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PROOF OF INSURANCE (2019) CLOSED STEPH-1 OP ID: RH ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 02/27/2018 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). PRODUCER 714-283-1999 &NePcT Certificate Dept. Wright, Finnegan & Carter PHONE 714-283-1999 FAX 714-283-1997 Insurance Associates (A1C,No,Ext): (A1C,No): 23001 La Palma Ave#100 ADDRESS:certlflcates@wfclnsurance.com Yorba Linda, CA 92887 John Carter,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Travelers Indemnity Co of CT 25682 INSURED Stephen Doreck Equipment INSURER B:Westchester Surplus Lines Ins 10172 Rentals Inc. dba; Doreck Casualty Construction INSURER C:Travelers Property ClY Co 25674` 9075 Telegraph Road INSURER D Pico Rivera,CA 90660 INSURER E". INSURER 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 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 POLIC ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDNYYY) (M_M7DDNYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FKOCCUR DT22-CO-7200P538-TCT-18 0310112018 0310112019 DAMAGE TO RENTED 300,000 Y I PREMISES(Ea occurrences $ A X Contractual Liab NEW RESIDENTIAL EXCLUSIO 0310112018 0310112019 MELS EXP(Any one person) $ 5,000 B X Pollution Liab G27153136005 0310112018 0310112019 PERSONAL&ADV INJUR'! $ 1,000,000 GEN'L AGGREGATELIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY I....X...I wi H LOC PRODUCTS-COMPIOP AGS $ 2,000,000 _ OTHER Pollution $ 2,000,000 C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Fa accidenri $ X ANY AUTO DT-810-SD457897-TIL-18 03/01/2018 03/01/2019 BODIL'� INJUR'f(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJUR'f(Per accident) $ HIRED NON-OWNED PROPERTY DAIv1AGE AUTOS ONLY __. AUTOS ONLY (Per accident) $ X Phy Damage Comp/Coll $ $1000/1000 C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE CUP-2J30069A-18-26 0310112018 0310112019 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10000 $ C WORKERS AND EMPL YERS 'LIABILITY PENSATION X STATUTE IR I- Y!N UB-OK312895-18-26-G 03/01/2018 03/01/2019 1,000,000 JFFIEERMEMBFR�f EY.CLUMEM ECUTIVE LY] N/A Y E L EACH ACCIDENT $ (Mandatory in NH) USL&H COVERAGE INCLUDE 1,000,000 E L DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 _DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C Install Floater QT-660-2G410825-TIL-17 0811812017 0811812018 Ded 1,000 250,000 C Equip Rented From OTHERS QT-660-2G410825TIL 0811812017 0811812018 ACV 130,000 DESCRIPTION OF OPERATIONS 7 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF EL SEGUNDO IS ADDITIONAL INSURED AND PRIMARY WORDING APPLIES PER THE BLANKET ADDITIONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY -AS REQUIRED BY WRITTEN CONTRACT. JOB: CENTER ST WATER MAIN IMPROVEMENT, PINE AVE TO EL SEGUNDO BLVD, PROJECT NO PW#17-22. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF EL SEGUNDO ACCORDANCE WITH THE POLICY PROVISIONS. 350 MAIN STREET EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE A ACORD 25(2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STEPH-1 OP ID: RH ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 02/27/2018 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). PRODUCER 714-283-1999 &NePcT Certificate Dept. Wright, Finnegan & Carter PHONE 714-283-1999 FAX 714-283-1997 Insurance Associates (A1C,No,Ext): (A1C,No): 23001 La Palma Ave#100 ADDRESS:certlflcates@wfclnsurance.com Yorba Linda, CA 92887 John Carter,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Travelers Indemnity Co of CT 25682 INSURED Stephen Doreck Equipment INSURER B:Westchester Surplus Lines Ins 10172 Rentals Inc. dba; Doreck Casualty Construction INSURER C:Travelers Property ClY Co 25674` 9075 Telegraph Road INSURER D Pico Rivera,CA 90660 INSURER E". INSURER 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 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 POLIC ES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MMIDDNYYY) (M_MIDDNYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCURDT22-CO-7200P538-TCT-18 0310112018 0310112019 DAMAGE TO RENTED 300,000 Y Y PREMISES(Ea occurrences $ A X Contractual Liab NEW RESIDENTIAL EXCLUSIO 0310112018 0310112019 MELS EXP(Any one person) $ 5,000 B X Pollution Liab G27153136005 0310112018 0310112019 PERSONAL i ADV INJUR'! $ 1,000,000 GEN'L AGGREGATELIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY I....X...I wi H LOC PRODUCTS-COMPIOP AGS $ 2,000,000 _ OTHER Pollution $ 2,000,000 C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Fa accidenri $ X ANY AUTO Y Y DT-810-8D457897-TIL-18 03/01/2018 03/01/2019 BODIL'� INJUR'f(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJUR'f(Per accident) $ HIRED NON-OWNED PROPERTY DAIv1AGE AUTOS ONLY __. AUTOS ONLY (Per accident) $ X Phy Damage Comp/Coll $ $1000/1000 C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE CUP-2J30069A-18-26 0310112018 0310112019 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10000 $ C WORKERS AND EMPL YERS 'LIABILITY PENSATION X STATUTE IR I- Y!N UB-OK312895-18-26-G 03/01/2018 03/01/2019 1,000,000 JFFIEERMEMBFR�f EY.CLUMEM ECUTIVE LY] N/A Y E L EACH ACCIDENT $ (Mandatory in NH) USL&H COVERAGE INCLUDE 1,000,000 E L DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 _DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ C Install Floater QT-660-2G410825-TIL-17 0811812017 0811812018 Ded 1,000 250,000 C Equip Rented From OTHERS QT-660-2G410825TIL 0811812017 0811812018 ACV 130,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CITY OF EL SEGUNDO, ITS OFFICERS, OFFICIALS, EMPLOYEES,AGENTS AND VOLUNTEERS ARE ADDITIONAL INSURED AND PRIMARY WORDING APPLIES PER THE BLANKET ADDITIONAL INSURED ENDORSEMENT ATTACHED TO THE POLICY -AS REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED APPLIES TO AUTO LIABILITY. WAIVER OF SUBROGATION APPLIES TO GENERAL LIABILITY,AUTO LIABILITY AND CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF EL SEGUNDO 350 MAIN STREET EL SEGUNDO, CA 90245 AUTHORIZED REPRESENTATIVE A ACORD 25(2016103) 0 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE STEPH-1 PAGE 2 INSURED'S NAME Stephen Doreck Equipment OP ID: RH Date 02/27/2018 WORKERS COMPENSATION. JOB: ON CALL SEWER SYSTEMS MAINTENANCE AND REPAIR SERVICES, PROJECT #PW-17-05. 30 DAY WRITTEN NOTICE OF CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER, 10 DAY NON-PAYMENT OF PREMIUM. Policy#: DT22-GO-7200P838-TGT-18 ('OMMFR{':IAI GFNFRAI I IARII ITY 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 ll) is amended c) The insurance provided to the additional in- to include any person or organization that you cured 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' orations 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 darr7age" 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 conlracl requiring insur- requiring insurance" applies. The person or ante" requires you to provide such coverage organization does not quality 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—Lirnits Of Insurance, for ouch loss, and wo 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 cured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- surance", whether primary, excess, contingent or of the rendering of. or failure to render. any on any other basis, that i3 available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is voying 3crvicc3, 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 addilluiial insured riiusl give u5 wrilterr 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 engineering activities. claim. To the extent possible, such notice should include: GG D2 46 08 05 (P 2005 The SI. Paul Travelers Companies, Inc. Page 1 of 2 (.OMMFRC.IAI GFNFRAI I IARII ITY 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 ii. I he 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 ill. 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 nffpn-,P- 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 li. 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 Coveracae Part, provided that sawn 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 othervvise 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 12005 The SI. Paul Travelers Companies, Inc. CG D2 40 08 05 Policy#; DT22-CO-7200P538-TCT-18 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE HEAD IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part; and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments I. Blanket Additional Insured — States Or Political Subdivisions—Permits D. Incidental Medical Malpractice J. Knowledge And Notice Of Occurrence Or Offense E. Who Is An Insured — Newly Acquired Or Formed K. Unintentional Organizations 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 f.{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 carry any person or prop- or lightning; or arty for a charge. e. Water, B. DAMAGE TO PREMISES 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 cluaion 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 DamFagc 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 I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III -• LIMITS OF IN- SURANCE. CG D3 16 11 11 ra 2011 The Travelers Indemnify Company All eiCjhl&r*AA.eve�.Il Page 1 of 6 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 1.1b. 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. q. Up to $2,594 for the cost oT 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 bands. 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- Tho Damage To Promises Rcntcd 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 $644 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 or"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 tailing 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. pnrsnn nr organ17Atinn fnr "prPmiSaG damage" is not an "insured contract": 2. The following is added to Paragraph 2.a.(1) of SECTION II—WHO IS AN INSURED: 5. The following is added to the DEFINITIONS Section, Paragraph (1){d} above does not apply to "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age" to: (i) "Incidental medical services" by any of a. Any premises while reritcd to you or tem- your "employees" who is a nurse practi- porarily occupied by you with permission tioner, registered nurse, licensed practical of the owner; or nurse, nurse assistant, emergency medi- h. The uuii1eml5 ur 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) unteer doctor. Any such "employees" or of SECTION IV— COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide Tlrst ala 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 T. Paragraph 4.13.(11)(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. Paan 2 of 9 ra 2011 Th*,Travelers Indemn ly Company All e 0hlfi raAA.rvatl CG D3 16 11 11 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 appllca- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will quality 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 (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: 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 cats committed by, or with the knowledge or (2) Until the end of the policy period; when consent of,the insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you bection: 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 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 compen- offense committed boforc 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 fallowing is added to SECTION II —WHO IS AN INSURED: The insurance is excess over any valid and collectible other insurance available to the in- Any of your subsidiaries, other than a partnership, sured, whether primary, excess, contingent or joint venture ar lirniled lialailily company, that is nn any nthar hagiq, that iq availahla to any of not shown as a Named Insured In the Declara- 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 suhject to or "property darnage" that occurred, or "personal Paragraph 2.a.(9) of Section II — Who Is An injury" or "advertising injury" caused by an of- Insured. fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- The following replaces Paragraph 4. of SECTION sidiary. II—WHO IS AN INSURED- CG D3 16 11 11 ra 2011 The Travelers Indemnify Company All ei0hl&raAA.rvatl 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 15 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 elude 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 sect to lialmit far "bodil injury-, roe dam- for "bodily injury", "property damage", "personal p y y t � ' p j injury"or"advertising injury" that: age "personal injury"or"advertising injury"that: 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- injury„ caused by an offense that is commit- ted, suhsPquPnt to the PxPr:lltinn of that rnn- 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 causod, in whole or in part, by your acts or- use of that part of any premises leased to omissions in the maintenance, operation or use of equipment leased to you by such you. PgliipmPnt IPssor The insurance provided to such premises owner, The insurance provided to such equipment lessor rflanayer or lessor is subject to the followiny pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such equipment 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- contract 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 lessor does not apply to any "bodily injury” or b. The insurance provided to such premises property damage owner, manager or lessor does not apply to. that occurs. or 'personal 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 2 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-contrlbutory with, such other In- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS —PERMITS the written cnntraet or ngrPPmPnt that this. in- I he following is added to SECTION II — WHO IS surance must be primary to, or non- contributory with, such other insurance, in AN INSURED: 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 PacgP 4 of 9 ra 2011 Th*,Travelers Indemn 1Ly Company All e Ohl.&raAA.rvatl CG D3 16 11 11 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- that is your partner, joint venture erations. member or manager; or The insurance provided to such state or political (b) Any "employee' authorized by such subdivision does not apply to: partnership, joint venture; limited Il- a. Any "bodily injury," "property damage," "per- ability company or other organization sonar injury" or"advertising injury" arising out to give notice of an "occurrence' or of operations performed for that state or po- offense. Iltical 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 eluded in the "products-completed operations soon as practicable if it is given in good hazard". taith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only 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. (t) 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 lhis 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 "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of"pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), 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 R UNINTENTIONAL OMISSION company), any of your "executive offi- cers" or directors (if you are an organiza- 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, and none of your dlre yniir rights ilndar this insilranrp Hnwavar, 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 I}y: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The fallowing 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 D3 16 11 11 ra 2011 The Travelers Indemnify Company All ritjhlR r*AA.eve�.d Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental mens 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- Ieied. The following replaces the definition of ""bodily injury" in the DEFINITIONS Section: Page 8 of 8 Cl 2011 The Travelers Iildemnily Company All ei0hl.q rkvs.eve�.d CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: DT22-CO-720OP538-TCT-18 ISSUE DATE: 03/01/2018 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 GENERAL AGGREGATE A 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- haled 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 tho 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", arrd ilial limit is equal to the amount of "prnjerT'shnwn in the Srheriule shove_ 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) arc schod To You and Medical Exponse 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 cif all nPrlaratinns, Mich limits will hp sirhjPrt to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of "bodily injury" or "prop- yreyate Limil. 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 G, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical exppnsPs rausPd by ar.cidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: c. Persons or organizations making claims or bringing "suits". CG D2 11 01 04 Copyriyhl, The Travelers Indemnity Company, 20D4 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- ar the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregnte Limit, whiehgver is npplieablg; and gate Limit nor thA ❑Asignnted Project GAnArnl 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Deflni- 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 desiynaled "project" shown in lie considered a sinyle "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 Capyrighl, The Travelers Indemnity Company, 2004 GG D2 11 01 04 Policy#: DT-810-8D467897-TIL-18 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE HEAD IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 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 the 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. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who IS person or organization qualifies as an "insured" An Insured. of SECTION II —COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section It. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1.. 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured fur Business Auto Coverage. FRED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- cnntract nr agrPPmPnt in an "PmpinyPP's" ever is earlier. name, with your permission, while performing duties rclotcd to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.S., Who Is An Insured, of SECTION II —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any pamor, or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and acdn-, the following arc deemed to he cov- that person or organization, that is signed and ered "autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow: and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tlonal Insured Is an "Insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name; with your CA T3 53 02 15 -9-2015 The Travelers Indemnity Company.All rights rPgervnd. Page 1 of 4 Include&copyrighted material of Insurance Servioas Office, Inc.with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased: hired, of the United States of America, Puerto rented or borrowed with a driver is nota Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured. of SECTION II —COVERED AUTOS tions. LIABILITY COVERAGE: em (ii) Neither you nor any other involved Any "employee" of yours is an "insured"while us- "insured" will make any settlement ing a covered "auto" you don't own; hire or borrow without our consent. in your business of your personal affairs. E. SUPPLEMENTARY PAYMENTS -- INCREASED in We may, at our discretion; participate LIMITS In defending the "Insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II —COVERED AUTOS LIABIL- (Iv)We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent; but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance; of of SECTION II —COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your invoytiga- cause of time off from work. tlon of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit"„ but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The fulluwing replaces Subparagraph (S) in Para- graph C., Limits Of Insurance. of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to Such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of baigu, cr Similai iuyulativii impubvul by the insurance in payments far damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov and colloctiblc other incuranco available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. withnut s driver fnr a rprind of 0 rtay, nr IpcG (c) This. insurance is not a substitute for re- and that is not an "auto" you lease, hire; rent quired or compulsory insurance in any or burrow from any of your "employees", partners (if you are a partnership), members country outside the United States, its ter- ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ;w2015 The Travelers Indemnity Company.All rights rpservnd. CA T3 53 02 15 IncludGs copyrighted material of Insurance Servioas Office, Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto'. local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage. not invalidate the coverage afforded by this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following i, added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) 11 is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, Its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.i.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto' is a covered "auto" for Compro- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to Insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident' or "loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if yuu are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An cxocutivc officer, director or insurance The following replaces the first sentence in Para- manager(if you are a corporation or other or- graph AA.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (o) Any"employee" authorized by you to give no- AGE: tice of the"accident"or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,50fl for tampnrary transpnrtatinn axpanse? in- The fulluwiiiy replaeus Parayiapli A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, Bred "auto" of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- .J. PFRSONAI PROPFRTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others 10 Us DAMAGE COVERAGE- We waive any right of rocovcry we may havo Personal Property against any person or organization to the ex- tenl required or you by a wrilten cunlraul We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident' parel and other personal property which is: or"loss", provided that the"accident" or"loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 -9-2015 The Travelers Indemnity Company.All rights rPservnd. Page 3 of 4 IncludGs copyrighted material of Insurance Servioas Office, Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of; or unintentional person or organization designated in such error in, any information given by you shall not nnntract_ prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph 13.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal- SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 2015 The Travelers Indemnity Company.All rights rPservad. CA T3 53 02 15 IncludG&copyrighted material of Insurance Servicas office, Inc.with its permission. TRAVELER5WORKERS COMPENSATION AND ONE TUHR SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06163 ENDORSEMENT WC 99 03 76 ( A)-- 001 POLICY NUMBER: UB-01<312899-18-26-0 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 riyhl ayainsl the person or oryarir_arior rained in the Schedule. The additional premium for this endorsement shall be 02.000 % 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 st�[Bd. (Tho information bolow is roquirod only whon this ondorsomont is issuod subsoquont to preparation of the policy.) Endorsement Effective Policy No. UB-OK312895-18-26-G Endorsement No. 03/01/2018 Insured Premiurn Insurance Company Countersigned by DATE OF ISSUE: 03-01-2018 ST ASSIGN: Pace 1 -of 1