a single designated "project" shown in the SCHEDULE above. D. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- tions Section is amended by the addition of the following definition: "Project" means an area away from premises owned by or rented to you at which you are per- forming operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance, each "project" that includes premises involving the same or connecting lots, or premises whose con- nection is interrupted only by a street, roadway, waterway or right-of-way of a railroad shall be considered a single "project". F. The provisions of SECTION III — LIMITS OF INSURANCE not otherwise modified by this en- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG D2 11 01 04 Policy #: 810-8L68787A-21-26-G COMMERCIAL. AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 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 annther Pndnmement to the CovPrnge Part, and these coverage broadening prnvisinns do not apply to the extent that coverage is excluded or limited by such an endorserrtent. The following lisling 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 COV- ERAGE —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 II — COVERED AUTOS LIABILITY COVERAGE: 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 1801h day after you acq uire or form the or- ganization or the end of the policy period, which- Pvpr is Pnrlipr. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., 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 execuled 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 tar damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person nr orrdani7atinn qualifieg 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 II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while porforming duties related to the conduct of your busi- ness. 2. The following replaces Pardgrdph 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 an "crnployce'a" namo, with your CA T3 53 02 15 �:-2015 -Mo Travok:rs Indemnity Company. AN rightareFerved. Page 1 of 4 Indudesmpyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. 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.'I., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: 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 —COVERED AUTOS LIABIL- ITY 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" wo covor. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II —COVERED AUTOS LIABIL- ITY COVERAGE: (a) 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- (1) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (11) Neither you nor any other Involved "insured" will make any settlement without our consent. (111) We may, at our discretion; participate in defending the "insured" against, or in the settlement of, any claim or "suit". (Iv) We will reimburse the "Insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable exppnseS inoirred by the. (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your Investlga- cause of time off from work. tion of such claims and your defense of the "insured" against ally such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (S) in Para- graph C., Limits Of Insurance, of graph 113.7., Policy Period, Coverage Territory, SECTION 11 — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit_ Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation Imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto"' that you lease, hire, rent or borrow contingent or on any other basis. without e drives for a period of 30 days or less (d) This insurance is not a substitute for re - and that is not an "auto" you lease, hire; rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) ar Canada. members of their households. Page 2 of 4 1=_?'016 -Fhk)Travok,,rs Indomnity. Company. An rightnn-carved. CA T3 53 02 15 Includes copyrighted material or Insurance Services Office, Inc. with its permission. 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 nompi lsnry 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. (d) 11 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 glas& damage if the glad is ropaired 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 $756 for any one "accident". 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE We will pay up to $5[) per day to a maximum of $1,500 for tempomry transportation expense in- curred by you because of the total thett of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (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 Property 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 tlate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.i..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 "Iosr." is known to: (a) You (if you are an individual); (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 "accidenl" 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: The following is added to Paragraph A.4., Cover- 5. Transfor Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 b210151ho Travokxe Indemnity Company,. AN rightareF.erved. Page 3 of 4 Includesmpyrighted material or Insurance Services Office, Inc. with its permission. such contract. The waiver applies only to the The unintentional omission of, 'or unintentional person or organi2atlon desIghated in such error in, any information given by you shall not contract prejudice your rights under this insurance. How- 14. .UNINTENTIONAL ERRORS OR,OMISSIONS ovor this provision loos not affoci our right to col - The folloWlnu IS added to Paragraph B.Z,. Con legit additional premium: or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV —'BUSINESS AUTO CONDITIONS: 'Page 4 of 4 C• 2015 -Mo Trovokxwz Indomn'ity Company. An righ& vsrusmd. CA T3 53 02 15 IndudesoopWghted material of I nsuranceSerOms Office. Inc, with its permission. �„� WORKERS COMPENSATION AND ONE TNER SQUARE EMPLOYERS LIABILITY POLICY MARTFORD, CT 061.93 ENDORSEMENT WC 99 03 76 ( A)— 001 POLICY NUMBER: UB-0K312895-21-26-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforr,A our right ncgainstthp. per4nn or orgnni7ntion named in the SnhediilP.. The additional premium for this endorsement shall be 02. 000 % of the Galifornia workers' compensation pre- mium_ Schedule Person or Organization Job Dascriptlon ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FHRN70 THIS WAIVER, This endnrqempnt chnnrgps the pnliny to which it is nftachpd nhd is pffPntivp can the date issued urlleas otherwise staled. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 03-01-2021 Policy No. uB-0K3.12895-Z-26-G Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 03-01-2021 ST ASSIGN: Page 1 of 1