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PROOF OF INSURANCE (2019) CLOSED Client#: 35044 PILCO ACORD,. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 1 06/0412018 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER cONTACr Kristen Wade NAME: Ross&Yerger Insurance, Inc,. PHONE PAX (AIC,No,Ext):601 948-2900 (AIC,No): 601 355-3227 P.O. Box 1139 r-MAIL Jackson,MS 39215 gl�ucass; 7N$u13EFktl5yAFFO RDING COVERAGE N.pI.C...0........ 601 948-2900 INSURERReR n.Travelers Propert.Cas. r INSUREDTravelers Casualty Ins,Co.of America INSURER B: r Pileum Corporation Travelers Property&Casualt Co of Am....................................................... INSURER C: P r r 190 East Capitol Street Suite 175 INSURER D: v Travelers n of IL Jackson, MS 39201INSUE INSURERR E F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 3Y PAID CLAIMS. iNSRR I ADDL SUBPo' ,POLICY NUMBER (MMIDDY�1 (M DDY�),,,,,,, TYPE OF INSURANCE LIMITS h$Ft. W)/D MI A X COMMERCIAL GENERAL LIABILITY ZLPlON176701 05106/2018 05/06/2019 EACH OCCURRENCE $1,000,000 CLAIMS-MADE Xq DAMAGE TI,RENTED SES Eaoceurrence) $300,000 OCCUR PREMI, _.... ................................ MED EXP(Any one person) $10,000 PERSONAL BADV INJU,RY $1,000,000 N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 � PRO POLICY ECT D LOC PRODUCT,S COMPIOPAGG $2,000,000 OTHER: $ D AUTOMOBILE LIABILITY BA7399PO6017 05/06/2018 05/06/2019 COM IN<'Lt:'Ltr4l( $110001000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS (Per _ ) X AUTOS ONLY X, DAMAGE - ...... __..... HIRED ............ AUTOS (Per as i enk�rAN�1A $ A. , XUMBRELLA LLA LIAB I X IoccuR ZUP10N176941 05/06I2018 05106/2019 EACH .. OCCURRENCE ,$2,,000,000 EXCESS LIAB -- CLAIMS-MADE AGGREGATE $2,000,000 DED ( X I RETENTION$10,000 B ANY EMPLOYERS' YIN UB5K9742161815G 0510612018 05106/2019,E L VEACHIA I i�FR. $ W MP PER ❑ X CCIDENT $1,O ERS'LIABILITY T.ITF aY PEVVI Iaa(m 00,000 d;%I F tl4"�LPtIMEtat&4Eta�EXCLUDED? NIA � ��� � If andall sry It)under EASE-EA EMPLOYEE $1,00000,0 00 decribe DESCRIPTION OF OPERATIONS below E.L.DISEASE.f`'C ICY LIMIT $ rE.L.DIS 1,000,000 C Professional ZPL14R391021 05/06/2018 05/06/2019 2,000,000/2,000,000 Liability DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Supplemental Names: Metrix Solutions, LLC General Liability and Auto Liability policies contain a Blanket Additional Insured Endorsement and Blanket Primary&Non-Contributory Endorsement as required by written contract subject to policy terms,conditions, and exclusions. Umbrella Follows form.The General Liability,Auto Liability,Workers Compensation,and (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION EI Segundo Police Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 348 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. EI Segundo,CA 90245 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S545176/M545154 KAW DESCRIPTIONS (Continued from Page 1) Umbrella policies contain a Waiver of Subrogation as required by written contract subject to policy terms, conditions,and exclusions, SAGITTA 25.3(2016ID3) 2 of 2 #S5,45176/M545154 r. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, TECHNOLOGY XT ND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE -- This endorsement broadens coverage. However, cover- age 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 limitod by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions rnay apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force Property Damage - J. Blanket Additional Insured - Lessors Of Exception To Expected Or. Intended In- Leased Equipment jury Exclusion B. Non-Owned Watercraft Less Than 75 K. Blanket Additional Insured - Persons Or Feet Organizations For Your Ongoing Opera- tions As Required By Written Contract Or Agreement C. Aircraft Chartered With Pilot L. Blanket Additional Insured - Broad Form Vendors D. Damage To Premises Rented To You M. Who Is An Insured - Unnamed Subsidi- aries E. Increased Supplementary Payments N. Who Is An Insured - Liability For Con- duct Of Unnamed Partnerships Or Joint Ventures F. Who Is An Insured - Employees And 0. Medical Payments .- Increased limits Volunteer Workers - First Aid G. Who Is An Insured - Employees - Su-- p, Contractual Liability -- Railroads pervisory Positions y, Who Is An Insured - Newly Acquired Or q, Knowledge And Notice Of Occurrence Formed Organizations Or Offense 1. Blanket Additional Insured - Owners, R. Unintentional Omission Managers Or Lessors Of Premises S. Blanket Waiver Of Subrogation PROVISIONS age" expected or intended from the A. REASONABLE FORCE PROPERTY DAMAGE standpoint of the Insured. This exclu- sion does not apply to "bodily injury" INJURY EXCLUSILIN or "proporty damage" rosulting from the use of reasonable force to protect The following replaces Exclusion a., Ex— any person or property. 1 petted Or Intended Injury, In Paragraph 2., B. NON—OWNED WATERCRAFT LESS THAN 75 of SECTION I -- COVERAGES — COVERAGE FEET A BODILY INJURY AND PROPERTY DAMAGE LIABILITY. The followingreplaces Paragraph (2) of t Exclusion g., ircraft , Auto Or Wa ercraft, in a. Expected Or Intended Injury Or Damage Paragraph 2. of SECTION I — COVERAGES -- "Bodily injury" or "property dam- COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: CG D4 17 01 12 O 2012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. i (2) A watercraft you do not own that a. ,The amount shown for the is: Damage To Premises Rented To (a) Less than 75 feet Long; and You Limit on the Declarationsof this Coverage Part; or (b) Not being used to carry any per- b. $300,000 if no amount is shown son or property for a charge. for the Damage To Premises C. AIRCRAFT CHARTERED WITH PILOT Rented To You Limit on the Declarations of this Coverage The following is added to Exclusion g., Part. Aircraft, Auto Or Watercraft, in Paragraph 4. The following replaces Paragraph a. of 2. of SECTION I — COVERAGES the definition of "insured contract" in COVERAGE A BODILY INJURY AND the DEFINITIONS Section: PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an a. A contract for a lease of premises. aircraft that is: However, that portion of the con- tract for a lease of premises that (a) Chartered with a pilot to any in- indemnifies any person or organiza- sured; tion for "premises damage" is not (b) Not owned by any insured; and an "Insured contract"; (c) Not being used to carry any person 5. The following is added to the or property for a charge. DEFINITIONS Section: "Premises damage" means "property D. DAMAGE TO PREMISES RENTED TO YOU damage" to: 1. The first paragraph of the excep- a. Any premises while rented to you tions in Exclusion j., Danrafla To or temporarily occupied by you Property, In Paragraph 2. of SECTION I with permission of the owner; or — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE b. The contents of any premises while LIABILITY is deleted, such premises is rented to you, if you rent such premises for a pe- t. The following replaces the last riod of seven or fewer consecutive paragraph of Paragraph 2., Exclu— days. sions, of SECTION I = COVERAGES -- 6. �I-lie following replaces Paragraph COVERAGE A BODILY INJURY AND 4.b.(1)(b) of SECTION IV - COMMERCIAL PROPERTY DAMAGE LIABILITY: GENERAL LIABILITY CONDITIONS: Exclusions c., g. and h., and Para- (b) That is insurance for "premises graphs (1), (3) arid (4) of Exclusion j., damage"; or do not apply to "premises damage," Exclusion C(1)(a) does not apply to 7. Paragraph 4.b.(1)(c) of SECTION IV — "premises damage" caused by fire COMMERCIAL GENERAL LIABILITY unless Exclusion f. of Section I - CONDITIONS is deleted. Coverage A - Bodily Injury And E. INCREASED SUPPLEMENTARY PAYMENTS Property Damage Liability is re- placed by another endorsement to 1. The following replaces Paragraph 11. this Coverage Part that has Exclu- of SUPPLEMENTARY PAYMENTS -- tion - All Pollution Injury Or Dam- COVERAGES A AND B of SECTION I - age or Total Pollution Exclusion in COVERAGES: its title. A separate limit of insur- ance applies to "premises damage" b. Up to $2,500 for cost of bail as described in Paragraph 6. of Sec- bonds required because of acci- tion III -- Limits Of Insurance. dents or traffic law violations aris- 3. The following replaces Paragraph 6. Ing out of the use of any vehicle of SECTION III — LIMITS OF to which the Bodily Injury Liability INSURANCE: Coverage applies. We do not have to furnish these bonds. 6. Subject to 5. above, the Damage 2. The following replaces Paragraph 1.d. To Premises Rented To You of SUPPLEMENTARY PAYMENTS -- Limit is the most we will pay COVERAGES A AND B of SECTION I - under Coverage A for damages COVERAGES: because of "promises damage" to any one premises. d. All reasonable expenses incurred by The Damage To Premises Rented the insured at our request to assist To You Limit will be: us in the Investigation or defense 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. i e of the claim or "suit", including G. WHO IS AN INSURED - EMPLOYEES - actual loss of earnings up to SUPERVISORY POSITIONS $500 a day because of time off from work. The following is added to Paragraph 2.a.(1) F. WHO IS AN INSURED - EMPLOYEES AND of SECTION 11 -- WHO IS AN INSURED: VOLUNTEER WORKERS - FIRST AID Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" or "personal in- 1. The following is added to the defi-- jury" to a co-"employee" in the course of C nition of "occurrence" in the the co-"employee's" employrnont by you DEFINITIONS Section: arising out of work by any of your "elrl- e Unless you are in the business or ployees" who hold a supervisory position. occupation of providing professional H. WHO IS AN INSURED -- NEWLY ACQUIRED OR health care services, "occurrence" FORMED ORGANIZATIONS also means an act or omission committed by any of your "em- The following replaces Paragraph 4. of ployees" or "volunteer workers", SECTION If - WHO IS AN INSURED of the other than an employed or volunteer Commercial General Liability Coverage doctor, in providing or failing to Form, and Paragraph 3. of SECTION If - provide first aid or "Good Samari-- WHO IS AN INSURED of the Global Com-- tan services" to a person. panion Commercial General Liability Cov- 2. The following is added to Paragraph erage Form, to the extent such coverage 2.a.(1) of SECTION 11 - WHO IS AN forms are part of your policy: INSURED. Any organization you newly acquire or foray, other than a partnership or joint Unless you are in the business or venture, of which you are the sole owner occupation of providing professional or in which you maintain the majority health care services, Paragraphs (1 ownership interest, will qualify as a )(a), (b), (c) and (d) above do not ap- Named Insured If there is no other insur-- ply to "bodily injury" arising out of ahce which provides similar coverage to providing or failing to provide first that organization. However: aid or "Good Samaritan services" by any of your "employees" or a. Coverage under this provision is af- "volunteer workers", other than an forded only: employed or volunteer doctor. Any (1) Until the 180th day after you ac- of your "employees" or "volunteer I workers" providing or failing to quire or form the organization or the end of the provide first aid or "Good Samari- policy period, tan services" during their work whichever is earlier, if you do not hours for you will be deemed to be report such organization writing acting within the scope of their to us within 180 days after you employment by you or performing acquire or form it; or duties related to the conduct of (2) Until the end of the policy period, your business, when that date is later than 180 3. The following is added to Paragraph days after you acquire or form S. of SECTION III -- LIMITS OF such organization, if you report INSURANCE: such organization in writing to us within 180 days after you acquire For the purposes of determining the or form it, and we agree in writing applicable Each Occurrence Limit, all that it will continue to be a Tamed related acts or omissions commit- Insured until the and of the policy ted by any of your "employees" or period; "volunteer workers" in providing or h, Coverage A does not apply to "bodily failing to provide first aid or "Good injury" or "property damage" that oc- Samaritan services" to any one per- son will be deemed to be one "oc- therorganization;do ancquired or formed currence". C.- Coverage B does not apply to "per- u 4. The following is added to the sonal injury" or "advertising injury" DEFINITIONS Section: arising out of an offense committed "Good Samaritan services" means before you acquired or formed the or- any emergency medical services for ganization. which no compensation is demanded or received. 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. I. BLANKET ADDITIONAL INSURED — OWNERS, and executed that contract or agree-- MANAGERS OR LESSORS OF PREMISES ment; and The following is added to SECTION Il — b. Is caused, in whole or in part, by your WHO IS AN INSURED: acts or omissions in the performance Any person or organization that is a of your ongoing operations to which premises owner, manager or lessor is that contract or agreement applies or an insured, but only with respect to li- the acts or omissions of any person ability arising out of the ownership, or organization performing such opera- maintenance or use of that part of any tions on your behalf. premises leased to you. The limits of insurance provided to such The insurance provided to such prem- insured will be the limits which you ises owner, manager or lessor does agreed to provide in the written contract not apply to: or agreement, or the limits shown in the Declarations, whichever are Tess. a. Any "bodily injury" or "property L BLANKET ADDITIONAL INSURED — BROAD damage" caused by an "occurrence" W that takes place, or "personal in-- FORM VENDORS jury" or "advertising injury" caused The following is added to SECTION Il — by an offense that is committed, WHO 1S AN INSURED: after you cease to be a tenant in that premises; or Any person or organization that is a ven- b. Structural alterations, new construe- dor and that you have agreed in a written tion or demolition operations per- contract or agreement to include as an formed, by or on behalf of such additional insured on this Coverage Part is an insured, but only with respect to li- ability owner, manager or lessor, ability for "bodily injury" or "property J. BLANKET ADDITIONAL INSURED — LESSORS damage" that: OF LEASED EQUIPMENT a. Is caused by an "occurrence" that takes The following is added to SECTION II — place after you have signed and exe-- WHO IS AN INSURED: cuted that contract or agreement; and Any person or organization that is an b. Arises out of "your products" which equipment lessor is an insured, but only are distributed or sold in the regular with respect to liability for "bodily in- course of such vendor's business. jury", "property damage", "personal in- jury" or advertising injury causod, in The insurance provided to such vendor is whole or in part, by your acts or orris_ subject to the following provisions: sions in the maintenance, operation or a. The limits of insurance provided to use by you of equipment leased to you such vendor will be the limits which by such equipment lessor. you agreed to provide in the written The Insurance provided to such equipment contract or agroernent, or the limits lessor does not apply to any "bodily in-- shown in the Declarations, whichever jury" or "property damage" caused by an are less. "occurrence" that takes place, or "per- b. The insurance provided to such vendor sonal injury" or ""advertising injury" does not apply to: caused by an offense that is committed, after tho oquipmont lease expires. (1) Any express warranty not author" K. BLANKET ADDITIONAL INSURED — PERSONS !zed by you; OR ORGANIZATIONS FOR YOUR ONGOING (2) Any change in "your products" OPERATIONS AS REQUIRED BY WRITTEN made by such vendor; CONTRACT OR AGREEMENT (3) Repackaging, unless unpacked The following is added to SECTION 11 — solely for the purpose of inspec- WHO IS AN INSURED: tion, r;t'ernonstration, testing, or the Any person or organization that is not substitution of parts under instruc- otherwise all: insured under this Cover- tions from the manufacturer, and age Part and that youl have agreed In a then repackaged in the origlriadl con- written contract or agroornent to in- tauter; elude as an additional insured on this (4) Any failure to make such inspec- Covorage Part is an insured, but only tions, adjustments, tests or servic- with respect to liability for "bodily in- ing as vendors agree to perform or jury" or "property damage" that: normally undertake to perform in a. Is caused by an "occurrence" that the regular course of business, in takes place after you have signed connection withthe distribution or sale of "your products"; Page 4 of 6 © 2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12 Includes comrighted material of Insurance Services Office, Inc. with its permission. l (5) Demonstration, installation, ser-- rent or past partnership or joint venture vicing or repair operations, ex- that is not shown as a Named Insured in cept such operations performed the Declarations. This paragraph does not at such vendor's premises in apply to any such partnership or joint connection with the sale of venture that otherwise qualifies as an in- "your products"; or sured under Section II - Who Is An In- (6) "Your products" which, after dis- sured. tribution or sale by you, have- 0. MEDICAL PAYMENTS - INCREASED LIMITS been labeled or relabeled or used as a container, part or in- The following replaces Paragraph 7. of gredient of any other thing or SECTION III - LIMITS OF INSURANCE: substance by or on behalf of 7. Subject to 5. above, the Medical Ex- such vendor. pense limit is the most we will pay Coverage under this provision does not under Coverage C for all medical ex- apply to: penses because of "bodily injury" sus- tained by any one person, and will be a. Any person or organization from the higher of: whom you have acquired "your products", or any ingredient, part or (a) $10,000; or container entering into, accompany- (bj The amount shown on the Declara- ing or containing such products; or tions of this Coverage Part for b. Any vendor for which coverage as Medical Expense Limit. an additional insured specifically is P. CONTRACTUAL LIABILITY - RAILROADS scheduled by endorsement. M. WHO IS AN INSURED -- UNNAMED 1. The following replaces Paragraph C. of SUBSIDIARIES the definition of "insured contract" in the DEFINITIONS Section: The following is added to SECTION Ii - c. Any easement or license agree- WHO IS AN INSURED: ment; Any of your subsidiaries, other than a 2. paragraph f.(1) of the definition of "in- partnership or joint venture, that is not sured contract" in the DEFINITIONS Sec- shown as a Named Insured in the Dec- tion is deleted. larations is a Named Insured if: a. You maintain an ownership interest a• KNOWLEDGE AND NOTICE OF OCCURRENCE OR of more than 50% in such subsidi OFFENSE ary on the first day of the policy The following is added to Paragraph 2., period; and Duties In The Event of Occurrence, Offense, b. Such subsidiary is not an insured Claim or Suit, of SECTION IV --- COMMERCIAL under similar other insurance. GENERAL LIABILITY CONDITIONS: No such subsidiary is an insured for e. The following provisions apply to "bodily injury" or "property damage" Paragraph a. above, but only for the that occurred, or "personal injury" or purposes of the insurance provided "advertising injury" caused by an of- under this Coverage Part to you or fense committed: any insured listed in Paragraph 1. or 2. a. Before you maintained an ownership of Section 11 - Who Is An Insured: interest of more than 50% in such (1) Notice to us of such "occurrence" subsidiary; or or offense must be given as soon as practicable only after the "oc- b. After the date, if any, during the currence" or offense is known to policy period that you no longer maintain an ownership interest of you (if you are an individual), any more than 50% in such subsidiary. of your partners or rxtepyrbers who is an individual (if you are a part- N. WHO IS AN INSURED - LIABILITY FOR nership or joint venture), any of CONDUCT OF UNNAMED PARTNERSHIPS OR Your managers who is an individual' JOINT VENTURES if your are a limited liability com- pany), any of your trustees who is The following replaces the last para- an individual ('if you are a trust), graph of SECTION II - WHO IS AN any of your "executive officers" or INSURED: directors (if you are an organiza- tion other than a partnership, joint No person or organization is an insured venture, limited liability company with respect to the conduct of any cur- or trust.) or any "employee" author- 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. I ized by you to give notice of an However, if this policy includes an en- "occurrence" or offense, dorsement that provides limited cover- (2) If you are a partnership, joint age for "bodily injury" or "property venture, limited liability company damage" or pollution costs arising out or trust, and none of your part- of a discharge, release or escape of "pollutants" which contains a require- ners, joint venture members, ment that the discharge, release or es- managers or trustees are indi- cape of "pollutants" must be reported viduals, notice to us of such to us within a specific number of "occurrence" or offense must be days after its abrupt commencement, given as soon as practicable this Paragraph e, does not affect that only after the "occurrence" or requirement. offense is known by: (a) Any individual who is: R. UNINTENTIONAL OMISSION (i) A partner or member of The following is added to Paragraph 6_ any partnership or joint Representations, of SECTION IV venture; COMMERCIAL GENERAL LIABILITY CONDITIONS: (ii) A manager of any limited The unintentional omission of, or uninten-- liability company; tional error in, any information provided by you which we relied upon in issuing (iii) A trustee of any trust; or this policy will not prejudice your rights under this insurance. However, this pro- (Iv) An executive officer or vision does not affect our right to collect director of any other or-, additional premium or to exercise our ganization; rights of cancellation or nonrenewal in that is your partner, joint accordance with applicable insurance laws venture member, manager or or regulations. trustee; or S. BLANKET WAIVER OF SUBROGATION (b) Any "employee" authorized The following is added to Paragraph B., by such partnership, joint Transfer Of Rights Of Recovery Against Oth- venture, limited liability com- ers To Us, of SECTION IV -- COMMERCIAL pany, trust or other organiza- GENERAL LIABILITY CONDITIONS: tion- to give notice of an "occurrence" or offense. If the insured has agreed in a contract or agreement to waive that insured's right of (3) Notice to us of such "occur- recovery against any person or organiza- rence" or offense will be tion, we waive our right of recovery deemed to be given as soon as against such person or organization, but practicable if it is given in good faith as soon as practicable to only for payments we make because of: your workers' compensation in-- a. "Bodily injury" or "property damage" surer. This applies only if you caused by an "occurrence" that takes subsequently give notice to us place; or of the "as soon" ascprac practicable off onse any b. "Personal injury" or "advertising in- of the persons described in jury" caused by an offense that is Paragraphs e. (1) or (2) above committed; discovers that the "occurrence" subsequent to -the execution of the Con- or offense may result in sums tract or agreement. to which the insurance provided under this Coverage Part may apply. s Page 6 of 6 O 2012 The Travelers Indemnity Company. All rights reserved. CG D4 17 01 12 Includes copvriahted material of Insurance Services Office, Inc, with its permission, P COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a., named insured, and we will not share with Primary Insurance, of SECTION IV — that other insurance, provided that: COMMERCIAL GENERAL LIABILITY CONDITIONS: (1) The "bodily injury" or "property damage" However, if you specifically agree in a writ- for which coverage is sought is caused ten contract or agreement that the insurance by an "occurrence" that takes place; and afforded to an additional insured under this (2) The "personal injury" or "advertising in- Coverage Part must apply on a primary ba- sis, or a primary and non-contributory basis, out of an offense that is committed; this insurance is primary to other insurance that is available to such additional insured subsequent to the signing and execution of which covers such additional insured as a that contract or agreement by you. II pYI I CG D4 25 07 08 © 2008 The Travelers Companies, Inc. Page 1 of 1 I i TRAVELERSJ WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00)- 001 POLICY NUMBER: UB-5x974216-18-25—G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT G 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, r SCHEDULE a 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. ju . IIG Vp Y! �I I Y N li k 41 I e� 'N. i4 DATE OF ISSUE: 05-1.5-18 STASSIGN: PAGE 1 OFA. I I