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PROOF OF INSURANCE (2025)DATE (MM/DDIYYYY) C"J?" CERTIFICATE OF LIABILITY INSURANCE �.s. 11120l2024 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 endorsements), co �c PRODUCER ....... Acrisure Southwest Partners Insurance Services, LLC PHONE "". -_7 18952 MacArthur Blvd., Suite #300 ws cc..t (94s„ assasoo ww a edg N4: _ �..........._...m E MA(t Irvine, CA 92612 AD s www.patrisk.com OK07568 _............... ....... .... INSURED Su erior Pavement Markings, Inc. 532 Cypress St. Cypress CA 90630 AFFORDING COVERAGE An! Indemnitty Inc. A++ XV ......_. 35181ITmmm ce Clanpany A++ Xis ., ......_. 20281ITmmm rplusmLines Insurance Co A*+ XV 10172mm altv Insurance Comoanv 16992 IC =111«lnm MIIMRFR- 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 IES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM ONS AND CONDITIONS OF SUCH POLICIES. _.._. ........... .....__.m.. .. _.. _. gi ADOL sRR POLIaY EFfr POLICY ap— LIMITS LTR TYPE OF INSURANCE POLICY NUMBER IMMtDDIYYyn (MMIDPIYYYY)- A ✓ COMMERCIAL GENERAL LIABILITY �/ �/ 54326762 9/18/2024 6/1/2025 EACH OCCURRENCE $1,000�00Qwwwwwwwwwm ......, OCCUR CLAIMS -MADE C � PA;�.riS�R�"dbfU"m PREMISi;:. Do u7r.uarglnce).,,,,: _$,,0,t1.O00 ,,..... MED EXP (An one person) $ 5,000 ....... ..... .... ......... PERSONAL &ADVINJU , INJURY ............ ... $1 000000 �z—s _ ,w,wwwwwwwwwwwwwmm, GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0O0 POLICY 0 PR' LOC PRODUCTS COMP/OP AGG $ 2,000e000 O'Qt•BIL B AUTOMOBILE LIABILITY ✓ �/ 54326761 9/18l2024 6/1/2025 � oMeINFD sl'fIGLE; I.uNl('r � .._....__ .... .. Ea a�ciderlOS $ 1 000 000........._.....� �. ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ „,. AUTOS ONLY ''. AUTOS WW HIRED NON -OWNED mPROERT�'LYAMyFAOeE P w•••• $ AUTOS ONLY AUTOS ONLY „(Pr*r acciderrl) ........ _ „„„„„„.. $ B / B ,/ occuR UMBRELLA�RETENTI!ON 56717371 9/18/2024 6/1/2025 EACH OCCURRENCE.... $5,000,000 ........... EXCESS LICLAIMS -MADE AGG .__. AGGREGATE _..._._...._.__._..,,.. $ 5,000,000 DED $ - $ B WORKERS COMPENSATION �/ 54326701 6/1/2024 611/2025 ✓ PER ERH AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUI N / A „STATUTE E L EACH,ACCIDENT _ m$_1 R000,000 wwwwwww (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1((T(00Q If yes, describe under DESCRIPTION OF OPERATIONS below____T El, DISEASE - POLICY LIMIT $ 1 000 000 C Contractors Pollution Liability G74464518002 9/13/2024 6/1/2025 Ea Occ: $2,000,000 Aggregate: $4,000,000 D Excess Liability XSL408079POl 10/21/2024 6/1/2025 Occurrence: $4,000,000 Aggregate: $4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ICE: SPM Job #10298 ! Jab Location: On Call l Thermoplastic Striping Services, Pro°ect No. St 24-02 / El Segundo, California. tua L Auto Liability the endorsements attached as required City of EI Segundo Public Works are named as Additional Insured with respects and per by Written contract.. Coverage is Primary and Non-contributory. Waiver of subrogation apples to GL, Auto and WC. 30 days notice of cancellation / 10 days notice for non payment City of El Segundo CIO El Segundo Public Works 350 Main Street EI Se undo CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. g AUTHORIZED REPRESENTATIVE Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 62787527 1 24/25 GWBA116p B(WC/PtML I Kelly Vincent 1 11/.20✓2024 7:47:05 AM (PST) I Page 1 of 10 This certificate cancels and supersedes ALL previou0 y issued certificates. Superior Pavement Markings, Inc. POLICY NUMBER: 54326762 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES E S OIL CONTRACTORS - SCHEDULED PERSON O ORGANIZATION IZA'TION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations) Location(s) Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT 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 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. 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: 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. r i 82787527 1 24/25 GL/BAd'piM'.trVWC/P0LL I Kelly Vincent 1 11/20J2024 7:47:05 AM (PST) I Page 2 of 10 This certificate cancels and supersedes ALL previolAsly issued certificates. Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or � 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. p . - • s ! :] CG20101219 82787527 1 24/25 GL/BA/UME/WU'POLL I Kelly Vincent 111/.;2Of2O24 7t47:05 AM (PST) I Page 3 of 10 This certificate cancels and supersedes ALL previously t.,Sijed certificates. %rI3�%Ingg�ings, Inc. COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s) Location And Description Of Completed Operations WHERE REQUIRED BY WRITTEN CONTRACT, BUTONLY WHEN THE CONTRACT SPECIFIES COVERAGE FOR COMPLETED OPERATIONS ALL LOCATIONS WHERE REQUIRED BY WRITTEN CONTRACT 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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. N B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 4 • 1 Page 1 of 1 82787527 1 24/25 GL/BA r6P9�BNCI,i"OLL I Kelly Vincent 1 11/ 0/2024 A 7:05 AM (PST) I Page 4 of 10 This certificate can:;Q.'!.s and supersedes ALL previ misl.y issued certificates. Superior Pavement Markings„ Inc. POLICY NUMBER: 54326762 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "NNEII I� IMu • '" This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Additional Insured: Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at the Location Of Covered Operations shown in the Schedule, the following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under this 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 any other insurance available to the Additional Insured. 10-02-2461 (Ed. 7-15) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 .. r I 1 .0 024 7,97:05 A1N O'ST) I v3..90 `x a£ :1.0 7?1H"7,>77 ( ��17.� GLl1.iY4d tl0"^�f%�W( dfi�',�L ( Ke.11r Vincent I II(s`„Vd i", This certificate caflCe7.., ate ✓.i. su ez.-sE.cie=s ALI, previously issued cert.:Lfa. ates. 54326761 Superior Pavement Markings, Inc. COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement modifies the Business Auto Coverage Form. 1. EXTENDED CANCELLATION CONDITION Paragraph A.2.b. — CANCELLATION - of the COMMON POLICY CONDITIONS form IL 00 17 is deleted and replaced with the following: b. 60 days before the effective date of cancellation if we cancel for any other reason. 2. BROAD FORM INSURED A. Subsidiaries and Newly Acquired or Formed Organizations As Insureds The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 60% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy buffor its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is an "insured" under any other automobile policy; (b) That has exhausted its Limit of Insurance under any other policy; or (c) 180 days or more after its acquisition or formation by you, unless you have given us written notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. B. Employees as Insureds Paragraph A.1. — WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. Lessors as Insureds Paragraph A.I. —WHO IS AN INSURED — of SECTION II — LIABILITY COVERAGE is amended to add the following: e. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: (1) The agreement requires you to provide direct primary insurance for the lessor; and (2) The "auto" is leased without a driver. Such leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. However, the lessor Is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: 1. You; 2. Any of your "employees" or agents; or 3. Any person, except the lessor or any "employee" or agent of the lessor, operating an "auto" with the permission of any of 1. and/or 2. above. D. Persons And Organizations As Insureds Under A Written Insured Contract Paragraph A.1 —WHO IS AN INSURED —of SECTION II — LIABILITY COVERAGE is amended to add the following: f. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed under an express provision in a written "Insured contract", written agreement or a written permit issued to you by a governmental or public authority to add such person or organization to this policy as an "insured". However, such person or organization is an "insured" only: Form: 16-02-0292 (Rev. 11-16) Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" 82787527 1 24/25 GL/BA/UM;BNC.+POLL I Kelly Vincent 1 11/2012024 7:47:05 AM (PST) I Page 6 of 10 This certificate cancels and, supersedes ALL previw,' au�,,ly issued certificates. (1) with respect to the operation, maintenance or use of a covered "auto"; and (2) for "bodily injury" or "property damage" caused by an "accident" which takes place after: (a) You executed the "insured contract" or written agreement; or (b) The permit has been issued to you. 3. FELLOW EMPLOYEE COVERAGE EXCLUSION B.5. - FELLOW EMPLOYEE — of SECTION II — LIABILITY COVERAGE does not apply. 4. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. — TRANSPORTATION EXPENSES — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $50 per day for temporary transportation expense, subject to a maximum limit of $1,000. 5. AUTO LOANILEASE GAP COVERAGE Paragraph A. 4. — COVERAGE EXTENSIONS - of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: c. Unpaid Loan or Lease Amounts In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the loan or lease for a covered "auto" minus: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue loan/lease 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 lessor: 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. We will pay for any unpaid amount due on the loan or lease if caused by: 1. Other than Collision Coverage only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; 2. Specified Causes of Loss Coverage only if the Declarations indicate that Specified Causes of Loss Coverage is provided for any covered "auto"; or 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any covered "auto. 6. RENTAL AGENCY EXPENSE Paragraph A. 4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: d. Rental Expense We will pay the following expenses that you or any of your "employees" are legally obligated to pay because of a written contract or agreement entered into for use of a rental vehicle in the conduct of your business: MAXIMUM WE WILL PAY FOR ANY ONE CONTRACT OR AGREEMENT: 1. $2,500 for loss of income incurred by the rental agency during the period of time that vehicle is out of use because of actual damage to, or "loss" of, that vehicle, including income lost due to absence of that vehicle for use as a replacement; 2. $2,500 for decrease in trade-in value of the rental vehicle because of actual damage to that vehicle arising out of a covered "loss"; and 3. $2,500 for administrative expenses incurred by the rental agency, as stated in the contract or agreement. 4. $7,500 maximum total amount for paragraphs 1., 2. and 3. combined. 7. EXTRA EXPENSE — BROADENED COVERAGE Paragraph A.4. — COVERAGE EXTENSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: e. Recovery Expense We will pay for the expense of returning a stolen covered "auto" to you. 8. AIRBAG COVERAGE Paragraph B.3.a. - EXCLUSIONS — of SECTION III — PHYSICAL DAMAGE COVERAGE does not apply to the accidental or unintended discharge of an airbag. Coverage is excess over any other collectible insurance or warranty specifically designed to provide this coverage. 9. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - BROADENED COVERAGE Paragraph C.1.b. — LIMIT OF INSURANCE - of SECTION III - PHYSICAL DAMAGE is deleted and replaced with the following: b. $2,000 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss", is: (1) Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; (2) Removable from a permanently installed housing unit as described in Paragraph 2.a. above or is an integral part of that equipment; or (3) An integral part of such equipment. 10. GLASS REPAIR —WAIVER OF DEDUCTIBLE Form: 16-02-0292 (Rev. 11-16) Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" 82787527 1 29/25 GL/BA/0..SMS/WC,'V0 L I Kelly Vincent I 11/20M24 7:47:05 AM (PST) I Page 7 of 10 This certificate cancels ,ndtcm supersedes ALL previously issued certificates,. Under Paragraph D. - DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. 11. TWO OR MORE DEDUCTIBLES Paragraph D.- DEDUCTIBLE — of SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add the following: If this Coverage Form and any other Coverage Form or policy issued to you by us that Is not an automobile policy or Coverage Form applies to the same "accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; or 2. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Paragraph A.2.a. - DUTIES IN THE EVENT OF AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV - BUSINESS AUTO CONDITIONS is deleted and replaced with the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when the "accident" is known to: (1) You or your authorized representative, if you are an individual; (2) A partner, or any authorized representative, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer, insurance manager, or authorized representative, if you are an organization other than a partnership or limited liability company. Knowledge of an "accident", claim, "suit" or "loss° by other persons does not imply that the persons listed above have such knowledge. Notice to us should include:. (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons or witnesses. 13. WAIVER OF SUBROGATION Paragraph A.5. - TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: 5. We will waive the right of recovery we would otherwise have against another person or organization for "loss" to which this insurance applies, provided the "insured" has waived their rights of recovery against such person or organization under a contract or agreement that is entered into before such "loss". To the extent that the "insured's" rights to recover damages for all or part of any payment made under this insurance has not been waived, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. 14. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2. — CONCEALMENT, MISREPRESENTATION or FRAUD of SECTION IV — BUSINESS AUTO CONDITIONS - is deleted and replaced with the following: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not void coverage under this Coverage Form because of such failure. 15. AUTOS RENTED BY EMPLOYEES Paragraph B.5. - OTHER INSURANCE of SECTION IV — BUSINESS AUTO CONDITIONS - is amended to add the following: e. Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's" personal insurance. 16. HIRED AUTO — COVERAGE TERRITORY Paragraph B.7.b.(5). - POLICY PERIOD, COVERAGE TERRITORY of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced with the following: (5) A covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 45 days or less; and 17. RESULTANT MENTAL ANGUISH COVERAGE Paragraph C. of - SECTION V — DEFINITIONS is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death as a result of the "bodily injury*' sustained by that person. Form: 16-02-0292 (Rev. 11-16) Page 3 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" B2767527 1 24/25 GL/BA,A..&hiB/WC/1%1)LL I Kelly Vincent I 11/' J(2024 7:47:05 AM (PST) I Page 8 of 10 This certificate cancels a td supersedes ALL previously issued certificates. t a superior Pavement Markings, Inc. POLICY NUMBER: 54326761 COMMERCIAL AUTO 16-02-0316 Ed. 10 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY IM NON -CONTRIBUTORY IUSURANCE This endorsement modifies insurance provided under 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: SUPERIOR PAVING COMPANY, INC. DBA UNITED PAVING CO. Endorsement Effective Date: 06/0I/2024 SCHEDULE Name(s) Of Person(s) Or Organization(s); WHERE REQUIRED BY WRITTEN CONTRACT Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Item 5. — "Other Insurance" of Item B. — "General Conditions" under Section IV — "Business Auto Conditions": e. Regardless of the provisions of Paragraph 5.a. through d. above, for any liability arising out of the ownership, maintenance, use, rental, lease, loan, hire or borrowing by an "insured" of a covered "auto" for which an "insured" is contractually obligated to provide primary insurance coverage to a client, this Coverage Form will be primary and non-contributory with respect to the Persons or Organizations in the schedule, regardless of the availability or existence of other collectible insurance under any other Coverage Form or policy that applies on a primary basis. Page 1 of 1 82787527 1 24/25 GL/BA/1UMP?i:/WC/1?`X L I Kelly Vincent 1 11/,r20?2024 7:47:05 AM (PST) I Page 9 of 16 This certificate cancels and supersedes ALL previously issued certificates. Workers' Compensation and Employers" Liability policy Named Insured Endorsement Number Superior Pavement Markings, Inc. Policy Number Symbol: Number: 54326701 Policy Period Effecfive ate of Endorsement 06/01 /2024 06/01 /2025 06/01 /2024 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Co A++ XV Insert the poli number. The remainder of the information is to be completed only when this endorsement is issued subse uent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the light 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization: ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL OPERATIONS 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 Authorized Representative WC 90 03 75 (05/18) 8278'7517 0 24/25 GL/BA/C7M13/wc/PoV,I, I Kel.lyr trz.rxrer1t:. ( 11/20/2021 7.47�05 .AM (PSI'y I Page 10 of )a "1.'hr. certificate r-ui.rAr.els and stiper,edeS A. �.7, previously issued certificates,