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PROOF OF INSURANCE (2018) CLOSED DATE(MM/DD/YYYY) z� CERTIFICATE OF LIABILITY INSURANCE 3/9/2017 TH;8 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). —. i PRODUCER NAMEA'T: Noel Baxter hdAME HIED Insurance Services, Inc., PHONE act: (562)439-9731 I A/c„ No), (562)439-4453 3633 East Broadway E-IMAIL nbaxter@hmbd.com INSURER(S)AFFORDING COVERAGE NAIC# .g..................ww.........................................__......_...._...._......-.................................................... 'INSURER B: Prop Cas Co of Amer..._ ...�.�.6.......4..- .. .. Long Beach CA 90803-6035 _ - ww_ 7 mm Federal Technology Solutions, Inc. INSURER C: 1530 Consumer Cr. #102 INSURER D: INSURER E: ..,.,.,....._........__...,-...............................................-...,... .....-... Corona CA 92880 INSURE'RF: COVERAGES CERTIFICATE NUMBER:17-18 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 .lN.m...................................................... _..�..,_,._..,.."__ SR At)t7L SUER POLICY EFF POLICY EXP LIMITS LT TYPE OF INSURANCE ��, POLICY NUMBER IMMIDD/YYYY) (MMIDD/YYYYI GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0ool DAMAGE NTED X COMMERCIAL GENERAL $ 500,000 1 MED EXP An o n person) $ 10,000 A CLAIMS-MADE � OCCUR ZLP-51M54094 ,3/1/2017 3/1/2018 PERSONAL&ADV l NJURY $ 1,000,0001 GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY G...X PRO. -. � _..................$ AUTOMOBILE LIABILITY .._.-._ COMBINED SINGLE LIMI I Ea ar cdenI). $ 1r 000,000 �. w............................._.............._................ . ............_..... A X ANY AUTO BODILY INJURY(Per person) $ ............................................................. ALL OWNED SCHEDULED BA-BG727446 3/1/2017 3/1/2018 BODILY INJURY(Per accident) $ AUTOS AUTOS ..................................................................................... _...- NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ combined single limit $ X UMBRELLA LIAB X CLAIMS-MADE EACl±O ATEwnITITIT�ITITITmm 4,000,000 ............... ..., .-._............................................,.,.,.,.,.......,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,.,......,.,.. , .....�.....0 A B 4 000,000 DE DE..S.S....A..RFTENTION$.........._._...._ ZUP-71M51978 .3/1/2017 8/1/2018 $..T.................................m.... — A WORKERS COMPENSATION .... .... X �nCYIATUG I FjRH .. II, AND EMPLOYERS'LIABILITY Y/Ni NU I ANY PROPRIETOR/PARTNER/EXECUTIVE "'”'"'"'°' E EACH ACCIDENT $ _1,000,000 OFFICER/MEMBER EXCLUDED? NIA 3/1/2017 3/1/2018 - $ .1 0„OrV.) 00,0 Manttatw in Nii 0B-8G729845 E L DISEASE-EA EMPLOYEE If F':,`a d s Id xl t,ndol^'I.ih'�A'p"IdStl I^draw E L DISEASE-P3LICY LIMIT .g... - 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) General liability includes blanket additional insureds, primary/no:,-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 ACCORDANCE WITH THE POLICY PROVISIONS. City of E1 Segundo 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Todd Miller/GOWENS6' 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 c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additionai insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage" or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III —Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to sured does not apply to "bodily injury", " the additional insured by this endorsement still is pp y y ,� ri ' prop- excess over any valid and collectible "other in- of damage or personal injury' arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities, should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 Policy#ZI-P-511VI54094 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 (1) The "bodily injury" or"property damage"for which Insurance, of SECTION IV -. COMMERCIAL GEN- coverage is sought is caused by an "occurrence" ERAL LIABILITY CONDITIONS: that takes place; and However, if you specifically agree in a written contract (2) The "personal injury" or "advertising injury" for or agreement that the insurance afforded to an addi- which Coverage is sought arises out of an offense tional insured under this Coverage Part must apply on that is committed; a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that subsequent to the signing and execution of that con- is available to such additional insured which covers tract or agreement by you. such additional insured as a named insured, and we will not share with that other insurance, provided that: CG D4 25 07 08 0 2008 The Travelers Companies,Inc. Page 1 of 1 Policy # ZLP-51 M54094 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TECHNOLOGY XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, cover- age 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 coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force Property Damage - J. Blanket Additional Insured - Lessors Of Exception To Expected Or Intended In- Leased Equipment jury Exclusion B. Non-Owned Watercraft Less Than 75 K. Blanket Additional Insured - Persons Or Feet Organizations For Your Ongoing Opera- tions As Required By Written Contract Or Agreement C. Aircraft Chartered With Pilot L. Blanket Additional Insured - Broad Form Vendors D. Damage To Premises Rented To You M. Who Is An Insured - Unnamed Subsidi- aries E. Increased Supplementary Payments N. Who Is An Insured - Liability For Con- duct Of Unnamed Partnerships Or Joint Ventures F. Who Is An Insured - Employees And 0. Medical Payments - Increased limits Volunteer Workers - First Aid G Who Is An Insured - Employees - Su- p_ Contractual Liability - Railroads pervisory Positions K Who Is An Insured - Newly Acquired Or 0. Knowledge And Notice Of Occurrence Formed Organizations Or Offense I. Blanket Additional Insured - Owners, R• Unintentional Omission Managers Or Lessors Of Premises S. Blanket Waiver Of Subrogation PROVISIONS age" expected or intended from the A REASONABLE FORGE PROPERTY DAMAGE — standpoint of the insured. This exclu- EXCEPTION TO EXPECTED OR INTENDED or does not apply to "bodily injury" INJURY EXCLUSION or 'property damage" resulting from the use of reasonable force to protect The following replaces Exclusion a, Ex— any person or property. pected Or Intended Injury, in Paragraph 2., B. NON—OWNED WATERCRAFT LESS THAN 75 of SECTION I — COVERAGES — COVERAGE FEET A BODILY INJURY AND PROPERTY DAMAGE The following replaces Paragraph (2) of LIABILITY: Exclusion g., Aircraft, Auto Or Watercraft, in a Expected Or Intended Injury Or Damage Paragraph 2. of SECTION I — COVERAGES — "Bodily injury" or "property dam- COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: 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. of the claim or "suit", including G. WHO IS AN INSURED — EMPLOYEES — actual loss of earnings up to SUPERVISORY POSITIONS $500 a day because of time off from work. The following is added to Paragraph 2.a(1) of SECTION II — WHO IS AN INSURED: F. WHO IS AN INSURED — EMPLOYEES AND Parag VOLUNTEER WORKERS — FIRST AID r�al�l`1°° (1)'(a)" (b)' and (c), above do not apply to "bodily injury" or "„personal in- 1. The following is added to the defi- jury" to a, co-"°employee. in the course of nition of "occurrence" in the the co-"ernplloye(-,,",�" ernployrnent by you DEFINITIONS Section: arising out of wort, by any of your "el-n- Urules,s you are in the business or ploye.es" who hold a supervisory position. occupation of providing professionaV H. WHO IS AN INSURED — NEWLY ACQUIRED OR health care services, "occurrence" FORMED ORGANIZATIONS also means an act or omission corl.rMitted by any of your "°er1-r,- The following replaces Paragraph 4. of pioyeer," or "volunteer workers", SECTION 11 — WHO IS AN INSURED of the other than an employed or volunteer Commercial General Liability Coverage doctor, in providing or failing to Form, and Paragraph 3. of SECTION 11 — provide first aid or "Good Samari- WHO IS AN INSURED of the Global Com- tan services" to a person. panion Commercial General Liability Cov- 2. The following is added to Paragraph erage Form, to the extent such coverage 2.a.(1) of SECTION 11 — WHO IS AN forma; are part of your policy: INSURED: Any organization you newly acquire or form, other than a partnership or joint Unless you are in the business or verittrre, of which you are the sole owner occupation of providing professional or in which you rnaontain the majority health care services, Paragraplus (1 ownership interest, will qualify as a )(a), (b), (c) and K above do not ap- Famed Insured if there is no other insur- ply to "bodily injury'* arising out of ance which provides similar coverage to providing or failing to provide first that organization. However: aid or "Good Samaritan :services" by any of your "employees" or a. Coverage under this provision is af- "volunteer workers", other than an forded only: employed or volunteer doctor. Any (1) Until the 180th day after you ac- of your "employees" or" " volunteer quire or form the organization or workers" providing, or failing to the end of the policy period, provide first aid or "Good Samara- whichever is earlier, if you do not tan services" during their work report such organization in writing hours for you will be deemed to be to us within 180 days after you acting, within the scope of their acquire or form it; or employment by you or performing duties related to the conduct of (2) Until the end of the policy period, your business. when that date is later than 180 3. The following is added to Paragraph days after you acquire or form 5. of SECTION III — LIMITS OF such organization, if you report such organization in writing to us INSURANCE: within 180 days after you acquire For the purposes of determining tl°re or form it, and we agree in writing applicable Each Occurrence Lirnit, all that it will continue to be a Named related acts or omissions cornmit- Insured until the end of the policy ted by any of your "employees" or period; "volunteer workers" in providing or b. Coverage A does not apply to "bodily failing to provide first aid or "Good injury" or "property damage" that oc- Samaritan services" to any one per- curred before you acquired or formed son will be deemed to be one "oc- the organization; and currence". c. Coverage B does not apply to '"per- 4. The following is added to the sonal injtury" or "advertising injtury" DEFINITIONS Section: arising out of an offense committed "Good Samaritan services" means before you acquired or formed the or- any emergency medical services for ganization. which no compensation is demanded or received. 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. (5) Demonstration, installation, ser- rent or past partnership or joint venture vicing or repair operations, ex- that is not shown as a Named Insured in cept such operations performed the Declarations. This paragraph does not at such vendor's premises in apply to any such partnership or joint connection with the sale of venture that otherwise qualifies as an in- "your products"; or sured under Section II - Who Is An In- (6) "Your products" which, after dis- sured. tribution or sale by you, have 0. MEDICAL PAYMENTS — INCREASED LIMITS been labeled or relabeled or The following replaces Paragraph 7. of used as a container, part or in- gredient of any other thing or SECTION III — LIMITS OF INSURANCE: substance by or on behalf of 7. Subject to 5. above, the Medical Ex- such vendor. pense Limit is the most we will pay Coverage under this provision does not under Coverage C for all medical ex- apply to: penses because of "bodily injury" sus- tained by any one person, and will be a Any person or organization from the higher of: whom you have acquired "your products", or any ingredient, part or (a) $10,000; or container entering into, accompany- (b) The amount shown on the Declara- ing or containing such products; or tions of this Coverage Part for b. Any vendor for which coverage as Medical Expense Limit. an additional insured specifically is P. CONTRACTUAL LIABILITY — RAILROADS scheduled by endorsement. M. WHO IS AN INSURED — UNNAMED 1. The following replaces Paragraph C. of SUBSIDIARIES the definition of "insured contract" in the DEFINITIONS Section: The following is added to SECTION II — c. Any easement or license agree- WHO IS AN INSURED: ment; Any of your subsidiaries, other than a 2. Paragraph f.(1) of the definition of "in- partnership or joint venture, that is not sured contract" in the DEFINITIONS Sec- shown as a Named Insured in the Dec- tion is deleted. larations is a Named Insured if: a. You maintain an ownership interest O. KNOWLEDGE AND NOTICE OF OCCURRENCE OR of more than 50% in such subsidi- OFFENSE ary on the first day of the policy The following is added to Paragraph 2., period; and Duties In The Event of Occurrence, Offense, b. Such subsidiary is not an insured Claim or Suit, of SECTION IV — COMMERCIAL under similar other insurance. GENERAL LIABILITY CONDITIONS: No such subsidiary is an insured for e. The following provisions apply to "bodily injury" or "property damage" Paragraph a. above, but only for the that occurred, or "personal injury" or purposes of the insurance provided "advertising injury" caused by an of- under this Coverage Part to you or fense committed: any insured listed in Paragraph 1. or 2. a. Before you maintained an ownership of Section II - Who Is An Insured: interest of more than 50% in such (1) Notice to us of such "occurrence" subsidiary; or or offense must be given as soon b. After the date, if any, during the as practicable only after the "oc- policy period that you no longer currence" or offense is known to maintain an ownership interest of you (if you are an individual), any more than 50% in such subsidiary. of your partners or members who is an individual (if you are a part- N. WHO IS AN INSURED — LIABILITY FOR nership or joint venture), any of CONDUCT OF UNNAMED PARTNERSHIPS OR your managers who is an individual JOINT VENTURES If you are a limited liability com- pany), ally of your trustees who is The following replaces the last para- an individual (if you are a trust), graph of SECTION II — WHO IS AN any of your "executive officers" or INSURED: directors (if you are an organiza- tion other than a partnership, joint No p g venture, limited liability company with respect to the conduct of any cur- or trust) or any "employee" author- 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. 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 H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE— INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES— INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE — INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G, WAIVER OF DEDUCTIBLE —GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is Person or organization qualifies as an "insured" An Insured. of SECTION II — COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION 11 — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission; while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II — COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos" you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, " and property damage" occurs and that is in effect rent or borrow; during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 U 2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its perinission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph 8.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada, We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE — GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV— BUSINESS AUTO CONDITIONS: USE— INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III— PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner (if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- 1. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES — INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- 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 O 2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. �, ,,,,, � � �, WORKERS COMPENSATION 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