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PROOF OF INSURANCE (2019 - 2020) CLOSED
TG CONSTRU ItQPFZ CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) ....._...._.._...._.._._ �............_. 51/31/231/20..x.9.. 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 tate holder in lieu of such endorsement(s). this certificate does not confer rights to the certificate ....................._ CONTACT PRODUCER NAME: THE BROKERAGE COMMERCIAL INSURANCE SERVICES, Inc. PHONN , Ext): (949) 287-5677 (AJFAX No): 20261 SW Acacia St., Suite 200 E-MAIL Newport Beach, CA 92660 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: United Specialty Insurance Company 12537 INSURED INSURER B: Wesco Insurance Company 25011 TG Construction, Inc. INSURER C: First Mercury Insurance Co. 10657 139 Nevada St. INSURER D: Everest Premier Insurance Company 16045 EI Segundo, CA 90245 INSURER E: Arch Specialty Insurance Company 21199 INSURER F: X ANY AUTO X ....NUMBER: k R ........................................ COVERAGE....,.,., CERTIFIAT .... VISION 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 ADOL S'UDR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE .R...ra! °�D.................. POLICY NUMBER (1Yggf�YNPAIYYYYY fMMJ'DG),�""1""/'1�.„,.,........... ..,................................ LIMITS �....m._.m......_....... A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ,000,000 CLAIMS -MADE I X � OCCUR LIG0056700 6/1/2019 6/1/2020 DAMAGE TO RENTED 100,000 X PREMISES (Ea occurrence) $ MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 DESCRIPTION OF OPERATIONS ) LOCATIONS R VEHICLES ('ACORD let, Additional Remarks Schedule, may bo attached if more space Is retiuired) . 'Except 10 days notice of cancellation for non-payment of premium by registered or certified mail. glai/aual/wcwv RE: Evidence of Coverage. City of EI Segundo, its officers, agents and employee's are included as Additional Insureds as respects General and Auto Liability per attached endorsements. Waiver of Subrogation for Workers' Compensation: See Attached Endorsement. CERT'I'FICATE HOLDER A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of EI Segundo Public Works Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORI'ZFD REPRESENTATIVE ...... ....... . ....................... ....................................... rw................................. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY', yL-R.t�T LOC 2,000,000 PRODUCTS - COMP/OP AGG OTHER, .... B AUTOMOBILE LIABILITY _ 1,00'0,000 (En AC 6dtM) X ANY AUTO X WPP1556738 02 S OWNED SCHEDULED AUTOS ONLY , AUTOS ' PROPERTY DAMAGE (Per accident) LL�� AYRp� S ONLY 'i AUTOS ONNt.Y S 5,000,000 C X UMBRELLA LIAB X OCCUR 6/1/2019 6/1/2020 5,000,000 EXCESS LIAB CLAIMS -MADE ID 1524220 DED i RETENTION $ X STATUTE j ER D WORKERS COMPENSATION $ 1,000,000 AND EMPLOYERS' LIABILITY NN X 7600020485191 A®® N��EYICPROPRIETOR/PARTNER/EXECUTIVE N N A S 1,000,000 12/29/2018 1212912019 AggregatelPer Claim ER/MEMBER EXCLUDED? IMandatoryin NH) 11yos, dr scibe under DESCRIPTIONS OF O ERAT)ON S Wow .. .. E ProfessionWl' l-iab. PDCPP0019502 DESCRIPTION OF OPERATIONS ) LOCATIONS R VEHICLES ('ACORD let, Additional Remarks Schedule, may bo attached if more space Is retiuired) . 'Except 10 days notice of cancellation for non-payment of premium by registered or certified mail. glai/aual/wcwv RE: Evidence of Coverage. City of EI Segundo, its officers, agents and employee's are included as Additional Insureds as respects General and Auto Liability per attached endorsements. Waiver of Subrogation for Workers' Compensation: See Attached Endorsement. CERT'I'FICATE HOLDER A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of EI Segundo Public Works Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORI'ZFD REPRESENTATIVE ...... ....... . ....................... ....................................... rw................................. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2,000,000 GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG $ S COMBINED SINGLE LIMIT _ 1,00'0,000 (En AC 6dtM) S 6/1/2019 6/1/2020 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $' S 5,000,000 EACH OCCURRENCE S. 6/1/2019 6/1/2020 5,000,000 AGGREGATE 3 X STATUTE j ER 6/1/2019 6/1/2020 E.L. EACH ACCIDENT $ 1,000,000 1,000,000 E L DISEASE - EA EMPLOYEE $ ''c' Y. DISEASE • POLIC'Y LIMIT S 1,000,000 12/29/2018 1212912019 AggregatelPer Claim 1,000,000 DESCRIPTION OF OPERATIONS ) LOCATIONS R VEHICLES ('ACORD let, Additional Remarks Schedule, may bo attached if more space Is retiuired) . 'Except 10 days notice of cancellation for non-payment of premium by registered or certified mail. glai/aual/wcwv RE: Evidence of Coverage. City of EI Segundo, its officers, agents and employee's are included as Additional Insureds as respects General and Auto Liability per attached endorsements. Waiver of Subrogation for Workers' Compensation: See Attached Endorsement. CERT'I'FICATE HOLDER A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of EI Segundo Public Works Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 350 Main Street EI Segundo, CA 90245 AUTHORI'ZFD REPRESENTATIVE ...... ....... . ....................... ....................................... rw................................. ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TG CONSTRU JLOPEZ LOC #: 1..... CCORLY ADDITIONAL REMARKS SCHEDULE Page 1 of 1 .......... AGENCY NAMED INSURED THE BROKERAGE COMMERCIAL INSURANCE SERVICES, Inc. TG Construction, Inc. ......... 139 Nevada St. POLICY NUMBER EI Segundo, CA 90245 SEE PAGE 1 CARRIER NAIC CODE lSE..............__.._.______.�....__......._.__........._......_.._.. SEE P 1 EFFECTIVE DATE: SEE PAGE 7 E SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Cancellation: *Except 10 Days Notice of Cancellation for Non -Payment of Premium *Should this policy be cancelled before the expiration date, The Brokerage Commercial Insurance Services, Inc. will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.* ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: LIG0056700 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 O 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. If anyone, other than the Additional Insured, provides similar insurance for the Additional Insured, then this insurance will apply as outlined in SECTION IV - COMMERCIAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, subparagraph c. Method of Sharing. The inclusion of one or more Insured(s) under the terms of this endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Location(s) Of Covered Operations Any Location 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: 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 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 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: L!G0056700 COMMERCIAL GENERAL LIABILITY CG 28370413 THIS ENDORSEMENT CHANGES THE POLICY_ PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name OfAdditional Insured Person(s) Or Organization(s) As required by written ountnsci If anyone, other than the Additional |nnured, provides similar insurance for the Additional Insured, then this meuxenoe will apply as outlined in SECTION Mf — COMMERCIAL LIABILITY CONDITIONS, paragraph 4' Other Inawnanme, subparagraph c' Method of Sharing. The inclusion of one or more Insured(s) under the terms ofthis endorsement does not increase our limits of liability. All other terms and conditions remain unchanged. Location And Description OfCompleted Operations All locations.� Information required to complete this Schedule, if not shown above, will be shown in the Declarations, A. Smotmm U — Who Is An Insured in amended to include osan additional insured the pe/aon(s)or organization(s) shown in the Schedule, but only with respectliability �bi/i�y for "bodily injury" or "propertydamage" caused, iowhole orinpart, by ^ymur work" at the location designated and doaohbmd 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 tothe additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not bebroader than that which you are required bythe contract uragreement toprovide for such additional insured. CG 20 37Q413 @ Insurance Services Office, Inc,, 2012 Page I of 2 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. Page 2 of 2 C ISO Properties, Inc., 2004 CG 20 37 0413 ❑ POLICY NUMBER: LIG0056700 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: LIG0056700 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: As Required By Written Contract Information required to complete the Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER: WPP1556738 02 COMMERCIAL AUTO CA990187 0715 This Endorsement Changes The Policy. Please Read It Carefully BUSINESS AUTO COVERAGE EXPANSION ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the COVERAGE FORM apply unless modified by the endorsement. A. Newly Acquired or Formed Organizations, Employee Hired Car Liability and Blanket Additional Insured Status for Certain Entities. Item of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership of a majority interest (greater than 50%), will qualify as a Named Insured; however, (1) coverage under this provision is afforded only until the 180'" day after you acquire or form the organization or the end of the policy period, whichever is earlier; (2) coverage does not apply to "bodily injury", "property damage" or "covered pollution cost or expense" that results from an "accident" which occurred before you acquired or formed the organization; and (3) coverage does not apply if there is other similar insurance available to that organization, or if similar insurance would have been available but for its termination or the exhaustion of its limits of insurance. This insurance does not apply if coverage for the newly acquired or formed organization is excluded either by the provisions of this coverage form or by endorsement. e. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. t.............A.ny...pprson or oroani t.�gra...yfau cf.. rpgpared.m y. rrltt rl...cgntrg!M_q[_ gr@rcuroR to...gafn.t'. a..gmr �iitiorrg9,.. tigbdtityr cr�gte w,v_6�fal�,,�rr ig_part..�y. _-Ph"'nr. rr at B. Increase Of Loss Earnings Payment Subpart (4) of a. Supplementary Payments of Item 2. Coverage Extensions of Paragraph A. Coverage under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to read: (4) We will pay reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $1,000 per day because of time off from work. C. Fellow Employee Injured By Covered Auto You Own Or Hire Item 5. Fellow Employee of Paragraph B. Exclusions under SECTION II — COVERED AUTOS LIABILITY COVERAGE is amended to add: This exclusion does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. Such coverage as is afforded by this provision is excess over any other collectible insurance. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 5 Used with permission D. Limited Automatic Towing Coverage Item 2. Towing, of Paragraph A. Coverage, under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: 2. Towing We will pay for towing and labor costs each time that a covered "auto" is disabled. All labor must be performed at the place of disablement of the covered "auto". a. The limit for towing and labor for each disablement is $500; b. No deductible applies to this cover- age. E. Item 3. Glass Breakage — Hitting A Bird Or Animal — Falling Objects or Missiles of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: Glass Repair Coverage We will waive the Comprehensive deductible for Glass, if one is indicated on your covered "auto", for glass repairs. We will repair at no cost to you, any glass that can be repaired without replacement, provided the "loss" arises from a covered Comprehensive "loss" to your "auto". F. Increase Of Transportation Expense Coverage Subpart a. Transportation Expenses of Item 4. Coverage Extensions of Paragraph A. Coverage under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". G. "Personal Effects" Coverage Item 4. Coverage Extensions of Paragraph A. Coverage, under SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Coverage We will pay actual cash value for "loss" to "personal effects" of the "insured" while in a covered "auto" subject to a maximum limit of $2,500 per "loss", for that covered "auto" caused by the same "accident". No deductible will apply to this coverage. H. "Downtime Loss" Coverage Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: "Downtime Loss" Coverage We will pay any resulting "downtime loss" expenses you sustain as a result of a covered physical damage "loss" to a covered "auto" up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide "downtime loss" beginning on the 51h day after we have given you our agreement to pay for repairs to a covered "auto" and you have given the repair facility your authorization to make repairs; b. Coverage for "downtime loss" expenses will end when any of the following occur: (1) You have a spare or reserve "auto" available to you to continue your operations. (2) You purchase a replacement "auto". (3) Repairs to your covered "auto" have been completed by the repair facility and they determine the covered "auto" is road -worthy. (4) You reach the 30 day maximum coverage. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission I. Item 4. Coverage Extensions, of Paragraph A. Coverage, under SECTION III. PHYSICAL DAMAGE COVERAGE, is amended to add: We will pay any resulting rental reimbursement expenses incurred by you for a rental of an "auto' because of "loss" to a covered "auto' up to a maximum of $100 per day, for a maximum of 30 days for the same physical damage "loss", subject to the following conditions: a. We will provide rental reimbursement incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy expiration, with the number of days reasonably required to repair or replace the covered "auto'. If the "loss" is caused by theft, this number of days is the number of days it takes to locate the covered "auto" and return it to you or the number of days it takes for the claim to be settled, whichever comes first. b. Our payment is limited to necessary and actual expenses incurred. c. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. d. If a "loss" results from the total theft of a covered "auto' of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. J. "Personal Effects" Exclusion Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE, is amended to add: "Personal Effects" Exclusion We will not pay for "loss" to "personal effects" of any of the following: a. Accounts, bills, currency, deeds, evidence of debt, money, notes, securities or commercial paper or other documents of value. b. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry; watches; precious or semi-precious stones. c. Paintings, statuary and other works of a rt. d. Contraband or property in the course of illegal transportation or trade. e. "Loss" caused by theft, unless there is evidence of forced entry into the covered "auto' and a police report is filed. K. Accidental Airbag Discharge Coverage Item 3.a. of Paragraph B. Exclusions under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to read: a. Wear and tear, freezing, mechanical or electrical breakdown. The exclusion relating to mechanical break -down does not apply to the accidental discharge of an air bag. L. Loan or Lease Gap Coverage Paragraph C. Limit Of Insurance under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: If a covered "auto' is owned or leased and if we provide Physical Damage Coverage on it, we will pay, in the event of a covered total "loss", any unpaid amount due on the lease or loan for a covered "auto', less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease or loan payments including penalties, interest or other charges resulting from overdue payments at the time of the "loss'; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (4) Security deposits not refunded by the lessor; and (5) Carry-over balances from previous loans or leases CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 3 of 5 Used with permission M. Aggregate Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Regardless of the number of covered "autos" involved in the same "loss", only one deductible will apply to that "loss". If the deductible amounts vary by "autos", then only the highest applicable deductible will apply to that "loss". N. Diminishing Deductible Paragraph D. Deductible under SECTION III — PHYSICAL DAMAGE COVERAGE is amended to add: Any deductible will be reduced by the percentage indicated below on the first "loss" reported during the corresponding policy period: Loss Free Policy Periods Deductible With the Expansion Reduction on the Endorsement first "loss" E 0% ................................................. 25% 3 50% 4....................._................................................... 75% 5 100% If we pay a Physical Damage "loss" during the policy period under any BUSINESS AUTO COVERAGE FORM you have with us, your deductible stated in the Declarations page of each such COVERAGE FORM will not be reduced on any subsequent claims during the remainder of your policy period and your deductible reduction will revert back to 0% for each such COVERAGE FORM if coverage is renewed. O. Knowledge of Loss and Notice To Us Subsection a. of Item 2. Duties In the Event of Accident, Claim, Suit or Loss of Paragraph A. Loss Conditions under SECTION IV -- BUSINESS AUTO CONDITIONS is amended to add: However, prompt notice of the "accident', claim, "suit' or "loss" to us or our authorized representative only applies after the "accident', claim, "suit' or "loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An "executive officer" or director, if you are a corporation; (4) A manager or member, if you are a limited liability company; (5) Your insurance manager; or (6) Your legal representative. LqAs,es,.Assut"rla.d..Un a I.n ..ored + 9ntraet Item 5. Transfer Of Rights Of Recovery Against Others To Us of Paragraph A. Loss Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: 5. Transfer of Rights of Recovery Against Others To Us If any person or organization to or for whom we make payments under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after an "accident" or "loss" to impair them. H.owqyer, if the insured h,. ; s,,A4iv90-jhpApright; ,te..r ppypr r,EopcjbA written contraypt,_Ae lG, +gjyk !ptt�tr.111.? _p�'et�ag,_e�e�rtt�. CL.. Irfsgr nce is Prirr ly a-nd- N n.. o.nt.ri.b..mtgry Subpart a. of Item 5. Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: a...........TBw.i...ir7.g„nca_irirnary lard. poncontribut r as Insurance, if required_i.n. a, written. C.entra.Qt with you. R. Other Insurance — Hired Auto Physical Damage Subpart b. of Item 5..Other Insurance of Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended to read: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos” you own: (1) Any covered "auto" you lease, hire, rent or borrow; and CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". S. Unintentional Failure To Disclose Hazards Paragraph B. General Conditions under SECTION IV — BUSINESS AUTO CONDI- TIONS is amended to add: 9. Your failure to disclose all hazards existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided that such failure to disclose all hazards is not intentional. However, you must report such previously undisclosed hazards to us as soon as practicable after its discovery. T. Additional Definition SECTION V — DEFINITIONS is amended to add: "Personal effects" means personal property owned by the "insured". "Downtime loss" means actual loss of "business income" for the period of time that a covered "auto": 1. Is out of service for repair or replacement as a result of a covered physical damage "loss" and 2. Is in the custody of a repair facility if not a total "loss". "Business Income" means: 1. Net Income (Net Profit or Loss before income taxes) that would have been earned or incurred; and 2. Continuing normal operating expenses incurred, including payroll. In this endorsement, Headins and 'Titles are inserted solely for the convenience and ease of reference. They do not affect the coverage provided by this endorsement, nor do they constitute any part of the terms and conditions of this endorsement. All other policy wording not specifically changed, modified, or replaced by this endorsement wording remains in effect. CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 5 of 5 Used with permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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 2% of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 06/0112019 Policy No. 7600020485191 Endorsement No. 001 Insured: TG Construction, Inc. Premium $ INCL. Insurance Company: Everest Premier Insurance Company Countersigned By: - 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB's California Workers' Compensation Insurance Forms Manual - 1999. 4