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PROOF OF INSURANCE (2024 - 2024) CLOSEDTRUEREC-01 �AUGAHA ACOR�z �� � CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYI� 8/31/2023 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. _W... ........ 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 ,„.,..... ...... a AA E •... HUB International Insurance Services Inc. PHONE gArc No Extl IA/ woi 1526 Faraday Avenue Suite 150 - .�. ___ MAIL 3 dani.plsSSQbubirtWrlational comet m..— Carlsbad, CA 92008 .... , IUNSURSRI�j API�'ORDING CO'VEEI2AGEW' ................... ...m._ ..„.�....... ________ _ rICt9 INSURER A Allied Insurance !Cl��"pa3ni ` of America INSURED INSURER B ;Travelers Property Casualty Company of America Nancy K. Bohl, Inc. D.B.A. The Counseling Team International .. N YTE_R.p.,........____..................__....................................�....-- 20351 SW Acacia Street Floor 2 INSURER D : ��.............._.......�W.._ Newport Beach, CA 92660 INSURER E E............................................. N .rvrv_ I INSURER F : ,,,,,�,,..........V COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 TYPE OF INSURANCE ..........„„.^^^ADDLSUBR ....,..,....„... .NUMBER ... . POLICY EFF fPoLiCYI YW1.....,....... ---- .... ...____.__ POLICY--......-_-- LTR LIMITS A COMMERCIAL GENERAL LIABILITY ..EACH OCCURRENCE. ,()0, d R $ 1 000 000 1 000 00 I CLAIMS -MADE X OCCUR 5088-1981-00 8/31/2023 8/31/2024 DAMAGE TO RENTED $ _ 1 X X MEDEXPnone person)-... $ ..... 20,000 .. ..„n. .�_ �PERSONAL S ADV INJURY 1,000,000 .niEN'L AGGREGATE T APPLIES PER: GENERAL AGGREGATE 31000,000 JPE o 3,000,000 POLICY � (�, Loc P�c��aucrs„ c�ann�to� Ark .$ ..m OTHER; $ • AUTOMOBILE LIABILITY COMBINED SIN M- E LIMIT 1,000,000 �dass1. .......... ... ...� ..m....._ X AUTOS ONLY ( AUTOS X BODILY INJURY (Per person] ANY AUTO 5091-0457-00 8/31 /2023 8131 /2024 BODILY IN „� OWNED SCHEDULED dURYJPer accident I.$.., HIRED NON -OWNED PRE". PERTY DAMAGF AUTOS ONLY „- AUTOS ONLY (Per acddnt $ - .......... ...... ....... $ „__ A X UMBRELLA LIAB X OCCUREACH EXCESS LIAB CLAIMS -MADE .5090-0559-00 8/31/2023 8/31/2024 $ 00000 DED I RETENTION $ 2,000 000 ... ,,,,... EH OCCURRENCE RENCE 2 ..„ 11 X 10,11 000 B WORKERS COMPENSATION X PTER NTH D EMPLOYERS' LIABILITY YIN X UB7T831211 8/11/2023 8/11/2024 1,000 000 ANY PROPRIETOR/PARTNER/EXECUTIVE _,E.L.FAFI ACCIDENT y$ ,„„„„m�,_,. %,, "ER/MEMBER EXCLUDED? NIA ,000,000 an story in NH) E L.iS..,FAS-_EAMPLOYFE$—..........................1.................m ._ SE . _ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below _ _ E-L, DISEASE -POLICY LIMIT LA*Abuse ssional Liab 5088-1981-00 8/31/2023 8/31/2024 See Below for Limits Liability 5088-1981-00 8/31/2023 8/31/2024 See below for limits DESCRIPTION' OF OPERATIONS / LOCATIONS F VEHICLES IACOR'D 101, Addddonal Remarks Schedule, may be attached if more space is required) Professional Liability I Occurrence Form 1 $1,000,000 Per Claaiml$3,000„000 Aggregate Abuse Liabilityl Occurrence Form 1 $1,000,000 Per Claim/$3,000,000 Aggregate Cyberl Cyber/Privacy/Network I Ret: $5,0001 Limit 2,000,000 *Umbrella Underlying Policies: General Liability I Professional Liability I Abuse Liability I Auto Liability I Workers Compensation SEE ATTACHED ACORD 101 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof El Segundo, its officers officials, employees, a ents THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 99 ACCORDANCE WITH THE POLICY PROVISIONS. and volunteers 350 Main St. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TRUEREC-01 ASUGAHARA ............................ w LOC #: 1 A+tC>/ ADDITIONAL REMARKS SCHEDULE Page 1 of 1 ". ........ .wwwwwww. AGENCY License # 0757776 NAMED INSURED HUB International Insurance Services Inc. Nanc K. Rohl, Inc. D.B.A. The Counseling Team International 2035 N/U Acacia Street Floor 2 Y NU .............. _.. __.... Newport Beach, CA 92660 POLICY NUMBER SEE PAGE 1 .......... ................................................ _ . .... CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE�E,EP El ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: AC R0 25 FORM TITLE: GeltiFcate of Liabili Insurance Description of Operations/Locations/Vehicles: Business Office Policy Property Locations: 1881 Business Center Dr. Suite 11, 12 A & 12 B, San Bernardino, CA 92408 1545 Anacapa Rd Suite 7C, Victorville, CA 92392 444 Camino Del Rio South, Suite 215 & #208, San Diego CA 92108 74075 El Paseo Suite A9 & A16, Palm Desert, CA 92260 4160 Temescal Canyon Rd Ste 309, Corona, CA 92883 41750 Rancho Los Palmas Dr ST #13-2, Rancho Mirage, CA 92270 39755 Murrieta Hot Springs Rd, Suite D160, Murrieta, CA 92563 135 S State College Blvd Ste 200, Brea, CA 92821 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 232 Harrison Ave Ste D, Claremont, CA 91711 City of El Segundo, its officers, officials, employees, agents and volunteers are named as Additional Insureds with respects to General Liability per form CG8128 01/18 and Auto Liability per form AC7005 0316. Waiver of subrogation applies for General Liability and Workers Compensation. All forms valid where required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:5088-1981-00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON-PROFIT AND SOCIAL SERVICES GENERAL LIABILITY ENHANCEMENT ENDORSEMENT It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words "you" and "your" refer to the "Named Insured" shown in the Declarations. The words "we", "us", and "our' refer to the "Company" providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. A) Medical Payment — Limit increased to $20,000 B) Supplementary Payments — Bail bonds increased to $3,000 / Loss of Earnings increased to $1,000 each day C) Legal Liability Extension — For fire, lightning, explosion, smoke, and leaks from sprinklers limit increased to $1,000,000 D) Broadened definition of Who is an Insured E) Knowledge or Notice of Occurrence F) Broadened definition of Advertising Injury includes televised or videotaped publication G) Amended definition of Bodily Injury to include mental anguish H) Amended Unintentional Failure to Disclose Hazards 1) Amended Liberalization Clause J) Property Damage — Removal of exclusion for "Property Damage" resulting from the use of reasonable force to protect persons or property K) Premises Sold or Abandoned by You L) Added Blanket Additional Insured - Funding sources M) Added Blanket Additional Insured - Managers or lessors of premises N) Additional Insured — By Contract, Agreement or Permit O) General Aggregate Limit Per Location P) Blanket Special Events Coverage Q) Non -Owned Watercraft Coverage - Length is increased to 65 feet R) Blanket Waiver of Subrogation S) Violation of Rights of Residents Coverage (Patient's Rights) T) Liquor Liability Exception to Exclusion U) Employee Criminal Defense Costs Only Coverage - $25,000 limit of insurance — each "criminal proceeding" A) MEDICAL PAYMENTS If Medical Payments Coverage (Coverage C) is not otherwise excluded from this coverage part: NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Pagel of 9 I ) The Medical Expense Limit is increased, subject to all the terms of Limits of Insurance (Section III) to $20,000. 2) The requirement in the Insuring Agreement of Coverage C, that expenses must be incurred and reported to us within 'one year" of the accident date is changed to "three years." 3) Exclusion of Coverage, at your option, does not apply to your "volunteer workers" or any person or organization under your direct supervision and control. B) SUPPLEMENTARY PAYMENTS -COVERAGES A AND B: 1) The limit for the cost of bail bonds is changed from $250 to $3,000. 2) The limit for loss of earnings is changed from $250 per day to $1,000 per day, C) LEGAL LIABILITY EXTENSION — FIRE, LIGHTNING, EXPLOSION, SMOKE, AND LEAKS FROM SPRINKLERS 1. The last paragraph of Section I — Coverage A — 2. Exclusions, is deleted and replaced by the following: Exclusions c. through n. does not apply to: a. damage by fire, lightning, explosion, smoke or leaks from automatic fire protective systems; to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. 2. Paragraph 6. of Section III — Limits of Insurance is deleted and replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under COVERAGE A for damages because of "property damage": a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination thereof; and b. caused by a resident; to premises, rented to you or temporarily occupied by you with the permission of the owner. Damage To Premises Rented To You Limit is the greater of: a. $1,000,000 for damages due to fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination there of. D) WHO IS AN INSURED Paragraph 2. of Section II — Who Is An Insured is deleted and replaced by the following: 2. Each of the following is also an insured, but only while working within the scope of their duties related to the conduct of your business; a. "Employees", but only for acts within the scope of their employment by you; b. "Volunteer Workers"; c. Independent Contractors However, no "employees", "volunteer workers" or independent contractors are insureds for: (1) `Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are al limited liability company), to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" or independent contractors while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee", "volunteer worker" or independent contractors as a consequence of Paragraph (1)(a) above; NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 2 of 9 (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 Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (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 "employees", "volunteer workers", independent contractors, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). d. Medical directors and administrators, including professional persons; e. If you are an organization other than a partnership or joint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors; f. If you are a limited liability company, your members are insureds, but only with respect to their duties related to the conduct of your business; g. Any organization and subsidiary thereof which you control and actively manage on the effective date of this endorsement; h. Any person or organization that has financial control of you or owns, maintains or controls premises occupied by you and requires you to name them as an additional insured but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. L Any State or Political Subdivision subject to the following provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership, maintenance, or use of any elevators covered by this insurance. However, the insurance afforded for any organization and subsidiary thereof not named in the Declarations as a Named Insured, does not apply to injury or damage with respect to which an insured under this endorsement is also an insured under another policy, or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. j. Students in training, but not for "bodily injury" or "property damage" arising out of his or her rendering or failure to render professional services to patients; k. Your members but only with respect to their liability for your activities or activities they perform on your behalf; I. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf; m. Any entity you are required in a written contract (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability arising out of your premises, NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 3 of 9 "your work" for the Additional Insured, or acts or omissions of the Additional Insured in connection with the general supervision of "your work" to the extent set forth below: Insurance 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: (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) Supervisors, inspection, or engineering services. Any coverage provided under this provision shall be excess over any other valid and collectible insurance available to the Additional Insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. Paragraph 3.a. of Section II — Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is, subject to (1) and (2) below: (1) Effective on the acquisition or formation date; and (2) Afforded only until the end of the policy period of this Coverage Part or the next anniversary of its inception date, whichever is earlier. E) KNOWLEDGE OR NOTICE OF OCCURRENCE 1) As respects any loss reporting requirements under this policy, it is understood and agreed that knowledge of an accident or incident by an agent, servant or "employee" of yours or any other person shall not in itself constitute knowledge by you, unless a corporate officer of yours shall have received notice from said agent, servant, "employee" or any other person. 2) Your failure to give first report of a claim to us shall not invalidate coverage under this policy if the loss was inadvertently reported to another insurer. However, you shall report any such "Occurrence" to us within a reasonable time once you become aware of such error. F) ADVERTISING INJURY —TELEVISED OR VIDEOTAPED PUBLICATION 1) The definition of "Personal and Advertising Injury" items 14. d., e., f. and g. are changed to read: "Personal and Advertising Injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: d. Oral, written, televised, or videotaped publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; e. Oral, written, televised, or videotaped publication of material that violates a person's right of privacy; f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title, or slogan. 2) Exclusions b. and c. of Coverage B., Personal and Advertising Injury Liability, are changed to read: b. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material whose first publication took place before the beginning of the policy period. G) BODILY INJURY— MENTAL ANGUISH The definition of "bodily injury" is changed to read: NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 4 of 9 "Bodily Injury" means: a. Bodily injury, sickness, or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (item above) at any time. H) UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. 1) LIBERALIZATION If we adopt a change in our forms or rules which would broaden your coverage without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. J) EXTENDED "PROPERTY DAMAGE" SECTION I — Coverages, Coverage A, 2. Exclusions, a. 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. K) PREMISES SOLD OR ABANDONED BY YOU SECTION I — Coverages, Coverage A., 2. Exclusions, j. (2) is deleted and replaced by the following: (2) Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those premises, and occurred from hazards that were known by you or should have reasonably been known by you, at the time the property was transferred or abandoned. L) ADDITIONAL INSURED — FUNDING SOURCE Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain, or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction, and demolition operations performed by or for that person or organization. M) ADDITIONAL INSURED — MANAGERS OR LESSORS OF PREMISES Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of the ownership, maintenance, or use of that part of the premises leased to you in writing, subject to the following additional exclusions:. This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alteration, new construction, or demolition operations performed by or on behalf of that person or organization. N) ADDITIONAL INSURED - BY CONTRACT, AGREEMENT OR PERMIT 1) Any person or organization is an insured with whom you are required to add as an additional insured to this policy by a written contract or written agreement, or permit that is: a) currently in effect or becoming effective during the term of this policy; and NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 9 b) executed prior to the "bodily injury," "property damage," "personal and advertising injury". 2) This insurance provided to the additional insured by this endorsement applies as follows: a) That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (1) Premises you own, rent, lease, or occupy, or (2) Your ongoing operations performed for the additional insured at the job indicated by written contract or written agreement. b) The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. 3) With respect to the insurance afforded these additional insureds, the following additional exclusions apply: a) This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations on or at the same project. b) This insurance does not apply to "bodily injury," "property damage," "personal and advertising injury" caused by the rendering of or failure to render any professional services. 4) Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. O) GENERAL AGGREGATE LIMIT PER LOCATION SECTION III — Limits of Insurance, paragraph 2. is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard, and c. Damages under Coverage B. A separate Location General Aggregate Limit applies to each "location" and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. SECTION V — DEFINITIONS, is amended by adding the following: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. P) BLANKET SPECIAL EVENTS This insurance applies to "Bodily Injury," "Property Damage," and "Personal and Advertising Injury" arising out of all your special events. However, this insurance does not apply to the following EXCLUDED EVENTS: a) Parades b) Aircraft NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 9 c) Motorcycle runs and automobile rallies d) Fireworks e) Firearms f) Animals g) Carnivals and fairs with mechanical rides h) Concerts i) Events including contact sports j) Rodeos k) Political rallies 1) Any event lasting more than three (3) days (including otherwise acceptable events) m) Any event with greater than 1,000 people in attendance (including otherwise acceptable events) Separate coverage may be available at the company's discretion for the events excluded above. Possible additional charges may apply if coverage is provided. Q) NON -OWNED WATERCRAFT SECTION I — Coverages. 2. Exclusions, paragraph g.(2) is deleted and replaced by the following (2) A watercraft you do not own that is: (a) Less than 65 feet long, and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. R) WAIVER OF SUBROGATION We will waive our right of subrogation in the event of a loss. We must be advised, prior to the loss, of your intention to waive subrogation. We also must know whom subrogation will be waived against. If your request meets the underwriting criteria it will be done at no additional charge. S) VIOLATION OF RIGHTS OF RESIDENTS (PATIENT'S RIGHTS) 1) The following is added to Section 1 — Coverages — Coverage A, paragraph 1. Insuring Agreement: "Bodily Injury" damages arising out of the violation of "Rights of Residents," shall be deemed an "occurrence." 2) As respects the coverage provided in paragraph A.1. of this endorsement, the following exclusions are added to Section I — Coverages — Coverage A-2. Exclusions: This insurance does not apply to: a) Liability arising out of the willful or intentional violation of "Rights of Residents." b) Fines or penalties assessed by a court or regulatory authority. c) Liability arising out of any act or omission in the furnishing, or failure to furnish, professional services in the medical treatment of "residents." 3) As respects the violation of "Rights of Residents" Coverage, the following definition is added to Section V — Definitions: "Rights of residents" means: a. Any right granted to a resident under any state law regulating your business as a health care facility. NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 7 of 9 b. The "Rights of Residents" as included in the United States Department of Health and Welfare regulations governing participation of Intermediate Care Facilities and Skilled Nursing Facilities, regardless of whether your facility is subject to those regulations. T. LIQUOR LIABILITY EXCLUSION — EXCEPTION FOR FUNDRAISING EVENTS SECTION I — Coverages, Coverage A., 2. Exclusions, c. is amended by adding the following subparagraph: This exclusion does not apply to "bodily injury" or "property damage" arising out of the selling, serving or furnishing of alcoholic beverages at any fundraising events. U. EMPLOYEE CRIMINAL DEFENSE COSTS ONLY COVERAGE 1. The following provision is added to the Policy: Employee Criminal Defense Costs Only Coverage We will pay, on your behalf, for "defense costs" incurred by your "employee" in a "criminal proceeding". We will have the right, but not the duty to defend your "employee" in such "criminal proceeding". 2. The most we will pay for any one "criminal proceeding" is $25,000, regardless of the number of "employees" involved in such "criminal proceeding". The payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is in addition to and does not reduce the Limits of Insurance shown on the Declarations. However, the payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is included within and shall reduce the $25,000 each "criminal proceeding" Limit shown in Item V) of the Schedule above and we will not pay for any further "defense costs" for a "criminal proceeding" after the $25,000 limit has been exhausted. 3. The following additional Exclusions apply to this Employee Criminal Defense Costs Only Coverage: This insurance does not apply to: a. Coverage Provided Under Coverages A or B Any "defense costs" for which coverage is provided under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY AND COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY of this policy. b. Damages, Fines or Penalties Any damages, fines or penalties. 4. The following additional Definitions apply to this Employee Criminal Defense Costs Only Coverage: a. "Criminal proceeding" means: The prosecution of any of your "employees" commenced by the filing, with a court, or other regulatory enforcement agency, of an information, a complaint, or an indictment, and any NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 8 of 9 amendments thereto, alleging that your "employee" had, during the policy period, committed one or more crimes involving one or more incidents, acts, or events. Such incidents, acts or events must arise within the scope of your "employee's" employment by you or occur while your "employee" is performing duties related to the conduct of your business. Any "criminal proceeding" shall be considered a single "criminal proceeding", notwithstanding the fact that the prosecution or investigation may involve multiple incidents, multiple counts or charges, and/or multiple trial and/or appellate proceedings. A subsequent or different prosecution or investigation based on the same incidents, acts, or events that provided the basis for the original prosecution or investigation shall not constitute a separate "criminal proceeding". b. "Defense costs" means (1) Reasonable attorney fees (including fees for the services of paralegals, law clerks and/or investigators working under the direction of said attorney); and (2) Reasonable and necessary costs, excluding loss of income. 5. Under no circumstances will "defense costs" payable under this Employee Criminal Defense Costs Only Coverage be payable as Supplementary Payments under Coverages A or B. All other terms and conditions of the policy remain the same. I� Nllllu�� AUTHORIZED REPRESENTATIVE NPSS GL 00004 00 (04118) Includes material copyrighted by ISO Properties, Inc., with its permission Page 9 of 9 6. SUPPLEMENTARY PAYMENTS Paragraphs a.(2) and a.(4) of Supplementary Payments in Paragraph A.2. Coverage Extensions of Section II — Covered Autos Liability Coverage are deleted and replaced by the following: (2) Up to $5,000 for 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 actual loss of earnings up to $500 a day because of time off from work. 7. FELLOW EMPLOYEE Paragraph B.5. Exclusions of Section II — Covered Autos Liability Coverage is deleted. 8. TOWING AND GLASS BREAKAGE Paragraph A.2. Towing of Section III — Physical Damage Coverage is deleted and replaced by the following: 2. Towing We will pay up to $250 per disablement for towing and labor costs incurred each time a covered "auto" is disabled. However, the labor must be performed at the place of disablement. Paragraph A.3. Glass Breakage of Section III — Physical Damage Coverage is deleted and replaced by the following: 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered "auto", we will pay for the following under Comprehensive Coverage, without application of a deductible: a. Glass breakage; or b. "Loss" caused by hitting a bird or animal; and c. "Loss" caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. 9. PHYSICAL DAMAGE — TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a. Transportation Expenses of Section III — Physical Damage Coverage is deleted and replaced by the following: a. Transportation Expenses We will pay up to $100 per day/$3,000 maximum per policy period for temporary transportation expense incurred by you because of the total theft of a covered "auto". We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 3 Of 7 10. PHYSICAL DAMAGE — LOSS OF USE EXPENSES Paragraph A.4.b. Loss Of Use Expenses of Section III — Physical Damage Coverage is deleted and replaced by the following: b. Loss Of Use Expenses 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 indicates that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $50 per day, subject to a maximum of $1,500 per policy period. 11. COVERAGE EXTENSIONS —PHYSICAL DAMAGE The following are added to Paragraph A.4. Coverage Extensions of Section III — Physical Damage Coverage: c. Rental Reimbursement We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". We will pay a maximum of $100 per day for a maximum period of 30 days for each covered auto. The most we will pay for rental reimbursement expenses because of 'loss" to any one covered "auto" during the policy term is $3,000. No deductible applies to this coverage. d. Personal Effects If Comprehensive Coverage is provided on this coverage form for a covered "auto" you own and that covered "auto" is stolen, we will pay, without application of a deductible, up to $1,000 for personal effects stolen with that covered "auto". This coverage is excess over any other collectible insurance. Personal effects do not include tools, jewelry, money or securities. e. Hired Auto Physical Damage Physical Damage Coverage is provided for covered "autos" you hire without drivers to the same extent as Physical Damage Coverage for covered "autos" you own, except: (1) The most we will pay for `loss" in any one "accident" is (a) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (b) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, whichever is smallest, minus a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for Physical Damage Coverage shown on the Declarations page of the policy. This deductible is applicable to any "loss" except "loss" caused by fire or lightning. NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 4 of 7 (2) Subject to Paragraph e.(1) of this endorsement, we will provide coverage equal to the broadest Physical Damage coverage applicable to any covered "auto". f. Limited Physical Damage Deductible Coverage For Employees Or Volunteer Workers At your request, we will pay up to $1,000 as reimbursement of deductible payments made by your "employee" or "volunteer worker' under the Physical Damage Coverage of the "employee's" or "volunteer worker's" policy of automobile insurance but only if: (1) The "loss" is to an "auto" owned by the "employee" or "volunteer worker' but not hired or borrowed by you; and (2) The "auto" was being used at the time of the "loss" in the course and scope of the "employee's" employment by you or while the "volunteer worker' was performing duties related to the conduct of your business. With regards to this endorsement, travel to and from a normal place of employment is not within the course and scope of employment by you unless such travel is in response to an emergency summons of that "employee" or "volunteer worker'. 12. LOAN/LEASE GAP Paragraph A.5. Loan/Lease Gap is added to Section III - Physical Damage Coverage. 5. In the event of a total "loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that Auto Loan/Lease Gap Coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. (3) Security deposits not refunded by the lessor; (4) Costs for extended warranties and additional protections such as, but not limited to, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (5) Carry-over, transfer or rollover balances from previous loans or leases; (6) Any amount representing taxes; (7) Loan or Lease Termination Fees; (8) The dollar amount of any unrepaired damage that occurred prior to the "total loss" of a covered "auto"; (9) All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement of a covered "auto'; and (10) Final payment under a "balloon loan". c. For the purposes of this Loan/Lease Gap Coverage provision, SECTION V — DEFINTIONS is amended by adding the following definitions: "Total Loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value at the time of "loss". A "balloon loan" is a load with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 7 13. AIRBAG COVERAGE AND FREEZING OF PERMANENTLY ATTACHED EQUIPMENT The following is added to Paragraph B.3.a. of Section III — Physical Damage Coverage: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. The exclusion relating to freezing does not apply to any "loss" caused by freezing to permanently attached special equipment common to a fire or rescue emergency vehicle, unless the "loss" is caused by your failure to properly maintain such equipment. Such equipment includes, but is not limited to, pumps, gauges, valves, fill lines, drains and tanks. In no event will any "loss" caused by freezing to an automobile engine be covered by this policy. 14. ELECTRONIC EQUIPMENT —BROADENED COVERAGE Paragraph B.4.c. of Section III — Physical Damage Coverage is deleted and replaced by the following: c. Any electronic equipment that receives or transmits audio, visual or data signals, and that is not designed solely for the reproduction of sound unless permanently installed in the covered "auto" or unless the housing unit for removable equipment is permanently installed in the covered "auto". 15. PHYSICAL DAMAGE — COMPREHENSIVE COVERAGE — DEDUCTIBLE The following is added to Paragraph D. Deductible of Section III — Physical Damage Coverage: Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss" from any one cause is $5,000. 16. KNOWLEDGE AND NOTICE OF ACCIDENT The following is added to Paragraph A.2. Duties In The Event Of Accident, Claim, Suit Or Loss of Section IV. Business Auto Conditions: d. The failure of any agent, servant, "volunteer worker" or "employee" of the "insured", other than an "employee" authorized by you to give or receive notice of an "accident", claim, "suit" or "loss", to notify us of any "accident" of which he or she has knowledge, shall not invalidate insurance afforded by this policy. 17. EMPLOYEE HIRED AUTOS — PHYSICAL DAMAGE Paragraph B.5. Other Insurance, subparagraph b. of Section IV — Business Auto Conditions, is deleted and replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any "auto" hired or rented under a written contract or agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" or elected or appointed official's employment by you. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 7 18. VOLUNTEER WORKER The following is added to Section V — Definitions: "Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. All other terms and conditions of the policy remain the same. NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 7 of 7 AOfk TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-7T831211-23-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 06-27-23 STASSIGN: PAGE 1 OF