PROOF OF INSURANCE (2023) CLOSEDl DATE (MMIDD/YYYY)
AC "RL> CERTIFICATE OF LIABILITY INSURANCE
6/30/2022
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; Brlanna Orchekowski
Edgevaood Partners Ins, Center PHONE F
10877 White Rack Road Suite 300 E-MAILFAtY
_( W
Rancho Cordova CA 95670 ' INSURERM)AFF AFFORDING
COVERAGE
Sacramento - P&C Lic #0B29370 a�rtDRe s b .....a orctlekowskl
YNGCOVERAGE ,.� ....NAdCp
INSURED
Cooperative Personnel Services
DBA: CPS HR Consulting
2450 Del Paso Rd., Ste. 220
Sacramento CA 95834
INSURER A : The Continental
INsuReRs; Lloyds of Londo
INSURER C : ....... ....... m Continental Cas
INSURER D : American Casu;
INSURER E: National Fire In:
INSURER F
rn1ffo0nr_1=c !`1=0TICIr`AT1- kit IMRI=R•QS292RQRdn3 REVISION NUMBER:
20427
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. ... ......
....'... ...... ADl?L SW'ARVR� . ........�.� POLICY NUMBER ...... PM/DDY EFF j � PO�L'4CYImmog=y..�
.................... .TYPE OF INSURANCE...... POLI.m....----- w-_.µY lff ..........__..... LIMITS .... .....---
INSR pp
TR
A
COMMERCIAL GENERAL LIABILITY
X CO
Y
Y
6072390517
7/1/2022
li 7/1/2023
EACH OCCURRENCE
$ 1 000 000
_ _
�X,..I
I"�AM,4ii� io i1�hYf'EU -
...� .......
1 000,000
CLAIMS -MADE OCCUR
.........
MED EXP (Any one person)
$5 000..1�.µ. ••W.____
PERSONAL &ADVINJURY
.... .......... ..-
$1,000.000
......... ..........
ENLA GGRE APPLIES PER:
GENER...... AGGREGATE
$ 2 000 000
PRO -
POLICY X LOC
PRODUCTS COMP/OP AGG
$ 2 000 000
m,m
R . LI
$... .. „•,
OTHER..
D
AUTOMOBILE
Y
Y
6072390548
7/1/2022
7/1/2023
.COgMsaBa,rndurel�'�EL_.I..M..IT
a
,00,000 ........
ANY AUTO
BODILY INJURY Per person)
$
• SCHEDULED
OWNEDAUTOSONLY
- .....$
BODILY INJURY (Per accidenl)�
•..-...e.
$
X••'
.. AUTOS
HIRED X� NON -OWNED
AUTOS ONLY AUTOS ONLY
...
.�.� ....w,
t�ROPER�'Diat�kAt3E..
....... .. ....
$
....... ..,.
•,•,•W
j
I.
$
A
X
UMBRELLA LIAB X OCCUR
6072390551
7/1/2022
7/1/2023
I EACH OCCURRENCE
-
$ 66
- , 000 000
EXCESS LIAR CLAIMS -MADE
..X ... _
AGGREGATE
$ 6 000 , 000 _
NTION $
DED RETE.
$
C
WORKERS COMPENSATION
Y
6072390534
j 7/1/2022
7/1/2023
STATACCI TENT OTH
X PER TE ER 5 tap Gap, Applies
E
AND EMPLOYERS' LIABILITY YIN
6072390520
7/1/2022
7/1/2023
..... 1
ANYPROPRIETOR/PARTNER/EXECUTIVE N
NIA
E L EACH 000 000
.E...
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH) _
DISEA S -- ............. ..., 000
................................W,.E..;,•EA EMPLOYEE.... $1,000.._.......-. ..................,
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT $ 1,000.000
B
Errors & Omissions
PSL0039482791
7/1/2022
7/1/2023
Per Claim/Agg
$3,000,000
Claims Made/Retro Date 10/13/1989
SIR Per Claim
$50 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space "
ritten Agreements between the Certificate Holder City of El 'Segundo, Its officials and employees. When
Re; All ContractslWand the Insured, Additional lnsured
required by written contract, Additional Insured status with pnmM coverage applies to General Liability and Automobile Liability and Waiver of Subrogation
applies to General Liability, Automobile Liability, and Workers' Compensation, all per the attached endorsements.
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
i
V IyiSO-L1.1I9 AI.UKLJ I.UKrUKA1 IVIY. All rlgrl15 re5Cf V6U.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CNA CNA PARAMOUNT
General Liability Extension Endorsement
1. ADDITIONAL INSUREDS
a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs
A. through K. below whom a Named Insured is required to add as an additional insured on this Coverage Part
under a written contract or written agreement, provided such contract or agreement:
(1) is currently in effect or becomes effective during the term of this Coverage Part; and
(2) was executed prior to:
(a) the bodily injury or property damage; or
(b) the offense that caused the personal and advertising injury,
for which such additional insured seeks coverage.
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer
will not provide such additional insured with:
(1) a higher limit of insurance than required by such contract or agreement; or
(2) coverage broader than required by such contract or agreement, and in no event broader than that described
by the applicable paragraph A. through K. below.
Any coverage granted by this endorsement shall apply only to the extent permissible by law.
A. Controlling Interest
Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or
organization's liability for bodily injury, property damage or personal and advertising injury arising out of:
1. such person or organization's financial control of a Named Insured; or
2. premises such person or organization owns, maintains or controls while a Named Insured leases or
occupies such premises;
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by, on behalf of, or for such additional insured.
B. Co-owner of Insured Premises
A co-owner of a premises co -owned by a Named Insured and covered under this insurance but only with respect
to such co -owner's liability for bodily injury, property damage or personal and advertising injury as co-owner
of such premises.
C. Grantor of Franchise
Any person or organization that has granted a franchise to a Named Insured, but only with respect to such
person or organization's liability for bodily injury, property damage or personal and advertising injury as
grantor of a franchise to the Named Insured.
D. Lessor of Equipment
Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for
bodily injury, property damage or personal and advertising injury caused, in whole or in part, by the Named
Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such
bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place
prior to the termination of such lease.
CNA74879XX (1-15) Policy No: 6072390517
Page 2 of 13
CONTINENTAL INSURANCE COMPANY Effective Date: 0 7 / 01 / 2 02 2
Insured Name: COOPERATIVE PERSONNEL SERVICES
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services office, Inc., with its permission.
CNA 1
CNA PARAMOUNT
General Liability Extension Endorsement
E. Lessor of Land
Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily
injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use
of such land, provided that the occurrence giving rise to such bodily injury or property damage, or the offense
giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The
coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of, or for such additional insured.
F. Lessor of Premises
An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but
only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of
the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that
the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal
and advertising injury takes place prior to the termination of such lease. The coverage granted by this
paragraph does not apply to structural alterations, new construction or demolition operations performed by, on
behalf of, or for such additional insured.
G. Mortgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's
liability for bodily injury, property damage or personal and advertising injury arising out of the Named
Insured's ownership, maintenance, or use of a premises by a Named Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of, or for such additional insured.
H. State or Governmental Agency or Subdivision or Political Subdivisions — Permits
A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization,
but only with respect to such state or governmental agency or subdivision or political subdivision's liability for
bodily injury, property damage or personal and advertising injury arising out of:
1. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which
this insurance applies:
a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults, street banners, or decorations and similar exposures; or
b. the construction, erection, or removal of elevators; or
c. the ownership, maintenance or use of any elevators covered by this insurance; or
2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations performed
for the state or governmental agency or subdivision or political subdivision; or
b. Bodily injury or property damage included within the products -completed operations hazard.
With respect to this provision's requirement that additional insured status must be requested under a written
contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the
Named Insured to add the governmental entity as an additional insured.
CNA74879XX (1 - 15) Policy No: 6072390517
Page 3 of 13
CONTINENTAL INSURANCE COMPANY Effective Date: 07/01/2022
Insured Name: COOPERATIVE PERSONNEL SERVICES
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CNA CNA PARAMOUNT
General Liability Extension Endorsement
I. Trade Show Event Lessor
1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or
displayer, any person or organization whom the Named Insured is required to include as an additional
insured, but only with respect to such person or organization's liability for bodily injury, property damage or
personal and advertising injury caused by:
a. the Named Insured's acts or omissions; or
b. the acts or omissions of those acting on the Named Insured's behalf,
in the performance of the Named Insured's ongoing operations at the trade show event premises during the
trade show event.
2. The coverage granted by this paragraph does not apply to bodily injury or property damage included
within the products -completed operations hazard.
J. Vendor
Any person or organization but only with respect to such person or organization's liability for bodily injury or
property damage arising out of your products which are distributed or sold in the regular course of such person
or organization's business, provided that:
1. The coverage granted by this paragraph does not apply to:
a. bodily injury or property damage for which such person or organization is obligated to pay damages by
reason of the assumption of liability in a contract or agreement unless such liability exists in the absence
of the contract or agreement;
b. any express warranty unauthorized by the Named Insured;
c. any physical or chemical change in any product made intentionally by such person or organization;
d. repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the
substitution of parts under instructions from the manufacturer, and then repackaged in the original
container;
e. any failure to make any inspections, adjustments, tests or servicing that such person or organization has
agreed to make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of the products;
f. demonstration, installation, servicing or repair operations, except such operations performed at the such
person or organization's premises in connection with the sale of a product;
g. products which, after distribution or sale by the Named Insured, have been labeled or relabeled or used
as a container, part or ingredient of any other thing or substance by or for such person or organization; or
h. bodily injury or property damage arising out of the sole negligence of such person or organization for
its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this
exclusion does not apply to:
(1) the exceptions contained in Subparagraphs d. or f. above; or
(2) such inspections, adjustments, tests or servicing as such person or organization has agreed with the
Named Insured to make or normally undertakes to make in the usual course of business, in
connection with the distribution or sale of the products.
2. This Paragraph J. does not apply to any insured person or organization, from whom the Named Insured has
acquired such products, nor to any ingredient, part or container, entering into, accompanying or containing
such products.
CNA74879XX (1-15) Policy No: 6072390517
Page 4 of 13
CONTINENTAL INSURANCE COMPANY
Effective Date: 07/01/2022
Insured Name: COOPERATIVE PERSONNEL SERVICES
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CNA PARAMOUNT
General Liability Extension Endorsement
3. This Paragraph J. also does not apply:
a. to any vendor specifically scheduled as an additional insured by endorsement to this Coverage Part;
b. to any of your products for which coverage is excluded by endorsement to this Coverage Part; nor
c. if bodily injury or property damage included within the products -completed operations hazard is
excluded by endorsement to this Coverage Part.
K. Other Person Or Organization
Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such
additional insured is an Insured solely for bodily injury, property damage or personal and advertising injury
for which such additional insured is liable because of the Named Insured's acts or omissions.
The coverage granted by this paragraph does not apply to any person or organization:
1. for bodily injury, property damage, or personal and advertising injury arising out of the rendering or
failure to render any professional service;
2. for bodily injury or property damage included within the products -completed operations hazard; nor
3. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part.
2. ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE
A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended
to add the following paragraph:
If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non-
contributory relative to an additional insured's own insurance, then this insurance is primary, and the Insurer will
not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own
insurance means insurance on which the additional insured is a named insured.
B. With respect to persons or organizations that qualify as additional insureds pursuant to paragraph I.K. of this
endorsement, the following sentence is added to the paragraph above:
Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to
such person or organization is excess of any other insurance available to such person or organization.
3. BODILY INJURY — EXPANDED DEFINITION
Under DEFINITIONS the definition of bodily injury is deleted and replaced by the following:
Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock,
mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical
injury, sickness or disease.
4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended
to add the following:
A. BROAD KNOWLEDGE OF OCCURRENCE
The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence,
offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a
partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the
above to give such notice.
B. NOTICE OF OCCURRENCE
CNA74879XX (1-15) Policy No: 607239OS17
Page 5 of 13
CONTINENTAL INSURANCE COMPANY
Effective Date: 07/01/2022
Insured Name: COOPERATIVE PERSONNEL SERVICES
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
........CNA -
CNA PARAMOUNT
General Liability Extension Endorsement
not be deemed to be damages for personal and advertising injury and will not reduce the limits of
insurance.
D. This PERSONAL AND ADVERTISING INJURY - LIMITED CONTRACTUAL LIABILITY Provision does not
apply if Coverage B —Personal and Advertising Injury Liability is excluded by another endorsement attached
to this Coverage Part.
17. PROPERTY DAMAGE — ELEVATORS
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of
the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Other Insurance conditions is amended to add the following paragraph:
This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
18. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows:
A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit; and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a
$1,000. limit.
19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named
Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure.
20. WAIVER OF SUBROGATION - BLANKET
Under CONDITIONS, the Transfer Of Rights Of Recovery Against Others To Us Condition is amended to add the
following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of.
1. the Named Insured's ongoing operations; or
2. your work included in the products -completed operations hazard.
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
a written contract or written agreement, and only if such contract or agreement:
1. is in effect or becomes effective during the term of this Coverage Part; and
2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the
claim.
All other terms and conditions of the Policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes
effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,
and expires concurrently with said Policy.
CNA74879XX (1-15) Policy No: 6072390517
Page 13 of 13
CONTINENTAL INSURANCE COMPANY
Effective Date: 07/01/2022
Insured Name: COOPERATIVE PERSONNEL SERVICES
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.
Policy #6072390548
CNA8370OXX
CNA
(Ed. 10-15)
EXTENDED COVERAGE - BA PLUS - FOR HIRED AND NON -OWNED AUTOS
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows. If
any other endorsement attached to this policy amends any provision also amended by this endorsement, then that
other endorsement controls with respect to such provision, and the changes made by this endorsement to such
provision do not apply.
TABLE OF CONTENTS
I. AMENDMENTS TO LIABILITY COVERAGE
A. Who Is An Insured
1. Majority Owned Corporations
2. Newly Acquired Organizations
3. Additional Insureds Required By Written Contracts
4. Employee -Hired Autos
B. Increased Loss of Earnings Allowance
C. Fellow Employee Coverage
II. AMENDMENTS TO PHYSICAL DAMAGE COVERAGE
A. Increased Loss of Use Expense
B. Broadened Electronic Equipment Coverage
III. AMENDMENTS TO BUSINESS AUTO CONDITIONS
A. Knowledge of Accident or Loss
B. Knowledge of Documents
C. Waiver of Subrogation
D. Unintentional Failure To Disclose Hazards
E. Primary and Non -Contributory When Required By Contract
IV. AMENDMENTS TO DEFINITIONS
A. Broadened Bodily Injury
1. AMENDMENTS TO LIABILITY COVERAGE
A. Amendments to Who Is An Insured
Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Who Is An
Insured is amended to add the following:
1. Majority Owned Corporations
Any incorporated entity in which you own a majority of the voting stock on the inception date of this
Coverage Form is an "insured", but only if such entity is not an "insured" under any other liability "policy"
that provides "auto" coverage.
2. Newly Acquired Organizations
Any organization you newly acquire or form during the policy period, other than a limited liability
company, partnership or joint venture, and in which you maintain majority ownership interest is an
"insured", but only if such organization is not an "insured" under any other liability "policy" that provides
"auto" coverage. The insurance afforded by this provision:
CNA8370OXX (Ed. 10-15) Page 1 of 3
Copyright, CNA All Rights Reserved.
CNA83700XX
CNA
(Ed. 10-15)
a. Is effective on the date of acquisition or formation of the organization, and applies until:
(1) The end of the policy period of this Coverage Form; or
(2) The next anniversary of this Coverage Form's inception date,
whichever is earlier; and
b. Does not apply to "bodily injury" or "property damage" caused by an "accident" that occurred before
you acquired or formed the organization.
3. Additional Insureds Required By Written Contract
Any person or organization that you are required by written contract to make an additional insured under
this insurance is an "insured", but only with respect to that person or organization's legal liability for acts
or omissions of a person who qualifies as an "insured" for Liability Coverage under Section II — Who Is
An Insured of this Coverage Form.
4. Employee -Hired Autos
Any "employee" of yours is an "insured" while operating with your permission an auto" hired or rented
under a contract in that "employee's" name, while performing duties related to the conduct of your
business.
With respect to provisions A.I. and A.2. above, "policy" includes those policies that were in force on the
inception date of this Coverage Form, but:
L Which are no longer in force; or
ii. Whose limits have been exhausted.
B. Increased Loss of Earnings Allowance
Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Coverage
Extensions is amended under Supplementary Payment subparagraph (4) to delete the $250 a day limit for
loss of earnings and replace it with a $500 a day limit.
C. Fellow Employee Coverage
Under SECTION II — COVERED AUTOS LIABILITY COVERAGE, the paragraph entitled Exclusions is
amended to delete the exclusion entitled Fellow Employee.
II. AMENDMENTS TO PHYSICAL DAMAGE COVERAGE
A. Increased Loss of Use Expense
Under SECTION III — PHYSICAL DAMAGE COVERAGE, the paragraph entitled Coverage Extensions is
amended under Loss of Use Expenses to delete the maximum of $600, and replace it with a maximum of
$800.
B. Broadened Electronic Equipment Coverage
Under SECTION III — PHYSICAL DAMAGE COVERAGE, the paragraph entitled Exclusions is amended to
delete paragraphs 5.a through 5.d. in their entirety, and replace them with the following:
5. Exclusions 4.c. and 4.d. above do not apply to "loss" to any electronic equipment that at the time of
"loss" is:
a. Permanently installed in or upon a covered "auto", nor to such equipment's antennas or other
accessories used with such equipment. A $100 deductible applies to this provision, and supersedes
any otherwise applicable deductible; or
b. Designed to be operated solely by use of the power from the "auto's" electrical system and is:
(1) Removable from a housing unit which is permanently installed in or upon the covered "auto";
(2) An integral part of the same unit housing any electronic equipment described in paragraphs a. or
b.(1) above; or
(3) Necessary for the normal operation of the covered "auto" or the monitoring of the covered
"auto's" operating system.
_....... ................
CNA83700XX (Ed. 10-15) Page 2 of 3
Copyright, CNA All Rights Reserved.
CNA
III. AMENDMENTS TO BUSINESS AUTO CONDITIONS
A. Knowledge of Accident or Loss
CNA8370OXX
(Ed. 10-15)
Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Duties In the Event of Accident,
Claims, Suit, or Loss is amended to add the following subparagraph a.(4):
(4) If your "employees" know of an "accident" or "loss", this will not mean that you have such knowledge until
such "accident" or "loss" is known to a natural person Named Insured, to a partner, executive officer,
manager or member of a Named Insured, or to an "employee" designated by any of the above to be your
insurance manager.
B. Knowledge of Documents
Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Duties In the Event of Accident,
Claims, Suit, or Loss is amended to add the following subparagraph b.(6):
(6) If your "employees" know of documents concerning a claim or "suit", this will not mean that you have
such knowledge until such documents are known to a natural person Named Insured, to a partner,
executive officer, manager or member of a Named Insured, or to an "employee" designated by any of the
above to be your insurance manager.
C. Waiver of Subrogation
Under BUSINESS AUTO CONDITIONS, the Loss Condition entitled Transfer Of Rights Of Recovery
Against Others To Us is amended to add the following:
We waive any right of recovery we may have, because of payments we make for injury or damage, against
any person or organization for whom or which you are required by written contract or agreement to obtain
this waiver from us.
This injury or damage must arise out of your activities under a contract with that person or organization.
You must agree to that requirement prior to an "accident" or "loss."
D. Unintentional Failure To Disclose Hazards
Under BUSINESS AUTO CONDITIONS, the General Condition entitled Concealment, Misrepresentation
or Fraud is amended to add the following:
Your failure to disclose all hazards existing on the inception date of this Coverage Form shall not prejudice
you with respect to the coverage provided by this insurance, provided such failure or omission is not
intentional.
E. Primary and Non -Contributory When Required By Contract
Under BUSINESS AUTO CONDITIONS, the General Condition entitled Other Insurance is amended to
add the following:
Notwithstanding provisions 5.a. through 5.d. above, the coverage provided by this Coverage Form shall be
on a primary and non-contributory basis when required to be so by a written contract entered into prior to
"accident" or "loss."
IV. AMENDMENTS TO DEFINITIONS
A. Broadened Bodily Injury
Under DEFINITIONS, the definition of "bodily injury" is deleted and replaced by the following:
'Bodily injurymeans physical injury, sickness or disease sustained by a person, including death, mental
anguish or mental injury sustained by that person which results as a consequence of the physical injury,
sickness or disease.
All other terms and conditions of the Policy remain unchanged„
CNA8370OXX (Ed. 10-15) Page 3 of 3
Copyright, CNA All Rights Reserved.
CNA
Workers Compensation And Employers Liability Insurance
PoUcy Endorsement
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two -
Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for
California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G-19160-B (11-1997)
Endorsement Effective Date: Endorsement Expiration Date:
Endorsement No: 2; Page: 1 of 1
Underwriting Company: American Casualty Company of Reading, Pennsylvania
Policy No: WC 6072390520
Policy Effective Date:
07/01 /2022
o Copyright CNA All Rights Reserved.
Workers Compensation And Employers Liability Insurance
CNAPolicy Endersemo kt
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 shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may
execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this
waiver of subrogation does not apply to any construction group of classifications as designated by the waiver
of right to recover from others (subrogation) rule in our manual.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover
from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: WC 00 03 13 (04-1984)
Endorsement Effective Date: Endorsement Expiration Date:
Endorsement No: 4; Page: 1 of 1
Underwriting Company: Continental Casualty Company
Policy No: WC 6072390534
Policy Effective Date:
07/01 /2022
Copyright 1983 National Council on Compensation Insurance.