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HomeMy WebLinkAboutCertificate of Insurance 2018A� �® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 8/29/2018 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 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 Edgewood Partners Insurance CenterPHONE Lic# OB29370 PO Box 13847 CONTACT NAME: Kim Coleman Berger FAX A C No Ext): 916-576-1534 A/c No): 916-583-7613 ADDRESS: Kim.Coleman Berger@6picbrokers.com INSURER(S) AFFORDING COVERAGE NAIC # Sacramento CA 95853 - INSURER A: Travelers Prop Casualty Co of America 25674 6608899NB80 INSURED ENGEINCO INSURER B: Travelers Indemnity Co. of IL 25658 ENGEO Incorporated 2010 Crow Canyon Place #250 INSURER c : Lloyds of London 85202 CLAIMS -MADE � OCCUR7 San Ramon CA 94583-4634 INSURER D : INSURER E: INSURER F : RENTED DAMAGE ToEa occurrence) $ 300,000 PREMISES COVERAGES CERTIFICATE NUMBER: 1688905210 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6608899NB80 9/1/2018 9/1/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR7 RENTED DAMAGE ToEa occurrence) $ 300,000 PREMISES MED EXP (Any one person) $10,000 X Ded - NIL PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO- LOC JECT $ OTHER: B AUTOMOBILE LIABILITY 8108899N880 9/1/2018 9/1/2019 COMBINED INGLE LIMIT $1,000,000 Ea accidentS1 000 000 BODILY INJURY (Per person) $ AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOAUTOS IXXANY HIREDSAUTOS X AUTOSNON-OWNED Penacident AMAGE $ $ Ded -NIL A X UMBRELLA LIAB X OCCUR CUP6J082242 9/1/2018 9/1/2019 EACH OCCURRENCE $ 6.000,000 AGGREGATE $ 6.000,000 EXCESS LIAB CLAIMS -MADE DED I X RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN UB4J940442 9/1/2018 9/1/2019 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below C E & 0 (Professional Liability) Claims Made Retro Active Date 03/08/89 BN301420M 9/1/2018 9/1/2019 Per Claim $2,000,000 Aggregate u $2,000,000 Deductible $150,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Matadero Creek Bank Repair. Additional Insured: Town of Los Altos Hills, it's officers, employees and Volunteers. When required by written contract, additional insured status with primary coverage applies to General Liability and Automobile Liability and waiver of subrogation applies to General Liability, Automobile Liability and Workers' Compensation, all per the attached endorsements. UtK I IVIUAI t HULUtK Town of Los Altos Hills Public Works Department 26379 Fremont Road Los Altos Hills CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �+ -'" V 'IbItsS-ZU14 AL;UKU UUKYUKA I IUIV. All rlgnis reserve0. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6608899N880- COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - ALL PROJECTS SUBJECT TO A WRAP-UP INSURANCE PROGRAM WITH LIMITED EXCEPTIONS FOR CERTAIN ONGOING OPERATIONS This endorsement modifies-_ insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 1. The following exclusion is added to Paragraph 2., The exceptions in this exclusion do not apply to Exclusions, of SECTION I— COVERAGES — "bodily injuryor "property damage" included in COVERAGE A BODILY INJURY AND PROP- the "products -completed operations hazard" even ERTY DAMAGE LIABILITY: if you are required to provide such coverage for Wrap-up Insurance Programs an additional insured by a written contract or "Bodily injury" or "property damage" arising out of agreement. any project that is or was subject to a wrap-up 2. The following is added to the DEFINITIONS Sec - insurance program". tion: This exclusion does not apply to "bodily injury" or "Wrap-up insurance program" means any agree-' "property damage" arising out of your ongoing ment or arrangement, including any contractor t - controlled, owner -controlled or similar insurance performed at any location owned program, under which: ed to, you that is outside the project a. Some or all of the contractors working on a it; project and is not covered by the specific project, or specific projects, are re- nsurance program for that project; quired toenrollin a program to obtain insur- or ance that:, (2) Are punch list or warranty work, if coverage (1) Includes the same or similar insurance as was available to the insured under the "wrap that provided -by this Coverage Part; and up insurance program" for "bodily injury" and (2) Is issued specifically for injury or damage; "property damage" arising out of your ongoing arising out of such project or projects; and operations and the "bodily injury" or "property b. You are or were enrolled or allowed to enroll. damage" occurs after the expiration of all such coverage. CG D3 91 08 13 ©2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Policy #6608899N880 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WRITTEN CONTRACTS (ARCHITECTS, ENGINEERS. AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS plies only to such "bodily injury" or "property AN INSURED: ` pe- damage" that occurs before the end of the pe - Any person or organization that you agree in a riod of time for which the "written contract re- "written contract requiring insurance" to include as quiring insurance" requires you to provide an additional insured on this Coverage Part, but: such coverage or the end of the policy period, whichever is earlier. a.Only with respect to liability for "bodily injury", "property damage" or "personal injury"; and 2. The following is added to Paragraph 4.a. of SEC- TION IV — COMMERCIAL GENERAL LIABILITY b. If, and only to the extent that, the injury or CONDITIONS': damage is caused by acts or omissions of, you or your. subcontractor in the performance The insurance, provided to the additional insured of "your work" to which the "written contract is excess over any valid and collectible "other in- requiring insurance' applies. The person or surance", whether primary, excess, contingent or organization does not qualify as an additional on any other basis, that is available to the addi- insured with respect to the independent` acts tional insured for a loss we cover. However, if you or omissions of such person or organization. specifically agree in the "written contract requiring insurance" that this insurance provided to the ad- ditional insured under this :Coverage Part must is limited as follows: apply on a primary basis or a primary and non - c. In the event that the Limits of Insurance of contributory basis, this insurance is primary to this Coverage Part shown in the Declarations "other insurance" available to the additional in - exceed the limits of liability required by the sured which covers that person or organization as "written contract requiring insurance", the in- a named insured for such loss, and we will not surance provided to the additional insured share with that "other insurance". But this insur- shall'be limited to the limits of liability required ante provided to the additional insured still is ex - by that "written contract requiring insurance". cess over any valid and collectible "other insur- This endorsement shall not increase the limits ante", whether primary, excess, contingent or on of insurance described in Section III — Limits any other basis, that is available to the additional Of Insurance. insured when that person or organization is an d. This insurance does not apply to the render- additional insured under any "other insurance". ing of or failure to render any "professional 3. The following is added to SECTION IV - COM - services" or construction management errors MERCIAL GENERAL LIABILITY CONDITIONS: or omissions. Duties Of An Additional Insured e. This insurance does not apply to "bodily in- As a condition of coverage provided to the addi- jury" or "property damage" caused by "your tional insured: work" and included in the "products- . completed operations hazard" unless the a. The additional insured must give us written „ " . written contract requiring. insurance specifi- notice as soon as practicable of an "occur- tally requires you to provide such coverage rence" or an offense which may result in a for that additional insured, and then the insur- claim. To the extent possible, such notice ante provided to the additional insured ap- should include: CG D4 14 04 08 © 2008 The Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of other insurance which would or offense tookplace; cover the additional insured for a loss we ii. The names and addresses of any injured cover. However, ,this condition does not affect persons and witnesses; and whether this insurance provided to the addi- iii. The nature and location of any injury or tional insured is primary to that other insur- damage arising out of the 'occurrence" or ance available to the additional insured which offense. covers that person or organization as a named insured. b. If a claim is made or "suit" is brought against the additional insured, the additional insured 4. The following is added to the DEFINITIONS Sec- must: tion: i. Immediately record the specifics of the "Written contract requiring insurance" means that claim or "suit" and the date received; and part of any written contract' or agreement under which you are required to include a person or or- ganization as an additional insured on this ;Cover - The additional insured must see to it that we age Part, provided that the "bodily injury" and receive written notice of the claim or "suit" as "property damage" occurs and the "personal in - soon as practicable. jury" is caused by an offense committed: c. The additional insured must immediately send a. After the signing and execution of the contract us copies of all legal papers received in con- or agreement by you; nection with the claim or "suit", cooperate with b. While that part of the contract or agreement is us in the investigation or settlement of the in effect; and claim or defense against the "suit", and oth- erwise comply with all policy conditions. c. Before the end of the policy period. d The additional insured must tender the de- fense and indemnity of any claim or "suit" to Page 2 of 2 Oc 2008 The Travelers Companies, Inc. CG D4 14 04 08 POLICYNUMBER: 6608899N880 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsementmodifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE ;PART PROVISIONS b. The "personal injury" or "advertising injury" for COMMERCIAL GENERAL LIABILITY' CONDITIONS which coverage is sought arises out of an of - (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a.' Primary' contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex - However, if you specifically agree in;a written con- cess'; Insurance regarding any other primary in tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured' under this 3. The following is added to Paragraph b Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur Subparagraph (1): Vance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and wepolicy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and y I CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 Policy Number 6608899N880 (2) The total of all deductible and self-insured amounts under that "other insurance We will share the remaining loss, if any, with any "other insurance" that is not described in this Excess Insur- ance provision. c. Method Of Sharing If all of the "other insurance" permits contribution by equal shares, we will follow this method also. Under this approach each provider of insurance contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, which- ever comes first. If any of the "other insurance does not permit contribution by equal' shares, we will contribute by limits. Under this method, the share of each provider of insurance is based on the ratio of its applicable limit of insur- ance to the total applicable limits of insurance of all providers of insur- ance. 2 The following definition is added to SECTION V —'DEFINITIONS: "Other insurance": a. Means insurance, or the funding of losses, ,that is provided by, through or on behalf of: (1) Another insurance company; (2) Us or any ;of our affiliated insurance companies, except when the Non cumulation of Each Occurrence`, Limit section of Paragraph 5. of LIMITS OF INSURANCE (Section lll) or the Non cumulation of Personal and Advertis- ing jInjury limit sections of Paragraph 4. of LIMITS OF INSURANCE (Sec- tion III) applies;' (3) Any risk retention group; (4) Any self-insurance method or pro- gram, other than any funded by you and over which this Coverage Part applies; or (5) Any similar risk transfer or risk man- agement method. b. Does not include umbrella insurance, or excess insurance, that you bought spe- cifically`to apply in excess of the Limits of COMMERCIAL GENERAL LIABILITY Insurance shown on the Declarations of this Coverage Part. R. UNINTENTIONAL OMISSION 1. The following is added to Paragraph 6. Rep- resentations of `'SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or uninten- tional error in, any information provided by you which we relied upon in issuing this policy shall not prejudice your tights under this in- surance. 2. This Provision R does not affect our right to collect additional' premium or to exercise our right of cancellation or nonrenewal in accor- dance with applicable insurance laws or regu- lations. S. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST'' OTHERS TO US WHEN REQUIRED BY CONTRACT The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: 1. Premises owned by you, temporarily occu- pied by you with permission of the owner, or leased or rented to you; 2. Ongoing operations performed by you; or on your behalf, under a contract or agreement with that person or organization; 3. "Your work'; or 4. "Your products". We waive these rights only where you have agreed to do so as part of a "written contract re- quiring insurance" entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense or "advertising injury" offense is committed'. T. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per - CG D4 15 05 08 (Rev. 10-08) ` © 2008 The Travelers Companies, Inc. COMMERCIAL GENERALLIABILITY POLICY NUMBER: 660-8899NBBO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s) General Aggregate(s) EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN $2,,000,000 A WRITTEN CONTRACT WHICH IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT I'S SIGNED AND EXECUTED' BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- ' nated Project General ; Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations' at a single desig- shall not reduce the General Aggregate Limit nated "project" shown in the Schedule above: shown in: the Declarations nor shall they re - 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated "pro- Aggregate Limit' for any other designated �� ject , and that limit is equal to the amount of "project" shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage' To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit -shown in the Limit is the most we will pay for the sum of all ` Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag - damages because of "bodily injury" or "prop- gregate Limit. erty ` damage" included'' in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur - cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un - a. Insureds; der COVERAGE C. (SECTION 1), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule above: c. Persons or organizations making claims or bringing "suits". CG D2 11 01 04 Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under 'COVERAGE C. for - "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products -completed operations hazard" will available under the General Aggregate Limit reduce: the Products -Completed Operations Ag - or the Products -Completed Operations_ Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable; and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. Hated Project General Aggregate Limit. E. For the purposes of this endorsement the ,Defini- C. Part 2. of SECTION 111- LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2 The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B and agreement. For the purposes of determining the b. Damages from "occurrences" under 'applicable aggregate limit of insurance, each COVERAGE A (SECTION I) and for all "project" that includes premises involving the medical expenses caused by accidents' same or connecting lots, or premises whose con - under COVERAGE C (SECTION 1) which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project" shown in the considered a single "project". SCHEDULE above. F. The provisions of SECTION 111 - LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en - n-"products-completed '.prod ucts-com pl etedoperations hazard" is pro- dorsement shall continue to apply as stipulated. I u Paget of 2 Copyright, The Travelers i Indemnity Company, 2004 CG D2 11 01 04 Policy Number: 8108899N880 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS F. HIRED AUTO - LIMITED WORLDWIDE COV- ERAGE - INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE - GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.I., Who Is An Insured, of SECTION 11 - COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.I., Who Is An Insured, of SECTION 11 - COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE - INCREASED LIMIT I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS Is Insurance applies 50-651-y-fo-Wd-5fent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section 1111. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 - COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is 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 busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV - BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 02 16 0 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 lnclutles copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL AUTO permission, while performing duties related to the conduct ofyourbusi- However, any "aulo"that ka |omsad, hirmd, rented or borrowed with u driver is not m covered "auto". D. EMPLOYEES AS INSURED The following kaadded toParagraph A.1,Who &m AnInsured, ofSECTION U—COVERED AUTOS LIABILITY COVERAGE: Any "employeo"ofyours iwan"ineurmd"while us- ing acuvarad"auto"youdVn'town,hireorbornmw inyour business oryour personal affairs. E. SUPPLEMENTARY PAYMENTS —|NCREASED LIMITS X. The following replaces Paragraph A.2.a.(2). mfSECTlONU—COVERED AUTOS LIABIL- ITY (2) Up to $3,000 for cost of bail bond (in- cluding bonds for ndaiad traffic law vio|a- hunn) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4). oySECTION U—COVERED AUTOS LIABIL- ITY (a) With respect to any claim mode or "suit" brought outside the United Btmtmn of Amwhca, the territories and possessions of the United Gimtos of America, Puerto Rico and Canada: @U You must arrange todefend the "in- surmd"against, and investigate orset- tle mnysuch claim or"ouit"and keep us advised of all proceedings and mm - (ii) Neither you mor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv)We will reimburse the "insured" for mums that the "insured" |ogoUy must pay as damages because of "bodily injury" or"property damage" hmwhich this insurance app|ima, that the "in- sured" pays with our uonsent, but only uphuthe limit described inPara- graph C.' Limits Of |naununcm. of SECTION KU — COVERED AUTOS LIABILITY COVERAGE. (4)/Q| reasonable expenses incurred by the (v)Wewill reimburse the "insured for "insured" at our request, including actual the reasonable expenses incurred |oen of earnings up to $508 a day be- with our consent for your invemUQa' caumecfOmeoffbomwurk. tion ofsuch claims and your defense c� the "insured" mQminm� any much P �|��E� ��U�� — L|&8|�E0 N�3F��O���E ���- ' 'suit', but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para - ora+Thofo||owing The followingrup|mmas Subparagraph (6) in Pmn+ graph C', Limits Of Insurance, of graph B.7., Policy Pe,imd, Coverage Territory, SECTION KU — COVERED AUTOS of SECTION |V — BUSINESS AUTO CONDU~ LIABILITY OOVERAGE, and not in TIONS: addition to such limit. Our duty to (@) Anywhere in the world, except any country or make such payments ends when we jurisdictionwhile any trade emnction, em' have used upthe applicable limit of bmrgo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pm~ meU|mmantm or defense expenses. hibits the transaction of business with or (b)This insurance isexcess over any valid within such country or jurisdiction, for Ouv- and oo||motikUe other insurance available eredAutos Liability Coverage for any covered tothe "insured"whether primary, excess, "auto" that you |oase, hire, rent or borrow contingent uronany other basis. without adriver for mperiod cf3Odays prless (m) This insurance is not m substitute for re - and that isnot mn "auto" you !emmm, hire, rent quirad or compulsory insurance in any or bonnvv from any of your "employees", country outside the United Stetes, its ter - partners (if you are m partnership), members Mturien and possessions, Puerto Rico and (if you are e limited liability company) or Canada. members nftheir households. Page 2 of @ 2015The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will coverage. not invalidate the coverage afforded by this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.l.b. and A.I.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no - M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 6. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by CA T3 63 02 15 O 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 .O 2015 The Travelers Indemnity Company. All rights reserved. CA T3 63 02 15 Inclddes copyrighted material of Insurance Services Office, Inc. with Its permission. Policy Number: 8108899N880 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The ibilowing is added to Paragraph A.1.c., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tonal insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in SECTION 11. 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an addi- tional insured person or organization Is the first named Insured when the written contract or agreement between you and that person or or- ganization, that Is signed and executed by you before the "bodily injury" or "property damage" occurs and that Is in effect during the policy pe- riod, requires this Insurance to be primary and non-contributory. CA T4 74 02 1511 Q 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. ��A�rcl cp�''�, WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) POLICY NUMBER: U13-4,1940442 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. Schedule 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 09/01/2018 Policy No. UB -4J940442 Endorsement No. Insured Engeo Inc. Premium Insurance Company Travelers Property Casualty Countersigned by DATE OF ISSUE: 1. . ST ASSIGN CA Page 1 of 1