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PROOF OF INSURANCE (2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 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 Baker, Romero & Associates Insurance Brokers, Inc. 750 Terrado Plaza #238 Covina, CA 91723 License #: OG22790 Christine R Sousa INSURED Galvin Preservation Associates Inc. INSURERB -fFl�..."ate �nS.CiQ-------_2044.'..................... DBA GPA Consulting INSURERC: 840 Apollo Street, Suite 312 INSURERD: El Segundo, CA 90245 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00002920-18115093 R'EVISIO'N NUMBER: 1167 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. 'INSR' LTR TYPE OF INSURANCE AOD �SUBR� POLICY NUMBER, POLICY EFF MM/DDdYYYY I"OL1CY iJ( MMI DfYYYY, "---.___,.,.,,.__ ..______,,..,.....—__ LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 680-4H777478-23-47 03/14/2023 03/14/2024 EACH OCCURRENCE $ 2.000.000 CLAIMS -MADE I ^ I OCCUR 13A en $ 1,000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000,... APPLIES Nx GEPOLLIICYE� FGATE T OC PRODUCTSGCOMPOPAGG $ 2�,000,009J A AuromoBlLE LIABILITY Y Y BA-4R690875-23-47 0311412 03/14/2024 COMBINEDS10M UWT023 $_ 1,0,00,000,mm X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ .. ....... HIRED NON -OWNED X X PROPEFd''L'Y DAMAGE $ AUTOS ONLY AUTOS ONLY AftJ�.01. ........ _........... A X mm UMBRELLALIAB X OCCUR Y Y CUP-OJ605520-23-47 03/14/2023 03/14/2024 EACH OCCURRENCE $ 7,000,000 EXCESS LIAB CLAIMS -MADE I AGGREGATE $„ 7„,000,000 X _ DED..----..., RETENTION$..................0................ Pr ps $ 7,000,000 A WORKERS COMPENSATION Y UB-OK1T826877-23-47 031l4/2023 03/14/2024 ER X STT TUTS ERH 1,000,000 YIN AND EMPLOYERS' LIABILITY,,,,,,,,EA ANY PROPRIETOR/PARTNER/EXECUTIVE ., �_._..�....-.-. E.L CH A ID CC,.. •_..................... $ 1,000,000 -...........-�,000 F N / A ,,, _ ...., EEMPLOYEET ..............—.a OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL��„�,�. i EAS DISEASE S E EA, $ 1 If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ 1,000 000 B Prof. Liab. $15K Ded EEH288371840 03/14/2023 03/1412024 $5M Ea claim retro: 3/20/12 B Pollution, $15K Ded EEH288371840 03/14/2023 03/14/2024 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) A.M. Best Ratings: Travelers Property Casualty Company of America (A++ XV); Continental Casualty Company (A XV); The City of EI Segundo Planning & Building Safety, its officials, and employees are Named as Additional insureds). This inusrance is Primary and Non -Contributory and any other insurance that may be carried by the City will be excess thereto. The following blanket forms apply to the Additional Insured(s) attached herewith: Workers Comp: Andrea Galvin continued on ACORD 101 Additional Remarks Schedule t;LK I It -ILA I t MULUtK City of El Segundo Planning & Building Safety Department 350 Main Street Attention: Gregg McClain, Planning Manager gmcclain@elsegundo.org El Segundo, CA 90245-3813 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 CRS © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by CRS on 03/08/2023 at 11:52AM AGENCY CUSTOMER ID: 00002920 LOC #: AC"R'Or ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMEDINSURED Baker, Romero & Associates Insurance Brokers, Inc. Galvin Preservation Associates Inc,. POLICY NUMBER .. DBA GPA Consulting N/A CARRIER Multiple Carriers NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) Richard Galvin Additional Remarks: Blanket Additional Insured CGD3810915; Coverage Xtend Endorsement CGD3790219; Aggregate Limit Per Project CGD4690219; Products/Completed Ops Endt. CGD3090219; 30 Day Notice of Cancellation ILT4001209; Auto Coverage Plus Endorsement CAT4200215; Auto Blanket Additional Insured Primary and Non -Contributory CAT4740216; Schedule of Underlying E000030818; Waiver of Rights UM04880708; Worker's Compensation Blanket Waiver of Subrogation Travelers Form WC 990376. Coverage shall not be canceled, non -renewed or materially altered except after thirty (30) days prior written notice has been given. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CRS on March 08, 2023 at 11:52AM POLICY NUMBER: 680-4H777478-23-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UABILITY COVERAGE PART 1. The following is added to SECTION 11— WHO IS AN INSURED: Any person or organization that you agree in a contractNiften requiring lnsumrvW to Include as an additional insured on this Coverage Part. but: a. Only with respect to liability for "bodily injury°. "property damage" or "personal injury": and b. If. and only to the extent that the Injury or damage is caused by acts or omissions of you or your subcontractor In the performance of "your world'O to which the Nwritten contract requiring insurance" applies. or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodiy injury". "property damage" or "personal injury" for which such person or organization has assumed babllity In a contract or agreement. The insurance provided to such additional insured Is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. E This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the Omits of liability required by the Owrttten contract requiring Insurance". the Insurance provided to the additional insured shag be limited to the Omits of liability required by that "written contract requiring insurance". This endorsement does not increase the Omits of insurance described in Section III — Limits Of Insurance. h. This Insurance does not apply to %odlly Injury or "property age's causedby "your work" and Inc uteri In the "products - completed operations hazard" unless the °written contract requiring insurance° specifically requires you to provide such coverage for that additional insured. and then the insurance provided to the additional Insured applies only to such "bodily injury" or "property damage° that occurs before the end of the period of time for which the `Written contract requiring insurance" requires you to provide such coverage or the end of the policy period. whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured Is excess over any valid and collectible other Insurance. whether primary. excess. contingent or on any other basis. that is available to the additional Insured for a loss we coven However. if you specifically agree In the `written contract requiring insurance" that this Insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non—contributory basis. this insurance is primary to other Insurance available to the additional insured which covers that person or organizations as a named insured for such loss. and we will not share with the other insurance. provided that: (1) The "bodily Injury or "property damage" for which coverage is sought occurs; and (2) The "personal Injury" for which coverage Is sought arises out of an offense committed', after you have signed that en contract requiring insurance"'. But this Insurance provided to the additional insured still Is excess over valid and collectible other insurance. whether primary. excess, contingent or on any other basis. that is available to the additional Insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 is 02015"Me TmetOrs Iron +I*ttMpea'y. AD Page 1 of 2 Includes ft capydghted material ctlasura w Sonvices 01110, Ian., m4h he penalsailon COMMERCIAL GENERAL LIABILITY 3. The following Is added to Paragraph S.. Transfer Of Rights Of Recovery Against Others To Us. of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery, we may have against any, person or organization because of payments we make for "bodily injury". "property damage'" or "personal injure arising out of "your work" perkmed by you, or on your behalf. done under a''"written contract requiring Insurance" with that person or organization. We waive this right. only where you have agreed to do so as part of the 'written contract requiring Insurance'" with such person or organization signed by you before. and In effect when. the ubodily Injury' or "pmperty damage" occurs, or the "personal Injury" offansW6 committed. 4. The following deliinhion Is added to the DERNITIONS Section: "Written contract requiring insurance" means that part of any written contract under which you are required to include a person or organization as an additional insured on this Coverage Part. provided that the "bodily injury" and "property damage" occurs and the °personal injury" is caused by an offense committed: a. After you have signed that written contract; b. W vIe that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2016 The TrwAftm Indem n4 Company. Ali tights msemd. CO D3 810915 koWes the oopAhted Ott l afkWUMMOOMm Odd , tim. with Its VemleWan POLICY NUMBER: 680-4H777478-23-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However. coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening pr"ons do not apply to the extent got coverage Is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read al the provisions of this endorsement and the rest of your policy carefully to determine rights. duties, and what is and is not covered. A. Non -Owned Watercraft — 7S Feet Long Or Less B. Who Is An Insured — Unnamed Subsidiaries C. Who Is An Insured — Retired Partners, Members. Directors And Employees D. Who Is An Insured — Employees And Volunteer Wow — B ; InJ'ury To Co —Employees, Co - Volunteer Workers And Retired Partners. Members, Directors And Employees E. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies F. Blanket Additional Insured — Controlling Interest G. Blartket Additional Insured — Mortgagees. Assignees. Successors Or Receivers PROVISIONS A. NON -OWNED WAS — 75 FEET LONG OR LESS 1. The following replaces Paragraph (2) of Exclusion g.. Aircraft. Auto Or Watercraft. in Paragraph 2. of SECTION l — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less: and (b) Not being used to carry any person or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION 11— WHO IS AN INSURED: e. Any person or organization that, with your express or implied consent. either H. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises I. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations J. Incidental Medical Malpractice K. Medical Payments — Increased Limit L. Amendment Of Excess Insurance Condition — Professional Liability M. Blanket Waiver Of Subrogation — When Required By Written Contract Or Agreement N. Contractual Liability — Railroads uses or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION 11— WHO IS AN INSURED: Any of ,your subsidiaries, other than a partnership or Joint venture. that Is not shown as a Named Insured In the Declarations Is a Named Insured IP a. You are the sole owner of, or maintain an ownership interest of more than 50% In, such subsidiary on the first day of the policy period; and CG D3 79 0219 0 2017 The TmWers InftmaRy Company. Alt do's msewW. Page 1 of 6 cowo w nwAft of msumme so ice. Irm VAth 48 p . COMMERCIAL GENERAL LIABILITY b. Such subsidiary Is not an insured under similar other insurance. No such subsidiary Is an Insured for "bodily nj'ury" or "property damage'" that occurred. or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than SO% in such subsidiary; or b. After the date. 9 any. during the policy period that you no longer maintain an ownership Interest of more than 50% In such saubsidiary. For purposes of Paragraph 1. of Section II — Who Is An Insured► each such subsidiary will be deemed to be designated In the Declarations as: a. A limited liability company. b. An organization other than a partnership, joint venture or limited liability company: or c. A trust; as indicated in its name or the documents that govern its structure. C. WHO IS AN INSURED — RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any person who Is your rellred partner. member. director or 10employW that is performing servbn for you under your direct supervision. but only for acts within the scope of their employment by you or white performing duties related to the conduct of your business. However. no such retired partner. member, director or "employW Is an Insured for. (1) "Bodily injury": (a) To you, to your current partners or members (if you are a partnership or Joint venture). to your current members (if you are a limited llabtllty company) or to your current directors; (b) To the spouse. child. parent, brother or sister of that current partner. member or director as a consequence of Paragraph (1)(a) above: (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. Unless you are In the business or occupation of providing professional health care services. Paragraphs (1)(a). (b). (c) and (d) above do not apply to "bodIV Injury"" arising out of providing or falling to Provide first aid or "Good Samaritan services" by any of your retired partners, members. directors or "employees". other than a doctor. Any such retired partners. members. directors or "empl " providing or falling to provide first a or "*Good ,Samaritan services'" during their work hours for you will) be deemed' to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2) "Personal injury": (a) To you, to your current or retired partners or members {d you are a partnership or joint venture), to your current or retinue members Of you are a limited liability company). to your other current or retired directors or "employees" white In the course of his or her employment or performing duties related to the conduct of your business. or to your other 'volunteer workers" while performing duties related to the conduct of your business: (b) To the spouse. child. parent, brother or sister of that current or retired partner. member. director. "employee" or "volunteer worker" as a consequence of Paragraph (2)(a) above: (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the Injury described In Paragraph (2)(a) or (b) above: or (d) Arising out of his or her providing or faiiiing to provide professional health care services. (3) "Property damage" to property: (a) Owned. occupied or used by; or (b) Rented to. in the care. custody or control of. or over which physical control Is being exercised for any purpose by: you. any of your retired partners. members or directors, your current or retired "err es" or "volunteer workers". any current partner or member (if you are a partnership or joint venture). or any current member (if you are a limited liability company) or current director. Page 2 of 6 0 sot? The Twetere InMOWlY ftnWV. AU dGhts a CG D3 79 0219 a hu9udes d material attna m f t Sa O�Dro,� km th b. an. D. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS, MEMBERS, DIRECTORS AND EMPLOYEES The following is added to Paragraph 2.a.(1) of SECTION U — WHO IS AN INSURED: Paragraphs (1)(a). (b) and (c) above do not apply to "dodgy injury° to a current or retired co - °employee" while in the course of the co - °employee's° employment by you or performing duties related to the conduct of your business. or to "bodily injury" to your other "volunteer workers" or retired partners. members or directors while performing duties related to the conduct of your business. E. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION n — WHO IS AN INSURED: 3. Any organizatiori you newly acquire or forin. other, than a partnership or joint venture, and of which you are the sole owner or In which you maintain an ownership interest of more than 50%. wig qualifyas a Named Insured If there Is no other similar insurance available to that organization. However. a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it: or (2) Until the end of the policy period. when that date is later than 180 days after you acquire or form such organization. If you report such organization in writing to us within 180 days after you acquire or form it: b. Coverage A does not apply to 'bodily Injury" or "properly damage that occurred before you acquired or formed the organization: and c. Coverage B does not apply to "personal and advertising Injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section U — Who Is An insured. each such COMMERCIAL GENERAL LIABILITY organization wig be deemed to be designated In the Declarations as: a. A limited liability company; b. An organization other than a partnership. joint venture or limiited liability company: or c. A trust: as indicated in its name or the documents that govern its structure. F. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that has financial control of you Is an Insured with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" that arises out of. a. Such financial control; or b. Such person's or organization's ownership. maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations. new construction or dernoiition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTIO N II — WHO IS AN INSURED: This paragraph does not apply to any premises owner. manager or lessor that has financial control of you. G. BLANKET ADDITIONAL INSURED — MORTGAGEES. ASSIGNEES. SUCCESSORS OR RECEIVERS The following is added to SECTION II — WHO iS AN INSURED: Any person or organization that Is a mortgagee. assignee. successor or receiver and that you have agreed, In a written contract or agreement to Include as an additional Insured on this Coverage Part is an insured, but only with respect to its liability as mortgagee. assignee, successor or receiver for "bodily injury". "property damage" or "personal and advertising injury" that: a. Is "bodily injury" or "property damage" that occurs, or is al and advertising injury" caused by an offense that is committed. CG D3 79 0219 02077he T k# aAy. All dahisireserved. Page 3 of 6 lrokAn cepftltted W+cif tnwnmw Sandws CMw, bm Wth b penniaWcm COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement: and b. Arises out of the ownership, maintenance or use of the premises for which, that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional Insured on this Coverage Part. The Insurance provided to such mortgagee, assignee, successor or receiver is subject; to the following provisions:. a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agraW to provide In the written contract or agreement, or the limits shown In the Declarations, whichever are less. b. The Insurance provided to such person or organization does not apply to: (1) Any "bodily Injury" or "property damagev" that occurs, or any "personal and advertising Injury" caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury". "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. H. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS ABIATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has Issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to Include as an additional' Insured on this Coverage Part Is an Insured, but only with respect to liability for "bodily injury". "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmentalentity has issued such permit or autho rrr:. advertising signs. awnings. canopies, cellar entrances, coal holes, driveways, manholes, marquees. hoist away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has Issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance. law. building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured', but only with respect to llability for "bodily injury", "property damage" or "personal and advertising Injury" arising out of such operations. The Insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage or "personal and advertising Injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of 'occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or falling to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION 11— WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury' arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who Is a nurse, nurse ass rot, emergency medical technician. paramedic, athletic trainer. audiologist. dietician, nutritionist. Page 4 of 6 ® 2017 The Twelere Indemnity CompwW, Aa rWhU rosented. CG D3 79 0219 Inhrdes copyrtoted material of mauranoe Son4cm Office, tm v is tte permbdon. occupational therapist or occupational therapy assistant, physical therapist or sp ge thst: or (b) First aid or "Good Samaritan services" by any f your "emmpioyeas� or "volunteer vvorkere, other than an employed or. volunteer doctor. Any such "employeess' or "volunteer workers" providing or failing to provide first aid or OGood Samaritan services" during their work hours for you, will be deemed to be acting within the sce�ra of their employment by ,you or penning duties related to the conduct. of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III — LIMIT'S OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed In providin or falling to provide incidental m5cal services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exdusion is added to Paragraph 2.. Exclusions. of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or ,property damage" arising out of the violation of a penal statute or. ordinance . relating to the sale of pharmaceuticals committed by. or with the knowhWge or consent of the Insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical. surgical. dental, laboratory, x- ray or nursing service or treatment, advice or Instruction, or the related furnishing of food or beverages: or b. The furnishing or dispensing of drugs or medical, dental. or surgical supplies or appliances.. 6. The following is added to Paragraph 4.b.. Excess Insurance. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excest, contingent or on any other basis, COMMERCIAL GENERAL LIABILITY that Is available to any of your °employees" for °bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section It — Who Is An insured. K. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to Paragraph S. above. the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person, and will be the higher of: a. $10,000: or b. The amount shown in the Declarations of this Coverage Part for Medical Expense Limit. L AMENDMENT OF EXCESS INSURANCE CONDITION — PROFESSIONAL LIABILITY The following is added to Paragraph 4.b., Excess Insurance, of SECTION N — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any of the other insurance. whether primary. excess. contingent or on any other basis, that is Professional Liability or similar coverage, to the extent the loss Is not subject to the professional services exclusion of Coverage A or Coverage 8. M. BLANKET WAIVER OF SUBROGATION — WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a written contract or agreement to waive that Insured's right of recovery against any person or organization. we waive our right of recovery against such person or organization. but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed: subsequent to the signing of that contract or agreement. CG D3 79 0219 0 2017 The TreveWm WORVAY Company. All dgft reserved. Page 5 of 6 lm*Wes CAWY00ted maWW of MMOAM Services Office. Ina. With Ile peaniselon. COMMERCIAL GENERAL UABIUTY N. CONTRACTUAL UABIUTY — RAILROADS 1. The Wowing replaces Paragraph c. of the definition of 'insured contract" in the DEFINMONS Section: c. Any easement or license agreement; 2. Paragraph E(1) of the definition of "insured contract" In the DEFINITIONS Section Is deleted. Page 6 of 6 0 2017 The Travelers [Aftnv t4",U Company. AD dobts re aerved, CG D3 79 0219 Indudoo COWSfad, matedid of Irmwam Semkoa Offloo. Im vAIn Ito f COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680-4H777478-23-47 ISSUE DATE: 3/14/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL AGGREGATE LIMIT OTHER THAN PROJECTS AND DESIGNATED PROJECT AND LOCATION, This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE — LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ 10, 000, 000 (Other Than Projects and Products -Completed Operations) Designated Location Aggregate Limit $ 2,000,000 (Other, Than Ptoducts-Compl Operations) Designated Project Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) General Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) Designated i Projects: teach apro ect° for which you have agreed, in a written contract which is in effect during this policy period, to provide a separate General Aggregate Limit, provided that the contract is signed by you before the "bodily injury" or "property damage" occurs. Designated Locations: All locations listed in Item 3. of in any Master Pee Account Exposure policy. PROVISIONS the CQ=Rou Policy Declarations or Endorsement included in this 1. The General Aggregate Limit (Other Than 1. The Limits of Insurance shown in the Produds-Completed Operations) shown In the Declarations or the Schedule — Limits Of Declarations Is replaced by the Limits of Insurance And Designated Projects And Insurance shown in the Schedule — Limits Of Locations, whichever apply, and the rules Insurance And Designated Projects And below fit the most we will pay regardless of Locations. the number of: 2. The following replaces Paragraph 1. of SECTION a. Insureds: III — LIMITS OF INSURANCE: b. Claims made or °suits" brought; CG D4 69 0219 ® 2017 The Tnmfts Indemft Company. A9 r9ohls reserved. Page 1 of 3 Indudes copydoled material of Insumrwo Sandowe Giros, hm Wth ft pamdsslon. COMMERCIAL GENERAL LIABILITY c. Persons or organizations making claims under Coverage B. Instead, the or bringing "suits": or General Aggregate Limit described In d. "Projects" or "locations". Paragraph 2.d. below applies to such 3. The following replaces Paragraph 2. of SECTION damages. III — LIMITS OF INSURANCE: (5) Any payments made for damages or 2. a. The Total Aggregate Limit shown in the medical expenses to which the Designated Project Aggregate Limit Schedule — Limits Of Insurance And applies will reduce the Designated Designated Projects And Locations is the Project Aggregate Limit for the most we wig pay for the sum of all applicable "project". Such payments amounts under the Designated Location will not reduce the Total AggregateLimit. Aggregate Limit and all amounts under Limit.the General Aggregate Limit the General Aggregate Limit. This in Paragraph 2.d. below. includes: the Designated Project Aggregate (1) Damages under Coverage A, except Limit for any other "project' or the damages because of "bodily injury" or Designated Location Aggregate Limit. "property damage" included in the "products -completed operations c. Subject to the Total Aggregate Limit hazard"' described In Paragraph 2.a. above, the Designated Location Aggregate Limit (2) Damages under Coverage B: and shown In the Schedule — Limits Of (3) Medical expenses under Coverage C. Insurance And Designated Projects And b. The Designated Project Aggregate Limit Locations all of the folpplies and is further subject to Ong Provisions: shown in the Schedule -� Limits Of Insurance And Designated Projects And (1) The Designated Location Aggregate Locations applies and is further subject to Limit is the most we will pay for the all of the following provisions: sum of. (1) The DesignatedProject Aggregate (a) Damages under Coverage A Limit Is the most we will pay for the because of "bodily Injury" and sum of: "property damage" caused by "occurrences": and (a) Damages under Coverage A because of "bodily Injury" and (b) Medical expenses under rty damage"" caused by Coverage C for "bodily injury "occurrences": and caused by accidents: (b) Medical expenses under that can be attributed only to Coverage C for "bodily injury" operations at a single "location". caused by accidents: (2) The Designated Location Aggregate that can be attributed only to Limit applies separately to each operations at a single "project". "location". (2) The Designated Project Aggregate (3) The Designated Location Aggregate Limit applies separately to each Limit does not apply to damages "project". because of "bodily injury" or "property (3) The Designated Project Aggregate damage" included in the "products - completed operatlans hazard*. Limit does not apply to damages because of "bodily injury" or "property Instead, the Products -Completed damage'" Included in the "produce- Operations Aggregate Limit described in Paragraph 3. below completed operations hazard. Instead. the Products -Completed applies to such damages. Operations Aggregate Limit (4) The Designated Location Aggregate described in Paragraph 3. below Limit does not apply to damages applies to such damages. under Coverage S. Instead, the (4) The Designated Project Aggregate General Aggregate Limit described In Limit does not apply to damages Page 2 of 3 0 M7 The Thwelft IrdwWY CWpWW. Afl dgtste mewved. CG D4 69 0219 DwWdee copyd#Wed maWW of rwr eetnm vft, ds peaWWon. Paragraph 2.d. below applies to such damages. (S) Any payments made for damages or medical expenses to which the DesignatedLocation Aggregate Limit applies will reduce: (a) The Total Aggregate Limit; and (b) The Designated Location Aggregate Limit for the applicable "location". Such payments will not reduce the General Aggregate Limit described in Paragraph 2.d. below. the Designated Project Aggregate Limit or the Designated Location Aggregate Limit for any other "location". d Subject to the Total Aggregate Limit described in Paragraph 2.& above. the General Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The General Aggregate Limit Is the most we will pay for the sum of: (a) Damages under Coverage A because of Udi r Injury" and "property damage" caused by "occurrencee. and medical expenses under Coverage C for "bodlly Injury's caused by accidents, that cannot be attributed only to operations at a single 'project' or a single "location": and (b) Damages under Coverage B. (2) The General Adt)gregate Limit. does not apply to a es for "bodily Injury" or Oproperty damage" Included In the *products-cornplete;d opwer- adons hazard". Instead. the Products -Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (3) Any payments made for damages or medical expenses to which the COMMERCIAL GENERAL LIABILITY General Aggregate Limit applies will reduce: (a) The Total Aggregate Limit: and (b) The General Aggregate Limit. Such payments will not reduce the Designated • Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". 4. The following replaces Paragraph 3. of SECTION III — LIMITS OF INSURANCE: 3. The Products -Completed Operations Aggre- gate Limit shown in the Declarations Is the most we will pay under Coverage A for damages because of "bodily injury" or 1*property damage" Included In the "products - completed operations hazard". Any payments made for such damages will not reduce the Total Aggregate Limit. the General Aggregate Limit. the Designated Project. Aggregate: Limit for any "project" or the Designated Location Aggregate Limit for any "location". S. The following is added to the DEFINITIONS Section: "Location" means any designated location shown in the Schedule — Limits Of Insurance And Designated Projects and Locations that is owned by or rented to you. For the purposes of determining the applicable aggregate limit of Insurance. each "location" that includes a premises involving the same or connecting lots, or premises whose connection Is Interrupted only by a street, roadway or waterway, or by a right-of- way of a railroad, will be considered' a single "location". "Project" means any designated project shown in the Schedule — Limits Of Insurance And Designated Projects And Locations that is away from premises owned by or rented to you and at which you are performing operations pursuant to a contract or agreement. For the purposes of determining the applicable aggregate limit of insurance. each "project* that Includes a premises Involving the same or connecting lots, or premises whose connection Is Interrupted only by a street. roadway or waterway. or by a right-of- way of a rallroa4 will be considered a single "project". CG D4 69 0219 0 2017 The TmMets b%do rttf Compaq. All rights mserved. Page 3 of 3 Wkwes anwowd mowal of kmmnw sorykes ofilm try. tsi Its r md"on. POLICY NUMBER: 680-4H777478-23-47 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modiffes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following replaces Paragraph b.(3) of the definition of "products -completed operations hazard" In the DEFINITIONS Section: (3) Products or operations for which the classification, listed In the Declarations, in a policy Schedule or in our manual of rules. states that the products -completed operations are subject to the General Aggregate Limit. CG D3 09 0219 0 2017 The TraV080 Indem* Company. All ryMe Page 1 of 1 Inchades eopyrt8hted meWW of Umm= Servim Me% Inc. v fth No pennWom POLICY NUMBER: 680-4H777478-23-47 ISSUE DATE: 3/14/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ......... .............. . 4 4,110'."19 This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewal: 30 PERSON OR ORGANIZATION: ANY PERSON OR OPWANIZATION TO NEON YOU HAYS AGREED IN A WRITTEN CONTRACT TEAT NOTICE OF CANCELLATION OR N 81" OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SMW US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRSNEWAL OF THIS 2. WE RECEIVE SUCH WRITTEN REQUEST AT LRAST 14 DAYS BEFORE TEE BEGINNING OF TOR APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCREDWA. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS: A. If we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium. and a number of days is shown for cancellation in the schedule above. we will mail notice of cancel- lation to the person or organization shown in the schedule above. We will mail such notice to the address shown In the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of can- cellation. POLICY; AND B. If we decide to not renew this policy for any statu- torily permitted reason, and a number of days is shown for nonrenewal in the schedule above, we will mail notice of the nonrenewal to the person or organization shown In the schedule above. We will mail such notice to the address shown In the schedule above at least the number of days shown for nonrenewal In the schedule alcove be- fore the expiration date. IL T4 0012 09 0 2009 The Traveters IndemMty Company Page 1 of 1 POLICY NUMBER: BA-4R690875-23-47 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM - 14 • Eel A ejelyJi . i • .: i Sri N : . i^. :'. ar. « i w r; i . i wr„ ,i :. t = .. w e ♦w r i •.' + i i « ww i e... w,. ice: LLia 'w . ' • i dµ1�M i •A: i i M Ti 4 iAl :«..�; :: i 1�: uw YU �. •'M A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES... INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a wftm contract or agreement between you and that person or organbratton, that is signed and executed by you before the 'bodily injury" or "properly damage occurs and that is in effect during the policy period, to be named as an addl- tional insured is an "Ensured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT I. WAIVER OF DEDUCTIBLE — GLASS J. PERSONAL PROPERTY K. AIRBAGS Li AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.S., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: 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 an "employee''sP name, with your permission, white performing duties related to the conduct of your bust- ness. However, any "auto" that Is leased, hired, rented or borrowed with a driver Is not a covered "auto". An "employee" of yours Is an 'Insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1.. Who Is under a contract or agreement In an "am- An Insured, of SECTION 11— COVERED AUTOS ployse''s" name, with your permission, while LIABILITY COVERAGE: CA T4 20 021 S ® 2015 The Twoka Indamedy Company. All ftIds reswved. Page 1 of 3 Indudes =WSMed' materiel er Insurance Office. Inc. wflh fte permiseion. Any "employee" of yours Is an "Insured" while us- ing a covered "auto" you don't own. hire or borrow In your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION 11— COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of ball bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident' we cover. We do not have to fumish these bonds. 2. The following repkoes Paragraph A.2.a.(4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION 1— COVERED AUTOS: 1. 'Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following Is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we wlil pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a) $60.000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen properly with other property of like kind and quality. (2) An adjustment for depredation and physical condition will be made In determining actual cash value In the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality. we w111 not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver, or (b) Any "auto" that Is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up -to $50 per day to a maximum of $1,500 for temporary transportation expense In- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.1.b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D.. Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible fora covered "auto" will appl to glassdamage If the glass Is fired rather gran replaced. J. PERSONAL PROPERTY The followingg Is added to Paragraph AA., Cover- age Extensions. of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for °"ions" to wearing ap- parel and other personal property which Is: (1) Owned by an "insured`; and (2) In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto'. No deductibles apply to Personal Property cover- age. Page 2 of 3 ® 2015 The Travelers Indemnity Company. AU rights reserved. CA T4 20 0215 Includes copyrlgtded material of Insurance Serviaw once, Inc. with he pemftslon. K. AIRBAGS The following Is added to Paragraph B.3.. Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags to a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth In Paragraphs A.1.1b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty, and c. The airbags were not intentionally Inflated. We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following Is added to Paragraph AA., Cover- age Extensions, of SECTION ill — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total °loss" to a covered "auto" of the private ger t�pe shown in the Schedule or ores for wh Phy0w image Cov- e is provided, we will pay any unpaid amount due on the [am or loan for such covered "auto' less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss"; (b) Financial penalties imposed under a feass 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. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss". pro- vided that the "socidenr or loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated In such contract. CA T4 20 0215 ® 2018 The Travelers lndenu ft company. al tights reserved. Page 3 of 3 Includes copyrighted matwlel of lnwmm Services Office. his. with Be . POUCY NUMBER BA-4R690875-23-47 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the folawing: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following Is added to Paragraph A.1.a., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that Is signed by you before the "bodily injuryf' or "property damage" occurs and Me Is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this Insurance apples and only to the Went of that person's or orgnlzation's liability for the conduct of another "insured". 2. The following Is added to Paragraph B.S., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part S. Other Insurance. this Insurance Is primary to and non-contributory with applicable other Insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that Is signed by you before the "bodily injury" or "property de age" occurs and that Is in effect during the policy period, requires this Insurance to be primary and non-contributory. CA T4 74 0216 0 2018 no Irmalws Ire emft Cmpany. M rWft R=nM& Page 1 of 1 Induces 00pydqMW1 matedW of InswargS SaMm 010M bm wflh Us pembsion. POLICY NUMBERCUP-OJ605520-23-47 UMBRELLA ISSUE DATE: 3/14/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Thts endorsement modifies Insurance provided under the following: EXCESS FOLLOW -FORM AND UMBRELLA LIABILITY INSURANCE Employee Benefits Liability Carter TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA. Policy Number 680-4H777478-23-47 Polity Period From: 3/14/2023 to: 3/14/2024 Commercial General Liability Carrier THAVELMM PROPERTY chsoALTx COMPANY OF AMERICA Policy Number 680-4H777478-23-47 Policy Period From: 3/14/2023 to: 3/14/2024 Automobile Liability CarderTRAVELERs PROPERTY CUMbTY COMPANY OF AMERICA Policy Number BA-4R690875-23-47 Policy Period From: 3/14/2023 to: 3/14/2024 Limits Of Liability Each Employee $1,000,000 Aggregate $1,000,000 Limits Of Liability General Aggregate $2,000,000 Products -Completed $2,000,000 Operations Aggregate Personal and $1,000,oao Advertising Injury Each occurrence $1,000,000 Limits Of Unbillty Bodily Injury And Property $1,000,000 Dame Combined single Limit PRODUCERXhLL a COMPANY OFFICE:spaclALlsT AM 21x EU 00 03 0818 0 2018 The Travelers Indemnity Company. AU rW is reserved. Page 2 of 2 POLICY NUMBER: UMBRELLA ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: EXCESS FOLLOW -FORM AND UMBRELLA LIABILITY INSURANCE Employers Liability Carrier 17 TRAVELERS PROPERTY CASUALTY CO. Policy Number; UB-OK1T826877-23-47 Policy Period From: 3/14/2023 to: 3/14/2024 Carder Policy Number Policy Period From: to: Carrier Policy Number Polity Period From: to: Limits Of Liability Bodily Injury By Accident $2,000,000 Such Accident Bodily Injury By Disease Policy Limit Bodily Injury By Disease Each employee Limits Of Liability Umits Of Liability $2,000,000 $1,000,000 PRODUCER:BALL a compmr OFFICE:sPECIALIST Aas 21X EU 00 03 0818 0 2010 The Tmelem Indemnity Ccmpeny. An dghre reee,ved. Page 2 of 2 POLICY NUMBER: 680-4H777478-23-47 ISSUE DATE' 3/14/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGRUM IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NO -OF THIS POLICY VIM BE GIVEN, BUT ONLY IF s 1. YOU SEND US A MITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER TEE FIRST NAMED INVU RECEIVES NOTICE FROM US OF THE CANCELLATION OR NOMBNEWAL OF THIS a. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEOXM13iG OF THE APPLICABLE NUMBER OF DAYS BERM IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEBT FROM YOU TO US. PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium. and a number of days Is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown In the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. POLICY? AND S. If we do not renew this policy for any legally permitted reason other than nonpayment of premium. and a number of days Is shown for When We Do Not Renew (Nonrenewal) in the Schedule above. we will mail notice of nonrenewal to the person or organization shown In such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for When We Do Not Renew (Nonrenewal) In such Schedule before the effective date of nonrenewal. IL T4 00 0519 0 2010 The Treatm k demnity company. All d9his ramved. Page 1 of 1 POLICY NUMBER: CUP-OJ605520-23-47 UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifles Insurance provided under the following: COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE The following is added to Paragraph 11.. OUR RIGHT a. "Bodily injury' or "properly damage° caused by an TO RECOVER FROM OTHERS.. of SECTION N — "occurrence" that takes place; or CONDITIONS.: b. "Personal Injury" or "advertising injury' caused by If the. Insured has agreed In a contract or agreement an "offense" that is committed; to waive that Insu°red's right of recovery against any subsequent to the execution of the contract or agree - person or organization. we waive our right of recovery ment. against such person or organization, but only for payments we matte because of UM "88 07 OB ® 2008 The Travelers Companies, In` Page 1 of 1 Indudes the Copyrighted material of 1 O(6oe, Inc. VAhh Its pemlesbm TRAVELERSe WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) ` POLICY NUMBER: OB-OK1T826877-23-47 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2. 00 % of the California workers' compensation pre- mium. Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule ENGINEERS Job Description 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium DATE OF ISSUE: ST ASSIGN: Page 1 of 1