Loading...
PROOF OF INSURANCE (2017) CLOSED" SUPETAN -01 _,_.... ELIM ACORO" r DATE (MMIDD /YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/16/2016 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 CONTACT ""� ........ ". ". "." NAME: James P. Bennett & Company PHONE i=Ytt 310) 450-9184 [FA k License #0210226 (..., _ (A C N gyp: (310y 452 - 7515 2716 Ocean Park Blvd., Suite 1045 EMAIL Santa Monica, CA 90405 Arai R, SS __ ...- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSURER(S) AFFORDING COVERAGE ._ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NAIC # �...,,,,. ,m.. -..., ,�, �. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL ......._ ...... .. ......... INSURER Surplus Lines Insurance Company 1..... EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, 13604 --- INSURED LTR ,...mm, TYPE OF INSURANCE .. .... I I' M/R POLICY NUMBER IMMILDDY EFF PM /DDfY xi' INSR '�` 59 r. IYYYYI IMMIDDIYYYYI .................... - .. _..- .... -. -. ..�;_._. , .. ..... ...... ... ... , INSURER B: Starr Indemnity & Liability Company ... _.. .,.,.� 38318 Superior Tank Solutions, Inc. 5,000,000 INSURER C DAMAGE TG RENTTC 100,00 9500 Lucas Ranch Road PR MUl�ES,(LaocrAmem�.e) $ INSURER D: . ...... �,,,,,,,, ,,,,,,,,,,,,,,,, MED EXP (Any one person) $ Rancho Cucamonga, CA 91730 INSURER E 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,000,000 INSURER F: PRODUCTS COMP /OP AGG $ 5,000,00 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 HAVE BEEN REDUCED BY PAID CLAIMS, LTR ,...mm, TYPE OF INSURANCE .. .... I I' M/R POLICY NUMBER IMMILDDY EFF PM /DDfY xi' INSR '�` 59 r. IYYYYI IMMIDDIYYYYI .................... - .. "` ..................... LIMITS .. ... _.. .,.,.� A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS FXIOCCUR X X 1000066106161 02101/2016 0210112017 DAMAGE TG RENTTC 100,00 .. -MADE PR MUl�ES,(LaocrAmem�.e) $ . ...... �,,,,,,,, ,,,,,,,,,,,,,,,, MED EXP (Any one person) $ 5,006 PERSONAL & ADV, NJURY $ ... 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 5,000,000 POLICY T PR� LOC PRODUCTS COMP /OP AGG $ 5,000,00 AUTOMOBILE LIABILITY LOMONED SINGLE. LIiW $ !Eq ggigent) 1,000,000 ANY AUTO X X 1000066106161 02/0112016 0210112017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS ...,. .. BODILY INJURY (Per accidenl) $ ..� . ... ... X HIRED AUTOS X NON - OWNEDPROPERTY _.- . -. -.. , AUTOS .., MACwt $ (POraa0gHgan9y ........._.. ------------------- . _.. _ ....., m,. m,. m,�..H�.d....___________..m.._� UMBRELLA LIAB X OCCUR - ...._ EACH OCCY,RRE­NCE11 $ 5,000,00 A X EXCESSLIAB ,pE 1000336845161 02/01/2016 02/01/2017 AGGREGATE $ 5,000,00 DED C C RETENTION $ $ __..w..,... _.,...,.,.I.. ..L.....m..,�. H AND EMPLOYERS' LIABILITY YNN X ST FIR, B ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ X 100 0002002-0 02/01/2016 02/01/2017 OFFICER/MEMBER EXCLUDED? N / A E L EAATUTE EACH ACCIDENT $ � •" 1,000,000 (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E,L, DISEASE - POLICY LIMIT $ ................. -- ... ------_ 1,000,000 ...DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD ... .. ......._.,,. w.,,_. w ..............................._..... w.... w„......,.............._......,....................................... ---- 101, Additional Remarks Schedule, may be attached if more space Is required) ................... . ,.,.,.,.,. 30 days notice of cancellation except 10 days for non - payment. The City of El Segundo, its officers, officials, employees, agents, and volunteers are named as Additional Insureds as respects General Liability and Auto Liability. Primary wording and waiver of subrogation applies per company forms attached for General Liability. Waiver of subrogation form for Workers' Compensation applies. ..... ......_.m....... . ...... ... - ... . � .._......... _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY CLERK City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 1000066106161 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I ;fti R�. OR 01i a 011 This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract 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 fiabirdy 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 ads 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 some project, 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000066106161 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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) Or Where Required By Written Contract 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 wig not be broader than that which you are Location And Description Of Completed Where Required By Written Contract 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 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. CG 20 37 0413 0 Insurance Senrioes Office, Inc., 2012 Page 1 of 1 *Starr Surplus tines Insurance Company Chicago, IL 1- 646- 227 -6300 Primary and Non-contributory, Additional Insured and Waiver of Subrogation Policy Number: 1000066106161 Effective Date: February 1, 2016 at 12:01 A.M. Named Insured: Superior Tank Solutions, Inc. This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. Commercial General Liability Coverage Form Owners and Contractors Protective Liability Coverage Form Products /Completed Operations Liability Coverage Form Contractors Pollution Liability Coverage Form Professional Liability Coverage Form Site Pollution Liability Coverage Form SCHEDULE Where Required By Written Contract A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the schedule of this endorsement, but only with respect to liability arising out of "your work" for that insured by or for you. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage" arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insured's shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against these additional insured's because of payments we make for injury or damage arising out of "your work" done under a written contract with the additional insured. 3. The term insured is used separately and not collectively, but the inclusion of more than one insured shall not increase the limits or coverage provided by this insurance. Insureds and Agents are advised that certificates of insurance should be used only to provide evidence of insurance in lieu of an actual copy of the applicable insurance policy. Certificates should not be used to amend, expand or otherwise alter the terms of the actual policy. All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY Charles H. Da Belo, President Nehemiah E. Ginsburg, GeneraVCounsel SL 023 (06111) Page 1 of 1 Copyright m C. V. Starr 6 Company and Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of ISO Proportlas, Inc.. used with lie permission. POLICY NUMBER: 1000066106161 COMMERCIAL GENERAL LIABILITY CG 20 010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modff m insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART PRODUCTS1COMPL ETED 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 prlmery to and WHI not seek conntutlon from any other Insurance avalloble, to an additional Insured under your policy provided that: 11) The additional Insured is a Named Insured, under such other twurance, and (2) You have 89AXW In writing Ina =Wd or agreement that thls Insurance would be 9 mary and would not seek contribution m any other Insurance avallobte to the ,additional insured. CO 20 010413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000066106161 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVER'T AGAINST This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Where Required By Written Contract (tf no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) r w snr z•. w • • w •. • • :• M rZ1 w: rulcauun sbbwn In the Schedule. CG 24 04 1185 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 11 O INSURED: Superior Tank Company POLICY NUMBER: 810-6C539549- TCT -16 POLICY TERM: 2/1/2016 to 2/1/2017 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS I ESS 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 11— 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.S., 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 63 0216 ® 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. 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 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 in defending the "insured" against, or 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 the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COW "suit ", but only up to and included "s 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 11 — 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 Of 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 0215 Includes copyrighted material of Insurance Services Office, Inc. with its permisslon. 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 AA.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 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 0215 ® 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Oflice, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non - renewal. 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. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization 2 . o 0 of the California workers' compensation premium Schedule Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Job Description Where required by contract 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: 02/01/2016 Insured: SUPERIOR TANK COMPANY, INC. Insurance Company: STARR INDEMNITY & LIABILITY CO WC 04 03 06 (Ed. 04 -84) Policy No.: 100 0002002 Endorsement No.: 001 Premium: $271,824.00 Countersigned by:� Page 1 of 1