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PROOF OF INSURANCE (2018) CLOSED DAVIFAR-01 SP912746 ACORO" DATE(MMIDDIYI'YY) CERTIFICATE OF LIABILITY INSURANCE 5/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFIC ATE 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. e ii i5iii-�----- I subject to certificate does not confer rights to the certificate holder in lieu oflsuch endorsement(s).ipolicies may require an endorsement. A statement on thisf SUB ' c f' g PRODUCER License#OE77964 I CONTACT NAME: Suzanne POsada II! Integro,USA Inc.,dba:Newport Birch Street 92660 rp gro Insurance Brokers xsta a49e„posatl a�'irttOgro coup COAm,Nu) 1 Q949�419-1674 INSURERS)AFFORDING COVERAGE NAIC 0 INSURER Travelers Pr..,,.p A; ve Property Casualty Company of America 25674 INSURED INSURER B:Travelers Casualty Insurance Company of America 19046 Company Davis Farr,LLP party 25224 INSURER c:Great Divide 2301 Dupont Dr.,Ste 200 INSURER D: Irvine,CA 92612 wsu RER E INSURER.F,.............,.......,...,. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INDICATED. MAY m __m .... N CERTIFIC CERTIFY BE7 ISSUED OR POLICIES OF THEN INSURANCE AFFORDEDEBY THE POLICIES TDESCRIBED HEREIN IS FOR THE TO ALL THE PERIOD D. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT T WHICH THIS E TERMS, EXCLUSIONS .....................AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR„ .,. .... Ary00p AMP... POLICYY „R,,, (MMIDDY EF F POLICY EXP INS TYPE OF INSURANCE Y NUM,BE fYYYY,) (MMIDDfYYYY) LIMITS . A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0001 CLAIMS-MADE I.X I OCCUR X 6804.1154861 05/2112017 05/21/2018 MEM,SES(Ea,o,,c,,,cur,enq„e ) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000' YLIMI ( LOO GENERAL AGGREGATE $ 2,000,000 ' PRO, PER: G X C:(7 p(Y. PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMBIrJED SIPJGLE".u.6M� $ 1,000,00a Ea acckruuzk 113 ANYAUTO BA4J155058 05/21/2017 05/21/2018 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ „ AUTOS AUTOS NON-OWNED X„ PROPERTY DAMAGE .�.. HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAB X OCCUR EACH,OOC,UR,RENCE $ 1,000,000 A EXCESS LAB CLAIMS-MADE CUP4J155126 05/2112017 05/21/2018 AGGR EGATE $ 1,000,000 DED I X I RETENTI ON$ 0 $ A ANY PROPREERS'LIABILITY ECUTIVE "'"""""°""'1 IJUB4678T66 ....0.............................. X ........,....... .,...�.,�m WORKERS COMPENSATION �� E.L.EACH ACCIDENT EN�ER $ ,000,000 YIN 512112017 05/21/2018 OFFICERIMEMBER EXCLUDED? Y N I A 1' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY L MITE ,000000 If yes,describe und $ 1 ,er C Professional Liab.- CAB20185201 05/15/2017 1 05121/2018 Ea Claim/Aggregate 1,000,000 C (Claims Made) CAB20185201 05115120171 05121/2018 Ded.-Ea Claim/Agg. 50,00011 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) 1' Professional Liability(Claims Made)Policy: Retroactive Date:05/15/2015 ti Re:RFP#08-16 "Bf, The certificate holder is additional insured,per the attached form#CGD186(11103),to the extent required by written contract,subject to polic,y< rrns and conditions. __ .............................................w ..............................__.............,.............................................................................. ............. ...W...... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of El Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street El Segundo,CA 90245-0989 ®_...—------- AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSURED: Davis Farr, LLP POLICY NO.: 6804J154861 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: A. CANCELLATION C. EXAMINATION OF YOUR BOOKS AND 7 1. The first Named Insured shown in the Decla- RECORDS rations may cancel this policy by mailing or We may examine and audit your books and re- delivering to us advance written notice of cords as they relate to this policy at any time dur- cancellation. ing the policy period and up to three years after- 2. We may cancel this policy or any Coverage ward. Part by mailing or delivering to the first D. INSPECTIONS AND SURVEYS Named Insured written notice of cancellation 1. We have the right to: at least: a. Make inspections and surveys at any a. 10 days before the effective date of can- time; cellation if we cancel for nonpayment of premium;or b. Give you reports on the conditions we b. 30 days before the effective date of can- find;and es.c, Recommend than cellation if we cancel for any other rea- g son. 2. We are not obligated to make any inspec- 3. We will mail or deliver our notice to the first tions, surveys, reports or recommendations Named Insured's last mailing address known and any such actions we do undertake relate to us. only to insurability and the premiums to be 4. Notice of cancellation will state the effective charged.We do not make safety inspections, date of cancellation. If the policy is cancelled, We do not undertake to perform the duty of any person or organization to provide for the that date will become the end of the policy period. If a Coverage Pali is cancelled, that health or safety of workers or the public.And date will become the end of the policy period we do not warrant that conditions: as respects that Coverage Part only. a. Are safe or healthful;or 5. If this policy or any Coverage Part is can- b. Comply with laws, regulations, codes or celled, we will send the first Named Insured standards. any premium refund due.If we cancel,the re- 3. Paragraphs 1. and 2. of this condition apply fund will be pro rata. If the first Named In- not only to us, but also to any rating, advi- sured cancels, the refund may be less than sory, rate service or similar organization pro rata. The cancellation will be effective which makes Insurance inspections, surveys, even if we have not made or offered a re- reports or recommendations. fund. 4. Paragraph 2. of this condition does not apply 6. If notice is mailed, proof of mailing will be to any inspections, surveys, reports or rec- sufficient proof of notice. ommendations we may make relative to certi- B. CHANGES fication, under state or municipal statutes, or- This policy contains all the agreements between dinances or regulations, of boilers, pressure you and us concerning the insurance afforded. vessels or elevators. , The first Named Insured shown in the Declara- E. PREMIUMS tions is authorized to make changes in the terms 1. The first Named Insured shown in the Decla- of this policy with our consent.This policy's terms rations: can be amended or waived only by endorsement a. Is responsible for the payment of all pre- issued by us as part of this policy. miums;and b. WIII be the payee for any return premi- ums we pay. IL T3 15 09 07 (Rev.03-11) Includes the copyrighted material of Insurance Services orrice,Inc.with its permission. Page 1 of 2 2. We compute all premiums for this policy in 3. Standard Property forms \nduding, but not accordance with our rules, rabes, rating plans, limited to,the following: pomrn|unm and mmimumm a. Building and Personal Properly Coverage nmiunm shown In the Declarations was omm- Form; puted based on rates and rules In effect effect wt he time! the Policy Wag Issued. On each re- b, Business Income Coverage Form; | mmwmk continuation or anniversary uf the ef- c' Commercial Property Conditions: fectke date of this policy, we will compute d, Condominium Association Coverage the premium in accordance with our rates Form. and rules then lneffect. ' F. TRANSFER OF YOUR RIGHTS AND DUTIES w' Condominium Commercial Unit-Owners Coverage Form; UNDER THIS P��UCY ' ' Your rights and duties Linder � Causes nf Loss Bom|c Form; mdarthi� policy not ba transferred without our vvrIUen consent except g. Causes xf Loss Special Form; and |n the, case of death ofmn Individual named in- h. Causes nf Loss Earthquake Form. ounod. ` Endorsements referencing the Commercial If you die, your rights and duties will be <nmnm- pnmVorly Coverage Part or the Standard � harmd to your legal representative but only white Property Forms referenced above apply to att\m0 m8th|m the scope of duties as your legal the Bus<nesmowmexs Property,Coverage Spe- pap*a entati e Until your legal representative Is dm| Form In the same manner as they apply appointed, anyone having proper,wu^p",a/yov:- tu the forms they reference, todymf your property will have '-- '=N� end Endorsements re#*pmmdng the Commercial duties but only md1h respect hm that property, General Liability Coverage Part apply to the G. BUQUNESSDWNERS COVERAGE PART — Commercial General Liability Coverage Form REFERENCES TO FORMS AND ENDORSE- (included in the Bua|n000uwnmm OuvoroQn K0GNTS Part)in the same manner ao they apply tothe In some |nuianuno.the Common Policy Duc|umu' form they reference. tinno may list endorsements included'in the Bus)- H. INSURANCE UNDER TWO OR MORE COVER' nu000wmemCovaragePart that reference: AGE PARTS 1. The Commercial Property Coverage Part; |f two or more of this policy's Coverage Podoap' 2. The Commercial General Liability or Liquor ply tothe name loss or dmmagm, we will not pay Liability Coverage P,art;ur more than the actual amount cf the loss ordam- age, This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that ' declarations form. � In for payment of the premium,we agree with the Named Insured to provide the Insurance afforded bye � Coverage Part forming part of this policy.That insurance will bo provided byth company indicated as insuring � company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below(each a stock company) has executed this policy,and this policy is counter- signed by\heoffiuem1iot»dbo|ow: � The Travelers|ndomnit Company The Phoenix Insurance Company(PHX) The Charter Oak Fire Insurance Company(COF) Travelers Property Casualty Company of America(TIL) The Travelers Indemnity Company of Connecticut(TICT) The Travelers Indemnity Company of America(TIA) Travelers Casualty Insurance Company of America(ACJ) ^ � � | Secretary President Page 2 of 2 Includes the copyrighted material of Insurance services Oftice,Inc.with Its permission. IL T3 15 09 07 (Rev.03-111) INSURED: Davis Farr, LLP COMMERCIAL GENERAL LIABILITY POLICY NO.: 6804J154861 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I XTEND ENDORSEMENT W This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. The following listing is a general coverage description only.Limitations and exclusions may apply to these coverages.Read all the PRO- VISIONS of this endorsement carefully to determine rights,duties, and what Is and is not covered. A. Broadened Named Insured I. Injury to Co-Employees and Co-Volunteer B. Damage To Premises Rented To You Extension Workers •Perils of fire, explosion, lightning,smoke,water J. Aircraft Chartered with Crew • Limit increased to$300,000 K. Non-Owned Watercraft—Increased C. Blanket Waiver of Subrogation from 25 feet to 50 feet D. Blanket Additional Insured—Managers or L. Increased Supplementary Payments Lessors of Premises •Cost for bail bonds Increased to$2,500 E. Blanket Additional Insured—Lessor of •Loss of earnings increased to$500 per day leased Equipment M. Knowledge and Notice of Occurrence F. Incidental Medical Malpractice or Offense G. Personal Injury—Assumed by Contract N. Unintentional Omission H. Extension of Coverage—Bodily Injury O. Reasonable Force—Bodily Injury or Property Damage PROVISIONS B. DAMAGE TO PREMISES RENTED TO YOU A. BROADENED NAMED INSURED EXTENSION 1. The Named Insured in Item 1,of the Declara- 1. The last paragraph of COVERAGE A. BOD- tions is as follows: ILY INJURY AND PROPERTY DAMAGE LI- The person or organization named in Item 1. ABILITY (Section I — Coverages) is deleted of the Declarations and any organization, and replaced by the following: other than a partnership or joint venture, over Exclusions c,through n. do not apply to dam- which you maintain ownership or majority in- age to premises while rented to you, or tem- terest on the effective date of the policy. porarily occupied by you with permission of However, coverage for any such organization the owner, caused by: will cease as of the date during the policy pe- riod that you no longer maintain ownership of, a. Fire; or majority interest in, such organization. b. Explosion; 2. WHO IS AN INSURED (Section 11) Item 4.a. c. Lightning; is deleted and replaced by the following: d. Smoke resulting from such fire,explosion, a. Coverage under this provision is afforded or lightning;or only until the 180th day after you acquire e. Water. or form the organization or the end of the policy period,whichever is earlier, unless A separate limit of insurance applies to this reported in writing to us within 180 days. coverage as described in LIMITS OF INSUR- 3. This Provision A. does not apply to any per- ANCE(Section 111). son or organization for which coverage is ex- 2. This insurance does not apply to damage to cluded by endorsement. premises while rented to you, or temporarily CG D1 66 11 03 Copyright,The Travelers Indemnity Company,2003 Page 1 of 5 COMMERCIAL GENERAL LIABILITY occupied by you with permission of the COVERAGE A. BODILY INJURY AND owner,caused by: PROPERTY DAMAGE LIABILITY(Section I— a. Rupture, bursting, or operation of pres- Coverages)is excluded by endorsement. sure relief devices; C. BLANKET WAIVER OFSUBROGATION b. Rupture or bursting due to expansion or We waive any right of recovery we may have swelling of the contents of any building or against any person or organization because of structure, caused by or resulting from wa- payments we make for injury or damage arising ter; out of premises owned or occupied by or rented c. Explosion of steam boilers, steam pipes, or loaned to you; ongoing operations performed steam engines,or steam turbines, by you or on your behalf, done under a contract 3. Part 6. of LIMITS OF INSURANCE Section with that person or organization; "your work"; or ( your products". We waive this right where you i1I)is deleted and replaced by the following: have agreed to do so as part of a written contract, Subject to 5. above, the Damage To Prem- executed by you prior to loss, ises Rented To You Limit is the most we will D, BLANKET ADDITIONAL INSURED — MANAG- pay under COVERAGE A. 'for damages be- ERS OR LESSORS OF PREMISES cause of"property damage"to any one prem- WHO IS AN INSURED Section II is amended to „ ises while rented to you, or temporarily occu- ( ) �,r i pied by you with permission of the owner, include as an insured any person or organization u caused by fire, explosion, lightning, smoke (referred to below as "additional insured") with ^' resulting from such fire, explosion, or light- whom you have agreed in a written contract,exe- ning, or water. The Damage To Premises cuted prior to loss, to name as an additional in- Rented To You Limit will apply to all damage sured, but only with respect to liability arising out proximately caused by the same 'occur- of the ownership, maintenance or use of that part rence", whether such damage results from of any premises leased to you, subject to the fol- fire, explosion,lightning,smoke resulting from lowing provisions: such fire, explosion, or lightning, or water, or 1, Limits of Insurance. The limits of insurance any combination of any of these, afforded to the additional insured shall be the The Damage To Premises Rented To You limits which you agreed to provide, or the lim- Limit will be the higher of: its shown on the Declarations, whichever is a. $300,000; or less. b. The amount shown on the Declarations 2. The Insurance afforded to the additional in- for Damage To Premises Rented To You sured does not apply to: Limit. a. Any 'occurrence" that takes place after 4. Under DEFINITIONS (Section V), Paragraph you cease to be a tenant in that premises; . a. of the definition of "insured contract" is b. Any premises for which coverage is ex- amended so that It does not include that por- cluded by endorsement; or tion of the contract for a lease of premises c. Structural alterations, new construction or that indemnifies any person or organization demolition operations performed by or on for damage to premises while rented to you, behalf of such additional insured. or temporarily occupied by you with permis- 3, The insurance afforded to the additional in- sion of the owner, caused by: sured Is excess over any valid and collectible a. Fire; insurance available to such additional in- b. Explosion; sured, unless you have agreed in a written c, Lightning; contract for this insurance to apply on a pri- mary or contributoy basis. d. Smoke resulting from such fire,explosion, E. BLANKET ADDITIONAL INSURED — LESSOR or lightning;or OF LEASED EQUIPMENT e. Water. WHO IS AN INSURED (Section ll)is amended to 5. This Provision B. does not apply if coverage include as an insured any person or organization for Damage To Premises Rented To You of (referred to below as "additional Insured") with Page 2 of 5 Copyright, The Travelers Indemnity Company,2003 CG D1 86 1103 COMMERCIAL GENERAL LIABILITY whom you have agreed in a written contract, exe- for which no remuneration is demanded cuted prior to loss, to name as an additional in- or received. sured,but only with respect to their liability arising 3. Paragraph 2.a.(1)(d) of WHO IS AN IN- out of the maintenance, operation or use by you SURED (Section II) does not apply to any of equipment leased to you by such additional in- registered nurse, licensed practical nurse, 1 sured,subject to the following provisions: emergency medical technician or paramedic 1. Limits of Insurance. The limits of insurance employed by you, but only while performing afforded to the additional insured shall be the the services described in paragraph 2. above limits which you agreed to provide,or the lim- and while acting within the scope of their em- its shown on the Declarations, whichever is ployment by you. Any"employees"rendering less. "Good Samaritan services"will be deemed to 2. The Insurance afforded to the additional in- be acting within the scope of their employ- sured does not apply to: ment by you. a. Any 'occurrence" that takes place after 4. The following exclusion is added to paragraph the equipment lease expires;or 2. Exclusions of COVERAGE A. — BODILY INJURY AND PROPERTY DAMAGE LIABIL- b. 'Bodily injury" or"property damage" aris- ITY(Section I—Coverages): Ing out of the sole negligence of such ad- (This insurance does not apply to:) Liability ditional insured. arising out of the willful violation of a penal 3. The Insurance afforded to the additional in- statute or ordinance relating to the sale of sured Is excess over any valid and collectible pharmaceuticals by or with the knowledge or insurance available to such additional in- consent of the insured. sured, unless you have agreed in a written 5. For the purposes of determining the applica- contract for this Insurance to apply on a pri- ble limits of insurance, any act or omission, mary or contributory basis. together with all related acts or omissions in F. INCIDENTAL MEDICAL MALPRACTICE the furnishing of the services described in 1. The definition of "bodily injury" in DEFINI- paragraph 2. above to any one person,will be TIONS(Section V) is amended to include"In_ considered one occurrence". cidental Medical Malpractice Injury", 6. This Provision F. does not apply If you are in 2. The following definition is added to DEFINI- the business or occupation of providing any of TIONS(Section V): the services described in paragraph 2,above. 'incidental medical malpractice injury"means 7. The Insurance provided by this Provision F. bodily injury, mental anguish, sickness or dis- shall be excess over any other valid and col- ease sustained by a person, including death lectible insurance available to the Insured, resulting from any of these at any time, aris- whether primary, excess, contingent or on Ing out of the rendering of, or failure to ren- any other basis, except for insurance pur- der,the following services: chased specifically by you to be excess of this policy. a. Medical,surgical,dental,laboratory,x-ray G. PERSONAL INJURY -- ASSUMED BY CON- or nursing service or treatment, advice or TRACT instruction, or the related furnishing of food or beverages; 1. The Contractual Liability Exclusion in Part b. The furnishing or dispensing of drugs or 2., Exclusions of COVERAGE B. PER- medical, dental, or surgical supplies or SONAL AND ADVERTISING INJURY LIABIL- appliances;or ITY (Section I — Coverages) is deleted and C. First aid. replaced by the following: d. "Good Samaritan services". As used In (This Insurance does not apply to:) this Provision F., "Good Samaritan ser- Contractual Liability vices" are those medical services ren- "Advertising Injury" for which the insured has dered or provided in an emergency and assumed liability In a contract or agreement. This exclusion does not apply to liability for CG D1 86 11 03 Copyright,The Travelers Indemnity Company, 2003 Page 3 of 5 COMMERCIAL GENERAL LIABILITY damages that the Insured would have in the 3. Subparagraphs 2.a.(1)(a), (b) and (c) and absence of the contract of agreement. 3.a.of WHO IS AN INSURED (Section II) do 2, Subparagraph f. of the definition of"insured not apply to"bodily injury"for which Insurance contract" (DEFINITIONS — Section V) is de- is provided by paragraph 1.or 2.above. feted and replaced by the following: J. AIRCRAFT CHARTERED WITH CREW "u f. That part of any other contract or agree- 1. The following is added to the exceptions con- ment pertaining to your business (includ- tained in the Aircraft, Auto Or Watercraft ing an indemnification of a municipality in Exclusion in Part 2., Exclusions of COVER- connection with work performed for a AGE A. BODILY INJURY AND PROPERTY municipality)under which you assume the DAMAGE LIABILITY(Section I—Coverages): tort liability of another party to pay for (This exclusion does not apply to:) Aircraft "bodily injury," "property damage"or"per- chartered with crew to any Insured. sonal injury" to a third party or organiza- tion. Tort liability means a liability that 2. This Provision J. does not apply If the char- would be Imposed by law in the absence tered aircraft is owned by any insured. of any contract or agreement. 3. The insurance provided by this Provision J. 3. This Provision G. does not apply if COVER- shall be excess over any other valid and col- AGE B. PERSONAL AND ADVERTISING IN- lectible insurance available to the insured, JURY LIABILITY is excluded by endorse- whether primary, excess, contingent or on ment. any other basis, except for insurance pur- H. EXTENSION OF COVERAGE — BODILY IN- chased specifically by you to be excess of JURY this policy. The definition of "bodily injury' (DEFINITIONS -- K. NON-OWNED WATERCRAFT Section V) is deleted and replaced by the follow- 1. The exception contained in Subparagraph(2) Ing: of the Aircraft, Auto Or Watercraft Exclu- sion in Part 2., Exclusions of COVERAGE A. "Bodily injury" means bodily injury, mental an- BODILY INJURY AND PROPERTY DAMAGE gulsh, mental injury, shock, fright, disability, hu- LIABILITY(Section I—Coverages)is deleted miliation, sickness or disease sustained by a per- and replaced by the following: son, including death resulting from any of these at any time. (2) A watercraft you do not own that is: I. INJURY TO CO-EMPLOYEES AND CO- (a) Fifty feet long or less;and VOLUNTEER WORKERS (b) Not being used to carry persons or 1. Your "employees" are insureds with respect property for a charge; to "bodily injury" to a co-"employee" in the 2. This Provision K. applies to any person who, course of the co-"employee's"employment by with your expressed or Implied consent, either you, or to your"volunteer workers"while per- uses or is responsible for the use of a water- forming duties related to the conduct of your craft. business,provided that this coverage for your 3. The insurance provided by this Provision K. "employees" does not apply to acts outside shall be excess over any other valid and col- the scope of their employment by you or while lectible insurance available to the insured, performing duties unrelated to the conduct of whether primary, excess, contingent or on your business. any other basis, except for insurance pur- l. Your "volunteer workers" are insureds with chased specifically by you to be excess of respect to "bodily injury" to a co-"volunteer this policy. worker while performing duties related to the L. INCREASED SUPPLEMENTARY PAYMENTS conduct of your business,or to your"employ- ees" in the course of the "employee's" em- Parts b. and d. of SUPPLEMENTARY PAY ployment by you, provided that this coverage MENTS — COVERAGES A AND B (Section I — for your "volunteer workers" does not apply Coverages)are amended as follows: while performing duties unrelated to the con- 1. In Part b.the amount we will pay for the cost duct of your business. of bail bonds is Increased to$2500. Page 4 of 5 Copyright,The Travelers Indemnity Company,2003 CG D1 86 1103 COMMERCIAL GENERAL LIABILITY 2, In Part d. the amount we will pay for loss of which you are required to notify us in writing earnings Is increased to$500 a day. of the abrupt commencement of a discharge, M. KNOWLEDGE AND NOTICE OF OCCUR- release or escape of "pollutants" which RENCE OR OFFENSE causes "bodily injury" or "property damage" which may otherwise be covered under this 1. The following is added to COMMERCIAL policy. GENERAL LIABILITY CONDITIONS(Section N. UNINTENTIONAL OMISSION IV), paragraph 2.(Duties In The Event of Oc- currence,Offense,Claim or Suit): The following is added to COMMERCIAL GEN- Notice of an "occurrence" or of an offense ERAL LIABILITY CONDITIONS (Section IV), which may result in a claim under this Insur- paragraph 6.(Representations): ance shall be given as soon as practicable af- The unintentional omission of, or unintentional ter knowledge of the "occurrence"or offense error in,any Information provided by you shall not has been reported to any insured listed under prejudice your rights under this insurance. How- Paragraph 1. of Section II — Who Is An In- ever,this Provision N.does not affect our right to sured or an "employee" (such as an Insur- collect additional premium or to exercise our right ance,loss control or risk manager or adminis- of cancellation or nonrenewal in accordance with trator)designated by you to give such notice. applicable state Insurance laws, codes or regula- Knowledge by other"employee(s)"of an"oc- tions. currence"or of an offense does not Imply that O. REASONABLE FORCE — BODILY INJURY OR you also have such knowledge. PROPERTY DAMAGE 2. Notice shall be deemed prompt if given In The Expected Or Intended Injury Exclusion in good faith as soon as practicable to your Part 2., Exclusions of COVERAGE A. BODILY workers' compensation insurer. This applies INJURY AND PROPERTY DAMAGE LIABILITY only if you subsequently give notice to us as (Section I — Coverages) is deleted and replaced soon as practicable after any insured listed by the following: under Paragraph 1.of Section II—Who Is An (This insurance does not apply to:) Insured or an "employee" (such as an insur- ance,loss control or risk manager or adminis- Expected or Intended Injury or Damage trator) designated by you to give such notice "Bodily injury" or "property damage"expected or discovers that the "occurrence", offense or intended from the standpoint of the Insured. This claim may Involve this policy. exclusion does not apply to "bodily Injury" or 3. However,this Provision M. does not apply as "property damage" resulting from the use of rea- respects the specific number of days within sonable force to protect persons or property. �I CG D1 86 11 03 Copyright,The Travelers Indemnity Company,2003 Page 5 of 5 INSURED: Davis Farr, LLP COMMERCIAL GENERAL LIABILITY POLICY NO.: 6804J154861 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury'or"advertising injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However,if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written-agreement that the insurance pro- surance available to you is deleted, vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph(1); ance Is primary to other insurance that Is avail- That is available to the insured when the insured able to such additional insured which covers such Is added as an additional insured under any other additional insured as a named insured, and we policy,including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property.damage" for which coverage is sought occurs;and I CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of i TRAVELERS, WORKERS COMPENSATION AND OAH Tomas sQUARS EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76( A)— 001 POLICY NUMBER: (1JUB-4676T66-1-17) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA (BLANKET WAIVER) Wb 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 00.2 % of the California workers' compensation pre- mium. schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED r, l BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS f, WAIVER. 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 05121/2017 Policy No. IJUB467BT66 Endorsement No. Insured Davis Farr, LLP Premium Insurance Company Travelers Property Casualty Countersigned by Co.of America DATE OF ISSUE! 114-12-17 ST ASSIGN: psela 1 of 1