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PROOF OF INSURANCE (2026 - 2027)BoldSign Document ID: 8aa9228e-82ad4la2-93ef-Oce9107e5ad3 GOLDGAT-25 AJ' ,a►coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1 /29/226........_ 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 pollc les must have ADDITIONAL INSURED provisions Y(� ) 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 9 this certificate does not confer rights to the certificate holder in lieu of such en orsement(s). PRODUCER License # 0757776„ 1 co TtACT Anna Joo I4�...._ m-. ._ HUB International Insurance Services Inc.PHONE 714 590 3508 FAX f IAIC No/ 9122 Garden Grove Blvd ArC N'� bintern3tNonal c EprAtL om Garden Grove, CA 92844 A00g�,g antra jooi�hu„ . --------- _._.___.. ................. ... ................... INSURERA HUds on Excess Insurance„ Company 1,4484 Golden Gate Construction a United S ec Automob'llile InsuI'lrance Company_38342 INSURED DBA Go date Steel, Inc. INSIUIRER B UniteCaliforniap A..lalty Insurance Company .. �12537 , 14709 Carmenita Rd. IM, RaR D Insurance Company of the._West .27847 P n ...... _ ... p .. Norwalk, CA 90650 _ INSURER F . Westchester Sur lus Lines Insurance Co COVERAGES _ CERTIFICATE NUMBER. _.... _ 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 HA1111111.1­VE BEEN REDUCED BY PAID CLAIMS. I A NSRf X .,........TYPE OF INSURANCE ._....,..,.. __ ......IADDL SIJ�BEY POLICY NUMBER ....., ...— POLICY MMDA1EFF POLICY EXP EACH OCCURRENCE E .-..... LIMITS Ty ........... ... ...., L.T COMMERCIAL ENERAL LIABILITY I P „„„„„„ „„„„„ - � V = DAMAGE 1 000 000 CLAIMS -MADE X OCCUR X X HBL20000004-00 1/31/2026 1/31/2027 PIxIls® Raoc� Doi w1 100 000 .... ...j 5 000 ..... ,.,,,,. ,. „„ .... „..... PERSONALP jAny one person) .$ „ MEO EX ........- -------....... , .. & ADV INJURY $ 1,000,000 GEN AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2 OOO L .... Oae IC X ] �PR ELpT ❑ LOG I PFOD s .COMPiOP AGG _$... ,,.. 2,000,000 .� _..._._._._.__ .......,... ... _.._. B AUTOMOBILE LIABILITY ida 3aGIVCOMBIN6D;06~14wl.E LIMIT $ 1 O�O,Q(7� ANY AUTO X X BA040000028522 7/21/2025 7/21/2026 BODILYJNJURV (Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY eOat'c INJURY (Per accldenU $, AUTOS ONLY ,. AUTOS ONLY I ODILY IN HIRED J NON -OWNED TYDAMAGE 1 $ 4,000,000 �+ UMBRELLA LIAB X OCCUR gTN2613662 1/31/2026 1/3112027 EAOH OCCURRENCE „ r I, $„ 0!00,000. X „ EXCESS LIAB CLAIMS MADE X X AGGREGATE ,,,,,, ,;,, ,, _ DED X RETENTION$ D PER OTH- WORKERS COMPENSATION D AND CEMPLLO EMPLOYERS' EXCLUD LIABILITY� _... NIA IWVE 5083464 00 4/17/2025 4/17/2026 1 X (EACH ACCiDEN I, .1,000,000 W A�N_Y PROPRIETORIPARTNER/EXECUTIVE YIN X E STATI)T P,.$1,„000 ()()t) Ifes, descnln NH) l..L DISEASE EA EM,P,LOYEK_$....-.-...., ' e go E POIIUtion Liati l tyDESCRIPTION OF RAnoNs below .... G49668909u001 1/26/2026 1/26/2027 EachSEASE - Condition POLICY LIMIT 2,000,000 be under 1 �000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Se�hedule, may be attached if more space is required) Project Name: Repair of Distressed Walls and Surfaces at Recreation Park Project Site Address: 339 Sheldon Street, El Segundo, CA 90245 The City of El Segundo, its elected and appointed officials, employees, and volunteers as additional insureds when agreed in written contract. Coverage is primary and non-contributory such that any other insurance that may be carried by the City will be excess thereto when agreed in written contract. Waiver of Subrogation in favor of the additional insureds when agreed in written contract. The City of El Segundo will receive thirty (30) days written notice in the event of cancellation, nonrenewed or reduction. 10 days cancellation notice for non-payment of premium. .. - ............... CERTIFICATE, HOLDER _ CANCELLATION _..- ....... - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo, CA 90245-3813 ......._ ................ m _ AUTHORIZED REPRESENTATIVE �6 v4,.z r ..... ... _..._ _ ............._ ......... _. ......... ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BoldSign Document ID: Baa9228e-82ad-4la2-93ef-Oce9107e5ad3 POLICY NUMBER: HBL 20000004 00 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s : Locations Of Covered O erations Any person, entity, or organization with whom you 1 have agreed, in a written contract or agreement, to be added as an Additional Insured on your policy, provided such written contract or agreement is fully executed prior to an "occurrence" in which coverage is sought under this policy. 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 ether than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 BoldSign Document ID: 8aa9228e-82ad-41a2-93ef-Oce9107e5ad3 C. With respect to the insurance afforded to these 2.Available under the applicable limits of insurance; additional insureds, the following is added to Section whichever is less. III — Limits Of Insurance: Iprovided to the additional insured is This endorsement shall not increase the applicable f coverage 9 p limits of insurance. 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 CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 BoldSign Document ID: 8aa9228e-82ad-41 a2-93ef-0ce9107e5ad3 POLICY NUMBER: HBL 20000004 00 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Any person, entity, or organization with whom you 1 have agreed, in a written contract or agreement, to be added as an Additional Insured on your policy, provided such written contract or agreement is fully executed prior to an "occurrence" in which coverage is sought under this policy. This coverage applies to Commercial Operations Only. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III — Limits Of Insurance: with respect to liability for "bodily injury" or "property If coverage provided to the additional insured is damage" caused, in whole or in part, by "your work" required by a contract or agreement, the most we at the location designated and described in the will pay on behalf of the additional insured is the Schedule of this endorsement performed for that amount of insurance: additional insured and included in the "products - 1. Required by the contract or agreement; or completed operations hazard". However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; whichever is less. insured only applies to the extent permitted by law; and This endorsement shall not increase the applicable 2. If coverage provided to the additional insured is limits of insurance. 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. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 BoldSign Document ID: 8aa9228e-82ad-41 a2-93ef-0ce9107e5ad3 POLICY NUMBER: HBL 20000004 00 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "'WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person, entity or organization with whom you have agreed, in a written contract or agreement, to waive the transfer or rights of recovery against others to us, provided such written waiver is fully executed prior to an "occurrence" in which coverage is sought under this policy. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 BoldSign Document ID: 8aa9228e-82ad-4la2-93ef-Oce9107e5ad3 POLICY NUMBER: HBL 20000004 00 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition 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 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 any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 BoldSign Document ID: 8aa9228e-82ad-4la2-93ef-Oce9107e5ad3 Policy Number: BA040000028522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Mercury Business Auto Broadening Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) II. EMPLOYEES AS INSUREDS III. SUPPLEMENTARY PAYMENTS IV. ADDITIONAL TRANSPORTATION EXPENSE V. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE VI. GLASS REPAIR — DEDUCTIBLE WAIVER VII. TWO OR MORE DEDUCTIBLES Vill. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS IX. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS X. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT XI. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH XII. PERSONAL EFFECTS COVERAGE XIII. LOSS OF USE EXPENSES XIV. DEVICES DESIGNED FOR USE WITH AUDIO, VISUAL OR DATA ELECTRONIC EQUIPMENT XV. PHYSICAL DAMAGE DEDUCTIBLE — VEHICLE TRACKING SYSTEM XVI. CHAINS, TARPS, AND BINDERS COVERAGE Copyright 2023 Mercury Insurance Services, LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 4 BoldSign Document ID: 8aa9228e-82ad-47a2-93ef-Oce9107e5ad3 BUSINESS AUTO COVERAGE FORM NEWLY ACQUIRED OR FORMED ENTITY (Broad Form Named Insured) SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, the following is added: Any business entity newly acquired or formed by you during the policy period provided you own 50% or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Coverage does not apply to an "accident" which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. COVERAGE, 1. Who Is An Insured, the following is added: Any "employee" of yours is an "insured" while using a "covered auto" you do not "own", lease, hire, rent, or borrow, which is used in connection with your business. III. SUPPLEMENTARY PAYMENTS SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 3. Coverage Extensions, a. Supplementary Payments, Subparagraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We are not obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. IV. ADDITIONAL TRANSPORTATION EXPENSE SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, 2. Coverage Extensions, a. Transportation Expenses, is amended by: Replacing $20 per day with $50 per day, and the $600 maximum with $1,000 maximum. If your business shown in the "Declarations" is other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen "covered auto' from the place where it is recovered to its usual garaging location. V. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. VI. GLASS REPAIR — DEDUCTIBLE WAIVER SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. Copyright 2023 Mercury Insurance Services, LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 4 BoldSign Document ID: 8aa9228e-82ad-4la2-93ef-Oce9107e5ad3 VII. TWO OR MORE DEDUCTIBLES SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible, the following is added: If two or more "company" policies or coverage forms apply to the same accident: 1. If the applicable Business Auto deductible is the smallest, it will be waived; or 2. If the applicable Business Auto deductible is not the smallest, it will be reduced by the amount of the smallest deductible; or 3. If the loss involves two or more Business Auto coverage forms or policies the smallest deductible will be waived. For the purpose of this endorsement "company" means the company providing this insurance and any of the affiliated members of the Mercury Insurance Group of companies, Vill. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The requirement in SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit, Or Loss, a., In the event of "accident", you must notify us of an "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. IX. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS SECTION IV - BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, or Fraud, the following is added: Any unintentional omission of or error in information given by you, or unintentional failure to disclose all exposures or hazards existing as of the effective date or at any time during the policy period shall not invalidate or adversely affect the coverage for such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. X. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, S. Other Insurance, the following is added 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 any other insurance available to the additional insured. XI. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH SECTION V — DEFINITIONS, D. "Bodily Injury" is amended by adding the following: "Bodily injury" also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness, or disease. Copyright 2023 Mercury Insurance Services, LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 of 4 BoldSign Document ID: 8aa9228e-82ad-4la2-93ef-Oce9107e5ad3 XII. PERSONAL EFFECTS COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, A: Coverage, 2. Coverage Extensions, the following is added: Personal Effects We will pay up to $500 for "loss" to personal effects which: (1) Are owned by you or a driver listed in the "Declarations"; and (2) Are in or on a "covered auto" at the time of "loss". This coverage applies only in the event of a total theft of a "covered auto". No additional deductible applies to the coverage. Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment are not considered personal effects. XIII. LOSS OF USE EXPENSES If you pay the premium for Hired Auto Physical Damage, we will pay expenses for which you become legally responsible to pay for loss of use of an "auto" due to "loss" or "accident' covered by Hired Auto Physical Damage. However, the most we will pay for any expenses for loss of use is $20 per day, to a maximum of $600. The insurance provided by this provision is excess over any other collectible insurance. XIV. DEVICES DESIGNED FOR USE WITH AUDIO, VISUAL OR DATA ELECTRONIC EQUIPMENT SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions, 4.a., is replaced by the following: a. Under Comprehensive Coverage we will pay up to $200 for "loss" to tapes, records, discs or other similar audio, visual, data electronic devices designed for use with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment: (1) Are your property or that of a driver listed in the "Declarations"; and (2) Are in a "covererd auto" at the time of "loss". This coverage applies only in the event of a total theft of a "covered auto". No additional deductible applies to this coverage. XV. PHYSICAL DAMAGE DEDUCTIBLE — VEHICLE TRACKING SYSTEM SECTION III — PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the "Declarations" will be reduced by 50% for any "loss" caused by theft if the "covered auto" is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of that "covered auto" by the "insured" or law enforcement. XVI. CHAINS, TARPS, AND BINDERS COVERAGE SECTION III — PHYSICAL DAMAGE COVERAGE, C. Limits Of Insurance, the following is added: The most we will pay for the "loss" to chains, tarpaulins, binders, and cargo securing devices will be $500. The chains, tarpaulins, binders, or cargo securing devices must be in or on the "covered auto" at the time of "loss". Copyright 2023 Mercury Insurance Services, LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 4 of 4 BoldSign Document ID: Baa9228e-82ad4la2-93ef-Oce9707e5ad3 Policy Number: BA040000028522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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. SECTION IV — BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MCA04440913 BoldSign Document ID: Baa9228e-82ad-4la2-93ef-Oce9107e5ad3 Policy Number: BA040000028522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section II - Liability Coverage, Paragraph A.I. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for 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. MCA20480711 BoldSign Document ID: Baa9228e-82ad-47a2-93ef-Oce9107e5ad3 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER. 2 % of the total California Workers' Compensation premium Schedule Job Description 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 04/17/2025 Policy No. WVE 5083464 00 Endorsement No. Insured GOLDEN GATE STEEL, INC. Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) 11601NO