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PROOF OF INSURANCE (2024 - 2025) CLOSED
' DATE (MM/DDNYYY) AM I CERTIFICATE OF LIABILITY INSURANCE 1 /12/2024 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). PRODUCERSerra Oak Insurance Services Inc PHONE Daniel Brock coNTAc NAtifE --: 9700 Business Park Drive Suite 105 d NqG.,�) 616647380 _ FAX , Nax 9163647381 E MAIL Sacramento CA 95827 ADCtRF;* S, ce @slerra aklnG C .~FI INSURED FS Contractors, Inc. 14838 Bledsoe St Sylmar CA 91342 CoV�RAGE Navigators Specalty�s 36056 R FSCONT01 GuideOne National ins Co INSURER� .........................__—..........,.,....................... 1417 _-m.....,olt. INSURER c Insurance Co an of the West 2784 Security National InsuranceCoIT^ INSOREI ... .... 19879 INSURER E : The Ohio Casualty Insurance Co 2407 4, .. AC DTI ni.-A rm Li wecm cennccmG RFVISION 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. ........... ...__ ...-. _ ........... E.. .. _ . Ud ILTR .. FF PClLICY EXP LIMITS MPOLICY TYPE OF INSURANCE.._ POLICY NUMBER lYYYY MMlbO A X GENERALLIABILITYY COMMERCIAL GENERA Y LA24CGLZOD4RWIC 1/13/2024 1/13/2025 EACH $1000000 ,m - CLAIMS -MADE X... OCCUR PREMlSES(Ea,ogG4url�nco _ mm — 1100000 ,,. MED EXP (Any one person W - -... PERSONAL&AD V INJURY $1 000,00 0 _. ------- GEN ..,---...... p, AGGREGATE LIMIT APPLIES PER: GENERAL _AGGREGATE 000 000 , PRO- POLICYXECT LOC PROD_MP/1OG ._._ $ 2 000,000 OTHER; �$ D AUTOMOBILE LIABILITY Y Y SPP181596600 8/26/2023 8/26/2024 COMBINED SINGLE LIMIT (acdasYap) $1 000 000 ....,, X... ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED X X -- $ AUTOS ONLY AUTOS ONLY _(PReraAtIAMAGE A UMBRELLA LIAB X OCCUR SF24EXCZOD4QLIC 1/13/2024 1/13/2025 EACH OCCURRENCE $ 8 000 000 X EXCESS LIAR f CLAIMS -MADE (' AGGREGATE . $ 8 000 000 m.—....... DED RETENTION $ —� GL AU WC �m:.. c Y WSA 5032771 08 7/31/2023 7/ 1/2024 '( PER, OTH- 3 �STAT;I)TE — AND EMPLOYERS' LIABILITY AND EMPSCOMPENSATIONYERS' LIILIT Y/ N $1 000 OOO ANYC'ROPRPET4SRFPARTNERiEXECU'TIVE REXCLUOED7 N / A E L EACH _ E.L. tTISASE - EA EMPLOYEE -- in N his NH) (Mandatory 1 es„ describe under T ION OF OPERATIONS below mm„v E.L. DISEASECPOLICY LIMITm $1 000 OO B Pollution Liab I ENV56201286901 1/13/2024 1/13/2025 Pollution Rentilease 2,000,000 25,000 E Installation Float BM056680768 8/26/2023 8/26/2024 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Job: On -Call Concrete Maintenance Various Locations in the City of El Segundo The City of El Segundo, its officers, officials, employees, agent's,& volunteers to be named additional insured on the general liability & auto.Pnmary & noncontributory applies. Waiver of subrogation applies to general liability, auto & work comp. ULKIIFIUAIt MULUrK warxavvr M rw-.— City of El Segundo 350 Main St El Segundo CA 90245 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOtIII MO EPR'ESENTATIVE.. lJ 78ifC-2U7ClAGVKU lrVRl'VRAIIVIY. An rrgnw rtsa=rvWU- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD "0 DATE (MM/DDNYY10 At►1 CERTIFICATE OF LIABILITY INSURANCE �,„... 1 /12/2024 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 ... 9163647380 --- ...�.. ..- AIC No.. 9-16 NAME Daniel Brock Sierra Oak Insurance Services Inc PHONE � 3647381 9700 Business Park Drive Suite 105 �t� ).. _ 1 -- — ( —' Sacramento CA 95827 p R s ., certs@S:'am 9 lt!nq cram INSURED FS Contractors, Inc. 14838 Bledsoe St Sylmar CA 91342 R@) AFFORDING COVERAGE . .................... -- _-INSU.RE.m,-.-:,.........,.-_. ...... ................. NAIC # ..,.-------- RA: Navigators Specialty Ins Co „IT 36056 FSCONTR-01 uuSURERB GuideOne National Ins Co __14167 INSURERC: Insurance Cgmpanv of the West 27847 INSURERD Secure National Insurance Co 19879 INSURER E : The Ohio Casualty Insurance Co 24074 e rl w w Mwra. rrnrlrlPrA rc ul liiiIQeo• -in i ciangnal; RFVISIAN 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. ---.... ....-_. ........_._ ..MM/DCYisFF ... __._ - ..... -,._. ........... ........... LIMITS POLICY NUMBER MMID L TR TYPE OF INSURANCE I D A X COMMERCIAL GENERALLIABILITY Y LA24CGLZOD4RWIC 1/13/2024 1/13/2025 EACH OCCURRENCE $ 1 000 0 0 0................ CLAIMS MADE X OCCUR PREM S (O a �{ppunet,aaar ,,, rc$ 100 000 " .. .....�. MED (Any one person) $ PERSONAL 8 ADV INJURY $ 1 OOQ 000 �, , GEN , _. __ m 'L AGGREGATE E LIMIT APPLIES PER: GENERAL AGGREGA TE $ 2 000 000 POLICY X PET 4 LOC PRODUCTS COMP/OP AGG ,.. ..-_ �. $ 2,000,000 _ ._ ....� OTHER D AUTOMOBILE LIABILITY Y SPP181596600 8/26/2023 8/26/2024 � ..tEteld'4l9¢) INGLE;..ILGMIT .._$ $1,000,00 "". ..0 )( ANY AUTO BODILY INJURY (Pe r person) $ OWNED SCHEDULED BODILY INJURY (Per accident)� $ HIRED NON -OWNED XN PROPERTYOAiwtAGE $ AUTOS ONLY „X AUTOS ONLY {Per aoclalpntj.-- "", .....-- A X uMBRELLAuae OCCUR SF24EXCZOD4QLIC 1/13/2024 1/13/2025 ,OCC EACH OCCURRENCE $ 8 000w000 ___.................... X EXCESS LIAB CLAIMS -MADE AGGREGATE � . ..__. � $ 8,000,000 ...__ DED J_ I.....RETENTION" $ GL AU WC $ O WORKERS COMPENSATION WSA503277108 7/31/2023 7/31/2024 X PER OTH STATUTE AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE T E L EACH ACCIDENT $ 1,000,000 _ --- OFFICER/MEMBEREXCLUDED? EJ (Mandatory in NH)0,000 N/A-'""""�""" i E.L.E L DISEASE - EA EMPLOYEE $1,0 If yes, descKbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 B Pollution Liab. ENV56201286901 1/13/2024 1/13/2025 'Pollution Rentnease 2,000,000 25,000 E Installation Float BM056680768 8/26/2023 8/26/2024 DESCRIPTION/VEHICLES maybe al ace required)to 101, Additional athe rete ImpOCATIONS 23CoOPERATIONS/ p City gundo. City of El Segundo to be named additional insured on the Job: rrovements PW 22-17 Various Locations inCity of l Segundo, . City Segundo general liability & auto. rA11,Ir Cl 1 Arinu SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St AUTHORIZED qEPRESENTAT VE El Segundo CA 90245 USA V ivoo'LU IQ NVVRY VVr%r1%J v I Ivn. nu nyl lw ....... ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be primary contrary: and would not seek contribution from any other Primary And Noncontributory Insurance insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 9 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: LA23CGLZOD4RWIC COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL ZONAL INSURED - OWNERS, LESSEES O CONTRACTORS - SCHEDULED, PERSON OIL ORGANIZATION ON This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered On erations As Required by written contract Conejo Recreation and Park District, its Directors, Officers, Agents, and Employees. 403 W. Hillcrest Drive Thousand Oaks CA 91360 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply. - 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 location 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 for a principal as a part of the same project. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance additional insureds, the following is added to shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required) by a contract or agreement, the most we Limits of Insurance shown in the Declarations. will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER:LA23CGLZ0D4RWIC COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL OWNERS, OR CONTRACTORSSCHEDULED PERSON ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered O erations Any person or organization for whom you are performing operations during the policy period when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and any other person or organization you are required to add as an additional insured under the contract or agreement described above. Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for ""bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 2' However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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 location of the covered operations has been completed; or 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 for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance additional insureds, the following is added to shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we Limits of Insurance shown in the Declarations. will pay on behalf of the additional insured is the amount of insurance: I. Required by the contract or agreement; or CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: LA23CGLZOD4RWC COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Conejo Recreation and Park District, its Directors, Officers, Agents, and Employees. 4 03 W. Hillcrest Drive Thousand Oaks CA 91360 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we snake for infury or damage arising out of your ongoing operations or "your work" done under a contract with that person. or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 0 a cn ou °' CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 O POLICY NUMBER: WPP1976320 00 COMMERCIAL AUTO CA990189 0514 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY WAIVER OF SUBROGATION - NAMED INTERESTS This endorsement modifies insurance provided under the following:, AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. For accident or loss occurring after the Endorsement Effective Date, the CONDITION entitled "TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US" does not applyto: Cone'o Recreation and Park District its Directors Officers Agents and Em to ees: 403 W Hillc (Name of Person or Organization) This provision does not apply unless the contract is made prior to the accident or loss. CA990189 0514 Page 1 of 1 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully NO 0 .I:USINESS AUTO COVERAGE EXPANSION UR This endorsement modifies insurance provided by the following. BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement. A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item 1. Who is an Insured of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will B qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 1801h day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or C formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. f. Any person or organization you are required by written contract or agreement to name as an additional "insured", but only with respect to liability created in whole or in part by such agreement. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II —COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury' results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 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". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 5th day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of Paragraph A., Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto" because of "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto". If the "loss" is caused by theft, this number of days is the number of days it takes to locate the covered "auto" and return it to you or the number of days it takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. d. Contraband or property in the course of illegal transportation or trade. e. "Loss" caused by theft, unless there is evidence of forced entry into the covered "auto" and a police report is filed. K. Accidental Airbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto" is owned or leased and if we provide Physical Damage Coverage on it, we will pay, in the event of a covered total "loss", 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 d. If a "loss" results from the total theft of a b. Any: covered "auto" of the private passenger (1) Overdue lease or loan type, we will pay under this coverage payments including penalties, only that amount of your rental interest or other charges reimbursement expenses which is not resulting from overdue already provided for under the Physical payments at the time of the Damage Coverage Extension. D loss"; J. "Personal Effects" Exclusion (2) Financial penalties imposed Paragraph B. Exclusions under SECTION under a lease for excessive use, III — PHYSICAL DAMAGE COVERAGE, is abnormal wear and tear or high amended to add: mileage; "Personal Effects" Exclusion (3) Costs for extended warranties, We will not pay for "loss" to "personal Credit Life Insurance, Health, effects" of any of the following: Accident or Disability Insurance a. Accounts, bills, currency, deeds, purchased with the loan or evidence of debt, money, notes, lease; securities or commercial paper or (4) Security deposits not refunded other documents of value. by the lessor; and b. Bullion, gold, silver, platinum, or other (5) Carry-over balances from precious alloys or metals; furs or fur previous loans or leases garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of art. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss". If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods Deductible With the Expansion Reduction on the Endorsement first 'loss" 1 0% 2 25% 3 50% 4 75% 5 100% If we pay a Physical Damage `loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident', claim, "suit' or "loss" to us or our authorized representative only applies after the "accident', claim, "suit' or `loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. P. Waiver Of Subrogation For Auto Liability Losses Assumed Under Insured Contract Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident' or "loss" to impair them. However, if the insured has waived those rights to recover through a written contract, we will waive any right to recovery we may have under this Coverage Form. Q. Insurance is Primary and Noncontributory Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a. This insurance is primary and noncontributory, as respects any other insurance, if required in a written contract with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 5..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 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 CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headings and Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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). The additional premium for this endorsement shall be 2% of the total California Workers' Compensation premium otherwise due. Any person or organization for whom the named insured is required under written contract to furnish this waiver. Policy Number: WSA 5032771 08 Endorsement Effective: 07/31/2023 Issue Date: 07/17/2023 WC 99 06 34 (Ed. 8-00) Schedule California operations only. Insured: F S Contractors Inc Coverage Provided by: Insurance Co of the West Countersigned by: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 37 (Ed. 5-02) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT .CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the schedule. The additional premium for this endorsement shall be 2% of the California Workers' Compensation premium otherwise due on such remuneration, subject to a minimum premium of $0.00. Schedule Person or Organization Conejo Recreation and Park District, its Directors, Officers, Agents, and Employees. 403 W. Hillcrest Drive, Thousand Oaks CA 91360 Job Description Required by Contract Policy Number:WWSA 5032771 07 Insured: F S Contractors Inc Endorsement Effective: 07/31/2022 Issue Date: 04/27/2023 WC 99 06 37 (Ed. 5-02) Coverage Provided by: Insurance Company of the West Countersigned by: