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PROOF OF INSURANCE (2019 - 2019) CLOSED0I DATE(M MIDD/YYYY) CC)R' "" CERTIFICATE OF LIABILITY INSURANCE III 1110 1 4/30/2019 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sha'by Anajad Wood Gutmann & 5901 Red Hill Ave., Suite 100 :e v ... HONE 714-505-7000 ...............�.. ��?rX, Lic #0679263 AODRF() Bogart L' :Sr, 5arn�ad (VWtltY.�COri7 ... Tustin CA 92780 Imm NSU # RER(Sl AFFORDING COVERAGE ..., NAIC ...... . m„ INSURER A: UNITED SPECIALTY. .......... (nsurance Co. 16535 Hardy & Harper Inc NSURED HARDv-i IS NURER URER c . AGCS Marine InZurich Americansurance ance Compan 22837 Maas Equipment, LLC INSURER D : Evanston I p y 1312 E. Warner Ave. Insurance Company35378 Santa Ana CA 92705 INSURE........... .....................RE: ALLIED WORLD NATL ASSUR CO..., ' ................ 10690............. INSURER F: COVERAGES CERTIFICATE NUMBER: 1000834640 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. (LTR ....,.. ........, .IAD-aC n�-- -- ..NUMB POLICYEFP P.,,LICY EXP ...., .... ............... OO TYPE OF INSURANCE POLICY ER LIMITS IMMIDDlYYWI fMMIDD/YYYYI „ A X COMMERCIAL GENERAL LIABILITY ATNSF1813471 12/31/2018 12/31/2019_ EACH OCCURRENCE $1.000000 .t��;MrOL t`(9IvLNTEfJ--- CLAIMS -MADE �I OCCUR P_R'Fl4rGk�!K';4cr,^uiytrnc,j $50,,000 MED EXP (Any one Person) $ 5.000 PERSONAL 8 ADV INJURY $ 1,000,000 "L. aGGRE�.G_AT.E LIMIT APPLIES PER: GENERAL AGGREGATE _ POLICY IPRO- LOC ..............................„$,"2000 .000 PRODUCTS -COP/OAGG $ 200,000 ,q,...E..,,.N. OTHER _ B AUTOMOBILE LIABILITY BAP373645414 10/12018 10112019 SINICLL LIMIT CO'O$ BINED X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED ISCHEDULED BODILY INJURY (Per accident) $ .. AUTOS X Aurro'— NON -OWNED K'FI4DPER'Td DAMAC,E ......,„ ...X HIRED AUTOS AUTOS Aper.0!"'A4!'M1t1..................................m.......... $ REL CUR 03116679 . 12/31/2018 12/312019 OCCURRENCE $ 10.000 000 EACHOCCU X EXCESS LIAB ^� CLAIMS -MADE E $ 10,000 000 AGGREGATE .... ...... DED I RETENTION$ B WORKERS COMPENSATION WC373645314 10/12018 10/12019 ” " I PER E9 AND EMPLOYERS' LIABILITY YIN . ANY PROPRIETOR/PARTNER/EXECUTIVE DENT $1,000.000 _ EXCLUDED N I A OMandat /M LJ CIEA i NH) ( rY ) E L DISEASE EMPLOYEE $ 1,01,010,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1.000,000 D Po llulion/Professional Liability MKLVSENV100621 12/31/2017 12/31/2019 $2,000,000 agg, $1,000,000 occ C Renled/Leased Equip SML93020423 12/31/2018 12/312019 $300,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ENDORSEMENTS ATTACHED ONLY APPLY AS REQUIRED BY WRITTEN CONTRACT SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. GENERAL LIABILITY: Add'itionat 'insured applles per attached endorsement's CG 20 10 04 13 and CG 20 37 04 13 Primary and Non Contributory Wording a,ppties per attached endorsement VEN 051 00 (01/15) V+/'atver of Subrogation a'ppl'ies per attached enrlorsenient CG 24 04 10 93' /91/ Per Project Aggregate applies per attached endorsement VEN 079 01 (03/18) See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of EI Segundo 350 Main Street AUTHORIZED REPRESENTATIVE EI Segundo CA 90245 w ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HARDY -1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE, LIABILITY., Additional Insured applies per attached endorsement U-CA-424-FCW (04-14). Primary worming applies per the atlached U-CA424-FCW (04-14). Waiver of Subrogation applies pet atlached endorsement U-CA•424-FCW (04 -14) - WORKERS COMPENSATION: Waiver of Subrogation applies per attached endorsement WC 04 03 06 04-84. RE.: Job Name: FY 18/19 Pavement Rehabilitation Additional Insured; City of EI Segundo Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LOC #: A4CR" 1,.�' ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Wood Gutmann & Bogart Hardy & Harper Inc Maas Equipment, LLC POLICY NUMBER 1312 E. Warner Ave. Santa Ana CA 92705 ..............— CARRIER ... ... a NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE AUTOMOBILE, LIABILITY., Additional Insured applies per attached endorsement U-CA-424-FCW (04-14). Primary worming applies per the atlached U-CA424-FCW (04-14). Waiver of Subrogation applies pet atlached endorsement U-CA•424-FCW (04 -14) - WORKERS COMPENSATION: Waiver of Subrogation applies per attached endorsement WC 04 03 06 04-84. RE.: Job Name: FY 18/19 Pavement Rehabilitation Additional Insured; City of EI Segundo Page 1 of 1 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: ATN-SF1813471 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Location(s) Of Covered Operations As Required By Written Contract, Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other 1. The insurance afforded to such additional insured only than another contractor or subcontractor engaged applies to the extent permitted by law; and in performing operations for a principal as a part of 2. If coverage provided to the additional insured is the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number: ATN-SF1813471 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY VEN 079 01 (03118) POLICY LIMITATION - TOTAL AGGREGATE LIMIT FOR ALL CONSTRUCTION PROJECTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE SECTION III - LIMITS OF INSURANCE - 2, is amended by the addition of the following. d_ The General Aggregate Limit, shown in the Policy Declarations, a ppliesseparatelyto each "construction project". e. Notwithstanding the application of the General Aggregate Limit to each "Project" of the Named Insured, under no circumstances shall we pay more than1D000,00 for all claims under this policy that are subject to the General Aggregate Limit. The following are added to the DEFINITIONS section of this policy: "Construction project" means any construction project, development, property, or group of properties, including all premises, phases, lots, and areas of such project, development, or property, and any building or group of buildings or other structures contained in any business or housing project, development, subdivision, or business park. If a construction project, or construction activity related thereto, has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same location or construction project under this endorsement Mutiple jobs, work orders, purchase orders, change orders or work done at multiple locations under one contract or master contract are not considered separate "construction projects" within the meaning of this policy ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED VEN 079 01 (03118) Page iof 1 POLICY NUMBER: ATN-sF1813471 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES O CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART U "' PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations As Required By Written Contract, Fully Executed Prior As Required By Written Contract, Fully Executed Prior To The Named Insured's Work To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 COWIA. k- - ,V , Extelosion Eladorsieftiefit I 0 -"ff [)Are or pirkce I rx,!, DaW of n� rEncf p1mduc, C� _­ ­­_ "- ]'­­ .............. BAP373645414 ' 10-1-20 18 10-1-2019 THIS ENDORSEMENTCHANGES THE POLICY. PLEASE READ ITCAREFULLY, his enclorserl-P'nt modifiw,,, insurh.r.L-e pra'Vided un(kr thf Business Auto Coverage rann Motor Carrier CoVerage'Fortn A. Amended Who Is An lnsured (fo,Z. ZURICH i. Thefollovellig isklddn'd tothe-Whohi Ati l?'NureJ Pl(WiMuh ill Sectiott If -Covered Autos Liability Cciverage: T'he followiog Rre*al$a Insureds': Any "MrI, 11 of V jS � -1 �1 pltlyf�,j_, -t yIotl dan't ovin, fill-+- or bartow for i3cts ush 11 q rill "it W110a perforrred Wilhin the scope Of e'PDl0Vfrert k)y Y'11.1. Afly of pi.w'is also arl "insu�ecl` Mfhilo up'eratirig 'ar" hired or re'Ned Under a cixitract or agreerT*nt in 411 `wr'lployee's` name: with }'wr pern1lSf4ion'v;hlIe perfarming duties !efis;.ted tri lk%c toriduct (-,f your busin.-A, b, Anyone volunteerin, � se -. rvice.s to you is an 1titured" while LJSI)l� 8 GOVer-ed "aUkt" YOU dOrl"I Own hire or borrow to transport your client;, or oiliew pe.rpryn,- in q;lfivitieine.Qassary to your business. c.. Anyoric, else w1ho tiumisf-ip-5 an 'Duln" referenced. in Paraqw-aph-:5 A.I.a. and Al.b. in Ns Ondorserric"it, d, Wlrrs and to the extezil i p:urnitted by law, any psison(j) �)f whfa'p. required by writterf (*ntract or wdilen agreerrietit �,vdh you executed prior to arty "accidelit", tncjudmg those pownts) of organizattor1j") directing your work purstiant t,,) such 'Al'itteri C*ntra�"t or \-'vriften aln,,ennoIt ib,,itIj yogi. prj)vijj(-j 11 - ­- ;dd, e, I if- 11( nf " saris out of operations goerredby such contract or z4greorrient and only up to the 41*1"� required in the writte-n contract ot-writion agnecment, or the Linlits of Insuran-cc, sbmwi irl the Whir-hevoris tress. 2. The following is added to tire, Other fri-surosice Guridjtjotl ill tile, Btjt*iiss AuD CdVilrage: Foirn Rild the Other Insurance - Primary and Excess Insurance Provisions Conditlon ill The Maim Carrier Coverage Forin: Crivt?r?40&' for sang I oorgalflyation(s)! when= required by wril-en t,,,antl'act or with you executed prior to any "accl8ent.. kr6if apply On a prilTf@ry and non-rantributory biasil, and arly 411,:jUl'aTIFf, 111ainta jtJP, by the addffionat "insured' will apply or., an excess basis. Hci�?%lcver, jr, tic, i_-varLf jhj:�, r,,OV,_trjp exterid lx!yorld thp, temii�. nrid onriditimis of Fami, 8. Amendment - Supplementary N4ymellfs Paragraphs a.(2) end a,(4) I the CGveerage Extensions Provisio�j in �jprtjarl tj - covered, Autop. Liability Coverage are repNi;fid by 11,18 g: (2) Up to $5.000 for the cost of ba!! borids, (including borift for related traffic [aoj vjc-lationsl required because ofarl "a�:cidcnW,4'e covar, VVe do not have to fUmi,-sh these bonds, (4) All reasonable. oypensa; incurred by the "insured" at our request.. includiinq actual loss of earnings up. to $,Isoo a jay be.,r;au��,e-of time rift fioll, z: -CA -424-F <VV r04-14) pa-, t� , h-Audns, t:opliiqh1c3 C. Fellow Empi9yop Covenelige The Fellow Employee ExclusluP cL)titaifled I'll suction 11 -- Covered Autos Liablifty Coverage does jitst.3pp,y D. Driver SRfet'YPTdgfam Liability and Physical D;jqlage C0v#r;4q0 I. T fie following is I-Idded to the Radn g Extl lisiof i in Section It -Covered Autos Liability Coverage, This; exdu:,ion does riot apply to covered *autos' parti6pating in a d6ver safety progrgin ave!jj, suc.,11 j�,_ I)tll t1c)l 11"litud to, auto or Irurk rodemc and other` au -n or- truck agility dsmonstratkms,. 2. The follawifig Is added to Paragraph 2. In the Exclusions of Section M - Physical Damage Coverage of .tile BLjs1nr­_;;§ Auto Coveracle Form and ?,oaqraph 2.b. In the Exclusions (if saction IV - p ysic Ia.., D ri a ge Coverage of the NlDtoi, Carrier Coverage Form:' This exclusion dues not apply tr-t vorvered 'auto!-," par6cipating in t drivt�r safety program event, such as, LZut not limilted to, auto or ti ck rodeos -_Mnd o11W emfo of tnick agility denlionstratior-is. E. Lease or Loain'Gap Coverage Tile roffowing is added to thiz, Coverage Pro,&ion of the Physical Damage Covarage Secliom Lai Or Loarl Gap CovLaraga In the e -Vent of q ictal 16n:F", to a covered "auto", w6 voill pay arY Umlid -mmouol diie oil the lease or' loan for a (;Qvered. -(,auto", less: b. Any. OVI-r- � dim IeAse or loan payrnenm,at the 6me of the loss`,: (2) Fimancinl penallies imps ,,,ed under a lei,- e for excessive use. abnormiai weal and t( -,;;,r o; hic ,ih milea9p; (3) Secority not relumez(l by the jc-,%5oj,; (4) Cost -s for extended warrmities, rTedit life insuram;e. health, Amident or disa-Wity insun-ace purchmer,' vvitll Ilhe toan or lease,, and (5) Carry-over balanrii,­a �rrjrn previow- 1-,o5eF or loan�3 F. Towing and Labor Paragraph A.2, of the Pliysicai Darnage Coverage se -Wore is replarwed by trig follokvmg: W;� will prey lip to $75 for ' towiiV asid 1,)bc)r c-0sts innuiTcd faulttinie a covered ';:tjlo" of the privat(.,, p�jfstlrj,:�er typt; j�, disabled. However, the latioY miust be parform-ed a,, the piece of 'G. Extended Glass Coverage The following is added to Paragraph A,3,a, of the, Pfiysk.al Oamage Cciveraga Ser tial): If glass must br," rejilactrd, than dedudible rhown in the Declamtko)�,,vijp z�tpply, Ho%'evea',- ran be rcpajla�d and is 8( 'Wally lep?i(ifetj riatiic.a than Vie deduclibte wA he wairqed. YOU t)8V(- 01P, ()fjiiT.1r ofhavillrg lhn, repaired rattler thall, F-eplaced. H, Fired Aoto PhY61fr-'Al 03M39 -e - Increased Loss of U -.se Expenses The Coverage Extension for Loss Of Use Expenses in (lip, PhyMeal D;imagQ Coyorage SeL:zjon 11S rcplaoh(j Jjy(jje folia,ving, Loss Of Use Expenses For 11-Ilmd Auto Ph).Sicaf Damage, 11fiewill Pay -expenses for which al b�omes legally responsitilt- to pay for ftnqR of lisp of a v0*1z" taOted of'llimd lvvithaul A d1rivPr under & wriften rprital mnntraft ;)T writtes") foqml agfeemns% We tMll pay for lc is of unts e.YpPFiqF,-.L, if caused by: CIN 04-14) fric-ludz'n P r (1) furor than cullieiarr only it the DeLcL-iralliuns indir:rats? that Comprahem>iva Cum*,ge, ig provided fnr any covgl-ed `auto": (r) SI:,r;i.11lud Causes, Of Lcla§ only if til -9 dr Vlore["torts indr,,;ata 111at Specified t':suse:, Of Lu&sB Gmiernga is NFO)vided for any Coverall "alAto or (3) Col isirrr'e only if J)e D4edarolic€ns Indioatc th-M CO€Ii�Iir=ar CoVO."Age is Provided for any cov;red %[Lito". Howre 4��r, the [jibs, we ,ill pay for any expense-, ror• loss c,i use is,$100 per day: to a maximum -of $3000, Personal Efferts Coverage The fallowing is ;;added tsr 0* Coverage F'rovizion of the Physiml i'aI114:ge C£yverage 8eCtiOn; persojml Effecto Coverage a, Wi: %01 lzay up -to :W% for lm'ss" to pt samil erffc rte t.ttrich arc;: (1) Personal grope€-ty,6me€€ by an `insured"; and (2) In or -ors a f.Qveered "autn". b. Suli r --c; to Paragraph a.. akimie, the armuret :o be paid for -"loss" to personal effcc s -Mill be based on the lesser af. (1) T}ie re-asnrlable rw.,�t to 1'li€cat:f ; or (z) T1je actual r ash VaIIJe, c, the ir>werage prnvided in Par:agf'a hs a, arsd b, above, tinily apfrlies in the everd of a total `INI ; "If 1 c;OV".CF(I "Auto". No deduQtiW, applies, to this uove.ragt_I kcv�e�,r�r ,��b vJlll cert[ pay for "loss" .a personal effoots of any of the following: (1) 1:cxjunt% bills, currency, deeds. evidence of cleft, rnoiney, notes, securities, or commercial paper sir other domilmarrls of ;;talc_€-_. (2) Bullion, gold, silver, €;lr-rlinuill, or othf'r prfrioLl5 aalloyS or r( elals; fur±; or IV(. -9arr emits; ewl-lry, NgatGh-5; pFF4t.3 pl;; Or ,sc ctrl-prat:€ctr r Str�rss�. (3) Paintings, statuary and other [marker, of art. (4) Cowratrand or property in the £;ours of illegal .ransportataara or trade - (5) Tapes., records, discs or other i*nilar devives used vAth audio, meual or data elactrt-nil; equipment. Any cuverage provtded by this PTOVisiorl is t xX -:a&s ovtir any CM)er insurance CS£rverage avolhable for 1i{a 53me_ "Ims". J. Topcoat Rr�cs�r'ds �trld t3ibc;;:. Cc�veregcl 1. Tile in € aragrraph B.4.a. of Sect!Vi III — Physical DaInage Coverage in the Ru.,_-.iness Auto i✓r•Jverage Form and IN E;cc;lusinn in Parnrrrafh B -2-c. c,f Secticln Ili — Physical Damaye Coverage in the Motor Carrier C-wefage f°brm d065 Alai Apply 2. The following is added to P araq%yeah Ira, Compreshensive CoveraSr_- cinder the Coverage Provision of t€ e Physical aamage Coverage Section: Vd will pay far "Inas' €:; [-rhes, rerxrds, rimcs or other wirlil€ar udevires used -vwiiy audio: visual or data electramc equipmehl. Wu Will 11,@Y ur.ly if the iapes, recard s, discs oc oti-ter similar audio, visual ot-,data elLctlnhir_.- d6Vi1Ws: (a) Are the props tly "irisureW: and (l:) Are in a covered "a€iio" at the lime of The most We will 1_ -lay fol- se.€LI-1 "loss" w tal.es,'records, Oiscs er other Slay€lar devices is $500. The Phys€"I Damage Coverage Deductible Pro*ion r !)m not apply to st.:rl.l "€ass k-rrk•I;:'4-F CVV c04-14) F°-,.xIeyaa Irrd;jd„s-_-Qpjiighted relsklojal c,° r•dlicz, III-_ •Hill! ;lts K. Airbag CoveragE- Tho Exclush79i ill f ai-agl- Pl? 8.3.a. Of Sectl!Wl Ill - PlIPJ- r -a1 banlage CcIverage in Autt: Coverage rorm i5:i0 ffie EydI<laion in Paragt raph B.4.a. of Sectioil IV - pliysicsal Datha5e Coveimge in thea Motor Carrier (;Overage I ;arm sli eN—, 001 c4r3fily Io Illi: ccc;icianta: discharge of an airbag, L Trva or More Dodtrotitlles The fallowing is added fo the Deductible iof one Physical C°ci: mge Coverage Secti=on: if @n accident is coveieri hclh by lhi:; pocky or Coverage Form and by atmb-ter Policy or Covemge,, P01 -I'll is9UP-d 10 YQU b,r us, the foll1cstirintl ;ippliFs for e:ac h rover :d 'auto" on a );Pr vehiclebasis; i. If the dfs,iucliEole vel this tTLII$:y or {;f3verayfs Farr e is ffif. s:ir illor (rT;;mai+€ nt) der'uc:}tool✓• is L iII br; :vaiu_d 2. If :he deductilale on this poil,�j; or Goverage Form is not the-rrfaller (or svizille st) deduc-f€ble, it will he reduced by t115 amount of the smaller deductible, M, P ;ysical D anlage - Comprehensive Cover -age ,,, Qeduc ibl>� The fallf)wi;)g is a, Ci'd (0 tht, Deductible Pr u islslrl Ota t:le PI1�1.5ieal DBYT!4ge Coverage Seakion: Re�atdfev, of the 111J1"fll3f, ref covat'ed "owtosi° alr]MV,)'ed or stole n, ti'tle ii'Gla:?'li'r um >dePs't3C ifbl�' int- will be. 81Y1" firfl ts; <;alilllll'i l'fr rls3"rPk i.>f1v#:s "ge for all la3W' fmal iiny C)ref'd;ai>"se jti $7,000 or ;the iit;{fwn in Ilii' vlitc:haver is greater. N. Temporary Substitute Autos - Physfcal Darllage 'i. Th. folk,;,,inr is added to SeiAlan I - Covered Avtos' Temporary Substitute Autos - Physiri l Onnia.cge Y{ry 1 if Physical EJafl agc C iUVer,:3ege is �lrwilde.d try this Coverage Form on your owrind (x vC?red "aulus", the U101IM05 t -)1€:1e8 of vahi6fafi sre :alSrf co*vared "aijtos" for Physical Darnsgf, CoVer ge: Arty "ai,kA` you do not UMI When us.A With the 17ar mission of its 0111 ner aps a te-Impal-ory siilost=dote for 2 c.-wi'ved °"jiii:to" °t )u do own bw Is otic of service: bpVc-ILJ:�.C.i of its; C Breakdown, 2. Rep;.4ir; 3. ser'vic;ing; "Lo"r's",or �. f.�+:SlYlis:tif;tl. 2. The is tided to the Pa magrapli A. Coverage Provision of the Physical Damage Coverage Section: Tenipdra)y Si6stiLcate Autos - Physica€ Damage We btiill pay the oviner for ;Taos, to :l"1-- tmnpnra- sul3stltuin `auta` C nk7ss the 1oss" rr:`'-ults from fi udulont acts or (xrlli:ilpSlS nn your rOr!- II' Vve. i7'7?iCe ar,y pF'.ymit;nt iC the o',mer, we Mill obtain the. owner's dght5 against any other Party, The doduoUbir, for the., ternpc+l•ary substitute "autcl, vil€ be the sn1'm as the, dedt;bliblfa fbr oho coverer; "auto" it replaces. D, Amended Deai;ias In The Event Of Accident, Chain, Stilt Or Lass Paraoraph a. -of the butles lig Tile Event Of A,<r.ddeut, Claim, Suit Or Lass Qondit}can is replared by ifs follov villg: a. In the event or "a-cidenl" GI?rirrl, "�5u,;V or "loss", you anus; give tis or Pur atithaifzwJ rG pret:qrit tit=e prfJlript notice of tole: "eccident". clairil, "Nle►t" or ' lrTss". I -It w,,,;,er, these dudes only appiy tvil-an the "nocit ent", Clam), "S'dit" or ""I S's" is lcilfwwn to yotj (if You c(tfa an lrlcli'vlcllial), a J),ar nne (if you are ti a inlcwrrhber (if Soo ;are a limited liability a:*IT;P"fI ly) or an exeCutive officer or insurance manager (if you we a .;Dt-poralion). 1 h{1 f?t.lure of any i?-r�A ii i F CAl .04_14) P:y v. k c� n 1rv,1ud:;s t*pyriWitcd rnattelial of it+, re eicc r>'I:L. Qr`ice, If='. wj-,,If :ls psflm <;i;,a. ager;, si3mant or ernployee, of the ",nssored" to notify us of any 10mydenQ jakn. %R" y "los ' Shall nca inv; liideite the insurance afforded L;f this Polk;f. Include, as oon as ora€ bt ;able: (1) How, where and 1whem Me: " aNdent" or "loss' occurred and it a ciairn is made ar "sail" is Brought, WMtei) twk:; of Me claim or"st.rit" inrlt,Jinti, bbl not timhed tip. 'Me daft and details Far sua riaim or -%uir; (2) The "rns+_Ire V' riarne acid address, and P) Q Me ua✓€ms pDSSi le, the names and addresses of any injured persons and ;' lnass",8- If You re:'por'i, all "Qr "1«^ss" to analsier Kosherm w1'twi you shouid l"ld'we r'E*0,,"tte(1 to ',M yrAur failure to, rapo,-1 to us wail: nal he s n as e vicalatbn of these :+no"ded dlrt ,,ys pruv� je.d yoo give us n ati,-s as soon as pract!cabte after the fact at thr? d --!ay becorrl es known LO You. P. Waiver ref Tratisfer Of Rigia'ts bf R�-,coveryr Agrti.r,st Cutters To l.ls The Tollowing i5 added to the Transfar Cif Rights Of Recovery Again6t Others 7o Ur. C'r:sdition: •f"tais C.widitii n doe", ool apt ly w tJii; a,yla rt required of you by a KRan conhad, eXecuted p for is any "arar:ldefir or "Inss', ra _ � d u � n 4 t r' 4 r p n:° p� w y c C r f'. t% y i`cx�ida�al tl al � �t: arcrd.,nt .,r'lo.�;:� arises ra.tf .�€ � ei°�-lar-rs r"aratrrn� I�ali�d to .�uol� ar�l�ra.,t, i�.ars �aalrt;,.l rrr11, applies to #lie person or arganizat€on dcsignawd in the t�ontraa _ Q, Employee Mired Autos — Physical[ Damage Paragraph b- of lhrr Other insurance Ct)ndition In the Bus;inevF; Auto w£,rm and Paragraph f. of the other insurance — Prit-nary and Excess Insuranci5 Provisions Condition tri the Motor 08rr€er Coverage Foie 3 are replaced by Mn followNg. Pw ht and Aran Physical Damage GaVemg? the ft7OMIN are deerneO is I e cm.IKre-d "a!il:as" you ovol" (1) Any covered °auto" you lease, hire, rew ©i borrow; and (2) Any mwered 'Ito a' Nr ed or reviled a.lr der a m rMen £.prrl a';t or wri l -ell acit•t eiajt,ril el�ti': a d :rat.tia by tlj „errrts€oy e' or eieit,d or appointpd ofi3ciah vviih your pertydu;, on wfN being oper,�tJd within Ilia course and Scope of that " %rola, ee`S" arnployFnent by you or that decied or ;.el:'€x}ir e(j (.affiC•lil': Cfuties,'i as respaut. thele o1 lgations to you, However, 8n'v "alAto* tlzixt Is € 'c;$$Cf, tiii etl, re ded X31 botrawed with a dritier Is nat a covmmd 'nut". R. Uhintentional Failure to Clisclase Hazards The fo1h-YV ir)q is; AlIrfPd To the Conceahrttent, Or Fraud Condition: Hnvlevz:r we WM oat dent ccrvu:°age under this Coverage Form if you uDin trntlottallr: (1) FaU to tJ!sdoae any hazards existing at the inaepoon date of this coverage F�oirrt: or (2) N4zsk.,, an error, omission, imri?,Oper desCiption of :)I other I'riiSfilrJtGrr1@ llt .�f irrfarnizltiori. You must notiry us as soon as poswkoy ieRar the rliscovr-,ry of any hazards or any ather infot:natioh that wa&� not pmvided to us prior to the ar;cept ince of :h S Policy, S, Hired Aulo—World Wide Coverage PE aglaph 704q of tha Imlay Mad, Cflvw age Ter ho, Condition isop.1; uc �:r,I by tho following: (5) Anywhere In the world if a ,over d "auto" ig leaseck hirers, nanted of borrowed for a pett�,d of 60 days or less, T, $odify Injory R�Ndefinsd The def!rition of "boli y irtji,ry" ill the 001VIri100hS'SVtati011 is rr?frlhcPd by the foilowirip, "Finality injut.y`" fTi ? I'1s t 0dily' itrjii;y, e:,icl<nese or E]i:;iW, , sJsla€ned by a Berson including death — spier:tal anguish, CesufMg fear°, any of these, at ally Nyle, Mental anguish meals any type of mental err e motiunat ilirress or disease. ? i-C:A-Y24-i' 0,P (04-1+) IrtstU&S Uwl yhod r€}aleow V Irr:tr€WICC 5_<<iccs r i;fice, lei , WI:11 :i5 U. Expected Or iritetided Injury The Expected Or Intended Injury 5Yc;1usjor1 ill par.ttor;aph, 13, Exclusions under SectiGn 11 --Covered Auto Liability Covari3ge is replaced by the. fo€€nming: Expected Or Intended €nf try 'Bo-i€y irljwyr' or "propF:rty d:7rrt s;;" mp clod' or inte6dari frnm the Stiirrdpaint of t€.e 'lrt$,ured This exclu,:I,ml does rnot apply to Ybadily injury' :W "property 'ditr?`sed,, e` MSL]Ilill� frOM the use of reasonable force of €}ri.)H� 4 persons or prr pl sdy. V. Physical Ua.ffiage - Additional Temporary Transportation Expense Coverage Paragraph A.4.a. of Saction III -Physical Dannage Coverage is replace i by Iha followitig: 4. Coverage Extensions a. TFa»sportation Experlsos kmR svilf ppy til) to F,, -)o p.er (fray to a 'rrraxinwrri (if $1,.000' for t.:rrlp :mry trPnsPC1f`tati,3rl (ax�sr Pte €rlf;{irrod by pu because of 'htl, !.D'al Chert of a covered "auEra" of thr; priv8tr_' passenger type_ We will pay t)Wy for those covered "aautosl' for which you ca' -ry either t-lomprehensive or Spec Tied Causes: of 'Lar -S CoveraClu, We 1;111 pay for ter porary trar}spat-ration exparises iri tUrred during the period beginrsi.ig-48' hours atter Ilio thaft and anding, rtaf ardle S of lbar l; c icy's expiraiic,n, when the G7vered "autcf'' is rprtUrne€j to tjSB or we pay for JCS "loss", K Replacement of a Private ',-1sse i9dr Auto with a Hybrid nr Alterrla€lve- Fuel Source Auto "lite following :s added to PiaragiJ iph A. Coverago al the FhyStCal Dam,39 , Coverage Ser;tiQr3: irr the r'vent of.a total ``Ips.s" to a clovered "autlo" of the private passenger type that is replaced with a hybrid `Guto" or "auto" pr w+ !red by an afternative fuel 9s:ume of the private passenger type, we will gray ar? �ddrtleriaf °I t3'ia ,f itle CUSt of the. f6pl8cerrient "auto", vcluding (aY, lido, 11Cel!80, Gtller fees a,Md arty 6ternitr-ket vehicke to 2. maximum of $2500. The c,overeci 'aut:>" r;tust tar', FfRI)1,8Ceu by a flys lid "Milo' far 811 "800" prav�+ars:'d "y arc all:erti;.qtiv-; hief . otirce wigiin 60 c-mlerldar days or the payrinr}t of the "13x5" aito evidevc.! ti ley a bill i,,f ;rale or t(evv vehUe Mahe ag re o -m fail t. T,� qualify ilii a hybtid 'auto` tl' e rtlost 1,e p&:a' Bled by a f;onv'entlttil-A gls alloe t":d °it le god 21'&lOffisr! 5t`llsrs,t of flrr)1'r8,r€.°ion 1.7r1wei. The otilm sr..itt'rfm -:)f 1'Yr'f'11.ulsifm 1,7r"rwriz riil 1 t?f° einut"ie, 1lyrirafl¢?1}, pJ-ot}%inw. 5r3iM far11BUD'31 Qui -5, eithor P,orrpl"srr:'sstM or li:at.%" 'li tf. To 'qualify ass. arr "61lriFJ" powered by ars aft c:rrt,ltive fm -1 souroe, the; "at ta" ri}i. 5t tie, ` bland t:lhol r lel 8rtr a c^rwvem ir:irrtil c��l c'.iliric s:.>rlgina. Ari 'aIuto" Folely propellcd by pri^'r�:rt:rl try t� �wstti�r°.,e r.rf 1'.i`'r'sl'itrl.�irsrr j:t l�:rlitr Mi, t' l;f,ilit� ,sr rila l firr' d r° arty bland tl rrrrc�iof 'i, lot all alias" pov,,er�-cl by ,ori alternalive ir'al s50vrce. X. Return of Sfolen Automobile The follov- frig is added to the Cover -Age Extension ProVislor, at the Physical oatnage Coverage Section: If a ccwc,red "autU; is stole-) and recovered, five will pry the cosi of transport fo return the "autip= to you. We :^ill pay (Elly for t" lo.-- cove reG ';1 fQz 'yvjiiofl yoQ rarry eltoe-r �,;r)rnp-e1-ierisive q.ar St'e6fled, Hs r:rf t-oFss Oc;vera., ie. All Oiler terms. ,7;oriditioris, prvvisicwri= and s?xcltasiotis of this policy reisaain the szme. rrr:ludF s ^o;sr?ightccd rrmtemar if 1n1:, ta?mC Of:ice, W!.11 :ts F :irirts i tit, Policy Number: ATN -SF 1813471 UNITED SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 06100 (01/15) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Any coverage provided to an Additional Insured shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: 1) a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis; or 2) prior to a loss, you request in writing and we agree that this insurance shall apply on a primary and non-contributory basis. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 051 00 (01115) Page 1 of 1 POLICY NUMBER: ATN-SF1813471 COMMERCIAL GENERAL LIABILITY CG 24 0410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Per Written Contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applica-ble to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 0 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (rhe following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 10/1/2018 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. WC 3736453-14 of the issued to HARDY & HARPER, INC. Premium (if any) $ Endorsement No. 001 (NAME OF INSURANCE COMPANY) Authorized Representative 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description All persons and/or organizations that are required by written contract or agreement with the insured, executed prior to the accident or loss, that waiver of subrogation be provided under this policy for work performed by you for that person and/or organization. WC 252 (4-84) WC 04 03 06 (Ed. 4-84) Page 1 of 1