PROOF OF INSURANCE (2022 - 2023) CLOSEDACC �' CERTI ICATE OF LIABILITY INSURANCE [=12'�8/2021
FDI�N,YYY)
I
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, EXTENDOR 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(ios) must 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. COOT..: T U'u.1ie Rybak
-NAME
Kellogg & Moreland Agency, Inc. A PHONE (909) 792-895et1 AFC Nor tm,ap?sa-aa:rn
Arroyo Insurance Services ADDRESS, julier@arroyoins.com
�..__.
1654 Plum bane IdJSURER s AFFORL3tlNta covERACE NAIL
Redlands CA 92374-4532 INSURER A: Admiral Insurance Company
INSURED _�....�.......... ._�_ INSURERB:United Financial Casualty Co 11770
�.... .._
California Street Lighting, A California Corp INSURER C:Insurance Coaany of the West 27847
3700, C'uasti Road #I100
Ontario CA 91761 [NSURERF:
COVERAGES CERTIFICATE NUMBER:
REVISION NUMBER;
THIS IIS TO CERTIFY THAT THE POLICIESOF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE (POLICY PERIOD
INDICA1 ED. NO"IWTHSTANDING ANY REQUIREMENT "TERN( OR CONDITION OF ANY CONTRACT OR OTf IER DOCUMENT
WITH RESPECTTO WHICH; I"HIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN,
IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM'S.
dPOLICY EFF POLICY EXP
LTRR TYPE OF INSURANCE A CAL '...BIR POLICY N.0 MBER MtuV7L7di YYYY NlhllCYWYYYY
T
LIMITS
C�5'RwIIME'RCdALGENERAL LIABILITY
EACH OCCURRENCE
$
1,000,000
',... ',..
OAMAG'ETORENTED
3l?47„BBB'
A CLAIMSMAl7E OCCUR
PREMISES rE c-c.t:.urreJ5& ,_ .
..$
CAB0004.375901 12/1/2421 12/1/2022
X.P (Any one ppersrn)
�'11'lmsl'
5, 0'0'01
..,
NA.L &ADV INJURY
$
1,000,000
GE N L AC�LR EGAT E: LEI�dIT APPLIES PER
C'FNE:RAI ACn6.ltT;9.C''`,'AM
$
2, EBB, B'BB
JZX IRO- D
_
PRODUCTS-CICMIPf(3P Au�C
$
2,dJd1B', dUOB
_ I GLEC'Y EC I L.pr'.
�
01HER .
AUTOMOBILE LIABILITY
COMBINED SINGLE LNMIT'.
(Ea accid kntl
,5
1,000,000
ANYAUI"S0
BODILY MJrURY (Rtal P¢Irsony
$
I.
ALL OWNED SCHEDULED 06.588638-4 2/23/2022 2/23/202:3
800iLY IN,PURY (Per acodenl)
S
AUTOS AUTOS
NClN-C7'NNrL0
PROPERTY DAMAGE.
'i�eraccadewd
$
HIRE"JAU"I"C15 PI:F'TC'1SS
m.
$
UMBRE.LLALIAB X OCCUR
EACH OCCURRENCE
$
2 B00... BBO
A EXCESS LIAB CLAIMS MADE:
AGGREGATE
'.., $
2 , �n1BB, 000
IDELi RETEN"NION $.... GX00700496201. 12 /i,/2g21 12/1./2622
$
WORKERS COMPENSATION
� PER 7 "H.-
AND LITY YEN
ANY PROPRIE.TO. RIPARTNERlEXEC;IITIVE
EE
EACH ACCIDENT
'aElvMl
$
1,000,000 ..
_ EX "BLdLNL7 •r NIA
C (MandatwyCup NH) H 5S159'.L56 L71,. 1�2/1/2B21. 1.2/1/2C122
B L DISEASE, E A LbMEiF;
5
1 BBB BBB...(
,
Id yes desul lbe undef
I:: EESC,RIPTLON C)IE OPCRAT"IONS b0owa I
E L DSEASE - POLICY LIMIT
$
7. BBB BB41
DESCRIPTION OF OPERATIONS I LOCATION'S I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It rnote sp�ace Is rrquired)..
CERTIFICATE HOLDER CANCELLATIION
City of El Segundo
1 Main Street
El Segundo, CA 9!0245
SHOULD ANY OF THE ABOVE (DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHOPUZED REPRESENTATIVE:
?-1r Rynak/,Il,dl TR
a 1988-2014 ACORD' CORPORA
ACORD 25 (2014)01 j The ACORD name and logo are registered marks of ACORD
INS025 ,2B 4m)
Policy Number: C'A000043759-01
CA;20 W 1219,
Ni:f`fective Dale: P/01/21021,
T111SENDORSEM ENTO IANC ES'1 III POLICY,
Y,
OR ORGANIZATION
Thi's c'na.lwrrsc.utacttl ttacaaliCiCS itastrr,"ttacc proviadccd trtac er thy^ 1,0H rw,nrradn:
C"OCtIMER(°CAl. CiFNl-'.'.RA1, LIABILITY d Y ('."OVd;RAGI,; PART
Name Of* Adelilionad Irrstrred Perwerrr(s) I,ticartion(s) 01'Co e*red Operations
Or 01-1-ullizalucym�(s�
Any person or cart",arn/altiarlt that is all arwwqacr, dc°sscc Or man- Alt lawcatieolaswhich the Named Insured is rcrt'G:rrrr in
as to 4'at�read d�rcr�c'r°t'y err' personal g�l`eadvertwy, Oil Which VOU M'C 01111 aitta' a rd�;rcraatiarlaS.
peri`"aar'r'krrrtu ongoing t:operatiollo " or a colltrarr oi, on whose
hCharWvarrt arrc d1c1t"0Fl1)iva ongoing Operations, 1wt.r1 Only it`
Carvc1`110,c als an additional i11serITC1 is racdtrircal bV as Wl'it Cra
c ontr4m or wwYrlttcn agreement that is an "lllsUrc d Contract",
and provided the .`lwarcdily ill „jury `' or -property damage" 'lirsl
OC M's, art' tlac "perscrrl«rl aticd alcdwcHISiva(t Ill JLWr , " OCCICHSe is
first CarlaalrliltCcl. srlbSCclttCrat law the cWcntiarlr all tlrc Contr4act
It as rc;c la Cvlt.
-caltgttccd' tar ca7rll rketc � art shOW _ ill, dhc Declarations,
ddtt€rr'aalaatlarra l„ 'pals �cdamcadrrdc ll lrlr ld7rrvc wwtdd be salrravvtr„_�._...,n„ .._
A.c"ulirrrw 11 _ y,ta 1ra'a Is An Irrtimrraatl is aatacndced to irrcdrradc as all acdclttiarraaul irastrr'cCd tklc gwcrsrrrr(s) of art_,,;tuw'iraatderta(s) slar�wwrrirw
the `schedule, but only with respw to halaihty Im- "bodily rtatnry", "property edam gc" or "personal and d advertising in
perry"
caused, in whole or in quart, d.ry'r
. 'd'hc aIcts car or llssions oa ' tlac sc acting on your hch,;rd4;
ill the perf'orilla acc ot,y o ur ol>gariltx, Operations for dic aedahticrraal insurcd(s) at floc location(s) edcsl'griaatc'sd above,
oweve
1. The instlralicc aftor dcCd to such additional rlwst.lrccl crralr alyd lies to the a;vtcrlt lrenniacad by daaww , Lanai
, 11'coverage proviadcr:d to rtac aadclltiernafl ilasttrcd is rcalraitcad lay a cariutt', ct Or a accralcatt, tllea rutstittrallccr arl't'rrtcdcCd to such
a aadeditirrutaal insured will not be hroa&r thala tdMt wwhicla you Sara:° required try the carlrtralc:t or rloree l em rar provide tiwr
such additional ratse.trccd.
W With re:speo to the insetratracc afforded to these a acdaditiarltar't irasarr�cels, tltc d'c,rdda'rww�iatt_l, acladltiaalrat8 CXCltasucrras a1[1pdy":
This insurance does tacit a�l��,dydyY ter ""t�aradikyr iagjtur ""err' " �ro'radacrty Cda��llau,rr�er" arccrlrriatg att'tcr:.
L """tk9 Work, nlCltacdind, rawaatcrlaals, harts Or calnipinerrat 6,urllislwd in Connection "vith such morel;, aria the l:rr�arlcc,t (irthcr that,
scar rcc, ralaairatcut<tlacc or rcpairs) to be ped'orttacad by Or aril bchall`of' tile' aelchticraaatl irlsrircad(S) tat the IC)Catre'rrl of'thc
Caow elrccl a per a'tiotl'i 1ls been comlrka^tc°u:d: or
C+G:W 20 10 12 19 a;'> dtl,trraat'tcc sell-vace:s otCice. drac„ 2018 Page 1 ar1'2 13
2. That portion or''yoamr work" out ofwhich the rralarry or damage arises has lreema brut to its intended ause by any person of,
arm Graavir.atmarrti Other Wlmsrsa amtacrtlacr ccrrmtlr'ama;tarm' arr stmhcarmrtm°tt'tcma eub aa;ed in timer hrrrrmrimam" arlreratia rtis for a prrmrcipai as a taa N
of the sail me proJect.. � � v
C. With respect to the insurance al•tirraled to thesc additional rrastrrcds, the hamldaawin- is added tsr Section III — Limits Of
Insurance:
lf•ca'rw era ge p rm ided to the amdclmtio4�,ral itmsarred as rcwlamired b' a ca;raattamct of, a agm`ceraacmat, the nws't we ww'mNl pay on behalt'art•
the additional insured k the aamaarunt of insatramaee.
t. Rcalauired by the cuntr°act OF aal;rwcmracrat; of,
2. AvailaaWc tuirdu the applicable Iwmaauts of inSu'alice:
whichever is icss.
This eimdor-Setrremat. slash raavt incra:amsc the applicable h mmits ul insurauacc.
C'C' 20 10 '12 19 "("' Insara•ance SCm•vices OlTiee, 'lrac , 2018 Page 2 of 2 3
Policy Nuathcr: (:n0000,137 a)-Ot
1l fcoive Date: 1?/01%2021
" 1 I^,1'1) l ;l��:a4T ��'i "' (">F[ N( 1�:` THE POLICY. PLEASE l~�I�� AD ITCAREFULLY.
ADDirriO L INSURED OWNERS, LESSEES OR
This endorseaaaetat modif Ics itasuratrtaac prcrvidcd under (lie I0ilcaww itt :
("C)MML1WIAL Cil:NERAL LIABILITY C"OV1?FCAG1�, i)r1RT
PROM.X,;TSX(:Afl 1,1 1°1.1) 0111'RATIONS 1.1AB1111`1,Y C OVF;RAGt' 1'ART
Name OfAdditional Insured Person(s) Location Arrc1 Description 01`
Or
leted
G1}' d'7crb41a'a era aaC t',a.8at at a at tlanttzustaataaa 'tactl", less 4hC" ll 1tsS <6lBta1 1 Operations� 1` wVatrd,� is C ww`aaS
�, rty Forww�hOM wcau rCL11�
is except laacatiolis wwhct 'W'a.ata,
utaarm�tra�a�er and a°a.�taV lwrarpeml�� or 1��tersarit;tl pratgwe�•„ _ eel to atJob Or p�mca,pect iawwarlvaatg spatg,6aa-9v-rrstrly (hweltlaolg5,
work ur have Worked, of as colltriaetor on ww'h0se hcdtatll yraa.r WUICI' th,111 kM1."B'l O al)"il"Iml"Ws ill an
work or have worked, grit a:rmtdy it'a;crwcmauc as aua aaddmaia,md apau'tmaldll, hUitdimlg: (al aari+grivall�' c'arustructc•d ;autcl att aadl liaracs
insured cxtcltdiaap. to `hcadil t iut�amry" or �apropcaty damuat,e'' used Im such purpose, or(h) cuuwerted dircatla at Commercial
included ill tfac "products-ccyutmpleted operations 11',v rd" is building), r;`crmrrVrratriurmumils, lrlwtrht+mcs, tarW11101,lscs, timt're-
o equired by a written contract or wwritteu w2reelttcatt that is "tut share udaits, d�a'aac'ttctutadl-aawwuersltilt units, cooperatives and/or
"insured cctar'taacl , and provided that tlae "lwawdily iat„dury Ot' aaty atllaea• structure tau' slIarc.c toscd or intended to be used as, a
pr'aapeny clmn aide" Isrst aaccum`s suhscclueatt to thy: exea:uticrra residence.
crl,the Contract ear avrec:tatcart.
1 qta carratlwletc this �Seheacltk, i alaat sh0Wta all uve, wwmll he ltarwwrt aua tltc Declarations,
fatta�iralmraltran a'CikaBtlCG t�
A. ,Seciiarra 11 - Who Is An Insured is 1u11011ded tea inclamde as ant cudditiaautad insuucd the person(s) or organization(s) shown ill
the Scltccdttle, but only wwith respect ace haahihty I'agr buddy auatury" car',propco.y cdatmrrat�u;t�', t,alused.. in whoic a:rm' ill part, by
"your wkork" at the location designated and described in (lie Sehedulc awt'tllts cmtcicarsetrteaat pem I'a:arntcd Barr- that additional
aaosttrea.l land aaledUdCd ill the 'products-corlrpdctccl caperaaGons haxaarcl
I lcrwwewet :
1. The insurance aal`fa.trde:d tat suc:la additional, iaasurcd onty applies to tlae cwtew perattilled by hwand
2, if ecrwcaugre pr[aVicicacl to) tlae aadclrticauaal aaaaua'erl is required tw at contract err a grccuiierra, the insurance aal` orded taw `watch
additirtraaad amasured Will aaatt he hrualder than that which You arc requir-ed by the contrac.I or ty'reclOcatt 10 pt(rvicdca Itrr-
such aa9diticami al iusurcd.
B. Will) respect tea tile musuraatacc alf<,raded to tlaeSC alddttictraaad insureds, the k llatw ill," is mided to SCCOarra Ill — Umils C.)1"
1nsur r aee':.
11'catvcraage provided to the aadditional insured is recluarcd by a, caaariract ()a a� re�amtac^air, the rnosi. we will pay on hchaalf'of'
the atdclitieruwd ivatrteci us tita ,aawratumtt ()f" iotscu'ancc:
1. Required by the contract aru' av:,tccataent; a:ra
2, Available under the ,ipplicaablc limits of iarsuratatice,
whichever is less.
[his eudttrsciatcrat shall not iotcrearsc (lie 'applicable lttttils of instaraaatce.
CC 20 37 12 19... mac:..' Insurattaa:c serviccs {:.itflice, dttc., 20 18 Page 1 of 1 0
Policy Numbci,. CA0(I004379-0 �
A 1) 68 93 (11 17
Effective Date; t2/01/20N
T11IS l?NI)OIZSt.M[;',N'I'('IIAN(;ES'I'IIF, POLICY. PLLASERFAD [TCARFIVIAN.
CONTRACYORS ENHANCED COVERAGE
(Commercial General Liability Coverage For
This endmscmcnt modifles insurance provided kindcl. tile k)Hovvhlg:
COMWR("dAL GFINFRAL LIAB11 ITY COVERAGE FORM
1, ANIEND1,J) J[,-',-XCLtJS10NS
NON-OWNEJ) Up to 55 fect
SEICTION I —CIOVERAGES - COVE"RAGF J" BODILY INJURY AND PROPFIRTY DANIAC31" HAMLITY, Exclkl-
sion g. Aircraft, Auto or, Wajcj-ct-,jft, Pm-w-n,aph t2) is deleted in uts enthmy and 1-ciflaced bV tile
(2) A watul-craft you do not OW11 thW is;
(a) Less than 55 fect lorl', and
(b) Not be ing used to can-y pCI-solls or' pl-opaty For. as chal-ge�
MEDIC AL 11 A Y M ENTS —
11 JZO 1) M III, 1,,TE 1) OPFRATIONS HAZARD
SECITION I -- C0VERA(;F1'S,-, C()VF1'KAGF1 C MENCAL PAYMEN FS FXCIUSi011 f.
I hazal-d is delmd in its CM il'ety,
CONSOLIDATED (WRAP -LIP) INSURANCE, PROGRAM EXCLUSION
(LIMITED EXCEPTION FOR OPERATIONS AWAY FROM PROJECTLOCATION)
1 he followill- " eXCILISWII is Ui&d toFXCtUSl0l1S ofCOVEAAGE A HODILY INJURY AND PROPER IN
DANIM& LIAMITIN (Section I Covcl-aLles):
This insul ance does not apifly w "b(Kfily inimY, or- arising out of either youl. ongoing olict-alions m. opena-
6011S illCkl&d Wilhill the opel'aliffilS aa any locitic)II fa�j� which as consolidated (wl-ap-uy)) il1SUl--
ance pt-oi,,raln has been ided by tile p6mc coati actor /pl'o.ject mallaga or owna of the consll'uctioll pl-olvo ill Which you
al-C involved,
This exclusion �applies whedlet, ol, not the Consolid"licd (wrap-up) insw-ancc pi-ogn,"ll:
(1) PI-OVidCS CONet'aIL2,C idOlticLd to that pt-ovided by thus Covcuag2,e Fo"M;
(2) 1 las d im ks "Idequate to cover- a] l C h ims ; or-
(3) Rcmains, ill effect -
I loweva. ii'dic consolidated (wrap. -up) insurance Paogl-ain does not pl-ovide cove arc f0l- y!Mlr that Marc pufot'nied
away fimill tile location of the constniction i)I'OljccL, this CXCJLlSkM Will 110t
AD 68 93 (11 17 f11cilt(9es (,if Insknance Services Offlcc, lute., Page I of8 13
with its pcyjjlissjon, 2009, 2012 & 2013.
It. AMENDED COVERAGES
NOVVLI^.I C'E, OF OCCAJRRLNCE
The following prurroagnipah is added to Section IV (.'cruauaercial General Liability Conditions laarargrauph 2. Duties In "Hie.
I`vcr t C:)l ()ccurr'cracc, 0iTeuse, C l aiva or Suit:
Notice orl'aart "occuro"cuce" which ruay result in a claiva under this tausuraaracc° shall he given tts soowra as practicable after
l nowICCIg"C of -occurrence" ., � bars daeerr rclucardcd tos y'erur" one arl"yo;atgr. "ew:ectrlivc uonkco•s", or any AraalrVoorc"t°" ararthucar'uvcci Parr
you taY f"tlw'e S"'kq" r"o'cerwe notice otl ara-occulrr"crlee" .
UNINTENTIONAL ERRORS AND C)V1ISSIC)`wlS
The li:olloowOng paragraph is aMal too Sutdou IV e C::" nuuaachl Ge1wral Liaabihly Conditions Paragraph do. I' �epre:s;eutatdoorus:
However, the urarrtter"Wriah caluk dun 0C or uuiattcutiaaual error hi, auy halkrautataoau r;"hwrerr or Mo vided by you LAI not gar'e#
dice your r i'ghts uuedcr this insurance, I loawwever, this p t- ovasitaot clans runt talTC0 error rdldht to corlpcct ardoditaorrual 11reurruua owl- to
a.xemise otrH Hoc. oTcwwcllartioora or noun-raw"ad.
III.. rMD DUA) ('( 'FR, G'ES
PERSONAL PR.d)I'ERTV (w O 1 n,-.IzS IN YOUR CARE, C LIS"I'O DY OR CONTROL —
LIIVII°I"EI'D COVERAGE
Sub-Livarits ofInsurance;
ace:
10,I; 00 Bach Occurrence l luchrded it flue. IAdi Occurrence I Am it shoo"11 irI the C:7ccAra 6onsj
51O,4)CIO Aggregate (luchuded hi floc (heneml Ag regatc I.imit shown in the l)eckrations')
p be suh-i in,ils or hismtanec slirrw n aalterwfe am ducludcol %vidAn and not in addUioou'tow the IAch (kcrrrrcitce Livait and die
General aggregate lArnh show in the Declarations.
Supplementary Payments wvdl reduce the Enh (bccuarrence and Apy,gmgme All MOB eof irsuraraace shcrww'ra arN wee.
ur care,
t.
It is Guw;r�ccd C:C:)i��Cl�Iliil��C'Ityl� Cal r�N&d,�l 1,1�4131q_,&"I'"� �`C)VIWI�Ja"C�p��: @ C)RNI _ SECTION lC)N I _ ("C)V 1�.�h(al? ,1 1 �:cdusraou '" 4)
is deloud, but a.oupyr %with respect to puersoanaal properly aol etidaers in the care, custody or cuutrorl col the Name(], Insured, Subject to
tlue fo'rllaoww iotl e>ticlusicwns, carrrodiriorrts and limitations',
1. li:xclusi ons
This insurance doses plot apply to:
aa, "Pro perty darn rlrc`" arising cant eol a:op"uerautieons lrerlaarraaed on belaaatCoal"the Named Insured by others,
h. ""Vmpscrty daaura"g" aars&g oaut of all -occurrence" at premises owned, rented, leased, operated, occupied or used by
you',
c, "Properly elcaraaage" to properly while ill Irausdt„
uI. "'1're pwy dw-n agn- aurisdnp;, ow or any crrcor, oornkshn or delmw aeucyr ru the desrgu, spsccilacuutdoons, woorl".nunshapa or
materials os'I`tlac personal property in We Named 1115ured'S carre. custaudy Or C0 111rasl:
C. "Pro roomy darcaaap- Moog out owl dedy% loss ofmarks. loss oruse, pass oof lsrcrdits, or any s niHaar indirect or co nse-
educ"utiail lcahs cod"away lsrrac:d;
L "Pi-operty a �aruaarge.'" iruclu&d watluiar We rolaer°utrcu"pt<u:+mX ; or
I)uraaag es ercceding the actual caash value of the l:oersotnaal property 'cot the care, custody orl eawratr"oil or9"tpte Naotucci lrs-
sur'ed it the titue oal`thc " oscc:urrence."
("saurelutirartiti
()Ur r awe,, u and daltw too dCI'c ad crtds ww loon we have used arpo the Qal-rlahearhle sula-INnh of ursuraance in We pa gqnent oof pudg-
ments ur setticuaents or Sulwplcnaentaary 14y orrent:s urrdcr We insurance lNoow ideo;d lay this crrdoarsement.
40) 68 93 Ill 17 hwlmks a apay"righted rnautcriaal ol" lrasu.rmwcr ,Scr w'iccs 011`ice, Inc., INge 2 of 8 �
1001 ihs P0111 NQUIL 2009, 2012 & 2013.
3. Limits or Insurance
a. Ile amount we M pay rox damages is Ahed as dcwYled helom, with respect to danuqges covered under this en-
domonsw
The Aggrcgate Unit shon"i in the bielleckde is the most we will pay th1he sum orall darnagn twcatne of
Ile fAch Mcurrence I Arnit shown above is the most we will pay loin the surn ol'ah damages because cal "prop-
erty thillial"'Carisin!gout of any one -occu rrenc C" y
(3) SupIflcmemary Payments Will NdLICC be Mch CkcwTowc and Aggmguw finihs or insurance shosm, in the
Scholuk; and
(I AH mms we pay A daInages or SupplemeMary Pa ' vnjcujts under this enm dorscent wiff reduce the 0CCIAr-
rence I Ah and We Kneml Aggregate link shown in the Declarations.
A Other Insurance
Ilk inswarIce is excess over any other- valW and collculk Property or Niand make Insumme au blable no you, cidler
Prinlary, excess, contingent or any other basK
as a Named InSUrCd 01'an Additional Insured, WhCtllet
PRIMARY AND 1somico1'rmuBUT014Y —
rcv OTIIER INSURANC'E. CONDITION
(Insurance Services 01"fice E.ndorsement CG 20 (11 0413)
The kAlownug k added to the Mher Insurance Conchion araku"Beks My pwvix"l to ow cWmary:
Prituary And Noncontributory lusurance
Ilk Insurmwe is prhnary to and will not seek cmArImbn Imn my ova hbwallcc zivai[able to an additional Insured under
y0l,ff j)0HCy provided LIUL
(1) rhe additional insured is a Named humahmder such other hawwwo aml
(2) NA;u have ag,rced in "ThUng in a cony act or agreclawnt that this hmurance would be primary and would not seek con-
tribution Croill ally other insurance available to die addiflonal insure(l
NVAIVEN OFTIMNSFElt OF RIGAITS OF ]ZECOVEM' ACMNSTOTI[ERS TO US
(Insurance Services Mcc Endorsemmut CK 24 04 05 09)
SCHEDULE,
[Narne OrPerson Or Organization:
Any person or organization, but only TWU r0thwinu C(MITIAMn UM nwt:
( I) Ycw have expressly agre'ed to the waiver in a wrictcli contract; and
(2) The injury or daniagC (11-St OCCLU'S subsequent to die execution of the wrimn smumt.
hif'orillation required to cNnplete this Scheclule, it shown above, will he showyin the Ded.arations.
The f cfflowing is added to Paragraph S. TransUr Of Rights or Reonwry Against Others To IJs ol'Section IV -- CoRdi-
lions:
We wake my rjM of maway we nlay have aphw the: pumm or orgAzadnn shown i,l,l the Sdledl,ile rAbOVC beCaUSC 01'
paymalts wv make ror injury or ciamage arking out or your ongoing operations or lotIr wwM clone under a conumcl M
Al, person or oTanization and included in the ,productYcwnpKWd operadma ll"aa% 'Mis waiver app ties only to the per -
Son ShoWAl in the SCIICClLItC above.
Ad) 68 93 01 17 hAwks copyrighted material cal' rsurame SUOUS Onk" JIM, I'age 3 or 8 El
wkh its is eninisdom 201200 2 80 20 t 1
C0 NTR ACATA 1, 1, 1 A 1311, ITY —RA I LH () A 1) S
(Insurance Services (HRee Kndonement CC 24 17 10 00
SC"EDULE
Scheduled RaHroad: DeAgnated Job She-,
Any railroad, but only irthe ronowing con,iitiojis are met: Any,job AW CMTrCd by MIS QUM= WkrC YOU are Per-
Aminirig operations for or afYidiRg a Schedukd RAIRmd.
YOU have c\pressly agreed to WtuniCy the railroad in
an vVI-itten Colih-act entered into by you: and
h. The uAwy or dantage Occurs subsequent to the cxecu-
ton of Me written contract.
(if nu entry appears above, information required to complele 1his anlwsonov W be shown in Me WKWkws as applica-
ble to this vndorscnlent.)
With respect to operations performed for, or affecting,. as Scheduled Rab-oad at a Wgimted AM Re, the detbition of %i-
surod contract" in the Definitions section is Qued by lk following:
9. "Insured Contract" rrleans:
a. A contract for a lease or 1mvnikes. I lowever, Mai portion of be cmanwl Wr as lease of juernises that hideinnines any
person or organization [,n, dainupc by 1"ire to prenikes while rented to )ivu or cernpomdhr occupied by you w1h per-
mission of the owner k mA an 'insured cmUrecA
b, A sidetrack apreeinciW
c. Any easement or license ag,,reemetw
cf. An obh�,,aticqi, as rquired by oaliriunce, to indennd(y as niunicipality, except in c(murection "Tth work for an rnubci-
paHy;
e, An elevator niainteruawc agreenient',
L Vim pan of any Nhu cmitiva or agremnent penainh% to your hmixicm (including an indernnification of a n1unici-
pality in connection with vwwk perTornwd for a munkoalky) uncler whidi you assume the ton habiliq, oranothcr
p-arty to pay for "hoddy irnjUFY" Or "PrOf)Crty Wage to as Chard person or cum anizai%, Ibil liability means a liabil-
ity' that would be imposed by law in Ilve absence of any contract or agi-Cenicnt.
thwagraNi 12 does imm &LIUdU thin Part Of any "MIX30 Or 09MCMCK:
(1) `hat indowAks an archW engincer or"urvywlbr i0my or dmnqc ,king Ma of
(a) 1'repadrig, appmving or Nihng to prepare or approve inaps. stwp dmwirigs, o0imunep0l smvqq field
orders, change orders or, drawiti,M,,s and specifications. or
(b) Givin.g directions or instructions, or fading to give then'. HAW is The P&MA"Y clusc Orthe injury or dam-
agea
(2) t.jucler vvjjjcjj tlw howTA illin Whem engMecr or surveyor, asswncs Hability for an injury or damage arising
out of the insureds rendering, or FaWe to render professional services, klcludin�al, those listed in Paragraph (1)
above amd SUJICFVkOry, k1sI)CCtion, 3rChkWUl'al OrCWgineCting IICIiVIOCS,
DESIGNATED coNmaxyrION PROJECTS) GENPAAL AGGRUZA111 1ANirl'
(mim mm, AGGREGATE UMIT FOR COVFRACFS A, B AND C)
SCHEDULE,
Designated Construclion Projects:
All C011SIT-LIC6011 prtnjCCIS COVCmd by this inSIn-811Ce,
(Ifno entry appears above, inforimnion required to coinplete this; endorseinent xvM he slw\vn in the Declarations as 01pka-
bl Unhk ndoiwrncn1.)
10) 68 93 01 17 hWW&S avyrighted niatcrial or losurance scrvices Office, Inc., Page 4 of 8 EO
with is penriAssioin 2W11 20 12 & 2013.
A. For aH surris which the insured becomes legally obhgated to pay as darn ages caused by -occurrences' under COVER-
AGI, A (SFC] ION I), and [or all nledical expenses caused by accidents under CA)VERACT (: (SIANION ly which can
Ise aniriburred oidy to oilgoing opemdons a a shoe designawd pRject shomi in the Schedtdc above:
I . A separate Deskgnalcd C'onstructik)n Pndect Ouncrul AggrcgWv link anylks, to each dcsQnmcd emisuvokin pm
ject, and that limit is equal to the aniount of the Geneml Aggrcgale Lilnit shown ill [tic Declara6041s,
I loweva, the nust we \viH pay under the Dnignawd C'orimniction Project (knowl Aggregme lAmik Ibr all Iksl,-
nwed Conwohn PnQts cmilbilwd Is StONAWO -
2, The I)csignmed Qnsarmlion Projeo Ckneral Aggregate lArnk is the most we "Al pay Rw the swn WVII dart iges
under C"OVI,'RAGL, A. eNcepi liccausc ol`°llodily injury" or "property damago" included in the "produds-
curripIctcd operations hazard'% arld for rnewcal expenses un(jer (.'()V I RA(3 I i-eg aal-tfless cd' the number of:
(:'jaitus nladC Or "Suits" brOL11,111L OV
C. Persons or or", all izations making claims or brin.g.inv, "Si.IkS",
3, Any paymeMs ni'ade under L'OVERAGE A Rw dwiiages (w under (MVERAGE C Rw mccliml expenses shall reducc
the I)cshnated Construction Protect General AggmgWv Linin for that designat"l construction prqjccL Such pay-
mems shall not reduce the Geneml Aggregate I Hit shown in the Declarations nor shall Mey m5we any Oka Iks-
ignalcd Uollstruo ion pndeci. Genend Aggregate I in A Rw all 01m,signmed cmnouokm project shown in be
Schedulu above.
4, Ile Hmhs Kom hi the Declarations Rw Kch Ckcurrence, Fire lkinuMe and Ndaliml Expose couthwu to LIPS.
I jo%N!CvrCr' instead of being suyea to the General Aggregate lAmh shown in the Duclaradans, SUL11 IWAS Will he
subjeo io be applicable lksymed (j,nmnrcdon Pnoco (Ineml AggreyMe linift.
it I% all sw-ns which the imsured becomes legally obUgatecho payass danugus cmmed by -oaurrenus- under CYVER-
AGk A (SECTION 11, wid RK Al medical uxlwnses caused Ivey accikkim under (I)VERA(W c (sayrim it which can -
[lot he attributed only to ongoing operas loos m a -single dedplated amsmielbri prqVc-t shown h"he Schedule above:
1. Any payments nude under CA)VERAGE A Rw damages or under COVERAGE C for medical expenses shall reduce
the amount available under the Geneiral Aggregme !Arnh or the Ihoducu-Curnpiewd (Jwnakns AggregaW lArnh,
whichever is applicable, and
2. Such paynicnis shall nm reduce an tlesigim,ed Construction PnQui General Aggregate 11-nd.
CA When coverage Or 15bilig arkhT out of the -paduc-ts.complewd "crainions hazord" is provided, an), payinems Q
daluages, because ot"toddy hljury- or -pajony damage- included in we -pnoucts-curnpIcted cm qw6ol-m hazai-d" will
reduce the jyodua.CompWwd yewdons AggmIgme Airil and nm rKwe be Galeral Aggwye t%R nor Me Iksj-
nawd CAmmiawdon lhojea (kireml Aggregate Lhnh.
1), If d1c applicabo desonated construction pR§cci has been abiulclunsh delayed, or abandoned and then restarled, or iftliv
authorized contracting parties dcviate fi-om plans, bluept-iJuS, deSH2,11S, SpCCiifielnions or timetables, the ptojcct vviH still be
decnicd to be the SaIlIC COnSU'LIC60VI PrQjCd,
I The provisions of Limit's Of h15L1rduCC (SLL'TION 111i not otherwise modified by this cndorscillcut shall contillue to ap-
ply as stipubled.
Ill. AJ)DITIONAL INSUREDS
AD011104%I. INSURED - IXSSOR OF LFASED EQUIP54mr
.kUT054ATIC sor/knis VVIIEPN REQUIRED IN WITH YOU
(limura"ce !jenves (Hfice Endonement (T 20 34 04 13)
A. Section 11 - Who is An Imured is amended to include as an addhional insured Huy POAAQ Or Of9mintKn(s) 40111
whorn You Icase equillniclit when ym'l and such person('s) or or",
t anization(�) have agrecd in writing, ill a Contract or agree-
inern that such persoi4s) or organinikmqO he added as an adldoiud insured on your policy. Such pasonyklr organka-
don(s) is an insured only with respect to habilky lot- "bodily injury", "IlLroperty damagle" or "persorlat and advertising,
hijury" cause$ in whole or in pare by your i-nalive ....... jenam"m rase or etluilitiumt icase(i io you by, such person(s)
or org"Inization(s).
I lowm0r. the: Visuralice alowded to Such ad"KA NUM&
1. ()nly al)PjjeS Co jlle CXtelu pennifled 1)), all(i
Ad) 6H 93 01 17 Includes copyrighted nwrawi or imurance scrous onk" In- INge 5 or 8 El
wit its pennisdon. 200% 2012 &. 2013.
sured.
A person's or organization's status as ,in additional n1SUrCd UodCr this cridorscment ends when their contract or alvee-
fnern. Will) yOU fOr SUCh ]eased equipment ends,
B. Willi respect to the insurance afforded 10 LhCSC additional Insureds, this insurance does riot apply, to any -occurrence"
mfich to Us plau after the equipment lease expires.
C. With respect to the insurance aff'orded to these additional insumds, die follwaving is a&kd IN QdWn 1111 - ILK% Of
Insurance:
The most vw c wilt pay on halialrofle adclidwral wisured Is the amouia of QuInance:
I. Recluired by the contract or agreemcm )wu have entered ulto with the additional insured, M'
1 Avadahlc u,nict, tho amwicawc inits or Insurance slunyn in the Declarathno
whichcVcr is less.
Ifis enclorscInent shall not increase the applKable linnits oflnwranee Alown 6 A lkdawkms.
AkDIMI(,DNAL INSURIA) - AdANAVERS OR LESSORS 0111 PREV"SES
(inmwance SuNilces (01fice Endorseme"! (1; 20 11 04 13)
SCHEDULE,
DesignKon (9 11hremiso (NO Uased To VoW.,
All prerniscs leased to you and covered by this Insurance.
Name w Person(s) Or C)rganizmion(Q (Addhim"al Insured):
Any person or oTanizwion that is a manager or lessor orreal pi,operty. but (mly ifcoverage as an addhOnal Cured is re-
ydred by a written coliti-act or %whwn agreemwit that k an -hmwvd contract", mul provAd dw'todily Qry- or -prop-
erty darnagc" first occurs. or 1he -personal wid advemising quy, onowe is that committed, subsequent to the executhn
of the Contract or ag reeincrw
InforniaLion rcuuircd to compictc this Schedule, if nol sho%"l above, wvM be sh(nvn it the Declarations.
A, Section 11 -- NN'ho Is Ail Insured is wincluled to Kchwe as an addidwmll Insured the person(s) or organization(s) show n
ill IIIC SCIMIUIC, bUt Only %vidl rcsj)ccj to thwhy awhig out of flue uwwInship minacumwe or uw of dwl part of the
prerniscs leased to yint and shm"i in the Scliedule and swNect U) the tWknvhg additional exclushns:
Ilk hinuralice TVs MA apt to;.
I,. Any -occurrcrtce" which lAcs phce after you ecase to he a Wnwa in than pandscs.
2. StuoundahcmdmmiwwcmmnwdonordauWdkmiopultmepaMmmdbyo"mbA&rwthe pumnqooror�-
an ization(s) slioNvIl in the Schedule,
I I oweve r:
i. Ile iwtwwwc affintled to such addWouad wstwW only applies to the extent permitted hy-ANY; arld
2. l Ccovcrai ge provided to the addWonal hisured is mquhTd by as conmwl o"gruclunt, we irrswarwe Wforded to such
additional insured w'ill no be broader than tat whih you, are required by the C011tract or agreenwilt to provide for
such additional insured.
.
11. With respect tea me insunnice arlbMcd to these additional hnurdv the is added to Sedion Ill .UnAls Of
Insurunce:
ircovvragc provided to the additional insured is rCqUu_Cd by a C0111ract oragjcenwnt. the most we vviH pay on beh"'Ill'of
the addidonal insured is the amount or insuRmce:
1. iUquircd by flic Contract or m"recuient; or
2. Available under the applicable !,Mots of Insunulce shown in die Decluralion,
whichever is Ics's,
1% oicimsemelit shall nW kwwase the apikable I imits rd'hnurance shoM in the DCLIarations.
AD 6H 93 01 17 pwkdn c"yHQhtcd inalsial oHnsuraInce Services Onk" hue., Page 6 of 8 E3
vvitj I its pcI,rnissioo, 2001), 2012 & 2013.
ADDITIONAL INSURED — MORTGAGEE, ASSIGNEE OR RFCTI V"I',R
(Insurance Services Office 1?t dorsernent C:;C;< 0 18 04 13)
C"11KDULli
._
N:;rtaue 4)I I'er±ar7n'r) (1r IAcsi 'cr.rtrrroy Of 1 ur.rrld:wes
Any person or organization that is as trrarnVIce assignee or to ' Ald lnrernn'iscs cowered by this unswaaime,
cciver for premises shown, in this SCIMIL11C, Inuit early prcu'rV-
ctogu as an a.dditdaanal rnsarucd is required by <a wwa'tdte n ccoirtrad
or wwrhwn agreement that is an "insured comract`% and pro-
vided the -bodily injun - or-pimpnerty dairnage'° Isrst rrccuar's„ or
the "personal arnd advertising injury" urfdcrtsc is Cirst corniradt-
ted, subsequent to the cXcCeatien arf the carratract err <a�seetnrerrt.
Information re a c,nlete dta�tar arrtnthis Schedule, sha�rwwrt in the D cdaratianns.
.aed __.�...��. 1�tl ncrt shown aharwe, wvr[l l-te.__�.....�..._�..._..�.� ......_�..
A. Section. 11 -. Who Is An Irt4 ued is aatnacrrclewd tar Nclutde as an addidol al instarr l the person(s) ena sw9mizaatien0) shaawVra
in the `schedule„ but only vwhh respect to dhcar H alntlij, as nion agee, 2assig,rrcc, or receiver and arisanpp, out arrthe mvner-
shipr, nnaintenaaroce, or use of the premises by you and shown ill the schcudulc,
Ilenww'cver:
I. The insurance afforded to such additional insured only, applies, to the cvtent pncrmittcd by haws; and
2. 1fearvcnge parawkkd to the additional insured is reclwrirud by a caoartract or aagrec:nnent, the insrararree atftowrcdcd to suelr
aadddtionM Burred wwdll not be Nader Main that which you are requked 17ly the conuou or agreement to pn ovide 11or
such aadditiannad insured.
B. This insurance dares not apply tarstructural aultcmdiartm neww ccrwntetdon and demolhion operations pncrfoinncd by or for
that person or orr?,anna/aatar,nn.
C:, Willi respect to tine insurrancc afforded to these additional ursured% the RAbwhg is added to Secliaan III - lairr"rils Of
V'fcaovcrage p-rreov'ii c.d to the radditiunal dnsuved is rcapukTd by a ciontuact or <agreetnnean't, the trrarst wwe will [nay on behalf'Of
the aaMiticrnaal insured is the anatnunt or insurance:
1. Kecpuaired by the carurtraact or Or
1 Avaitable under the apnpniRuble LknA of Nsurance slaarwwrr in the Dec lanions;
Whichever is less..
This etndorscuntctrt shardl not increase the adn#kabk l,aannrtas O' lnsuranee sha7wwn in the Decdaratianns.
AI)I)rrl()N,kl, INSURED .-- TRADE SII{)W SPONSOR —
AUTI(.) lv IC" s I'At,°us vvillEN Rl^;Ql.ilRED IN VVICI°I"'1 EN AGRFA:MENT'"w'VITII YOU
it Secti m 11 Who Is An Insrared is amended tc:r incM as aaia addrtienaaal hrsarred arty prctscwn err organiz.tat M "to ds a
sponsor or a Iraade show where you are op'reraatrn.g as booth, or displaying ycour product, hut only:
1. For injury arr d tuns ge incurring at We trade slaaY and
2, "wwJlncrr y'rnrr aand such p',ner"nalrr a+r tra�;atndattivara l awe rrwtp'cccd irr wnra'rtiurry irr a ccrra'tr to trau a rcc.rtnenl cwecuttcal ptriurr taa tl'ne
beinnin't" or'the mile showw than such person or orgarnizaton be andalc:ad as an add AM Mired on ymH pWly.
;such person or arrp.,anrration is all aadcliticrntal insured only with respect to liability lot, "hardily injury", " pnroptcrty" danras�e"
orr 'lrersonal and aadvoAsMg irijrury" caused, in wvdrarle or in pnML by:
1. "r'rvurr acts or tonnkslons, or
2. 11c acts arr omissions or those aantdn ,, on your hchal l;,
while arttcnadrng,, the trade show sponsored by this additional insured,
AD 6H 901 17 hwludes crrpnyru: hted material err lnsurancc Services ices Office, Inc., I'an,ge 7 of H I
ww Kh its pvernatssia n ?dptW, ,r I & 2013,
A person's or aargauaintiont status as an acdaddtia hill inswv d under this en dtarsetarcnt ends %vhcn ycaur attc�ucdaance at the
traade slrcrww' cncds.
B3 With resh7e:a:t tea the irasur°aanec ad'darradecd to these a cdedi6onal urstare ds, the darddaaww�irru�r" a�adut'itraraV exclusion ad:rlydic,s;
This insurance does rraat apply to "handily A daury or "drrcrprwr ty Idaataraa r.e" arasing out aad`a`y'craar work— asp•-y,arrir pr°t aduct" and
included in the "`praraductocarraadrdc e d operations haaz arK
+C' W'dth respect to the insurance afforded to these artdalatraanM hasatrak 81 e Caallaawwing is, Lidded to Section It - Lunits 01'
Irrsur arace
lfcovcra;„c provided tar the Aaadaditdunaal drasurwtd is rrequirecd by a contract or,aumeuarent„ tdae aaatast we "All pray on behadd"rat,
tdre aadahtiarlaal Quxed is the amount of insuaraaace:
I. Required by (dac contract or of,
?. Avaaidaable under flee adrprH"hrla LhnnS Of lNasurana°c slrOWB it) the DCCIaar°taticrrt.s;
wwhiclrcwca• is less.
,dllis craadeaasenieni whelk uaaat Krease the a apl'ucaable d.iraauts tal`dtrsurarace shcamm in the Declarations,
ADDITIONAL INSURED — STATE E (YR (a(:)Vl-0;RIwwiV`I1?NTAL, AGENCY Oil SUBDIVISION
OR I'OL,I'I"If:'Al. SUBDIVISION -m- PERMITS S Oil AU T11ORli+'A TIONS
dlNSURA,NCE S1?1t`wIC s OFFICE ENDORSEMENT (.4;, :W 12 04 13)
Mate Or Coverrameniaal Agency Or Sub diVisiarra Of- 1'01dtieaal Sul:aadiw isicrra:
Any state or agency or stthcdivdsuaarl "pwraditaeaal stabdivasiaara that has issued as pennh or authcarkatrarra for tap3as-
tiaans d)erfOrnlead by ytauu car• aru y aaur l:?chaHI
hla orinataaata rcultiread to wirrntrlcte this Schedule, il`raaat shown above. %wall he sharwni in the Declarations.
A. Section 11 NNIhro Is An Insured is amended to inchWe as an acdtlilaaaraaad insa.trccd any state or ga:awernmerltaad agency or
subdivision or political subedivkl n shown in the Scha°adtad, suly"I ta) the d`tadknving gvvawaa nsa
1. This insurance aaprdrdhes onV ww pth res"et to qrertttucans prerh'wmecd dry you wort you behalf char mlich the .wtautc or
governmental agency or htrl'.7Cdiviti n tar pa9ptlfllc al subdivision has issued a pLnnit 4;y a 6lohmizakt1.on.
d lowever:
aa, Ise itasuraaime aMrrcdecd to sisch aadeda tonal insum d study apadadres tar the e;wterat prcrnaattecd lay hawv, and
ha. ld cov,craw7e prra:rviadwtd tta the additional hisurecd is mquit'ecd by a ceaerteaac,t or aagreen writ, the illsurance afforded to
such additional insttm d will nor be koaaadw- tan drat "hick you are rududrwad by the curatraact or aayreetarent to
prtaav& Barr such a atdtditiarraaal iaasum d.
2. This ptrsurance closes not aaprpaly, to:
ar. "ddaacdidy "Property cdaaraaage" or "pel'son al and aadvertislrag houryaarishil" out a: ad'taprcrations performed for
tlae federal ;governrarent„ state or rrrulaicipraadity,err
l:a. "Hodilyr injury'' or "property daaanaaage" incducdeed within the "prod ucN-c crrtaprVoted rad7ermions hazard"
,
13. Wth tespect to the humane afforded to these racdcdWoraaad uasaurecds, the daallarwwirag as achrdecd Car Sea^thn III — I.adrarits O1,
Insurance:
If caavcra,age provided to the additional drrsuretd is required by a culatraact or agrcenacrn. thae most we wwV pray on lrchadCa
the additional ansrrrecd is 'tlac aauaOurrt Of illsatraaaace:
Requir-ed by the (ontr act or aa"+,rCen1clW or
Available under 11w aapadrduuthle l..itnits aarVurrance slunvu in the Declarations',
ww'darwlrcvel is peas.
Ibis etra.ha:arscaraent ,lu dl not increase the applicable Knih s aallnsuaaince wla(mal in the lOcdaraatazara,
00) 6H 93 01 17 Incltucdcw carpryrighw d nuatakil of Insuuraarace 4envices Office, Me., Page 8 or E3
ww Mi its prerrrrawsiarra, N'Dt: % 2012 & 2013.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34
(Ed8-00)
V\k� have the right to recover our rv,)yrnents ftonianyone Iiable for an irnjury covered by this policy. We krill not enforce
OUr right against the person or organization narned in the Schedule. (This agreernent apl.'.Aes only to theextent that
YOU perform work under a written contract that re(','juires you to obtain this agreemerit frond us),.
The additional prerniurn for this endorser-nent shall be
otherwise due.
R",,rsoini (yr Organization
ANY PERSON / ORG
WHEN REQUIRED BY
WRITTEN CONTRACT
2 % of the total California Workers' Cornpensation prernum,
Schedule
Job Description
ALL CALIFORNIA
OPER.A1'IOUS
This enclorsernent changes the pollcy 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 poficy.)
Endorsement Effective 12/01/2021 Floflcy No, WVE 5058158 01 Endorsernent No.
Insured CALIFORNIA STREET LIGHTING Premium $ INCL .
Insurance Company INSURANCE COMPANY OF THE WEST
Countersigned By.
NSUIO 0