Loading...
PROOF OF INSURANCE (2025)DATE (MMIDDIYYYY) `"R " CERTIFICATE OF LIABILITY INSURANCE 10/21/2024 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 pol"cy(tes) 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 NAME Francisco Honzura ................ Arthur J. Gallagher Risk Management Services, LLC PHONE - rAx' 4201 Westown Parkway, Suite 120 7 8849 ( �Q FMta 515-309 6220 ....... .. tArq, N�) West Des Moines IA 5 266 nDPp`k i ranuisco Hon ura a g_com (S" AFFORDING COVERAGE _ I ,_NAIC.# INSURER. .... ......._ .,., ....._. .... A: Sentry Insurance Company 24988 INSURED MUSCLIG-01 INSURER Travelers Casualty Compa Musco Cor oration "� 100 1st Ave W, PO BOX 808 wsuRERc Indian Harbor Insurance C Oskaloosa, IA 52577-3244 INSURER D': INSURER E ...,..�.,w..cc r00T1o11A•r0 kitIRAcco• 4Annlmr1901 b RPVISIAN NItMRER! 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. ,.........._.__ .................. .. •. ......................... ......... .... CY EXP +,... .. 0' ....... _. ',�iODL�S0.f R EFF LIMITS ILTR MOLIC MM/D.,. I TYPE OF INSURANOE.. INSE, WVD POLICY NUMBER D A X COMMERCIAL GENERAL LIABILITY Y Y 9016877004 7/1/2024 7/1/2025 EACH OCCURRENCE $ 1.000.000 AMAra N D 1 000 000 CLAIMS -MADE ._..� OCCUR.P',RkMgE,',ftr5cUrr9n;nqj,—„ $ .mmm ......., $ 10 000 A& ADV INJURY PERSONAL $1,000 000 GXE,,.N'L AGGREGATELIMIT APPLIES GENERALAGGREGATE$2000000 ... POLICY JECT LOCPRODUCTS -COMP/OPAGG $2.000000 O OTH A AUTOMOBILE LIABILITY Y 9016877003 7/1/2024 7/1/2025 COML9INEDSM LERIMI'T src(daral- -.. $1,000000 X ANY AUTO BODILY INJURY (Per person) $ ••� OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PITOI'ERrYCJAkJIAiE .. •• $ X-AUTOS ONLY �.. AUTOS ONLY tl''ar,aucp�fla,wtt_ .... .........$ .......... _.. .. B UMBRELLAjLIAB X }If CUP9X03061124NF 7/1/2024 7l1/2025 ACH OCCURRENCE .. ... EACHOCUs10,000,000 -- 10,000,000 ...X...I, CLAIMS -MADE EXCESS LIAR C... DED X I, RETENTION $ +, _AGGREGATE • $ WORKERS COMPENSATION 7l1/2024 7/1/2025 X PER RH STATUTE E,. A Nam,., D EMPLOYERS' LIABILITY Y 7 N 7002 7l1/2024 7l1/2025 , .� ANYPR PRIV RM EXEC.U'TIVE E„L EACH ACCI EN 11,000,990 ,,,,,.... .......... CL.h? � (Mandatory to NH) NIA 77001 .L DISEASE EA EMPLOYEE . E..... --------- .. ..1.... $ 1,000 00 .. ...,..... ....., ----._ ,. IT yt;s. describe under DESCRIPTION OF OPERATIONS bdowa E.L. DISEASE- POLICY LIMIT $ 1,000,000 C Architects & Engineers CE0742113904 7/1/2024 '' 7/1/2025 Each Claim Aggreciale 5,000,000 5,000,000 Professional Liability & Pollution Liability Retention 250,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Musco Project SVC-503880 — Campus El Segundo Athletic Fields. City of El Segundo is included as Additional Insured solely With respect to General Liability and Auto Liability coverages as evidenced herein on primary/non-contributory basis as required by Written contract. A Waiver of Subrogation in favor of A,ddttlonal Insured is included under the General Liability coverage as evidenced herein as required by Written contract. 30 Days` Notice of Cancellation applies in favor of Certificate Holder as required by written contract. 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 350 Main Street El Segundo CA 90245 I AUTHORIZEDREPRESENTATIVE 7 ,Y CJ 1U' t S-LUl0 AL UKIJ L umrVKA 1 IVIV. MI nynw Ieael VUU- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policy: 9016877003 IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS . This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation applies. All other terms and conditions of this policy remain unchanged. IL 70 58 02 14 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N cbc22a b5-ecOc-4bfb-a2ad-fd 19ac300206 Page 1 of 1 06/23/2023 POLICY NUMBER: 9016877004 COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULES PERSON OIL ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: As required by written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the additional insureds, added: 2. Exclusions insurance afforded to these the following exclusion is This insurance does not apply to "bodily injury" or "property damage" occurring after: CG20101001 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. © ISO Properties, Inc., 2000 736fc4 db-2e6c-478e-b349-d2 b7d0627690 Page 1 of 1 06/23/2023 POLICY NUMBER: 9016877004 COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: As required by written contract Location And Description of Completed Operations: As required by written contract Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section 11 - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, bu,t only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products -completed operations hazard". CG 20 37 10 01 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N @ ISO Properties, Inc., 2000 159ad763-de4c-45d7-8d2e-a28b4ce123c9 Page 1 of 1 06/23/2023 Policy: 9016877004 COMMERCIAL GENERAL LIABILITY CG 7124 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS, PRIMARY & NONCONTRIBUTORY, WAIVER OF SUBROGATION This endorsement modifies the coverage provided under the following Coverage Form(s): COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Coverage enhancements are listed below. For details of each coverage, please read the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds - Automatic Status for 12 Additional Insured Types A. Automatic Status When Required In Written Contract Or Agreement (for Acts or Omissions In The Performance of Your Operations) B. Lessor of Leased Equipment C. Owners or Other Interests From Whom Land Has Been Leased D. Manager or Lessor of Premise E. Mortgagee, Assignee, or Receiver F. Controlling Interest G. Co-owner Of Insured Premises H. Executors, Administrators, Trustees Or Beneficiaries I. State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Relating To Premises J. Any Person Or Organization You Are Performing Work For K. Vendors L. Grantor of Franchise 2. Primary and Noncontributory - Other Insurance Condition 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 1. Additional Insureds - Automatic Status for 12 Additional Insured Types Section II - Who Is An Insured is amended to include the following as additional insureds when you have agreed to add that person or organization as an Additional Insured on your policy in a written contract or written agreement with that person or organization, or because of a permit issued by a state or political subdivision; provided the injury or damage occurs subsequent to the execution of the contract or agreement or issuance of the permit and while the contract, agreement or permit remains in effect. CG 7124 06 22 9016877 Sentry Insurance Company 1 00003 0000000000 23174 0 N A. Automatic Status When Required In Written Contract Or Agreement (for Acts or Omissions In The Performance of Your Operations) 1) A person or organization with respect to liability for: a. 'Bodily injury" or "property damage" not included in the "products - completed operations hazard"; or b. 'Personal and advertising injury"; caused by, in whole or in part, your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your operations. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 816e8467-3c5a-4950-8dca-6cd95aced88e Page 1 of 5 06/23/2023 2) With respect to insurance afforded to This exclusion applies even if the claims these additional insureds, the following against any insured allege negligence or additional exclusion applies: other wrongdoing in the supervision, This insurance does not apply to "bodily hiring, employment, training or injury", "property damage" or "personal monitoring of others by that insured, if and advertising injury" due to rendering of the "occurrence" which caused the or failure to render any professional "bodily injury" or "property damage", or service. This includes but is not limited to: the offense which caused the "personal a. Legal, accounting or advertising and advertising injury", involved the rendering of or failure to render any services; professional service. b. Preparing, approving, or failing to or approve, maps, shop B. Lessor of Leased Equipment prepare drawings, opinions, reports, surveys, 1) Any person(s) or organization(s) with field orders, change orders or drawings respect to liability for "bodily injury", or specifications; "property damage" or "personal and c. Inspection, supervision, quality control, advertising injury" caused, in whole or in architectural or engineering activities part, by your maintenance, operation or done by or for you on a project on use of equipment leased to you by such which you serve as construction person(s) or organization(s). manager; 2) With respect to the insurance afforded to d. Engineering services„ including related these additional insureds, this insurance supervisory or inspection services; does not apply to any "occurrence" which e. Medical, surgical, dental, X-ray or takes place after the equipment lease nursing services treatment, advice or expires. instruction; C. Owners or Other Interests From Whom f. Any health or therapeutic service Land Has Been Leased treatment, advice or instruction; 1) Any person(s) or organization(s) with g. Any service, treatment, advice or respect to liability for "bodily injury", instruction for the purpose of "property damage" or "personal and appearance or skin enhancement, hair advertising injury" caused, in whole or in removal or replacement, or personal part, by you or those acting on your behalf grooming or therapy; in connection with the ownership, h. Any service, treatment, advice or maintenance or use of that part of the land instruction relating to physical fitness, leased to you by the additional insured including service, treatment, advice or person(s) or organization(s). instruction in connection with diet, 2) With respect to the insurance afforded to cardiovascular fitness, bodybuilding or these additional insureds, the following physical training programs; additional exclusions apply: i. Optometry or optical or hearing aid services including the prescribing, This insurance does not apply to: preparation, fitting, demonstration or a. Any "occurrence" which takes place distribution of ophthalmic lenses and after you cease to lease that land; similar products or hearing aid devices; b. Structural alterations, new construction j. Body piercing services; or demolition operations performed by k. Services in the practice of pharmacy; or on behalf of the additional insured I. Law enforcement or firefighting person(s) or organization(s). services; and m. Handling, embalming, disposal, burial, cremation or disinterment of dead bodies. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 71 24 06 22 9016877 with its permission. 06/23/2023 Sentry Insurance Company D. Manager or Lessor of Premise Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you by the additional insured person(s) or organization(s), subject to the following additional exclusions: This insurance does not apply to: 1) Any "occurrence" which takes place after you cease to be a tenant in that premises. 2) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. E. Mortgagee, Assignee, or Receiver Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of a premises by you. -This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured person(s) or organization(s). F. Controlling Interest 1) Any person(s) or organization(s) with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. 2) This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. G. Co-owner Of Insured Premises Any person(s) or organization(s) with respect to their liability as co-owner of a premises coowned by you and covered under this insurance. H. Executors, Administrators, Trustees Or Beneficiaries Any executor, administrator, trustee or beneficiary of your estate or living trust while acting within the scope of their duties as such. CG 7124 06 22 9016877 Sentry Insurance Company 3 00003 0000000000 23174 0 N I. State Or Governmental Agency Or Subdivision Or Political Subdivision .. Permits Or Authorizations Relating To Premises Any state or governmental agency or subdivision or political subdivision, subject to the following additional provision: This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: 1) The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or 2) The construction, erection or removal of elevators; or 3) The ownership, maintenance or use of any elevators covered by this insurance. J. Any Person Or Organization You Are Performing Work For Any person(s) or organization(s) with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1) In the performance of your ongoing operations; or 2) In connection with your premises owned by or rented to you. K. Vendors 1) Any person(s) or organization(s) (referred to throughout this endorsement as vendor), but only with respect to liability for "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. However: a. The insurance afforded to such vendor only applies to the extent permitted by law; and Includes copyrighted material of Insurance Services Office, Inc., with its permission. 816e84b7-3c5a-4950-Bdca-6cd95aced88e Page 3 of 5 06/23/2023 b. If coverage provided to the vendor is 8) "Bodily injury" or "property damage" required by a contract or agreement, arising out of the sole negligence of the insurance afforded to such vendor the vendor for its own acts or will not be broader than that which you omissions or those of its employees are required by the contract or or anyone else acting on its behalf. agreement to provide for such vendor. However, this exclusion does not 2) With respect to the insurance afforded to apply to: these vendors, the following additional (1) The exceptions contained in exclusions apply: Subparagraphs d. or f.; or a. The insurance afforded the vendor (2) Such inspections, adjustments, does not apply to: tests or servicing as the vendor 1) "Bodily injury" or "property damage" has agreed to make or normally for which the vendor is obligated to undertakes to make in the usual pay damages by reason of the course of business, in connection with the distribution assumption of liability in a contract or sale of the products. or agreement. This exclusion does not apply to liability for damages b. This insurance does not apply to any that the vendor would have in the insured person or organization, from absence of the contract or whom you have acquired such agreement; products, or any ingredient, part or 2) Any express warranty unauthorized container, entering into, accompanying by you; or containing such products. 3) Any physical or chemical change in L. Grantor of Franchise the product made intentionally by Any person(s) or organization(s) with respect the vendor; to their liability as grantor of a franchise to you. 4) Repackaging, except when However: unpacked solely for the purpose of 1. The insurance afforded to such additional inspection, demonstration, testing, insureds only applies to the extent permitted or the substitution of parts under by law; and instructions from the manufacturer, and then repackaged in the original 2. If coverage provided to the additional insured container; is required by a contract or agreement, the insurance afforded to such additional insured 5) Any failure to make such will not be broader than that which you are inspections, adjustments, tests or P J required by the contract or agreement to servicing as the vendor has agreed provide for such additional insured. to make or normally undertakes to make in the usual course of With respect to the insurance afforded to these business, in connection with the additional insureds, the following is added to distribution or sale of the products; Section III - Limits Of Insurance: 6) Demonstration, installation, If coverage provided to the additional insured is servicing or repair operations, required by a contract or agreement, the most we except such operations performed will pay on behalf of the additional insured is the at the vendor's premises in amount of insurance: connection with the sale of the 1. Required by the contract or agreement; or product; 2. Available under the applicable limits of 7) Products which, after distribution or insurance; sale by you, have been labeled or whichever is less. relabeled or used as a container, part or ingredient of any other thing This endorsement shall not increase the or substance by or for the vendor; applicable limits of insurance. or If there is any difference in coverage afforded to an additional insured in this endorsement and Page 4 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 71 24 06 22 9016877 with its permission. 06/23/2023 Sentry Insurance Company that provided under another additional insured endorsement attached to this policy, the broader coverage will apply to that additional insured. Primary And Noncontributory Insurance The following is added to the Other Insurance Condition and supersedes any provision to the contrary: 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from CG 71 24 06 22 9016877 Sentry Insurance Company 5 00003 0000000000 23174 0 N any other insurance available to the additional insured. 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) - Automatic The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. Includes copyrighted material of Insurance Services Office, Inc., with its permission. 816e84b7-3c5a-4950-8dca-6cd95aced88e Page 5 of 5 06/23/2023 Policy: 9016877004 IL 70 58 02 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE FORM EMPLOYMENT RELATED PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we cancel this policy, we shall endeavor to also mail to the person(s) or organization(s) listed in the Schedule for this endorsement advance written notice of cancellation. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. Schedule Person(s) or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation applies. All other terms and conditions of this policy remain unchanged, IL 70 58 02 14 Page 1 of 1 9016877 06/23/2023 Sentry Insurance Company 1 00001 0000000000 23174 0 N 3194d834-732f-4a8e-905-1b82b503e7bc Policy: 9016877003 COMMERCIAL AUTO CA 80 07 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AD D:ITIOI AL INSURE - AUTOMATIC STATUS WHEN REQUIRED BY CONTRACT ACT OR AGREEMENT EI T iIIT YOU This endorsement modifies insurance provided under the following. AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. A. The Who Is An Insured provision of Covered Autos Liability Coverage is amended to include as an additional insured any person or organization for whom you are performing operations 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. The status of an additional insured under this endorsement ends when your operations for that additional insured are completed. B. The most we will pay on behalf of the additional insured is the lesser of the amount payable under the Limit of Insurance for Covered Autos Liability Coverage or the amount of insurance required by the contract or agreement. C. Notwithstanding any requirement, term or condition of any contract or agreement with respect to which this endorsement may pertain, the insurance afforded to the additional insured is subject to all the terms, exclusions and conditions of the COMMERCIAL AUTO COVERAGE FORM to which this endorsement is attached. CA 80 07 06 18 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N Includes copyrighted material of Insurance Services Office, Inc., with its permission. 88d bcc96-Oafa-48a 1 -98 ba-9bca65a85908 Page 1 of 1 06/23/2023 POLICY NUMBER: 9016877003 COMMERCIAL AUTO CA 76 01 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED w INSURED _ PRIMARY AND NONCONTRIBUTORY COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: 07/01/2024 SCHEDULE Name Of Person(s) Or Organ ization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in: (1) Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms; or (2) Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 76 01 06 15 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N B. Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other auto insurance issued to the person or organization in the schedule under your policy provided that: (1) The person or organization is a Named Insured under such other insurance; and (2) Prior to the "accident" you have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the person or organization. Includes copyrighted material of Insurance Services Office, Inc., with its permission. f91bH47-ea114522-995e-3e045032ab3f Page 1 of 1 06/23/2023 POLICY NUMBER: 9016877003 COMMERCIAL AUTO CA76160618 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF FIGHTS OF RECOVERY AGAINST OTHERS TO IDS (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Musco Corporation Endorsement Effective Date: 07/01/2024 The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to a person(s) or organization(s), but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a written contract with that person or organization. CA 76 16 0618 9016877 Sentry Insurance Company 1 00001 0000000000 23174 0 N Includes copyrighted material of Insurance Services Office, Inc., with its permission. e72eff71-a3cb•4426-8f2e-1be3a20eab17 Page 1 of 1 06/23/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CAI CELLATIOI -C RTIFICATE HOLDERS WORKERS ERS COMPENSATION The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancellation when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancellation that we sent to you. Such copies of the notice will be mailed as soon as practicable to the address or addresses provided by your broker or agent. This notification of cancellation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancellation date nor impact or negate any cancellation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. SCHEDULE Person(s) or Organization(s) including mailing address: Per the listing of certificate holders provided by the Broker upon our request. 30 day notice of cancellation applies All other terms and conditions of this policy remain unchanged.. 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 07/01/2024 Policy No. 9016877001 Insured Insurance Company Countersigned by WC 99 06 72 (Ed. 09 11) 9016877 Sentry Casualty Company 1 00002 0000000000 23174 0 N 66bda496-c326-49ad-95ff-c007362d2ce2 Endorsement No. , Premium: Page 1 of 1 06/23/2023 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 Name: Address: AL, AR, CO, CT, FL, GA, IA, ID, IL, IN, KS, LA, MD, MI, MN, MO, MS, NC, NY, OK, OR, PA, RI, SC, TN, VA Description of Waiver: Any person or organization for whom the Named Insured has agreed by written contract executed prior to loss. JobID: 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 07/01 /2024 Insured Insurance Company WC000313 (Ed. 4-84) ©1983 National Council on Compensation Insurance. Policy No. 9016877001 Countersigned by Endorsement No. Premium Page 1 of 1 9016877001 Sentry Casualty Company 1 00002 0000000000 21179 0 N 85847514-b51d-454c-a68e-be75ff5ffc32 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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 Name: Address: AZ, WI Description of Waiver: Any person or organization for whom the Named Insured has agreed by written contract executed prior to loss. Jobl D: 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 07/01/2024 Insured Insurance Company WC 00 0313 (Ed. 4-84) ©1983 National Council on Compensation Insurance. Policy No. 9016877002 Countersigned by Endorsement No. Premium Page 1 of 1 9016877002 06/23/2023 Sentry Casualty Company 1 00001 0000000000 23174 0 N 6aec8ffb-796d-4f14-80c3-eOeca171f74a WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) 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 premium otherwise due on such remuneration. Person or Organization Schedule % of the California workers' compensation Job Description Any person or organization for whom the Named Insured has agreed by written contract executed prior to loss. 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 07/01/2025 Policy No. 9016877001 Endorsement No. Insured Insurance Company Countersigned by WC 04 03 06 (Ed. 4-84) ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual ©2001. 9016877001 Sentry Casualty Company 1 00002 0000000000 24185 0 N e3549c74-e59c-4d79-a8af-bdeccc776caa Page 1 of 1 07/03/2024