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PROOF OF INSURANCE (2019 - 2019) CLOSED DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1011212018 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). cCrlaYiac.T PRODUCER United " NAME: .,.,., United J4_gel"rCieS Inc, Igted Agencies,Drive I � sa2 iAPC.No4: 23'421 S. Pointe Crive Ste. 190 PHDN FAX Laguna Hills CA 925 3 E-MA '.L•.a xis: _............... ADDRESS: kdumatol uwl"ited.gRtpci .c..com .......................................... ........................................." INSURER(S)AFFORDING COVERAGE ................... NAIC# INSURER A:Travelers Property Casualty CO of America .. 2m,"." 74 ......................23764.. 5t%_ INSURED INSURER B: Backflow Apparatus&Valve Company _. ..""""""" BAVCO INSURERC: 20435 S. Susana Roadg .... iNsuRRn: Lon Beach CA 90810 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 44870645 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR TYPE OF INSURANCE ''AWL��'ti'8�A'.� POLICY'EFF"'�m"" i'OLIdi EXP LIMITS ITmmmmITITITITITITITITITITITIT^^^ LTR SD wvn POLICY NUMBER IMMIDD/YYYYI (MMIDDIYYYYI .,.,., A VCOMMERCIAL GENERAL LIABILITY ✓ ✓ 630-8J664090 10/31/2018 10/31/2019 EACH OCCURRENCE $1,000.000 ....._.._._................. � "tSAlui'74� "TO'"l1' "PJ �D' CLAIMS-MADE 1 OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 OTHER ✓ LOC P..-... ��PRO" RODUCTS-COMP/OPAGG $2,000,000 ......._� JEC"r A AUTOMOBILE LIABILITY BA-8J664090 10/31/2018 10/31/2019 {OM nEDn15INGLiELIMIT $1000,000 .................... ✓ ANY AUTO BODILY INJURY(Per person) $ ...__..... w. ............................. OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOSNON-OWNED HIRED PR_ ✓ AUTOS ONLY „f, AUTOS ONLY War accI o 4 wG., "................ $ A UMBRELLA EXCESS pLIAB OCCUR CUP-9J209005 10/31/2018 10/31/2019 EACH OCCURRENCE $51,000,000 ✓ CLAIMS-MADE AGGREGATE $5.000,000 DED I. ✓R RETENTION SD $ A WORKERS COMPENSATION v1 UBOL941578TIL18 8/27/2018 8/27/2019 ,/ sT,nTUTE oRH AND EMPLOYROPRIEERSPART ER/ITY Y �EACHACCIDENT OFFICER/MEMBEREXCLUDED7 Y NIA $1,000,000 (Mandatory in PARTNER/EXECUTIVE E.L DISEASE-EA EMPLOYEE $..1.a9Q�?.ffl0 If yes,describe under DESCRIPTION OF OPERATIONS below E L,DISEASE-POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of EI Segundo,its officers,agents,and employees are added as additional insureds on the general liability policy only per the attached. Waiver of Subrogation is included in the general liability and work comp policies only per the attached forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit Of EI Segundo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUNIC Works Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main St. EI Segundo CA 90245 AUTHORIZED REPRESENTATIVE Ga Champlin (r'� n � ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 44870645 1 19-19 GL, Auto, Umb, WC Katherine Dumatol 110/12/2018 9:02:41 AM (PDT) I Page 2 of 12 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURE (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED— (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you "property damage" or"personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section III— Limits Of Insurance. for such loss, and we will not share with that b) The insurance provided to the additional in- "other insurance". But the insurance provided to the additional insured by this endorsement still is sured does not apply to bodily injury", prop- �� excess over any valid and collectible other in- of t damage or personal injuryarising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ance". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- ii. Supervisory, inspection, architectural or rence" or an offense which may result in a claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 C 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 44870645 18-19 GL, Auto, Umb, WC I Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 3 of 12 COMMERCIAL GENERAL LIABILITY L How, when and where the "occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the"occurrence" or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit" as person or organization as an additional in- soon as practicable. sured on this Coverage Part, provided that the bodily injuryand property damage oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ©2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 44870645 18-19 GL, Auto, Umb, WC I Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 4 of 12 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTE D ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured J. Bodily Injury To Co-Employees And Co-Volunteer B. Blanket Additional Insured—Broad Form Vendors Workers C. Damage To Premises Rented To You K. Aircraft Chartered With Crew • Perils of fire, explosion, lightning, smoke, L. Non-Owned Watercraft— Increased From 25 Feet water To 50 Feet • Limit increased to$300,000 M. Increased Supplementary Payments D. Blanket Waiver Of Subrogation • Cost of bail bonds increased to$2,500 E. Blanket Additional Insured — Owners, Managers 0 Loss of earnings increased to$500 per day Or Lessors Of Premises F. Blanket Additional Insured — Lessors Of Leased N. Medical Payments- Increased Limit Equipment O. Knowledge And Notice Of Occurrence Or Offense G. Incidental Medical Malpractice P. Unintentional Omission H. Personal Injury—Assumed By Contract Q. Reasonable Force — Bodily Injury Or Property I. Amended Bodily Injury Definition Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS 1. The following is added to SECTION II —WHO The following is added to SECTION II —WHO IS AN INSURED: IS AN INSURED: Any organization, other than a partnership or Any person or organization that is a vendor and joint venture, over which you maintain owner- that you have agreed in a written contract or ship or majority interest on the effective date agreement to include as an additional insured on of the policy qualifies as a Named Insured. this Coverage Part is an insured, but only with re- However, coverage for any such organization spect to liability for "bodily injury" or "property will cease as of the date during the policy pe- damage"that: riod that you no longer maintain ownership of, or majority interest in, such organization. a. Is caused by an "occurrence" that takes place after you have signed and executed that con- 2. The following replaces Paragraph 4.a. of tract or agreement; and SECTION II—WHO IS AN INSURED: a. Coverage under this provision is afforded b. Arises out of "your products" which are dis- only until the 180th day after you acquire tributed or sold in the regular course of such or form the organization or the end of the vendors business. policy period, whichever is earlier, unless The insurance provided to such vendor is subject reported in writing to us within 180 days. to the following provisions: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 44870645 110-19 GL, Auto, Umb, WC I Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 6 of 12 COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- JURY AND PROPERTY DAMAGE LIABIL- dor will be the limits which you agreed to pro- ITY: vide in the written contract or agreement, or Exclusions c.through n. do not apply to dam- the limits shown in the Declarations of this age to premises while rented to you, or tem- Coverage Part,whichever are less. porarily occupied by you with permission of b. The insurance provided to such vendor does the owner, caused by: not apply to: a. Fire; (1) "Bodily injury" or "property damage" for b. Explosion; which the vendor is obligated to pay damages by reason of the assumption of c. Lightning; liability in a contract or agreement. This d. Smoke resulting from such fire, explosion, exclusion does not apply to liability for or lightning; or damages that the vendor would have in e. Water. the absence of the contract or agreement; A separate limit of insurance applies to such (2) Any express warranty unauthorized by damage to premises as described in Para- you; graph 6.of Section III—Limits Of Insurance. tt (3) Any physical or chemical change in "your This insurance does not apply to damage to products" made intentionally by such premises while rented to you, or temporarily vendor; occupied by you with permission of the (4) Repackaging, unless unpacked solely for owner, caused by: the purpose of inspection, demonstration, a. Rupture, bursting, or operation of pres- testing, or the substitution of parts under sure relief devices; ' instructions from the manufacturer, and then repackaged in the original container; b. Rupture or bursting due to expansion or swelling of the contents of any building or (5) Any failure to make such inspections, ad- structure, caused by or resulting from wa- justments, tests or servicing as vendors ter; agree to perform or normally undertake to • perform in the regular course of business, C. Explosion of steam boilers, steam pipes, in connection with the distribution or sale steam engines, or steam turbines. of"your products"; 2. The following replaces Paragraph 6. of SEC- (6) Demonstration, installation, servicing or TION III—LIMITS OF INSURANCE: repair operations, except such operations Subject to S. above, the Damage To Prem- performed at such vendor's premises in ises Rented To You Limit is the most we will connection with the sale of "your prod- pay under Coverage A for damages because ucts"; or of "property damage" to any one premises (7) "Your products"which, after distribution or while rented to you, or temporarily occupied sale by you, have been labeled or rela- by you with permission of the owner, caused beled or used as a container, part or in- by fire; explosion; lightning smoke resulting gredient of any other thing or substance from such fire, explosion, or lightning; or wa- by or for such vendor. ter. The Damage To Premises Rented To Coverage under this provision does not apply to: You Limit will apply to all damage proximately a. Any person or organization from whom you caused by the same "occurrence", whether have acquired "your products", or any ingre- such damage results from fire; explosion; dient, part or container entering into, accom- lightning; smoke resulting from such fire, ex- panying or containing such products; or plosion, or lightning; water; or any combina- b. Any vendor for which coverage as an addi- tion of any of these. tional insured specifically is scheduled by en- The Damage To Premises Rented To You dorsement. Limit will be the higher of: C. DAMAGE TO PREMISES RENTED TO YOU a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- COVERAGES — COVERAGE A BODILY IN- ises Rented To You Limit. Page 2 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. 44870645 118-19 GL, Auto, Umb, WC I Katherine Dumatol 110/12/2018 9:02:41 AM (PDT) I Page 7 of 12 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph a. of the a. Is "bodily injury" or"property damage" caused definition of "insured contract" in the DEFINI- by an "occurrence" that takes place, or "per- TIONS Section: sonal injury" or "advertising injury" caused by a. A contract for a lease of premises. How- an offense that is committed, after you have ever, that portion of the contract for a signed and executed that contract or agree- lease of premises that indemnifies any ment; and person or organization for damage to b. Arises out of the ownership, maintenance or premises while rented to you, or tempo- use of that part of any premises leased to rarily occupied by you with permission of you. the owner, caused by: The insurance provided to such premises owner, • (1) Fire; manager or lessor is subject to the following pro- visions: it (2) Explosion; a. The limits of insurance provided to such (3) Lightning; premises owner, manager or lessor will be (4) Smoke resulting from such fire, ex- the limits which you agreed to provide in the plosion, or lightning; or written contract or agreement, or the limits (5) Water. shown on the Declarations of this Coverage Part, whichever are less. is not an"insured contract"; b. The insurance provided to such premises 4. The following replaces Paragraph 4.b.(1)(b) owner, manager or lessor does not apply to: of SECTION IV — COMMERCIAL GENERAL (1) "Bodily injury" or "property damage" LIABILITY CONDITIONS: caused by an "occurrence" that takes (b) That is insurance for premises rented to place, or "personal injury" or "advertising you, or temporarily occupied by you with injury" caused by an offense that is com- the permission of the owner; mitted, after you cease to be a tenant in that premises; or D. BLANKET WAIVER OF SUBROGATION (2) Structural alterations, new construction or The following is added to Paragraph 8., Transfer demolition operations performed by or on ci Of Rights Of Recovery Against Others To Us, behalf of such premises owner, manager of SECTION IV — COMMERCIAL GENERAL LI- or lessor. ABILITY CONDITIONS: c. The insurance provided to such premises We waive any right of recovery we may have owner, manager or lessor is excess over any against any person or organization because of valid and collectible other insurance available payments we make for injury or damage arising to such premises owner, manager or lessor, out of premises owned or occupied by or rented unless you have agreed in a written contract or loaned to you; ongoing operations performed for this insurance to apply on a primary or by you or on your behalf, done under a contract contributory basis. with that person or organization; "your work"; or F. BLANKET ADDITIONAL INSURED — LESSORS "your products". We waive this right where you OF LEASED EQUIPMENT have agreed to do so as part of a written contract, The following is added to SECTION II —WHO IS executed by you prior to loss. AN INSURED: E. BLANKET ADDITIONAL INSURED —OWNERS, Any person or organization that is an equipment MANAGERS OR LESSORS OF PREMISES lessor and that you have agreed in a written con- The following is added to SECTION II —WHO IS tract or agreement to include as an additional in- AN INSURED: sured on this Coverage Part is an insured, but Any person or organization that is a premises only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertis- owner, manager or lessor and that you have agreed in a written contract or agreement to ing injury"that: name as an additional insured on this Coverage a. Is "bodily injury" or"property damage" caused Part is an insured, but only with respect to liability by an "occurrence" that takes place, or "per- for "bodily injury", "property damage", "personal sonal injury" or "advertising injury" caused by injury"or"advertising injury"that: an offense that is committed, after you have CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 44870645 l 18-19 GL, Auto, Umb, WC I Katherine DUmatol 1 10/12/2018 9:02:41 AM (PDT) I Page 8 of 12 COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- 3. The following is added to Paragraph 2.a.(1)of ment; and SECTION II—WHO IS AN INSURED: b. Is caused, in whole or in part, by your acts or Unless you are in the business or occupation omissions in the maintenance, operation or of providing professional health care services, use by you of equipment leased to you by Paragraphs (1)(a), (b), (c) and (d) above do such equipment lessor. not apply to any "bodily injury" arising out of any providing or failing to provide "incidental The insurance provided to such equipment lessor medical services" by any of your"employees", is subject to the following provisions: other than an employed doctor. Any such a. The limits of insurance provided to such "employees" providing or failing to provide equipment lessor will be the limits which you "incidental medical services" during their work agreed to provide in the written contract or hours for you will be deemed to be acting agreement, or the limits shown on the Decla- within the scope of their employment by you rations of this Coverage Part, whichever are or performing duties related to the conduct of less. your business. b. The insurance provided to such equipment 4. The following exclusion is added to Para- lessor does not apply to any "bodily injury" or graph 2., Exclusions, of SECTION I — COV- "property damage" caused by an "occurrence" ERAGES —COVERAGE A BODILY INJURY that takes place, or "personal injury„ or "ad- AND PROPERTY DAMAGE LIABILITY: vertising injury" caused by an offense that is Sale Of Pharmaceuticals committed, after the equipment lease expires. "Bodily injury" or "property damage" arising c. The insurance provided to such equipment out of the willful violation of a penal statute or lessor is excess over any valid and collectible ordinance relating to the sale of pharmaceuti- ® other insurance available to such equipment cals committed by, or with the knowledge or lessor, unless you have agreed in a written consent of,the insured. contract for this insurance to apply on a pri- 5. The following is added to Paragraph 5. of mary or contributory basis. SECTION III—LIMITS OF INSURANCE: G. INCIDENTAL MEDICAL MALPRACTICE For the purposes of determining the applica- ble1. The followingis added to the definition of"oo- Each Occurrence Limit, all related acts or omissions committed in the providing or fail- currence" in the DEFINITIONS Section: ing to provide "incidental medical services" to Unless you are in the business or occupation any one person will be considered one "oc- of providing professional health care services, currence". "occurrence" also means an act or omission 6. The following is added to Paragraph 4.b., Ex- committed in providing or failing to provide cess Insurance, of SECTION IV — COM- "incidental medical services"to a person. MERCIAL GENERAL LIABILITY CONDI- 2. The following is added to the DEFINITIONS TIONS: Section: This insurance is excess over any valid and "Incidental medical services" means: collectible other insurance, whether primary, excess, contingent or on any other basis, that a. Medical, surgical, dental, laboratory, x-ray is available to any of your "employees" for or nursing service or treatment, advice or "bodily injury" that arises out of providing or instruction, or the related furnishing of failing to provide "incidental medical services" food or beverages; to any person to the extent not subject to b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED. medical, dental, or surgical supplies or appliances; H. PERSONAL INJURY — ASSUMED BY CON- I. First aid; or TRACT d. "Good Samaritan services". 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION "Good Samaritan services" means any emer- — COVERAGES — COVERAGE B PER- gency medical services for which no compen- SONAL AND ADVERTISING INJURY LI- sation is demanded or received. ABILITY: Page 4 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 44870645 i 18-19 GL, Auto, Umb, WC I Katherine DUmatol 1 10/12/2018 9:02:41 AM (PDT) i Page 9 of 12 COMMERCIAL GENERAL LIABILITY e. Contractual Liability the insured and the interests of the in- "Personal injury" or"advertising injury" for demnitee; which the insured is obligated to pay 4. The following replaces the first subparagraph damages by reason of the assumption of of Paragraph If. of the definition of "insured liability in a contract or agreement. This contract" in the DEFINITIONS Section: exclusion does not apply to: if. That part of any other contract or agree- (1) Liability for damages that the insured ment pertaining to your business (includ- would have in the absence of the ing an indemnification of a municipality in contract or agreement; or connection with work performed for a (2) Liability for damages because of municipality) under which you assume the "personal injury" assumed in a con- tort liability of another party to pay for p "bodily injury," "property damage" or"per- tract or agreement that is an "insured sonal injury"to a third person or organiza- contract", provided that the "personal tion. Tort liability means a liability that injury" is caused by an offense com- would be imposed by law in the absence mitted subsequent to the execution of of any contract or agreement. the contract or agreement. Solely for I. AMENDED BODILY INJURY DEFINITION the purposes of liability assumed in an "insured contract", reasonable at- The following replaces the definition of"bodily in- torneys fees and necessary litigation jury" in the DEFINITIONS Section: expenses incurred by or for a party "Bodily injury" means bodily injury, mental an- other than an insured will be deemed guish, mental injury, shock, fright, disability, hu- to be damages because of "personal miliation, sickness or disease sustained by a per- injury", provided that: son, including death resulting from any of these at (a) Liability to such party for, or for any time. the cost of, that party's defense J. BODILY INJURY TO CO-EMPLOYEES AND has also been assumed in the CO-VOLUNTEER WORKERS same"insured contract"; and The following is added to Paragraph 2.a.(1) of (b) Such attorney fees and litigation SECTION II—WHO IS AN INSURED: expenses are for defense of that Paragraph (1)(a) above does not apply to "bodily party against a civil or alternative injury" to a co-"employee" in the course of the co- dispute resolution proceeding in "employee's" employment by you or performing which damages to which this in- duties related to the conduct of your business, or surance applies are alleged. to "bodily injury" to your other"volunteer workers" 2. The following replaces the third sentence of while performing duties related to the conduct of Your business. Paragraph 2. of SUPPLEMENTARY PAY- MENTS—COVERAGES A AND B: K. AIRCRAFT CHARTERED WITH CREW Notwithstanding the provisions of Paragraph The following is added to Exclusion g., Aircraft, 2.b.(2) of Section I —Coverage A — Bodily In- Auto Or Watercraft, in Paragraph 2.of SECTION jury And Property Damage Liability or Para- I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: graph 2.e. of Section I — Coverage B — Per- sonal and Advertising Injury Liability, such This exclusion does not apply to an aircraft that payments will not be deemed to be damages is: because of"bodily injury", "property damage" (a) Chartered with crew to any insured; or "personal injury", and will not reduce the (b) Not owned by any insured; and limits of insurance. (c) Not being used to carry any person or prop- 3. The following replaces Paragraph 2.d. of erty for a charge. SUPPLEMENTARY PAYMENTS — COVER- L. NON-OWNED WATERCRAFT AGES A AND B: 1. The following replaces Paragraph (2) of Ex- d. The allegations in the "suit" and the in- clusion g., Aircraft, Auto Or Watercraft, in formation we know about the "occur- Paragraph 2. of SECTION I — COVERAGES rence"or offense are such that no conflict — COVERAGE A BODILY INJURY AND appears to exist between the interests of PROPERTY DAMAGE LIABILITY: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 44870645 118-19 GL, Auto, UMb, WC I Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 10 of 12 COMMERCIAL GENERAL LIABILITY (2) A watercraft you do not own that is: e. The following provisions apply to Paragraph (a) Fifty feet long or less; and a. above, but only for the purposes of the in- (b) Not being used to carry any person or surance provided under this Coverage Part to property for a charge. you or any insured listed in Paragraph 1. or 2. of Section II—Who Is An Insured: 2. The following is added to Paragraph 2. of (1) Notice to us of such "occurrence" or of- SECTION II—WHO IS AN INSURED: fense must be given as soon as practica- Any person or organization that, with your ex- ble only after the "occurrence" or offense press or implied consent, either uses or is re- is known to you (if you are an individual), sponsible for the use of a watercraft that you any of your partners or members who is do not own that is: an individual (if you are a partnership or (1) Fifty feet long or less; and joint venture), any of your managers who (2) Not being used to carry any person or is an individual (if you are a limited liability property for a charge. company), any of your trustees who is an M. INCREASED SUPPLEMENTARY PAYMENTS individual (if you are a trust), any of your "executive officers" or directors (if you are 1. The following replaces Paragraph 1.b. of an organization other than a partnership, SUPPLEMENTARY PAYMENTS — COVER- joint venture, limited liability company or AGES A AND B of SECTION I — COVER- trust) or any "employee" authorized by AGES: you to give notice of an "occurrence" or b. Up to $2,500 for cost of bail bonds re- offense. quired because of accidents or traffic law (2) If you are a partnership,joint venture, lim- violations arising out of the use of any ited liability company or trust, and none of vehicle to which the Bodily Injury Liability your partners, joint venture members, Coverage applies. We do not have to fur- nish ur- managers or trustees are individuals, no- tice to us of such "occurrence" or offense 2. The following replaces Paragraph 1.d. of must be given as soon as practicable only SUPPLEMENTARY PAYMENTS — COVER- after the "occurrence" or offense is known AGES A AND B of SECTION I — COVER- by: AGES: (a) Any individual who is: d. All reasonable expenses incurred by the insured at our request to assist us in the (i) A partner or member of any part- investigation or defense of the claim or nership or joint venture; "suit", including actual loss of earnings up (ii) A manager of any limited liability to $500 a day because of time off from company; work. iu A trustee of an trust; or N. MEDICAL PAYMENTS—INCREASED LIMIT (Iii) y (iv)An executive officer or director of The following replaces Paragraph 7. of SECTION any other organization; III—LIMITS OF INSURANCE: 7. Subject to 5. above, the Medical Expense that is your partner, joint venture 42 Limit is the most we will pay under Coverage member, manager or trustee; or ts C. for all medical expenses because of"bod- (b) Any "employee" authorized by such INA ily injury" sustained by any one person, and partnership, joint venture, limited li- will be the higher of: ability company, trust or other organi- (a) $10,000; or zation to give notice of an "occur- rence" or offense. (b) The amount shown on the Declarations of (3) Notice to us of such "occurrence" or of- this Coverage Part for Medical Expense fense will be deemed to be given as soon Limit. as practicable if it is given in good faith as O. KNOWLEDGE AND NOTICE OF OCCUR- soon as practicable to your workers' RENCE OR OFFENSE compensation insurer. This applies only if The following is added to Paragraph 2., Duties In you subsequently give notice to us of the The Event of Occurrence, Offense, Claim or "occurrence" or offense as soon as prac- Suit, of SECTION IV — COMMERCIAL GEN- ticable after any of the persons described ERAL LIABILITY CONDITIONS: in Paragraphs e.(1) or (2) above discov- Page 6 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office,Inc.with its permission, 44870645 118-19 GL, Auto, Umb, WC I Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 11 of 12 COMMERCIAL GENERAL LIABILITY ers that the 'occurrence" or offense may your rights under this insurance. However, this result in sums to which the insurance provision does not affect our right to collect addi- provided under this Coverage Part may tional premium or to exercise our rights of cancel- apply. lation or nonrenewal in accordance with applica- However, if this policy includes an endorse- ble insurance laws or regulations. ment that provides limited coverage for "bod- Q. REASONABLE FORCE — BODILY INJURY OR ily injury" or "property damage" or pollution PROPERTY DAMAGE costs arising out of a discharge, release or escape of "pollutants" which contains a re- The following replaces Exclusion a., Expected Or quirement that the discharge, release or es- Intended Injury, in Paragraph 2. of SECTION I — cape of "pollutants" must be reported to us COVERAGES — COVERAGE A BODILY IN- within a specific number of days after its JURY AND PROPERTY DAMAGE LIABILITY: abrupt commencement, this Paragraph e. rt does not affect that requirement. a. Expected or Intended Injury or Damage P. UNINTENTIONAL OMISSION "Bodily injury" or"property damage" expected The following is added to Paragraph 6., Repre- or intended from the standpoint of the in- sentations, of SECTION IV — COMMERCIAL sured. This exclusion does not apply to "bod- GENERAL LIABILITY CONDITIONS: ily injury" or "property damage" resulting from The unintentional omission of, or unintentional er- the use of reasonable force to protect any ror in, any information provided by you which we person or property. relied upon in issuing this policy will not prejudice CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 44870645 18-19 GL, Auto, Umb, WC Katherine Dumatol 1 10/12/2018 9:02:41 AM (PDT) I Page 12 of 12 � �j � �'"I WORKERS COMPENSATION 1 AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76( A)— POLICY NUMBER: UBOL941578TIL18 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSRED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) 08/27/2018 Endorsement Effective Policy No. Endorsement No. Insured Premium Backflow Apparatus&Valve Company Insurance Company Travelers Property Casualty Countersigned by Company of America DATE OF ISSUE: - - ST ASSIGN: Page 1 of 1 44876645 1 18-19 GL, Auto, UMb, WC I Katherine DUmatol 1 18/12/2818 9:82:41 AM (PDT) I Page 5 of 12