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PROOF OF INSURANCE (2019 - 2019) CLOSED .�0' I DATE(MMIDDIYYYY) �,,..O CERTIFICATE OF LIABILITY INSURANCE 10/24/2018 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(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 rights to the certificate holder in lieu of such endorsement(s). r CONTACT PRODUCER Renton... ..P�A&W62 844 3070 Peters __ ....... .....I� F". 790 E Colorado Blvd#460 &Associates Aft,,W'P}....................................................................-..- . AX . . -aleyr IL tnlon�.com ... .................. Pasadena, CA 91101 ur�,PR9'"s"„,-_s et r d License#0020739 INSURER( AFFORDING COVERAGE NAIC# INSURER A:Westchester Surplus Lines Insurance Co. 10172 INSURED GALEJORDA INSURER 8 Gale/Jordan Associates, Inc. V 3858 Carson Street, Suite 200 I-INSURERC: Torrance, CA 90503-5613 INSURER D: .. 310-316-4377 INSURER E I INSURER F: COVERAGES CERTIFICATE NUMBER:147449047 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 'OLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADpF .....------........................----...................... ......................................................._...................... POLICY iEXP LTR TYPE OF INSURANCE 1 Nr2: POLICY NUMBER V0�mfDofFyYYFY) tMMIDDNYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y G24391656006 4/28/2018 4/28/2019 EACH OCCURRENCE $3,000.000 'ITLS�i�GSETO kENTED CLAIMS-MADE OCCUR PREMIS_LEjR ragcurrgnap,)" $50,000 X Contractual Liab MED EXP(Any one person) $5„000 X XCU Included PERSONAL&ADV INJURY $2„000,000 - Gffl-AGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE _ $4,000,000 ...X....�OTh'F�IR: r PLs PaI�POLICY LOC ConoDPpII. Liab.UCTS- OMP/OP AGG... $3,000,OOO......,........m...". . l. A AUTOMOBILE LIABILITY Y G24391656006 4/28/2018 4/28/2019 COMBINED SINGLE LIMIT $2,000,000 ............. _ffa accidenll ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ,. NON-OWNED AUTOS ONLY AUTOS ONLY _ n. A�M�FkC"E" $ X X.. Pe UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR .....,._._._...-,-,..w.A.....E.................�...,.,.,.,.,.,.,.,.,.,. CLAIMS-MADE AGGREGAT $ ............... .........................................�. ... .-.. DED I RETENTION$ $ $ WORKERS COMPENSATION $TATUTB V ETH AND EMPLOYERS'LIABILITY YIN .............."...................... . ANYP'ROPRNETORFPARTNER/EXECUT'IVE � NIA ELT $ FFICEWEEXCLUDED/ (Mandatory n Ni' E.L..L.DISEASECEA $ If ns,d'escdbe under DESCRIPTION OF OPE,RA1IONS bomtwr E.L.DISEASE-POLICY LIMIT $ A Professional Liability G24391656006 4128/2018 4/28/2019 $3,000,000 Per Claim $3,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:All Operations--City of EI Segundo,its officers,agents and employees are named as additional insured as respects general and auto liability for claims arising from the operations of the named insured as required per written contract or agreement. CERTIFICATE HOLDER CANCELLATION 30 Day Notice of 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 EI Segundo, Public Works Dept. 350 Main Street EI Segundo CA 90245 Au RIZEDREPR'EnTIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE ADDITIONAL INSURED ENDORSEMENT— PRODUCTS-COMPLETED OPERATIONS HAZARD PRIMARY& NON-CONTRIBUTORY Named Insured Endorsement Number Gale/Jordan Associates Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP I G24391656 006 04/28/2018 to 04/28/2019 04/28/2018 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for bodily injury or property damage caused, in whole or in part, by your work performed for that additional insured and included in the products-completed operations hazard. Furthermore, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. All other terms and conditions remain the same. ENV-3226 (10-08) Page 1 of 1 Named Insured Endorsement Number Gale/Jordan Associates Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP I G24391656 006 04/28/2018 to 04/28/2019 04/28/2018 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number, The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT-OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON-CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Ornanization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II -WHO IS AN INSURED is amended to include: A. SECTION II - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the site of the covered operations has been completed; or (2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV-3101 (08-04) Includes copyrighted material of Insurance Services Office, Inc.with its permission Page 1 of 1 Named Insured Endorsement Number Gale/Jordan Associates Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP l G24391656 006 04/28/2018 to 04/28/2019 04/28/2018 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person,or Ornanigaii n, Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same, ENV-3143(03-05) Includes copyrighted material of Insurance Services Office, Inc.with its permission Page 1 of 1 Named Insured Endorsement Number Gale/Jordan Associates Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G24391656 006 04/28/2018 to 04/28/2019 04/28/2018 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. HIRED AND NON-OWNED AUTO LIABILITY COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Limits of Insurance: $2,000,000 Each Occurrence $2,000,000 Aggregate Limit(included in the General Aggregate) With respect to the insurance provided by this endorsement,the following is added to Section I- COVERAGES: A. HIRED AUTO LIABILITY The insurance provided under this Coverage Part applies to bodily injury or property damage arising out of the maintenance or use of a hired auto by you or your employee in the course of your business. B. NON-OWNED AUTO LIABILITY The insurance provided under this Coverage Part applies to bodily injury or property damage arising out of the use of a non-owned auto in your business. With respect to the insurance provided by this endorsement: A. The COMMERCIAL GENERAL LIABILITY COVERAGE FORM, SECTION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2, Exclusions, Items c., e., g., h., i.,j., k., m., n. and o. are deleted in their entirety. B. The following additional exclusions are added: 1. Employee Indemnification and Employer's Liability Bodily Injury: 1. To an employee of the insured arising out of and in the course of employment by the insured; or 2. To the spouse, child, parent, brother or sister of that employee as a consequence of 1. above. This exclusion applies: 1. Whether the insured maybe liable as an employer or in any other capacity; and 2. To any obligation to share damages with or repay someone else who must pay damages because of injury. This exclusion does not apply to: 1. Liability assumed by the insured under an insured contract; or ENV-7110(02-05) Page 1 of 3 2. Bodily injury arising out of and in the course of domestic employment by the insured unless benefits for such injury are in whole or in part either payable or required to be provided under any workers compensation law. 2. Care, Custody or Control Property Damage: 1. To property owned or transported by, or rented or loaned to the insured; or 2. Property in the care, custody or control of the insured. 3. Fellow Employee Bodily injury to any fellow employee of the insured arising out of and in the course of the fellow employee's employment or while performing duties related to the conduct of your business. With respect to the insurance provided by this endorsement the COMMERCIAL GENERAL LIABILITY COVERAGE FORM,SECTION II -WHO IS AN INSURED is deleted in its entirety and replaced by the following: 1. Each of the following is an insured under this insurance to the extent set forth below: a. You; b. Anyone else while using with your permission a non-owned auto or hired auto except: 1. The owner or anyone else from whom you hire or borrow a non-owned auto or hired auto. 2. Your employee if the non-owned auto is owned by that employee or a member of his or her household, 3. A partner(if you are a partnership), or a member(if you are a limited liability company)for a non-owned auto owned by him or her or a member of his or her household. 4. Any person while employed in or otherwise engaged in duties in connection with an auto business,other than an auto business you own or operate. c. Any other person or organization, but only with respect to their liability because of acts or omissions of an insured under a., b. or c. above. With respect to the insurance provided by this endorsement, SECTION III - LIMITS OF INSURANCE, Items 1. and 2. are deleted in their entirety and replaced by the following: 1. Regardless of the number of hired autos or non-owned autos, premiums paid, claims made or vehicles involved in the occurrence, the most we will pay for the total of all damages resulting from any one occurrence is the Each Occurrence Limit shown in the schedule of this endorsement. 2. The Aggregate Limit shown in the schedule of this endorsement is the most we will pay for the sum of all damages under this Coverage Part. The Aggregate Limit shown in the schedule of this endorsement is included within the General Aggregate Limit shown in the policy declarations. The General Aggregate Limit is the most we will pay for the sum of all damages under all Coverage Parts provided within this policy except damages because of bodily injury or property damage included in the products-completed operations hazard. ENV-7110(02-05) Page 2 of 3 With respect to the insurance provided by this endorsement, the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS are not changed with respect to HIRED AUTO LIABILITY or NON-OWNED AUTO LIABILITY Insurance. With respect to the insurance provided by this endorsement, the COMMERCIAL GENERAL LIABILITY COVERAGE FORM,SECTION V. DEFINITIONS is amended as follows: A. Item 9. Insured contract is amended to include the following: f. That part of any contract or agreement entered into, as part of your business, pertaining to the rental or lease, by you or any of your employees, of any auto. However, such contract or agreement shall not be considered an insured contract to the extent that it obligates you or any of your employees to pay for property damage to any auto rented or leased by you or any of your employees. An insured contract does not include that part of any contract or agreement: 1. That indemnifies a railroad for bodily injury or property damage arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; or 2. That pertains to the loan, lease or rental of an auto to you or any of your employees, if the auto is loaned, leased or rented with a driver; or 3. That holds a person or organization engaged in the business of transporting property by auto for hire harmless for your use of a covered auto over a route or territory that person or organization is authorized to serve by public authority. B.The following additional DEFINITIONS are added: 1. Auto business means the business or occupation of selling, repairing, servicing,storing or parking autos. 2. Domestic employment means the employment of persons engaged in household or domestic work performed principally in connection with residential premises. 3. Hired auto means any auto you lease, hire or borrow. This does not include; a. any auto you lease, hire or borrow from any of your employees or members of their households, or from any of your partners or executive officers; b. any substitute, replacement or extra auto needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor; or c. any auto you lease, hire, rent or borrow for a period of time longer than six(6) months. 4. Non-owned auto means any auto you do not own, lease, hire or borrow which is used in connection with your business. This includes autos owned by your employees, partners (if you are a partnership), members (if you are a limited liability company), or members of their households but only while used in your business. All other terms and conditions remain the same, ENV-7110(02-05) Page 3 of 3 '�'CC?Ra CERTIFICATE OF LIABILITY INSURANCE 2/7/20 � ° 18°DnYYY} PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EJMS Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO.Box 33289 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (CA 1994) Los Gatos CA 95031 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: State Compensation insurance Fund 35076 - g IN.. a! Orden associates,inc, _SURER B: 3858 Carson St INSURER C: - Suite 200 INSURER D: Torrance I CA 90503 INSURER E: tl COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A00"'t� PCI-Lei-EFFECTIVE POLICY EXI tRATION ......................-..............a'�.- INSRTYPE Of r, POLICY NUMBER 12=fIDDIYYYYI DATE IMNIP'D ryYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ..............a- CGMMERCIAL GENERAL LIABILITY ,,,+ EMR, IS'l^S(,I: qgw(v ence1 $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN`L AGGREGATE LIMIT APPLI'E'S PER: PRODUCTS-COMPIOP AGG $ POLICY�-..__..�PRO• LOC ..�................. _�....,,,....__._. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accidenl) $ ALL OWNED AUTOS BODILY INJURY $ _ SCHEDULED AUTOS (Per person) V HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per aoddenl) $ —•-- PROPERTY DAMAGE $ (Per eccidenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER T AN �AGG .............. ..w AUTO EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE ( $ RETENTION $ $ " A ANY PROPR KERS COMPENSATION XECUTIVE YIN 1118442-18 21112018 21112019 WC STATU-Mr . DTH. AN EMPLOY'ER'S'LIABILITY V m„_...._�_.5............. ..EEL. AND R�II' OFFICERIMEMBER EXCLUDED? __;L,EACH ACCIDENT $ 1,000,000 nda"InNH) E.L,DISEASE-EA EMPLOYEE $ 1,000,000 Ir yas,describe under1,000.000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT r SPECIAL PROVISIONS Christopher X.Gale,President-Excluded Thomas A.Jordan,Secretary Treasurer-Excluded CERTIFICATE HOLDER CANCELLATION City of EI Segundo,Public Works Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 350 Main St. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN EI Segundo,CA 90245-3813 NOTICE TO THE CERTIFICATE HOLDER NAMED TO TME LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, ��� / AUTHORIZED REPRESENTAft)rE Daniel J.Cloud fl ACORD 25(2009101) 0 1988.2009�t�D CORPOR TION. All rights reserved. The ACORD name and logo are registered marks of AC D i IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(iss) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 26(2001108) ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 1118442-18 STATE RENEWAL COMPENSATION INSURANCE NA FUND 2-70-70-25 PAGE 1 HOME OFFICE SAN FRANCISCO EFFECTIVE OCTOBER 13, 2018 AT 12 . 01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING FEBRUARY 1, 2019 AT 12 . 01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME GALE/JORDAN ASSOCIATES, INC. 3858 W CARSON ST STE 200 TORRANCE, CA 90503 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, THE CITY OF EL SEGUNDO PUBLIC WORKS WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, GALE/JORDAN ASSOCIATES, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: OCTOBER 16, 2018 2570 A TI E7RI ED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) OLD DP 217