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PROOF OF INSURANCE (2023 - 2023) CLOSEDGENTR-3 OP ID: CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 10113/202.2 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 NTACT PRODUCER 909-9802 ANC Nara..m. Silverstone Insurance Services E 1 11 906 980.4785 _ 909-980-4211 � E Kyle VIscI li Jetton & Associates, Inc a PO BOX 1200 RANCHO CUCAMONGA, CA 91729 ...,.-INSURrt.. Ai MP! Kyle Visciglia . _ A : Ascot Special ty Insurance 23752 AFFOR ING COVERAG9 NA. al Ins ---... .. � ... ..... m. ..�.....-_ ......., .. _.r, ........ .�. -- INSURER.. � ...... Gent INSURED General Engineering Inc INSURER 6 Insurance Insurance Co West 127847 Regent24449 9277rArchiibald Avg u g INsuRER C Company of the Rancho Cucamonga, A 91730 Westchester Surplus Lines Ins �10172 INSURER D : p .......... INSURER F : AT;: REVISION R: 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 AN IE MAY VE BEEN REDUCED BY PAID D CONDITIONS OF SUCH POLICIES LIMITS SHPOWc _—�••""°° ... .m .. ICY EXP POLICY EFF POLCY EXP INs""R TYPE of INSURANCE NUMBERN LTR ._.- LIMITS _ A 11 11 X ,COMMERCIAL GENE RAL LIABILITY EACH QgCURRENCE. 8, -_ 1,000 ,00..... CLAIMS -MADE X OCCUR X X ESGL2210001438-01 10119/2022 10/19/2023 DAMAGE TO RENTED A'REAlE GEC OGCUL&� 50,000 X Ltd Contractual ( y rson _ 5,000'' _ X' C U NOT EXCLUDED N PENERALAGGRuRY - 1,000,000 ^ ...�... N°I. AGGREGATE LIMIT APPLIES PER. — _G ATE $ 2,000,000.. .. POLICY � � ,Pp�9' .. LOC PRODUCTS- 0,.__ ....._-. G MP,/QP AGG_ �,� ..... 0 000 2'00..-._ T R, B COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY „.� n. m.. X.. ANY AUTO X X BCA0005149-02 BODILY IN BY IPer.person $ LIED OWNED SCHEDULED J r,.. 6 BODILY IN_VRYLPe„ accident) ".. JU r $.._............. ., N H � r X AUT��O��yyS ONLY ArU��ITyyO��SaaWW D AOS ONLY X... ALIYOS C7r f _ P OPER R IIkFC aG 1 6 E .,, ,__ �....,, A UMBRELLA LIAB X OCCUR C EACH OC„uRRENCE _ 6,000' y EXCESS LIAB � � CLAIMS MA�.. X D� ESXS2210001439-01 10/19/2022 10/19/2023 _AGGREGATE .....: $ . ..m 5 000,000 ' 000 DED X RETENTION $ C WORKERS COMPENSATION f X PER X OTH "' S_TUQQ AND EMPLOYERS' LIABILITY YIN: WSA504815303 05/06/2022 05106I2023 ANY PROPRIETOR/PARTNER/EXECUTIVE N { N / A X EXCLUDED? '"'"" E L- EACH A IDENT $ ,,m 1 1,000 1,000 000 000 %t�FFICER/MEMBER d6 (fimandatory in NH) .E I DISEASE EA EMPLOYEE $ If yes, describe under DESCRIPTION F RATIONS below E L I PoucY uMIT 000 D POLLUTION LIAB G71564630 004 10/19/2022 10119/2023 GEN AGG 2,000, 000 B PROPERTY BPK0008360-02 05/06/2022 06/06/2023 BLDG 303,246 1 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE 400 BLOCK W. MARIPOSA AVE. AND 300 BLOCK W. PINE AVE. SIDEWALK CONSTRUCTION PROJECT PROJECT NO.: PW 21-07. City of El Segundo, its officers, officials, employees and volunteers are additional insureds to general and auto liability. Waiver of subrogation applies to general, auto liability and l workers comp. Coverage is primary/non-contributory, City of El Segundo 350 Main Street El Segundo, CA 90245 CITELSE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ESGL2210001438-01 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, (LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following;: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations As required by written contract signed by both parties All locations prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodi!y injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law, and 2. If coverage provided to the additional insured isrequired by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these additional insureds, the following is added' to 'Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or B. With respect to the insurance afforded to these additional insureds, the following addltionalexclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at thelocation of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to itsintended use by any person or organizalionother than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project. 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in theDeclarations. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: ESGL2210001438-01 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NEM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anlzatlon s Location And Description Of Completed O erations As required by written contract signed by both parties All locations prior to loss Information required to complete this A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. will be shown in the Declarations. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 Policy No. ESGL2210001438-01 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As required by written contract signed by both parties prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 06 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Policy No. ESGL2210001438-01 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NO. BCA0005149-02 COMMERCIAL AUTO AHCA85900917 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CLANG ES I N COM M ERCIAL AUTO COVERAG E FORM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. BROADENED WHO IS AN INSURED (4) All reasonable expenses incurred by Paragraph A.I. Who Is an Insured of SECTION II the "insured" at our request, including — LIABILITY COVERAGE is amended to include actual loss of earnings up to $500 a the following: day because of time off from work. d. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. e. Any "employee" of yours is an "insured" while using an "auto" hired or rented under a contract or agreement in that "employ- ee's" name, with your permission, while performing duties related to the conduct of your business. f. Each person or Organization to whom you are required by a written contract or agreement to provide additional insured status is an "insured" under Liability Cov- erage, but only to the extent that person or organization qualifies as an "insured" un- der the Who is an Insured Provision con- tained in Section II of the coverage form. The written contract or agreement must be in effect during the policy period shown in the Declarations and must have been exe- cuted prior to the "bodily injury" or "proper- ty damage." B. LIABILITY COVERAGE EXTENSIONS SUPPLE- MENTARY PAYMENTS Paragraphs A.2.a. (2) and A.2.a. (4) Coverage Extensions — Supplementary Payments of SECTION II — LIABILITY COVERAGE are deleted and replaced with the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "ac- cident" we cover., We do not have to furnish these bonds. C. FELLOW EMPLOYEE COVERAGE Paragraph B.5. Fellow Employee Exclusion con- tained in SECTION II — LIABILITY COVERAGE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire that is not a bus, motorcycle or van used to transport em- ployees. This Fellow Employee Coverage is excess over any other collectible insurance. D. POLLUTION LIABILITY — BROADENED COV- ERAGE FOR COVERED AUTOS 1. Liability Coverage is changed as follows: a. Paragraph B.11.a. of the Pollution Exclu- sion in SECTION II — LIABILITY COV- ERAGE applies only to liability assumed under a contract or agreement. b. With respect to the coverage afforded by Paragraph 1.a. Above, Exclusion B.6. Care, Custody or Control of SECTION II LIABILITY does not apply. 2. Changes in Definitions For the purposes of this endorsement, Para- graph D. of SECTION V — DEFINITIONS is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statuto- ry or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, de- toxify or neutralize, or in any way re- spond to, or assess the effects of "pol- lutants"; or Includes copyrighted material of Insurance Services Office, Inc., AH CA 85 90 09 17 with its permission. Page 1 of 6 2. Any claim or "suit" by or on behalf of a governmental authority for damages be- cause of testing for, monitoring, cleaning up, removing, containing, treating, detoxify- ing or neutralizing, or in any way respond- ing to or assessing the effects of "pollu- tants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dis- persal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally deliv- ered, disposed of or abandoned by the "insured Paragraphs a. and b. above do not apply to "accidents" that occur away from prem- ises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (1) The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (2) The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or damage. This Pollution Liability Coverage is subject to an Annual Aggregate Limit of Liability of $100,000. E. NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words you and your al- so refer to any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, and over which you maintain ownership or majority interest, but only if there is no similar insurance available to that organization, However: 1. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. 2. Unless you notify us to add coverage to your policy, the coverage under this provision is af- forded only until: a. The 120th day after you acquire or form the organization, or b. The end of the policy period, whichever is earlier. F. EXTENDED TOWING Paragraph A.2. Towing of SECTION III — PHYS- ICAL DAMAGE COVERAGE is deleted and re- placed with the following: We will pay for towing and labor costs each time a covered "auto" is disabled. All labor must be per- formed at the place of disablement. If the "auto" is of the private passenger type, there will be no de- ductible. If the "auto" is other than a private pas- senger type, a $100 deductible will apply. The most we will pay under this EXTENDED TOW- ING coverage is $750 per occurrence. G. PHYSICAL DAMAGE COVERAGE EXTENSIONS Paragraph A.4. — Coverage Extensions of SEC- TION III — PHYSICAL DAMAGE COVERAGE is amended as follows: a. Transportation Expenses The amount we will pay for temporary transportation expense is increased to $50 per day to a maximum of $3,000. b. Loss of Use Expenses The amount we will pay for loss of use is increased to $75 per day and to a maxi- mum limit of $1,000. H. RENTAL REIMBURSEMENT 1. This coverage applies only to a covered "auto" described or designated in the Schedule or in the Declarations as carrying physical damage coverage. 2. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" be- cause of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of coverage you have on each covered "auto". 3. We will pay only for those expenses incurred during the policy period beginning 24 hours af- ter the "loss" and ending, regardless of the pol- icy's expiration, with the lesser of the following number of days: Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 6 with its permission. AH CA 85 90 09 17 a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and re- turn it to you; or b. 30 days. 4. Our payment is limited to the lesser of the fol- lowing amounts: a. Necessary and actual expenses incurred; or b. $50 per day 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations, 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already prodded for under the paragraph A.4. Coverage Extensions in SECTION III — PHYSICAL DAMAGE COVERAGE. No Deductible applies to this coverage. I. AIRBAG COVERAGE Exclusion 6.3. in SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: This exclusion does not apply to the accidental discharge of an airbag. J. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT 1. Cove rage a. We will pay with respect to a covered "au- to" described in the Schedule for "loss" to any electronic equipment that receives or transmits audio, dsual or data signals and that is not designed solely for the repro- duction of sound. This coverage applies only if the equipment is permanently in- stalled in the covered "auto" at the time of the "loss" or the equipment is removable from a housing unit which is permanently installed in the covered "auto" at the time of the "loss", and such equipment is de- signed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto". b. We will pay with respect to a covered "au- to" described in the Schedule for "loss" to any accessories used with the electronic equipment described in Paragraph 1.a. above. However, this does not include tapes, records or discs. 2. Exclusions The exclusions that apply to SECTION III — PHYSICAL DAMAGE, except for the exclusion relating to Audio, Visual and Data Electronic Equipment, also apply to coverage prodded by this endorsement. In addition, the following ex- clusions apply: We will not pay, under this endorsement, for either any electronic equipment or accessories used with such electronic equipment that is: a. Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system; or b. Both: (1). An integral part of the same unit hous- ing any sound reproducing equipment designed solely for the reproduction of sound if the sound reproducing equip- ment is permanently installed in the covered "auto"; and (2). Permanently installed in the opening of the dash or console normally used by the manufacturer for the installation of a radio. 3. Limit Of Insurance With respect to coverage under this endorse- ment, the Limit Of Insurance provision of SECTION III — PHYSICAL DAMAGE COV- ERAGE is replaced by the following: a. The most we will pay for all "loss" to audio, dsual or data electronic equipment and any accessories used with this equipment as a result of any one "accident" is the lesser of. (1). The actual cash value of the damaged or stolen property as of the time of the "loss"; (2). The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality; or (3). $1,500. b. An adjustment for depreciation and physi- cal condition will be made in determining actual cash value at the time of the "loss". c. If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. 4. Deductible No deductible applies to this coverage. The insurance provided by this extension is excess over any other collectible insurance. Includes copyrighted material of Insurance Services Office, Inc., AH CA 85 90 09 17 with its permission. Page 3 of 6 K. TAPES, RECORDS AND DISCS COVERAGE Exclusion B.4.a. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: a. Tapes, records, discs or other similar au- dio, visual or data electronic devices de- signed for use with audio, visual or data electronic equipment except when the tapes, records, discs or other similar au- dio, visual or data electronic devices: (1) Are your property or that of a family member, and (2) Are in a covered "auto" at the time of "loss". (a). The most we will pay for "loss" is $200. No Physical Damage Cov- erage deductible applies to this coverage. This extension provides coverage only to a covered "auto". L. PHYSICAL DAMAGE DEDUCTIBLE — SINGLE DEDUCTIBLE AND GLASS REPAIR Paragraph D. Deductible in SECTION III — PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: D. Deductible For each covered "auto," our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable de- ductible shown in the Declarations. Any Com- prehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. When two or more covered "autos" sustain "loss" in the same occurrence, the total of all the "loss" for all the involved covered "autos" will be reduced by a single deductible, which will be the largest of all the deductibles apply- ing to all such covered "autos." No deductible applies to glass damage if the glass is repaired rather than replaced. M. PERSONAL EFFECTS COVERAGE 1. If you purchase Comprehensive Coverage on this policy for a stolen owned "auto", we will pay up to $600 for "personal effects" stolen with the "auto". 2. "Personal effects" as used in this extension means tangible property that is worn or carried by the "insured". "Personal effects" does not include tools, jewelry, money, securities, radar or laser detectors, or tapes, records, discs or similar audio, visual or data electronic equip- ment. No Deductible applies to this extension. The insurance provided by this extension is excess over any other collectible insurance. N. LOAN/LEASE PAYOFF COVERAGE The SECTION III — PHYSICAL DAMAGE COV- ERAGE is amended by the addition of the follow- ing: In the event of a total "loss" to a covered "auto" shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered "au- to", less: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "loss"; b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. c. Security deposits not returned by the les- sor; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases. O. CUSTOM SIGNS AND DECORATIONS In the event of a total loss to a vehicle insured for auto physical damage coverage on this policy, in addition to the ACV of the vehicle, we will pay the actual cost to repair'or replace signage or custom paint details up to $5,000. P. HIRED AUTO PHYSICAL DAMAGE If hired "autos" are covered "autos" for Liability Coverage and if Physical Damage Coverage of Comprehensive, Specified Causes of Loss, or Col- lision are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverage's provided are extended to "autos" you hire of like kind and use subject to the following limit: The most we will pay for any one loss is the lesser of the following: 1. $50,000 per accident, Includes copyrighted material of Insurance Services Office, Inc., Page 4 of 6 with its permission. AH CA 85 90 09 17 2. Actual Cash Value, or 3. The cost of repair. The deductible will be equal to the largest deducti- ble applicable to any owned "auto" for that cover- age. No deductible applies to "loss" caused by fire or lightning. This Hired Auto Physical Damage cov- erage is excess over any other collectible insur- ance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. Q. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Subparagraphs A.2.a. of SECTION IV — BUSI- NESS AUTO CONDITIONS is deleted and re- placed by: a. In the event of "accident", claim, "suit" or "loss", you, your insurance manager or any other person you designate must give us or our authorized representative prompt notice of such "accident" or "loss". Include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insureds" name and address; and (3) To the extent possible, the names and ad- dresses of any injured persons and wit- nesses. Knowledge of an "accident" or "loss" by your agent, servant or "employee" shall not be consid- ered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "accident" or "loss" from your agent, servant, or "employee." R. WAIVER OF SUBROGATION SECTION IV — BUSINESS AUTO CONDI- TIONS— A. 5. Transfer of Rights of Recovery Against Others to Us is amended as follows: This condition does not apply to any person or or- ganization to which you waived this condition by written contract or agreement, but only to the ex- tent that subrogation is waived prior to the "acci- dent" or "loss" under a contract with that person or organization. S. UNINTENTIONAL FAILURE TO DISCLOSE HAZ- ARDS Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business Auto Coverage Form or at any time dur- ing the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed expo- sure or hazard to us as soon as reasonably possi- ble after its discovery. T. EXTENDED EMPLOYEE HIRED AUTO PHYSICAL DAMAGE Paragraph B.5.b. Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced by the following: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: 1. Any covered "auto" you lease, hire, rent or borrow; and 2. Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing du- ties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto U. POLICY PERIOD, COVERAGE TERRITORY Paragraph B.7. Policy Period, Coverage Territo- ry of SECTION IV — BUSINESS AUTO CONDI- TIONS is deleted and replaced by: 7. Policy Period, Coverage Territory Under this Coverage Form, we cover "acci- dents" and "losses" occurring: a. During the policy period shown in the Dec- larations; and b. Within the coverage territory. The coverage territory is: a. The United States of America; b. The territories and possessions of the United States of America; c. Puerto Rico; d. Canada; and e. Anywhere in the world if: Paragraph B.2. Concealment, Misrepresentation (1) A covered "auto" is leased, hired, Or Fraud in SECTION IV — BUSINESS AUTO rented or borrowed for a period of 30 CONDITIONS is amended by adding the following: days or less; and Includes copyrighted material of Insurance Services Office, Inc., AH CA 85 90 09 17 with its permission. Page 5 of 6 (2) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and posses- sions of the United States of America, Puerto Rico, or Canada or in a settle- ment we agree to. We also cover "loss" to, or "accidents" involving, a covered "auto" while being transported between any of these places. V. DEFINITION OF BODILY INJURYAMENDED Paragraph C. of SECTION V — DEFINITIONS is amended to include: "Bodily Injury" includes mental anguish or other mental injury resulting from "bodily injury." Howev- er, no coverage is provided for mental anguish or mental injury absent physical injury. None of the extensions provided under this cover- age endorsement apply if coverage is more specifi- cally identified elsewhere in the policy or endorse- ments, for which a premium charge is made or a higher limit is identified. Under no circumstances is any limit provided under this extension to be com- bined with a limit provided elsewhere in the policy or endorsements. Includes copyrighted material of Insurance Services Office, Inc., Page 6 of 6 with its permission. AH CA 85 90 09 17 COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "Insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "Insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing In a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER 2 % of the total California Workers' Compensation premium Schedule Job Description CALIFORNIA OPERATIONS ONLY This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 05/06/2022 Policy No. WSA 5048153 03 Endorsement No. Insured GENTRY GENERAL ENGINEERING INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00)