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PROOF OF INSURANCE (2018 - 2018) CLOSED DATE(MM/DD/YYYY) ACCO" CERTIFICATE OF LIABILITY INSURANCE 9/28/2017 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 I CONTACT NAME: Carrie Allen PHORobert Harris Insurance Agency, Inc. I(A/C,Nro.Ext): (714)619-4480 (A//C,No): (714)619-4481 Lic. #0216736 IE-MAIL ADDRESS:Carrie@reharris.com 3150 Bristol St. , Suite 200 I INSURER(S)AFFORDING COVERAGE NAIC# Costa Mesa CA 92626INSURERA:Travelers Cas Ins Co of America 19046 INSURED INSURERB:Hartford Accident & Indemnity 22357 Complete Paperless Solutions LLC IINSURERC:Lloyds of London/S&C 4025 E. La Palma Ave #204 I INSURER D: INSURER E: Anaheim CA 92807 I INSURER F: COVERAGES CERTIFICATE NUMBER:17-18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 300,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ X Y 6808B847614 6/23/2017 6/23/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY ❑ PRO- JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ p' ALL OWNED SCHEDULED AUTOS AUTOS 6808B847614 6/23/2017 6/23/2018 BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I SPER TATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N N/A B (Mandatory in NH) y 72WECZX9262 6/23/2017 6/23/2018 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability ESE02166413 1/11/2017 1/11/2018 Policy Limit: $1,000,000 Claims Made Form Aggregate Limit: $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City, its officials and employees are Additional Insured per form# CGD105 (04/94) , which is attached to and made part of policy for General Liability. Coverage is Primary over any other insurance maintained. Waiver of Subrogation on Workers Compensation is attached. In the event of non-payment of premium, a 10 Day notice of cancellation will be sent. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of E1 Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 350 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. E1 Segundo, CA 90245 AUTHORIZED REPRESENTATIVE Carrie Allen/CALLEN - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED(SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- 2. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cludin liabilityapply: g� pp y: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- o. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. 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 "property damage" resulting from the use of rea- C. AIRCRAFT CHARTERED WITH PILOT 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 ©2012 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 — 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 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 LIABIL- consecutive days. ITY: Exclusions c., 6. The following replaces Paragraph 4.b.(1)(b) 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 Exclusion in its title. A separate limit of insur- E. INCREASED SUPPLEMENTARY PAYMENTS ance applies to "premises damage" as de- 1. The following replaces Paragraph 1.b. of scribed in Paragraph 6. of Section III — Limits SUPPLEMENTARY PAYMENTS — COVER- Of Insurance. AGES A AND B of SECTION I — COVER- 3. The following replaces Paragraph 6. of SEC- AGES: TION III—LIMITS OF INSURANCE: b. Up to $2,500 for cost of bail bonds re- 6. Subject to 5. above, the Damage To quired because of accidents or traffic law Premises Rented To You Limit is the violations arising out of the use of any most we will pay under Coverage A for vehicle to which the Bodily Injury Liability damages because of "premises damage" Coverage applies. We do not have to fur- to any one premises. nish these bonds. The Damage To Premises Rented To 2. The following replaces Paragraph 1.d. of You Limit will be: SUPPLEMENTARY PAYMENTS — COVER- 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, II — 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 II—WHO IS AN INSURED: are the sole owner or in which you maintain the majority ownership interest, will qualify 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" or "volunteer workers", other than an (1) Until the rgth day after you acquire or o employed or volunteer doctor. Any of your form the organization or the end of the "employees" or "volunteer workers" providing policy period, whichever is earlier, if you or failing to provide first aid or "Good Samari- do not report such organization in writing tan services" during their work hours for you to us within 180 days after you acquire or will be deemed to be acting within the scope form it; or 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 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- I. 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 II — 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- The limits of insurance provided to such ven- ment leased to you by such equipment lessor. a. dor will be the limits which you agreed to pro- The insurance provided to such equipment lessor vide in the written contract or agreement, or 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 AN INSURED: (3) Repackaging, unless unpacked solely for Any person or organization that is not otherwise the purpose of inspection, demonstration, an insured under this Coverage Part and that you testing, or the substitution of parts under have agreed in a written contract or agreement to instructions from the manufacturer, and include as an additional insured on this Coverage then repackaged in the original container; Part is an insured, but only with respect to liability (4) Any failure to make such inspections, ad- for"bodily injury" or"property damage"that: justments, tests or servicing as vendors a. Is caused by an "occurrence"that takes place agree to perform or normally undertake to after you have signed and executed that con- perform in the regular course of business, tract or agreement; and in connection with the distribution or sale of"your products"; b. Is caused, in whole or in part, by your acts or omissions in the performance of your ongoing (5) Demonstration, installation, servicing or operations to which that contract or agree- repair operations, except such operations ment applies or the acts or omissions of any performed at such vendor's premises in connection with the sale of "your prod- person or organization performing such op- ucts"; or erations on your behalf. The limits of insurance provided to such insured (6) "Your products" which, after distribution will be the limits which you agreed to provide in or sale by you, have been labeled or re- the written contract or agreement, or the limits labeled or used as a container, part or in- shown in the Declarations,whichever are less. gredient of any other thing or substance 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 f.(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 you or any insured listed in Paragraph 1. or 2. No such subsidiary is an insured for"bodily injury" of Section II—Who Is An Insured: or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an of- (1) Notice to us of such 'occurrence" or of- fense committed: fense must be given as soon as practica- ble only after the 'occurrence" or offense a. Before you maintained an ownership interest 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 joint venture, limited liability company or SECTION II—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- graph does not apply to any such partnership or oliability company or trust, and none of joint venture that otherwise qualifies as an in- your r partners, joint venture members, sured under Section II—Who Is An Insured. managers or trustees are individuals, no- 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 C for all medical expenses because of"bodily (i) A partner member of any part- nership orjoint venture; injury" sustained by any one person, and will be the higher of: (i i) A manager of any limited liability (a) $10,000; or company; CG D4 17 01 12 ©2012 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 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 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 li- 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 following is added to Paragraph 8., 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- 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 within a specific number of days after its subsequent to the execution of the contract or 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. COMMERCIAL GENERAL LIABILITY 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 will not share with that other insurance, provided policy, including any umbrella or excess policy. that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 A IV THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 72 WEC ZX9262 Endorsement Number: Effective Date: 06/23/17 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: COMPLETE PAPERLESS SOLUTIONS LLC 4025 E LA PALMA AVE STE 201 ANAHEIM, CA 92807 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 extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description ANY PERSON OR ORGANIZATION BLANKET OPERATIONS FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 05/06/17 Policy Expiration Date: 06/23/18