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PROOF OF INSURANCE (2017) CLOSEDAC CERTIFICATE OF LIABILITY INSURANCE 312120 6YYY)
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(es) 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 NANitls Noel Baxter
HMBD Insurance Services, Inc. (562) 439 -9731 AX (562)439 -4453
PHONE ..ITITITITmm. -..� FAX N l4
3633 East Broadway E'MAi ,,,nbaxter @hmbd.COM
INSURER(S) AFFORDING COVERAGE NAIC #
Beach CA 90803 -6035 I INSURER A: Travelers Pror, Cas
INSURED
Federal Technology Solutions, Inc.
1530 Consumer Cr. #102
Corona CA 92880
1 INSURER F;
COVERAGES CERTIFICATE NUMBER:16 -17 All Lines
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
INSPOLICY POL9CFF POLDCY EXP .
E' P
LTR TYPE OF INSURANCE POLICY NUMBER MM0DRYYY l D1YYYY1
_._ ...................................... _.....
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE_
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
i"fAIJf FSLFAI Iurr
�ro ruran�w0
$ 500,000
A
'.... CLAIMS -MADE :X OCCUR
Z LP- 51M54094
/1/2016
3/1/2017
_
MED EXP (Any one person)
$ 10,000
PERSONAL 8 ADV INJURY
$ 1,000,000
GENERALAGGREGArE
$ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP /OP AGG
$.... 2,000,000
POLICY X 21 LOC
$
AUTOMOBILE LIABILITY
COMBINED
Eaa actuda,N d 1 000,000
—��
A X ANY AUTO
BODILY INJURY (Per person) $
ALL OWNED SCHEDULED A- 8G727446 3/1/2016 /1/2017
AUTOS AUTOS
BODILY INJURY (Per accident) $
X X
Y DAMA(,;L $
HIRED AUTOS AUTOS
(Per Ra'I
as
I
combined single limit $
X UMBRELLA LIAB X OCCUR
EACH OCCURRENCE $ 4,000,000
A EXCESS LIAB CLAIMS -MADE
AGGREGATE $ 4,000,000
DE.O RETENTION $ UP- 71M51978 3/1/2016 3/1/2017
--
$
A WORKERS COMPENSATION
X WC STAr uU OTH
AND EMPLOYERS' LIABILITY Y,i N
(J,RY LIh�flT�
ECUTIVE .u,'""�j NIA
ACCIDENT
(Mandatory in BN HRdeEXCLUDED? J B- BG729845 /1/2016 3/1/2017
E L DISEASE EA EMPLOYEE $ 1, 00�0.
DESCRIPTION OF OPERATIONS below ..... ....... ........ ... uuuuu
E.L DISEASE - POLICY LIMIT $ 1 000 000
A Blanket Bus Pers Prop LP- 51M54094 /1/2016 3/1/2017
Special Iorrn, RC, $1,Q:WDed $500,000
''.... A Blanket BI & EE LP- 51M54094 /1/2016 3/1/2017
Special Foun, AA $600,000
DESCRIPTION OF OPERATIONS I LOCATIONS R VEIIICLCS (Attach ACORD 101, Additional Remarks. Schedule, if move space Is required)
General liability includes blanket additional insureds, primary /non -- contributory wording, & waiver of
subrogation when required by written contract, agreement, or permit per attached forms CGD2460805,
CGD4250708, CGD4170112. Auto liability includes blanket additional insureds and waiver of subrogation
per attached form CAT3530215. Blanket work comp waiver form WC990376 attached. City of E1 Segundo, its
officers, officials, employees, agents and volunteers.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of E1 Segundo ACCORDANCE WITH THE POLICY PROVISIONS.
350 Main Street
El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE
Todd Miller /GOWENS ✓,
ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved.
INS025 (201005) 01 The ACORD name and logo are registered marks of ACORD
Policy #ZLP- 51M54094
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED — (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury ",
"property damage" or "personal injury "; and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization.
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance ", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section III — Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury ", "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or sur-
veying services, including:
I. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products- completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The insurance provided to the additional insured
by this endorsement is excess over any valid and
collectible "other insurance ", whether primary,
excess, contingent or on any other basis, that is
available to the additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non - contributory basis,
this insurance is primary to "other insurance"
available to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance ". But the insurance provided to
the additional insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organization is
an additional insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc, Page 1 of 2
COMMERCIAL GENERAL LIABILITY
L How, when and where the 'occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the 'occurrence" or
offense.
b) If a claim is made or "suit' is brought against
the additional insured, the additional insured
must:
i. Immediately record the specifics of the
claim or "suit' and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit' as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit', cooperate
with us in the investigation or settlement of
the claim or defense against the "suit', and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit' to
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to 'other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
— DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the policy period
Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
Policy #ZLP- 51M54094
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE - ADDITIONAL INSUREDS -
PRIMARY AND NON - CONTRIBUTORY WITH RESPECT TO
CERTAIN OTHER INSURANCE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
The following is added to Paragraph 4. a., Primary
Insurance, of SECTION IV — COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS:
However, if you specifically agree in a written contract
or agreement that the insurance afforded to an addi-
tional insured under this Coverage Part must apply on
a primary basis, or a primary and non - contributory
basis, this insurance is primary to other insurance that
is available to such additional insured which covers
such additional insured as a named insured, and we
will not share with that other insurance, provided that:
(1) The "bodily injury" or "property damage" for which
coverage is sought is caused by an "occurrence"
that takes place; and
(2) The "personal injury" or "advertising injury" for
which coverage is sought arises out of an offense
that is committed;
subsequent to the signing and execution of that con-
tract or agreement by you.
CG D4 25 07 08 Q 2008 The Travelers Companies, Inc. Page 1 of 1
Policy #ZLP- 51M54094
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TECHNOLOGY XTE iD ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
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 this 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. Reasonable Force Property Damage — Ex-
ception To Expected Or Intended Injury Ex-
clusion
B. Non -Owned Watercraft Less Than 75 Feet
C. Aircraft Chartered With Pilot
D. Damage To Premises Rented To You
E. Increased Supplementary Payments
F. Who Is An Insured — Employees And Volun-
teer Workers — First Aid
G. Who Is An Insured — Employees — Supervi-
sory Positions
H. Who Is An Insured — Newly Acquired Or
Formed Organizations
I. Blanket Additional Insured — Owners, Manag-
ers Or Lessors Of Premises
J. Blanket Additional Insured — Lessors Of
Leased Equipment
PROVISIONS
A. REASONABLE FORCE PROPERTY DAMAGE —
EXCEPTION TO EXPECTED OR INTENDED IN-
JURY EXCLUSION
The following replaces Exclusion a., Expected Or
Intended Injury, in Paragraph 2., of SECTION I —
COVERAGES — COVERAGE A BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY:
K. Blanket Additional Insured — Persons Or Or-
ganizations For Your Ongoing Operations As
Required By Written Contract Or Agreement
L. Blanket Additional Insured — Broad Form
Vendors
M. Who Is An Insured — Unnamed Subsidiaries
N. Who Is An Insured — Liability For Conduct Of
Unnamed Partnerships Or Joint Ventures
O. Medical Payments — Increased Limits
P. Contractual Liability — Railroads
Q. Knowledge And Notice Of Occurrence Or Of-
fense
R. Unintentional Omission
S. Blanket Waiver Of Subrogation
B. NON -OWNED WATERCRAFT LESS THAN 75
FEET
The following replaces Paragraph (2) of Exclusion
g., Aircraft, Auto Or Watercraft, in Paragraph 2.
of SECTION I — COVERAGES — COVERAGE A
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY:
(2) A watercraft you do not own that is:
a. Expected Or Intended Injury Or Damage (a) Less than 75 feet long; and
"Bodily injury" or "property damage" expected or (b) Not being used to carry any person or
intended from the standpoint of the insured. This property for a charge.
exclusion does not apply to "bodily injury" or C. AIRCRAFT CHARTERED WITH PILOT
"property damage" resulting from the use of rea-
sonable force to protect any person or property. The following is added to Exclusion g., Aircraft,
Auto Or Watercraft, in Paragraph 2. of SECTION
CG D4 17 01 12 © 2012 The Travelers Indemnity Company, All rights reserved, Page 1 of 6
Includes copyrighted material of Insurance Services Office, Inc. with its permission,
COMMERCIAL GENERAL LIABILITY
I — COVERAGES — COVERAGE A BODILY IN-
JURY AND PROPERTY DAMAGE LIABILITY:
This exclusion does not apply to an aircraft that
is:
(a) Chartered with a pilot to any insured;
(b) Not owned by any insured; and
(c) Not being used to carry any person or prop-
erty for a charge.
D. DAMAGE TO PREMISES RENTED TO YOU
1. The first paragraph of the exceptions in Ex-
clusion j., Damage To Property, in Para-
graph 2. of SECTION I — COVERAGES —
COVERAGE A BODILY INJURY AND
PROPERTY DAMAGE LIABILITY is deleted.
2. The following replaces the last paragraph of
Paragraph 2., Exclusions, of SECTION I —
COVERAGES — COVERAGE A BODILY IN-
JURY AND PROPERTY DAMAGE LIABIL-
ITY:
Exclusions c., g. and h., and Paragraphs (1),
(3) and (4) of Exclusion j., do not apply to
"premises damage ". Exclusion f.(1)(a) does
not apply to "premises damage" caused by
fire unless Exclusion f. of Section I — Cover-
age A — Bodily Injury And Property Damage
Liability is replaced by another endorsement
to this Coverage Part that has Exclusion - All
Pollution Injury Or Damage or Total Pollution
Exclusion in its title. A separate limit of insur-
ance applies to "premises damage" as de-
scribed in Paragraph 6. of Section III — Limits
Of Insurance.
3. The following replaces Paragraph 6. of SEC-
TION III — LIMITS OF INSURANCE:
6. Subject to 5. above, the Damage To
Premises Rented To You Limit is the
most we will pay under Coverage A for
damages because of "premises damage"
to any one premises.
The Damage To Premises Rented To
You Limit will be:
a. The amount shown for the Damage
To Premises Rented To You Limit on
the Declarations of this Coverage
Part; or
b. $300,000 if no amount is shown for
the Damage To Premises Rented To
You Limit on the Declarations of this
Coverage Part.
4. The following replaces Paragraph a. of the
definition of "insured contract" in the DEFINI-
TIONS Section:
a. A contract for a lease of premises. How-
ever, that portion of the contract for a
lease of premises that indemnifies any
person or organization for "premises
damage" is not an "insured contract";
5. The following is added to the DEFINITIONS
Section:
"Premises damage" means "property dam-
age" to:
a. Any premises while rented to you or tem-
porarily occupied by you with permission
of the owner; or
b. The contents of any premises while such
premises is rented to you, if you rent such
premises for a period of seven or fewer
consecutive days.
6. The following replaces Paragraph 4.11b.(1)(b)
of SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS:
(b) That is insurance for "premises damage ";
or
7. Paragraph 4.b.(1)(c) of SECTION IV —
COMMERCIAL GENERAL LIABILITY COW
DITIONS is deleted.
E. INCREASED SUPPLEMENTARY PAYMENTS
1. The following replaces Paragraph 1.b. of
SUPPLEMENTARY PAYMENTS — COVER-
AGES A AND B of SECTION I — COVER-
AGES:
b. Up to $2,500 for cost of bail bonds re-
quired because of accidents or traffic law
violations arising out of the use of any
vehicle to which the Bodily Injury Liability
Coverage applies. We do not have to fur-
nish these bonds,
2. The following replaces Paragraph 1.d. of
SUPPLEMENTARY PAYMENTS — COVER-
AGES A AND B of SECTION I — COVER-
AGES:
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"suit ", including actual loss of earnings up
to $500 a day because of time off from
work.
Page 2 of 6 © 2012 The Travelers Indemnity Company, All rights reserved. CG D4 17 01 12
Includes copyrighted material of Insurance Services Office, Inc, with its permission
F. WHO IS AN INSURED — EMPLOYEES AND
VOLUNTEER WORKERS — FIRST AID
1. The following is added to the definition of "oc-
currence" in the DEFINITIONS Section:
Unless you are in the business or occupation
of providing professional health care services,
"occurrence" also means an act or omission
committed by any of your "employees" or
"volunteer workers ", other than an employed
or volunteer doctor, in providing or failing to
provide first aid or "Good Samaritan services"
to a person.
2. The following is added to Paragraph 2.a.(1) of
SECTION II — WHO IS AN INSURED:
Unless you are in the business or occupation
of providing professional health care services,
Paragraphs (1 )(a), (b), (c) and (d) above do
not apply to "bodily injury" arising out of pro-
viding or failing to provide first aid or "Good
Samaritan services" by any of your "employ-
ees" or "volunteer workers ", other than an
employed or volunteer doctor. Any of your
"employees" or "volunteer workers" providing
or failing to provide first aid or "Good Samari-
tan services" during their work hours for you
will be deemed to be acting within the scope
of their employment by you or performing du-
ties related to the conduct of your business.
3. The following is added to Paragraph 5. of
SECTION III — LIMITS OF INSURANCE:
For the purposes of determining the applica-
ble Each Occurrence Limit, all related acts or
omissions committed by any of your "employ-
ees" or "volunteer workers" in providing or
failing to provide first aid or "Good Samaritan
services" to any one person will be deemed to
be one "occurrence ".
4. The following is added to the DEFINITIONS
Section:
"Good Samaritan services" means any emer-
gency medical services for which no compen-
sation is demanded or received.
G. WHO IS AN INSURED — EMPLOYEES — SU-
PERVISORY POSITIONS
COMMERCIAL GENERAL LIABILITY
your "employees" who hold a supervisory posi-
tion.
H. WHO IS AN INSURED — NEWLY ACQUIRED
OR FORMED ORGANIZATIONS
The following replaces Paragraph 4. of SECTION
II — WHO IS AN INSURED of the Commercial
General Liability Coverage Form, and Paragraph
3. of SECTION II — WHO IS AN INSURED of the
Global Companion Commercial General Liability
Coverage Form, to the extent such coverage
forms are part of your policy:
Any organization you newly acquire or form, other
than a partnership or joint venture, of which you
are the sole owner or in which you maintain the
majority ownership interest, will qualify as a
Named Insured if there is no other insurance
which provides similar coverage to that organiza-
tion. However:
a. Coverage under this provision is afforded
only:
(1) Until the 180th day after you acquire or
form the organization or the end of the
policy period, whichever is earlier, if you
do not report such organization in writing
to us within 180 days after you acquire or
form it; or
(2) Until the end of the policy period, when
that date is later than 180 days after you
acquire or form such organization, if you
report such organization in writing to us
within 180 days after you acquire or form
it, and we agree in writing that it will con-
tinue to be a Named Insured until the end
of the policy period;
b. Coverage A does not apply to "bodily injury"
or "property damage" that occurred before
you acquired or formed the organization; and
c. Coverage B does not apply to "personal in-
jury" or "advertising injury" arising out of an
offense committed before you acquired or
formed the organization.
I. BLANKET ADDITIONAL INSURED — OWNERS,
MANAGERS OR LESSORS OF PREMISES
The following is added to SECTION II — WHO IS
AN INSURED:
The following is added to Paragraph 2.a.(1) of Any person or organization that is a premises
SECTION II — WHO IS AN INSURED: owner, manager or lessor is an insured, but only
with respect to liability arising out of the owner -
Paragraphs (1)(a), (b) and (c) above do not apply ship, maintenance or use of that part of any prem-
to "bodily injury" or "personal injury" to a co- ises leased to you.
"employee" in the course of the co-"employee's" The insurance provided to such premises owner,
employment by you arising out of work by any of manager or lessor does not apply to:
CG D4 17 01 12 © 2012 The Travelers Indemnity Company. All rights reserved, Page 3 of 6
Includes copyrighted material of Insurance Services Office, Inc with its permission.
COMMERCIAL GENERAL LIABILITY
a. Any "bodily injury" or "property damage"
caused by an "occurrence" that takes place,
or "personal injury" or "advertising injury"
caused by an offense that is committed, after
you cease to be a tenant in that premises; or
b. Structural alterations, new construction or
demolition operations performed by or on be-
half of such premises owner, manager or les-
sor.
J. BLANKET ADDITIONAL INSURED — LESSORS
OF LEASED EQUIPMENT
The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that is an equipment
lessor is an insured, but only with respect to liabil-
ity for "bodily injury ", "property damage ", "per-
sonal injury" or "advertising injury" caused, in
whole or in part, by your acts or omissions in the
maintenance, operation or use by you of equip-
ment leased to you by such equipment lessor.
The insurance provided to such equipment lessor
does not apply to any "bodily injury" or "property
damage" caused by an "occurrence" that takes
place, or "personal injury" or "advertising injury"
caused by an offense that is committed, after the
equipment lease expires.
K. BLANKET ADDITIONAL INSURED — PERSONS
OR ORGANIZATIONS FOR YOUR ONGOING
OPERATIONS AS REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT
The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that is not otherwise
an insured under this Coverage Part and that you
have agreed in a written contract or agreement to
include as an additional insured on this Coverage
Part is an insured, but only with respect to liability
for "bodily injury" or "property damage" that:
a. Is caused by an "occurrence" that takes place
after you have signed and executed that con-
tract or agreement; and
b. Is caused, in whole or in part, by your acts or
omissions in the performance of your ongoing
operations to which that contract or agree-
ment applies or the acts or omissions of any
person or organization performing such op-
erations on your behalf.
The limits of insurance provided to such insured
will be the limits which you agreed to provide in
the written contract or agreement, or the limits
shown in the Declarations, whichever are less.
L. BLANKET ADDITIONAL INSURED — BROAD
FORM VENDORS
The following is added to SECTION II — WHO IS
AN INSURED:
Any person or organization that is a vendor and
that you have agreed in a written contract or
agreement to include as an additional insured on
this Coverage Part is an insured, but only with re-
spect to liability for "bodily injury" or "property
damage" that:
a. Is caused by an "occurrence" that takes place
after you have signed and executed that con-
tract or agreement; and
b. Arises out of "your products" which are dis-
tributed or sold in the regular course of such
vendor's business.
The insurance provided to such vendor is subject
to the following provisions:
a. The limits of insurance provided to such ven-
dor will be the limits which you agreed to pro-
vide in the written contract or agreement, or
the limits shown in the Declarations, which-
ever are less.
b. The insurance provided to such vendor does
not apply to:
(1) Any express warranty not authorized by
you;
(2) Any change in "your products" made by
such vendor;
(3) Repackaging, unless unpacked solely for
the purpose of inspection, demonstration,
testing, or the substitution of parts under
instructions from the manufacturer, and
then repackaged in the original container;
(4) Any failure to make such inspections, ad-
justments, tests or servicing as vendors
agree to perform or normally undertake to
perform in the regular course of business,
in connection with the distribution or sale
of "your products ";
(5) Demonstration, installation, servicing or
repair operations, except such operations
performed at such vendor's premises in
connection with the sale of "your prod-
ucts"; or
(6) "Your products" which, after distribution
or sale by you, have been labeled or re-
labeled or used as a container, part or in-
gredient of any other thing or substance
by or on behalf of such vendor.
Page 4 of 6 © 2012 The Travelers Indemnity Company. All rights reserved, CG D4 17 01 12
Includes copyrighted material of Insurance Services Office, Inc, with its permission.
Coverage under this provision does not apply to:
a. Any person or organization from whom you
have acquired "your products ", or any ingre-
dient, part or container entering into, accom-
panying or containing such products; or
b. Any vendor for which coverage as an addi-
tional insured specifically is scheduled by en-
dorsement.
W WHO IS AN INSURED — UNNAMED SUBSIDI-
ARIES
The following is added to SECTION II — WHO IS
AN INSURED:
Any of your subsidiaries, other than a partnership
or joint venture, that is not shown as a Named In-
sured in the Declarations is a Named Insured if:
a. You maintain an ownership interest of more
than 50% in such subsidiary on the first day
of the policy period; and
b. Such subsidiary is not an insured under simi-
lar other insurance.
No such subsidiary is an insured for "bodily injury"
or "property damage" that occurred, or "personal
injury" or "advertising injury" caused by an of-
fense committed:
a. Before you maintained an ownership interest
of more than 50% in such subsidiary; or
b. After the date, if any, during the policy period
that you no longer maintain an ownership in-
terest of more than 50% in such subsidiary.
N. WHO IS AN INSURED — LIABILITY FOR CON-
DUCT OF UNNAMED PARTNERSHIPS OR
JOINT VENTURES
The following replaces the last paragraph of
SECTION II — WHO IS AN INSURED:
No person or organization is an insured with re-
spect to the conduct of any current or past part-
nership or joint venture that is not shown as a
Named Insured in the Declarations. This para-
graph does not apply to any such partnership or
joint venture that otherwise qualifies as an in-
sured under Section II — Who Is An Insured.
O, MEDICAL PAYMENTS — INCREASED LIMITS
The following replaces Paragraph 7. of SECTION
III — LIMITS OF INSURANCE:
COMMERCIAL GENERAL LIABILITY
(b) The amount shown on the Declarations of
this Coverage Part for Medical Expense
Limit.
P. CONTRACTUAL LIABILITY — RAILROADS
1. The following replaces Paragraph c. of the
definition of "insured contract" in the DEFINI-
TIONS Section:
c. Any easement or license agreement;
2. Paragraph f.(1) of the definition of "insured
contract" in the DEFINITIONS Section is de-
leted.
Q. KNOWLEDGE AND NOTICE OF OCCUR-
RENCE OR OFFENSE
The following is added to Paragraph 2., Duties In
The Event of Occurrence, Offense, Claim or
Suit, of SECTION IV — COMMERCIAL GEN-
ERAL LIABILITY CONDITIONS:
e. The following provisions apply to Paragraph
a. above, but only for the purposes of the in-
surance provided under this Coverage Part to
you or any insured listed in Paragraph 1. or 2.
of Section II — Who Is An Insured:
(1) Notice to us of such 'occurrence" or of-
fense must be given as soon as practica-
ble only after the 'occurrence" or offense
is known to you (if you are an individual),
any of your partners or members who is
an individual (if you are a partnership or
joint venture), any of your managers who
is an individual (if you are a limited liability
company), any of your trustees who is an
individual (if you are a trust), any of your
"executive officers" or directors (if you are
an organization other than a partnership,
joint venture, limited liability company or
trust) or any "employee" authorized by
you to give notice of an 'occurrence" or
offense.
(2) If you are a partnership, joint venture, lim-
ited liability company or trust, and none of
your partners, joint venture members,
managers or trustees are individuals, no-
tice to us of such 'occurrence" or offense
must be given as soon as practicable only
after the "occurrence" or offense is known
by:
7. Subject to 5. above, the Medical Expense (a) Any individual who is:
Limit is the most we will pay under Coverage (i) A partner or member of any part-
C for all medical expenses because of "bodily
injury" sustained by any one person, and will nership or joint venture;
be the higher of: (ii) A manager of any limited liability
(a) $10,000; or company;
CG D4 17 01 12 © 2012 The Travelers Indemnity Company, All rights reserved. Page 5 of 6
Includes copyrighted material of Insurance Services Office, Inc. with its permission,
COMMERCIAL GENERAL LIABILITY
(iii) A trustee of any trust; or
(iv) An executive officer or director of
any other organization;
that is your partner, joint venture
member, manager or trustee; or
(b) Any "employee" authorized by such
partnership, joint venture, limited li-
ability company, trust or other organi-
zation to give notice of an "occur-
rence" or offense.
(3) Notice to us of such "occurrence" or of-
fense will be deemed to be given as soon
as practicable if it is given in good faith as
soon as practicable to your workers'
compensation insurer. This applies only if
you subsequently give notice to us of the
"occurrence" or offense as soon as prac-
ticable after any of the persons described
in Paragraphs e. (1) or (2) above discov-
ers that the "occurrence" or offense may
result in sums to which the insurance
provided under this Coverage Part may
apply.
However, if this policy includes an endorse-
ment that provides limited coverage for "bod-
ily injury" or "property damage" or pollution
costs arising out of a discharge, release or
escape of "pollutants" which contains a re-
quirement that the discharge, release or es-
cape of "pollutants" must be reported to us
within a specific number of days after its
abrupt commencement, this Paragraph e.
does not affect that requirement.
R. UNINTENTIONAL OMISSION
The following is added to Paragraph 6., Repre-
sentations, of SECTION IV — COMMERCIAL
GENERAL LIABILITY CONDITIONS:
The unintentional omission of, or unintentional er-
ror in, any information provided by you which we
relied upon in issuing this policy will not prejudice
your rights under this insurance. However, this
provision does not affect our right to collect addi-
tional premium or to exercise our rights of cancel-
lation or nonrenewal in accordance with applica-
ble insurance laws or regulations.
S. BLANKET WAIVER OF SUBROGATION
The following is added to Paragraph 8., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV — COMMERCIAL GENERAL LI-
ABILITY CONDITIONS:
If the insured has agreed in a contract or agree-
ment to waive that insured's right of recovery
against any person or organization, we waive our
right of recovery against such person or organiza-
tion, but only for payments we make because of:
a. "Bodily injury" or "property damage" caused
by an "occurrence" that takes place; or
b. "Personal injury" or "advertising injury"
caused by an offense that is committed;
subsequent to the execution of the contract or
agreement.
Page 6 of 6 © 2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12
Includes copyrighted material of Insurance Services Office, Inc, with its permission,
Policy #BA- 8G727446
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.
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) We may, at our discretion, participate
E. SUPPLEMENTARY PAYMENTS — INCREASED
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
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.
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 A.4.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 A.4., 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-
tent required of you by a written contract
We will pay up to $400 for "loss" to wearing ap- 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.
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.
L�»��w WORKERS COMPENSATION
L'1'
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 ( A) —
POLICY NUMBER:
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 % of the California workers' compensation pre-
mium.
Schedule
Person or Organization
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 3/1/2016 Policy No. UB- 8G729845 Endorsement No.
Insured Premium
Insurance Company Travelers Prop Cas Co of America Countersigned by
DATE OF ISSUE: - ST ASSIGN: Page 1 of 1