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PROOF OF INSURANCE (2025 - 2025)0 DATE (MM/DD/YYYY) +" CERTIFICATE OF LIABILITY INSURANCE1 9/18/2024 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 Tom Belding _ Arthur J. Gallagher Risk Management Services, LLC (PHON9 X rA NAMEA w • 500 N Brand Boulevard, Suite 100 g Ig Nay Glendale CA 91203 EMAIL rI) 714 ...1 0 {A/ ADDR�s� Tom BaIIn com .� -_ INSURER-(3) AFFORDING COVERAGE NAIC # ... Licensed OD$,_ 99� INSURER a Travelers Propert y Casualty Co of America_1111 25674 INSURED Consulting, Inc. RTicoNs-01 INsuRER•,B Republic Indemnity Company of California 43753ww 8325 McConnell Ave.m.._..__ arty Company _•••,• m m .„_ w a2374 INSURERO HoustonCasu, Los Angeles, CA 90045 D: INSURER _..._. .._..............- _ � .- ....... . INSURER E : COVERAGES CERTIFICATE NUMBER:84896445 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. m.. e........ . IIV5F1 .. ......TYPEOFINSURANCE..�,,.., ...... MO1L'SOr f$ .,.�,.._.. POLIC.,..._ m.....,.,. IMMI DIYY' � ---POLICY EXP• LTR ..YNUMBER MM/DOIYYYY MM/OOlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 6809H2765932447 3/30/2024 3/30/2025 EACH OCCURRENCE $2.000.000 X occuR ?•. E�niSE_(Fa ocpw�enca), $11,000,000 ca�r4o�rt� iil�N"rI_r9 CLAIMS -MADE Ii MED EXP (Any one person) $10,000 .„ _. ._.. _ PERSONAL & ADV INJURY $ 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4000000 _ POLICY PE LOC RODUCTS COMP/OP AGG $ 4 000 000 P.ITm .,.� .._...._ OTHER; I I I $ A AUTOMOBILE LIABILITY Y Y BA-1S98785A-24-47-G 9/12/2024 9/12/2025 ,Or B'INED ING E LIMIT $1 000 000 LE'a euceldenl@.__._ _ ,...- ..—........,.�.,--,,.-._ _ ..... X ANY AUTO BODILY INJURY (Per person) $ - SCHEDULED BODILY INJURY (Per _ �•• m AUTOS ONLY AUTOS ONLY t URY (Per accident) $ OWNED ONLY ........._ _.,.-,.. AUTOS ... HIRED NON -OWNED ,n f'ROX"LR�'Y DAMAGT. $ PprarCo.nm*. ...... $ 00 000 A UMBRELLA LIAB X _ OCCUR Y Y CUP4W7386532447 3I30I2024 3/30I2025 EACH OCCURRENCE X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2 000 000 ......... ...... ,. .�.-. ., ........ ._ .........._ _........ a. .._w.,-., ... 0ED RETENTION$ $ B WORKERS COMPENSATION 25580603 6/1/2024 6/1/2025 X H AND EMPLOYERS' LIABILITYYIN ___ STE;RATETUETR ANYPROPRIETOR/PARTNER/EXECUTIVE -- N /A E.L.EACH ACCIDENT $1,000,000 OFFICE(Mandatory InNEXCLUDED7 E.L DISEASE - EA EMPLOYEE $ 1,000 000 —., (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 C Professional Liability HCC2425759 6/25/2024 6/2512025 Per Claim $1,500,000 Aggregate $3,000,000 Retention $10,000 DESCRIPTION'. OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks'Sohadulq maybe attached if more space is required) EMPLOYMENT PRACTICES LIABILITY INSURANCE - HOUSTON CASUALTY COMPANY - POLICY # H723-936250 - 10/4/2023-10/4/2024 - $1,000,000 EACH CLAIM LIMIT $1,000,000 AGGREGATE LIMIT. CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED (GENERAL LIABILITY) PER BLANKET ADDITIONAL INSURED UB ARCHITECTS,(SENGINEERS AND SURVEYORS) FORM CG D3 8109 15. PRIMARY & NON-OONTMUTORY AND WAIVER OF ROGATION WHEN REQUIRED BY CONTRACT, DESIGNATED PERSON OR ORGANIZATION — NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US (30 DAYS) FORM IL T4 00 05 19. CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED (AUTO LIABILITY) PER AUTO COVERAGE PLUS ENDORSEMENT CA T4 20 02 15. DESIGNATED PERSON OR ORGANIZATION — NOTICE OF CANCELLATION See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO CA 90245 AUTHORIZEDREP ESENTATIVE USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED Arthur J. Gallagher Risk Management Services, LLC RTI Consulting, Inc. 8325 McConnell Ave. POLICY NUMBER Los Angeles, CA 90045 CARRIER I NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE .. OR NONRENEWAL PROVIDED BY US (30 DAYS FORM IL T4 00 05 ICY INCLUDES BLANKET WAIVER OF OUR RIGHTS TO RECOVER FROM OTHERS E'NDOR 19. WORKERS COMPENSATION POLEMENT WC 00 03 13 (Ed. 04-84). Project: Park Vista Senior Living Center Plumbing Upgrade - 615 East Holly Ave, El Segundo, CA 90245. ACORD 101 (2008/01) 0 ZUUU AtwUrsu l.;UHI UHA I wrv. All ngnza reserveu. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Arthur J„ Gallagher Risk Management Services, LLC RTI Consulting, Inc. 8325 McConnell Ave. POLICY NUMBER I Los Angeles, CA 90045 CARRIER [',, NAIC CODE EFFECTIVE DATE: It1 N] I] I I Lou G11 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE _ OR NONRENEWAL PROVIDED BY US (30 DAYS FORM IL T4 00 05 19. WORKER'S COMPENSATION POLICY INCLUDES BLANKET WAIVER OF OUR RIGHTS TO RECOVER FROM OTHERS ENDOR EMENT WC 00 03 13 (Ed 04.84). CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL, INSURED (GENERAL LIABILIY) PER BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) FORM CG D3 81 0915. PRIMARY & NON-CONTIBUTORY AND WAIVER OF SUBROGATION WHEN REQUIRED BY CONTRACT, CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL. INSURED (AUTO LIABILIY) PER AUTO COVERAGE PLUS ENDORSEMENT CA T4 20 02 15. WORKERS COMPENSATION POLICY INCLUDES BLANKET WAIVER OF OUR RIGHTS TO RECOVER FROM OTHERS ENDORSEMENT WC 00 03 13 (Ed. 04-84). ACORD 101 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Arthur J. Gallagher Risk Management Services, LLC POLICY NUMBER CARRIER NAIC CODE NAMED INSURED RTI Consulting, Inc. 8325 McConnell Ave. Los Angeles, CA 90045 EFFECTIVE DATE: Page 1 of 1 ACORD 101 (200$101) © 2008 ACORD CORPORATION. All flgnts reservea. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Arthur J. Gallagher Risk Management Services, LLC POLICY NUMBER CARRIER NAIC CODE NAMED INSURED RTI Consulting, Inc. 8325 McConnell Ave. Los Angeles, CA 90045 EFFECTIVE DATE: Page 1 of 1 ACORD 101 (2008/01) c9 2UU8 AcoF1U QaaHFUHA I IUN.. AN rlgnis reserves. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LAC #: ADDITIONAL REMARKS SCHEDULE AGENCY Arthur J. Gallagher Risk Management Services, LLC POLICY NUMBER CARRIER NAIC CODE NAMED INSURED RTI Consulting, Inc. 8325 McConnell Ave. Los Angeles, CA 90045 EFFECTIVE DATE: Page 1 of ACORD 101 (2008101) © 2008 ACORD COHPUHATIUN. All rignis reservea. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Arthur J. Gallagher Risk Management Services, LLC POLICY NUMBER CARRIER NAIC CODE NAMED INSURED RTI Consulting, Inc. 8325 McConnell Ave. Los Angeles, CA 90045 EFFECTIVE DATE: Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC M: ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, LLC RTI Consulting, Inc. 8325 McConnell Ave. POLICY NUMBER Los Angeles, CA 90045 CARRIER I NAIC CODE EFFECTIVE DATE: Page 1 of The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: RTICONS-01 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY Arthur J. Gallagher Risk Management Services, LLC POLICY NUMBER CARRIER NAIC CODE NAMED INSURED RTI Consulting, Inc. 8325 McConnell Ave. Los Angeles, CA 90045 EFFECTIVE DATE: Page 1 of ACORD 101 (2008/01) U 200$ ACURU WHFUHAI IUIV. AN rlgnis reservea. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE LUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11— COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while CA T4 20 02 15 H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT I. WAIVER OF DEDUCTIBLE — GLASS J. PERSONAL PROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: © 2015 The Travelers Indemnity Company. Al rights reserved, Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. IIfl/`1 `00DE, (",lick herofol,nIole!1d011ruatlull COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION 11— COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION li — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. Page 2 of 3 (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.1.b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. m 2015 The Travelers Indemnity Company. Al rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. I 1R1r1.MODE Click 11cre folrinor inToliriadori K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto'; and CA T4 20 02 15 COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the loss'; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: S. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or 'loss", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. l"I"'kl//I 1w:)cnf Cl, ci',iiuo ho7 in ioLfrninalilnn COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 0915 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, Of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS:: We waive any right of recovery we may have against any person or organization because of Payments we make for "bodily Injury"„ itpropertydamage" or "personal injury" arising Out of "Your work" performed by you, or on your behalf, done tinder a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by yotu before, and in effect when, the "bodily injury" or ""property damage" occurs, or the "personal injury' offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that Part of any written contract under which you are required to include a person or organization as an additional insured oil this Coverage Pad" Provided that the "bodily Injury"" and "property damage" occurs and the "personal injury" is caused by an offense committed. a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services Office, Inc., with its permission CG D3 81 0915 POLICY NUMBER: 690-9H276593-24-47 ISSUE DATE: 02/14/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION E OF CANCELLATION O IOI E E L PROVIDED TIC Y US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: SCHEDULE Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): PERSON OR ORGANIZATION: Number of Days Notice: 30 ANY PERSON OR ORGANIZATION TO HAVE AGREED IN A WRITTEN WHOm YOU CONTRACT NOTICEOF CANCELLATIon OR r rNLY POLICYWILL Bx CIVEN, BUT 1• YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE„ INCLUDING THE NAME AND ADDRESS 'op SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR XONRENEWAL OF THIS 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE E'R OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESSFOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in.such Schedule before the effective date of cancellation. IL T4 00 05 19 POLICY; AND B. If we do not renew this policy for any legally permitted reason other than nonpayment of Premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such .Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for When We Do Not Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 04-84) 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 anyone not named in the Schedule. Schedule State Person or Organization ....... Job Description California All persons or organizations All jobs whom the Named whom the Named Insured has Insured has agreed by written agreed by written contract to contract to furnish this waiver. furnish this waiver. The charge for this endorsement shall be 3% of total manual premium, subject to a minimum premium of $100. This charge will be billed on your next invoice based on current manual premium, and the final charge will be calculated and billed at the final audit. WC000313 (Ed.04-84) 1 of 2 Insured Copy 0 1983 National Council on Compensation Insurance.