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PROOF OF INSURANCE (2017) CLOSEDACRD CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 11/7/2016 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 San Marcos- Alliant Insurance Services, Inc. 570 Rancheros Dr Ste 100 San Marcos CA 92069 INSURED Downstream Services, Inc. 2855 Progress Place Escondido CA 92029 NAME: CONTACT Kay Helmick PHONE r,. 760 - 304 -7121 ADDRESS: E-MAIL khelmick ©alliant.com INSURER(S) AFFORDING COVERAGE INSURER A :Valley Forge Insurance Company DOWNSER -01 INSURER B : Continental Insurance Company 1 INSURER C : National Fire Insurance Co of Hartf I INSURER D : I INSURER E : I INSURER F : COVERAGES CERTIFICATE NUMBER: 601020160 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM /DD /YYYY) (MM/DD/YYYY) C X COMMERCIAL GENERAL LIABILITY Y Y 2094163615 11/15/2016 11/15/2017 FAX NM: 760-304-7743 (A / NAIC # 20508 35289 20478 CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO- JECT LOC OTHER: B AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS X HIRED AUTOS A X UMBRELLA LIAB EXCESS LIAB ■ SCHEDULED AUTOS NON -OWNED AUTOS X OCCUR CLAIMS -MADE DED X RETENTION $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N Y Y 5091396971 N/A 11/15/2016 11/15/2017 2094163629 11/15/2016 11/15/2017 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OP AGG PD Deductible COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $1,000,000 $100,000 $15,000 $1,000,000 $2,000,000 $2,000,000 $5,000 $2,000,000 $10,000,000 $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: MAINTENANCE AGREEMENT, CITY WIDE LOCATIONS INSTRUMENTATION MAINTENANCE. CITY OF EL SEGUNDO, ITS OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED, WAIVER OF SUBROGATION APPLIES. 30 DAY NOC APPLIES. CERTIFICATE HOLDER CITY OF EL SEGUNDO PUBLIC WORKS 350 MAIN STREET EL SEGUNDO CA 90245 -3813 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD (LO 0 0 0 0 0 CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement with respect to such provision do not apply. TABLE OF CONTENTS 1. Additional Insureds 2. Additional Insured - Primary And Non-Contributory To Additional Insured's Insurance 3. Bodily Injury - Ex. :,Inded Definition 4. Broad Knowledge of Occurrence/ Notice of Occurrence 5. Broad Named Insured 6. Broadened Liability Coverage For Damage To Your Product And Your Work 7. Contraclual Liability - Railroads 8. Electronic Data Liability 9. Estates, Legal Representatives and Spouses 10. Ex . ted Or Intended Injury - Exception for R sonable Force 11. General Aggregate Limits of Insurance - Per Protect 12. In Rem Actions 13, Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Lim,ited Liability Companies 15. L al Liability - Da age To Premises / Alienated Premises / Pro Care, Custody or Control 16. Liquor Liabilfty 17. Medical Payments 18. Non-owned Aircr Coverage 19. Non-owned Watercraft 20. Per *nal And Advertising Injury - Discrimination or Humiliation 21. Personal And Advertising Injury - Contractual Liability 22. Property Damage - Elevators, 23. Supplementary Payments, 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subr ation - Blanket 26. Wrap-Up Extension: OCIP COP, or Consolidated (Wrap-Up) Insurance Pr rams n The Named Insured's CNA74705XX (1-15) Page 1 of 17 Nat'l Fire Ins Co of Hartford Insured Name: DOWNSTREAM SERVICES INC . Copyrighi CNA Ail Rights Reserved Includes copyrhghted material 01 Insurance ServIces °Him lnc,, with Its per cm Policy No: 2094163615 Endorsement No: Effective Datec 11/15/2015 CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through H. below whom a Named Insur is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during. the term of this Coverage Part; and (2) was executed prior to: (a) the *1** ily Injury or property damage; or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage, b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with': (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A. through H. below. Any coverage granted by this endorsement shall apply only to the extent permissible by Ilaw, A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liabty for ''.0.44:11y injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or tor such addition& insured, B. Co-owner of Insured Premi A co-owner of a premises co-owned by a Named Insured and covered under this insuranc but only with respect ly injury; pr damage or personal and advertising injury as co-owner to such co-owner's liability for of such premises. C. Lessor of Equipment O * Any person or organization from whom a Named Insured leases equipment but only with respect to liability for ily injury, pro rty damage or personal and advertising injury caused, in whole or in part, by the Named Insured's maintenance, operation or use of such equipment provided that the occurren giving rise to such ily injury, proicerty damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. 0 0 0 o * o D. Le 4. 0 r of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for ily injury, pr rty dam or per nal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such lily Injury, p rty damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by. on behalf of, or for such additional insured, CNA74705XX (1-15) Page 2 0117 Nat'l Fire Ins CO of Hartford Insured Name: DOWNSTREAM SERVICES INC . Copyright CNA All Rights Reserved. 0 0 Policy No; 2094163615 Endorsement No: 1 Effective Date: 11/15/2015 Includes copyrighted material of Insurance Services Oltice„ Inc., with Its permission,. CNA E. Lessor of Pre ises CNA PARAM CUNT Contractors' General Liability Extension Endorsement An owner or lessor of premises leased to the Named Insured„ or such owner or lessor's reai estate manager, but only with respect to liability for ily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense: giving rise to such personal and advertising injury, takes place prior to the termination of such lease„ The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured, F. Mortgagee, A ign or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for injury, property damage or personal and advertising injury arising out of the Named Insured's ownership, maintenance, or use of a premises by a Nam Insured„ The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured, G. State or Governmental A !,1,ncy or Subdivision or Political Subdivisions — Permits A state or governmental agency or subdivision or political sulbdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for ily injury, property damage or personal and advertising injury arising out of: 1. the following hazards in connection with premises, a Named Insured owns, rents, or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk, vaults, street banners, or decorations and similar exposures; or b. the construction, erection, or removal of elevators; or c. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted or authorized operations performed by a Named Insured or on a INamed Insured's behalf, The coverage granted by this paragraph does, not apply to: a. Bodily injury„ property damage or personal and advertising injury arising out of operations performed, for the state or governmental agency or subdivision or political subdivision,,, OT b. ..ily injury or property damage included within the pr ..ucts-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. H. Trade Show Event Lessor 1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization' whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization's liability for Hy injury, pr rty damage or personal and advertising injury caused by: a. the Named Insured's acts or omissions; or b. the acts or omissions of those acting on the Nam lnsureds behalf, CNA74705XX (1-15) Page 3 of 17 Nat'l Fire Ins, CO of Hartford„ in,sured Name: DOWNSTREAM SERVICES , INC . Copyrigni CNA Ail Rights Reserved, includes copyrighted material of Insurance Services Mae, Inc., with Its permission, Policy No; 2094163615 Endorsement No:, 1 Effective Date: 11/15/2015 CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement in the performance of the Named Insured's ongoing op rations at the trade show event premises during the trade show event 2. The coverage granted by this paragraph does not apply 10 the products-completed operations. hazard. ly injury or p go included within 2. ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL !NSW EL'S INSURANCE 3. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insureds own insurance, then, this insurance is primary, and the Insurer will not seek contribution from that other insurance, For the purpose of this Provision 2., the additional insureds own insurance means insurance on which the a,dditional insured is a named insured, Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization 0 ILY INJURY — EXPANDED DEFINITION Under DEFINITIONS, the definition ot ily injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death„ humiliation„ shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury, sickness or disease, 4. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE OF OCCURRENCE Under CONDITIONS, the condition ntitied Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the insurer' or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner: executive officer, manager or member of a Named Insured, or an employee, designated by any of the above to give such notice, B. NOTICE OF OCCURRENCE The Named Insured's rights under this Cover Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Nam Insured's reasonable belief that the Uy injury or pr rty dam is not covered under this Coverage Part However, the Named Insured shall giv written notice of such occurrence, offense, or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence, offense or claim.. 5. BROAD NAMED INSURED WHO IS AN INSURED is amended to delete its Paragraph 3, in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4, below, any organization in which a Named Insured has management control: 0. on the effective date of this Coverage Part, or b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary, contributory, excess, contingent or otherwise, which, provides coverage to such organization, or which would have provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or narrower than that provided by this insurance: CNA74705XX (1-15) Policy No: 2094163615 Page 4 of 17 Endorsement No: Nat'l Fire, Ins Co of Hartford Moths° Date: 11/15 / 2015 insured Name: DOWNSTREAM SERVICES INC . Copyright CNA All Rights Reserved. Indudes copyrighted material o'l lnsurame Services Office, Inc., with Its permission CNA CNA PARAM OUNT Contractors' General Liability Extension Endorsement But this BROAD NAMED INSURED provision does not apply to: (a) any partnership, limited liability company or joint venture; or (b) any organization for which coverage is excluded by another endorsement attached to this Coverage Part. For the purpose of this provision, management ,control means: A. owning interests representing more than 50% of the voting„ appointment or designation power for the selection' of a majority of the Board of Directors of a corporation; or B. having the right, pursuant to a written trust agreement, to protect, control the use of, encumber Of transfer or sell property held by a trust 4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to: a. b. 0,1O* ily injury or property damage that first occurred prior to the date of management control, or that 'first occurs after management control ceases; nor personal or advertising injury caused by an offense that first occurred prior to the date of management control or that first occurs after management control ceases. 5. The insurance provided by this Coverage Part applies, to Named Insureds when trading under the own names or under such other trading names or doing-business-as names (dba) as any Named Insur should choose to employ. 6. BROADENEt LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK A. Under COVERAGES, Coverage A — Bodily Injury and Pr.,. arty Damage Liability„ the paragraph entitled Exclusions is amended to delete exclusions k. and 1. and replace the m with the foilowing: This insurance does not apply to; k. Damage to Your Pr uct Property damage to your product arising out of it, or any part of it except when caused by or resulting from: (1) fire; (2) smoke (3) collapse; or (4) explosion, I. Damage to Your Work Property damage to your work arising out of it, or any part of it and included in the products-completed operations hazard This exclusion does not apply: (1) if the damaged work,. or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor; or (2) It the cause of loss to the damaged work arises as a result of: (a) fire; (b) smoke; (c) collapse; or CNA74705XX ( -15) Page 5 of 17 Nat'l Fire, Ins Co of Hartford Insured Name,: DOWNSTREAM SERVICES, INC Copyright CNA All Rights Reserved includes copyrighted material of Insurance Services Mice, Inc, Mb is peu Policy No: 2094163615 Endorsement No: Effective Date: 11/15/2015 ludiAludiAludiAludiAlu,,u,,,u,,,u,,,u,,,u,,,u,Idd a 1. on CNA Contractors' Genera (d) explosion. The foliowing paragraph is added to LIMITS OF INSURANCE: CNA PARAMOUNT Liability Extension Endorsement Subject to 5. above,, $100,000 is the most the Insurer will pay under Coverage A for the sum of dame.' s arising, out of any one occurrence because of pr rty damage to your pr.. utt and your work that is caused by fire, smoke, collapse or explosion and is included within the product-completed o* ations hazard, This sublimit does not apply to property damage to your work if the damaged work, or the work out of which the damage arises, was performed on the Named Insured's behalf by a subcontractor, C. This Broadened Liability Coverage. For Dam: To Your Product And Your Work Provision does not apply it an endorsement of the same name is attached to this policy 7. CONTRACTUAL LIABILITY — RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of Insur contract is replaced by the following: Insured Contr means: a. A contract, for a lease of premises. However, that portion of the contract for a lease of premises th t indemnifies any person or organization for damage by fire to premises while rented to a Named Insured or temporarily occupied, by a Named Insured with permission of the owner is not an insured contract; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. Th t part of any other contract or agreement pertaining to the Named lInsured's business (including an indemnification of a municipality in connection with work performed for a municipality) under which the Named' Insured assumes the tort liability of another party to pay for ily injury or property damage to a third person or organization. Tort liability means a liability that would be imposed by law in the absen,c of any contract or agreement,, Paragraph 1. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing,, approving or falling to prepare or approve maps, shop drawings„ opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities, 8. ELECTRONIC DATA LIABILITY A. Under COVERAGES, Coverage. A — Bodily Injury and Pro* Damage Liability, the paragraph entitled Exclusions is amended to delete exclusion p. E ronic Data and replace it with the 'following: This insurance does not apply to: p. A s Or Disclosure Of Confidential Or Personal information And Data-related Liability CNA74705XX (1-15) Policy No: 2094163615 Page, 6 of 17 Endorsement No: Nat'l Fire Ins Co of Hartford Effective Date: 11 / 15 / 2015 Insured Name: DOWNSTREAM SERVICES, INC ., Copyrighl CNA AI Rghis Reserved. Includes copyrighted materiai of insurance Services Mice, inc., with its perrolisslon. CNA CNA PARAM OUNT Contractors' General Liability Extension Endorsement Damages arising out of (1) any access to or disclosure of any person's, or organization's confidential or personal information„ including patents, trade secrets, processing methods, customer lists, financial information, credit card information„ health information or any other type of nonpublic information; or (2) the loss, of, loss of use of, damage, to, corruption of', inability to access, or inability to manipulate electronic data that does not result from physical injury to tangible property,. However. unless Paragraph (1) above applies, this exclusion does not apply to damages because of bodily Injury. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relation expenses, or any other loss, cost or expense incurred by the Named Insured or others arising out of that which is described in Paragraph (1) or (2) above, B. The following paragraph' is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for all dam ges arising out of any one occurrence because of property dame e that results from physical injury to tangible property and arises out of electronic, data. C. The following definition is added to DEFINITIONS: Electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks„ CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purpose of the coverage provided by this ELECTRONIC DATA LIA LITY Provision, the definition of pro. ,-rty damage in DEFINITIONS is replaced by the following: Property damage means: a. Physical injury to tangible, property, including all resulting loss of use of that properly. AR such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability 10 properly nipulate electronic data, resulting from physical injury to tangible property., All such loss of electronic da shall be deemed to occur at the time of the occurrence that caused it, For the purposes of this insurance, electronic data is not tangible property, E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the $100,000 limit provided by this ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that higher limit 9. ESTATES, LEGAL REPRESENTATIVES, AND SPOUSES The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and .spouses only for ctalms arising solely out of their capacity or status as such and, in the case' of a spoul,,:4,, where such claim seeks damages from marital community property, jointly held properly or property transferred from such natural person Insured to such s se. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or use outside the scope of such person's capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership CNA74705XX (1-15) Page 7 of 17 Nat 'I Fire Ins Co of Hartford insured Name: DOWNSTREAM SERVICES INC . Copyrfght CNA All Rights FieservecL Includes copyrIghled material of Insurance SeMoes Moe, Inc., with Its msson Policy Noi 2094163615 Endorsement No: 1 Effective Date: 1 1 /15 /2015 C AfA NA PARAMOUNT Contractors' General Liability Extension Endorsement Named Insureds are Insureds with respect to such uses' acts, errors or omissions in the conduct of the Named Insured's business. 10. EXPECTED OR INTENDED INJURY — EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A — injury and Property Damage WM4,, the paragraph entitled Exclusions is amended to delete the exclusion entitled Ex, 4,1ted or Intended Injury and replace it with the follewing: This insurance does not apply to: Ex ed or Intended Injury odily injury or property dame. .4,, expected or intended from the standpoint of the Insured. This exclusion does not apply to ily injury or pr.,. rty dam e resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE - PER PROJECT A. For each construction: project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations:, is the most the Insurer will pay for the sum of: 1. All damages under Coverage A, except damages because of fly injury or property damage included in the products-completed ,operations hazard; and 2. Ali medical expenses under Coverage C, that arise, from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shali not reduce the General Aggregate Li' 11 shown ni the Declarations„ nor the Construction Project General Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage regardless of thi number of locations or construction projects involved; 2. Damages, under Coverage A, caused by occurren s which cannot be attributed solely to ongoing operations at a single construction project, except damages because ot ily injury or pro damage included in the products-completed operations hazard, and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a :single, construction project., witi reduce the General Aggregate Limit shown in the Declarations,. C. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project. D. When coverage for liability arising out of the products-completed operations h rd is provided, any payments for damages because of :00,:::41ily injury or damage included in the pr ucts-compleed operations hazard will reduce the Products-Completed Operations Aggregate Limit shown in tho Declarations, regardless of the number of protects involved. E. 11 a single construction protect away from premises, owned by or rented to the Insured has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project,. F. The provisions: of LIMITS, OF INSURANCE not otherwis:e modified by this endorsement shall continue to apply as stipulated. CNA 74705XX (1-15) Page 8 of 17 Nat '1 Fire Ins Co of Hartford Insured Name: DOWNSTREAM SERVICES , INC . Copyright CNA All Rights Reserved, Includes copyrigritedl material of Insurance Services Office, inc„ wilt Its permisslom 41 Policy No: 2094163615 Endorsement No: Effective Date: 11/15/2015 0 CNA 12. IN REM ACTIONS CNA PA RAM OUNT Contractors' General Liability Extensio Endorsement A quasi in rem action against any vessel owned or operated by or for the Named Insured, or chartered by or for the Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. 13. INCIDENTAL HEALTH CARE MALPRACTICE COVERAGE Solely with respect to bodily injury that arises out of a he Ith care incident: A. Under COVERAGES, Coverage A — Bodily Injury and Properly Damage Liability, the paragraph entitled Insuring Agreement is amended to replace Paragraphs 1.b.(1) and 1.b.(2) with the following: b. This insurance applies to wily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes pin:, in the coverage territory, (2) the bodily injury first occurs during the policy period, AIf bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and B. Under COVERAGES, Coverage A — Exclusions is amended to: ily Injury and Property Dam 1. add the following to the Employers Liability exclusion: Liability, the paragraph entitled This exclusion applies only if the I** iIy injury arising from a health care incident is covered by other liability insurance available to the insured (or which would have been available but for exhaustion of its 11. delete, the exclusion. entitled Contractual ILiability and replace it with the following: This insurance does not apply to: Contractual Liability the Insured's actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees, 111. add the following additional exclusions,: This insurance does not apply to: Discrimination ono 0 any actual or alleged discrimination, humiliation or harassment including but not limited to claim's. based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation. Dishonesty or Crime Any actual or alleged dishonest, criminal or malicious act, error or omission. MedicareiMedicaid Fraud any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state or local governmental program. Services Excluded by Endorsement Any health care incident for which coverage is excluded by endorsement. CNA74705XX (1-15) Policy No: 2094163615 Page 9 of 17 Endorsement No: 1 Nat 'I Fire Ins Co of Hartford Effective Date: 11/15/2015 insured Name,' DOWNSTREAM SERVICES , INC , Copyright CNA Ail Ricfhts Reserved. includes copyrighted material of Insurance SeNces. Office', Inc„, with its permissiom MAIAWMA,AUU.611a "Wli I LI CNA Contractors' Genera CNA PARAMOUNT 1 Liability Extension Endorsement C. DEFINITIONS is amended to: 1. add the following definitions: Health care incident means an act, error or omission by the Named Insured's employ s or volunteer workers in the rendering of; a. professional h Ith care rvices on behalf of the Named Insured or b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received, Professional health care rvicos means any health care services or the related 'furnishing of food, beverages, medical supplies or appliances by the following providers in their capacity as such but solely to the extent they are duly licensed as required: a. Physician; b. Nurse; c. Nurse practitioner; d, Emergency medical technician; e. Paramedic; 1. Dentist; g. Physical therapist; h. Psychologist i. Speech therapist Other allied health professional; or Professional health care services does not include any services rendered in connection with human clinical trials or product testing. H. delete the definition of occurrence and replace it with the following Occurrence means a health care incident All acts, errors or omissions that are logically connected by any common fact, circumstance„ situation, transaction, event, advice or decision will be considered to constitute a single occurrence; Hi. amend the definition of Insured to: a. add the following: • the Named Insured's employees are Insureds with respect to: (1) Ily injury to a co-employ while in th course of the co-employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; and (2) iyinjury to a volunteer worker while performing duties related to the conduct of the Named Insured's business; when such ly injury arises out of a health care incident the Named Insured's volunteer work s are Insureds with respect to: (1) iIy injury to a co-volunteer worker while performing duties related to the conduct of the Named Insured's business: and CNA74705XX (1-15) Policy No: 2094163615 Page 10 of 17 Endorsement No: Nat '1 Fire Ins Co of Hartford Effective Date: 11/15/2015 Insured Name: DOWNSTREAM SERVICES, INC Copyright CNA All Rights Reserve* includes copyrighted materiall of Insurance Services Office, inc., with its permission. ANA Contractors' General Liabi CNA PARAMOUNT lity Extension Endorsement (2) bodily injury to an employee while in the course of the employee's employment by the Named Insured or while performing duties related to the conduct of the, Named Insur l's business; when such bodily injury arises out of a h ° Ith care incident, b. delete Subparagraphs (a), (b), (c) and (d) of Paragraph 2.a.(1) of WHO IS AN INSURED,, D. The Other Insurance condition is amended to delete Paragraph b.(1I) in its entirety and replace it with the following: Other Insurance b. lE,xcess Insurance (1) To the extent this insurance applies, it is excess over any other insurance, self insurance or risk transfer instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by the Named Insured) to be excess of this coverage. 14. JOINT VENTURES / PARTNERSHIP / LIMITED LIABILITY COMPANIES WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following: No person or organization is an Insured 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, except that if the Named Insured was a joint venturer, partner, or member of a limited liability company and such joint venture„ partnership or (limited liability company terminated prior to or during the policy rind, such Named Insured is an Insured) with respect to its interest in such joint venture, partnership or limited liability company but only to the extent that :. a. any offense giving rise to personal and advertising injury occurred prior to such ter'minat'ion date, and the personal and advertising Injury arising out of such offense first occurred after such termination date; b. the ily injury or pro damage first occurred after such termination date, and c, there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or limited liability company; and If the joint venture, partnership or limited liability company is or was insured under a consul « W -edl (wrap -up) insurance program, then such insurance will always be considered valid and collectible for the purpose of paragraph c. above, But this provision will not serve to exclude ily injury, property d age or personal and advertising injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision entitled WRAP -UP EXTENSION: OCIP, CLIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS. Please see that provision for the definition of consolidated (wrap -up) insurance (program, 15. LEGAL LIABILITY — DAMAGE TO PREMISES / ALIENATED PREMISES / PROPERTY IN THE NAMED INSURED'S CARE, CUSTODY OR CONTROL A. Under COVERAGES, Coverage A — Bodily Injury and Pro rty Dam LiabiIity, the paragraph entitled Exclusions is amended to delete exclusion j. (Damage to Property in its entirety and replace it with the following: This insurance does not apply to j• Damage to Prop Pro r* _ rty damage to: (1) Property the Named Insured owns, rents, or occupies, including any costs or expenses incurred by you, or any other person, organization or entity, f'or repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; CNA74705XX (1-15) Page 11 of 17 Nat'l Fire Ins Co of .H'airtfosd Insured Name: DOWNSTREAM S'ERVI'CES , INC Copyrlip,ht CNA Altl Rig as Reserved. Includes copyrighted material of insurance San/foes Office. Inc., with its permission. Policy No; 2 094163615 Endorsement No: 1 Effective Date: 11/15/2015 CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement (2) Premises the Named Insured sells„ gives away or abandons, if the p' part of those pre,mises; (3) Property loaned to the Named Insured; (4) Personal property in the care, custody or control of the Insured; (5) damage arises out of any That particular part of real property on which the Na ed Ilnsured or any contractors or subcontractors working directly or indirectly on the Named Insured's behalf are performing operations, if the property damage arises out of those ,operations; or (6) That particular part of any property that must be restored, repaired or replaced because your work was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to property da oe (other than damage by fire) to premises rented to the Named Insured or temporarily occupied by the Named Insured with the per ission of the owner, nor to the contents of premises rented to the N :med Insured for a period of 7 or fewer consecutive days. A separate limit of insura,nce, applies to Damage To Premises Rented To You as described in LIMITS OF INSURANCE. Paragraph (2) of this exclusion does not apply if the premises are your work. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to IabiUty assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to property damage included in the products-completed o rations hazard, Paragraphs (3) and (4) of this exclusion do not apply to pr* arty damage to i. tools, or equipment the Named Insured borrows from others, nor IL other personal property of others in the Named Insured's care, custody or control while being used in the Named in.sured's operations away from any Named Insured's premises. However,, the coverage, granted by this exception to Paragraphs (3) and (4) does not apply to: a. property at a job site awaiting or during such preperty's installation„ fabrication, or erection, b. property that is mobile equipment leased by an Insured; c. property that is an auto, aircraft or watercraft d. property in transit; or e. any portion of property damage for which the Insured has available other valid and collectible insurance, or would have such insurance but for exhaustion ,of its limits, or but for application of one of its exclusions. A separate limit of insurance and deductible apply to such property of others. See LIMITS OF INSURANCE a:s amended below, B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete its last paragraph and replace it with the 'following: Exclusions c. through n, do not apply to damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of premises rented to a Named lInsured for a period of 7 or fewer consecutive days. , A separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE. CNA74705XX (1-15) Policy No: 2094163615 Page 12 of 17 Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 11/15/2015 Onsured Name: DOWNSTREAM SERVICES, INC Copyright CNA All Rights Reserved, Includes copyrighted material of Insurance Services Office, inc.,. with its permission. CNA CNA PARAM ou NT Contractors' General Liabil4 Extension Endorsement The 'following paragraph is added to LIMITS OF INSURANCE: Subject to 5, above, $25„000 is the most the Insurer will pay under Covera A for damages arising out of any one occurrence because of the sum of all property damage to borrowed tools or equipment, and to other personal property of others in the Named Insured's care, custody or control, 'while being used in the Named insured's operations away from any Named Insured's premises. The insurers obligation to pay such property darn e does not apply until the amount of such pro rty damage exceeds $1,000. The Insurer has that right but not the duty to pay any portion of this $1,000 in order to effect settlement It the Insurer exercises that right, the Named Insured will promptly reimburse the insurer for any such amount. D. Paragraph 6., Damage To Premises Rented To You Limit, of LIMITS OF INSURANCE is deleted and replaced by the following: 6. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit is the most the Insurer willl pay under Coverage A for damages because of property damage to any one premises while rented to the Named Insured or temporarily occupied by the Na ed Insured with the permission of the owner, including contents of such premises, rented to the Named Insured for a period of 7 or fewer consecutive days. The Damage To Premises Rented To You Limit is the greater of: a. $500,000; or b. The Damage To Premises Rented To You Limit shown in the Declarations, E. Paragraph 4.b.(11XaXII) of the Other Insurance Condition is deleted and replaced by the following: (ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by the Named insured with the permission of the owner; or for personal property of others in the Named Insur 's care, custody or control; : 16. LIQUOR LIABILITY Under COVERAGES, Covev! A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Liquor ILiability, This LIQUOR LIABILITY' provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverito Part, 17. MEDICAL PAYMENTS A. LIMITS OF INSURANCE is a nded to delete Paragraph 7. (the Medical Expense Limit) and replace it with the following:: 7. Subject to Paragraph 5. above (the Each Occurrence Limit), the Medical Expense Limit is the most the Insurer will pay under Coverage C — Medical Payments, for all medical, expenses because o injury sustained by any one person. The Medical Expense Limit. is the greater of: (1) $15,000 unless a different, amount is shown here: ; or MI the amount shown in the Declarations for Medical Expense Limit, B. Under COVERAGES, the Insuring Agreement of Coverage C — Medical Payments is amended to replace Paragraph Lapp) with the following.: (b) The expenses are incurred and reported to the Insurer within three years of the date of the accident; and This Paragraph B. does not apply to medical expenses incurred in the state of Missouri. 16. NON-OWNED AIRCRAFT Under COVERAGES, Coverage A B ty Injury and Property Damage Liability, the paragraph entitled Exclusions is amended as follows: CNA74705XX (1-15) Page 13 of 17 Nat 'I Fire Ins Co of Hartford Insured Name: DOWNSTREAM SERVICES, INC. 4. • Copyright CNA Al FRghts Policy No: 2094163615 Endorsement No: 1 Effective Date: 11115/2015 rved, Includes copyrighted lad at insurance Services Otto, , with Is permission., CNA Contractors General CNA PARAMOUNT Liability Extension Endorsement The exclusion entitled Aircraft, Auto or Watercraft is amended to add the following This exclusion does not apply to an aircraft not owned by any Named Insured, provided that: 1. the pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America or Canada, designating that person as a commercial or airline transport pilot 2. the ai,rcraft is rented with a trained, paid crew to the Named Insured; and 3. the, aircraft is not being used to carry persons or property for a charge. 19. NON-OWNED WATERC AFT Under COVERAGES, 1Coverage A - Wily Injury and Pr Dam: .!e Liability, the paragraph entitled Exclusions is amended to delete subparagraph (2) of the exclusion entitled Aircraft, Auto or Watercraft, and replace it with the following. This exclusion does not apply to: (2) a watercraft that is not owned by any Named Insured, provided the watercraft is: (a) less than 75 feet long; and (b) not being used to carry persons or property for a charge, 20. PERSONAL AND ADVERTISING INJURY -DISCRIMINATION OR HUMILIATION A. Under DEFINITIONS, the definition of personal and advertising injury is amended to add the following tort • Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. . Under COVERAGES, Coverage B Personal and Advertist..!. Injury Liability, the paragraph entitled Exclusions is amended to:, 1. delete the Exclusion entitled Knowing Violation Of Might!) Of Another and replace it with the following: This insurance does not apply to: Knowing Violation of Rights. of Another Personal and advertising injury caused by or at the direction of the Insured with the knowledge that the act would violate, the rights of another and would inflict personal and advertising injury. This exclusion shali not apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is not done intentionally' by or at the direction of: (a) the Named Insured: or (b) any °smutty°. 0fficor„ director, stockholder, partner, member or manager (if the Named Insured is a limited liability company) of the Named Insured. 2. add the following exclusions: This insurance does not apply to: Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any Insured. Premi s Related Discrimination discrimination or humiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any Insured. CN„A74705XX (1-15) Policy No: 2094163615 Page 14 of 17 Endorsement No: 1 Nat'l Fire Ins Co ot Hartford Effective Date: 11/15/2015 insured Name: DOWNSTREAM SERVICES , INC . Copyright CNA M Flights Reserved. includes copyrighted material! of Insurance Services Orrice Inc., with Its permission. CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination. The coverage provided by this PERSONAL AND ADVE, TISING INJURY — DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely from Provision 1. ADDITIONAL INSURED of this endorsement; or • attachment of an additional insured endorsement to this Coverage Part. This PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part, 21. PERSONAL AND ADVERTISING INJURY - CON'TRAC'TUAL LIABILITY A. Under COVERAGES, Coverage B —Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Contractual Liability, B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY provision, the following changes are made to the section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insur and the interests of the indemnitee; 2. The first unnumbered paragraph beneath Paragraph 2.1.(2Xb) is deleted and replaced by the following: So long as the above conditions are met„ attorneys fees incurred by the Insurer in the defense of that lindemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the Insurer's request will be paid as defense costs, Such payments will not be deemed to be damages for personal and advertisi injury and will not reduce the limits of insurance. C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if Coverage — Personal and Advertising Injury Liability, is excluded by another endorsement attached to this Coverage Part. Thin PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Cover rye Part, 22. PROPERTY DAMAGE — ELEVATORS A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended) such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of the Dame t e to Property Exclusion do not apply to property damage that results from the use of elevators. B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE ELEVATORS Provision, the Other insurance conditions is amended to add the following) paragraph: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators. 23. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows: A. Paragraph 11.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000, limit; and CNA'74705XX (1 -15) Policy No: 2094163615 Page 15 of 17' Endorsement No: 1 Nat'l Fire Ins Co of Hartford Effective Date: 11/15/2015 Insured Name: DOWNSTREAM SERVICES , INC Copyright CNA, M nights Reserved. Includes copyrighted material of insurance Services Cate, inc., with its permission, CNA Contractors' Genera CN A PARAMOUNT Liability Extension Endorsement B. Paragraph 1.d. is amended to delete the limit of $250 shown :for daily loss of earnings and replace it with a $1,000. limit., 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part, the insurer will not deny coverage under this Coverage Part because of such failure, 25. WAIVER OF SUBROGATION BLANKET Under CONDITIONS, the condition entitled Transfer 01 Rghts Recovery Against Others To Us is amended to add the following The Insurer waives any right of recovery the ns,urer may have against any person or organization because of payments the Insurer makes for injury or damage arising: out at 1. the Named Insured's ongoing operations; or 2. your work included in the products-completed operations. rd, However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the claim oo * illy Injury, pro damage or personal a dvertising injury giving rise to the 26. WRAP-UP ENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following: provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation., If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy„ or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (OL,J.P.) or Contractor Controlled Insurance Programs (C,C,I.P,), is attached, then the following changes apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance pr*.,..t.,ram project in which the Named Insu is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Nmed Insured's ongoing operations at the project, or during such operations of anyone acting on the Na nsuredits behalf; nor 2. Bodily injury or pro damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures B. Condition 4. Other Insurance is amend to add the following subparagraph 4.b,(1Xc): This insurance is excess over: (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program„ but only as respects the Named Insured's involvement in that consolidated (wrap-up) insurance program, C NA74705XX (1-15)1 Page 16 of 17 Nat '1 Fire Ins Co of Hartford Insured Name; DOWNSTREAM SERVICES , INC Copyright CNA Ali Rights Reserved, Includes c+opyrighted material or Insuran©e Services Office, Inc,, with Ilts perrnl on Policy No: 2094163615 Endorsement No 1 lEllective Date: 11 /15 /2015 I41 .1111aNifile CNA CNA PARAMOUNT Contractors' General Liability Extension Endorsement C. DEFINITIONS is amended to add the following definitions. Con . o lidated (wrap-up) insurance pr* !rani means a construction, erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled Insurance Program (0.C.i.R) or Contractor Controlled Insurance Program (CLIP.). Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency, including but not limited to:, 1. singl or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments; and 2. the common areas and structures appurtenant to the structures in paragraph 1. (including poolls,, hot tubs, detached garages, guest houses or any similar structures). However, when there is no individual ownership of units, residential structure does not include military housing, collegeluniversity housing or dormitories, long term care facilities,, hotels or Imotels. Residential structure also does not include hospitals or prisons. This WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (W AP-UP) INSURANCE PROGRAMS Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms: a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy, CNA74705XX (1-15) Policy No: 2094163615 Page 17 of 17 lEndorsement No: Nat 'I Fire Ins Co of Hartford Effective Date: 11/15/2015 Insured Name: DOWNSTREAM SERVICES, INC Copyright 1CNA API Flights Reserved, Includes copyrighted materiel of insurance Services Office, Inc. , Ills permission, 0 0 0 CNA Cancel CNA PARAMOUNT lation / Non-Renewal - California Wherever used in this endorsement: 1) insurer means "we', 'us', "our" or the "Company" as those terms may be d,efined in the policy; and 2) Named Insured means the first person or entity named on the declarations page; and 3) "Insureds" means all persons or entities afforded coverage under the policy. Any cancellation, non-renewal Or termination provisions in the policy are deleted in their entirety and replaced with the following: CANCELLATION AND NON-RENEWAL A. CANCELLATION The Named Insured may cancel the policy at any time To do so, the Named Insured must return the policy to the insurer or any of its authorized representatives, indicating the effective, date of cancellation; or provide a written notice to the Insurer, stating when the cancellation is to be effe,ctive, 2. If the policy has been in effect for less than sixty (60) days and is not a renewal the Insurer may cancel the policy for any reason by mailing or delivering written notice to the Named insured, at the last malting address: known to the Insurer,„ and the producer of record., The notice of cancellation will be provided at least ,sixty (60) days prior to the effective date of cancellation except that in the case of cancellation for nonpayment of premiums the notice will be given no less, than ten (10) days prior to the effective date of the cancellation, 3. if the poky has been in effect for more than sixty (60) days or if it is a renewal, effective immediately, the Insurer may not cancel the policy unless such cancellation is based on one or more of the following reasons: .a, Nonpayment of premium, including payment due on a prior policy is,sutd by the insurer and due during the current policy term covering the same risks, A Judgment by a court or an dministrative tribunal that the Named Insured has violated any law of this state or of the United States having as one of its necessary elements an act which materially increases any of the risks insured against, c. Discovery of fraud or material misrepresentation by either of the following: (11), The Named Insured or insured(s) or a representative of same in obtaining the insurance; or (2) The Named Insured or his or her representative, in pursuing a claim under the policy. d., Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulation.s establishing safety standards, by the Named insured or insured(s) or a representative of same, which materially increase any of the risks insured against,. Failure by the Named Insured or Insured(s) or a representative of same to implement reasonable loss, control requirements which were agreed to by the Named Insured as a condition of policy issuance or which were conditions precedent to the use by the insurer of a particular rate or rating plan, if the failure materially increases, any of the risks insured against. A determination by the commissioner that the lloss of, or changes in, the Insurer's reinsurance covering all or part of the risk would threaten the financial integrity or solvency of the Insurer,. g. A determination by the commissioner that a continuation of the policy coverage would place the Insurer in violation of the laws of this state or the state of its domicile or that the continuation of coverage would 'threaten the .solvency of the Insurer. h,, A change by the Named Insured or Insured(s) or a representative of same in the activities or property of the commercial or industrial enterprise which results in a material added risk, a materially increased risk or a materially changed risk, unless the added, increased, or changed risk is included in the policy. CNA62814CA (9-12) Page 1014 Nat'l Fire, Ins Co of Hartford insured Name: DOWNSTREAM SERVICES, INC . Copyright CNA All Rights R Policy No: 2094163615 Endorsement No: 18 Effective Date: 11/15/2015 mumumumuMMWarnaM6 CNA Cancellation N CNA PARAMOUNT on-Renewal California A notice of cancellation will be in writing and will be delivered or mailed to the Named Insured, at the last mailing address known to the insurer, and the producer of record at ieast sixty (60) days prior to the effective date of canceilation. Where cancellation is for nonpayment of premium, notice shall be given no less than ten (10) days prior to the effective date of cancellation. 4. The notice will state the actual reason for the cancellation. 5,, Notice of cancellation will state the effective date of cancellation. The policy period wiIt end on that date. 6. if notice is mailed„ proof of mailing will be sufficient proof of notice. B. PREMIUM REFUND If this policy is cancelled„ the insurer will send the Named Insured any premium refund due. If the Insurer cancels the, refund will be pro rata. If the Named insured cancels„ the refund may be less than pro rata. The cancellation will be effective even if the Insurer has not made or offered a refund,. C. NON-RENEWAL 1, The insurer can non-renew the policy by giving written notice to the Named Insured, at the last mailing address known to the Insurer, and the producer of record at least sixty (60) days but not more than one hundred twenty (120) days before the expiration date. 2. The notice of non-renewal will state the actual reason for non-renewai. 3. If notice is mailed, proof of mailing will be sufficient proof of notice. 4, A notice of non-renewal will not be required in any o,:f the following situations: a. The transfer of, or renewal of, a policy without change in its terms or conditions or the rate on which the premium is based between insurers that are embers of the same insurance group. b, The policy has been extended for ninety (90) days or less, if the notice required has been given prior to the exten,sion. c. The Named Insured has obtained replacement coverage or has agreed, in writing, within sixty (60) days of the termination of the policy, to obtain that coverage„ d. The policy is for a period of no more than sixty (60) days and the Named insured is notified at the time of issuance that it may not be renewed. e. The Named insured requests a change in the terms or conditions or risks covered by the policy within sixty (60) days prior to the end of the policy period, f, The insurer has made a written offer to the Named Insured„ within the prescribed time period„ to renew the policy under changed terms or conditions or at a changed premium rate, where the increase is more than 25%. As used herein, 'terms or conditions, inciudes, but is not limited to, a reduction in limits, elimination of coverages„ or an increase in deductibles. 5. In the case of conditional renewal, failure of the Named insured to satisfy conditions provided by the Insurer for renewal, by the expiration date of the policy or sixty (60) days after mailing or delivery of such notice, whichever is later, the conditional renewal shall be treated as an effective non-renewal. CNA62814CA (9-12) Page 2 of 4 Nat 'I Fire Ins Co of Hartford Insured Name: DOWNSTREAM SERVICES , INC . Copyright CNA All Rights R Policy No: 2094163615 Endorsement No: 18 Effective Date: 11 /15 /201.5 0 1,=== SANIESBNIM WINAVOMO SOWN CNA D. CONDITIONAL RENEWAL CNA PARAMOUN T Cancellation / Non-Renewal — California 1. the policy has been in effect for more than sixty (60) days or if the policy is a renewal, effective immediately no increase in premium, reduction in limits, or change in the conditions of coverage shall be effective during the policy period unless based upon one of the following reasons: a. Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards by the Named Insured or Insured(s) which materially increase any of the risks or hazards insured against, b. Failure by the Named insured or Insured(s) to implement reasonable loss control requirements which were agreed to by the Insured as a condition of policy issuance or which were conditions precedent to the use by the Insurer of a particular rate or rating plan, if the failure materially increases any of the risks insured against, c, A determination by the commissioner that loss of or changes in an insurers reinsurance covering all or part of the risk covered by the policy would threaten the financial integrity or solvency of the Insurer unless the change in the terms or conditions or rate upon which the premium is based is permitted. d. A change by the Named Insured or Insured(s) in the activities or property of the commercial or industrial enterprise which results in a materially added risk, a materially increased risk, or a materially changed risk, unless the added, increased, or changed risk is included in the policy. 2. A written notice will be mailed or delivered to the Named insured, at the Ilast mailing address known to the Insurer, and the producer of record at least sixty (60) days prior to the effective date of any increase,. reduction or change. 3. The notice will state the effective date of, and the reasons for, the increase, reduction' or change, 4,, If notice is mailed, proof of mailing will be sufficient proof of notice. E. ADDITIONAL PROVISIONS 1. It the Insurer is an associate participating insurer as established by Cal, Ins, Code Section 10089.16, solely with respect to coverage for real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit: a, The Insurer shall not cancel or refuse to renew such coverage existing on the date the Insurer elected to become an .associate participating insurer after an offer of earthquake coverage is accepted solely because the insured d has accepted that offer of earthquake coverage; and b., The insurer shall not cancel such coverage unless the policy is properly canceled pursuant to Paragraph A above; and c., The Insurer may refuse to renew a policy of residential property insurance after an offer of earthquake coverage has been accepted only 1. The policy is terminated by the Named Insured.; The policy is refused renewal on the basis of sound underwriting; principles that relate to the coverages provided by the poiicy and that are consistent with the approved rating plan and related documt nits filed with the Department of Insurance as required by existing law; The Commissioner of insurance, finds that the exposure to potential losses will threaten the solvency of the Insurer or place the Insurer in a hazardous condition. A hazardous condition inciudes, but is not Ilimited to, a condition in which the insurer makes claims payments for losses resulting from an CNA62814CA. (9-12) Page 3 of 4 Nat '1 Fire Ins Co of Hartford insured Name: DOWNSTREAM SERVICES; INC Copyright CNA Ali Rights Reserved. Policy No: 2094163615 Endorsement No: 18 Effective Date: 1 1 /15/2 0 15 CNA Cancellation / N CNA PARAMOUNT on-Renewal California earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least twenty-five percent (25%) 'for payment of those claims; or iv. The Insurer has lost or experienced a substantial reduction in the, availability or scop of. reinsurance coverage or a substantial increase in the premium charged for reinsurance coverage for its residential property insurance policies, . and the Commissioner of linsurance has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in the Insurer's reinsurance position, 2. lf this policy contains an exclusion barring coverage for the peril of corrosive soil conditions, the nsurr shall not cancel or refuse to renew the policy solely because corrosive soil conditions exist on the location. Ali other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA62014CA (9-12) Policy No: 2094163615 Page 4 of 4 Endorsement No: 18 Nat'l Fire Ins Co of Hartford Effective Date: 11 /15 /2015 Insured Name: DOWNSTREAM SERVICES, INC . Copyright CNA All Rights Resetved. 113839540484 20020039116 1111111111111111111111 11111■11 CNA CNA63359XX (Ed. 04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 'CONTRACTORS EXTENDED COVERAGE ENDORSEMENT BUSINESS AUTO PLUS - This ,endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM LIABILITY COVERAGE A. Who Is An Insured The following is added to Section 11, Paragraph Al., Who Is An Insured:, 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of inception of this Coverage Form; provided that„ b. The insurance afforded by this provision A.1. does not apply to any such entity that is an "insured' under any other liability 'policy' providing "auto'lcoverage. 2. Any organization you newly acquire or form, other than a Ilimited liability company, partnership or joint venture„ and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation dale, and is afforded only until the end of the policy period of this 'Coverage IForm, or the next anniversary of its inception 111 date, whichever is earlier. b. Does not apply to: (1) *Bodily injury' or 'property damage' caused by an 'accident that occurred before you acquired or formed the organization; or (2) Any such organization that is an *insured' under any other Inability "policy" providing "auto' coverage. 3. Any person or organization that you are required by a written contract to name as an additional insured is an *insured' but only with respect to their legal liability for acts or omissions of a person, who qualifies as an 'insured' under Section II — Who Is An Insured and for who Liability Coverage is afforded under this policy. If required by written contract, this insurance will be primary and non-contributory to insurance on which the additional insured is a Named Insured. 4. An *employee' of yours is an 'insured" while operating an 'auto' hired or rented under a contract or agreement in that 'employee's' 1. name, with your permission, while performing duties retailed to the conduct of your business. 'Policy,' as used in this provision A. Who Is An Insured, includes those policies that were in force, on the inception date of this Coverage Form but: 1. Which are no longer in force; or 2. Whose limits have been exhausted. B. Bail Bonds and Loss of Earnings Section 11, Paragraphs A.2. (2) and A.2. (4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and 2. In a.(4), the limit for the loss Of earnings is changed from $250 to $500 a day. Fellow Employee Section 11, Paragraph B.5 does not apply. Such coverage as is afforded by this provision C. is excess over any other collectible insurance. PHYSICAL DAMAGE COVERAGE. A. Glass Breakage — Hitting A Bird Or Animal Falling Objects Or Missiles The following is added to Section III, Paragraph A.3.: With respect to any covered 'auto,' any deductible shown in the Declarations, will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. B. Transportation Expenses Section 111,, Paragraph A.4.a. is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, in lieu of $20; subject to b. $1,800 maximum, in lieu of $600. C. Loss .of Use Expenses. Section lin, Paragraph A.41... is revised„, with respect to loss, of 'use expenses incurred by you, to provide': a. $1„000 maximum, in lieu of $600. CNA63359XX Copyright, CNA Corporation, 2000, (Ed. 04/12) includes copyrighted matoriat of tile insurance Services Office used with its permission. 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 1111 1 1 1111111111111111111111 Page 1 of 3 11111111111111111111111111111111111 D. Hired "Autos" The following is added to Section III. IParagraph A.; 5. Hired "Autos" It Physical Damage coverage is provided under this policy, and such ,coverageldoes not extend to Hired Autos, then Physical Damage coverage is extended to: a. Any covered "auto' you lease, hire, rent or borrow without a driver, and b. Any covered *auto' hired or rented by your *employee' without a driver, under a contract in that individual 'employee's" name, with your permission, while performing duties related to the conduct of your business, c. The most we will pay for any one 'accident' or *loss" is the actual cash value, cost ,of repair, cost of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto. No deductible applies to 'loss' caused by fire or lightning. d. The physical damage coverage as is provided by this provision is equal to the physical damage ,coverage(s) provided on your owned 'autos.' e. Such physical damage coverage for hired 'autos' will: (1) Include loss of use, provided it is the consequence of an 'accident for which the Named Insured is Ilegaliy liable, and as a result ,of which a monetary loss is sustained by the leasing or rental concern. (2) Such coverage as is provided by this provision will be subject to a limit of $750 per 'accident.' E. Airbag Coverage The following is added to Section III, Paragraph The accidental discharge of an airbag shall not be considered mechanical breakdown. F. Electronic Equipment Section 111,, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: c. Physical Damage Coverage on a covered 'auto' also applies to "loss' to any permanently installed electronic equipment including its antennas and other accessories. CNA63359XX (Ed. 04/12) d. A $100 per occurrence deductible applies to the coverage provided by this provision,. G. Diminution In Value, The following is added to Section III, Paragraph B.6.: Subject to the following, the "diminution in value' exclusion does not apply to: a. Any covered 'auto' of the private, passenger type, you lease, hire, rent or borrow, without a driver for a period ,of 30 days or less„ while performing duties related to the conduct of your business; and b. Any covered 'auto' of the private, passenger type hired or rented by your 'employee' without a driver for a period of 30 days or less, under a contract in that individual "employee's' name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is Ilimited to a 'diminution in value' loss arising ,directly out ,of accidental damage and not as a result, ,o1 the failure to make repairs; faulty or incomplete maintenance, or repairs; or the installation of substandard parts. d. The most we will pay for "loss' to a covered 'auto' in any one accident is the Iesser of: (1) $5,000, or (2) 20% of the "auto's' actual cash value (ACV). 111 Drive Other Car Coverage — Executive Officers, The following is added to Sections II and 1. Any 'auto" you don't own, hire or borrow is a covered "auto' for Liability Coverage while being used by, and for Physical Damage Coverage, while, in the care, custody or control of, any of your 'executive officers„' except: a. An 'auto owned by that "executive officer" ,or a member of that person's household; or b. An 'auto' used by that "executive officer' while working in a business of selling, servicing, repairing or parking 'autos.' Such Liability andfor Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those, coverages, afforded any covered "auto"; and CNA63359XX Copyright, CNA Coportafion, 2000, (Ed. 04/12) Illnoludes copyrighted 'material of the Insurance Services office used with its permission, IPage 2 of 3 (2) Excess over any other collectible insurance. 2. For purposes of this provision, °executive officer" means a person holding any of the officer positions created by your charter, constitution, by- laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "'executive officers' are Insureds while using a covered "auto' described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A:2.a.: (4) Your 'employees ' may know of an 'accident' or loss." This will not mean that you have such knowledge, unless such "accident' or loss* is known to you or 1 you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph (6) Your 'employees' may know of documents received concerning a claim or 'suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us The following is added to Section IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or V. CNA633,59XX (Ed. 04/12) damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an 'accident' or loss," C. 'Concealment, Misrepresentation or Fraudl The following is added to Section IV, Paragraph 82. ,: Your failure to disclose all hazards existing on the dale of inception of this Coverage, Form shall not prejudice, you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph' B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract, That written contract must have been entered into prior to 'Accident' or loss."' Policy Period, Coverage Territory Section IV, Paragraph B. 7(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: odily injury' means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these., E. CNA63359XX ,Copyright, CNA Corporation, 2000. (Ed. 04/12) Includes copyrighted 'material or the Insurance Services ipttice used with IS permission. Page 3 of 3 11111 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I III I II ACORO® 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. CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /YYYY) 4/25/2016 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGRATION 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 OnPoint Underwriting Inc. 8390 E Crescent Pkwy, Suite 200 Greenwood Village, CO 80111 INSURED Barrett Business Services, Inc. L /C /F DOWNSTREAM SERVICES, INC. 2855 PROGRESS PLACE ESCONDIDO, CA 92029 COVERAGES CERTIFICATE NUMBER: CONTACT NAME: Steven McComb PHONE (A/C, No Ext): (360) 828 -0644 FAX (A/C, NO): (360) 828 -0699 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: 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 ISSUES 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM /DD /YYYY) (MM /DD /YYYY) GENERAL LIABILITY ................ COMMERCIAL GENERAL LIABILITY ...............� ....... .......................1CLAIMS -MADE ...............� OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ................ POLICY .................... PROJ- ............... LOC ECT AUTOMOBILE LIABILITY ................ ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ................ EXCESS UMBRELLA LIABAB DED ..................��OCCUR ........ OCCUR RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR /PARTNER/ EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A RWC C48809789 Covered states: CA EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ EACH OCCURRENCE $ AGGREGATE $ 05/01/16 05/01/2017 ✓ IWCS ATU- I IOTH TORY E.L. EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER City of El Segundo - Public Works, it's officers and employees 350 Main Street El Segundo, CA 90245 ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Richard Poling c) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. AC-ORE) AGENCY OnPoint Underwriting Inc. POLICY NUMBER RWC C48809789 CARRIER ACE American Insurance Company ADDITIONAL REMARKS AGENCY CUSTOMER ID: LOC: #: ADDITIONAL REMARKS SCHEDULE NAMED INSURED Barrett Business Services, Inc. 8100 NE Parkway, Suite 200 Vancouver WA 98662 NAIC CODE 22667 EFFECTIVE DATE: 05/01/16 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of El Segundo - Public Works, it's officers and employees ADDRESS: 350 Main Street El Segundo, CA 90245 All California Operations" ACORD 101 (2008/01) Page 2 of 2 c) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD.