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PROOF OF INSURANCE (2017) CLOSED Page 1 of 2 s�� I DATEIMMIDOIYYYY) CERTIFICATE OF LIABILITY INSURANCE III 07/17/2017 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 cortiflcat'o holder Is an ADDITIONAL INSURED,the pollCy('tes)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificale does not confer rights to the certificate holder In Ileu of such endorsement(s), PRODUCER CONTACT Willis Insurance Services of California, Inc. jims c/o 26 Century Blvd ,JA1C-Hp„E1t)• 1'877-945-7378 141 IJot,: 1-688-467-2318 E-RAAIL P.O. Box 305191 .d1OVRER9 55: oert1fic4tas0wil1is.,c0m Nashville, TN 372305191 USA INSURERISW AFFORDING COVERAGE _NAICAI_ INSURER Al Travelers Casualty Insurance Ca or America - 19046 INSURED INSURERS: Traveler. Property Casualty Company of America 25674 DynTek, Inc., Dyntek Services, Inc. — – - 4440 Von Karman Ave., Ste 200 INSURER C; Travelers Indamnity Company of America 25666 No-port Beach, CA 92660 INSURER O: INSURER E_ .. INSURER F: COVERAGE'S CERTIFICATE NUMBER:W3035BB2 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 DOLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSA ADOL SUBR POLICY EFF POLICY EXP AIRas TYPE OF INSURANCE l , I A LIMITS I PpL10V NUMBER JMN oam&9VYYYI i X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000000 U+MADE TCd 1�EIITED X CLAIMS-MADE OCCUR fad_ S 300,, 000 A MEDEXP(�2yana.—I $ 10,000 Y Y 6302G9101B3 10/01/2016 30/01/2017 PERSONALE ADV INJURY S 1,000,000 GEN'Ln'0GREGATELIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 ��� ... POLICY M JECOTT [E LOC PRODUCTS-COMPtOPAGG I S 2,000,000 OTHER I'S AUTOMOBILELIABIUTY IwC0IEIVIEOR SINGLE LINA"6 is 1,000,000 ANY AUTO BODILY INJURY(Per person) S B 1 OWNED SCHEDULED Y Y ��. AUTOS ONLY AUTOS 9A 2G970163 10/01/2016 10/01/20171'rGODILYINJURY(P.,8.ddecd, S X HIRED X NON-0VNJED I''ROP'Clkr"Y'r.1A149+','GC: S AUTOS ONLY AUTOS ONLY 1 err agpCdhY 5 X UMBRELLAUAS X OCCUR EACH OCCURRENCE S 5,000,000 A — EXCEISIISUABCLAIMS-MADE N N CUP 20970183 10/Dl/2016 10/01/2017,AGGREGATE S 5,000,000 DEI) Y X II,RETENTIONS 0 WORKERS COMPENSATIONX PER 1 OTY•I- AND EMPLOYERS'LIABILITY Y I IJ —1...5FPzT1�.E....,_.....l.. �C....�..„ A ANYPROPRIETORIPARTNERrEXECUTIVE E L EACH ACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED7 'NCI NIA N UB 3GO79113 16 10/01/2016 10/01/20171 IMandats In NH 1,000,000 ry } £L_DISEAS£.£AEMPLOYEE S if yyet,dadta�Ua wry�Ier `-..... ..__,..........._._.y_ DESCAlcl PI OF OPERATIONS beksw E L DISEASE-POLICY LIMIT S 1,000,000 C Professional Liability- N N ZPL 21NS5554 10/01/2016'1110/01/2017 per Claim 6 Aggragote$5,000,000 Claims Made Deductible $25,000 DESCRIPTION OF OPERATIONS J LOCATIONS/VEHICLES(ACORD 101,Adddllonal Remarks Schedule,may be attached Ir mora space U required) City of E1 Segundo, its parent, subsidiaries and other affiliates, and its directors, officers, employees, representatives and agents are named Additional Insureds with respects to General Liability and Auto liability, but only if required by a written contract with the Named Insured prior to an occurrence, and always subject to the terms and conditions of the policy. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be 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. AUTHOR REPRE... ... . City o! E3 Segundo SENTATiVE 3SO Main Street E1 Segundo, CA 90245 Q 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD OR M: 14847025 RhTca: 354561 AGENCY CUSTOMER ID: LOC#: CC)R" ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY 14440 NAMEDINSURED Hillis Insurance Services of California, Inc. DynTak, Inc., Dyntak services, Inc. Von Herman Ave., Ste 200 POLICY NUMBERNewport Beach, CA 92660 See Page 1 CARRIER NAIL CODE See Page 1 See Page 11 EFFECTIVE DATE:See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Auto Liability and Workera Compensation as permitted by law. Y ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORDsme and logo are re� stered marks of ACORD SR ID: 14'847CI 5 aAn"C 18561, CERT: W3035082 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 630-2G970183 ISSUE DATE: - - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY TOTAL AGGREGATE LIMIT AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE The Limits of Insurance shown In the Declarations are replaced by the following: LIMITS OF INSURANCE Total Aggregate Limit $ 2,000,000 (Other Than Products-Completed Operations) Designated Project Aggregate Limit $ 2,000,000 (Other Than Products-Completed Operations) Designated Location Aggregate Limit $2,000,000 (Other Than Products-Completed Operations) General Aggregate Limit $2,000,000 (Other Than Products-Compleled Operations) Products-Completed Operations Aggregate Limit $ 2,000,000 Personal and Advertising Injury Limit $ 1,000,000 Each Occurrence Limit $ 1,000,000 Damage To Premises Rented to You Limit $ 300,000 Any One Premises Medical Expense Limit $ 10,000 Any One Person Designated Projects: Each "project" for which you have agreed, in a written contract which is in effect dur..ing thio policy period, to provide a separate General Aggregate Linst, provided that the contract is signed and executed by, you before the "bodily injury" or "property damage" occurs. Designated I...ocations: Per policy location schedule PROVISIONS (4) Designated "projects" or "locations" A. The following replaces SECTION Ili— LIMITS OF shown in the Schedule above. INSURANCE- b, The Total Aggregate Limit shown in the 1. a. The L'mits of Insurance shown in the Schedule above is the most we will pay Schedule above and the rules below fix for the sum of all amounts under the Des- the most we will pay regardless of the ignated Project Aggregate Limit, all number of: amounts under the Designated Location (1) Insureds; Aggregate Limit and all amounts under the General Aggregate Limit. This in- (2) Claims made or"suits"brought; eludes: (3) Persons or organizations making (1) Damages under Coverage A, excep( claims or bringing"sults";or damages because of"bodily injury"or CG D4 68 0109 Q 2n09 Rie YI rv9vaWs Companies,Inc, Page 1 of 4 63 0-2G97018 3 COMMERCIAL GENERAL LIABILITY .property damage" Included in the shown in the Schedule above and "products-completed operations haz- described in 2. below, the Designated ard"; Project Aggregate Limit for any other (2) Damages under Coverage B;and designated "project" shown in the Schedule above or the Designated (3) Medical expenses under Coverage C. Location: Aggregate Limit shown in c. Subject to the Total Aggregate Limit the Schedule above, shown in the Schedule above and de- d. Subject to the Total, Aggregate Limit scribed in b,above, a Designated Project shown in the Schedule above and de- Aggregate Limit is provided and is also scribed in b. above, a Designated Loca- shown in the Schedule above, The Des- tion Aggregate Limit is provided and is ignated Project Aggregate Limit is subject also shown in the Schedule above. The to all of the following provisions: Designated Location Aggregate Limit is (1) The Designated Project Aggregate subject to all of the following provisions: Limit is the most we will pay for the (1) The Designated Location Aggregate sum of: Limit is the most we will pay for the (a) Damages under Coverage A be- sum of. cause of "bodily injury" and (a) Damages under Coverage A be- "property damage" caused by cause of "bodily injury" and .occurrences"and "property damage" caused by (b) Medical expenses under Cover- "occurrences"and age C for "bodily injury" caused (b) Medical expenses under Cover- by accidents', age C for "bodily injury" caused which can be attributed only to opera- by accidents; tions at a single designated "project" which can be attributed only to opera- shown in the Schedule above. tions at a single designated"location" (2) The Designated Project Aggregate shown in the Schedule above. Limit applies separately to each des- (2) The Designated Location Aggregate Ignated"project". Limit applies separately to each des- (3) The Designated Project Aggregate ignated"location". Limit does not apply to damages be- (3) The Designated Location Aggregate cause of "bodily injury" or "property Limit does not apply to damages be- damage" included in the "products- cause of "bodily injury" or 'property completed operations hazard." In- damage" Included In the "products- stead, the Products-Completed Op- completed operations hazard" Irt- erations Aggregate Limit shown in the stead, the Products-Completed Op- Schedule above and described In 3. eratlons Aggregate Limit shown in the below applies to such damages. Schedule above and described In 3. (4) The Designated Project Aggregate below applies to such damages. Limit does not apply to damages un- (4) The Designaled Location Aggregate der Coverage B. Instead,the General Limit does riot apply to damages un- Aggregate Um1 shown in the Sched- der Coverage B. Instead,the General ule above and described in 2. below Aggregate Limit shown in the Sched- applies to such damages. ule above and described in 2. below (5) Any payments made for damages or applies to such damages. medical expenses to which the Des- (5) Any payments made for damages or ignated Project Aggregate Limit ap- medical expenses to which the Des- plies shall reduce both the Total Ag- ignated Location Aggregate Uniipt ap- grega(a Limit shown in the Schedule plies shall reduce both the Total Ag- above and the Designated Project gregate Limit shown in the Schedule Aggregate Lim't for that designated above and the Designated Location "project". Such payments shall not Aggregate Lin-,it fnr that closignated reduce the General Aggregate Limit ""location". Such payments shalt not Page 2 of 4 9)2000 Tho CoM�Qda%1161C CG D4 68 01 09 620-26970183 COMMERCIAL GENERAL UABILTY reduce the General Aggregate Limit completed operations hazard", Any payments shown In the Schedule above and made for such damages shall reduce the described in 2. below, the Designated Products-Completed Operations Aggregate Project Aggregate Limit shown In the Limit shown in the Schedule above. Such Schedule above or the Designated payments shall not reduce the Total Ag re- Location Aggregate Limit for any gate Unlit shown in the Schedule above, the other designated "location" shown fn General Aggregate Limit shown in the the Schedule above. Schedule above, the Designated Project Ag- 2. Subject to the Total Aggregate Limit shown in gregate Limit for any designated 'project" the Schedule above and described In 1.b. shown in the Schedule above or the Devg- above, a General Aggregate Unlit Is provided nated Location Aggregate Limit for any des and is also shown in the Schedule above. Ignited "location"' shown in the Schedule The General Aggregate Limit is subject to all above. of the following provisions: 4. Subject to the Total Aggregate Limit and the a. The General Aggregate Limit is the most General Aggregate Limit shown in the we will pay for the sum of: Schedule abovo and described In I.b. and 2. (1) Damages under Coverage A be- above, the Personal and Advertising injury Limill is the Most we will pay under Coverage cause of"bodily injury" and "property 8 for the sum of all darnagos because, of all damage" caused by "occurrences", "personal injury" and all "advertising injury" and medical expenses under Cover- sustained by any one person or organization. age C for "bodily injury" caused by accidents, which cannot be attributed 5. Subject to the Total Aggregate Limit and el- only to operations at a single desig- ther the Designated Project Aggregate Limit, nated "project" or"location" shown in the Designated Location Aggregate Limit or the Schedule above;and Itie General Aggregate Limit, or subject to tho (2) Damages under Coverage B. Products-Coniplete(l Operations Aggregate Limit, shown In the Schedule above and de- b. The General Aggregate Limit does not scribed in I.b., I.e., 1A., 2. and 3. above, apply to damages for "bodily injury" or whichever apply or applies, the Each Occur- .property damage" included fn the "prod- rence Limit Is the most we will pay for the ucts-completed operations hazard." In- sum of: stead, the Products-Completed Opera- a. Damages under Coverage A;and tions Aggregate Limit shown in the Schedule above and described in 3. be- b. Medical expenses under Coverage C low applies to such damages, because of all "bodily injUr�r" and `p,opnrty c. Any payments made for damages or damage"arising OUI of any one"occun,ence". medical expenses to which the General 6. Subject to the Each Occurrence Limit shown Aggregate Limit applies shall reduce both in the Schedule above and described in 5. the Total Aggregate Limit shown In the above, the Damage To Premises Rented To Schedule above and the General Aggre- You Urnit is the most we, will psy under Col- gate Limit shown in the Schedule above. (."rage A for damages because of Such payments shall not reduce the Des- d4lmz'90"10 any one pre nines,while rented to Ignated Project Aggregate Limit for any you, or In the case of damage by fire, while designated "project" shown in the Sched- rented to you or letriporafily occupied by you ule above or the Designated Location with permission of the owner. Aggregate Limit for any designated 'loca- 7. Subject to the Each Occurrence Limit shown tion"shown in the Schedule above. in the Schedule above and described in 5. 3. If coverage for liability arising out of the above, the Medical Expense Limit Is the most .products-completed operations hazard" is we will pay under Coverage C for all medical provided,the Products-Completed Operations expenses because of"bodily injury"sustained Aggregate Limit shown in the Schedule above by any one person. is the most we will pay under Coverage A for The of Insurance of this C'Overage Part sats. damages because of "bodily Injury" or"prop- iDlY sePalf0tely lo each coasectAive annual period "prop- erty damage" included in the "products- and to any rernihling period of N,*s than 12 CG D4 68 0169 5 2,,30VU1111a SPage 3 of 4 630-2G970183 COMMERCIAL GENERAL LIABILITY months, starting with the beginning of the policy rupled only by a street, roadway or wateiway, or period shown in the Declarations, unless the pol- by a right-of-way of a railroad, shall be considered icy period is extended after issuance for an addi- a single"iocabon". tional period of less than 12 months. In that case, "Project" means any area, away from premises the additional period will be deemed part of the owned by or rented to you, shown in the schedule last preceding period for purposes of determining above at which you are performing operations the Limits of Insurance, pursuant to a contract or agreement For the pur- B. The following is added to the DEFINITIONS Sec- poses of delermining the applicable aggregate tion: limit of insurance, each "project" that includes a "Location" means any premises owned by or premises involving the same or connecting lots, rented to you shown in the Schedule above. For or premises whose conneclion is interroplod only the purposes of determining the applicable ag- by a street, roadway or waterway,or by a right-of- gregate limit of insurance, each 'location"that in- Way of a railroad, shall be considered a ws'rngk) cludes a premises involving the sarne or connect- "project". Ing lots, or promises whose connection is Inter- Page 4 of 4 0,)2W)9)9 a"dhn'r«raad«;fi«z n 'aau rogy«un;aa urro. CG D4 68 01 09 COMMERCIAL GENERAL LIABILITY Policy # 630-2G970183 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.,-jlamage_pr..medi4al expenses described_io.aRkof_thl�pPo�lSioA�-lzf 3his-�[LdSrtS.t*0?r�k�]aY-1?r", ckded or--- limited r -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 Gy Written Contra Ll O'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 Renied To You M. Who Is An Insured-Unnamed Subsidiaries E. Increased Supplementary Payments N. Who Is An Insured-Liability For Conduct Of Unnamed Partnersh'ps Or Joint Ventures F. Who Is rk Insurers-Employees And Volun- 0. Medical Payments-Increased Limits teer Workers-First Aid y 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-LessorsOf Leased Equipment PROVISIONS B. NON-OWNE=D 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:ong;and "Bodily injury' or "property damage" expected or (b) Not being used to carry any person or Intended from the standpoint of the insured, Thls properly 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 0 2012 The Travelers Indemnily Company All rights reserved Page 1 of 6 Includes copyrighted material or Insurance Sery ces Office,Inc.Wt''is permission. Policy # 630-2G970183 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-P-REMIS.E&.RENTED-TQ Y_QU._ i_ Tlie first paragraph of the exceptions In Ex- "Premises damage" means "property darn- clusion j., Damage To Property, in Para- age"to. graph 2. of SECTION I -- COVERAGES - - -a. Any premises while rented to you or tem-_ 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 LIASIL- consecutive days. ITY: 6- The foltow'ng 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"; rre 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 Fxclusion in its title, A separate limit of insur- ance applies to "premises damage" as de- 1. The foliow;ng replaces Paragraph 1.b. of scribed In Paragraph 6.of Section II!—Limits SUPPLEMENTARY PAYMENTS — COVER- Insurance. AGES A AND B of SECTION I — COVER- Of 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 Limitwill 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. $300,00D if no amount is shown for "suit",including actual less 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 worm. Coverage Part Page 2 of 6 a 2012 The Travelers Indemnity Company All rights reserved. CG D417 01 12 Indudes copyrighted malarial of Insuranco Services Once,Inc.with its purm:Bsion Policy # 630-213970183 COMMERCIAL GENERAL.LIABILITY F. WHO 15 AN INSURED — EMPLOYEES AND your "employees" who hold a supervisory posi- VOLUNTEER WORKERS—FIRST AID tion. �i 1. The following Is added to the definition or'oc- H. WHO IS AN INSURED — NEWLY ACQUIRED cirrence"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, __ If — 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 11—WHO IS AN INSURED of the "volunteer workers", other than an employed Global Companion Commercial General Liabitty or_volunteer_doctor,-in-proyiding_or_failing-lo. _.-m„ Coverage Form, to the extent such coverage provide first aid or"Good Samaritan services" l6rTi5 ai" part bryr Gr"p a o�. 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 simi'ar 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- or ees" or "volunteer workers', other than an (1} Until the organization day after you acquire form the org employed or volunteer doctor_ Any of your anization the end of the policy period, whichever is earlier, if you "employees" or "volunteer workers' providing do not report such organization in writing or failing to provide first aid or"Good Samari- to us within 180 days after you acquire or Ian services" during their work hours for you 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 III—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 acqu red 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, satian is demanded or received. MANAGERS OR LESSORS OF PREMISES G. WHO IS AN INSURED — EMPLOYEES — SU- The following is added to SECTION 11 —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--"emp'oyee'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 D417 01 12 m 2012 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 Indides copyrighled material of Insurance Services Office,Inc.with its pemission. Policy 1t 630-2G970183 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 11—WHO IS caused by an offense that is committed, after AN INSURED. you cease to be a tenant in that premises;or II Structural alterations, new construction or Any person or organization that ta vendor and t that you have agreed In a written contract or demolition operations performed by or on be- agrepment 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 IialI for "bodily injury" or "property J. BLANKET ADDITIONAL INSURED —LESSORS damage"that: I",rli° tit . a t:r ir."u'„ltJI PiY4ulr,,ta1'll ..". ... a . . Is caused by an"occurrence"thal takes place The following is added to SECTION II --WHO IS after you have signed and executed thal con AN INSURED; tract or agreement;and Any person or organization that is an equipment b. Arisen 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- vendof'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 provided to such equipment lessor dor will be the limits which you agreed to pro• does nota I to an "bodily injury" or"property vide in the written contract or agreement,or apply y y j ry es the limits shown in the Declarations,which- damage" caused by an "orcutrence" 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 ease 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 11—WHO IS AN INSURED: (3) Repackaging,unless unpacked so"ely For 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 far"bodily injury"or"property damage"that: agree encs,tests or servicing as vendors agree to 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 n- 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 02012 The Travelers Indemnity Company All rights reserved. CG D4 17 0112 I copyrighted materia,or Insurance Services Office,Inc with its permission. Policy fl 630-2G970183 COMMERCIAL GENERAL LIABILITY Coverage under this provision does not apply to (b) The amount shown on the Dec'arat;ons 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 fol;owing replaces Paragraph c. of the b. Any vendor for which coverage as an addl- 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 (.(1)I of the definition of "Insured _.. PG M,,..... contract in.the.DEFINITIONS-Section The following is added to SE=CTION Il—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 1n 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 in,uly" you or any insured listed in Paragraph 1.or 2. of Sec#son 11—Who Is An Insured: or "properly damage" [hat occurred, or"personal injury" or "advertising inury" caused by an of- (1) Notice to us of such "occurrence" or of. fense committed: fense must be given as soon as practica- a. Before you maintained an ownership interest bre only after the"occurrence" or offense Y p is known to you (if you are an individual), of more than 50%in such subsidiary;or 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 SECTION II—WHO 15 AN INSURED joint venture, limited liability company or 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, I'm- 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 otherw'se qualifies as an in- managers or trustees are individuals, no- sured under Section II—Who Is An Insured. rice 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 S. 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 nership or joint venture; injury" sustained by any one person, and will be the higher of (it) A manager of any limited liability (a) $10,000;or company; CG 04 17 01 12 0 2612 The Travelers Indemnity Company AN rights resermd. Page 5 of 6 Includes copyrigiNted material of lnsuraw,a Services Ofte,Inn,with Its petralsston Policy 4 630-2G970163 COMMERCIAL GENERAL LIABILITY (iii)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 G., Repre- member,manager or trustee;or sentations, of SECTION IV – COMMERCIAL (b) Any "employee" authorized by such GENERAL LIABILITY CONDITIONS'. partnership, joint venture, limited ii- The unintentional omission of, or unintentional er- ability company,trust or other organi- nor in, any information provided by you which we zation to give notice of an "occur- relied upon in issuing this policy will not prejudice rents_or of ense� --- _____Your,rig'CRs t�ncJgrt_ "mis..insaur .nc:p.,.,.j:'owe re,r 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 appllca- 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 following is added to Paragraph 8., Transfer "occurrence" or offense as soon as prat- 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 an 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- However, If this policy includes an endorse- tion,but only for payments we make because of, ment that provides limited coverage for"bod- 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 0 2012 The Travelers lodemnity Company All rights reserved. CG D417 0112 Includes copyrghted material of Insurance Sery ccs Office,Inc with its perm' ion. r 1.31 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 2009 Tho Travelers Companies,Inc Page 1 of 1 Policy # SA 2G970183 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to the Paragraph A.1,c., Who occurs and that is in effect during the policy period,to Is An Insured, of SECTION II—COVERED AUTOS be named as an additional Insured is an "insured"for LIABILITY COVERAGE: Covered Autos Liability Coverage, but only for dam- Any person or organization who Is required under a ages to which this insurance applies and only to the written contract or agreement between you and that extent that person or organization qualifies as an"in- person or organization, that is signed and executed sured" under the Who Is An Insured prevision con- by you before the"bodily injury"or"property damage" tained in SECTION 11. CA T4 37 02 15 ®2055 The Travelers Indemnity Company,All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance services Office,Inc with its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. ELE4SE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces Paragraph A5., Transfer of required of you by a written contract executed Rights Of Recovery Against Others To Us, of the prior to any"accident"or"loss", provided that the CONDITIONS Section: "accident' or "loss" arises out of the operations 5. Transfer Of Rights Of Recovery Against Oth- contemplated by such contract. The waiver ap- ers To Us plies only to the person or organization desig- We waive any right of recovery we may have nated in such contract. against any person or organization to the extent CA T3 40 0215 m 2015 The Travelers Indemnity Company.All rights reserved, Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its pennisslon. Aftk TRAY " f WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD. CT 06163 ENDORSEMENT WC 00 03 13 (00)-01 POLICY NUMBER: (HOUR-3G07917-3-16) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. (This agreement applies only to the Went that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or Indirectly to benefit any one not named In the Schedule. SCHEDULE DESIGNATED PERSON: d� m a DESIGNATED ORGANIZATION: o'= ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS °= AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO "— FURNISH THIS WAIVER. o= e� o� o DATE OF ISSUE: 10-20-16 ST ASSIGN: rc,�iva,uim„u,