Loading...
PROOF OF INSURANCE (2023) CLOSEDCSGCONS-01 TWAI ,d►co�z CERTIFICATE OF LIABILITY INSURANCE ........... F--111 2022z/zolozmz 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 ate holder is an ADDITIONAL INSURED, the olic ies) must have ADDITIONAL INSURED provisions or If the certificate p y( 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 o such en o rsement s Melissa HIII ....-- PRODUCER c TACT License # OC36861 T Alliant Insurance Services, Inc. PHONE FAX 560 Mission St 6th FI lA c Nd„ E Kth (A)c No): , e... ....e.................. F MAI Melissa.Hill alliant.com Sx* San Francisco, CA 94105 APQR „�, �. _. �w iNSURER(S)AFFORDING COVERAGE NAIC # .............. INSURER A:Fire mans Fund Insurance Company,,, 21873 INSURED,INSURER B,:Ame.rican,Automobile Insurance „C,ofllpany 21849 CSG Consultants INSURER c:National Sure! Corporation _ 21881 550 INsuReR,D:Pacific Insurance Company, Limited q 10046 Foster Cim CA 94404 Fos INSURER E INSURER F OVE Ea CERTIFICATE ,NUMBER: REVISION,NUMBER, -------- SUED TO THE INSURED NAMED ABOVE FOR THE POLICYY PERIOD THIS IS TO CERTIFY THAT WTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS ._.. _ ERIOD 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, �„� , _. ................. JSR ADDL SUBR POLICY EFF POLICY EXP 1,000,000 TR. TYPE OF INSURANCE INSD � POLICY NUMBER t { 1 ................. .. LIMITS A X COMMERCIAL GENERAL LIABILITY E,A("H QC°C IJRRENCE m, _.... CLAIMS MADE X OcruR X .USC032768220 12I412022 1214/2023 DAMAGE TORENTED 100,000 a � PE yEE I,E .,�Rs rI, J ,, , ME EXP lAny one person} $ 10,000 INJU., �FNFRAI �A yCREGATERY 1,000,000 5 q� GEN AGGREGATE IJMru AI PI ES PER 2,000,000 �. � ;, � 2,000,000 P02.It Y y �p I.00 PRODIJC 75 COMP[OP,ACC 6 r OTb-lE'iR.. `a B CDMSINEDS NG r LIMIT 1,000,000 AUTOMOBILE LIABILITY I � � X i ANY AUTO SCV013084-22-01 12/4/2022 12/4/2023 p Per INJURY e.. BODILY IN ,I l rspnJ„ OWNED SCHEDULED AUTOS ONLY AUTOS�Per HODILY INJU FdY (Per apcidentk 8 .. HIRED NOr, PROPFRiY DAMAGE Igida,r�, . AUTOS ONLY ',.,m,®m AUTO' ..0 A X UMBRELLA LIAB X OCCUR ...........,.,.. ............_ ...... .-..... EACH OCCURRENCE 00,000 EXCESS LAB ! CLAIMS -MADE 'USCO29989221 12/4/2022 12/4/2023 ., .,AGGREGATE .. .....,y' 5,000,000 _ ,,..� ...... DEC X RETENTIONS 10,000.. . � _. � . . ._ C 'WORKERS ... .. ......... ........: COMPENSATION . ........ �... _. X PEA LI,J 1' AND EMPLOYERS' LIABILITY Y N. SCW023953-22-01 12/4/2022 12/4/2023 ,OTTH 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE FFICERIOEMBER N r A E L EACH ACCIDENT $ EXCLUDED? gandatory in NH) E L DISEA FM.. OYFFy 1 000,000 _ If yes, describe under m' ,F,,,FA E L DISEASE POLICY LIMIT 1,000,000 $ _ D Professional Liab. 3b� 83 OH 048950-22 12/4/2022 12/4/2023 Ded. $50,000; A99� 5,000,000 D ,Retro Date: 111/1991 83 OH 0489503-22 12/4/2022 12/4/2023 Occurrence: 5,000„000 DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES IACORD 101, Additional Remar" Schedule, may be attached if more space is required) City of El Segundo, its officials and employees are included as additional insureds on Primary/Non-Contibutory basis on GL per attached endorsement City of El Segundo attn: Sam Lee 350 Main Street El Segundo, CA 90245 ACORD 25 (2016/03) 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 _.. © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: USC032778220 MultiCovelr® - Without Medical Payments - CG 71 93 03 19 Policy Amendment(s) Commercial General Liability Coverage Form Your Commercial General Liability Coverage Form is revised as follows: Broadened Named Insured A. SECTION II -WHO IS AN INSURED, item 3., is deleted and replaced by the following: 3. Any organization that you own at the inception of this policy, or newly acquire or form during the policy period, and over which you maintain during the policy period majority ownership or majority interest, will qualify as a Named Insured if: a. There is no other similar insurance available to that organization; and b. The first Named Insured shown in the Declarations has the responsibility of placing insurance for that organization; and c. That organization is incorporated or organized under the laws of the United States of America,. However: (1) Coverage under this provision 3 is afforded only until the next occurring annual anniversary of the beginning of the policy period shown in the Declarations, or the end of the policy period, whichever is earlier; and (2) Coverage A does not apply to bodily injury or property damage that occurred before you acquired or formed the organization; and (3) Coverage B does not apply to personal and advertising injury arising out of an offense committed before you acquired or formed the organization. B. SECTION II -WHO IS AN INSURED, the last paragraph, is deleted and replaced by the following: No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture, or limited liability company that is not shown as a Named Insured in the Declarations. However, this does not apply to a limited liability company that meets all of the conditions in Section II - Who Is An Insured, item 3., above. 2. Additional Insured If an Additional Insured endorsement is attached to this policy that specifically names a person or organization as an additional insured, then this Section 2. Additional Insured does not apply to such person or organization. SECTION II - WHO IS AN INSURED, subsection 2.e., is added as follows: e. Any person or organization is included as an additional insured, but only to the extent such person or organization is legally obligated to pay for bodily injury, property damage or personal and advertising injury caused by your acts or omissions. With respect to the insurance afforded to such additional insured, all of the following additional provisions apply: (1) You have agreed in a written insured contract that such person or organization be added as an additional insured under this policy; (2) The bodily injury, property damage or personal and advertising injury for which said person or organization is legally obligated to pay occurs subsequent to the execution of such insured contract; (3) The most we will pay is the lesser of either the amount of insurance available under the applicable Limits of Insurance shown in the Declarations or the limits of insurance required by the insured contract; (4) The insurance afforded to such additional insured only applies to the extent permitted bylaw; Policy Number: USC032778220 (5) Such person or organization is an additional insured only with respect to: (a) Their ownership, maintenance, or use of that part of the premises, or land, owned by, rented to, or leased to you, except such person or organization is not an insured with respect to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization; (b) Your ongoing operations performed for that insured; (c) Their financial control of you, except such person or organization is not an insured with respect to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization; (d) The maintenance, operation or use by you of equipment leased to you by such person or organization; (e) Operations performed by you or on your behalf and for which a state or political subdivision has issued a permit, provided such operations are not performed for such state or political subdivision, and are not included within the products -completed operations hazard; or (f) Their liability as a grantor of a franchise to you. (6) This insurance does not apply to bodily injury, property damage, personal and advertising injury, occurrence or offense: (a) Which takes place at a particular premises after you cease to be a tenant of that premises; (b) Which takes place after all work, including materials, parts or equipment furnished in connection with such work to be performed by or on behalf of the additional insured at the site of the covered operations, has been completed; (c) Which takes place after that portion of your work out of which the injury or damage arises has been put to its intended use by any other person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project; or (d) Which takes place after the expiration of any equipment lease to which (4)(d) above applies; (7) With respect to architects, engineers or surveyors, coverage does not apply to bodily injury, property damage or personal and advertising injury arising out of the rendering or failure to render any professional services by or for you, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; or (b) Supervisory, inspection, architectural, or engineering services. These exclusions apply even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage, or the offense which caused the personal or advertising injury, involved the rendering of or the failure to render any professional services by or for you. 3. Additional Insured -Vendors If an Additional Insured Vendors endorsement is attached to this policy that specifically names a person or organization as an additional insured, then this Section 3. Additional Insured - Vendors does not apply to that person or organization. Unless the products -completed operations hazard is excluded from this policy, SECTION II - WHO IS AN INSURED, item 2.f. is added as follows: f., Any vendor of yours is included as an additional insured, but only with respect to bodily injury or property damage caused by your products which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: Policy Number: USC032778220 IM ISIS! 0 Alflanz (1) The insurance afforded such vendor does not apply to: (a) Bodily injury or property damage for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, unless 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 such inspections, adjustments, tests or servicing as the vendor 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 by the vendor in full compliance with the manufacturer's written instructions at the vendor's premises in connection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) Bodily injury or property damage arising out of the liability of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products or any ingredient, part or container, entering into, accompanying or containing such products; (3) The most we will pay is the lesser of either the amount of insurance available under the applicable Limits of Insurance shown in the Declarations or the limits of insurance required by the contract or agreement; and (4) The insurance afforded to such vendor only applies to the extent permitted bylaw. 4. Additional Insured - Limited Primary and Noncontributory Provision The following is added as a second paragraph to Section IV Conditions, Condition 4. Other Insurance, following paragraph b.(2): However, if you have added any person, organization or vendor of yours as an additional insured to this policy by way of this MultiCover® endorsement and have agreed in a written insured contract that this insurance is primary and non-contributory with other insurance available to that additional insured, this insurance is primary and we will not seek contribution from such additional insured's other insurance, provided that the additional insured is a Named Insured under such other insurance. 5. Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 8., is deleted and replaced by the following: 8. Transfer of Rights of Recovery Against Others to Us and Blanket Waiver of Subrogation a. If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after the loss to impair those rights. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. b. If required by a written insured contract executed prior to the occurrence or offense, we waive any right of recovery we may have against any person or organization named in such insured contract, because of payments we make for injury or damage arising out of your operations or your work for that person or organization. Policy Number: USC032778220 6. Cancellation - 90 Days Common Policy Conditions endorsement IL0017, A. Cancellation, item 2.b. is deleted and replaced by the following: b. 90 days before the effective date of cancellation if we cancel for any other reason. 7. Liberalization SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the following is added as an additional Condition: Liberalization If we adopt a change in our forms or rules which would broaden the coverage provided by any form that is a part of this policy without an extra premium charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such broader coverage in your state. 8. Fire, Explosion, Sprinkler Leakage, or Lightning Legal Liability Coverage A. SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, the last paragraph, is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, explosion, sprinkler leakage, or lightning to premises while: Rented to you; 2. Temporarily occupied by you with the permission of the owner; or 3. Managed by you under a written agreement with the owner. A separate limit of insurance applies to this coverage as described in Section III - LIMITS OF INSURANCE. B. SECTION III -LIMITS OF INSURANCE, item 6,, is deleted and replaced by the following: 6. Subject to 5. above, the Damage to Premises Rented To You Limit shown in the Declarations, for property damage to any one premises while rented to you, or in the case of damage by fire, explosion, sprinkler leakage, or lightning while rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner, is the greater of: a. $1,000,000 Any One Premises; or b. The Damage To Premises Rented To You Limit shown in the Declarations. C. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, b. Excess Insurance, (1)(a), items (i) and (iii), are deleted and replaced by the following: (i) That is Fire, Explosion, Sprinkler Leakage or Lightning insurance for premises while rented to you, temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for property damage to premises rented to you, temporarily occupied by you with the permission of the owner, or managed by you under a written agreement with the owner; or D. SECTION V -DEFINITIONS, 9. Insured Contract, item a., is deleted and replaced by the following: (a) A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, explosion, sprinkler leakage, or lightning to premises while rented to you, temporarily occupied by you with permission of the owner, or managed by you under a written agreement with the owner, is not an insured contract; 9. Damage to Invitees' Automobiles from Falling Trees or Tree Limbs -Limited Coverage Policy Number: USC032778220 This coverage applies to direct physical damage to automobiles owned by invitees subject to all of the following: 1. Provided such damage originates from trees on premises owned, managed, leased or rented by an insured; 2.. Coverage applies only to invitees of an insured or an insured's tenant; 3. Such damage is directly caused by wind -driven falling trees or tree limbs; 4. The most we will pay for any one loss is the lowest of: a. the actual cash value of the damaged automobile as of the time of the loss; or b. the cost of repairing the damaged automobile; or c. the cost of replacing the damaged automobile with another automobile of like kind and quality. Regardless of the number of occurrences, losses or claims, this coverage is subject to a limit of $25,000 in any one policy period; 5. This coverage is not subject to the General Liability General Aggregate Limit; and 6. We will make payments under this coverage without regard to fault. 10. Non -Owned or Chartered Watercraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, item g. Aircraft, Auto, or Watercraft, item (2), is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 51 feet long; and (b) Not being used for public transportation or as a common carrier; 11. Chartered Aircraft SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions, g. Aircraft, Auto Or Watercraft, item (6), is added as follows: (6) An aircraft in which you have no ownership interest and that you have chartered with crew. 12. Coverage Territory - Broadened SECTION V - DEFINITIONS, item 4.a., is deleted and replaced by the following: a. The United States of America (including its territories and possessions), Puerto Rico, Canada, Bermuda, the Bahamas, The Cayman Islands and the British Virgin Islands; 13. Personal and Advertising Injury - Contractual Unless personal and advertising injury is excluded from this policy the following applies: SECTION I - COVERAGES, COVERAGE B, 2. Exclusions, item e., is deleted. 14. Fellow Employee Coverage SECTION II - WHO IS AN INSURED, 2.a., item (1) is deleted and replaced by the following: (1) Personal and advertising injury: However, subsections (a), (b), (c) and (d) of item (1) remain unchanged. 15. Bodily Injury Definition - Broadened SECTION V - DEFINITIONS, 3. Bodily Injury is deleted and replaced by the following: Bodily injury means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. 16. Expected or Intended Injury -Amendment to Exclusion Policy Number: USC032778220 Allianz SECTION I. Coverage A Bodily Injury and Property Damage Liability, 2. EXCLUSIONS, a. Expected or Intended Injury, is deleted and replaced by the following: a. Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property. 17. Unintentional Failure to Disclose Hazards SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 6. Representations, the following is added: d. If you unintentionally fail to disclose any hazards existing at the inception date of this policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. 18. Supplementary Payments - Increased Limits SECTION I - COVERAGES, SUPPLEMENTARY PAYMENTS - COVERAGES A AND B, items 1.b. and 1.d., are deleted and replaced by the following: b. The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or suit, including substantiated loss of earnings up to $500 a day because of time off from work. 19. Duties in the Event of an Occurrence, Offense, Claim or Suit -Amended SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, item 2.a. is deleted and replaced by the following: (1) You must see to it that we or any licensed agent of ours are notified of a General Liability occurrence or offense which may result in a claim as soon as practicable after it becomes known to: (a) You, if you are an individual; (b) Your partner or member, if you are a partnership or joint venture; (c) Your member, if you are a limited liability company; (d) Your executive officer if you are an organization other than a partnership, joint venture or limited liability company; or (e) Your authorized representative or insurance manager. Knowledge of an occurrence or offense by persons other than those listed above does not imply that those listed above also have such knowledge. (2) To the extent possible, notice should include: (a) How, when and where the occurrence or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the occurrence or offense. 20. Non Employment Discrimination Liability Unless personal and advertising injury is excluded from this policy the following applies: A. SECTION V - DEFINITIONS, 14. Personal and advertising injury, item h. is added as follows: h. Discrimination. B. B. SECTION V - DEFINITIONS, item 23. is added as follows: Policy Number: USC032778220 Alliant. 23. Discrimination means the unlawful treatment of a person or class of persons because of their specific race, color, religion, gender, age, or national origin in comparison to one or more persons who are not members of the specified class. C. SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY, 2. Exclusions, the following are added: q. Discrimination directly or indirectly related to the past employment, employment or prospective employment of any person or class of persons by any insured; r. Discrimination directly or indirectly related to the sale, rental,'lease or sublease or prospective sale, rental, lease or sublease of any dwelling or permanent lodging by or at the direction of any insured; s. Discrimination, if insurance thereof is prohibited by law; or t. Fines, penalties, specific performance, or injunctions levied or imposed by a governmental entity, governmental code, law, or statute because of discrimination. All other terms and conditions of the policy apply. Policy Number: SC V 013084 22 01 FleetCover® Endorsement — CA 70 18 10 14 Policy Amendment This Endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A. Broadened Named Insured Section II — Covered Autos Liability Coverage, A. Coverage, 1, Who Is An Insured, the following is added: Any organization you own on the inception of this policy, or newly acquire or form during the policy period, and over which you maintain during the policy period, majority ownership or majority interest will qualify as a Named Insured if: (1) There is no other similar insurance available to that organization; and (2) The first Named Insured shown in the Declarations of this policy has the responsibility of placing insurance for that organization; and (3) The organization is incorporated or organized under the laws of the United States of America. However: (a) Coverage under this provision is afforded only until the next occurring 12 month anniversary of the beginning of the policy period shown in the Declarations, or the end of the policy period, whichever is earlier; and (b) Coverage under this provision does not apply to bodily injury or property damage that results from an accident that occurred before you acquired or formed the organization; and (c) No person or organization is an insured with respect to any current or past partnership, or joint venture that is not shown as a Named Insured in the Declarations; and (d) Coverage under A.(1), (2) and (3) above does not apply to any organization that is covered as an insured under any other automobile liability insurance policy whose limits of insurance have been exhausted or whose insurer has become insolvent. B. Broadened Who Is an Insured 1. Form CA0001 (if attached to this policy), Section II — Covered Autos Liability Coverage, A. Coverage, 1. Who Is An Insured, item b.(2) is deleted, and d. is added as follows: d. Your employee while using his owned auto, or an auto owned by a member of his or her household, in your business or your personal affairs, provided you do not own, hire or borrow that auto. 2. Form CA0020 (if attached to this policy), Section II — Covered Autos Liability Coverage, A. Coveraqe, 1. Who Is An Insured, item b.(2) is deleted, and f. is added as follows: f. Your employee or agent while using his owned private passenger type auto, or a private passenger type auto owned by a member of his or her household, in your business or personal affairs, provided you do not own, hire, or borrow that auto. This form must be attached to Change Endorsement when issued after the policy is written One of the Allianz Global Risks US Companies as named in the policy. CA701810-14 Page 1 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 C. Additional Insured Coverage and Waiver of Subrogation 11, Form CA0001 (if attached to this policy), Section II — Covered Autos Liability Coverage, A. Coverage, 1. Who Is An Insured, the following is added as item e.; and form CA0020 (if attached to this policy), Section II — Covered Autos Liability Coverage, A. Coverage, 1. Who Is An Insured; the following is added as item g,: Any person or organization with respect to the operation, maintenance, or use, of a covered auto, provided that you and such person or organization have agreed under an expressed provision in a written insured contract or written agreement, or a written permit issued to you by a governmental or public authority, to add such person, organization, or governmental or public authority to this policy as an insured. However, such person or organization is an insured: (1) Only with respect to the operation, maintenance, or use, of a covered auto; and (2) Only for bodily injury or property damage caused by an accident which takes place after: (a) You executed the insured contractor written agreement; or (b) The permit has been issued to you. 2. Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, A. Loss Conditions, item 5.; and form CA0020 (if attached to this policy), Section V - Motor Carrier Conditions, A. Loss Conditions, item 6.; the following is added: Waiver of Subrogation If required by a: a. Written insured contract or written agreement executed prior to the accident; or b. Written permit issued to you by a governmental or public authority prior to the accident; we waive any right of recovery we may have against any person or organization named in such contract, agreement or permit, because of payments we make for injury or damage arising out of the ownership, maintenance or use of a covered auto. D. Auto Medical Payments - Increased Limit For each covered auto described in the Declarations or shown in the Schedule as having Auto Medical Payments Coverage, the Medical Payments Limit of Insurance for those autos is revised to the greater of: 1. $5,000; or 2. The limit shown in the Declarations. E. Hired Auto Physical Damage Coverage and Loss of Use Expenses Hired Auto Physical Damage Coverage CA7018 10-14 Page 2 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 If Physical Damage Coverage is provided by this policy on your owned covered autos, the following applies: Any auto that you lease, hire, rent or borrow without a driver, will be covered under this policy for Physical Damage Coverage. However any such auto: 1. Will be covered only for the same Physical Damage Coverage that applies to your owned covered autos; 2. Will be subject to the same applicable deductible shown in the Declarations that applies to your most similar owned covered auto, except any Comprehensive Coverage deductible does not apply to loss caused by fire or lightning; and 3. The most we will pay for any one loss in any one accident is the lesser of the following: a. Actual cash value of the damaged or stolen property as of the time of the loss as determined by us; or b. The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. In addition, we will pay costs and fees associated with such covered loss only for a maximum time period of seven days beginning with the date of loss, subject to a maximum of $500. However: 1. If form CA0001 is attached to this policy, this coverage does not apply to autos you lease, hire, rent or borrow from any of your employees, partners (if you are a partnership), members (if you are a limited liability company) or members of their households; and 2. If form CA0020 is attached to this policy, this coverage does not apply to any private passenger type auto you lease, hire, rent or borrow from any member of your household, any of your employees, partners (if you are a partnership), members (if you are a limited liability company), or agents or members of their households. Hired Auto Loss of Use Expenses Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage, 4. Coverage Extension, b. Loss of Use Expenses; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A. Coverage, 4. Coverage Extension, b. Loss of Use Expenses; is deleted and replaced by the following: b. For Hired Auto Physical Damage, we will pay expenses for which an Insured becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered auto; (2) Specified Causes of Loss only if the Declarations indicate that Specified Causes of Loss is provided for any covered auto; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered auto. CA7018 10-14 Page 3 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $1,000. F. Coverage Territory - Hired Auto 1. Form CA0001, (if attached to this policy), Section IV - Business Auto Conditions, B. General Conditions, 7. Policy Period, Coverage Territory, b.(5) is deleted and replaced by the following: (5) Anywhere in the world if a covered auto of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 180 days or less, 2. Form CA0020 (if attached to this policy), Section V - Motor Carrier Conditions, B. General Conditions, 7. Policy Period, Coverage Territory, b.(5) is deleted and replaced by the following: (5) Anywhere in the world if a covered auto of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 180 days or less, G. Communication Equipment Coverage Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, C. Limits of Insurance, Paragraph 1.b.; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, C. Limits of Insurance, Paragraph 1.b.; is deleted and replaced by the following: b. All electronic equipment that reproduces , receives or transmits audio, visual or data signals in any one loss is $1,500, if, at the time of loss, such electronic equipment is: H. Tapes, Records, CDs and DVD Coverage The Physical Damage Coverage Section is amended as follows: 1. The exclusion referring to tapes, records, discs, or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment does not apply. 2. Under Comprehensive Coverage - Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage; and form CA0020 (if attached to this policy), Section IV- Physical Damage Coverage, A. Coverage; the following is added: We will pay for loss to tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: a. Are your property, or that of a family member; and b. Are in a covered auto at the time of a loss. The most we will pay for loss is $250. No deductible applies to this coverage. I., Personal Effects Coverage Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage, 4. Coverage Extensions; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A. Coverage, 4. Coverage Extensions; item c. is added as follows: CA7018 10-14 Page 4 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 c. Personal Effects Coverage We will pay up to $500 for loss for clothing items or other personal effects that are owned by an insured and are in an Owned auto at the time of a covered loss. Personal Effects do not include audio visual or electronic devices, money, giftcards, securities, jewelry, or tools. This coverage is excess over any other collectible insurance. No deductible applies to this coverage. J. Airbag Coverage 1. Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, B. Exclusions, 3.a.; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, B. Exclusions, 3.a.; the following is added: However, mechanical breakdown does not mean the unintended discharge of an airbag, provided that any loss covered under this provision is excess over any other collectable insurance or warranty designed to cover such unintended discharge. K. Rental Reimbursement Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage, 4. Coverage Extensions; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A. Coverage, 4. Coverage Extensions; item d. is added as follows: d. Rental Reimbursement or Transportation Expenses If loss occurs to a covered auto described or designated in the Declarations or Schedule and covered for Physical Damage Coverage, we will pay for rental expenses for the rental of a similar replacement auto and additional transportation expenses, incurred by you. This payment applies in addition to the otherwise applicable amount of each coverage you have on the covered auto. No deductible applies to this coverage. However: (1) We will pay only for those expenses incurred by you that begin 24 hours after the covered loss. (2) We will cease paying for those expenses, regardless of the policy's expiration date, at the earlier of the following dates: (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 and return the covered auto to you; or (b) 45 days from the date this coverage begins. (3) Our payment is limited to the lesser of the following amounts: (a) Necessary and actual expenses incurred by you; or (b) $1,500. (4) This coverage does not apply while there are spare or reserve autos available to you for CA7018 10-14 Page 5 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 your operations. (5) If loss results from the total theft of a covered private passenger type auto (if CA0020 is attached to this policy), or a covered private passenger auto (if CA0001 is attached to this policy), we will pay under this coverage only that amount of your covered rental expenses or additional transportation expenses which are not already provided for under the Physical Damage Coverage Extensions, L. Extended Towing Coverage 1. Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage, 2. Towing, is deleted and replaced by the following: 2. Extended Towing We will pay up to $750 per disablement for towing and labor costs you incur each time your covered auto is disabled. However: a. All labor must be performed at the place of disablement; and b. If the covered auto is of the private passenger type, no deductible applies; and c. If the covered auto is not of the private passenger type, our obligation to pay will be reduced by a $250 deductible per disablement. d. If the covered auto is not of the private passenger type and the disablement results from a loss covered under Section III - Physical Damage Coverage, A. Coverage, Paragraphs 1, a., b., or c., there is no separate deductible for the Extended Towing Coverage. For purposes of this coverage, disablement means a breakdown of the covered auto including mechanical breakdown, engine failure, or tire blowout, where re- pairs cannot be made roadside and a tow is required to remove the auto from the roadway and to seek additional services and repair. 2. Form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A. Coverage, 2. Towing - Private Passenger Autos, is deleted and replaced by the following: 2. Extended Towing We will pay up to $750 per disablement for towing and labor costs you incur each time your covered auto is disabled. However: a. All labor must be performed at the place of disablement; and b. If the covered auto is of the private passenger type no deductible applies; and c. If the covered auto is not of the private passenger type our obligation to pay will be reduced by a $250 deductible per disablement. d. If the covered auto is not of the private passenger type and the disablement results from a loss covered under Section III - Physical Damage Coverage, A. Coverage, Paragraphs 1, a., b.., or c., there is no separate deductible for the Extended Towing Coverage. For purposes of this coverage, disablement means a breakdown of the covered auto CA7018 10-14 Page 6 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 including mechanical breakdown, engine failure, or tire blowout, where repairs cannot be made roadside and a tow is required to remove the auto from the roadway. and to seek additional services and repair. M. Cancellation - 120 Days Notice If we cancel this policy for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured at the last mailing address known to us, written notice of cancellation at least 120 days prior to the effective date of cancellation. N. Supplementary Payments - Increased Limits Section II - Liability Coverage, 2. Coverage Extensions, a. Supplementary Payments, items (2) and (4) are deleted and replaced by the following: (2) Up to $2,500 for the cost of bail bonds (including bonds for related traffic law violations) required because of an accident we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including substantiated loss of earnings up to $500 a day, because of time off from work. O. Duties in the Event of Accident, Claim, Suit or Loss - Amended Form CA0001 (if attached to this policy) Section IV - Business Auto Conditions, A. Loss Conditions, item 2. a.; and form CA0020 (if attached to this policy) Section V - Motor Carrier Conditions, A. Loss Conditions, item 2. a.; is deleted and replaced by the following: a. In the event of accident, claim, suit or loss, you must promptly notify us or our authorized representative when it becomes known to: (1) You, if you are an individual; (2) Your partner or member, if you are a partnership or joint venture; (3) Your member, if you are a limited liability company; (4) Your executive officer if you are an organization other than a partnership, joint venture or limited liability company; or (5) Your authorized representative or insurance manager. Knowledge of an accident, claim, suit or loss by other persons does not imply that the persons listed above have such knowledge. Notice should include: (1) How, when and where the accident or loss occurred; and (2) The insured's name and address; and (3) To the extent possible, the names and address of any injured persons and witnesses. P. Unintentional Failure to Disclose Hazards Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, B. General CA7018 10-14 Page 7 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 Conditions, item 2.; and form CA0020 (if attached to this policy), Section V - Motor Carrier Conditions, B. General Conditions, item 2.; the following is added; However, if you unintentionally fail to disclose any hazards existing at the inception date of this policy, we will not deny coverage under this Coverage Form because of such failure. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. Q. Fellow Employee Coverage Section II - Liability Coverage, B. Exclusions, 5. Fellow Employee, the following is added: However, this exclusion does not apply if the bodily injury results from the use of a covered auto you own or hire, and provided that any coverage under this provision only applies in excess over any other collectible insurance. R. Limited Mexico Coverage WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED HERE MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING IN MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR OUTSIDE OF 25 MILES FROM THE BORDER OF THE UNITED STATES OF AMERICA. Form CA0001 (if attached to this policy), Section IV - Business Auto Conditions, B. General Conditions, item 7.; and form CA0020 (if attached to this policy), Section V - Motor Carrier Conditions, B. General Conditions, item 7.; the following is added: The coverage territory is extended to include Mexico, but only: a. For accidents or losses occurring within 25 miles of the United States border; and b. For trips into Mexico of 10 days or less; and c. If the covered auto is principally garaged and principally used in the United States; and d. If the insured is a resident of the United States. If a loss to a covered auto occurs in Mexico, we pay for such loss in the United States. If the covered auto must be repaired in Mexico in order to be driven, we will not pay for more than the actual cash value of such loss as determined by us at the nearest United States point where the repairs can be made.. Any insurance provided under this provision will be excess over any other collectible insurance. CA7018 10-14 Page 8 of 10 Copyright ©2014 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 S. Extended Glass Coverage Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, A. Coverage, item 3.a.; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, A. Coverage, item 3.a.; is deleted and replaced by the following: a. Glass breakage. If glass must be replaced, the deductible will be $100 or the deductible shown in the Declarations, whichever is less. If glass can be repaired and is actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. T. Broadened Definition of Bodily Injury Form CA0001 (if attached to this policy), Section V - Definitions, item C.; and Form CA0020 (if attached to this policy), SECTION VI - DEFINITIONS, item C.; is deleted and replaced by the following: C. Bodily Injury means bodily injury, sickness or disease sustained by a person including death or mental anguish resulting from any of these at any time, Mental anguish means any type of mental or emotional illness or disease,. U. Customer Lease or Loan Physical Damage Coverage Extension Form CA0001 (if attached to this policy), Section III - Physical Damage Coverage, C. Limit Of Insurance; and form CA0020 (if attached to this policy), Section IV - Physical Damage Coverage, C. Limits Of Insurance; item 4. is added as follows: 4. If your covered owned auto is: (1) Shown in the Schedule and designated as covered for Physical Damage Coverage; and (2) Shown in this policy as having a loss payee or additional -insured -lessor; and (3) Incurs a covered total loss; we will pay the greater of: (a) The actual cash value, as determined by us, of the damaged or stolen property as of the time of the total loss; or (b) The outstanding indebtedness under the initial finance agreement for the covered auto and its equipment. As used here, outstanding indebtedness means the amount you owe on the finance agreement at the time of total loss: (i) Less any amounts representing taxes, overdue payments, penalties, interest, or charges resulting from overdue payments, additional mileage, excess wear and tear, or lease termination fees; and (ii) Less any administrative costs or overhead fees assessed by the finance company who has leased the covered auto to you; and (iii) Less security deposits not returned by the lessor; and (iv) Less costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and CA7018 07-17 Page 9 of 10 Copyright © 2017 Allianz Global Risks US Insurance Company. All rights reserved. Policy Number: SC V 013084 22 01 (v) Less carry-over balances from previous loans or leases. V. Two or More Deductibles 1. Section III - Physical Damage Coverage, D. Deductible, of form CA0001 (if attached to this policy), the following is added: If another Allianz Global Risks US Insurance Company policy or coverage form that is not an automobile policy or coverage form applies to the same accident or loss, the following applies: (1) If the deductible under this Business Auto Coverage Form is the lesser of (or least) deductible, it will be waived. (2) If the deductible under this Business Auto Coverage Form is not the lesser, (or least) deductible, it will be reduced by the amount of the lesser (or least) deductible. 2. Section IV - Physical Damage Coverage, D. Deductible, of form CA0020 (if attached to this policy), the following is added: If another Allianz Global Risks US Insurance Company policy or coverage form that is not an automobile policy or coverage form applies to the same accident or loss, the following applies: (1) If the deductible under this Business Auto Coverage Form is the lesser of (or least) deductible, it will be waived. (2) If the deductible under this Business Auto Coverage Form is not the lesser, (or least) deductible, it will be reduced by the amount of the lesser (or least) deductible. All other terms and conditions of the policy remain unchanged. CA7018 07-17 Page 10 of 10 Copyright © 2017 Allianz Global Risks US Insurance Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2.00% of the California workers' compensation premium otherwise due on such remuneration, Schedule Associated Job Person or Organization Job Description Premium Blanket Waiver of Subrogation as required by written contract. 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 12/04/2022 Insured CSG Consultants, Inc. WC 04 03 06 (Ed. 04-84) Policy No, SCW0239532201 Endorsement No. Insurance Company National Surety Premium Corporation Countersigned By