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PROOF OF INSURANCE (2024 - 2024) CLOSEDCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 10/10/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT ' NAMP Heidi Farmanl SIP Insurance Services - Orange PHONE " , FAX 750 OrangeeCA 9 8rive 68 South, 450 ADDRESS: s wfk�cl(�iQti�irlll� i,r "�d) 626-564-6565 91 13 r 38 0 LDDR s"� rparm INSURER-(S) AFFORDING COVERAGE NAIC # Llrense#: 0M932.99 INSURER A: Travelers Property Casualty Company of America 25674 INSURED BACKAPP-01 INSURER B :,The Travelers Indemnity Company of Connecticut 25682 Backflow Apparatus & Valve Co, 20435 S. Susana Road iNsgRER c . Long Beach CA 90810 INSURER D INSURER E INSURER F . COVERAGES CERTIFICATE NUMBER: 422775077 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSR �,,, ,�„ ,,,,,,, ,,,,,,,, ............ ,,,-,,,,,,,, R�l'�1.I C'Y EI-P POLICY ........ ......... LTR POLICY-EX-0 LIMITS TYPE OF INSURANCE = � , POLICY NUMBER MM[DD1YYYY MM/DD. A X COMMERCIAL GENERAL LIABILITY Y 630BJ664090 10/31/2023 10/3112024 EACHOCCURRENCE $1.000,000 OAMAGE"1"O RENTED CLAIMS -MADE X � OCCUR PREMISES tFa orryrrence), $ 300 000 MED EXP (Any one person) $ 5,000 _ PERSONAL & ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 POLICY I_ X ,gLCr- I-OC PRODUCTS COMP/OP AGG $ 2,000,000 OTHER: $ 9 AUTOMOBILE LIABILITY Y BA7N173419 10/31/2023 10I31I2024 CC)M13 Ire kc,�Je�,tl NEE SING LE i IMI r $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ ...._. AUTOS ONLY AUTOS X HIRED X.... AUTOS ONLY , ((I"rnc� Id�letit�AMAe,r 1 I � AUTOS ONLY ..... , A y X UMBRELLA LIAB X OCCUR CUP9J209005 10/31/2023 10/31/2024 EACH OCCURRENCE $ 5.000 000 ..... EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5,000,000 X. DED RETENTION $ AwC1RKI rtSCOMPLNSATkrJN Y UB-3R155740 8/27/2023 8/27/2024 X PER OTH IN OFFICERIMI'Maf ALXC Nia'r1/EXt=(;LIrfVL, Y� . N /A E.L. DISEA5E�EA EMPLOYEE AND EMPLOYERS LIABILITY nfjmary In, rrorrlr rRlMt MSr rtLr.r.uDM t7°r IDENT $1,000,000 OYEE $ 1,000.000 19 yyos, describe under ...... ...... ........... 0-SCRIFION CMrOPERATIONS haetow E.LDISEASE- POLICY LIMIT $1,000,000 .,-..-.._..__._--._..._..-.__.....,...-�.._.___........_..... ... ......... ..... ..._,_..-............... A Property 6308J664090 10/31/2023 10/31/2024 I Bus Personal Property Included .-......... .... DESCRI.--PTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Subject to all policy terms, exclusions and condilicras, RL: WA 22 03, BackfloW testing and repair services (projects, Maintenance Agreement Dated July 7, 2022„ City of El Segundo, its officials, and employees are named as an Additional Insured with respects to General Liability endorsement if required by written contract subject to all policy terms, exclusions and conditions, General Ll°abiflly Primary and Nort Cora rlbLila ry endorsernent altrached, Auto Llabfllty ondolsemenl attached, Attached Workers Compensation Waiver (it StJbrogationi endorsement a(aplies to City of FI Seclpando, its officials, vials, and ornplo aes If rec upred b written contract subJJecl to all policy terms, exclusions, and conditions, "PI_tmASL ZTE COPYRIGHT LAWS APPLY TO THE ACORLI FORM �f t HIt ITtNt", U'S%ROI4G IVIODIFYING °'HE CANCELLATION CLAUSE. HOWEVER, PER S I P INSURANCE SERVICES PROCEDURES WILL NOTIFY YOU WITHIN 30 DAYS IF SAID POLICY CANCELS. Except 10 Days Notice Of Cancellation For Non -Payment Of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo Public Works Department 350 Main Street REPRESENTATIVE A El Segundo CA 90245 alrxcaua F'II ATIVr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD This endorserT'nent modufoes insurance provided under the foipowing° COMMERCIAL ERCIAL GEINERAL LIABILITY COVERAGE E PART N IN AIL DESCRIPTION F COVERAGE --- T-his endorsement broadens coverage. However, coverage for any injury, darTrnage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Dart" and these coverage broadening provisions do neat apply to the extent that coverage is excluded or limited by such an endorsement. The folly, vOng listing is a general coverage description onily. Read alll the provisions of this endorsement and the rest of your policy care -fully to determine rights, duutles, and ghat is and is riot covered, A Who is An Insured -- Unnamed Subsidiaries B. Who Its An Insured - Eir nployees And Volunteer Workers — Bodily pnjuury 'To Co -Employees And CD -Volunteer Workers A Who Is An Insured - Newly Acquired Or Formed Limited LiaWity Companies D. IBlanket Additional Insured Inroad Form Vendors Blanket Additional Insured -- C;ontrolling Interest IF. ElWiket Additional Insured - Mortgagees., Assignees, Successors Or Deceivers u Blanket Additional Insured -- Governmental Entities _. Perrrnpt. Or Authorizations Relating To Premises PROVISIONS A. WHO IS AIN INSURED — UNNAMED SUBSIDIARIES The following is advert to SECTION" III .,,,,,•WI-10 I Any of your subsidiaries, other than a partnership or joint venture, that is net shown as a Named Insured in the Declarations is a Naar ned Insured if:. as You are the sole owner of, or maintain an owroership interest of more than 50% fin, such subsidiary on the first day of the policy period-, and b. Such subsidiary is not an insured under sirmnilar other insurance, No such subsidiary is an insured for "bodily injury" or "'property damage" that caccuurred, or "persorial and advertising injury" caused by an offense cor nmMed. K Blanket Additional Insured — Goverrunental Enthi .. Permits Or Authorizations relating To Operations I. Blanket Additional Insured — Grantors Of Franchises J. incidental Medical Malpractice IC. Medical Payments -- Increased Lirnit L. Blanket Waiver Of Subrogation I . Contractual Liability —Railroads aw Before you maintained an ownership interest: of more than 50% i n such subsidiary; or bn After the date, if any, during the poky period that you no longer maintain an ownership interest ofmore than 50% in such subsidiary, II::`or purposes of Paragraph 1. of Section III -- Who Is An Insured, each such subsidiary will Nye deemed to be desigrnated in the Declarations as: a. A limited Niabillty coirrrnpany; b An organization other ° than a partnership„ joint venture or liiniited lialbillity company; or c, A trust; as indicated in its name or than documents that govern its structure, SDI 02 19 0 2017 The travelers hidemri ty Company. AH righis resoved. Page 'I of Pv and udes copyrighted matey M of 4-muwrance Services Office, Outs. Mtli ks perur iss. on COMMERCIAL, IAL, GENERAL LIABILITY II , WHO IS AN INSURED EMPLOYEES AND VOLUNTEER WORKERS --BODILY IINJ URY T -IEIMPLOYEE AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a,('f) of IECTION IN -- WHO IS AIN INSURED: Paragraphs (1)(a)" (b) and (c) above do not apply to "bodilyinjury" to a co -"employee" while in the course of the co -"employee's" ernpdoyrnent by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while, performing duuties related to the conduct of your business. C. WHO IS AN INSURED -- NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECT110N It WHO IS AN INSURED: 3„ Any organization your newarly acquire or forrmm, 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%, will qualify as a Naumed Insured if there is no other similar insuuraince available to that organization, However: a. Coverage gander this provision is afforded only: (1) ulrmtil the 1 0th day after you acquire or forme the organization or the end of the popicy period, whl chever is earbor, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) t_Untid the end of the policy period, when that date is later than 't 80 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 R, lb. Coverage A does riot apply to "bodilly injury" or "property damage" that occurred before you acquired or formed the organization, and c. Coverage IB does not apply to "personal and advertising injury" arising out of an offense conirnitted before you acquired or formed the organization„ For the purposes of (Paragraph 1.. of Section NN -- Who is An Insured„ each such organization will be deemed to be designated in the Declarations asu a. A dirmited liability cornpanyo b. An orgarmization" other than a partnership" joint venture or dimded liability company„ or c. A trust; as indicated in its name or the documents that govern its structure. D. BLANKET ADDITIONAL INSURED ED — BROAD FORM VENDORS The following is added to SECTION III — WHO I AN ITN LURE ; Any person or organization that is a vendorr and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Pan is an insured, but only with respect to liability for "bodily injury" or "property darrmage" that a„ Occurs subsequent to the signing of that contract or agreerementN and b.. Arose." out of "your products" that are distributed or sold in the regular course of such vendor's bausiness. The insurance provided to such vendor is subject to the following provisions: a, The limits of insuurance provided to such vendor will be the nminirriuurm limits that you agreed to provide in the written contract or agreement, or the lirrmits ;shown in the Ip"Declarations, whichever are less. b. The insurance provided to such vendor does riot apply to: ('t) Any express warranty snot authorized by your or any distribution or sale for a purpose not authorized by youu� (2) Any change in "your products" made by such vendor; (3) Repackaging, sunless unpacked solely for the purpose of inspection, demonstration, testing" or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; () Any failure to make such inspections" adjustments, tests or servicing as vendors agree to perform or normally undertake to perforrn in the regular course of business, in connection with the distribution or sale of "'your products IPage 2 of 5 0 2017 The'iravelers Indemnity counpan.y. All rights reserved. CG D4 58 02 1 includes copyrighted m ateuia0 Qf Insurance services Office, Inc. wrkh its permission (5) Demonstration, installation" servicing or repair opaeratbanns, exceptsuch operations performed at such verodoar"s premises in connection with time sale of "your products"; or () "Your products" that. after distdbuutiourn or sale by you, have been loabeied or relabeled or Used as a container, part or ingredient of any other thing or suubstance by or on behalf of such vender', Coverage under thi .s provision doves not apply to: a, Any person or organizatioar'u from whornn you have acquilred "your products,", or any ingredient, part or container entering into, accompanying or containing such products„ or fin, Any vendor for w Nclhn coverage as an additional insured sp ecifficaHy is sclhedUed by endorsement. E. BLANKET ADDITIONAL INSURED _. CONTROLLING INTEREST "Ii, 1"he following is added to SECTION Ill ,,,,,,, H IIS AN INSUREDEDl Any person oar aaa'ganizatuoun that Ihnas financial control of you is an insured with respect to Habilky for "bodily injury", "property damage" or "persona[ and adveutisiJng injury" that arises out of: a. Such tionancW control; or lb, Such pe.rson"s or organi atio n`s ownership, maintenance or use of premises idased to or osccu.up led by you, The insurance provided to such person or organization doves not alppaly to structural alterations, new construction or demolition operations performed by or on behalf of such person or oargaanization. „ The ff0lorowswing is added to Paragraph 4. of III!.::C1 I0N IUII WHO IS AN IIHSIUIRED4 °phis paraagralph dGes not allalpiy to any premises o vvner" manager our lessor that has ffonanc: al control of you. F:. BLANKET ET t DiTiO AIII„. Il1NSU llf D MORTGAGEIES. ASSIGNEES, SUCCESSORS OR I Ipa IV IR The following is added to SECTION pp — WI-40 IS AN IINSU11 pI D., Any person or oroganizaboarn that is a mortgagee, assignee„ successor or receiver, and that you Ihave agreed in a written contract or ar'eeru'nent to include as an additional insured on this Coverage Part is an insured, Ibuut o Ny with respect to its Halbillity as mortgagee, assignee.„ successor or receiver -for "bo&y unjtury"" "property damage" or "personal and advertising pnju.ury" that; ae Is "Iboadilly i npury"° our "property damage" that occurs, or is "personal and advert°usang injury" caused by an dense that is committed, subsequent to than signing of that contract or agreement; and b.. A6ses out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is requuired under that contract or agreermernt to Ibe. incWed as an additiionap insured on this Coverage Dart. The insurance provided to such rmonrtga ee" assignee, successor or receiver is subject to than ffo Hoarrwing pronvisionnsu a. The limits of insurance provided to such rnortgagee, assignee„ successor or receiver wpwiil be the rmpnirmuurm limits that you agreed to provide in the written contract or agreement, or the Nirmits shown in the Declarations„ wrwllnuchever are less, lb. The insurance provided to such person or orgarnizatpon dares not apply to., (1) Any "bodily injury°" or "property damage"" that occurs„ or any "personal and advertising injury` caused by an offense that is coairrnMed" after such coardract or agreement is no longer in effffect; or () Any "bodily injury", "prraperty dar rage"° or "personal and advertising injury" arising out of any structural alteraWns, new constructIon or demolition operations performed by or on Ibehapff of such mortgagee, assignee, successor or receiver. G. II IL NK111:.T ADID111110NAL INSURED GOVERNMEN"T"AL EN'nTIE IPd R110l"'I' OR UTI-1ul RIZA ION RELATING 1'0 PREMISES The ffo Hoaw'ung is added to SECTION pt W010 Is AIN INSURED: URED: Any governmental entity that has uss9uued a permit or authorization with respect to premises owned our occupied Iby, our rented or loaned to, you and that you are required by any ordinance„ law, buuild4ig code or w0tten contract or agreement to include as an additioanap insured on this Coverage Part is an insured„ but only with respect to H aWhty for "bodily iu.ujuury'% "property daimage°" or "personM and advertising Injury" aarisorng out of tp°ne existence„ owuvnerslhip" use, maintenance, repair, construction, erection or removal of any of the ffoaplloaw hung for w Nclh that governmental entity has CG D4 58 02 19 0 2017 The ..a"ravders haderinnity Compau'y. AH rights reserved. Page 3 of nnrludes copyrighted material or Insurance SerAces Office, Unr, with its p err nussb n 01MOVEIRC11At GENIEIRAU.... t...UAIMI1....rry issued such permit or aut oricatiort advertising signs, awrniongs, canopies, ceppar entrances, coal) holes, driveways, rrna ninnies" ranarquees" hoist away ope n rq% sidewalk va uRs, elevators, street banners or decormabouns. H BLANKET ADD1110NAL INSURED ` :RVgMEIg"rAL ENTITIES — PERMITS OR AUT11ORMATIONS RELATING TO IE A°iN"IONS e following is added to SECTION Uli WHO IS A114INSURED: Any govoMrn merntai entity that has issued a p errrnit or authorizatiaarn Mth respect to operations performed by you or on your behalf and that you are required by any ordinance, iavw" building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured,, but orniy with respect to piabi Ility for "bodilly injury ""„ "propaerty damage" or "°p ersornai and advertisiing iunpury" arising out of such operations, The irnsurance provided to such goverrnrunerntai entity does not.. apply to: a. Any "bod°ally irnjur_V" "property da.rrnage" or "personai and ,adveirtisirng injury " arising out of opaerat'iorns performed for the a overraarneratall eintiya or Itu" Any "bodoiy irujury" or "propaerty da,rrnage" included p n the, "products®corn°nplleted operations hazard". U"he ftaibMing is added to SECTION ill — WHO N AN INSUIREM Any paeson or orgaunLatiorn that girarnts a franchise to you is an insured, Nauut only with respect to liability for "bodfly ii njury" "property damage' or Wp ersornal and advertising injury" arising out of your orRratio ns iirn the franchise granted by that person or organization, services" first aid or ""Good Sairnarntarn services" to a person, unless you area in the business or occu..upnatiorn of providing prurofes sioarnall healltfo care services. 2. The ff0ovwirng repuiaces the last paragraph of Paragraph 2.a.(1) of li!!i n0N Np — M-10 N AN INSURIIIiiiIN : Unless you are in the business or occupation of -'providing purofessic nai health cave services, p::earagrap hs ('t)(a)" ()" (c) and () aldove do not alppw y to "bodily injury" adsirng out oaf providing or faaN ng to provide: (a) "Inciderntall rnnedicau services" by any of your "employees" who is a nurse. nurse assistant, ernergeuncy medical technician, pararrna^&, athletic trainer, audiologist, dietician, nutritionist, occupatioonai therapist our aaccup aticrnap therapy assistant, physicai therapist or spaeech- iarrguage pathologist; or (b) If=first aid or "Good Samaritan services" 4y any of your "employees" or, "voiurnteer workers", other than an ern i:floyed or volunteer doctor. Any such "employees" or "voluurnteer workers" providing or faliiung to provide first aid or "Good Samaritan services' during their work hours for you will be deemed to be acting vwitinirn the scope of their errnlployrrient Idy you or puerforrrnirng duties related to the conduct of your business. :3. The fMowwirng replaces the past sentence of Paragraph 5„ of SEcrioiN 11111 .,..... 1 MAITS OF N SU AINM if .a written contract or agreement exists between you and such additional insured, the limits of insurance p,airovided to such insured M11 The V-ie 4. minirrnu"rn Ilirrnits that you agreed to provide in the written contract or agreement, nt, or the piirnks shown in the (Declarations" whichever are less, U::::or the purposes of determining the apup: hcableW" Each Occurrence N_lrnnit" .alp related acts or orrni.ssiorns c¢arrnarnitteµd in parovidirug or failing to provide "'pncidental rnnedlcal seir0ces", first aid our "Good arruaritaru services" to aruy one Ipersoi will be deemed to the one "occurrence". "p"he folllovwinag exclusion is added to Paragraph 2., Exclusions, of SECTION l ..... OVE A Ii;;, — COVERAGE A ,,,.,,,. BODILY INJURY AND PROIPERTY DAMAGII!::'�' LIAIII! 111I.,,,.U"M 1. The following replaces Paragraph Id" of the Salle Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DI:.nU'1NITI0lNSection„ out of the vrollatiannn of a puenM statute or b., An act or omission committed in providing ordiunance rellating to the salle of pharmaceuticals corrna tted by, or, wiffi the or ffailirig to provide Incidental rnnediicap knoWedge or consent of,, the insured,, Page 4 of 5 0 2.017'TheTravelm nrnde=4 Company, AH Hghts reserved. CG D4 58 02 1 Includes cmapyrdghted unniqterW of hsii.nra ace Services Office, Vnc, veinal its pza rerapsnvfon 5. ...p...he following is added to the DEFINITIONS Section: "kicidental rmedlcal services" reams: ao Medical, surgical, dental, laboratory,, x-ray or nursing service or treatment, adviice or instrucfion, or the related furnishing of food or beverages; or It), "'I he furnishing or dispensing of dvugs or medical, deritall" or sn.urgicM supplies or apspliarkceso m The foIlovWng is added to Paragraph 4mb.v lExcess Insurance, of SECTION IV COMMERCIAL GENERAL. iTY .this insurance is excess over any valid and collectiNe rather insurance, whether primary, excess" contingent or on any other basis" that is available to any of your "ernployees" for "bradily injury" that arises out of providing or -failing to provide "incidental rnned"uca� services" t® any person to the extent not subject to ➢:Iaragraph aa.(I) of Section ➢p .......Who Is An ➢nsuredo COMMILp:ZCIAL II:::: II:: ➢: AII.... II....lABl➢..➢TY 1i). The amount shown in the Declarations of this Coverage Part for ]Medical Expense Limit, I BLANKET WAIVER OF SUBR.0GATlON The fellomfing is added to Paragraph S., transfer f Ifs➢gents Of Recovery Against th rs .T' Us" of SECTION ➢V — COMIMEIRCiAL GENERAL If the insured has agreed in a 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 pna,yrnei nts we make because of'. as "Bodily injury or "property dalrnage" that occurs; or b. "Persona➢ and advertising irijur°y" caused by an offense thiat is corrnrunittedk subsequent to the execution of the contract or aglreennerrt. M. ➢V"t"RACTtaU IL LII 131111...ITY .- RAILROADS 1, The fcuUlcniu~ng repalaces Paragraph c< ®f the The fsa owing replaces Paragraph 7. of silEcTION defirnitiorn of "Insured contract"" in the III •- I IMITS OF INSURANCE:: D111!, IFIINOTIONS Section: 7. Subject to Paragraph S. above, the Medical c, Any easement or kernse aglreem riL Expense ➢....irnnit is the most we w iH Ipay under 1 Paragralph f.(1) of the defirnitim of "insured Coverage C for all medical expenses because of "bodilly iirnpulry" sustained by any contract"' in the D11i...',.FINrn0NS Section is one person, and wnslH be the higher of: de➢eted. ID4 58 02 19 2017 The Travelers; lbws eminuky Company. All rights reserved. IPage 5 of 5 inc IucJrs copyrighted rnakevW of Insurance Services office, e, Onc. Mdi its perrnission POLICY NUMBER: 6308J664090 4. Other Insurance if valid and collectible other insurance Is avaaihble to the insured for a pass we carver under Coverages or IB of Oiis Coverage Part, our obligations are limited as describedd in Paragraphs a. and Ism below, As used anywhere in this Coverage Part, other insure -trice means insurance, or the funding of losses, that is provided by, through or on befialf of: tip Another insurance company, tdilp Us or any of our a'lfiluated insurance companies, except when the Non cumulation of Each Occurrence Llrnit provision of Paragraph 5 of Section 1111 — Limits Of Insurance or the Non curinuulation of Personal and Advertising injury L"urnit provision of Paragraph 4. of Section Ill - Ur nits of Insurance applies because tine Amendment — Non Cumulation Of Each Occurrerice Limit Of Lialoflity And Non Cumulation Of Personai And Advertising Injury Limit endorsernent is included in this policy (ill) Any risk reter-rVon grouopa or (iv) Any self•-insuurance method or program, in which case the insured will be deemed to be the provider of oilier insurance° Other insurance dews not Include urmbrefla Insurance, or excess Insurance, that was bought specifically to aapipay in excess of the Urmits of (insurance shown in the Decorations of this Coverage Part. As used arlywhere in this Coverage Part, anther hnsuurer reams a provider of rather insurance. As used In Paragraph c. below, insurer irneans as provider of insurance. a. Prinna lry Insurance This insurance is primary except when Paragraph b. bepowrw applies. if this insurance is pa6mary, our obligations are not affected unless any of the other insurance is also primary, Then, we will share with all that gather insurance by the method described in Paraagrap,ah c. below, except when Paragraph d. below applies. b. Excess Insurance (1) TH5 insurance is excess over. COMMERCIAL GENERAL LIABi11_l-TY 00 That is insurance for "premises damage" (III) if the loss arises out of the maintenance or use of aircraft, ""autos" or watercraft to the extent not subject to any exclusion in this Coverage Part that applies to aircraft, "autos" or watercraft-. 00 That is irnsuurance available to a premises owner, manager or lessor that q ualifiews as an insured under Paragraph 4, of Section Id - 'WWho is An insured, except when Paaragralph d. below applies; or (v) That is insurance available to an equuipau°vent lessor sear that qualifies as aarl insured under Paragraph Ian of Section pI - Who is An Insured„ except wheun Paragraph d. below applies. °. (b) Any of the other insurance" whether primary, excess" contingent or on any other basis,, that is avaiiable to tine insured when the insured is an additional Insured, or is any other insured that does not quuaffy as a narmed insured, under such Bather insurance, (2) When thiis insurance is excess, we will have no duty under Coverages A or B to defend the insured against any "suit" If any Bather insurer has as duty to defend the insured against that "suit". If no Bather Insurer defends" we awlli undertake to do so, but we wwiil be entitled to the inn sured"s rights against nip those other Insurers, (3) When this insurance is excess over other insurance, we will pay only our share of the arriouunt of the loss, if any, that exceeds the sum of: (a) The total arnoaurit that all such either insurance would pay for the loss in the absence of this 'insurance„ and (b) The total of ail deductible and self - insured amounts under all that other insurance. (a) Any of the other insurance„ whether (4) We will share the remaining loss" if any, primary, excess, contingent or on any with any rather insurance that its not other basis: described in this (Excess insurance parovisioru and was not bought specifically to {i� BoilThaIs Fire, Extended Coverage, apply In excess of the Limits of Insurance similar c Fisk, Installation ovk or shown iri the Declarations of this Coverage sirviilaar coverage for "your w�raari6"°p Part. CG n 00 02 19 0 2017 The "travelers indemnity Counraany, All rights reserved. Page 15 of 21 hicl odes copyrighted mate6al of Insurance Services office, Inc. wiffi its perrnissuon. COMMERCIAL GENIE R-AA... LJAIMLITY c„ Method Of Sharilrug Cd all of the other insurance permits comrnttrlbuttk)n by equal shares, we wwiH tto howdw this rn tthod also. Under trnis approach each insurer contributes equal amounts uuunttil itt: has paid its apupCio•:abk CClrmnitt of insurance or none of the loss re mmairns" whichever comes first. If any of the other insurance does not permit contribution by equab shares" we 0l conttr6uutt by iilrrnits. Under this nnettdnoud, each insurer's share is based on the ratio of itts appkable limit of insurance to the toW applicable limits of Irmsnurance of A insurers., d. PAirnary And Non onteibutory Insurance If I111equudred Ifyy Written Contract If you specificaCCy agree in a wwrittt(m core ractt our agreement that ffie insurance afforded to an ira.sunred under this Coverage Part must apply on a primary basis„ our a pdrnnar'•y and rnorn- cournttr'ibuutt:ory basis, ttpmps insurance is primary to onttdnelr irmsurarno;e that, is available to such insured which covers such insured as a rmarned'insuured, and we wwilli not shahs with that other insurance, parouWed that: (1) The "CbonodHy irniuur or "pronpertty dairnage°° for which coverage is sought cuur% and () 1"he "personal and adver'ttisNrmg injury' 'doer which coverage is Sought is ca usc- by an offense that is comrmnrm fitted; subsequent to the signing of that contract or agreement b.y yoauu, S. Premium Audit ao We w N compute all prenn'iuulrns ttoarthis Coverage Part in accordance with our rules and rates, Ib„ Prermniuurmm shown iro this Coverage Part as advance prernniuurmn is a rdep'uosR Iprerniuum only, At the close of each audit period we w0l comp.ute the earned premiurn for that period and send notice to the first Narrned Insured, The due date for audit and retrospective preruniaurmns is ,6e date showin as the due date on the hill. if the sum of ffie advance and audit purerriiuurmns paid for the podloy period is greater than the earned prerniuur'mnu we will return tti°'ne excess to the first INarmmed Insmulrede a. The statements in the N` eciarabo ns are accurate and compWe; Vim. Those statements are based upon representations you made to us; and c. We have issued this policy in rehance upon yonuulr rapraseunttattimm.s. The unintentional ormnissiu n of, our uornpruttentiornaC eirror in, any iinformation provided by you which we Ir6'W upon in issuing this l:,:)o cy wwHl not Iprejuudke your rights under this insurance, However, this Ipuru�vusu�rn does inot affect our right to c6le,"nt additional premr urn our to exercise our, rights of canceRattio n or nonrenewM in accordance with applicable insurance lawns aur' regulations, 7. Sepamation Of Nrnsuureds Except with respect to the Limits of Insurance, and any fights or duties spueciiddcaBy assigned in this Coverage Farm to the first Nalrned Nrusuured, this insurance applies; a,. As up each Narmned IInsured were the only Narned insured*, and bW Separately to each insured against whom'mn claim is made our °"sn•uid:"" is brouu l°ntta . Transfer Of Rights OF Recoveiy Against Oddnelrs To Us Ntt the insured has rights to (recover aill or part of any payment tt we have. unmade under this Coverage Part, those rights are transferred to us. The insured must do nothing a'Ntter loss to 'irmmpapr them. At our request, the insured wriV bdi ng "suit' or transfer those flghts to us and help us e nprx'ce tthermno g. When We Do Not Review If we decide Irnoatt: to renew ttHs Coverage Part, we will rmnaH or deHver to the first IMarmno d Insured shown in tthe Declarations e+wrbdtten notice of Ole rnouunlrerme wwall not Ness than 30 days before the axpuirattiourn date. If nouttice 'Ns Imailed, proofaf mailing wwili des mcieirlh pro d oud rnou4iceo 1,, "Advertisement" means a rnaNce that is broadcast or puulbished to the general puulNic or specific market. segments aborll..utt your goods, products our services for tire purpose of attttrac iung Customers oulr supporters, For the purposes of this dettirnittioun. um, "i"he first Named Insured must (keel:: records of a. Notices that are pnupnbished include rrmatteidal' the infoarrmnabourn we need for p:nrerniaum placed on the Internet or on sirrOar (9ecttroanic counnpu.0 .. ioarn, and send us copies at such ttirmnes r-neans of a::ourmnrmnuunicattiorn® and as we may request. bw Regarding wwe Oskes, only that part of a wwebsitte W Representations that is about your goods, pArondA..Acts or ser0ces I1:3y ac ep irng this policy, you agree° for the purposes of attracting cu.ustteurmnewrs or, supporters is coarnsUeMred an a r'Qiser'mnentt, ".m If�age "i�a Rb ��,� � 21�'m � IfrvrW* Travelers oar��uunrwr�w Company.Al rights re:�a�d�r�ad. � T"N 00 02 "d i nd udes copydghte d material of insaara ncL services es Office, nrnc, waunh its p*irrWssoora. POLICY NUMBER: BA7N173419 COMMIERCIIA0,,,. AUTO T11111 II1:..:. tl 'D0R, EM T C11°1MG111iii11T11111:..:." F LIIICY. PIII,,,EASE @ 11EAIIG) IT CAREFUl,,,,,III,,,,,Y. BUSINESS w EXTENSION ENDORSEMENT This endorsement modifies insuurarnce provided under tune fo lloaww0rng: BUSINESS AUTO COVERAGE FORM 101i NB I[ IDE CRNP110IN OIL COVERAGE .— This endorsement broadens coverage, However, cov rag for any injury, damage or rmnedicaai exp:uernse x described in any of the provisions of 0-iis endorsement rmnay Use excIluded or Hrrnited by another erndoarsernnerut to the Coverage Part" and these coverage broadening provisloarns dog not apply to the extent that coverage is excluded our 0irmnited by such an erndoarserneumt,. The following 0isting is as gerneraai cover - ,age descrip:atioru oarn0y.. LOmkatioarns and excluusiorns rmnaay apply to these coverages, IRead 0 the provisions of this ein.. do irservnernt and the rest of your p do cy carefu.u0ly to determine rig0'nts, duties, and what is and is inoat wavered.. Au 1311110AIB P�'"ORM NAMED INSURED B. B INK E"f" AII: DIrriONAll INSURED C, IEUW0M,,,.OY1EE HIRIED AUTO D. IEMPI...OYIEES AS INSURED III!!!i UPIP LIIEJMIEINTA Y PAYMENTS T — UO4CId 111!!i; E1l:) LIMIT Pa 149101111!.!:D AUTO L10M17"9ED WWORLI: "9IDE COV­ P OOE — pOWOlII:.. l NI BASIS OW WAUI"UarIER OF DEDUCTIBLE "GLASS PROVISIONS A. BROAD FORM NAMED INSURED The foa00a wkig is added to P r grzip 0"u AA.. Who Its An Insured, of SECTION III COVERED AUTOS LIAB19 ITY COVERAGE: Any organization you neww0y acquire or form dur ling the policy period over which you maintain E0"°luo or more ownership interest and that is not separately tely insured foar Business Auto Coverage.. Coverage under- this provision is aalfosrded only uurn- tiI the 180t0"t day after you acquire orform the or- garnizaado n oar tune end of the policy paeirioad, which- ever Gs e r0ier. B. R NIIKE'r AIDID01110INAII BNSURIE:`10 r"Use following is added to Paragraph cv irn A.A_ Who IUs An Insured, of SECTION 09 — COVERED AUTOS Il 1AII311JTY COVERAGE: Any person oar orgaarniz tiw-n vw0rooa is regOred under as written contract. or agreement 0raetwweern you and t0°uaat person or oargaarnizantuorn, that its signed and executed by you 0aefoare the "Iboadi0y✓ injury" or "property darnage" occurs and that is in effect during the pao k.y period, to be rnaarmned as an addi- tional urnsuuired is an "insured" for Covered Autos Liability Coverage, but o Ny for damages to which Ufa HIRED AU1`0 PHYSICAL DAMAGE — LOSS OIF' USE ,,,,,- INCREASED (LIMIT L RHYSICAIL IDAIMA IIIE' — "T"RANSPORTAT110114 EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. A91RBA`B I.... NOTICE AND OKNOWWLUEIDGE 01i::: ACCIDIU!!I:N"If OR LOSS K IBI:,,,,ANIIKIIIE,"'r WAIVER OF SUIBROGA710N 04. UNINTENTOONAL, ERRORS OR OMISSIONS this insurance applies and oMy to the extent that person or orgaaNzaatioarn qualifies 0ifues as an "irnsauu°ed" under the WWUno 0s An 0nsuured pnroavisioarn coarntairned C. EIWIIIDLOYEIIiI;° pt9RE11:) AUTO 1The foaOPaanrwirng is added to Paragraph A.I., Who Is Ain 9rrsuared„ of SECTIO1N pp ® COY- EI0 01EID AUTOS I IAIBIILITY COVERAGE: An "employee" of yours is an "insured" while operating an "autos" Ihnpred oir rented under coarntract or agreement in an "ermrp Ioayee"s" rnaarrne, with your p:neirrmaisslosrn„ while puerfoarrmnirng duties repaated to the conduct of your Ibuusi mess. 2m 1"tne foa00oawwirng rep Iaaces P. aaraagraap h b. irn B.S., (..)their Insurance, e, of SIECTIlON 9 USp NESS AUTO CONI UT0O0 s- b. For Hired Auto Physicaai Damage Cover age" ttm fo Honwwi ng are deermned to be cov,,, Bred "autos" you own: (1) Any wavered "aUtO" you lease" mire" rer-it or borrow; and () Any coveired "auto" hired or rented by your "ermp ioyee" under a co rMaact in an "employee's" name, ww0th your CA "' 3 53 02 1 S 0 2015 The Traveiers 4undi wnirrky Company, All Nghts reserved, Page 1 of 4 Indu des r orryi ghted ui ater A of insurance Services Off inc. with Ks permission.. COM ERCKL Al[J"TO permission, n" while p rfforrnnurng duties () With respect to any claim made or "suit" related to the conduLt of your bust- brought outside the Urnit rd States of rnoass. Arrn rica , the tag"rrltorles and possessions U"daavwre'wuar, any "'auto" that Is leased, hired, of the United States of America, Puerto rented oir borrowed wi9ii a driver is not a Wco and Canada., covered "auto". (I) You must arrange to deffer0 the ""Iln... III'r' I IP I I INSURED U V I .tle. sunred"" aga4nst, and investigate or set- any such claim or °"suuh" and keep p..he following is added to Paragraph AA., Who Is us advised of aH proceedings and aav,,,, Ain Insured, of SECTION 1p ,,,,,,COVII>RIED AU1"OS tilornsa LIAll dll-Il" Y COVERAGE: : Any "errnpblaubyee" of yours is an "insured" whHe us- (H) J eiither you maser any other arnvo➢ved dung a covered "auto" you don't own, hire or borrow "Irbsuar ad" w iH make any s ttl rlmarnt IIMn'�A�Il.rlr �rusrlrness oar yCGn.AIr personal affairs, t fthouat our consent, E, SUPPIXMIENTARY PAYMENTS..,,,. INCREASED (iiud) We may, at our discretion, participate 1-11MITS in defending the "insured" against, air In the seMerrn lrnt of, any claiiln or i. The following ng replaces Paragraph A.2..(2), of SiEcrm H ....., COVERED AUTOS LIA d1I„n l o IE!IUl A I (pv) e ww iH lraalrrnb ulrs the ""`arnsurnvud"" for sums that the "insured" legally must (2) Up to $3,000 for cost of ball bonds (Ion- pay as damages because of "bo dll'.y cluudi ng bonds for related traffic law v0ia llrniwy" or "property rdarroage" to which tloms) required because of an "accident" thlls insurance aplpPn s, that the "in - we cower, We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit dscrilbed in Para- 2, The following ng replaces Paragraph A.2.a.( ), graph C., U-Irrnits Of drnsuurarnce, of of ION ld .._ COVERED AUTOS LI 113111 SECTOlq Ull . COVEI ED AU�..p..0 U COVERAGE:: 1JAIl311V-lTY �'OVII.i.i.1' E, () All reasonaMe expenses incurred by the () We wvull r umburse the '1nsu.rred" for 1 nsunreud" at ouulr request, urbcludorng actual the reasonable xpe nses incurred loss of earnings up to 500 a day be- with our consent for your invesfiga- cause of ffurnne off from work, tlaarb of such cWrriis and your defense of the "insured" ono ornst any sauu:pn F. HIRED AUTO .- LIMITED WORLDWIDE V- ""suuit% but o Ny up to and included ERAGE INDEMNITY I1 A Us within the lillronit described in Para - The ffaailowwlr'ng relplaces Subparagraph () in Perna_ graph C., Limits Of IInsurance, off graph I w7., Policy Period, Coverage 'r rdtory" SEC11014 pd 0VERIi:::1AUTOS of SECTION p .- BUSINESS Aur D1- U,_UAU pl....MY COVERAGE, " and net In TION . aMtlopn to such llu'nnlff. Ouur. duty to make such payments ends when n we (5) Anywhere rrn the world, except any country or have used up the applocalble limit gaff jILnr'@srdlctlQbra wwU'bple any trade sanction,r"0"�•�. Ur'bs�'rrc�rnG�e In payments for audarwnu�ges, t�argua, or similar regulationimposedany the�'::nttloarnnrnts �r defense expenses.Uyrnite d States of Arnn dca applies to arid pans Ihibilts the transaction of business with or (b) This insurance is excess over any valid within such country or juurlsrdicfi arna for Cruv- and a.oHectilbl . otherinsurance ,awrallalble erect Autos Liability Coverage for any covered to the 1 nsureud" whether primary, excess, "°auto" that YOU lease, hire, rent or Ibabrrowaw co nfflmgernt or on any other basis, without t a driver for a period of 30 days or less (c) This insurance Is not a substitute for re - and that is not, an "auto" you lease„ hire, rent quuir ad or compulsory Irnsuuu°arnce in any or borrow from any of you it "employees", country outside the United d States„ Its ter- paalrtllm rs (if your are a partrnershipa), r'rn m beers rltorle.s and I:mssesslaarns, U'lu rto 'lco and (if you are a llrnited l°uab lllty company) or Canada. rnernbers of their households, Page 2 of 4 C 2015 The Tmwrd rug rridefnnfty Company. A4 nights reserved. CA T3 53 02 "fly includes copyrighted rrus#euisd of insurance Sevv6ces Office, Me, with u9s permission. You agree to rnaintAn ah required or compulsory insurance In any such coun- try up to the rniniiii 4irrii required by locall law, Your faNlure to comply with compulsory insurance requirements will not inva[idate the coverage afforded lby this poliqy, but we wfli only Nye. liable to the sairrie extent we wouild have been llaHe had you compiled with tl--w corripuilsM in- surance requirements, (d) It is understoodthat we are not an adnrilit- ted or authiorized insurer outside the United Slates of Ameirica, its territories and possessions, Puerto Rica and Can ada. We assurne no responsiNifty for the furnishing of certificates of insurance, or for compliance in any way with the Naws of other countdes relating to iiie, G. WAIVER OF IDEDUCTIBI ,E GLASS The folio wing is added to I::1aragralph D., Deducd- ble, of SECTION Ill PHYSWAL DAIMAGE, COVERAGE: No dedUd.ilble for a covered "auto" will apjpAy to glass darnage K the gass is repaired rather than replaced. 1 1. HIRED Alm i:41YSICA111 DAMAGE ILOSS 01i:'. USE - [INCREASED ll..1111WIT The foHawing replaces the [ast sentence of Para- graph A.4.1b., 1lass Of Use Expenses, of SEC- TION III - PHYSICAll DAMAGE COVE However, the ii we wipl pay for arty expenses for loess of use is $65 per day, to a maximurn of $750 for, any one "accident". L P1,4YSICAL DAMAGI::, ..- T'RANSPOR il"ATION EXPENSES - INCREASED I 11MIT The foflowing rep izices the first senterice in l3ara graph A.4.a.,, Transportation Expenses, of Sli: CTION 1111 - l:41YSICAL DAMAGE COVER AGE - We wifi pay ulp to $50 per day to a irriaximum of $1,500 for temporary transportation expense un- curred by you becau se of the tot,Y.,fll theft of a cov- ered "auto" of 1-ie private passenger type. J. PERSONAL PROPIE::1ZTY COIAMERCiAL AUTO (2) i1ri or on your covered "auto". Ttfls coverage applies only iii the event of a total theft of your covered "auto".. No deductiNes apply to this Personal Property coverage. K. AIRBAGS The followiing is added tt IParagrall B.3., Exclu- sloins, of SECTION III ­­ PHYSICAll DAMAGE COVERAGE: Exclusion 3.a, does riot apply to "loss" to mine or more airbags in a covered "auto" you own that pro.... flate &,ge to a cause other than a cause of "loss" set forth in Paragraphs A.1.1b. and A.1.c., but oNy: a, If that "auto" is a covered "auto" for Cornpre- hensive Coverage under this policy, b. The airbags are riot covered under any war i and c. The airbags were not intenfiona0y inflated. We will pay up to a maxiii-nuni of $1,000 for any one "'loss". 0 NOTIICE:'� , AND KNOWLI.JDGE OF ACCI[i OR 11...Oss "i"he foilowing !is added to Paragraph A.2.a,,. of SECTION IV - BUSIN111!!`SS AUTO CONDITION& Yoii.ir dUtly tO gNve us or our authorized relpreseirfta tive 1prompt notice of the "accident" or "loss" alp - plies onlly when the "accident" or "'loss" is known to: (a) You (if you are an indri, (b) A pairtirreir (lf you are a partnership)n (c) A member (if you are a Iiii liabiifty corn- paii, (d) An executive officer, director or insurance manager (ff you are a corporation or, other or- ganization); or (e) Any "eirnpioyee" authorized by you to giive no- fice of the "accident" or "loss". 110. IBLAN1K1i;.;.-,,T WAIVER OF SUBROGATIOIN "The f0lowing reppaces Paragraph A.S., Transfer Of IRjgll'sts Of Recovery Against Others To Us, of SEcrION IV - BUSINESS AUTO CONDI- TIONS � the followUig is added to Paragraph A.4., Cover 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION 1111 Pli-WSICAll,,,. theirs ,,,To Us I)AMAGIIi..", COVERAGE. We waive any right of recovery we irmnay have aqainst any person or organizafion to the ex - Personal PropertY tent required of you lby a written contract We will pay up to $400 for "'loss" to weaving ap sigined avid executed pirior to any "accident" paii and offier personal property which is: or "loss", provided that the "accident" or Noss" (1) Owned lrpy an `insured'% and arises ii:)ut of operafions conternpUted by CA T3 53 02 15 0 2015 1 he Tii IndemnKy Company, AN Ights resegved.. Page 3 of 4 includes ropy0ghited iwteiW of Insurance Seii Office, Inc. with hs peii C0MMl1c!'RC1 JL. All such corntil The waiver applies ofnpy to tlhe person n or or a npzdo n desiligrn ted in such contract, The following is added W Paragraph 6.2., Con- eaks-n rnt, Misrepresentation, Or Fil of t,p�, ° IO IV — BUSINESS AUTOlilu, I°time uNnt rutp snap omissiion of, our, unli nt n°mtp rn q error in, any irifforrnabori given ou shape not prejudice dice our rlights under this prm uir nce. ll ever fts provision does not affect, our dght W cops,, l rwt addilitional1 preil cir exercise our, right of nince tlio n or ornolrn ren w W, Page 4 nit' 4 Q 201 S The "11'ravellem lind mm nlit m Compm ny, AH rights. Foserved . CA T3 53 0215 pu°omr udes ooppighted mnatem!W or Itiouma noe Seivices Offlos, inc, wWi im p ermMkm, AW WORKERS COMPENSATION TRAVELERSJAND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-3R155740-23-14-G 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. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: ST ASSIGN: Page 1 of 1