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PROOF OF INSURANCE (2019) CLOSED DATE(MMIDD/YYYY) � CERTIFICATE OF LIABILITY INSURANCE 4F17J2018 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTAC PRODUCER PHONE AIC N9 F'Clr Adamson&McGoldrick Insurance Solutions NAME: Edith Maganda 11 0 E.Oran iattwor a Ave. Suite 100 (AIC.N s P em AIC Placentia, CA 923"0 E-MAIL S'" (,¢ No), 714,a257-9'833 aq a nd a,@ a da m son mcgold rick;com R(S)AFFORDING COVERAGE INSURER(S) NAIC#.., www,snains.COfrl INSURER A: Travelers Indemnity Company 25658 INSURED INSURER B: Travelers Property Casualty Co of Amer 25674 Ramona, Inc. w PO BOX 660219 suRER c: Homeland Insurance Comparry of New York 34452 Arcadia CA 91006 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 41401231 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 t""U60 POLICY EFF POLICYEXP TYPE OF INSURANCE LTR IVSD WVD POLICYNUMBER IMMIDDfYYYY) IMMIDDfYYYYI LIMITS A ,w/ COMMERCIAL GENERAL LIABILITY ✓ �/ C081<179447 '4/17/2018 4/17/2019 EACHOCCURRENCE $1'0W' 00 DAMAGE T4".Y RNc.IW;)1,D CLAIMS-MADE I ./I OCCUR PR(-.'MISE (Ehaaccusfel e) $300,000 ✓ Ded:$10,000 PD per occ MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2, POLICY ✓, j cLOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER. $ B AUTOMOBILE LIABILITY 8108K073930 4/17/2018 4/17/2019 „COMBINED SINGLE LINNT $1,000,000 V+ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY I,„(Per accident) $ $ B ✓ UMBRELLA LIAB ✓ OCCUR CUP 8K188456 4/17/2016 4/17/2019 EACH OCCURRENCE $5,000,000 EXCESS LAB AL DED 1 ✓I RETENTION$'10 ..,, $ , CLAIMS-MADE AGGREGATE 55000.000 B WORKERS COMPENSATION ✓YN UB8K156679 4/17/201$ 4/17/2019 ✓ PEEATUTE I ORH- OFFIC RANYPROPMEMBEREXCLUDED7ECUTIVE ")Y] NIA EL EACHACCI ESM $1 AND EMPL YER 'LIABILITY (Mandatory NH) describe under DIf ESCRIPTIiON OF OPERATIONS below E L,DISEASE-POLICY LIMIT PLOYEE IC $1,0W,000 A Installation Floater QT460-1H299981-TIL-18 4/1712018 4/17/2019 Limit$1,000,0001 Ded$1,000 A Leased/Borro Renied Equipment QT-660-1H299981-TIL-18 4/17/2018 4/17/2019 Limit$58,0001 Ded$1,000 U C Pollution LiaNily 793006169 0001 4/17/2018 4/17/2019 Limit:$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Oily of Et'Segrando,ifs officials and empl s are named additional insured,this insurance is primary and non-contributory. and waiver o saubrogation applies per er r ements altached- *10 days notice of cancellation for non-payment 30 days olherwise- CERTIFICATE HO'LD'ER CANCELLATION Clh/of'EI Segundo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 6 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PU liC'IP1Urortks ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90245 , AUTIAIiORI7EDREPRESENTATIVE a� B'ria'n McGoldrick ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 41401232 12802.9 A11 LIMM ,I EkUtim :,r,:,Randa 4//n7y2ane 3_20=55 sae kMT) I Page a Of 1® Ramona, Inc. COMMERCIAL GENERAL LIABILITY COSK179447 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS TEND IE 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. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments 1. Blanket Additional Insured — States Or Political D. Incidental Medical Malpractice Subdivisions—Permits E. Who Is An Insured— Newly Acquired Or Formed J. Knowledge And Notice Of Occurrence Or Offense Organizations K. Unintentional Omission F. Who Is An Insured — Broadened Named Insured L. Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: The following is added to Exclusion g., Aircraft, Exclusions c. and g.through n. do not apply Auto Or Watercraft,in Paragraph 2.of SECTION to "premises damage". Exclusion E(1)(a) I —COVERAGES — COVERAGE A BODILY IN- does not apply to"premises damage"caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured;and d. Smoke resulting from such fire,explosion, (c) Not being used to cant' any person or prop- or lightning;or erty for a charge. e. Water, B. DAMAGE TO PR'E'MISES RENTED TO YOU unless Exclusion f.of Section I—Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion—All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION 1 — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 ®2011 The Travelers Indemnity Company.All Nift reserved_ Page 1 of 6 11410u2M q mw,+" IUD Liavo IP rdcb Pagard3 Ip 4,:110.515 11111 IPM N Page 2 nf 10 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of"premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies.We do not have to fur- fire;explosion;lightning;smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or any combination of any of these causes. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part;or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit",including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the 1. The following is added to the definition of"oc- definition of"insured contract" in the DEFINI- currence"in the DEFINITIONS Section: TIONS Section: "Occurrence" also means an act or omission a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services"to a person. person or organization for "premises 2. The following is added to Paragraph 2.a.(1)of damage"is not an"insured contrail'; SECTION II—WHO IS AN INSURED: S. The following is added to the DEFINITIONS Paragraph (1)(d) above does not apply to Section: "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age"to: a. Any premises while rented to you or tem- (1) "Incidental medical services" by any of porarily occupied by you with permission Your employees who is a nurse practi- of the owner,or boner,registered nurse,licensed practical nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic;or premises is rented to you,if you rent such (ii) First aid or"Good Samaritan services" by premises for a period of seven or fewer consecutive days. any of your "employees" or "volunteer workers", other than an employed or vol- 6: The following replaces Paragraph 4.b.(1)(b) of SECTION IV—COMMERCIAL GENERAL unteer doctor. Any such "employees" or LIABILITY CONDITIONS: "volunteer workers" providing or failing to provide first aid or"Good Samaritan ser- (b) That is insurance for"premises damage"; vices"during their work hours for you will or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 020-1.1 The"riraveims i npanv.Pi 0ghtsw .. CG D3 16 11 11 4MD1231 8 18J19 All Lines p EkUth RMpada p 411,712na.ass 3:2an:55 m au ) � raqL 3 off Do COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE: other than a partnership,joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related ads or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide"incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that Or- son will be deemed to be one"occurrence". ganization. However: 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I—COV- only: ERAGES—COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (1) Until the 180th day after you acquire or form the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or 2 Until the end of the consent of,the insured. ( ) policy period, when that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form a. Medical,surgical,dental, laboratory,x-ray it, and we agree in writing that it will Con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages;or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization;and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services"means any emer- jury' or "advertising injury" arising out of an gency medical services for which no oompen- offense committed before you acquired or sation is demanded or received. formed the organization. 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED—BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- TIONS: The following is added to SECTION II—WHO IS The insurance is excess over any valid and AN INSURED: collectible other insurance available to the in- Any of Your subsidiaries,other than a partnership, sured.whether primary,excess,contingent or joint venture or limited liability company, that is on any other basis,that is available to any of not shown as a Named Insured in the Dedara- your "employees" or 'volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices", first aid or'Good Samaritan services" No such subsidiary is an insured for"bodily injury' to any person to the extent not subject to or "property damage"that occurred, or"personal Paragraph 2.&(1) of Section II —Who Is An Insured. injury" or "advertising injury' caused by an of- E. WHO IS AN INSURED — NEWLY ACQUIRED fence committed after the date, if any, during the OR FORMED ORGANIZATIONS policy period, that You no longer maintain an ownership interest of more than 500/6 in such sub- The following replaces Paragraph 4.of SECTION sidiary. II—WHO IS AN INSURED: CG 03 16 1111 0;2011"roue TivaveLevs Indenrdy. Owp3ay..AN dghft ireserved.. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED—OWNERS, H. BLANKET ADDITIONAL INSURED—LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II—WHO IS The following is added to SECTION II—WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on dude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability sped to liability for"bodily injury", "property dam- for "bodily injury", "property damage", "personal age","personal injury"or"advertising injury'that: injury"or advertising injurythat: a. Is "bodily injury' or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury' or "advertising occurs, or is "personal injury' or "advertising injury' caused by an offense that is commit- injurycaused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement;and tract or agreement;and b. Arises out of the ownership, maintenance or b. Is caused, in whole or in part, by your acts or use of that part of any premises leased to omissions in the maintenance, operation or you. use of equipment leased to you by such equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: Visions: a. The limits of insurance provided to such a. The limits of insurance provided to suchequipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contrail or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations,whichever are less. the limits shown on the Declarations, which- ever are less. b. The insurance provided to such equipment b. The insurance provided to such premises lessor does not apply to any"bodily injury"or "Property damage" that occurs, or "personal owner,manager or lessor does not apply to: injury' or advertising injury"caused by an of- (1) Any "bodily injury' or "property damage" fense that is committed, after the equipment that occurs,or"personal injury"or"adver- lease expires. tising injury"caused by an offense that is c. The insurance provided to such equipment committed,after you cease to be a tenant lessor is excess over any valid and collectible in that premises;or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDMONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDMSIONS—PERMITS the written contrail or agreement that this in- The following is added to SECTION II—WHO IS surance must be primary to, or non- AN INSURED: contributory with, such other insurance, in which case this insurance will be primary to. Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 0 2011 CG D3 16 1111 11 4ffi Aou"'''n 11a/ll9 Pamf Lim9glr,' 'i4 'u.1%h I%Mpi%PV5.uA J A,yI°n%10l(A M°20.'55 M 0+071 tlYI ,,pha '!.ry 4ar,0.� Wiu, COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company;or an insured, but only with respect to liability for (iii)An executive officer or director of "bodily injury', "property damage", "personal in- any other organization; jury"or"advertising injury'arising out of such op- erations. that is your partner, joint venture member or manager;or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership,p, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury'or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision; or (3) Notice to us of such"occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. orkJ. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE Ionly if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the"occurrence"or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. (1) or(2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply. surance provided under this Coverage Part to you or any insured listed in Paragraph 1.or 2. However, if this Coverage Part includes an en- of Section II—Who Is An Insured: dorsement that provides limited coverage for (1) Notice to us of such "occurrence" or of- "bodily injury" or "property damage" or pollution fense must be given as soon as practice- cow arising out of a discharge, release or es- ble only after the"occurrence"or offense rape of pollutants which contains a requirement is known by you(if you are an individual), that the discharge, release or escape of "pollut- ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual(if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- cers"or directors(if you are an organize- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL or limited liability company) 'or any "em- GENERAL LIABILITY CONDITIONS: ployee" authorized by you to give notice The unintentional omission of, or unintentional of an"occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company,andnone of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence"or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence"or offense is known by: L BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8.,Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV—COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG 03 16 11 11 ®2011 The Travelers Indemnity Company_M rights reserved. Page 5 of 6 Iu.n,MOU13n. 11 mem,/n.r, m I][ lows.xmes� III iidivu Ill M�.rxlh Iq w/nw;:,;xuu �,atO.r01 P" WVWw � w1m nx m, balk TO COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish,mental injury,shock,fright,disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. "Personal injury' or "advertising injury" definition of"insured contract" in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M'. AMENDED BODILY INJURY DEFINITION contract' in the DEFINITIONS Section is de- The following replaces the definition of "bodily leted. injury"in the DEFINITIONS Section: City of EI Segundo,its officials and employees Page 6 of 6 0 2011 The Twelers Indemcwty ComRny.AM rights reserved. CG D3 16 1111 9AVL ra:a a0V9 Ae Y r,,ws , &i,tt;r.xx3aam,18 „ 4 o'r..raua o 2011.V1.1 WWJ a;,u nr;, q !aw:: at za, Ramona, Inc. COSK179447 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL IIIA E ( T ) 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 b If, and onlyto the extent that, the injury or insured, and then the insurance provided to 1 rY 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 the additional insured by this endorsement still is sured does not apply to"bodily injury", "prop- 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 sessional architectural, engineering or sur-e on any other basis, that is available to the addi- vtional insured when that person or organization is ying services, including: an additional insured under such "other insur- L 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 pilo of an "occur- 1111. occurii. Supervisory, in n, architectural or rence" or an offense which may result in a inspection, claim. To the extent possible, such notice engineering activities_ should include: CG 2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 41401231 i 1019 All Lines 1 Mth NPAwg&nda� 11 9117720/8 3:20.55 FM (PDTh i PaW 9 of 10 COMMERCIAL GENERAL LIABILITY L 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 ii. The names and addresses of any injured cover under this endorsement. However, this pentons 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 ii. 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- soon as practicable. sured on this Coverage Part, provided that 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. PaulTravelers Companies, Inc. CG D2 46 08 05 4A40n2'.1 'q ms!!uq All Lanes � ndm Xagr da 3.,.20-.55 WIN MD71 1.0 of 10 Ramona,Inc. WORKERS COMPENSATIONTRA" �� � AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A)— POLICY NUMBER: UB81 158879 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 2 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description City of B Segundo,its officials and employees 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: Page 1 of 1 4 4oIiDs,I�;) A m Krnes, 1! mdhI a, KAI;Wnda, �p � �° �,.���,�m7 r� •,;���,F �-Yrm ;,w�,�,w������ SII T,&SN,, I ..,a tit