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PROOF OF INSURANCE (2026)PARTASS-01 .........w ASH N •• ^^^ •••• ^CE DATE(MMIDDIYYYY) A� 0' _ z/s/2ozs _ ....•CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C m ....._•.�...�. ERTIFICATE 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 enddorsement(s!__ _ .. CRNTACT Gallant Risk and Insurance Services ONE E=tl (851) 368 0700 FAX foal (9 1) 368 0707 PRODUCER 4160 Temescal Canyon Rd. Suite 214 E-M �.. R Corona, CA 92883 ..... INSURER,(Sf ,AF,FORDING COVE„RAGE; _ NAIC # -.- INSURER A Axis Surplus Insuranc � o mpany.of America 126620 p wsuRED lNsuRER B Travelers Pro ert Casual Co _a 125674 .. Partner Assessment Corporation dba Partner Engineering 8 Science, Inc. p 9 9 INSURER 111.. -- . Alhe„d World National Assurance C,,, p y 0 2154 Torrance Blvd., #200 om _an 1069 Torrance, CA90501 INSIJRERE --------------- SURER F . .,.... ._____...,....._.. ......_ _.... ....._. . ........ ...... COVERAGES _..� ERTiFICATE NUMBLY ._...,,_ .......... _..... ......�REVISIOt�1A �1 BER ............ .,,, 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. A X COMMERCIALOGE .,.._,. LIMITS .Ty. INSURANCE ADDLISUBRe. ...._ .....--_ POLICY EFF OLLICYEXP .. 1,000,000 � POLICY NUMBER GENERAL E:ACkIOG"9JRRIFNOk ,•, 11111111 DAMAGE 1'd iaE�uiD 300 000 CLAIMS -MADE 1 ;OCCUR X X JSP004650052025 9/27/2025 912712026 �flMlaldcrrxtld�nai , 00 Deductible .............. ry D .....(_stygntp p ii .... '1 25 000 X A X I 25 0-....--- Pd diS dNAL ADV IN�try ... . „ 3r. AGGREGATE LIMIT APPLIES PER: �,GENEF�AL Al',,�• RFGATE: � •• .,, POOLF•JX...i PE® LOC V�RODUtsTS,MCC,MPdOd�AGG 2, C __ 2,000,000 " e__.._......... ..... ? ......... -.- COMBINEOSINGLELINII , 1000,000 AUTOMOBILE LIABILITY 14 00i3).. .......... ......... .. .. ...._ X ANY AUTO X X 5810OX771722 9/27/2025 9/27/2026 �'B0DiLYIbNJURYff!g pPrs<u1 I ,,. OWNED SCHEDULED 6,----- AUTOS ONLY AUTOS'�DDtlLr'tlh&.AURY(,F�e�racccdo�wRii � _ ....- XH P aL'M NON- WN - P Oi'ER"1"Y i,1AMAGE . HT - S ONLY X AiJiO, ON „ , 5,000,,000 X EXCESS LIAR X CLAIMS -MADE X X dtlAT AtENCE S 5,, C UMBRELLA LIAB CCUR - 03098032 9127/2025 9/27/2026000000 444 - DED X RETENTION $ _ fFOIIOW Form D EMPLYRS'LlAIICOMPENSATION ' Y.. NIA nX mmUBOX817777 9/27/2025 9127I2026 X STA µid I B WORKERS KERS LfA "��'�"��. ANY PCR WEMBEREXCLUDEDXECUTIVE l hASCCVOEN7 S 1,004,000.. If as, describe under Y a N d 1 1.•w describe _0 � F sE -POg.. f�crEE .. 000,000 � R PTI ama of OPERA ftl dd�S helc�w� SP0046500 2025 ........ 9/27/2 25 W2T/2026 E Egg lte 1 000,0 acDIS aSE-P ro..,'_ A Pollution Liability SP004650052025 9/27/2025 9/27/2026 Each O ty cc./Aggregate 1,000,000 The City of El Segundo, its elected and appointed officials, employees, and volunteers are included as additional insureds. DIESCRI''PTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) ty PPeds. Coverage is primary and non-contributory. Waivers of subrogation apply. 30 Days Cancellation Notice, except for 10 day non-payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St El Segundo, CA 90245 .._......... _. .. ......... AUTHORIZED REPRESENTATIVE AAi ,(- ShvxV ti .....,.... .......... ................. . ....... ......... ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Endorsement No. 20 Effective Date: 09/27/2025 @12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650405-2025 Insured Name: Partner Assessment Cor oration Issuing Company: A?LZ_§yrplus Insyrnce ggLnp,�ny Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. PRIMARY AND NONCONTRIBUTORY OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY The following is added to SECTION VI, COMMON CONDITIONS, Paragraph 9, Other Insurance. It 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. Includes copyrighted material of Insurance Services Office, Inc with its permission SPP 200104 (0414) Page 1 of 1 CG 20 01 04 13 Endorsement No. �,` 11 Effective Date: 09/77 °202 e 12:01 a.m. Standard Time at the address of the Named Insured Policy Number: -'Pik S-205 Insured Name: Ia�n� ssrrau orportion Issuing Compaq " iirpTds 'Kiuf hci�-6—m-- ny Additional (ReturnTPr m"aurh: ........... If the Endorsement Effective Date is bld—nk, then the effective: date of this Endorsement is the Inception Dote of the Policy. '�I'"AIV1E OF TRA NSFER OF RIGHTS OF'RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Person Or Organization: Where regpired by written co ntract In force prior to any claim 0 Information required to com fete this Schedule„ if not shown above, will be shown in the Declarations. The following is added to Paragraph 12. Subrogation of Section VI — Common Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or Your Work done under a contract with that person or organization and included in the Products - Completed Operations Hazard. This waiver applies only to the person or organization shown in the Schedule above. SPP 2404 09 (0414) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc with its permission CG 24 04 05 09 SPP 2404 09 (0414) Page 1 of 1 Endorsement No. Effective Date: 09/27/2025@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-05-2025 Insured Name: Partner Assessment Corporation Issuing Company: A3rCiS Slus Cnstarance pmr�,r Additional (Return) Premium: $0 ..,__...__ If the Endorsement Effective Date is blank, then the effective date of this Endorsement is the Inception Date of the Policy. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTI CTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE A. Section III — 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. Includes copyrighted material of Insurance Services Office, Inc with its permission CG20100413 SPP 2010 13 (02 14) Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section IV — 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. Includes copyrighted material of Insurance Services Office, Inc with its permission CG 20 10 04 13 SPP 2010 13 (02 14) Page 2 of 2 Endorsement No. Effective Date: 09/27/2025@12:01 a.m. Standard Time at the address of the Named Insured Policy Number: SP004650-05-2025 Insured Name: Partner Assessment Corporation Issuing Company: AXIS Surplus Insurance Come LnA Additional (Return) Premium: $0 If the Endorsement Effective Date is blank, then the effective dote of this Endorsement is the Inception Dote of the Policy. ADDITIONAL INSURED - OWNERS, LESSEE'S OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: SPECIALTY PACKAGE POLICY SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Descri tion Of Com feted O erations Where required by contract in force prior to any claim. All Projects/Locations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section III — Who Is An Insured is amended B. With respect to the insurance afforded to to include as an additional insured the these additional insureds, the following is person(s) or organization(s) shown in the added to Section IV — Limits Of Insurance: Schedule, but only with respect to liability for If coverage provided to the additional insured Bodily Injury or Property Damage caused, is required by a contract or agreement, the in whole or in part, by Your Work at the most we will pay on behalf of the additional location designated and described in the insured is the amount of insurance: Schedule of this endorsement performed for that additional insured and included in the 1. Required by the contract or agreement; or Products -Completed Operations Hazard. 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent This endorsement shall not increase the permitted by law; and applicable Limits of Insurance shown in the 2. If coverage provided to the additional Declarations. 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. Includes copyrighted material of Insurance Services Office, Inc with its permission CG20370413 SPP 2037 13 (06 12) Page 1 of 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 1 a I 1 0 1 1 I►Lei 1 •� 0 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2. The following is added to Paragraph 113.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is the first named insured when the written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non-contributory. CA T4 74 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: 810OX771722 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage.broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS 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. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission.. Policy Number: 810OX771722 COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II — COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured" while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii) may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured" against, or in LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in - we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: 810OX771722 You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex - We will a u to $400 for "loss" to wearing a tent required of you by a written contract pay P 9 P- signed and executed prior to any 'accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 Of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: 810OX771722 COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. ���AW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-OX817777-25-43-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. 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 Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium DATE OF ISSUE: 09-19-25 ST ASSIGN: Page 1 of 1