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PROOF OF INSURANCE (2024) CLOSEDDATE0(M P02) mow. CERTIFICATE OF LIABILITY INSURANCE 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. It 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 Aon Risk Services Northeast, Inc. NAME.. New York NY Office (per No. E,xt)y (866) 283-7122 _ (800) 363-0105 one Liberty Plaza E-MAIL 165 Broadway, Suite 3201 ADDRESS: New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED KOA corporation 1100 Corporate Center Drive Suite 201 Monterey Park CA 91754 USA INSURERA: American Casualty Co. of Reading PA 20427 INSURER B: The Continental Insurance Company 35289 -- -- INSURER C: National Fire Ins. Co. of Hartford ........_ INSURERD: Beazley America insurance Co, Inc. 20478 16510 INSURER E: INSURER F: i u( nVFRAuCES CERTIFICATE NUMBER: 570099770839 REVISION NUMBER: 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. Limits shown are as requested INSIR Lin TYPE OF INSURANCE IN VIVO POLICY NUMBER I.'NNMf"D YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11, 000, 000 IALry CLAIMS -MADE X I OCCUR PREMISESSfEa. ocurrence Ea occurrence), MED EXP (Any one person) $15 , 000 .9 PERSONAL &ADV INJURY $1,000,000 GEN'L.AGGREGATE.LIMITAPPL.IESPER: GENERAL AGGREGATE S2,000,000 POLICY OPEC LOC -PRODUCTS-COMP/OPAGG $2,000,000 OTHER: C AUTOMOBILE LIABILITY BUA 7018734438 05/01/2023 05/01/2024 COMBINED SINGLE LIMIT $1,000,000 E rr( ent .... X ANY AUTO BODILY INJURY ( Per person) OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED PROPERTYDAMAGE ONLY AUTOS ONLY Peracckdent B X UMBRELLALIABI X OCCUR CUE7018734407 05/01/2023 05/01/2024 EACH OCCURRENCE $151000,000 AGGREGATE S15,000,000 EXCESS LIAB CLAIMS -MADE DED I X In ETENTION 410, 000 A WORKERS COMPENSATION AND WC7'1 734424 05/01/2023 05/01/2024 X PER STATUTE I OTH, EMPLOYERS' LIABILITY V / N ADS B ANY PROPRIETOR / PARTNER/ EXECUTIVE WC718734410 05/01/2023 05/01/2024 E,L, EACH ACCIDENT $1, 000, 000 OFFICER/MEMBEREXCLUDED, (Mandatory in NFQ N/A CA E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $1, 000, 000 D Environmental Contractor C2AEA4230401 06/01'2023 05/01/2024 Prof Per Claim 110,000,000 Poll/Prof [E&O] Prof Aggregate $10,000,000 Deductible $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) RE: Job Project No: c26044, ENG 22-28: on Call Construction Inspection Services. City of El Segundo is included as Additional Automobile Liability General Liability Insured in accordance with the policy provisions of the General Liability and policies. policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional insured, but only in accordance with the policy's provisions. A Waiver of Subrogation is granted in favor of City of E1 Segundo in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. Should General Liability and Automobile Liability policies be cancelled before the expiration date thereof, the policy provisions of each policy Will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE Attn: Arianne Bola 350 Main St. E1 Segundo CA 90245-3813 USA (�roazwe ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD m c Gf a d a 0 2 co cc 0 a, 0 0 n un O Z Gl A t7 N V AGENCY CUSTOMER ID: 570000088080 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMED INSURED KOA corporation POLICY NUMBER see certificate Number: 570099770839 CARRIER see certificate Number: 570099770839 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000088080 ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. KOA Corporation POLICY NUMBER See Certificate Number: 570099770839 CARRIER NAIC CODE EFFECTIVE DATE: See Certificate Number: 570099770839 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Description of Operations / Locations / Vehicles: of each policy. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD " ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/02/2023 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 NAY;'F"UN... Aon Risk Services Northeast, Inc. New York NY Office (pup•, No Ext): (866) 283-7122 Nkt (800) 363-0105 E-MAIL One Liberty Plaza 165 Broadway, Suite 3201 ADDRESS: New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: American casualty Co. of Reading PA 20427 KOA Corporation '...INSURERB: The continental insurance Company 35289 1100 Corporate Center Drive Suite 201 - 'INSURERC: National Fire Ins. Co. of Hartford __........ 20478 Monterey Park CA 91754 USA INSURERD: Beazley America Insurance Co, Inc, _................................ 16510 INSURER E: '., INSURER F: 11614TJ VAIA6"3fa3rl1�l11ifl'iJ;14t 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE C NNVAWU '. POLICY NUMBER T,4MF D,r4•YY M,'i001'Y Y LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE X OCCUR PREMISES Ea occunence MED EXP (Any one person) $15 , 000 PERSONAL &ADV INJURY $1,000,000 GEMLAGGREGATE LIMTTAPPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY [:] PRO-r AX71 LOC JECT PRODUCTS - COMPIOP AGG $2,000,000 OTHER: C AUTOMOBILE LIABILITY BUA 7018734438 05/01/2023 05/01/2024 COMBINED SINGLE LIMIT $1, 000, 000 BODILY INJURY ( Per person) '.... X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS -. HIREDAUTOS NON -OWNED PROPERTY DAMAGE ONLY AUTOS ONLY Par accident B X I UMBRELLALIAB X OCCUR CUE7018734407' 05/01 202'3 05/01/2024 EACH OCCURRENCE $15,000, 000 EXCESS LIAB CLAIMS -MADE '... AGGREGATE $15 , 000, 000 DED X RETENTION'T10,000 RKERS 05/01/2024 X PER STATUTE C09T EMPLOYERS' LIABILTY S' LIABILITY ILITUDOED �D YIN ADS E L. EACH ACCIDENT $1, 000, 000 B LOYE ANV PROPRIETOR / PARTNER/ EXECUTIVE NIA WC718734410 OS/Ol/2023 OS/Ol/2024 OFF (Mandatory In NH) CA E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000, 000 D Environmental Contractor c2AFA4230401 06/01/2023 05/01/2024 Prof Per Claim $10,000,000 Poll/Prof [E&O] Prof Aggregate $10,000,000 Deductible $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ff more space is required) RE: I(OA: J086053 El Segundo on Call cm & Inspection Service. Cityiof El Segundo, its officials, and employees are named as Additional insured as respects General and Auto Liability as requred per written contract or agreement. General Liability is Primary/Non-ConTlriibutory per policy form wording. VC CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE Attn: Orlando Rodriguez 350 Main Street E1 Segundo CA 90245-3813 USA �'� me J. d ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD w AGENCY CUSTOMER ID: 570000088080 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk services Northeast, Inc. KOA Corporation POLICY NUMBER see Certificate Number: 570099770833 CARRIER NAIC CODE see Certificate Number: 570099770833 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD V certificate form for policy limits. INSR LTR TYPE OF INSURANCE '.. ADDL '.. INSD 'SUBR WYD POLICY NUMBER '..... POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS OTHER D Poll/Prof EnvironmentalContractor c2AEA4230401 06/01/2023 05/01/2024 ClaimPer S10,000,000 Poll Aggregate $10,000,000 Deductible $2,000,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LABILITY INSURANCEDATE(MMDD/YI O6/02/2023 YY, 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. it 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 Aon Risk Services Northeast, Inc. New York NY Office CON "T NAh1E.,.. , exly (866) 283-7122 : (800) 363-0105 Ncw,. E-MAIL ADDRESS: One Liberty Plaza 165 Broadway, Suite 3201 INSURER(S) AFFORDING COVERAGE NAIC # New York NY 10006 USA INSURED INSURER A: American Casualty Co. Of Reading PA 20427 KOA Corporation 1100 Corporate Center Drive Suite 201 INSURER B: The Continental Insurance Company 35289 INSURER C: National Fire Ins. Co. of Hartford 20478 Monterey Park CA 91754 USA INSURERD: Beazley America Insurance CO, Inc, 16510 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570099770827 REVISION NUMBER: 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. Limits shown are as requested LTR TYPE OF INSURANCE fNS'C3 WVO POLICY NUMBER IDtYY1'Y Ofpp y,y. LIMITS X COMMERCIAL GENERAL 2024 EACHOCCURRENCE $1,000,000 --LIABILITY CLAIMS -MADE X I OCCUR ntT6-ArRTE�� PREMISES Ea. occurrence MED EXP (Any one person) $15 , 000 .�..A PERSONAL & ADV INJURY $1, 000, 000 GENTAGGREGATELIMrrAPPLIESPER: GENERAL AGGREGATE $2,000,000 POLICY [] PRO- X LOC '., JECT PRODUCTS - COMP/OPAGG 000 $2,,000 ......,.�..„ OTHER: C AUTOMOBILE LIABILITY BUA 7018734438 05/01/2023 05/01/2024 COMBINED SINGLE LIMIT $1, 000, 0001 X ANYAUTO BODILY INJURY( Per person) BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY ,. AUTOS HIREDAUTOS NON -OWNED PROPERTY DAMAGE Per accideut ONLY AUTOS ONLY B X UMBRELLA LIAB X L-.... OCCUR CUE 18714467 05/01 2023 05/01 2024 EACH OCCURRENCE $15,000,000 AGGREGATE $15 , 000, 006 EXCESS LIAR CLAIMS -MADE DIED I X RETENTION 310. 000 A WORKERS COMPENSATION AND WC718 34424 7 05 01/ 023 0 1 0 24 X PER STATUTE OTH EMPLOYERS' LIABILITY Y I H ADS E.L. EACH ACCIDENT $1, 000 , 000 , B ANY PROPRIETOR / PARTNER / EXECUTIVE N WC718734410 05/01/2023 OS/01/2024, OFF ICER/MEMBEREXCLUDED? (Mandatory In NH) N/A CA E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E„L.. DISEASE -POLICY LIMIT $1, 000, 000 D Environmental Contractor C2AEA4230401 06/01/2023 O5/01/2024'Prof Per Claim $10,000,000 Poll/Prof [E&O] Prof Aggregate $10,000,000 Deductible $2,000,000 '.. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: KOA Project Number/Name: #MC26044 / ENG 22-28: ON -CALL CONSTRUCTION INSPECTION SERVICES City of El Segundo, its officials, and employees are named as Additional Insured on General Liability and Auto Liability, per policy forms, with respect to the operations of the Named Insured as required by written contract or agreement. General Liability is Primary/Non-Contributory per policy farm wording. CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE Attn: Arianne Bola 350 main street E1 Segundo CA 90245-3813 USA J "�Zlllie J. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD m N W n rn 0 0 r� O Z d W V 0 AGENCY CUSTOMER ID: 570000088080 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. KOA Corporation POLICY NUMBER see Certificate Number: 570099770827 CARRIER NAIC CODE EFFECTIVE DATE: see Certificate Number: 570099770827 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER III) ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD II certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR wVD POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS OTHER D Environmental Contractor Poll/Prof CE&O1 c2AEA4230401 06/01/2023 05/01/2024 Poll Per Claim $10,000,000 Poll Aggregate $10,000,000 Deductible $2,000,000 i ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused in whole or in part by your acts or omissions, or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph I. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: s A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. N IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 7018734441 Page 1 of 2 Endorsement No: 20 The Continental Insurance Co. Effective Date: 05/01/2023 Insured Name: H. W. LOCHNER INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. 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. CNA75079XX (10-16) Page 2 of 2 The Continental Insured Name: H. W. Insurance Co. LOCHNER INC. Policy NO: 7018734441 Endorsement No: 20 Effective Date: 05/01/2023 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA I It is understood and agreed that: Business Auto Policy Policy Endorsement If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent of Record has issued a Certificate of Insurance, and if we cancel a policy term described on that Certificate of Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to such Certificate holders at least 30 days in advance of the date cancellation is effective. If notice is mailed, then proof of mailing to the last known mailing address of the Certificateholder on file with the Agent of Record will be sufficient to prove notice. Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or impose any liability or obligation upon us or the Agent of Record. 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. Form No: CNA68021 XX (02-2013) Policy No: BUA 7018734438 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 05/01 /2023 Endorsement No: 54; Page: 1 of 1 Policy Page: 225 of 744 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 0 Copyright CNA All Rights Reserved.