PROOF OF INSURANCE (2020) CLOSEDA� ® CERTIFICATE OF LIABILITY INSURANCE I DAT$i2a/2o�sYY>
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Allison Barga Licesnse #OK93926
Hall & Company PHONE FAx
A/E Insurance Services I (A/C. No. ExtC 360-626-2007 (A/C, No): 360-626-2007
19660 10th Ave NE I E-MAIL ADDRESS: an
ADDREss: abar p y.com
Poulsbo WA 98370 I INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA: ZURICH AMERICAN INSURANCE COMPANY 16535
INSURED 25 INSURER B: CNA Insurance Companies
Dudek
605 3rd Street I INSURER C :
Encinitas CA 92024 I INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 863877387 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYYYI
A X COMMERCIAL GENERAL LIABILITY GLOO14631103 8/28/2019 8/28/2020 EACH OCCURRENCE $ 1 000 000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of EI Segundo, its officials, and employees are an Additional Insured on the Commercial General Liability and Auto Liability when required by written
contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and any
other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of subrogation applies to the
Commercial General Liability, Auto Liability, Umbrella / Excess Liability and Workers Compensation / Employers Liability in favor of the Additional Insured.
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.
EI Segundo Planning & Building Safety Dept.
350 Main St AUTHORIZED REPRESENTATIVE
EI Segundo CA 90245 �24 z
6�
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
DAMAGE TO RENTED
CLAIMS -MADE � OCCUR
PREMISES (Ea occurrence) $ 100,000
X OCP/XCU/BFPD
MED EXP (Any one person) $ 10,000
X Cross Liability
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
PRO -
POLICY � 1:1 LOC
PRODUCTS COMP/OP AGG $ 2,000,000
ECT
-
OTHER:
$
A AUTOMOBILE LIABILITY
SAP014632903
8/28/2019 8/28/2020
COMBINED SINGLE LIMIT $ 1,000,000
fEa accident)
X ANY AUTO
BODILY INJURY (Per person) $
OWNEDSCHEDULED
BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
X HIRED I X NON -OWNED
PROPERTYDAMAGE $
AUTOS ONLY AUTOS ONLY
(Per accident)
A X UMBRELLALIAB OCCUR
AUC014640703
8/28/2019 8/28/2020
EACH OCCURRENCE $1,000,000
EXCESS LIAB CLAIMS -MADE
H
AGGREGATE $ 1,000,000
DED I X I RETENTION $ n
$
A WORKERS COMPENSATION
WC014633003
8/28/2019 8/28/2020
X I SPER TATUTE EORH
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N
E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
B Professional Liab Claims Made
EEH591932835
8/28/2019 8/28/2020
$1,000,000 Per Claim
Contractors Pollution Liab: Occur
$1,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of EI Segundo, its officials, and employees are an Additional Insured on the Commercial General Liability and Auto Liability when required by written
contract or agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability insurance is primary insurance and any
other insurance maintained by the Additional Insured shall be excess only and non-contributing with this insurance. A waiver of subrogation applies to the
Commercial General Liability, Auto Liability, Umbrella / Excess Liability and Workers Compensation / Employers Liability in favor of the Additional Insured.
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.
EI Segundo Planning & Building Safety Dept.
350 Main St AUTHORIZED REPRESENTATIVE
EI Segundo CA 90245 �24 z
6�
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Waiver Of Subrogation ( Blanket) Endorsement
' Policy No. I Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer AddT Prem
GLOO14631103 08 1 08/28/2020 1 08/28/2019 N/A $ N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Return Prem.
$ N/A
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from
others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to
any other operations in which the insured has no contractual interest.
U -GL -Ir -5-B CW ( 12/01)
Page I of I
19
Coverage Extension Endorsement ZURICH
Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. AWL Prem Return Prem.
BAP014632903 08/28/2019 � 0812812020 � 08/28/2019 N/A N/A N/A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section 11 — Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any "employee" of yours is also an "insured" while
operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.l.a. and A.l.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment — Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section 11 — Covered Autos Liability
Coverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an
.'accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a
day because of time off from work.
U -CA -424-F CW (04/14)
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C. Fellow Employee Coverage
The Fellow Employee Exclusion contained in Section 11 — Covered Autos Liability Coverage does not apply.
D. Driver Safety Program Liability and Physical Damage Coverage
1. The following is added to the Racing Exclusion in Section 11 — Covered Autos Liability Coverage:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
2. The following is added to Paragraph 2. in the Exclusions of Section III — Physical Damage Coverage of the
Business Auto Coverage Form and Paragraph 2.b. in the Exclusions of Section IV — Physical Damage
Coverage of the Motor Carrier Coverage Form:
This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not
limited to, auto or truck rodeos and other auto or truck agility demonstrations.
E. Lease or Loan Gap Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Lease Or Loan Gap Coverage
In the event of a total "loss" to a covered "auto", we wall pay any unpaid amount due on the lease or loan for a covered
"auto", less:
a. Any amount paid under the Physical Damage Coverage Section of the Coverage Form; and
b. Any:
(1) Overdue lease or loan 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) Security deposits not returned by the lessor;
(4) Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the
loan or lease; and
(5) Carry-over balances from previous leases or loans.
F. Towing and Labor
Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following:
We wall pay up to $75 for towing and labor costs incurred each time a covered "auto" of the private passenger type is
disabled. However, the labor must be performed at the place of disablement.
G. Extended Glass Coverage
The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section:
If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired and
is actually repaired rather than replaced, the deductible wall be waived. You have the option of having the glasq
repaired rather than replaced.
H. Hired Auto Physical Damage — Increased Loss of Use Expenses
The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by the
following:
Loss Of Use Expenses
For Hired Auto Physical Damage, we wall pay expenses for which an "insured" becomes legally responsible to pay for
loss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We
will pay for loss of use expenses if caused by:
U -CA -424-6 CW (04/14)
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(1) Other than collision only if the Declarafions indicate that Comprehensive Coverage is provided for any covered
"auto";
(2) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided
for any covered "auto"; or
(3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto".
However, the most we wall pay for any expenses for loss of use is $100 per day, to a maximum of $3000.
I. Personal Effects Coverage
The following is added to the Coverage Provision of the Physical Damage Coverage Section:
Personal Effects Coverage
a. We wall pay up to $750 for "loss" to personal effects which are:
(1) Personal property owned by an "insured"; and
(2) In or on a covered "auto".
b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects wall be based on the lesser of:
(1) The reasonable cost to replace; or
(2) The actual cash value.
c. The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered
"auto". No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of
the following:
(1) Accounts, Ufls, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or other
documents of value.
(2) Bullion, gold, silver, platinum, or other precious allays or metals; furs or fur garments; jewelry, watches,
precious or semi-precious stones.
(3) Paunfings, statuary and other works of art.
(4) Contraband or property in the course of illegal transportation or trade.
(5) Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment.
Any coverage provided by this Provision is excess over any other insurance coverage available for the same "loss".
J. Tapes, Records and Discs Coverage
1. The Exclusion in Paragraph 113.4.a. of Section III — Physical Damage Coverage in the Business Auto Coverage
Form and the Exclusion in Paragraph 113.2.c. of Section IV — Physical Damage Coverage in the Motor Carrier
Coverage Form does not apply.
2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the
Physical Damage Coverage Secfion:
We wall pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronic
equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices:
(a) Are the property of an "insured"; and
(b) Are in a covered "auto" at the fime of "loss".
The most we wall pay for such "loss" to tapes, records, discs or other similar devices is $500. The Physical
Damage Coverage Deductible Provision does not apply to such "loss".
U -CA -424-6 CW (04/14)
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K. Airbag Coverage
The Exclusion in Paragraph 13.3.a. of Section III — Physical Damage Coverage in the Business Auto Coverage Form
and the Exclusion in Paragraph 13.4.a. of Section IV — Physical Damage Coverage in the Motor Carrier Coverage
Form does not apply to the accidental discharge of an airbag.
L. Two or More Deductibles
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to you
by us, the following applies for each covered "auto" on a per vehicle basis:
1. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it wall be waived; or
2. If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by
the amount of the smaller (or smallest) deductible.
M. Physical Damage — Comprehensive Coverage — Deductible
The following is added to the Deductible Provision of the Physical Damage Coverage Section:
Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that wall be applied to
Comprehensive Coverage for all "loss" from any one cause is $5,000 or the deductible shown in the Declarations,
whichever is greater.
N. Temporary Substitute Autos — Physical Damage
1. The following is added to Section I —Covered Autos:
Temporary Substitute Autos — Physical Damage
If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the following
types of vehicles are also covered "autos" for Physical Damage Coverage:
Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered
"auto" you do own but is out of service because of its:
1. Breakdown;
2. Repair;
3. Servicing;
4. "Loss"; or
5. Destruction.
2. The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section:
Temporary Substitute Autos — Physical Damage
We wall pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or
omissions on your part. If we make any payment to the owner, we wall obtain the owner's rights against any other
party.
The deductible for the temporary substitute "auto" wall be the same as the deductible for the covered "auto" it
replaces.
U. Amended Duties In The Event Of Accident, Claim, Suit Or Loss
Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following:
a. In the event of "accident", claim, "suft" or "loss", you must glue us or our authorized representative prompt notice
of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or
"loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited
liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any
U -CA -424-6 CW (04/14)
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Includes copyrighted material of Insurance Services Office, Inc., with its permission.
agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit";
(2) The "insured's" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos — Physical Damage
Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
Insurance — Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the fallowing:
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
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or
elected or appointed official with your permission while being operated within the course and scope of that
"employee's" employment by you or that elected or appointed official's duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto — World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.
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U. Expected Or Intended Injury
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II Covered) Auto Liability
Coverage is replaced by the following:
Expected) Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does
not apply to "bodily injury" or "property damage" resulting from the use of reasonable farce to protect persons or
property.
V. Physical Damage Additional Temporary Transportation Expense Coverage
Paragraph Aka. of Section III Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We wall 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 Lass Coverage. We wall
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
'"Vass".
W. Replacement of a Private Passenger Auto with a Hybrid) or Alternative Fuel Source Auto
The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or
"auto" powered by an alternative fuel source of the private passenger type, we wall pay an additional 10% of the cast
of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a
maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative
fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease
agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of
propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,
either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be
powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by
bofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered "auto" is stolen and recovered, we will pay the cast of transport to return the "auto" to you. We will pay
only for those covered "autos" for which you curry either Comprehensive or Specified Causes of Lass Coverage.
All other terms, conditions, provisions and exclusions of this policy remain the same.
U -CA, -424-6 CW (04114)
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Additional Insured — Automatic — Owners, Lessees Or
Contractors
Policy No. I Eff. Date of Pol. I Exp. Date of Pol
G LOO 14631103 1 08/28/2019 1 08/28/2020
Named Insured:
Eff. Date of End
08/28/2019
Producer No.
64955000
AddT Prem
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Address (including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
Return Prem.
A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured 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 or "your work" as included in the "products -completed operations
hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted bylaw; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.
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C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an 'occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit' as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit' will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same 'occurrence", offense, claim or "suit'. This provision does not apply to any policy
in which the additional insured is a Named Insured on such other policy and where our policy is required by a
written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III — Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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.
All other terms and conditions of this policy remain unchanged.
U -GL -1175-F CW (04/13)
Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
. . . . . . . . . .
Policy Number,WC014633003
WORKERS' COMPENSATION A19DEMPLOYERS� UABU,fTY MURANCE POLICY WC 04 03 06
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—
CALIFORNIA
wo have the, 6gtl W rpcowN OUr paymeats from aiyon(� ffx,,In injury by this in the on o
upolk' �Y� we Will not
enforce, Or right z1gainst the fxv-sr organtzation named appiies m0y to the
extent thatyou perfon,T) work a wiften eantnact that' requ4(.!.", you to oblain ths agreenxn�, frorn iKj.)
You must fnaintain payroll rcCnfds accurately thO COTILMCYW,ion of your in
the wor~k desc6bed n the Scheduk),
'Fheaddifiomal premidrll for V,)is ondorsemen1,,5h,,,,jf; b(,� 0 of the California workers' ocimpensition pre,
othe ;
)rwise due On such ren'Kineration,
Schedule
Person or Organizatiori Job Description
WC 2,52
vvc Cw cj,", or, � Ed 4-84