PROOF OF INSURANCE (2019 - 2020) CLOSED RINCCON-01 PRI, "Pt dP CERTIFICATE OF LIABILITY INSURANCE ) DATE, ............................... 12/MM DD14/201.8............. 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.rt IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED p . ... rovisions 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 #OE67768nfer rights to the certificate holder In lieu o such enorsarnant sI License PRODUCER C2Q, c''. Elizabeth Leach Legends Environmental Ins.Services (A/C No.Ext):(949)297-5537 52011 FAx )297-5960 g (A1C,No):(949 Yantis E-MAIL Suite 250 ADf�RFSS:Elizabeth.Leach@ioausa.com Suite Aliso Viejo,CA 92656 INSURERM AFFORDING COVERAGENAIL# INSURER 1Crurr &Forster Specialty Insurance Company 44520 INSURED INPURE,Fs:Trumbull Insurance Comlpany 27120 Rincon Consultants,Inc. INSURERc;StarStone National Insurance C'omp'any 25496 180 N Ashwood Ave INSURER D Ventura,CA 93003 VNSURE'R E INSURER F: COVE.,......... _� ........ . � , . _...._. .... RACES, C.ERTI,MCATE NUMBER: REVI lIO 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 W'TH RESPECT FO WHICH THIS CERTIFICATE MAY BE RSSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THF POLICIES DESCRIBED HEREIN IS SUBJECT TO AI_I_'THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL)CLAIMS ALAR X COMMERCIA NydVD POLICY EFF POLICY'EXP LIMITS TYPE OF INSURANCE POLICY NUMBER tt,jadp �y"YYYI 4Mtu1VDDJY�"�'�'L ..,,., .... 3,000,000 L GENERAL LIABILITY PrrAi F!fNf,:V•,LG��etil:PJC:E51 CLAIMS MADE X OCCUR X X EPK125280 12/17/2018 12/17/2020 DAWAGE TO Plan,ally,l:,�S�;;E',�I r„'�r'.a�'^�racar4 '�, 50,000 ME E;;af”fAr!y onFr 'Vcrscp,j, 14 10,000 Pt'r'R,SC�PV,,L x ADV INJURY w 3,0001,000 GENL AG'~O'REi'.,4 EIJrAf I'API- IFS PFRF "�I»'� r A'aGGRER:;A,"E � 4,00'0,000 POLICY X " " �kCa„ e0 ,000 ( � 07HER Deductible „".".........................� t ,O� AUTOMOBILE ................. .,....,.,.,.,.,.,., w _w............. "' 1,000,....,"M.,.0 .. "' C�ImrT�Ilr�a;P�'S'Ixaa�d..:c.I..Innfl 0000 BILE LIABILITY F l ) X ANY AU r0 X X 72UUNPT4318 12/17/2018 12/17/2019 BCIDlLM INAPRil oPvr OWNED SCHEDULED BODILY AUTOS ONLY AUTOS Pia(pyrcir9eM dl' - E ., .,dIL'M IFJ.1L5'r,W'e'r szu:'C�d�rn°y 5 X Fi!NE,LV X NDNnri 'IED il:��,eJPE. tlDe"tiMSeO,v AI.IxD%ONLY AV.VT � Nl„'W' i A. UMBRELLA LLA......B X _.._.. . .,. .. .. ........ ...... ........_...,.......,.,.,.,.,.,...._.,.,..... EACH: ......°,.,'.,.,.,.,.,.,.,.,.R?Y...r..y':I E._._.........................5,000'00Q X EXCESS LIAB CLAIMS MADE EFX111982 12/17/2018 12/17/2019 ACC,RE.G,,,;'r 5,000„000 DELT X_ RETENTIONS 10,000 a............ .�................ ..........�...............,.... ............... A1�4 dt;ERtIRIE IORIPARI_UDED'� Y-- NIA ..1. ��FR Ca,l Poi D EMPLOYEES'LI RBIIIJER�ExECU FIVE N L STA,71,�rt',Pou.aT rra „ ,1,000,000 ER C w NSATION X ��IN'D )r 'T10180329 02/01/2018 02/01/2019 1 taal:FM'sl': Er�`LMc�LO^�r: s 1,000,000 C aAl ato m NH r• If es,describe under i 1,000,000 OF y�Professional Liab w IEPK125280 � ” ” 12/17/2018! L II:>I l A Professional LiabRArlr�,rf„�""np„ EPK125280 12/17/2018 12/171202®'PggCl9iYm"a��EaLI"�"�Y"!r�I"I"+"m s 3' 000,000 17/2020 IIIA re ate 4,000,000 ................ DESCRIPTION OF OPERATIONS a LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more s'pace is required) 'Professional Liability is written on a Claims Made basis. When required by written contract,the General Liability and Pollution Liability Limits are on a Per Project basis while dedicated;the Professional Liability is on a Per Policy basis.Professional Liability Deductible$50,000 Each Claim. The City of EI Segundo„its officials and employee's are Additional Insureds for General Liability and Auto Liability with respect to work performed for them by the Named Insured as required by written contract,per Blanket Additional Insured endorsement EN0147-1111,EN0320-0211,EN0321-0211&HA99160312. Liability Cover'a'ge is Primary and Non-Contributory as required by written contract,per endorsement EN0147.1111&HA99160312.Blank'e't Waiver of Subrogation applies to General Liability,Auto Liability and Workers Compensation as required by written contract,per Endorsement EN0147-1111, HA99160312&WC000313. Excess pot'icy follows General Liability,Auto Liability and Employers Liability form. CERTIFICATE HOLDER ......................... ... ._. YA....... NLLATION ................. ...---... 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 _� .......................................... —__.. Attn:Eduardo Schonborn AUTHORIZED REPRESENTATIVE Planning&Building Safety Department 350 Main Street �L6-4- 90245 .©1988 2015mACORD CORP.... ACORD 25(2016/03) ORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY#: EPK125280 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ITC L . ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Person(s)or Organization(s): LocaticinAnd- Description Of Completed Operations .............. Where Required by Written Contract. Where Required by Written Contract, Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section Ill — Who Is An Insured within the Common Provisions is amended to include as an 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" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". EN0320-0211 Page 1 of 1 POLICY#EPK125280 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED WITH WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART SCHEDULE .......................................... Name Of Additional Insured Person(s) or Organization(s) .__-- ------- Where Required By Written Contract, A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to liability arising out of "your work" for that person or organization performed by you, or by those acting on your behalf. B. As respects additional insureds as defined above, this insurance also applies to "bodily injury" or "property damage"arising out of your negligence when the following written contract requirements are applicable: 1. Coverage available under this coverage part shall apply as primary insurance. Any other insurance available to these additional insureds shall apply as excess and not contribute as primary to the insurance afforded by this endorsement. 2. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for injury or damage arising out of "your work" performed under a written contract with that person(s) or organization(s). 3. The term "additional insured" is used separately and not collectively, but the inclusion of more than one "additional insured" shall not increase the limits or coverage provided by this insurance. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, EN0147-1111 Page 1 of 1 Policy Number: 72UUNPT4318 COMMERCIAL AUTOMOBILE HA 99 16 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form. the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs, Declarations is amended to include: C. Lessors as Insureds (1) Any legal business entity other than a Paragraph A.1, - WHO IS AN INSURED -of partnership or joint venture, formed as a Section II - Liability Coverage is amended to subsidiary in which you have an add: ownership interest of more than 50% on e. The lessor of a covered "auto"while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an (1) The agreement requires you to "insured" under any other automobile provide direct primary insurance for policy or would be an "insured" under such a policy but for its termination or the lessor and the exhaustion of its Limit of Insurance (2) The"auto"is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership However, "auto"you hire. the Named Insured does not include any D. Additional Insured if Required by Contract newly formed or acquired organization: (1) Paragraph A.1. WHO 15 AN INSURED (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an "insured" under any other f. When you have agreed, in a written policy, contract or written agreement, that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or formation by you, organization is an"insured", but only unless you have given us notice of to the extent such person or the acquisition or formation, organization is liable for "bodily Coverage does not apply to "bodily injury" or"property damage"caused injury" or"property damage" that results by the conduct of an "insured" under from an "accident" that occurred before paragraphs a or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a covered"auto" Paragraph A.1. - WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add: C 2011, The Hartford (Includes copyrighted material Form HA 99 16 0312 of ISO Properties, Inc.,with its permission.) Page 1 of 5 The insurance afforded to any such E. Primary and Non-Contributory if additional insured applies only if the Required by Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional insured in 1 D - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3) Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance is also primary, we will share with all that other If you have agreed in a written contract insurance by the method described in or written agreement that another Other Insurance 5.d. person or organization be added as an additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement; or additional insured's own insurance, this insurance is primary and we will not (b) The Limits of Insurance shown in seek contribution from that other the Declarations. insurance. Such amount shall be a part of and not Paragraphs(3) and (4) do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this has been added as an additional insured. Section. When this insurance is excess, we will have no (3) Additional Insureds Other Insurance duty to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit" If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insured's rights against all insured must submit such claim or"suit" those other insurers to the other insurer for defense and When this insurance is excess over other indemnity insurance, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed in a of: written contract or written agreement (1) The total amount that all such other that this insurance is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance; and own insurance_ (2) The total of all deductible and self-insured (4) Duties in The Event Of Accident, Claim, amounts under all that other insurance Suit or Loss We will share the remaining loss, if any, by the If you have agreed in a written contract method described in Other Insurance 5 d or written agreement that another person or organization be added as an 2• AUTOS RENTED BY EMPLOYEES additional insured on your policy, the Any "auto" hired or rented by your "employee" additional insured shall be required to on your behalf and at your direction will be comply with the provisions in LOSS considered an"auto"you hire. CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended EVENT OF ACCIDENT, CLAIM , SUIT by adding the following: OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission ) Page 2 of 5 If an "employee's" personal insurance also 5 PHYSICAL DAMAGE ADDITIONAL applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE hired or rented by your "employee" on your COVERAGE behalf and at your direction, this insurance will Paragraph A 4 a of SECTION III - PHYSICAL be primary to the "employee's" personal DAMAGE COVERAGE is amended to provide a insurance, limit of $50 per day and a maximum limit of 3. AMENDED FELLOW EMPLOYEE EXCLUSION $1,000 EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE SECTION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE apply if you have workers' compensation COVERAGE, in the event of a total "loss" to a insurance in-force covering all of your covered "auto", we will pay your additional legal "employees". obligation for any difference between the actual Coverage is excess over any other collectible cash value of the "auto" at the time of the "loss" insurance and the"outstanding balance"of the loan/lease 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Outstanding balance" means the amount you If hired "autos" are covered "autos" for Liability owe on the loan/lease at the time of "loss" less Coverage and if Comprehensive, Specified any amounts representing taxes; overdue Causes of Loss, or Collision coverages are payments; penalties, interest or charges provided under this Coverage Form for any resulting from overdue payments; additional "auto" you ownthen the Physical Damage mileage charges; excess wear and tear charges; Coverages provided are extended to "autos"you lease termination fees; security deposits not hire or borrow, subject to the following limit returned by the lessor; costs for extended warranties, credit life Insurance, health, accident The most we will pay for "loss" to any hired or disability insurance purchased with the loan or "auto" is: lease; and carry-over balances from previous (1) $100,000; loans or leases. (2) The actual cash value of the damaged or 7. AIRBAG COVERAGE stolen property at the time of the"loss"; or Under Paragraph B. EXCLUSIONS - of (3) The cost of repairing or replacing the SECTION III - PHYSICAL DAMAGE damaged or stolen property, COVERAGE, the following is added: whichever is smallest, minus a deductible. The The exclusion relating to mechanical breakdown deductible will be equal to the largest deductible does not apply to the accidental discharge of an applicable to any owned "auto" for that airbag. coverage. No deductible applies to"loss"caused 8. ELECTRONIC EQUIPMENT - BROADENED by fire or lightning. Hired Auto Physical Damage COVERAGE coverage is excess over any other collectible insurance. Subject to the above limit, deductible a. The exceptions to Paragraphs B.4 - and excess provisions, we will provide coverage EXCLUSIONS - of SECTION III - PHYSICAL equal to the broadest coverage applicable to any DAMAGE COVERAGE are replaced by the covered "auto"you own. following: We will also cover loss of use of the hired "auto" Exclusions 4.c. and 4.d, do not apply to if it results from an "accident", you are legally equipment designed to be operated solely liable and the lessor incurs an actual financial by use of the power from the "auto's" loss, subject to a maximum of $1000 per electrical system that, at the time of"loss", "accident". is: This extension of coverage does not apply to (1) Permanently installed in or upon any "auto" you hire or borrow from any of your the covered "auto"; "employees", partners (if you are a partnership), (2) Removable from a housing unit members (if you are a limited liability company), which is permanently installed in or members of their households. or upon the covered "auto"; (3) An integral part of the same unit housing any electronic equipment described in Paragraphs (1)and (2)above; or ©2011, The Hartford (Includes copyrighted material Form HA 99 16 0312 of ISO Properties, Inc., with its permission.) Page 3 of 5 (4) Necessary for the normal If another Hartford Financial Services Group, operation of the covered"auto"or Inc. company policy or coverage form that is not the monitoring of the covered an automobile policy or coverage form applies to "auto's"operating system the same"accident", the following applies: b.Section III — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest) Damage Coverage, Limit of Insurance, deductible, it will be waived,- Paragraph aived:Paragraph C 2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto the Business Auto Coverage Form, Physical Coverage Form is not the smaller (or Damage Coverage, Limit of Insurance, smallest) deductible. it will be reduced by Paragraph C are each amended to add the the amount of the smaller (or smallest) following: deductible. $1,500 is the most we will pay for"loss" in 12. AMENDED DUTIES IN THE EVENT OF any one "accident" to all electronic ACCIDENT, CLAIM,SUIT OR LOSS equipment(other than equipment designed The requirement in LOSS CONDITIONS 2 a. - solely for the reproduction of sound, and DUTIES IN THE EVENT OF ACCIDENT,CLAIM, accessories used with such equipment) that reproduces, receives or transmits SUIT OR LOSS - of SECTION IV - BUSINESS audio, visual a data signals which, s the AUTO CONDITIONS that you must notify us of tune of"loss", is: an "accident" applies only when the "accident" is known to: (1) Permanently installed in or upon the covered "auto" in a housing, (1) You, if you are an individual; opening or other location that is not (2) A partner, if you are a partnership, normally used by the "auto" (3) A member, if you are a limited liability manufacturer for the installation of company;or such equipment; (4) An executive officer or insurance manager, if (2) Removable from a permanently you are a corporation installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE in Paragraph 2 a. above or is an HAZARDS integral part of that equipment; or (3)An integral part of such equipment. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we c.For each covered "auto", should loss be limited will not deny coverage under this Coverage to electronic equipment only, our obligation to Form because of such failure. pay for, repair, return or replace damaged or 14. HIRED AUTO-COVERAGE TERRITORY stolen electronic equipment will be reduced by the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. Declarations, or $250, whichever deductible is POLICY PERIOD, COVERAGE TERRITORY less. of SECTION IV - BUSINESS AUTO 9, EXTRA EXPENSE - BROADENED CONDITIONS is replaced by the following. COVERAGE a For short-term hired "autos", the coverage Under Paragraph A. -COVERAGE -of SECTION territory with respect to Liability Coverage is III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the pay for the expense of returning a stolen covered "insured's" responsibility to pay damages for "bodily injury' or "property damage" is "auto"to you. determined in a "suit,"the"suit" is brought in 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories Under Paragraph D -DEDUCTIBLE-of SECTION and possessions of the United States of III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a following is added: settlement we agree to No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by III - PHYSICAL DAMAGE COVERAGE, the adding the following.- following ollowing:following is added: ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc,with its permission.) Page 4 of 5 We waive any right of recovery we may have c Regardless of the number of autos deemed a against any person or organization with whom total loss, the most we will pay under this you have a written contract that requires such Hybrid, Electric. or Natural Gas Vehicle waiver because of payments we make for Payment Coverage provision for any one damages under this Coverage Form "loss" is $10,000 16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision, The definition of "bodily injury" in SECTION V- a A "non-hybrid" auto is defined as an auto that DEFINITIONS is replaced by the following: uses only an internal combustion engine to "Bodily injury" means bodily injury, sickness or move the auto but does not include autos disease sustained by any person, including powered solely by electricity or natural gas mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an these. internal combustion engine and one or more 17. EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal Paragraph 2. of the COMMON POLICY combustion engine and one or more electric CONDITIONS - CANCELLATION - applies motors to move the auto, or the internal except as follows: combustion engine to charge one or more electric motors, which move the auto. If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE nonpayment of premium, we will mail or deliver to the first Named Insured written notice of In the event of a total loss to an "auto" for which cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or date of cancellation. Collision coverages are provided under this 18. HYBRID, ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage VEHICLE PAYMENT COVERAGE Coverages are amended to add the following: In the event of a total loss to a "non-hybrid" auto In addition to the actual cash value of the "auto", we will pay up to $1,000 for vinyl vehicle wraps for which Comprehensive, Specified Causes of which are displayed on the covered "auto" at the Loss, or Collision coverages are provided under time of total loss. Regardless of the number of this Coverage Form, then such Physical autos deemed a total loss, the most we will pay Damage Coverages are amended as follows: under this Vehicle Wrap Coverage provision for a.If the auto is replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this an auto powered solely by electricity or natural coverage provision, signs or other graphics gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are maximum of$2,500, of the "non-hybrid" auto's not considered vehicle wraps. actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of"loss," ©2011,The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 5 of 5 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule WHERE REQUIRED BY WRITTEN CONTRACT, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. Pe" Pcokv Minto^a°aum VV'aive; P="reiavon I)v State $500: AI...,AFS,CA,CO,C'F' DC,ID,li.,,PN,BA,PCS,ME,MD,M0,MS,M"I" NV, NM,OH,CK,OR,PA, R1,SD, UT,VT,VA.WA,WV $260: AK, DE, I...A,NM $'100: NC $50: VVI N/A: AZ, Fl..,GA,H1, MA,MN, MU NF..,SC,TN, TA This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective 02/01/18 Policy No. T10180329 Endorsement No. 5 Insured Rincon Consultants, Inc Policy Effective Date 02/01/18 Insurance Company StarStone National Insurance Company Countersigned By WC 00 03 13 (Ed.4-84) Copyright 1983 Natlonal Council on Compensation Insurance.