No preview available
PROOF OF INSURANCE (2017 - 2018) CLOSED 'a DATE(MM/DD/YYYY) ACCIII? " CERTIFICATE OF LIABILITY INSURANCE 3/23/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Woodruff-Sawyer&Co. PHONE AM 415-391-2141 415-989-9923 HONE FAX 50 California Street, Floor 12 (A C,No,Ed) (P/G No); San Francisco CA 94111 ADPRpESS. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Prop Casualty Co of Ameri 25674 INSURED COULTEC-01 INSURERB:Lloyds of London ChargePoint, Inc. INSURERC:Travelers Indemnity Company of CT 25682 254 E Hacienda Avenue Campbell CA 95008 )I� JREra D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1877757055 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 �ADDCSU6R POLICY EFF - POLICY EXP _ INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6305144X310 3/29/2017 3/29/2018 EACH OCCURRENCE $1,000.000 II,CLAIMS-MADE X. OCCUR ITAMK6r Y'0 RENTlfb PRFMI.SES Ea ocrtprrence)_51,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY JE T I LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY Y BA6879X698 3/29/2017 3/29/2018 CCWIpiwNLDSINGLEI.IiAI '$ (En accident) 1,000.000 X I ANY AUTO BODILY INJURY(Per person) ( $ - ALL OWNED _ AUTOSULED BODILY INJURY(Per accident) $ AUTOS R -- NON-OWNED HIRED AUTO ¢tr',1r'�f:ti''FO' S �� (P cidesno $ A X UMBRELLA LIAB XINI OCCUR CUPOJ88357A 3/29/2017 3/29/2018 EACH OCCURRENCE $10,000,000 4 EXCESS LIAB V CLAIMS-MADE AGGREGATE $10,000,000 4 i qq DED ( RETENTION$ II$ WORKERS COMPENSATION PER ryry OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I, ER ANb'Pri0r'RHrTr, P'A r"IIVER/EXECUTIVE I ACH ACCIDENT $ OF NCI-RIMF' 1gFR r.XCLUDED? NIA E L E,,,,„ (Mandatory In NH) "' EL DISEASE-EA EMPLOYEE; $oodor't;RIPTION OFOPrRAT°IONS hr low EL DISEASE-POLICY LIMIT Y 11 B Errors&Omissions/Cyber Y ESF04222278 11/14/2016 11/14/2017 (Aggregate Limit 5,000,000 (Professional Liability) R DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of El Segundo, its officials, and employees are included as additional insureds with respect to General Liability, Professional Liability, and Auto Liability, as per attached. Coverage is primary with respect to General Liability and Auto Liability,as per attached. _41-/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of El Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATTN:Greg Carpenter,City Manager ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo CA 90245 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS -- PRIMARY AND NONI-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 ad& 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 O 2008 The Travelers Companies,Inc. Page 1 of 1 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, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force Property Damage—Ex- K. Blanket Additional Insured—Persons Or Or- ception To Expected Or Intended Injury Ex- ganizations For Your Ongoing Operations As clusion Required By Written Contract Or Agreement B. Non-Owned Watercraft Less Than 75 Feet L. Blanket Additional Insured—Broad Form C. Aircraft Chartered With Pilot Vendors D. Damage To Premises Rented To You M. Who Is An Insured—Unnamed Subsidiaries E. Increased Supplementary Payments N. Who Is An Insured—Liability For Conduct Of F. Who Is An Insured—Employees And Volun- Unnamed Partnerships Or Joint Ventures teer Workers—First Aid O. Medical Payments—Increased Limits G. Who Is An Insured—Employees—Supervi- P. Contractual Liability—Railroads sory Positions Q. Knowledge And Notice Of Occurrence Or Of- H. Who Is An Insured—Newly Acquired Or fense Formed Organizations R. Unintentional Omission I. Blanket Additional Insured—Owners, Manag- S. Blanket Waiver Of Subrogation ers Or Lessors Of Premises J. Blanket Additional Insured—Lessors Of Leased Equipment PROVISIONS B. NON-OWNED WATERCRAFT LESS THAN 75 A. REASONABLE FORCE PROPERTY DAMAGE— FEET EXCEPTION TO EXPECTED OR INTENDED IN- The following replaces Paragraph (2) of Exclusion JURY EXCLUSION g., Aircraft,Auto Or Watercraft, in Paragraph 2. The following replaces Exclusion a., Expected Or of SECTION I — COVERAGES — COVERAGE A Intended Injury, in Paragraph 2., of SECTION I— BODILY INJURY AND PROPERTY DAMAGE COVERAGES — COVERAGE A BODILY IN- LIABILITY: JURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: a. Expected Or Intended Injury Or Damage (a) Less than 75 feet long; and "Bodily injury" or "property damage" expected or (b) Not being used to carry any person or intended from the standpoint of the insured. This property for a charge. exclusion does not apply to "bodily injury" or C. AIRCRAFT CHARTERED WITH PILOT "property damage" resulting from the use of rea- sonable force to protect any person or property. The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2.of SECTION CG D4 17 01 12 02012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office,Inc,with its permission. COMMERCIAL GENERAL LIABILITY I — COVERAGES — COVERAGE A BODILY IN- 4. The following replaces Paragraph a. of the JURY AND PROPERTY DAMAGE LIABILITY: definition of"insured contract" in the DEFINI- This exclusion does not apply to an aircraft that TIONS Section: is: a. A contract for a lease of premises. How- (a) Chartered with a pilot to any insured; ever, that portion of the contract for a lease of premises that indemnifies any (b) Not owned by any insured;and person or organization for "premises (c) Not being used to carry any person or prop- damage"is not an"insured contract"; erty for a charge. 5. The following is added to the DEFINITIONS D. DAMAGE TO PREMISES RENTED TO YOU Section: 1. The first paragraph of the exceptions in Ex- "Premises damage" means "property dam- clusion J., Damage To Property, in Para- age"to: graph 2. of SECTION I — COVERAGES — a. Any premises while rented to you or tern- COVERAGE A BODILY INJURY AND porarily occupied by you with permission PROPERTY DAMAGE LIABILITY is deleted. of the owner; or 2. The following replaces the last paragraph of b. The contents of any premises while such Paragraph 2., Exclusions, of SECTION I — premises is rented to you, if you rent such COVERAGES — COVERAGE A BODILY IN- premises for a period of seven or fewer JURY AND PROPERTY DAMAGE LIABIL- consecutive days. ITY; 6. The following replaces Paragraph 4.b.(1)(b) Exclusions c., g. and h., and Paragraphs (1), of SECTION IV —COMMERCIAL GENERAL (3) and (4) of Exclusion j., do not apply to LIABILITY CONDITIONS: "premises damage". Exclusion f.(1)(a) does not apply to "premises damage" caused by (b) That is insurance for"premises damage fire unless Exclusion f. of Section I — Cover- or age A — Bodily Injury And Property Damage 7. Paragraph 4.b.(1)(c) of SECTION IV — Liability is replaced by another endorsement COMMERCIAL GENERAL LIABILITY CON- to this Coverage Part that has Exclusion -All DITIONS is deleted. Pollution Injury Or Damage or Total Pollution E. INCREASED SUPPLEMENTARY PAYMENTS Exclusion in its title. A separate limit of insur- 1. The following replaces Paragraph 1.b. of ance applies to "premises damage" as de- SUPPLEMENTARY PAYMENTS — COVER- scribed in Paragraph fi. of Section III —Limits Of Insurance. AGES A AND B of SECTION I — COVER- AGES: 3. The following replaces Paragraph 6. of SEC- TION Ill—LIMITS OF INSURANCE: b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law 6. Subject to 5. above, the Damage To violations arising out of the use of any Premises Rented To You Limit is the vehicle to which the Bodily Injury Liability most we will pay under Coverage A for Coverage applies. We do not have to fur- damages because of"premises damage" nish these bonds. to any one premises. 2. The following replaces Paragraph 1.d. of The Damage To Premises Rented To SUPPLEMENTARY PAYMENTS — COVER- You Limit will be: AGES A AND B of SECTION I — COVER- a. The amount shown for the Damage AGES: To Premises Rented To You Limit on d. All reasonable expenses incurred by the the Declarations of this Coverage insured at our request to assist us in the Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for "suit", including actual loss of earnings up the Damage To Premises Rented To to $500 a day because of time off from You Limit on the Declarations of this work. Coverage Part. Page 2 of 6 ©2012 The Travelers Indemnity Company. All rights reserved, CG D4 17 01 12 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY F. WHO IS AN INSURED — EMPLOYEES AND your "employees" who hold a supervisory posi- VOLUNTEER WORKERS—FIRST AID tion. 1. The following is added to the definition of"oc- H. WHO IS AN INSURED — NEWLY ACQUIRED currence"in the DEFINITIONS Section: OR FORMED ORGANIZATIONS Unless you are in the business or occupation The following replaces Paragraph 4. of SECTION of providing professional health care services, 11 — WHO IS AN INSURED of the Commercial "occurrence" also means an act or omission General Liability Coverage Form, and Paragraph committed by any of your "employees" or 3. of SECTION II —WHO IS AN INSURED of the "volunteer workers", other than an employed Global Companion Commercial General Liability or volunteer doctor, in providing or failing to Coverage Form, to the extent such coverage provide first aid or"Good Samaritan services" forms are part of your policy: to a person. Any organization you newly acquire or form, other 2. The following is added to Paragraph 2.a.(1)of than a partnership or joint venture, of which you SECTION 11—WHO IS AN INSURED: are the sole owner or in which you maintain the majority ownership interest, will quality as a Unless you are in the business or occupation Named Insured if there is no other insurance of providing professional health care services, which provides similar coverage to that organiza- Paragraphs (1 )(a), (b), (c) and (d) above do tion. However: not apply to "bodily injury" arising out of pro- a. Coverage under this provision is afforded viding or failing to provide first aid or "Good only; Samaritan services" by any of your "employ- ees organization or "volunteer workers", other than an (1) Until the 180th day after you acquire or employed or volunteer doctor. Any of your form the organization the end of the "employees" or "volunteer workers" providing policy period, whichever r is earlier, if you or failing to provide first aid or"Good Samari- do not report such organization c writing tan services" during heir work hours for you to us within 180 days after you acquire or g y form it; or will be deemed to be acting within the scope of their employment by you or performing du- (2) Until the end of the policy period, when ties related to the conduct of your business. that date is later than 180 days after you acquire or form such organization, if you 3. The following is added to„Paragraph 5. of report such organization in writing to us SECTION 111—LIMITS OF INSURANCE: within 180 days after you acquire or form For the purposes of determining the applica- it, and we agree in writing that it will con- ble Each Occurrence Limit, all related acts or tinue to be a Named Insured until the end omissions committed by any of your"employ- of the policy period; ees” or "volunteer workers" in providing or b. Coverage A does not apply to"bodily injury" failing to provide first aid or"Good Samaritan or "property damage" that occurred before services"to any one person will be deemed to you acquired or formed the organization; and be one"occurrence". c. Coverage B does not apply to "personal in- 4. The following is added to the DEFINITIONS jury" or "advertising injury" arising out of an Section; offense committed before you acquired or "Good Samaritan services" means any emer- formed the organization. gency medical services for which no compen- 1. BLANKET ADDITIONAL INSURED —OWNERS, sation is demanded or received. MANAGERS OR LESSORS OF PREMISES G. WHO IS AN INSURED — EMPLOYEES — SU- The following is added to SECTION II—WHO IS PERVISORY POSITIONS AN INSURED: The following is added to Paragraph 2.a.(1) of Any person or organization that is a premises SECTION II—WHO IS AN INSURED: owner, manager or lessor is an insured, but only with respect to liability arising out of the owner- Paragraphs (1)(a), (b) and (c)above do not apply ship, maintenance or use of that part of any prem- to "bodily injury" or "personal injury" to a co- ises leased to you. "employee" in the course of the co-"employee's" The insurance provided to such premises owner, employment by you arising out of work by any of manager or lessor does not apply to: CG D4 17 01 12 ©2012 The Travelers Indemnity Company. All rights reserved, Page 3 of 6 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY a. Any "bodily injury" or "property damage" L. BLANKET ADDITIONAL INSURED — BROAD caused by an "occurrence" that takes place, FORM VENDORS or "personal injury" or "advertising injury" The following is added to SECTION II —WHO IS caused by an offense that is committed, after AN INSURED: you cease to be a tenant in that premises; or Any person or organization that is a vendor and b. Structural alterations, new construction or that you have agreed in a written contract or demolition operations performed by or on be- agreement to include as an additional insured on half of such premises owner, manager or les- this Coverage Part is an insured, but only with re- sor. spect to liability for "bodily injury" or "property J. BLANKET ADDITIONAL INSURED— LESSORS damage"that: OF LEASED EQUIPMENT a. Is caused by an"occurrence"that takes place The following is added to SECTION it —WHO IS after you have signed and executed that con- AN INSURED: tract or agreement; and Any person or organization that is an equipment b. Arises out of "your products" which are dis- lessor is an insured, but only with respect to liabil- tributed or sold in the regular course of such ity for "bodily injury", "property damage", "per- vendor's business, sonal injury" or "advertising injury" caused, in The insurance provided to such vendor is subject whole or in part, by your acts or omissions in the to the following provisions: maintenance, operation or use by you of equip- ment leased to you by such equipment lessor, a. The limits of insurance provided to such ven- The insurance rovided,to such equipment lessor dor will be the limits which you agreed to pro- vide in the written contract or agreement, or P does not apply to any bodily injury" or"property the limits shown in the Declarations,which- damage" caused by an "occurrence" that takes ever are less. place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the b. The insurance provided to such vendor does equipment lease expires. not apply to: K. BLANKET ADDITIONAL INSURED—PERSONS (1) Any express warranty not authorized by OR ORGANIZATIONS FOR YOUR ONGOING you; OPERATIONS AS REQUIRED BY WRITTEN (2) Any change in"your products"made by CONTRACT OR AGREEMENT such vendor; The following is added to SECTION II — WHO IS (3) Repackaging, unless unpacked solely for AN INSURED: the purpose of inspection, demonstration, Any person or organization that is not otherwise testing, or the substitution of parts under an insured under this Coverage Part and that you instructions from the manufacturer, and have agreed in a written contract or agreement to then repackaged in the original container; include as an additional insured on this Coverage (4) Any failure to make such inspections, ad- Part is an insured, but only with respect to liability for"bodily injury"or"property damage"that: agree to o p tests or servicing as vendors agree perform or normally undertake to a. Is caused by an"occurrence"that takes place perform in the regular course of business, after you have signed and executed that con- in connection with the distribution or sale tract or agreement; and of"your products"; b. Is caused, in whole or in part, by your acts or (5) Demonstration, installation,servicing or omissions in the performance of your ongoing repair operations,except such operations operations to which that contract or agree- performed at such vendor's premises in ment applies or the acts or omissions of any connection with the sale of"your prod- person or organization performing such op- ucts"; or erations on your behalf. (6) "Your products"which, after distribution The limits of insurance provided to such insured or sale by you, have been labeled or re- will be the limits which you agreed to provide in labeled or used as a container, part or in- the written contract or agreement, or the limits gredient of any other thing or substance shown in the Declarations, whichever are less. by or on behalf of such vendor. Page 4 of 6 ©2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12 Includes copyrighted material of Insurance Services Office,Inc.with its permission, COMMERCIAL GENERAL LIABILITY Coverage under this provision does.not apply to: (b) The amount shown on the Declarations of a. Any person or organization from whom you this Coverage Part for Medical Expense have acquired"your products", or any ingre- Limit. dient. part or container entering into, accom- P. CONTRACTUAL LIABILITY—RAILROADS panying or containing such products; or 1. The following replaces Paragraph c. of the b. Any vendor for which coverage as an addi- definition of "insured contract" in the DEFINI- tional insured specifically is scheduled by en- TIONS Section: dorsement. c. Any easement or license agreement; M. WHO IS AN INSURED — UNNAMED SUBSIDI- 2. Paragraph C(1) of the definition of "insured ARIES contract" in the DEFINITIONS Section is de- The following is added to SECTION II —WHO IS leted. AN INSURED: Q. KNOWLEDGE AND NOTICE OF OCCUR- Any of your subsidiaries, other than a partnership RENCE OR OFFENSE or joint venture, that is not shown as a Named In- The following is added to Paragraph 2., Duties In sured in the Declarations is a Named Insured if: The Event of Occurrence, Offense, Claim or a. You maintain an ownership interest of more Suit, of SECTION IV — COMMERCIAL GEN- than 50% in such subsidiary on the first day ERAL LIABILITY CONDITIONS: of the policy period; and e. The following provisions apply to Paragraph b. Such subsidiary is not an insured under simi- a. above, but only for the purposes of the in- lar other insurance. surance provided under this Coverage Part to No such subsidiary is an insured for"bodily injury" you or any insured listed in Paragraph 1. or 2. of Section II—Who Is An Insured: or "property damage" that occurred, or "personal „ Notice to us of such "occurrence" or of- injury or advertising injury' caused by an f ( ) of- fense committed: fense must be given as soon as practica- a. Before you maintained an ownership interest ble only after the "occurrence" or offense of more than 50% in such subsidiary; or is known to you (if you are an individual), any of your partners or members who is b. After the date, if any, during the policy period an individual (if you are a partnership or that you no longer maintain an ownership in- joint venture), any of your managers who terest of more than 50% in such subsidiary. is an individual (if you are a limited liability N. WHO IS AN INSURED — LIABILITY FOR CON- company), any of your trustees who is an DUCT OF UNNAMED PARTNERSHIPS OR individual (if you are a trust), any of your JOINT VENTURES "executive officers"or directors(if you are an organization other than a partnership, The following replaces the last paragraph of joint venture, limited liability company or SECTION 11—WHO IS AN INSURED: trust) or any "employee" authorized by No person or organization is an insured with re- you to give notice of an "occurrence" or spect to the conduct of any current or past part- offense. nership or joint venture that is not shown as a (2) If you are a partnership,joint venture, lim- Named Insured in the Declarations. This para- ited liability company or trust, and none of graph does not apply to any such partnership or your partners, joint venture members, joint venture that otherwise qualifies as an in- managers or trustees are individuals, no- sured under Section II—Who Is An Insured, tice to us of such"occurrence" or offense O. MEDICAL PAYMENTS—INCREASED LIMITS must be given as soon as practicable only The following replaces Paragraph 7. of SECTION after the"occurrence"or offense is known III—LIMITS OF INSURANCE: by: 7. Subject to 5. above, the Medical Expense (a) Any individual who is: Limit is the most we will pay under Coverage (i) A partner or member of any part- C for all medical expenses because of"bodily injury" sustained by any one person, and will nership or joint venture; be the higher of: (ii) A manager of any limited liability (a) $10,000; or company; CG D4 17 01 12 02012 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY (ill)A trustee of any trust; or abrupt commencement, this Paragraph e. (iv)An executive officer or director of does not affect that requirement. any other organization; R. UNINTENTIONAL OMISSION that is your partner, joint venture The following is added to Paragraph 6., Repre- member, manager or trustee; or sentations, of SECTION IV — COMMERCIAL (b) Any "employee" authorized by such GENERAL LIABILITY CONDITIONS: partnership, joint venture, limited Il- The unintentional omission of, or unintentional ar- ability company, trust or other organi- ror in, any information provided by you which we zation to give notice of an "occur- relied upon in issuing this policy will not prejudice rence"or offense. your rights under this insurance. However, this (3) Notice to us of such "occurrence" or of- provision does not affect our right to collect addi- fense will be deemed to.be given as soon tional premium or to exercise our rights of cancel- as practicable if it is given in good faith as lation or nonrenewal in accordance with applica- soon as practicable to your workers' ble insurance laws or regulations, compensation insurer. This applies only if S. BLANKET WAIVER OF SUBROGATION you subsequently give notice to us of the " The fallowing is added to Paragraph B., Transfer occurrence" or offense as soon as prac- Of Rights Of Recovery Against Others To Us, ticable after any of the persons described of SECTION IV— COMMERCIAL GENERAL LI- in Paragraphs e. (1) or (2) above discov- ABILITY CONDITIONS: ers that the "occurrence' or offense may result in sums to which the insurance If the insured has agreed in a contract or agree- provided under this Coverage Part may ment to waive that insured's right of recovery apply. against any person or organization, we waive our right of recovery against such person or organiza- ment that provides limited coverage for "bod- However, if this policy includes an endorse- tion, but only for payments we make because of: ily injury" or "property damage" or pollution a. "Bodily injury" or "property damage" caused costs arising out of a discharge, release or by an"occurrence"that takes place;or escape of "pollutants" which contains a re- b. "Personal injury" or "advertising injury" quirement that the discharge, release or es- caused by an offense that is committed; cape of "pollutants" must be reported to us subsequent to the execution of the contract or within a specific number of days after its agreement. Page 6 of 6 ©2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12 Includes copyrighted material of Insurance Services Office,Inc.with its permission. TECH j mediation or some other form of alternative dispute resolution and by you or arising solely out of accidental bodily injury or damage shall pay on your behalf the amount so agreed by us and the caused by you,provided that: claimant.If we cannot settle by such means,we shall pay the amount a) you contracted in writing to indemnify the third party for which you are found liable to pay either in court or through such a claim prior to it first being made against them;and arbitration proceedings,subject always to the Limit of Liability shown b) had the claim been made against you, then you would be in the Declarations. entitled to indemnity under this Policy. If you refuse to consent to a settlement we recommend and the As a condition to our indemnification of any additional Insured: claimant will accept,you may continue the defense and investigation i) they shall prove to our satisfaction that the claim arose solely of that claim.However,the further costs and expenses incurred out of a wrongful act committed by you or arose solely out will be paid by you and us on a proportional basis,with 80%payable of accidental bodily injury or damage caused by you;and by us and 20%payable by you. [I) they shall full/comply with CONDITION I(a)above as if 7. Innocent non-disclosure they were you. We will not seek to avoid the Policy or reject any claim on the Where a third party is indemnified as an additional Insured as a grounds of non-disclosure or misrepresentation except where the result of this CONDITION, it is understood and agreed that any non-disclosure or misrepresentation was reckless or fraudulent or claim made by that third party against you shalt be treated by us your senior executive officers failed to conduct a full inquiry as if they were a third party,not an additional Insured. prior to providing the information that forms the basis of this insurance.In the event that we seek to avoid the Policy or reject 13. Prior subsidiaries any claim on this basis the burden of proving otherwise rests solely In respect of I NSURING CLAUS ES 1,2(S TI ISIS A and B with you. only) and 3, should an entity cease to be a subsidiary after the Inception Date of this Policy,cover in respect of such entity shall B. Your duty to advise us of changes continue as if it was still a subsidiary,until the termination of this If a senior executive officer becomes aware that any of the Policy, but only in respect of any claim or loss that arises out of information that you have given us in the Application Form or any wrongful act committed by that entity prior to the date that it elsewhere in connection with your application for this insurance has ceased to be a subsidiary. materially changed then you must advise us as soon as is practicable. In this event,we reserve the right to amend the terms.conditions 14. Mergers and acquisitions or premium of the Policy. During the period of the policy, if the company named as the Insured in the Declarations or any subsidiary: 9. Risk management conditions a) purchases assets or acquires liabilities from another entity in If we attach any additional conditions to your Policy regarding any an amount greater than 10% of the assets of the company risk survey or risk management timetable or any other similar named as the Insured in the Declarations as listed in its most conditions then it is your responsibility to ensure that these recent financial statement;or conditions are complied with bythe deadlines shown in the conditions, b) acquires another entity whose annual revenues are more than 10% of the annual revenues of the company named as the 10. Our rights of recovery Insured in the Declarations for their last completed financial If any payment is made under this Policy in respect of a claim,loss year; or damage and there is available to us any of your rights of recovery against any third party then we maintain all such rights then you shall have no coverage under this Policy for any claim, of recovery.We shall not exercise these rights against any senior loss or damage that arises directly or indirectly out of the executive officer or employee unless such Payment is in respect purchased or acquired entity unless the company named as the of any wilful,malicious or dishonest acts or omissions. Insured in the Declarations gives us written notice prior to the purchase or acquisition, obtains our written agreement to extend You must do nothing to impair any rights of recovery. At our coverage to these additional entities,assets or exposures,and agrees request you will bring proceedings or transfer those rights to us and to pay any additional premium required by us. help us to enforce them.Any recoveries shall be applied as follows: a) first,to us up to the amount of our payment on your behalf If during the period of the policy the company named as the including costs and expenses;and Insured in the Declarations consolidates or merges with or is b) then to you as recovery of your Deductible or other amounts acquired by another entity,then all coverage under this Policy shall paid as compensation or costs and expenses. terminate at the date of the consolidation, merger or acquisition unless we have issued an endorsement extending coverage under It. Cancellation this Policy, and the company named as the Insured in the This Policy may be cancelled: Declarations has agreed to any additional premium and terms of a) by you at any time on request;or coverage required by us. b) by us if we give you 30 days written notice;or c) by us if we give you IS days written notice,should any amount 15. Automatic extended reporting period in default not be paid within 15 days of the due date shown in In respect of INSURING CLAUSES 1,2(SECTIONS A and B the Debit Note that accompanies this Policy. only),3 and S(SECTION H),an Extended Reporting Period of 60 days following the Expiry Date as shown in the Declarations shall be Ifyou give us notice of cancellation in accordance with a)above,the automatically granted at no additional premium, This Extended earned Premium shall be pro rata to the number of days that the Reporting Period shall cover claims first made against you during Policy is in effect the period of the policy and reported to us during this 60 day Extended Reporting Period but only in respect of any wrongful act If we give you notice of cancellation in accordance with b) or c) committed prior to the Expiry Date shown in the Declarations,and above,the earned Premium shall he pro rata to the number of days that the Policy is in effect. subject to all other terms,conditions and exclusions of the policy. No claim shall be accepted by us in this 60 day Extended Reporting The Policy Administration Fee shall be deemed fully earned at the Period if you are entitled to indemnity under any other insurance, Inception Dam of the 1i or would have been entitled to indemnity under such insurance but for the exhaustion thereof. 12. Additional insureds We shall indemnify any third party as an additional Insured under 16. Optional extended reporting period this Policy,but only in respect of sums which they become legally In respect of INSURING CLAUSES 1,2(SECTIONS A and B obliged to pay(including liability for claimants'costs and expenses) only),3 and 5 (SECTION H),if we or you decline to renew or as a result of claim arising solely outof awrongful act committed cancel this Policy then you shall have the right,upon payment of the 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 1. 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 II — 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, "property damage" occurs and that is in effect rent or borrow; and 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 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.Wth its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II — COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured"while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii)We may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured" against, or LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 0215 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO 4. Loss Payment — Physical Damage Cover- son or organization holding, storing or trans- ages porting property for a fee regardless of any At our option, we may: other provision of this Coverage Form. a. Pay for, repair or replace damaged or sto- 5. Other Insurance len property; a. For any covered "auto" you own, this b. Return the stolen property, at our ex- Coverage Form provides primary insur- pense. We will pay for any damage that ance. For any covered "auto" you don't results to the"auto" from the theft; or own, the insurance provided by this Cov- c. Take all or any part of the damaged or erage Form is excess over any other col- lectible insurance. However, while a cov- stolen property at an agreed or appraised ered "auto" which is a "trailer" is con- value, nected to another vehicle, the Covered If we pay for the "loss", our payment will in- Autos Liability Coverage this Coverage clude the applicable sales tax for the dam- Form provides for the"trailer" is: aged or stolen property. (1) Excess while it is connected to a mo- 5. Transfer Of Rights Of Recovery Against for vehicle you do not own; or Others To Us (2) Primary while it is connected to a If any person or organization to or for whom covered "auto"you own. we make payment under this Coverage Form b. For Hired Auto Physical Damage Cover- has rights to recover damages from another, age, any covered "auto" you lease, hire, those rights are transferred to us. That person rent or borrow is deemed to be a covered or organization must do everything necessary "auto" you own. However, any "auto" that to secure our rights and must do nothing after is leased, hired, rented or borrowed with "accident"or"loss"to impair them. a driver is not a covered "auto". B. General Conditions c. Regardless of the provisions of Para- 1. Bankruptcy graph a. above, this Coverage Form's Bankruptcy or insolvency of the "insured" or Covered Autos Liability Coverage is pri- the"insured's" estate will not relieve us of any mary for any liability assumed under an obligations under this Coverage Form. "insured contract". 2. Concealment, Misrepresentation Or Fraud d. When this Coverage Form and any other Coverage Form or policy covers on the This Coverage Form is void in any case of same basis, either excess or primary, we fraud by you at any time as it relates to this will pay only our share. Our share is the Coverage Form. It is also void if you or any proportion that the Limit of Insurance of other "insured", at any time, intentionally con- our Coverage Form bears to the total of ceals or misrepresents a material fact con- the limits of all the Coverage Forms and cerning: policies covering on the same basis. a. This Coverage Form; 6. Premium Audit b. The covered "auto"; a. The estimated premium for this Coverage c. Your interest in the covered "auto'; or Form is based on the exposures you told d. A claim under this Coverage Form. us you would have when this policy be- gan. We will compute the final premium 3. Liberalization due when we determine your actual ex- If we revise this Coverage Form to provide posures. The estimated total premium will more coverage without additional premium be credited against the final premium due charge, your policy will automatically provide and the first Named Insured will be billed the additional coverage as of the day the re- for the balance, if any. The due date for vision is effective in your state. the final premium or retrospective pre- 4. No Benefit To Bailee — Physical Damage mium is the date shown as the due date Coverages on the bill. If the estimated total premium exceeds the final premium due, the first We will not recognize any assignment or Named Insured will get a refund. grant any coverage for the benefit of any per- CA 00 01 10 13 (D Insurance Services Office, Inc., 2011 Page 9 of 12 321791 AC R� CERTIFICATE OF LIABILITY INSURANCE DATE 5/4/20D/YYY) �,,,,�• 5/4/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jeff Koo NAME: Commercial Lines-(415)541-7900 PHONE FAX 650-413-4319 AICallo Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-MAIL etlee .koo wellsf'ar o cora� AIJDRESS: 1 y g 45 Fremont Street,Suite 800 INSURER(S)AFFORDING COVERAGE NAIC# San Francisco,CA 94105-2259 INSURERA: Travelers Property Casualty Co of America 25674 INSURED INSURER B: ChargePoint, Inc. INSURER C 254 E.Hacienda Avenue INSURER D: Campbell,CA 95008 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 11748913 REVISION NUMBER: See below 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.4LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. _M POLICY TYPE OF INSURANCE A SD SWVD POLICY NUMBER (MM/DDNYYY)_ (MM/DDIYY Y) ................................... LIMITS I___. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ IJAMA6E,�O.PLN,IE ............... ....................,,,,,, CLAIMS-MADE OCCUR PREMISE,S„(Ea,occurrence) $ Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY J1 C1' L d'X' PRODUCTS-COMPIOP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Fa accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS ............ HIRED NON-OWNED pIRdIcERTY DAMAGE � S AUTOS ONLY AUTOS ONLY Poa ucc.1t617ruIM I,S UMBRELLA LIAB OCCUR EACI-I OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE Cs DED RETENTION$ S or ND EEMIPL COMPENSATION 0441'11'N L ABILI ED' IN NIA 02/01/2017 02/01/2018 X s `HRH p A YPROP'6RI®,C>F1EEXIENO XECUTIVE YIN HJU64F37149917 E L EACH ACCIDENT III$ ',00,00.0........... WORKERS ITS F If yes,describe hw NH) E L DISEASE-EA EMPLOYEE,I S 0,000 If yes,describe under """"""”'"""""""""""'"" DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Waiver of Subrogation is granted as it relates to Workers Compensation in accordance with the terms and conditions of the policy. I„ CERTIFICATE HOLDER CANCELLATION City of El Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. El Segundo,CA 90245 AUTHORIZED REPRESENTATIVE I 9e--4_.1_ The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) (Thr—Uh.Be replaces wNhca Wp 17 M78655—d-113112017) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 08 93 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments frorn anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement form us,) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED IS OPERATING UNDER A WRITTEN "INSURED CONTRACT",WHEN SUCH CONTRACT REQUIRES A WAIVER OF SUBROGATION. This endorsement changes the policy to which It is altached and Is effective on the date issued unless otherwise stated. (The Information below Is required onlywhen this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Elleclive 02/01/2017 Policy No_ HJUB4F37149917 Endorsement No_ Insured Premium v ChargePoint, Inc. Insurance Company Countersigned by WC 00 03 13 NM FOf i a.$9NI666 (Ed.4-t34) Copyright t9tI3 National Council on Compensation Insurance. P'amtx�lrncCiv,y�s-�urarw