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PROOF OF INSURANCE (2026 - 2026) CLOSEDA" " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/11 /2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt Diablo Blvd, #230 Lafayette CA 94549 INSURED Gale/Jordan Associates, Inc. 310-316-4377 3868 Carson Street, Suite 328 Torrance CA 90503-5613 D.i E: Peters 696-1901 Admiral Insurance cnVERAGES CERTIFICATE NUMBER! 2144. 00031 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,.... ................ ................... .............. .. ff INSI n §V(J..l0ir8f 1 LIMITS 'MM/DO E�FI� ` TYPE OF INSURANCE POLICY NUMBER I. MMIDDYIYYYY LjRCLAIMS-MADE I A COMMERCIAL GENERAL LIABILITY Y Y FEIECC3656700 4/28/2025 4/28/2026 I EAMA�:iCCU 1 EACH OCCURRENCE $ 10 000 000 J OCCUR f'iENi6r1 i P��IS,�S4. nfrF) ..._ Ea nGGurre„,,,„ $100 000 .,�...�. - ....,,... , .. .-__ Contractual Liab MED EXP Any one person) $ 5 000 PERSONAL & ADV INJURY , ... $ 10 000 000 EN L AGGREGATE ...,. ...... .... LIMIT APPLIES PER: ENERALAGGREGATE $ 10,000,009 X G... PR�C?r LOC POLICY � JECT � P. R pUCTS COMPIOP AGG G-. .. $ 10 000 000 _ ...... . $ OTHEf •: A AUTO MOBILELIABILITY Y Y FEIECC3656700 4/28/2025 4/28/2026ORtBINED SIN t k LIMIT E t. a acr(de�wrt). ........ $1 000 000 7 ANY AUTO BODILY INJURY (Per person) $ .._. ....... OWNED SCHEDULED f --- .. BODILY INJURY (Per accident) _ AUTOS ONLY .J AUTOS NON 1 PROPERTY DAMAGE - X HIRED X -OWNED AUTOS ONLY AUTOS ONLY ' ...t`er zo��pa��rit;Y - -_....... $ ... X NoJO wined Auto ii � $ UMBRELLA LIAB OCCUR ,. EACH OCCURRENCE $ EXCESSS LIAB CLAIMS -MADE AGGREGATE $ .,. .,.... $ DED RETENTION $ PER Y OTH ,WORKERSCOMPENSATION STATE TUR AND EMPLOYERS' LIABILITY YIN �N/A , E, L EACH ACCIDENT $OFFICER/MEMBER ANYPROPRIETOR/PARTNER/EXECUTIVE EXCLUDED?. in NH) ..... E..L. DISEASE - EA EMPLOYEE. .... $ (Mandatory If yes, describe under t E.L DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A A Professional Liability Contractors Pollution Liab Y FEIECC3656700 FEIECC3656700 4/28/2025 4/28/2025 4/28/2026 4/28I2026 Per Claim/$10,000,000 'Per Claim/$10:000:000 '.. $10,000,000/agg. $10,000,000/agg. Deductible $5,000 each claim' DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Auto Liabili is follow -form to the General Liability. Insured owns no company vehictm therefore, hired/non-owned auto is the maximum coverage that applies. TL DedUCt le each claim: $5,000 & CPL Deductible each pollution condition: $5,000. RE: All Operations — City of El Segundo, its officers„ agents and employees are named as 'additional insured as respects general and auto liability as required per written contract. L;LK I IFI(:A I t MULUr-K t.Arvr rK a sw n iWlr' — "VY I. Ll— ..III — ­" My City of El Segundo, Public Works Dept. 350 Main Street El Segundo CA 90245 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. IJ 1V$S-ZU10 AL UKU LVKrVKAI1UN. All ngn[s resrrvcu. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Policy Number: FEIECC3656700 Endorsement Number: 5 Automatic Additional Insured — Owners, Lessees or Contractors This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of an additional premium of $A�lled, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC-319-0712 © 2018, Freberg Environmental, Inc. Page 1 of 1 Policy Number: FEIECC3656700 Endorsement Number: 6 Automatic Waiver of Subrogation Endorsement This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, This endorsement modifies coverage provided under the following coverage part(s): COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s) to whom the Named Insured agrees, in a written contract, to provide a waiver of subrogation. However, this status exists only for the project specified in that contract. The Company waives any right of recovery it may have against the person or organization shown in the above Schedule because of payments the Company makes for injury or damage arising out of the insured's work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement act to extend the policy period, change the scope of coverage or increase the Aggregate Limits of Insurance shown in the Declarations. ECC-320-0712 © 2018, Freberg Environmental, Inc. Page 1 of 1 Policy Number: FEIECC3656700 Endorsement Number: 16 Automatic Primary and Non -Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: SCHEDULE Name of Person or Organization: Any person(s) or organization(s) whom the Named Insured agrees, in a written contract, to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. Inconsideration of an additional premium of $Appjied, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third parry. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance. ECC-548-0317 © 2018, Freberg Environmental, Inc. Page 1 of 1 Policy Number: FEIECC3656700 Endorsement Number: 22 ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION- Blanket This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered Operations Any person(s) or organization(s) whom the Named Those project locations where this endorsement is Insured agrees, in a written contract, to name as an required by contract. additional insured. However, this status exists only for the project specified in that contract. ^ IT p shown above, will be shown in the Declarations. .......M Schedule, If not show Information required to complete this Sc � ITITITITIT�wwwww,,,IT A. Section II — Who Is An Insured is amended to B 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. 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 2 of 2 Policy Number: FEIECC3656700 Endorsement Number: 31 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - BLANKET This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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) Location And Description Of Completed Or Organization(s)O erations Any person(s) or organization(s) whom the Named Those project locations where this Insured agrees, in a written contract, to name as an endorsement is required by contract. additional insured. However, this status exists only for the project specified in that 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 B. With respect to the insurance afforded to include as an additional insured the person(s) or these additional insureds, the following is organization(s) shown in the Schedule, but only added to Section III — Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured "property damage" caused, in whole or in part, is required by a contract or agreement, the by "your work" at the location designated and most we will pay on behalf of the additional described in the Schedule of this endorsement insured is the amount of insurance: performed for that additional insured and included in the 'products -completed operations 1. Required b the contract or agreement; or q y g hazard". 2. Available under the applicable limits of However: insurance; 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. whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: FEIECC3656700 Endorsement Number: 26 Hired and Non -Owned Auto Liability Coverage Endorsement This endorsement, effective 04/28/2025, attaches to and forms a part of Policy Number. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of an additional premium of $lied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY It is hereby agreed that insurance is provided only with respect to those coverages for which a specific Sub -Limit of Insurance is shown: SUB -LIMIT OF INSURANCE SCHEDULE A. HIRED AUTO LIABILITY The insurance provided under this policy applies to "bodily injury" or "property damage" arising out of the maintenance or use of a "hired auto" by you or your "employees" in the course of your business. The insurance provided under this policy applies to "bodily injury" or "property damage" arising out of the use of a "non -owned auto" by any person other than you in the course of your business. C. CHANGES IN EXCLUSIONS Solely with respect to the insurance provided by this endorsement: a. SECTION I — COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended by the deletion of the following Exclusion items: (c.) Liquor Liability; (e.) Employer's Liability; (g.) Aircraft, Auto or Watercraft; (h.) Mobile Equipment; (i.) War; 0.) Damage To Property; (k.) Damage To Your Product;( m.) Damage To Impaired Property Or Property Not Physically Injured; (n.) Recall Of Products, Work Or Impaired Property; and (o.) Personal And Advertising Injury. b. SECTION I — COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended by the addition of the following exclusions: ECC-353-0217 ©2018, Freberg Environmental, Inc. Page 1 of 3 i. "Bodily injury": a) To an "employee" of the insured arising out of and in the course of employment by the insured; or b) To the spouse, child, parent, brother or sister of that "employee" as a consequence of (1) above. This exclusion shall apply: a) Whether the insured may be liable as an employer or in any other capacity; b) To any obligation to share damages with or repay someone else who must pay damages because of injury; or c) To any liability assumed by the insured under an "insured contract". This exclusion shall not apply to: a) "Bodily injury" to "domestic employees" not entitled to worker's compensation benefits. ii. "Property damage": a) To any vehicle rented or hired under a written rental contract or agreement; or b) To property owned or transported by, or rented to or loaned to the insured or in the insured's care, custody or control. D. SECTION II — WHO IS AN INSURED is deleted in its entirety with respect to coverage afforded by this endorsement and replaced by the following: Each of the following is an insured under this insurance to the extent set forth below: a. You; b. Any other person using a "hired auto" with your permission in the course of your business; c. With respect to a "non -owned auto", any partner or "executive officer" of yours, or any employee of yours but only while such "non -owned auto" is being used in your business and only if the "non -owned auto" is not operated by you; or d. Any other person or organization, but only with respect to their liability because of acts or omissions of an insured under a., b. or c. above. None of the following is an insured under this insurance: a. Any person engaged in the business of his or her employer with respect to "bodily injury" to any co -"employee" of such person injured in the course of employment, or to the spouse, child parent, brother or sister of that co -"employee" as a consequence of such "bodily injury", or for any obligation so share "damages" with or repay someone else who must pay "damages" because of the injury; b. Any partner or "executive officer" with respect to an "auto" owned by such partner or "executive officer' or a member of their household; ..........— _......... ........ ................ ...-.. _.-.-..— ........ _.._-. —_...� ECC-353-0217 © 2018, Freberg Environmental, Inca Page 2 of 3 c. Any person while employed in or otherwise engaged in duties in connection with an "auto business", other than an "auto business" you own or operate; d. The owner or lessee, of whom you are a sublessee, of a "hired auto" or the owner or lessee of a "non -owned auto" or any agent or "employee" of any such owner or lessee; e. Any person or organization with respect to the conduct of any current or past partnership joint venture or limited liability company that is not shown as a Named Insured in the Declarations. E. DEFINITIONS: The following additional definitions apply to coverage provided by this endorsement: 1. "Auto business" means the business or occupation of selling, repairing, servicing, storing or parking "autos". 2. "Domestic employees" are persons engaged in household or domestic work performed principally in connection with a residence premises. 3. "Hired auto" means any "auto" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire, or rent under a lease or rental agreement for a period of 180 days or more or any "auto" you lease, hire, rent or borrow from any of your "employees", your partners or your "executive officers", or members of their households. 4. "Non -owned auto" means any "auto" you do not own, lease, hire, rent or borrow which is used in connection with your business. This includes "autos" owned by your "employees", your partners or your "executive officers, or members of their households, but only while used in your business. F. LIMITS The Sub -limits of Insurance shown in the Schedule above shall be the most we will pay regardless of the number of "hired autos", "non -owned autos", insureds, "claims" made, or "suits" brought, or persons or organizations making "claims" or "suits". The Each Occurrence Sub -Limit and the Aggregate Sub -Limit shown in the Schedule above are subject to and not in addition to the General Aggregate Limit shown in the Declarations, and any payments made under either such limit are part of and shall erode the General Aggregate Limit of Insurance shown in the Declarations. The Aggregate Limit indicated in the Schedule shown above, subject to the Each Occurrence Limit indicated in the Schedule shown above, is the most we will pay as "damages" for "bodily injury" or "property damage" sustained regardless of how many persons assert claims or "suits" against you. G. CHANGES IN CONDITIONS The insurance provided by this endorsement is excess over any of the other insurance covering the "hired auto" or "non -owned auto", whether primary, excess, contingent or on any other basis, that applies to "bodily injury" or "property damage" arising out of the use or maintenance of a "hired auto" or "non -owned auto". .............._ _....._...... __.... .......... ...._ _... ECC-353-0217 © 2018, Freberg Environmental, Inc. Page 3 of 3 DATE(MMIDDIYYYY) ACC)R� CERTIFICATE OF LIABILITY INSURANCE 02/03/2025 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 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 C N A d A 4 -_ EJMS Insurance Services PHONE FAX PO Box 33289 E-MAIL ^„ AIY3iB.__ ......... TqGCOVE Los Gatos., CA 95031 Chu_iNSUbb N ER Insurance e ComR a 1005 p Y 2 INSURER A: INSURED INSURER B : ,... gale/'ordan associates J INSURER C 3868 W. Carson Street, Suite 328 INSURER D : Torrance. CA 90503 INSURER E r+I`41bcILY A tl, C'iL. rcoTtctrwTc kit IRa12C17• RFVI-glnN NCI IMIR Rt 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 ..P"f EXP ';A-�ii?.... .-.� _............. ...-MIV ILTR T .-.-.."......,.... ...... _ _„W.._ LIMITS TYPE OFINSURANCE POLICY NUMBER IDDIYYYX� MMIDD+YYYY GENERAL LIABILITY EACH OCCURRENCE $� �., � MF tOARM r GENERALLIABILITY , P „ f+gp Ito pwUe pil,. $ CERCIAL ADE OCCUR �., .. I on) $ MED EXP (Any one person) „ ,...... .-„�,.. ... GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PERPRODUCTS -COMP/OP AGG $ V POLICY 1 LOC. I $ AUTOMOBILE I AU LIABILITY M INE0 IN L I 1 . ANY AUTO '.... BODILYINJURY(Per person) ..... $ ,,,, . ALL OWNED SCHEDULED BODILY INJURY (Per amidenq $ AUTOS - AUTOS NON -OWNED $ HIRED AUTOS AUTOS 0 4f-0n�kth,E UMBRELLALIAO OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGAT , G DED j I RETENTION $ a $ WORKERS COMPENSATION A AND EMPLOYERS' LIABILITY 1 (26) 7178-54-63 2/01/2025 2/01/2026 WC STATU- OTU I- x TORY.LlBllTS : 'tt _ s N ANY PROPRIETORIPARTNERIEXECUTIVE E L .EACH ACC DENT $ I 000 OOo - _ OFFICERIMEMBER EXCLUDED .L N / A LJ (Mandatory In NH) E L DISEASE � EMPLOYEE $ 1.000.000 ., ....,� ....P ........n..._,m.... .. R yyes. dirscroptn crnrattt OE.SCRIPTION OF OPERATIONS below _T E L DISEASE _ POLICY LIMIT $ 1,000,000 1 h ' I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Christopher K Gale - President: Excluded / Thomas A Jordan - Secretary / Treasurer: Excluded r"`con`•ICtr`A'rc.. LJnt 111=0 !_etJrFl I ATION City of El Segundo, Public Works Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 Main St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN El Segundo, CA 90245-3813 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE-...,., Daniel J Cloud �z (Id IUtiti-LULU AC.;QK UKt'UKAI IVn. i u rignts re5ervea. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability 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 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, 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 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: 3. Premium: The premium charge for this endorsement shall be 1 % 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: WC 90 03 75 (05/18) Authorized Representative Insured Copy