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HomeMy WebLinkAboutFerma Corporation (5)P5260028002 A ®�CERTIFICATE 4F LIABILITY INSURANCE YY) TYPE OF INSURANCE 10/07/2022I 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(los) 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 LIC 0M77949 1-888-645-2248 MoShexry & Hudson, An A1era Group Company-RARE., 1901 S. Bascom Avenue Suite 1190 CO TACT _ PHONE 408 550_2130 �TM FAX 408-550 2119 (A r�Q, l x4) __. _" aC NOL EMAIL ADDRESS _ _._ .—.------ ------- — �_ _ INSURERfS�AFFORDING COVERAGE _! _ _--.---- NAIO# Campbell, CA 95008 STARR IND & LIAB CO 38318_ Charles M. Griswold T INSURED Forma Corporation _INSURERA: — — --_. INSURERS: HOMESITE INS CO 17221 _ INSURER C: Takia Marine Specialty insurance Compan Y.._ _ _ 23850 —� — INSURER D: 6639 Smith Avenue INSURER E. - :INSURER _ $ 100,000 00,000 �._...__ $ 10, 000 Newark, CA 94560 INSURER F : GOVERAGES CERTIFICATE NUVIRER- 66869506 tacv:c:nN: aumadcu. 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 A f5L SOAR _. -- — ' ___ POLICY NUMBER POLICY EFF MMID IY POLICY AXP MMID IYYYY LIMITS A GENERAL LIABILITY X X 1000025823221 10/01/2 10/01/23 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY l CLAIMS -MADE LX OCCUR —.0 CLAIMS -MADE I-XI DRgMIS_ O REITYED n-� I�REMISE5�(E arpy�rran�Coj__. MED EXP (Any ono parson _ $ 100,000 00,000 �._...__ $ 10, 000 PERSONAL & ADV INJURY _ $ 1,000,000 _ GENERAL AGGREGATE $2,000,000 — GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGG $ 2 000, 000 POLICY X PRO- LOC JECT _ __ �w.. ____ $-- A AUTOMOBILE LIABILITY X X 1000198707221 10/01/2 10/01/23 CO 61NED SINGLE LIMIT (Ea aoCi enter _$1_,T0 0, 000 ANY AUTO BODILY INJURY (Per person) $ 1_x ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Peracaldent ( ) $ NON -OWNED HIRED AUTOS R AUTOS PROERTYDAMAGE —� _Per ocident___�—�_„ _ T $ _ �—— $ B UMBRELLA LIASX_ OCCUR CXPOI062200 10/01/2 10/01/23 EACH OCCURRENCE $ 5,000,000 X EXCESS LIABv CLAIMS -MADE AGGREGATE ._ —LL$ 5,000,000 — — DED F RETENTION$ FOLLOW PORK $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNEPJEXECUTIVE OFFICERIMEMBEREXCLUDED? NIA X 1000004374 10/01/2 10/01/23 X WCSTATU• DTH• --S48Y_LIM_lIS_ R ---------- E.L. EACH ACCIDENT C $ 1,000,000 E.L. DISEASE - EA EMPLOYE _ —E E.L. DISEASE - POLICY LIMIT 1, 000, 000 $ 1,000,000 $ (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below C Protesvional Liability PPR 7 3 S ng a Aggregate M M C Pollution Liability PPK2471162 10/01/2 10/01/23 Single/Aggregate loM/lOM DESCRIPTION. OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 107, Additional Remarks Schedule, if more apace is required) _ RE: Encroachment Permit. Additional Insured: City of LOS Altos Hills. GER III IGAI E MOLDER CANCRI 1 ATIAN ACORD 25 (2010105) Grexelle24 66869506 ©1888.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of LOS Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26397 Fremont Road AUTHORIZED REPRESENTATIVE LOS Altos, CA 94022 0'" USA ACORD 25 (2010105) Grexelle24 66869506 ©1888.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P32601128002 SUPP (05/044) DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE ��....�.'•.� 10/07/2022 .� NAIVE OF INSURED: Forma Corporation �.o.,,____��..p. Ad I anal -Description of OAtAtlons/Remarks frO—M—Pa,0g,,1 Additional Info r t Qil: Includes; General Liabilitys Additional insured per forms attached CG20100413 and CG20370411.3. Coverage is Primary as required by written contract per from, attached 00 107 (04-11). Per Project Aggregate per attached Poria 0025030509. Waiver of Subrogation as required by written contracts per attached form CG24040509. Automobile 'Liability: Additional insured per attached form SICA-1016 (0919). Primary and Won -Contributory Wording per attached foam SICA-1017 (0919). Waiver of Subrogation per attached form CA04441013. Workers Compensation. Waiver of Subrogation per attached form WC040306 (Ed. 4-84). SUPP (05/044) P5260029002 o o ENV,] *Starr Indemnity& Liability Company O Dallas, TX 1.866-519-2522 Primary and Non -Contributory Condition Policy Number: 1000025823221 Effective Date: 10/01/2022 Named Insured: Ferma Corporation This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV — CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured Is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Founsel OG 107 (04/11) Page 1 of I Copyright @ C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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: Information if not shown Eabove, 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 P5260028002 POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. oIA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Rer a Requi r ed by W i t t on Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and formed! - cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. O Insurance Services Office, Inc., 2008 Page 1 of 2 ❑ is P5260028002 a N R E. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -- Coverage A, and for all medical expenses caused by accidents under Section I -- Coverage C, which cannot be attrib- uted only to ongoing operations at a single des- ignated construction project shown in the Sched- ule above. 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. Page 2 of 2 C. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. "rhe provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. 0 Insurance Services Office, Inc., 2008 CG 25 03 05 09 11 ilIIIIIp P5260028002 ■ o COMMERCIAL AUTO Starr Indemnity & Liability Company SICA-1016 (0919)ti O THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS AMENDATORY ENDORSEMENT Z Policy Number: 1000198707221 Effective Date: 10/1/2022 Named Insured: FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page, Please read the endorsement and respective policy(les) carefully. AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM It is hereby agreed that SECTION 11 — COVERED AUTOS LIABILITY COVERAGE, A. COVERAGE, 1. Who is An Insured of the Business Auto Coverage Form and Motor Carrier Coverage Form, and SECTION I — COVERED AUTOS COVERAGES, D. Covered Autos Liability Coverage, 2. Who Is An Insured of the Auto Dealers Coverage Form are amended to include the following: Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the less of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by such written contract or written agreement. All other terms and conditions of this Policy remain unchanged. SICA-1 016 (0919) Copyright@ Starr Indemnity & Liability Company, All rights reserved. Page 1 of I Includes copyrighted material of Insurance Services Office, Inc., with its permission. 115260028002 * Starr Indemnity & Liability Company COMMERCIAL AUTO SICA-1017 (0919) NOS= INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDJ AMENDATORY ENDORSMENT Policy Number: 1000198707221 Effective Date: 10/1/2022 Named Insured: FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page, Please read the endorsement and respective policy(ies) carefully. BUSINESS AUTO COVERAGE FORM SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 6. Other Insurance, C., is amended by the addition of the following: The Insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions of this Policy remain unchanged. SICA-1 017 (0919) Copyright 0 Starr Indemnity & Liability Company. All rights reserved. Page 1 of I Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 r- rszem02amn WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 Ed.04-84 y WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA w We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce 00 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.) N 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. 0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or or gani zat i on t o whom you becone obl i gat ed t o wai ve Wher a Requi r ed By W i t t en your r 1 ght s of r ecover y agai nst , under any cont r act or agr eermnt you Contract ent er i nt o pr i or t o t he occur r ence of I oss. 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: 10/01/2022 Policy No.: 1000004374 Endorsement No.: Insured: Ferma Corporation Premium: Insurance Company: STARR INDEMNITY & LIABILITY CO Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1 W McSherry & thidson, An Alera Group Company 1901 S. Bascom Avenue Suite 1190 Campbell, CA 95008 )Electronic Service :Requested SINGLE PIECE 6123 3.3477 SP 0.600 IIII°IIIIIIII'IIIIIIIilnh111111111111allJill III 'lan11111111111 Cit39y of Los Altos Hills 46 267 Fremont Road Los Altos, CA 94022 r r M This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement.- The data included in this notice and in the attached document is confidential to Bbix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www. ConfirmNet.00m - 877.669.6600 P3260028002 0 P5260028002 f6.O CERTIFICATE F LIABILITY INSURANCE DATE 1a/o7/2022 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 2022YY) 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($), 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 LIC #OM77949 1-888-845-2248 CONTAC MaSherry & Hudson, An Alera Group Company NAME: _ --- _PH4PHONE Q,0xt1 408-550-2130 (AC Nol_408-550-2119 1901 S. Bascom Avenue EMAIL ADDRESS_______e__ Suite 1190 EACH OCCURRENCE $ 1, 000, 0_0.0 Campbell, CA 95008 _ __. INSURERjS�AFFORDINGCOVERAGE �__ _NAIC# _ Charles M. Griswold T INSURERA: STARR IND & LIAB CO_ 38318 INSURED —� INSURERS: HOMESITE INS CO _ 17221 Ferma Corporation-- CLAIMS -MADE OCCUR INSURERC: Tokio Marine Specialty Insurance Compan 23850 T--- INSURER 0: _MED EXP An one parson) 6639 Smith Avenue INSURERS _ Newark, CA 94560 INSURER F: COVERAGES CERTIFICATE NUM®ER: 66878170 12MVIAInAI nil luno). 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 26397 Fremont Road POLICY NUMBER MMIDONYYYI (MMIDD[YYYY1 LIMITS A GENERAL LIABILITY X X 1000025823221 10/Q1/2 10/01/23 EACH OCCURRENCE $ 1, 000, 0_0.0 X COMMERCIAL GENERAL LIABILITY DARAUE—fo- LINIEp` PREMI ESE o urran e_,$ 100,OD0 —�— CLAIMS -MADE OCCUR _MED EXP An one parson) $ 10, 000 PERSONAL & ADV INJURY $ 1, 000, 000 _�Y• GENERAL AGGREGATE $ 2,000,000 GENIAGGREGATE LIMIT APPLIES PER:pRODUGTS-COMP/OP--AGG $2,000,0.00 POLICY X PRO• LOC - ._._...,._._,._�__-_$----...__ _._.._._ A AUTOMOBILE LIABILITY X X 1000198707221 10/01/2 10/01/23 COMBINED SINGLE.IMIT _(Eaorglrgnt. _____ _. 1,000,000_ X ANY AUTO BODILY INJURY (Per person) $ T ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (per accident) $ X NON•OWNED HIRED AUTOS X AUTOS PROPERTY 5-AWAGE — _(Per acgldent)�_, _. $ B UMBRELLA LIAS X _- OCCUR CXPOI062200 10/01/2 10/01/23 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAR A CLAIMS -MADE AGGREGATE -� $ 5,000,000 DED RETENTION �v FOLLOW FORM $ A WORKERS COMPENSATION X 1000004374 10/01/2 10/01/23 X WC STAT OTH• AND EMPLOYERS' LIABILITY YIN 'LIM1z5' :_E$,---------, ANY PROPRIETOR/PARTNER/EXECUTIVE E,LEACH ACCIDENT $ 1, 000, 000 OFFICER/MEMBER EXCLUDED? NIA _ _ _ E.L, DISEASE - EA EMPLOYEE - $ 1,000,000 (Mandatary In NH) f yes, describe under — -- E.L. DISEASE - POLICY LIMIT - $ 1,000,000 DESCRIPTION OF OPERATIONS below C Pro see onal Liability PPR 2 1 23 S ng a Aggregate 5M/10M C Pollution Liability PPK2471162 10/01/2 10/01/23 Single/Aggregate 10M/10M DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Encroachment Permit. Additional Insured: City of Los Altos Hills. CERTIFICATE HOLDER cANCFI I ArInm ACORD 26 (2010105) Grezelle24 66878170 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26397 Fremont Road AUTHORIZED REPRESENTATIVE Los Altos, CA 94022 9'" VSA ACORD 26 (2010105) Grezelle24 66878170 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P5200028002 SUPP (05/04) DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/07/2022 NAME OF INSURED: Ferma Corporation Addl anal DosorlDflon at O_pg tan /Remrks„fro_M age „1.,: Addltlonal 1nf4 rmatlon; Includes: 0eneral Liability: Additional Insured per forms attached CO20100413 and CO20370413. Coverage is Primary as required by written contract per from attached 00 107 (04.11). Per Project Aggregate per attached form 0025030509, Waiver of Subrogation as required by written contract: per attached form CG24040509. Automobile Liability: Additional Insured per attached form SICA-1016 (0919). Primary and Ion -Contributory Wording per attached form SICA-101,7 (0919). Waiver of Subrogation per attached form CA04441013. Workers Compensation: Waiver of Subrogation per attached form WC040306 (Ed. 4-84). SUPP (05/04) 1'3260028002 o WME aPOLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 26 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 01) 1 DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT > This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s). Mar a Aequl r ad by W I t t on Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by "occur- damages or under Coverage C for medical rences" under Section I — Coverage A, and for all expenses shall reduce the Designated Con - medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag - construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con - 1. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the, General Aggregate 4. The limits shown in the Declarations for Each Limit shown In the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appll- "property damage" Included In the "products- cable Designated Construction Project Gen - completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 @ Insurance Services Office, Inc,, 2008 Page 1 of 2 0 P5260028002 o B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -- Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be attrib- uted only to ongoing operations at a single des- ignated construction project shown in the Sched- ule above; 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit, Page 2 of 2 G. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- jecL B. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. © Insurance Services Office, Inc., 2008 CG 25 03 05 09 0 P5260028002 POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Ormaniaation(s) Wer a Requi r ed by W i t t en Cont r act SCHEDULE Location And Description Of Complete ner a Paqui r ed by W i t t on Cont r act information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 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. 0 Insurance Services Office, Inc., 2012 Page 1 of 1 N W P5260028002 *Starr Indemnity & Liability Company Dallas, TX 1.866-519-2522 Primary and Non -Contributory Condition Policy Number: 1000026823221 Effective Date: 10/01/2W.,!2 Named Insured: Forma Corporation This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV – CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph U. of the Other Inmirance condition: This insurance is primary insurance as respects Our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President 'N—oheivilath E. Ginsburg, Jen—e–ra--Iounsel OG 107 (04/11) Pageh1 of 1 Copyright 0 C. V. Starr & Company and Starr Indemnity 8, Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. W POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 011 LVA, ilo]■ r ~ - ;11 1 rZ 114111111 ■131"am 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: Information required to complete this 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 0 Insurance Services Office, Inc., 2008 Page 1 of 1 13 W 2 0 5 0 POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED O'W'NERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART &Tq-!1gf'1. Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations V+her a Requl r ed by W i t t on Cont r act Wer a Requi r ed by W i t t on Cont r act Information required to com Jete 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 organlzatlon(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 2010 0413 13. 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. 0 Insurance Services Office, Inc., 2012 Page 1 of 2 P5260028002 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 Page 2 of 2 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. © Insurance Services Office, Inc., 2012 CC 2010 0413 9 P5260028002 e 11111011111 R POLICY NUMBER: 1000198707221 COMMERCIAL. AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: FERMA CORPORATION Endorsement Effective Date: 1011/2022 Name(s) Of Person(s) Or Organization(s): Where Required by W i t t en Cont r act Information required to com latethis Serif not shown above, will be shown in the Declarations,_. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 11.5260028002 McSherry & Iludsou, An Alera Group Company 1901 S. Bascom Avenue Suite 1190 Campbell, CA 95008 202210t03916 Electronic Service Requested SINGLE PIECE 6123 3.3477 SP 0.600 IIII'IIIlllll°IIIIIIIII'el®II'III°Io111alllll°I°I��°'°I°In1I�Il° City of Los Altos Hills 86 26397 Fremont Road Los Altos, CA 94022 �, r it '■ �. r r This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed .. on the notice of cancellation/reinstatement.- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertiflcatesNow - www.ConfirmNet.com - 877.669.8600 a i'szeoozsooz M POLICY NUMBER; 1000025823221 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ► �Ilrol I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Mer a Paqui r ed by W t t en Cont r act n And Desai W4er a Requi r ed by W 1 t t en Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 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. O Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 1000025823221 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s Location a Of Covered Operations W4er a Requi r ed by W i t t en Cont r act Wer a Requi r ed by W i t t en Cont r act Information required to corn lete 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 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. 0 Insurance Services Office, Inc., 2012 Page 1 of 2 M w O 2 P5260 028002 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 Page 2 of 2 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. © Insurance Services Office, Inc., 2012 CG 2010 0418 h, w N P5260028002 COMIAt",11CIIAL AUTO *Starr Indemnity & Liability Company SICA-1017 (09-19) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS AMENDATORY ENDORSMENT Policy Number; 1000198707221 Effective Date: 10/1/2022 Named Insured- FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(les) carefully. BUSINESS AUTO COVERAGE FORM SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other insurance, c., is amended by the addition of the following: The insurance afforded under this policy to an additional insured will apply as primary Insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident, All other terms and conditions of this Policy remain unchanged. SICA-1 017 (0919) Copyright @ Starr Indemnity & Liability Company. All rights reserved. Page 1 of I Includes copyrighted material of Insurance Services Office, Inc., with its permission. P5260028002 ry COMMERCIAL AUTO Starr Indemnity & Liability Company 5ICA-1016 (0919) VAN O THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS P AMENDATORY ENDORSEMENT Policy Number: 1000198707221 Effective Date: 10/1/2022 Named Insured: FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(les) carefully, AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM It is hereby agreed that SECTION 11 — COVERED AUTOS LIABILITY COVERAGE, A. COVERAGE, 1. Who Is An Insured of the Business Auto Coverage Form and Motor Carrier Coverage Form, and SECTION I — COVERED AUTOS COVERAGE$, D. Covered Autos Liability Coverage, 2. Who Is An Insured of the Auto Dealers Coverage Form are amended to include the following: Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the less of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by such written contract or written agreement. All other terms and conditions of this Policy remain unchanged, SICA-1 016 (0919) Copyright @ Starr Indemnity & Liability Company. All rights reserved. Page 1 of I Includes copyrighted material of Insurance Services Office, Inc., with its permission. a POLICY NUMBER: 1000198707221 COMMERCIAL AUTO co CA 04 44 10 13 u.. 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) W This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the Inception date of the policy unless another date is indicated below. Named Insured: FERMA CORPORATION Endorsement Effective Date: 10/1/2022 ;•x`3:1-� �1�J �1 Or Wer a Requl r ed by W" i t t on Cont r act be The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organizations) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 4410 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 P5260028002 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 -- (Ed 04-84) NO w WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA ° 0 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.) M You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. P. The additional premium for this endorsement shall be 2. 0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Any person or organ! zat 1 on t o whom you becorre obl 1 gat ed t o wai ve your r 1 ght s of r ecover y agar nst , under any cont r act or agr eerrent you ent er I nt o pr 1 or t o t he occur r ence of I oss. Job Description Where lgequl red By Witten Dont r act This endorsement changes the policy to which It 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: 10/01/2022 Policy No,: 1000004374 Endorsement No.: Insured: Ferma Corporation Premium: Insurance Company: STARR INDEMNITY & LIABILITY CO Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1 7=