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PROOF OF INSURANCE (2017) CLOSED 0 DATE CC>R CERTIFICATE OF LIABILITY INSURANCE 6/27/2016 Dnyyv) 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. ,MPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 CONTNAME: Stacie Evans Edgewood Partners Ins. Center PHONEg16-576-1603 IIFAX 916-560-5393 A (mA/C.NILo.Exl), (A/C,No)': License Number-OB29370 MAstacie.evans@epicbrokers.com PO Box 13847 Dc)�Ess: ..... . Sacramento CA 95853 INSURER(S)AFFORDING COVERAGE NAC# INSURER A:Travelers Property Casualty Co of A 25674 INSURED COOPPERS INSURER B:Llo,yds of London 85202 Cooperative Personnel Services INSURER C: DBA: CPS HR Consulting; 241 Lathrop Way INSURER D Sacramento CA 95815 INSURER E INSURER F COVERAGES CER'TIFICA'TE.NUMBER: 1476513663 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 ADDL SUBR " tl ............... TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER /MMIDD/YYYYI (MMIDDIYYVYI�, A X COMMERCIAL GENERAL LIABILITY 6307704A197 7/1/2016 7/1/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ( X t ENit-0 OCCUR I"�DAMAGE TO p'l^iUC�,AI$E„S(E0 e)ct,unrerrvcep $500,000 P MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- ` MP'CJI"AGG $2,000,000 POLICY LOC PRODUCTS 00,,, OTHER: $ AUTOMOBILE LABILITY BA7704A197 7/1/2016 7/1/2017 (Ed / lt 11 a acciep) $1 '000,000 ANYAUTO BODILY INJURY $ OWNED SCHEDULED O BODILY INJURY(Per accident) $ NON-OWNED PROP'ERT'Y DAMAGE X HIRED AUTOS x AUTOS (Per aKcpdan_l) $ $ UMBRELLA OCCUR CUP7704A197 7/1/2016 7/1/2017 EACH OCCURRENCE $5,000,000( EXCESS LIAB 1IM �MADE CLASAGGREGATE $5,000,000 X gLIAB '"n'flCbN��u... DED ETE'NNIL $ A WORKERS COMPENSATION UB1176A220 7/1/2016 7/1/2017 x S' ( PER OTH- AND EMPLOYERLIABILITY t STATUTE F..R „ ANY PROPRIETOR/PARTNER/EXECUTIVE Y� C N/A` E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED' (Mandatory in NH) '',E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $1,000,000 B Prof Liab-Claims Made W 18DC5160201 7/1/2016 7/1/2017 Per Claim/Agg $5,000,000 A Retro Date-10/13/1989 UB1176A220 7/1/2016 7/1/2017 Deductible Per Claim $75,000 Stop Gap-Only ND,OH,WA,WY DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Additional Insured: City of EI Segundo, its officials and employees.When required by written contract,Additional Insured status with primary coverage applies to General Liability and Automobile Liability and Waiver of Subrogation applies to General Liability,Automobile Liability, and Workers'Compensation, all per the attached endorsements. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Martha Dijkstra ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo, CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY Policy Number:6307704A197 Effective Date: 07-01-16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage" or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to sured does nota I to "bodily u "prop- the additional insured by this endorsement still is apply y in ry p p excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications;and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we fl. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the'occurrence or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit' is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit' and the date received; and "Written contract requiring insurance" means IL Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit' as person or organization as an additional in- sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the"personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit', cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit', and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and-indemnity.of any claim or "suit' to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 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 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 CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SERVICE INDUSTRIES 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. Broadened Named Insured b. Amended Bodily Injury Definition B. Blanket Additional Insured—Broad Form Vendors J. Bodily Injury To Co-Employees And Co-Volunteer C. Damage To Premises Rented To You Workers • Perils of fire, explosion, lightning, smoke, K. Aircraft Chartered With Crew water L. Non-Owned Watercraft—Increased From 25 Feet • Limit increased to$300,000 To 50 Feet D. Blanket Waiver Of Subrogation M. Increased Supplementary Payments E. Blanket Additional Insured — Owners, Managers 0Cost of bail bonds increased to$2,500 Or Lessors Of Premises Loss of earnings increased to$500 per day F. Blanket Additional Insured — Lessors Of Leased N. Knowledge And Notice Of Occurrence Or Offense Equipment G. Incidental Medical Malpractice O. Unintentional Omission H. Personal Injury—Assumed By Contract P. Reasonable Force — Bodily Injury Or Property Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS The following is added to SECTION II —WHO IS 1. The following is added to SECTION II—WHO IS AN INSURED: AN INSURED: Any person or organization that is a vendor and Any organization, other than a partnership or that you have agreed in a written contract or joint venture, over which you maintain owner- agreement to include as an additional insured on ship or majority interest on the effective date this Coverage Part is an insured, but only with re- of the policy qualifies as a Named Insured. spect to liability for "bodily injury" or "property However, coverage for any such organization damage"that: will cease as of the date during the policy pe- a. Is caused by an "occurrence"that takes place riod that you no longer maintain ownership of, after you have signed and executed that Con- or majority interest in, such organization. tract or agreement; and 2. The following replaces Paragraph 4.a. of b. Arises out of "your products" which are dis- SECTION II—WHO IS AN INSURED: tributed or sold in the regular course of such a. Coverage under this provision is afforded vendor's business. only until the 180th day after you acquire The insurance provided to such vendor is subject or form the organization or the end of the to the following provisions: policy period, whichever is earlier, unless a. The limits of insurance provided to such ven- reported in writing to us within 180 days. dor will be the limits which you agreed to pro- CG D4 67 07 13 ©2013 The Travelers Indemnity Company.All right reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY " vide in the written contract or agreement, or Exclusions c.through In. do not apply to dam- the limits shown in the Declarations of this age to premises while rented to you, or tem- Coverage Part,whichever are less. porarily occupied by you with permission of b. The insurance provided to such vendor does the owner, caused by: not apply to: a. Fire; (1) "Bodily injury" or "property damage" for b. Explosion; which the vendor is obligated to pay c. Lightning; damages by reason of the assumption of liability in a contract or agreement. This d. Smoke resulting from such fire, explosion, exclusion does not apply to liability for or lightning;or damages that the vendor would have in e. Water. the absence of the contract or agreement; (2) Any express warranty unauthorized by A separate limit of insurance applies to such Para- you; damage to premises as described in Para- graph 6. of Section III—Limits Of Insurance. (3) Any physical or chemical change in "your products" made intentionally by such This insurance does not apply to damage to vendor; premises while rented to you, or temporarily occupied by you with permission of the (4) Repackaging, unless unpacked solely for owner, caused by: the purpose of inspection, demonstration, testing, or the substitution of parts under a. Rupture, bursting, or operation of pres- instructions from the manufacturer, and sure relief devices; then repackaged in the original container; b. Rupture or bursting due to expansion or (5) Any failure to make such inspections, ad- swelling of the contents of any building or justments, tests or servicing as-vendors structure, caused by or resulting from wa- agree to perform or normally undertake to ter; perform in the regular course of business, c. Explosion of steam boilers, steam pipes, in connection with the distribution or sale steam engines, or steam turbines. of"your products"; (6) Demonstration, installation, servicing or 2. The following replaces Paragraph 6. of SEC- repair operations, except such operations TION III—LIMITS OF INSURANCE: performed at such vendor's premises in Subject to 5. above, the Damage To Prem- connection with the sale of "your prod- ises Rented To You Limit is the most we will ucts'; or pay under Coverage A for damages because (7) "Your products" which, after distribution of "property damage" to any one premises or sale by you, have been labeled or re- while rented to you, or temporarily occupied labeled or used as a container, part or in- by you with permission of the owner, caused gredient of any other thing or substance by fire; explosion; lightning; smoke resulting by or for such vendor. from such fire, explosion, or lightning; or wa- Coverage under this provision does not apply to: ter. The Damage To Premises Rented To You Limit will apply to all damage proximately a. Any person or organization from whom you caused by the same "occurrence", whether have acquired "your products", or any ingre- such damage results from fire; explosion; dient, part or container entering into, accom- lightning; smoke resulting from such fire, ex- panying or containing such products; or plosion, or lightning; water; or any combina- b. Any vendor for which coverage as an addi- tion of any of these. tional insured specifically is scheduled by en- The Damage To Premises Rented To You dorsement. Limit will be the higher of: C. DAMAGE TO PREMISES RENTED TO YOU a. $300,000;or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- COVERAGES — COVERAGE A BODILY IN- ises Rented To You Limit. JURY AND PROPERTY DAMAGE LIABIL- ITY: Page 2 of 7 ©2013 The Travelers Indemnity Company.All right reserved. CG D4 67 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph a. of the a. Is"bodily injury"or"property damage"caused definition of "insured contract" in the DEFINI- by an "occurrence" that takes place, or "per- TIONS Section: sonal injury" or"advertising injury" caused by a. A contract for a lease of premises. How- an offense that is committed, after you have ever, that portion of the contract for a signed and executed that contract or agree- lease of premises that indemnifies any ment; and person or organization for damage to b. Arises out of the ownership, maintenance or premises while rented to you, or tempo- use of that part of any premises leased to rarily occupied by you with permission of you. the owner, caused by: The insurance provided to such premises owner, (1) Fire; manager or lessor is subject to the following pro- (2) Explosion; visions: (3) Lightning; a. The limits of insurance provided to such premises owner, manager or lessor will be (4) Smoke resulting from such fire, ex- the limits which you agreed to provide in the plosion, or lightning; or written contract or agreement, or the limits (5) Water. shown on the Declarations of this Coverage Part,whichever are less. is not an "insured contract"; b. The insurance provided to such premises 4. The following replaces Paragraph 4.b.(1)(b) owner, manager or lessor does not apply to: of SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS: (1) "Bodily injury" or "property damage" caused by an "occurrence" that takes (b) That is insurance for premises rented to place, or "personal injury" or"advertising you, or temporarily occupied by you with injury" caused by an offense that is com- the permission of the owner; mitted, after you cease to be a tenant in D. BLANKET WAIVER OF SUBROGATION that premises; or The following is added to Paragraph 8., Transfer (2) Structural alterations, new construction or Of Rights Of Recovery Against Others To Us, demolition operations performed by or on of SECTION IV — COMMERCIAL GENERAL LI- behalf of such premises owner, manager ABILITY CONDITIONS: or lessor. We waive any right of recovery we may have c. The insurance provided to such premises against any person or organization because of owner, manager or lessor is excess over any valid and collectible other insurance available payments we make for injury or damage arising to such premises owner, manager or lessor, out of premises owned or occupied by or rented unless you have agreed in a written contract or loaned to you; ongoing operations performed for this insurance to apply on a primary or by you or on your behalf, done under a contract contributory basis. with that person or organization; "your work"; or BLANKET ADDITIONAL INSURED — LESSORS " F. BL your products". We waive this right where you BLLEASED EQUIPMENT have agreed to do so as part of a written contract, OF executed by you prior to loss. The following is added to SECTION II —WHO IS E. BLANKET ADDITIONAL INSURED—OWNERS, AN INSURED: MANAGERS OR LESSORS OF PREMISES Any person or organization that is an equipment The following is added to SECTION II —WHO IS lessor and that you have agreed in a written con- AN INSURED: tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but Any person or organization that is a premises only with respect to liability for "bodily injury", owner, manager or lessor and that you have "property damage", "personal injury" or "advertis- agreed in a written contract or agreement to ing injury"that: name as an additional insured on this Coverage a. Is"bodily injury"or"property damage"caused Part is an insured, but only with respect to liability by an "occurrence" that takes place, or "per- for bodily injury", property damage", personal injury"or"advertising injury"that: sonal injury" or"advertising injury" caused by an offense that is committed, after you have CG D4 67 07 13 ©2013 The Travelers Indemnity Company.All right reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission, COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): EACH PROJECT FOR WHICH YOU HAVE AGREED, IN A $2,000,000 WRITTEN CONTRACT WHICH IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS GENERAL AGGREGATE LIMIT PROVIDED THAT THE CONTRACT IS SIGNED AND EXECUTED BY YOU BEFORE THE BODILY INJURY OR PROPERTY DAMAGE OCCURS. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated"project" shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- Aggregate Limit for any other designated ject", and that limit is equal to the amount of "project"shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of"bodily injury" or"prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- b. Claims made or"suits" brought; or nated "project"shown in the Schedule above: c. Persons or organizations making claims or bringing"suits". CG D2 11 01 04 Copyright,The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2. of SECTION III—LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1) which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated"project"shown in the considered a single"project". SCHEDULE above. F. The provisions of SECTION III — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright,The Travelers Indemnity Company, 2004 CG D2 11 01 04 COMMERCIAL AUTO Policy:BA7704A197 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 provision con- by you before the"bodily injury"or"property damage" tained in SECTION II. CA T4 37 02 15 @2015 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. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO Is An Insured, of SECTION II — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and Any person or organization who is required under paragraph d. of this part 5. Other Insurance,this a written contract or agreement between you and insurance is primary to and non-contributory with that person or organization, that is signed and applicable other insurance under which an addi- executed by you before the "bodily injury" or tional insured person or organization is the first "property damage" occurs and that is in effect named insured when the written contract or during the policy period, to be named as an addi- agreement between you and that person or or- tional insured is an "insured" for Covered Autos ganization, that is signed and executed by you Liability Coverage, but only for damages to which before the "bodily injury" or "property damage" this insurance applies and only to the extent that occurs and that is in effect during the policy pe- person or organization qualifies as an "insured" riod, requires this insurance to be primary and under the Who Is An Insured provision contained in SECTION II. non-contributory. CA T4 74 02 15 ©2015 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. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorse- required of you by a written contract executed ment, the provisions of the Coverage Form apply prior to any "accident' or'loss", provided that the unless modified by the endorsement. "accident' or 'loss" arises out of the operations Paragraph 5. Transfer of Rights Of Recovery contemplated by such contract. The waiver ap- Against Others To Us of the CONDITIONS section plies only to the person or organization desig- is replaced by the following: nated in such contract. 5. Transfer Of Rights Of Recovery Against Oth- ers To Us - We waive any right of recovery we may have against any person or organization to the extent CA T3 40 08 08 0 2008 The Travelers Companies,Inc. Page 1 of 1 T ELERS�' WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 03 76( A)— 001 POLICY NUMBER: (PJUB-1176A22-0-15) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 05.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 7/1/2016 ST ASSIGN: Page 1 of 1 WORKERS COMPENSATION TRAVE« S J AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 42 03 04(B)— 001 POLICY NUMBER: (PJM-1176A22-0-15) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in-the Schedule. Schedule 1. ❑ Specific Waiver Name of person or organization ® Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2.0 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: SEE SCHEDULE 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 7/1./2016 ST ASSIGN: Page 1 of 1 0 Copyright 2014 National Council on Compensation Insurance,Inc.Al:Rights Reserved. „�„�� ��� 5+��► WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 43 03 05(00) POLICY NUMBER: (PJUB-1176A22-0-15) UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Utah is shown in Item 3.A.of the Information Page. 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Our waiver of rights does not release your employees' rights against third parties and does not release our authority as trustee of claims against third parties. Schedule Designated Person: Designated Organization: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 7/1/2016 ST ASSIGN: Page 1 of 1 TRAVELERSI' WORKERS COMPENSATION AND ONE TOWER CT ARE 061 HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)-01 POLICY NUMBER: (PJUB-1176A22-0-15) 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 extent 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: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 7/1/2016 ST ASSIGN: