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PROOF OF INSURANCE (2019 - 2020) CLOSED 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/31/2019 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('$), PRODUCER CONTACT _...._ Woodruff-Sa er&Co. _PHONE ... ... ................................ P'HO'NE FNS& 50 California Street, Floor 12 _W t A t 4, ...... 2141 23 E-MAIL ......................... tA/c.Nnt:415-999-99,a_. San Francisco CA 94111 ADDRESS, _.. _...................................._.I ...................... PN'SURER(Sj AFFORDING$COVERAGE NAIC# INSURER A:Travelers of America 25674 I INSURED COULTEC-01 INSURER B.LIOydS Of OrndNBSU81Iy 0 Of ChargePoint, Inc. ................ 240 E Hacienda Avenue iNWRERC Campbell CA 95008 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1368675382 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 PAID CLAIMS. INSR' ADI"P�tL u�rlJ' ................... .......................w.....P�DLICY EFF POLICY E7CP.......... ......._......._..........._........... LTR TYPE OF INSURANCE INSQ,,,I,yr) POLICY NUMBER /MMIDWYYYYi !MM/DDNYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y 6305144X310 3/29/2018 3/29/2019 EACH OCCURRENCE $1,000,000 �AMAOETO-15 CLAIMS-MADE „X OCCUR PREMISS$Me occurrence! $1,000,000 ............ EXP (Any one p 000 PERSONAL&ADV INJURY $1 0 ..�..�., w 00,000 N%AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JECT (.�� ...._.........._._ X POLICY LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER'. $ A AUTOMOBILE LIABILITY BA6879X698 3/29/2018 3/29/2019 COMBINED SINGLE LIMIT $2,000,000 fE's accidontS ......................................... X ANY AUTO BODILY INJURY(Per person) $ .................. NLY OWNED AUTOSULED BODILY JU RY(Peraccident)I$ AUTOS OR ED TOS ONLYp AUTOS ONLY PROPERTY frEr_AccJINJURY fYAPIAGE AU A X UMBRELLALIAB X CUPOJ88357A 3/29/2018 3/29/2019 1 ,000,000 EXCESS LUUB OCCUR GGR GATE RENCE $$ 0 10 . ..._ CLAIMS-MADE ,000,000 DEQ u X RETENTION$n A WORKERS COMPENSATION UB009J783574 2/1/2019 2/1/2020 X �TATy:[IE J ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRI ETOR/PARTN ER/EXECUTI V E OFFICER/MEMBEREXCLUDED? 0 N/A ,,, SEA 000 (Mandatory in NH) REACH SECIEA EMPLOYEE $1.00DENT 0' If yes,describe under ... .... .................w- ..........000.............. . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Errors&OmissionsICyber W252139180101 11/14/2018 11/14/2019 Per Claim/Aggregate $5,000,000 (Professional Liability) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) RE:Master Services and Subscription Agreement The City of EI Segundo,its officials,and employees are included as additional insureds with respect to General Liability,as per attached.Coverage is primary and non-contributory with respect to General Liability,as per attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of EI Segundo ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo CA 90245 AUTHORIZED'REPRESENTATIVE l %k ©1988-2015 ACO,RD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: 6305144X310 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, OTHER INSURANCE - ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a., Primary (1) The"bodily injury"or"property damage"for which Insurance, of SECTION IV — COMMERCIAL GEN- coverage is sought is caused by an 'occurrence" ERAL LIABILITY CONDITIONS: that takes place;and However, if you specifically agree in a written contract (2) The "personal injury" or "advertising injury" for or agreement that the insurance afforded to an addi- which coverage is sought arises out of an offense tional insured under this Coverage Part must apply on that is committed; a primary basis, or a primary and non-contributory basis,this insurance is primary to other insurance that subsequent to the signing and execution of that con- is available to such additional insured which covers tract or agreement by you. such additional insured as a named insured, and we will not share with that other insurance, provided that: CG D4 25 07 08 0 2008 The Travelers Companies,Inc. Page 1 of 1 6305144X310 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, TECHNOLOGY 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 covoroge broadening ;provisions do not apply to the extent that coverage is excluded or limited by such an endrarstirriOnt. The following i'isting 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- Reasonable Farce Property Damage—Ex- K. Blanket Additional Insured—Persons Or Or- ceplion To Expected Or Intended Injury Ex- ganizations For Your Ongoing Operations As elusion Required By Written Contract Or Agreement B. Non-Owned Watercraft Less Than 75 Feet L. Blanket Additional Insured—Broad Form C. Aircraft Chartered With Pilot Vendors D. Damage To Premises Rented To You M. Who Is An Insured—Unnamed Subsidiaries 15. Increased Supplementary Payments N. Who Is An Insured—Liability For Conduct Of F. Who Is An Insured—Employees And Volun- Unnamed Partnerships Or Joint Ventures teer Workers—First Aid 0. Medical Payments—Increased Limits G. Who Is An Insured—Employees—Supervi- P. Contractual Liability—Railroads sory Positions Q. knowledge And Notice Of Occurrence Or Of- H. Who Is An Insured—Newly Acquired Or fense Formed Organizations R. Unintentional Omission I. Blanket Additional Insured—Owners,Manag- S. Blanket Waiver Of Subrogation ers Or Lessors Of Premises J. Blanket Additional Insured—Lessors Of Leased Equipment PROVISIONS B. NON-OWNED WATERCRAFT LESS THAN 75 A. REASONABLE FORCE PROPERTY DAMAGE— FEET EXCEPTION TO EXPECTED OR INTENDED IN- The following replaces Paragraph(2)of Exclusion JURY EXCLUSION 'g.,Aircraft,Auto Or Watercraft,in Paragraph 2, The following replaces Exclusion a., Expected Or of SECTION I—COVERAGES —COVERAGE A Intended Injury, in Paragraph 2.,of SECTION 1— BODILY INJURY AND PROPERTY DAMAGE COVERAGES — COVERAGE A BODILY IN- LIABILITY,, JURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: a. Expected Or Intended Injury Or Damage (a) Less than 75 feet long; and "Bodily injury" or "proporty damage" expected or (b) Not being used to carry any person or intended from the standpoint of the Insured. This property for a charge. exclusion does not apply to 'bodily injury" pr C, AIRCRAFT CHARTERED WITH PILOT "property damage" resulting from the use of rea- sonable force to protect any person or property. The following is added to Exclusion g., Aircraft, Auto Or Watercraft,in Paragraph 2.of SECTION CG D4 I7 01 12 02012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance 8ervloos office,Inc wlth its permission. COMMERCIAL GENERAL LIABILITY I — COVERAGES — COVERAGE A BODILY IN- 4. the following replaces Paragraph a. of the JURY AND PROPERTY DAMAGE LIABILITY: definition of"insured contract" in the DEFINI- This exclusion does not apply to an aircraft that TIONS Section: is: 2 a. A contract for a lease of promises. How- (a) Chartered with a pilot to any insured; ever, that portion of the contract for a b Not owned b an insured;and lease of premises that indemnifies any ( ) Y Y person or organization for "premises rc) Not being used to carry any person or prop- damage"Is not an"insured contract"; erty for a Charge, 5. The following is added to the DEFINITIONS D. DAMAGE TO PREMISES RENTED TO YOU Section: 1. The first paragraph of the exceptions in Ex- "Premises damage" means "properly dam- cluslon J., Damage To Property, in Para- age"to: graph 2. of SECTION I — COVERAGES — a, Any premises while rented to you or tem- COVERAGE A BODILY INJURY AND poradly occupied by you with permission PROPERTY DAMAGE LIABILITY is deleted. or the owner;or 2. The following replaces the last paragraph of b, The contents of any premises while such Paragraph 2., Exclusions, of SECTION I — premises Is rented to you,if you rent such COVERAGES —COVERAGE A BODILY IN- premises for a period of seven or fewer JURY AND PROPERTY DAMAGE LIABIL- consecutive days. ITY; s. The following replaces Paragraph 4.b,(1)(b) Exclusions c-, g.and h., and Paragraphs (1), of SECTION IV—COMMERCIAL GENERAL (3) and (4) of Exclusion J., do not apply to LIABILITY CONDITIONS: "premises damage". Exclusion 1`.(1)(a) does not apply to "premises damage" caused by (b) That is insurance for"premises damage' fire unless Exclusion f. of Section I — Cover- or age A— Bodily Injury And Property Damage 7. Paragraph 4.b.(1)(c) of SECTION IV — Liability is replaced by another endorsement COMMERCIAL GENERAL LIABILITY CON- to this Coverage Part that has Exclusion -All DITIONS Is deleted. Pollution Injury Or Damagd•or Total Pollution E. INCREASED SUPPLEMENTARY PAYMENTS Exclusion in its title.A separate limit of insur- ance applies to "premises damage" as de- 1. The following replaces Paragraph 1.b, of scribed in Paragraph 6.of Section III—Limits SUPPLEMENTARY PAYMENTS — COVER- Of Insurance. AGES A AND B of SECTION I — COVER- AGES; 3. The following replaces Paragraph 6. of SEC- TION III—LIMITS OF INSURANCE; b. UP 10 $2,500 for cost of bail bonds re- quired because of accidents or traffic law 6. Subject to S. above, the Damage To violations arlsing out of this use of any Premises Rented To You Limit is the vehicle to which the Bodily Injury Liability most we will pay under Coverage A for Coverage applies. We do not have to fur- damages because of"premises damage" nish these bonds. to any one premises, The Damage To Premises Rented To 2. The following replaces Paragraph 1.d. of g SUPPLEMENTARY PAYMENTS — COVER- You Limit will be: AGES A AND B of SECTION I — COVER- a. The amount shown for the Damage AGES: To Premises Rented To You Limit on d. All reasonable expenses incurred by the the Declarations of this Coverage insured at our request to assist us in the Part;or Investigation or defense of the claim or b. $300,000 if no amount is shown for "suit",including actual loss of earnings up the Damage To Premises Rented To to $500 a day because of time off from You Limit on the Declarations of this work, Coverage Part, Page 2 of 6 ®2012 The Travelers Indemnlly Company, All rights reserved. CG 04 17 0112 Includes copyrighted malerlal of Insurance services Office,Inc.wllh its permission, COMMERCIAL GENERAL LIABILITY F. WHO IS AN INSURED — EMPLOYEES AND your "employees" who hold a supervisory posi- VOLUNTEER WORKERS—FIRST AID tion. 1. The following Is added to the definition of"oc- H. WHO IS AN INSURED — NEWLY ACQUIRED currence"in the DEFINITIONS Seotion: OR FORMED ORGANIZATIONS Unless you are In the business or occupation The following replaces Paragraph 4. of SECTION of providing professional health care services, 11 — WHO IS AN INSURED of the Commercial "occurrence" also means an act or omission General Liability Coverage Form, and Paragraph committed by any of your "employees" or 3.of SECTION II—WHO IS AN INSURED of the "volunteer workers", other than an employed Global Companion Commercial General Liability or volunteer doctor, in providing or failing to Coverage Form, to the extent such coverage provide first aid or"Good Samaritan services" forms are part of your policy: to a person. Any organization you newly acquire or form,other 2. The following is added to Paragraph 2.a.(1)of than a partnership or joint venture, of which you SECTION II—WHO IS AN INSURED; are the sole owner or in which you maintain the majority ownership interest, will qualify as a Unless you are in the business or occupation Named Insured if there Is no other insurance of providing professional health care services, which provides similar coverage to that organiza- Paragraphs(1 )(a), (b), (c) and (d)above do tion.However: not apply to "bodily injury" arising out of pro- a. Coverage under this provision is afforded viding or failing to provide first aid or "Good only: Samaritan services" by any of your "employ- ees" or "volunteer workers", other than an (1) Until the rgth day after you acquire or o employed or volunteer doctor. Any of your form the organization or the end of the "employees" or"volunteer workers" providing policy period, whichever is earlier, if you or failing to provide first aid or"Good Samari- do not report such organization in writing tan services" during their work hours for you to us within 180 days after you acquire or farm it; or will be deemed to be acting within the scope of their employment by you or performing du- (2) Until the end of the policy period, when ties related to the conduct of your business, that date is later than 180 days after you 3. The followingis added lq„Para rah 5. of acquire or form such organization, If you 9 P report such organization in writing to us SECTION III—LIMITS OF INSURANCE: within 180 days after you acquire or form For the purposes of determining the applica- it, and we agree in writing that it will con- ble Each Occurrence Limit, all related acts or tinue to be a Named Insured until the end omissions Committed by any of your"employ- of the policy period; ees” or "volunteer workers" in providing or b. Coverage A does not apply to"bodily injury" falling to provide first aid or"Good Samaritan or "property damage" that occurred before services"to any one person will be deemed to you acquired or formed the organization;and be one"occurrence", c. Coverage B does not apply to "personal in- 4. The following Is added to the DEFINITIONS jury" or "advertising injuy" arising out of an Section; offense committed before you acquired or "Good Samaritan services" means any emer- formed the organization. gency medical services for which no compen- 1. BLANKET ADDITIONAL INSURED —OWNERS, sation is demanded or received, MANAGERS OR LESSORS OF PREMISES G. WHO IS AN INSURED — EMPLOYEES — SU- The following Is added to SECTION II—WHO IS PERVISORY POSITIONS AN INSURED: the following is added to Paragraph 2.e.(1) of Any person or organization that is a premises SECTION II—WHO IS AN INSURED: owner, manager or lessor is an insured, but only with respect to liability arising out of the owner- Paragraphs(1)(a), (b)and (c)above do not apply ship,maintenance or use of that part or any prem- to "bodily injury" or "personal injury" to a co- Ises leased to you. "employee" In the course of the co-"employee's" The insurance provided to such premises owner, employment by you arising out of work by any of manager or lessor does not apply to: CG D4 17 01 12 492012 The Travelers Indemnity Company, All rights reserved. Page 3 of 8 Includes copyrighted materlal of Insurance Services Office,Inc,with its permisslon, COMMERCIAL GENERAL LIABILITY a. Any "bodily injury" or "property damage" L. BLANKET ADDITIONAL INSURED — BROAD caused by an "occurrence" that takes place, FORM VENDORS or "personal Injury" or "advertising injury" The following Is added to SECTION II—WHO IS caused by an offense that is committed, after AN INSURED: you cease to be a tenant in that premises;or b, Structural alterations, now construction or Any person or organization lief t a vendor and that you have agreed in a written contract or demolition operations performed by or on be- agreement to Include as an additional insured on half of such premises owner, manager or les- this Coverage Part is an insured,but only with re- sor. spect to liability for "bodily Injury" or "property J. BLANKET ADDITIONAL INSURED—LESSORS damage"that: OF LEASED EQUIPMENT a. is caused by an"occurrence"that takes place The following is added to SECTION fl—WHO IS after you have signed and executed that con- AN INSURED: tract or agreement;and Any person or organization that is an equipment b. Arises out of "your products" which are dis- lessor is an insured, but only with respect to liabil- tribuled or sold in the regular course of such ity for "bodily injury", "property damage", "per- vendor's business, sonal injury" or "advertising injury" caused, In The insurance provided to such vendor is subject whole or In part, by your acts or omissions in the to the following provisions: maintenance, operation or use by you of equip- ment leased to you by such equipment lessor, a. The limits of insurance provided to such ven- The insurance provided to such equipment lessor dor will be the limits which you agreed to pro- vide in the written contract or agreement,or docs not apply to any "bodily injury" or"property the limits shown in the Declarations,which- damage" caused by an "occurrence" that lakes over are less. place, or "personal injury" or "advertising Injury" caused by an offense that is committed, after the b. The insurance provided to such vendor does equipment lease expires, not apply to: K. BLANKET ADDITIONAL INSURED—PERSONS (1) Any express warranty not authorized by OR ORGANIZATIONS FOR YOUR ONGOING you; OPERATIONS AS REQUIRED BY WRITTEN (2) Any change in"your products"made by CONTRACT OR AGREEMENT such vendor; The following is added to SECTION 11 —WHO IS (3) Repackaging,unless unpacked solely for AN INSURED: the purpose of inspection,demonstration. Any person or organisation that is not othery .se tasting,or the substitution of parts under an insured under this Coverage Part and that you instructions from the manufacturer,and have agreed in a written contract or agreement to then repackaged in the original container, include as an additional insured on this Coverage (4) Any failure to make such inspections,ad- Part is an insured,but only with respect to liability for"bodily injury"or"property damage"that: agree o p tests or servicing as vendors a. Is caused b an"occurrence"that takes lace agree to perform ul normally undertake to y P perform in the regular course of business, after you have signed and executed that con- in connection with the distribution or sale tract or agreement;and of"your products"; b. Is caused, in whole or in part, by your acts or (5) Demonstration, Installation,servicing or omissions in the performance of your ongoing repair operations,except such operations operations to which that Contract or agree- performed at such vendor's premises in ment applies or the acts or omissions of any connection with the sale of"your prod- person or organization performing such op- ucts":or erations on your behalf. (8) "Your products"which,after distribution The limits of insurance provided to such insured or sale by you, have been labeled or re- will be the iimits which you agreed to provide In labeled or used as a container,part or in- the written contract or agreement, or the limits gredient of any other thing or substance shown in the Declarations,whichever are less, by or on behalf of such vendor. Page 4 of 6 ®2012 The Travelers Indemnity Company_ All rights reserved. CG D4 17 01 12 Includes copyrighted maiedal of insuranoa servlges Office,Inc,with its permisslon, COMMERCIAL GENERAL LIABILITY Coverage under this provision does not apply fo:• (b) The amount shown on the Declarations of a. Any person or organization from whom you this Coverage Part for Medical Expense have acquired"your products", or any ingre- Limit. client, part or container entering into,accom- P. CONTRACTUAL LIABILITY—RAILROADS panying or containing such products;or 1. The following replaces Paragraph c. of the b. Any vendor for which coverage as an addi- definition of"insured contract" in the DEFINI- tional insured specifically is scheduled by en- TIONS Section: dorsement. c. Any easement or license agreement; M. WHO IS AN INSURED — UNNAMED SUBSIDI- 2. Paragraph f.(1) of the definition of "insured ARIES contract" in the DEFINITIONS Section is de- The following is added to SECTION II—WHO IS leted. AN INSURED: a. KNOWLEDGE AND NOTICE OF OCCUR- Any of your subsidiaries, other than a partnership RENCE OR OFFENSE or joint venture, that is not shown as a Named In- The following is added to Paragraph 2., Duties In sured In the Declarations is a Named Insured if: The Event of Occurrence, Offense, Claim or a. You maintain an ownership interest of more Suit, of SECTION IV — COMMERCIAL GEN- than 50% in such subsidiary on the first day ERAL LIABILITY CONDITIONS: of the policy period;and e. The following provisions apply to Paragraph b. Such subsidiary is not an Insured under simi- a. above, but only for the purposes of the In- lar other insurance. surance provided under this Coverage Part to No such subsidiary is an insured for"bodily injury" you or any insured listed In Paragraph 1.or 2.of Section II—Who Is An Insured: or "property damage" that occurred, or"personal injury" or ""advertising injury" caused by an of- (1) Notice to us of such "occurrence" or of- lense committed: fense must be given as soon as practica- a. Before you maintained an ownership interest ble only after the"occurrence"or offense of more than 50% In such subsidiary;or is known to you(if you are an individual), any of your partners or members who is b. After[lie date, if any,during the pollcy period an Individual (if you are a partnership or that you no longer maintain an ownership in. joint venture), any of your managers who terest of more than 50%in such subsidiary, is an individual(If you are a limited liability N. WHO IS AN INSURED— LIABILITY FOR CON- company), any of your trustees who Is an DUCT OF UNNAMED PARTNERSHIPS OR individual (if you are a trust), any of your JOINT VENTURES "executive officers""or directors(if you are an organization other than a partnershlp, The following replaces the last paragraph of Joint venture, limited liability company or SECTION II—WHO IS AN INSURED trust) or any "employee" authorized by No person or organization is an insured with re- you to give notice of an "occurrence" or spect to the conduct of any current or past part- offense, nership or Joint venture that is not shown as a (2) If you are a partnership,joint venture, lim- Named Insured in the Declarations. This para- graph does not apply to any such partnership or oliability company or trust,and none of joint venture that otherwise qualifies as an in- youu r partners, Joint venture members, es under Section II—Who Is An Insured, managers trustees are Individuals, no- tice to us of such"occurrence"or offense O. MEDICAL PAYMENTS—INCREASED LIMITS must be given as soon as practicable only The following replaces Paragraph T.of SECTION after the"occurrence"or offense Is known III—LIMITS OF INSURANCE: by: 7. Subject to 5. agave, the Medical 'Expense (a) Any Individual who is: Limit is the most eve will pay uncer coverage (i) A partner or member of any part- C for all medical expenses because of bodily nership or joint venture; injurysustained by any one person, and will be the higher of: (ii) A manager of any limited liability (a) $10,000;or company; CO D4 17 01 12 02012 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office,Inc,with its permleslon. COMMERCIAL GENERAL LIABILITY (II1)A trustee of any trust;or abrupt commencement, this Paragraph e. (Iv)An executive officer or director of does not affect that requirement, any other organization; R. UNINTENTIONAL OMISSION that is your partner, joint venture The following is added to Paragraph 6., Repre- member,manager or trustee;or sentations, of SECTION IV — COMMERCIAL (b) Any "empioyee" authorized by such GENERAL LIABILITY CONDITIONS: partnership, joint venture, limited Ii- The unintentional omission of, or unintentional ar- ability company,trust or other organi- ror in, any information provided by you which we zation to give notice of an "occur- relied upon in issuing this policy will not prejudice rence'or offense. your rights under this insiurance. However, this (3) Notice to us of such "occurrence" or of- provision does not affect our right to rolled addi- fense will be deemed to.be given as soon lional premium or to exercise our rights of canrel- as practicable if it is given in good faith as lation or nonrenewal in accordance with applica- soon as practicable to your workers' ble insurance laws or regulatlons. compensation insurer, This applies only if S. BLANKET WAIVER OF SUBROGATION you subsequently give notice to us of the The following is added to Paragraph 8..Transfer "occurrence" or offense as soon as prac- Of Rights Of Recovery Against Others To Us, ticable after any of the persons described of SECTION IV— COMMERCIAL GENERAL LI- In Paragraphs e.(1)or(2)above dlscov- ABILITY CONDITIONS: ers that the 'occurrence" or offense may If the insured has agreed in a contract yr agree. result in sums to which the insurance g g provided under this Coverage Part may ment to waive that Insured's right of recovery apply against any person or organization, we waive our right of recovery against such person or organiza- However, if this policy includes an endorse- tion, but only for payments we make because of: ment that provides limited coverage for"bod- ily Injury" or "property damage" or pollution a. "Bodily injury" or "property damage" caused costs arising out of a discharge, release or by an"occurrence"that takes place;or escape of "pollutants" which contains a re- b. "Personal injury" or "advertising Injury" quirement (hal the discharge, release or es- caused by an offense that is committed; cape of "pollutants" must be reported to us subsequent to the execution of the contract or within a specific number of days after its agreement. Page 8 of 6 m 7.012 The Travolors indemnity Company. All rights reserved. CG 0417 0112 Includes copyrighted material of Insurance Services Office,Inc.with Its permission.