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HomeMy WebLinkAbout4Leaf, Inc. 03.12.2026 V2��►1�"�� CERTIFICATE QF LIABILITY INSURANCE DATE (MM/DD/Y�YYY) �kv �,,. 03/12/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TYPE OF INSURANCE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES WVD BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED POLICY EFF MM/DD/YYYY REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. LIMITS IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. COMMERCIAL GENERAL LIABILITY CLAIMS-MADE®OCCUR 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 Brent Nishikawa NAME: DA A E RENTED 1,000,000 PREMISES (Ea occurrence) $ The Liberty Company Insurance Brokers PHONE (888) 918-3960 FAX A/C No Ext): A/C, No): Lic #OD79653 E-MAIL bnishikawa@libertycompany.com ADDRESS: A 5955 De Soto Ave, Ste 250 INSURER(S) AFFORDING COVERAGE NAIC # Woodland Hills CA 91367 INSURER A: Travelers Property Casualty Co of America 25674 INSURED INSURER B : The Travelers Indemnity Co of CT 25682 4Leaf, Inc. INSURER'C : Berkshire Hathaway Homestate Insurance Company 20044 2126 Rheem DrINsuREIR : Pacific Insurance Company, Limited 10046 INSURER E: $ Pleasanton CA 94588 INSURER F: COVERAGES r'.FRTIFIC`ATF MI IMRFR- ZULti 0=%/1Q1f%K1 A11111APPO- 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 ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE®OCCUR EACH OCCURRENCE $ 1,000,000 DA A E RENTED 1,000,000 PREMISES (Ea occurrence) $ MED EXP (Any one person) $ 5,000 A Y Y 6600519865A 03/15/2026 03/15/2027 PERSONAL &ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- ❑ JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident)$ 1,000,000 X ANYAUTO BODILY INJURY (Per person) $ B OWNED X SCHEDULED AUTOS ONLY X AUTOS Y Y BAC4831196 03/15/2026 03/15/2027 BODILY INJURY (Per accident) $ X HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS -MADE CUPC4831922 03/15/2026 03/15/2027 AGGREGATE $ 6,000,000 DED I X1 RETENTION $ 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A Y FOWC725735 03/15/2026 03/15/2027 X1 PER STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,0001000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liability Retroactive Date: 04/01/2007 130HO881505-26 03/15/2026 03/15/2027 Per Claim $5,000,000 Aggregate $5,000,000 Retention $50,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Los Altos, its officers, officials, employees, and volunteers are named as Additional Insured as respects to General Liability and Automobile Liability per attached endorsements. General Liability and Automobile Liability policies are Primary and Non -Contributory per attached endorsements. Waivers of Subrogation apply on General Liability, Automobile Liability and Workers' Compensation policies per attached endorsements. Excess Liability Follows Form over General Liability, Automobile Liability and Employers' Liability policies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Los Altos ACCORDANCE WITH THE POLICY PROVISIONS. 26379 W Fremont Rd AUTHORIZED REPRESENTATIVE A r Los Altos Hills CA 94022 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Additional Named Insureds f OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION 11. — WHO IS AN INSURED: Any person or organization that you agree in- a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury",. "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions Of you or your subcontractor in the performance of "your work" to which the. "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independe'nt acts or omissions of such person or organization; or d. For "bodily injury", . "property damage" or 4'personal injury" for which such, person or organization has assumed liability in a contract ontract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another. endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown. in the Declarations exceed the limits of -liability required by the "written contract requiring insurancelf the insurance provided to the additional insured shall be limited to the. limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. ho This insurance does not apply to "bodily injury" or "property damage" caused, by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of. the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever --is earlier. 2. The . following is added to Paragraph 4.a. of SECTION IV COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. -However,.-if you. specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to. other, insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: .(I) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided .to. the additional insured still is excess over valid ,and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person. or organization .is an additional insured under any other insurance. CG D3 8.1 09 15 @ 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8, Transfer 4. The following definition is added to the --- ------ --Of---Rights 0 -f -Recovery Against Others To Us DEFINITIONS Section: of SECTION IV - COMMERCIAL GENERAL Written contract. requiring insurance" means that LIABILITY CONDITIONS: part of. any written contract under which you are We waive any right of recovery we. may have required to include aperson or organization as an against any person, or organization because of additional insured. on this Coverage Part payments we make for "bodily injury "property provided that the ."bodily i nj u ryand "property" damage" or "personal injury" arising out, of .."your damage" occurs and the "personal injury" is work!' performed by you, or on your behalf,.done caused by an offense committed: under a "written contract requiring insurance" with that person or organization. We. waive this right a.. After yo u have s i g n ed t h at writte n co ntract; only where you have agreed to do so.. as part of bu While that part of the written contract is in the, "written contract r equirling insurance" with effect; and such person. or organization signed by you "bodil c.Before the end of the policy period. before,.and in effect when, the y injury" or , property damage" occurs, or the "personal. injury' offense is committed. Page 2'of 2 @ 2015 The Travelers Indemnity Company, All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY— OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED -OPERATIONS LIABILITY COVERAGE PART The following is added to the - Other -Inturance (1) The additional insured is a Named Condition and supersedes any provision to the Insured under such other insurance; and contrary: (2) You have agreed in writing in a contract Primary And Noncontributory Insurance or agreement that this insurance would This insurance is primary to and will not seek be primary and would not seek contribution from any other insurance available contribution from any other insurance to an additional insured under your policy available to the additional insured, provided that: CG 20 01 12 19 C Insurance Services Office, Inc.,, 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS EN DORSEM ENT- CH.A.'NGES1,TH E POLICY. PLEASE READ IT CAREFULLY, STEN d EN DORSEMIEN-TF'OR�.�.AR.CH:ITE'CTS.1 ENGINEERS AN USURVEYORS. This endorsement modifies insurance provided: under the following: COMMERCIAL GENERAL LIABILITY COVERAGE -,PART: GENERAL DESCRIPTION OF COVERAGE. This endorsementbro'adenSr -coverage. However, coverage for any injury, damage or medical expenses:, described in any of 1he, provisions of this endorsement may be excluded or limited by another endorsement -to. this Coverage Part, and ,thes..e, coverage broadening provisions do not apply to the extent that coverage is .excluded or limited by such an'endarsement. The following listing.is a general coverage description only. Read. all theprovisions of this, endorsement and the rest of your policy carefully to determine rights, duties, and,..W" is and is not covered, An Non -Owned Watercraft — 75 Feet Long Or Less HN Blanket. Additional Insured Governmental B. Who Is An Insured — Unnamed Subsidiaries EntitiesPermits.Or Authorizations Relating To Premises. C. Who Is An Insured — Retired Partners, Members, I. Blanket Additional Insured Governmental Directors And Employees Entities — Permits Or Authorizations Relating To D. Who Is An Insured — Employees And - Volunteer . Operations Workers — Bodily Injury To Co -Emplo'yee's, Co-.. Volunteer Workers And Retired Partners, in Incidental Medical Malpractice Members, Directors And Employees K. Medical Payments --..Increased Limit E. Who Is An Insured — Newly Acquired Or Formed L. Amendment Of. Excess Insurance Condition — Limited Liability Companies Professional. Liability F. Blanket Additional Insured— Controlling InterestWhen Required M. Blanket Waiver Of Subrogation G. Blanket Additional Insured — Mortgagees, By Written Contract Or Agreement Assignees, Successors Or Receivers N. Contractual Liability — Railroads PROVISIONS A. NON -OWNED WATERCRAFT 75 FEET LONG OR LESS 1. The following replaces Paragraph .(2) of Exclusion g., Aircraft, Auto Or Watercrat, in Paragraph 2. of SECTION 1. COVERAGES — COVERAGE A — BODILY. INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) 75 feet long or less; and (b) Not being used to carryanyperson or property for a charge; 2. The following replaces Paragraph 2.e. of SECTION 11 — WHO IS AN INSURED: e. Any person or organization that, with your express or implied consent, either uses, or is responsible for the use of a watercraft that you do not own that is: (1) 75 feet long or less; and (2) Not being used to carry any person or property for a charge; B. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is -added to. SECTION 11 — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and CG D3 79 02 19 @ 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc. With its permission. I -COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date,. if any, during, the policy period that you no longer maintain an ownership interest of more than 50% in such. Subsidiary. For purposes of Paragraph 1. of Section 11 —Who Is An Insured, each.. such subs idiary will. be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the . documents that govern its structure. C. WHO IS AN'INSURED— RETIRED *PARTNERS, M EMBERS, --DIRECTORS AND, EMPLOYEES The following is added- to, Paragraph 2. of SECTION 11 — WHO IS AN INSURED., Any person who is your retired partfler,'member, director or "employee" that is performing services for you under your direct:supervision,: but only for acts within the scope of their .employment by. you or while performing duties. related to the conduct of ----your-- -business. ----However,. no such- retired partner, member, director or "'employee" is an insured for: (1) "Bodily injury': (a) To you to --your current partners or members (if you. are a �.:partnership or joint venture), � to. your current .,.members (if you are a Jimited liability company) or to your current directors, (b) To the spouse; ,child, parent,` brother or sister of that current partner, me'mber or director as 'a consequence quence of Paragraph (1)(a) above; (c) For which. the . re is any obligation to share damages with or repay. . :someone else who must pay damages s . because of the injury described.• in Paragraph (1)(a) or(b) above; or (d) Arising out of. his- or her providing or failing to provide professional health care services. Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your retired partners, members, directors or "employees", other than a doctor. Any such retired partners, members, directors or employees" providing or failing to provide first aid or "Good Sam aritan services" during their work hours for you will be deemed to be acting ' within the scope of their employment by you or performing duties related to the conduct of your business. (2) '.'Personal injury"; (a) Toyou, to your current or retired partners or members (if you are a partnership or joint venture), to your ..current or retired members (if you are a limited liability company), to your other current or retired directors or .,"..employees" while in the course of his or her employment or performing duties related to the conduct of -yourbusiness, or your other "volunteer workers" �.while performing duties related to the conduct of your business; .(b) To'..the spouse, child, parent, brother or sister of that current or retired partner, member, director, "employee" or ."volunteer worker' as a consequence of Paragraph (2)(a) above; {o) ---For -- which, --there--is- any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (2)(a) or (0) above; or (d) Arising out of his or her providing or -failing. to provide professional health care services. 13) "Property damage" to property: (a) Owned, occupied or used by; or (b) Rented to, in the care, custody or control ofl': 'or over which physical control is being exercised for any purpose by; you, any of your retired partners, members or directors, your current or retired A"employees" or "volunteer workers", any current partner or member (if you are a partnership or joint venture), or any current member (if you are a limited liability company) or current director. Page 2 of 6 Q 2017 TheTravelersIndemnity Company. All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Offic6, Inc. with its permission. Q 9 WHO IS AN INSURED EMPLOYEES: ANP' VOLUNTEER WORKERS BODILY-, TO CO -EMPLOYEES, CO -VOLUNTEER WORKERS AND RETIRED PARTNERS,. MEMBERS, DIRECTORSANDEMPLOYEES The following is added to Paragraph.: SECTION 11 —WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above'. do apply to, "bodily injury" to A.current or theco retired --co- '': - employee" whi.le. in the* courseOf, , "employee's"employment by you. or performing.. duties related to the conduct of your busin'ess,. or, to your oth: r 'vivo 0 '. r' to "bodily injury e I 'htoe workers" or retired partners,, members. ar directors while performing duties. related.t(o.,:th'e conduct of your business. WHO IS AN INSURED — NEWLY ACQUIRED,'. OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph. 3. of SECTION 11 —WHO IS AN INSURED:'.. 3. Any organization you newly .acquire or -for' other than a partnership or joint venture - and of which- you are the sole owner . or in which you maintain an ownership interest. `of more than 50%, will qualify as a. Nanied -Insuredif there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only: (1) Until.the 180th day after you acquire uire or form the organization- or the, end of the policy period, whichever is earlier, if you,do not report port such, organization in, writing to us within 180 days after you acquire or form it,., or (2) Until the end of the policy perio . d, when that date is'laterthan 180.d.ays after you -acquire or form. such .organization, if' you report such organization in writing to us within 180 days after you acquire - or form it; b. Coverage A does not apply to '.'bodily injury" or "property damage.". that occurred before you acquired o formed the organization; and c. Coverage B does not apply toPerso.nal and advertising injury' arising out of' an offense committed before you acquired or formed the organization. Forthe purposes of Paragraph 1. of Section 11 — Who Is An Insured, each such COMMERCIAL GENERAL LIABILITY w be deemed to be organization JR designated . ig''hated in, the. Declarations as: a.A-limited liability. company; b.. An'organization other than a partnership, -joint venture or 'limited liability company; or cm, A trust as,, indicated in its ..name or the documents that Q-6V6ro its structure. F. BLANKET ADDITIONAL INSURED CONTROLLING INTEREST 1, The. following is* added to SECTION 11 WHO: IS'- AN... INSURED: AnyP. lerson or;. organization that has financial . . . .control of., you , is an insured. with respect to liabil.ity',for , "bodily injury". "property damage" or, "personal and 'advertising injury" that arises out of: Such financial control; or. b. Such person's or organization's ownrshipy- maintenance or use of premises. leased to or, occupied by you. The. insurance. provided to such person or organization does. .-not apply to structural ...alteratio,ns,, new --construction or demolition operations performed by or on behalf of such Person. or organization. 2.The following is added to Paragraph 4. of SECTION 11 WHO IS AN INSURED: This.. paragraph does not apply to any premises owner, manager or lessor that has financial control .of you. G. BLANKET ADDITIONAL INSURED MORTGAGEESw� ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION 11 — WHO IS AN INSURED: .Any person or organization that is a mortgagee, assignee, . successor or receiver and that you have', agreed in a written contract or agreement to include as an additional insured on this ,Coverage Part is an Insured, but only with respect to its -liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage"' or "personal. and, advertising injury' that: a. Is "bodily injury" or "property damage" that occurs, or is "personal and advertising injury' caused. by an offense that is committed, CG D3 79 02 19 @ 2017 The Travelers Indemnity Company. All. rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or agreement; and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver is required under that contract or agreement to be included as an additional., insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insuranceprovided to such mortgagee, assignee, successor or receiver will be -the minimum limits that 1you, agreed to provide in the written contract or agreement, reement, or the limits shown in 'the Declarations, whichever are less. b. The insurance. provided to such person or organization does not apply to: (1) Any bodily injury: or property: damage" that occurs, or any ."personal and advertising injury' caused .-by.a.6 offense that is- committed, - after--- such -.-contract or agreement is nolonger in effect; or (2) Any "bodily injury",. "property damage" ell or "personal and advertising. injury" arising out of any structural, -alterations, new construction or -demolition',.operations performed by: or - on. behalf of. such mortgagee, assignee,.,. successor or receiver. H. BLANKET ADDITIONAL INSURED.. GOVERNMENTAL ENTITIES PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added .to SECTION 1,1:— WHO IS AN INSURED: Any governmental entity that. has issued .a. permit or authorization with respect to premises owned or occupied by, or rented or -loaned .to'you and that you are requiredbyany. ord'inan'ce,. law, building code or written *contract or agreement to include as an additional insured. o . n this Coverage Part is an insured,'',' but. only with. respect to liability for "bodily in.jury1', "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair,. - construction,- erection or removal of any ofthe folloWingfor. which that governmental entity, has., issued.. such..,permit or authorization: advertising. - -signs:,-awnings, canopies, cellar entrances., coal holes, driveways, manholes, marquees, hoist. 'away openings, sidewalk vaults, elevators, street banners or decorations. I. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES PERMITS OR.. AUTHORIZATIONS RELATING TO :OPERATIONS Thefollowing is added to SECTION 11 —WHO IS AN INSURED: Any governmental. entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you arerequired by any ordinance, law, building code or written contract or agreement to include as an additional insured on, this Coverage Part is an insured, but only with respect to liability for ."bodily injury", "property damage" or "personal . and advertising injury" arising out of such operations. o0s. The. -insurance provided to such governmental ..entity:does not apply to: .a.... Any. "bodily injury", "property damage" or personal'and advertising injury" arising out of operations performed for the governmental entity; or sb.,-* Any "bodily injury" or "property damage" .Iincluded in the "prod ucts-completed operations hazard'. J. INCIDENTAL MEDICAL MALPRACTICE 1. The -following replaces Paragraph b. of the `.definition of lloccurrencell in the DEFINITIONS -Section: b.,.. An ;act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good :Samaritan services" to a person, unless you are in the business or occupation of ....:providing professional health care services.. 2* The following replaces the last paragraph of Paragraph 2.a.(I) of SECTION 1.1 — WHO IS ..-AN INSURED.* Unless.you. are in the business or occupation of. providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) abovedo not apply to "bodily injury" arising out, of providing or failing to provide: (a) "Incidental medical services" by any of you.r "employees" who is a nurse, nurse,, assistant, emergency medical Jechnician, paramedic, athletic trainer, audiologist, dietician, nutritionist, Page 4 of 6 @ 2017 The Travelers Indemnity Company. All: rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. occupational therapist or., occupational. therapy assistant, physical 'therapist:. or speech-language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunte.e:r workers", other than an- employed or volunteer doctor. Any such "employees" or "volunteer workers'" providing or fai_Iirtg to provide first aid or "'Good Samaritan services' during their work hours far you will be deemed to be acting within th ie scope of their employment by you `or performing duties related to..the .conduct of your business. 3. The following replaces the last sentence...of Paragraph 5. of SECTION 111 - LIMITS; F . INSURANCE: For the purposes of determining :. . the applicable. Each occurrence Limit, all related acts or omissions committed in providing. or failing to provide ..incidental medical services", first aid or "Good Samaritan services" to any oneperson will be deemed to be one "occurrence".. 4. The following exclusion is added to Paragraph 2., Exclusions,. of SECTIO -N .I ;- COVERAGES — COVERAGE A .�. BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising. out. of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals cornmitted . by or with the knowledge or consent of the 'insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the. related. furnishing of food or beverages; or b. The furnishing or dispensing.of drugs or medical, dental, or surgical: f supplies or appliances. 8. The following is added to Paragraph.. 4.b., Excess Insurance, of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, ...COMMERCIAL GENERAL LIABILITY that is ' available .to. any of your "employees" fcr ""bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject `to Paragraph 2.a.(1) of Section II — Who Is An Insured. K. MEDICAL PAYMENTS - INCREASED LIMIT The following replaces Paragraph 7. of SECTION 111 LIMITS OF INSURANCE: 7.. subject to Paragraph 5.. above, the Medical Expense Limit is the most we will pay under Coverage. C for all medical expenses .because of - "bodily injury" sustained by any oneperson, and will be the higher of: a $1 o,00 oiro. b. The -amount shown in the Declarations of this Coverage- Part for Medical Expense L. AMENDMENT of EXCESS INSURANCE CONDITION —.PROFESSIONAL LIABILITY The following ' is. added to Paragraph 4.b., Excess Insurance., .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, that is Professional Liability. or. similar coverage,. to the extent the loss .'.is not subjpet to the professional services exclusion of.Coverage A or Coverage B. M. BLANKET WAIVER OF SUBROGATION WHEN. REQUIRED BY WRITTEN CONTRACT .OR AGREEMENT` The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS. If the insured has. agreed in a written contract or agreement to waive that insured's right of recovery against arty person or organization, we waive our right of recovery against such person or organization, but only for payment's we make because of a. "Bodily.*.injury". or "property damage" that oQcu rs or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the signing of that contract or agreement. CG D3 79 02 19 @ 2017 The Travelers. Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or, license. agreement; 2. Paragraph f.(1) of the 'definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 @ 2017 The Travelers Indemnity Com,p'any. All rights reserved. Includes copyrighted material of Insurance Services office, Inc. with its permission. CG D3 79 02 19 ADDRESS: PROVISIONS If we cannel this policy for any legally permitted- reason other than nonpayment of premium, and a number of days is shown for Cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in such schedule. We will mail such. notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 0 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 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 theprovisions 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 right's 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.lo Paragraph- A.1.,Who Is An Insured, of SECTION. 11 COVERED AUTOS __._L.1A81_L1TY_C_OVERA0E: Any organization you I newly- acquire or form dur- ing the policy period -over which you maintain 50% or more ownership- interest and that is not separately insured far Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after. yo.u; adq.uire or*.fo.rm the or- ganization or -the end 'of the, policy.. period, which- ever is earlier.. B. BLANKET ADDITIONAL -INSURED The following is added to Para''graph.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 orga * nizatio'n, that :is signed and executed by you -� before the. lhe.,.. "bodily in jury"' or '"property damage" Occurs and that is in effect during the policy period, Jote''named as an addi- tional insured is an "insured". for.'Covered Autos Liability Coverage, but. only for'dam.ages to which H. HIRED AUTO. PHYSICAL DAMAGE —LOSS OF USE— INCREASED LIMIT I. .PHYSICAL DAMAGE TRANSPORTATION ..EXPENSES = INCREASED LIMIT im. PERSONAL PROPERTY KN' AIRBAGS'. L. NOTICE AND, KNOWLEDGE OF ACCIDENT OR LOSS: M BLANKET WAIVER OF SUBROGATION No. UNINTENTIONAL ERRORS OR OMISSIONS this-Jns.urance applies and only to the extent that person.- or.. organization qualifies as an "insured" ,under he Who.ls An Insured provision contained in.Section 11. C. EMPLOYEE HIRED AUTO IN The following is added to Paragraph A.1., ........Who Is An Insured, of SECTION 11 — COV- ERE,DAUTOS LIABILITY COVERAGE: An"e.,mployee of yours is an "insured" while o pe rati ng 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 2015 -The Travelers avelers Indemnity Company..All rights S reserved. Page 1 of 4 Includes co � Office I nc. with its permission. pyrighted material of Insurance Services COMMERCIAL AUTO permission, while-. perform -in -g. 'duties related to the conduct- -of'.. your'. bu.si" ness, However, any "auto" that is leased,. hired, rentedor borrowed with a. driver is a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.I.,..',Who . Is An Insured, of SECTION. 11. COVE RE-DAUTOS . LIABILITY COVERAGE: Any "employee" of yours is an "insured':'while us- ing a covered "auto','you don't own, h. i rOor bo rrow in your business or your personal affairs.-,. EN SUPPLEMENTARY PAYMENTS INCREASE.,!) LIMITS I The following replaces Paragraph.. A.2.,a.(2),- of SECTION 11- COVERED AUTOS. LIABI.L= ITY COVERAGE: (2) Up to $3,000 for cost of. bail. bonds `(in_ eluding bonds for related. traffic. law 'viola', - tions) required because o , �f an -,"Accident" .we cover. We do not have ..fo'. furnish these bonds. 2. The following replaces Paragraph,'. A.2.a.(4), of SECTION 11 — COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses.,. incurred ,.by the. "insured" at our request, including actual loss of earnings up to $50,0'a:,:'da y be. cause of time off from work..,.... , F. HIRED AUTO — LIMITED WORLDWIOE.Cov*_ .ERAGE INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period,, Coverage Territ'Ory, of SECTION IV BUSINESS AUTO CONDI-. TIONS: (5) Anywhere in the world, except ,.any ceuntry or jurisdiction while any trade- sanction, - em" bargo, or similar regulation., imposed. by, the United States of America applies:: to. �pro- hibits the transaction of business. with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for.any covered "auto" that you lease, hire, rent'. - or borrow without a driver for a period of.30 days or.less and that is not an "auto" you lease,- hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company). or members of their households. (a) With respeet.Jo. any claim. made or "suit" brought outside the United States of America; er'�icclj* theterritories and possessions . of.the :.United .. States of America, Puerto Rico and, Canada-., 0) You must arrange to defend the "in- ..,sured!!. aqai'n st, and investigate or set- :tle.'a'ny: such claim or "suit" and keep us advised of all proceedings and ac- tio . ns.-, (ii) Neither "'yOU nor any other involved "insured" will. make any settlement ..without our consent. (i,ii) we .may, {at our discretion, in defend.i-ng the "insured"against, or in. the settlement of, any claim or 1.1su it".. (iv).:We.:will.:reimburse the "insured" for sums that the "insured" legally must pay . As Aamacies because of "bodily injury" orProperty damage" to which this. insurance applies, that the* "in- ....'sured'. pays with our consent, but only upJo the limit described in Para- graph ':',C.., Limits Of Insurance, of SECTION -11 COVERED AUTOS LIABILITY COVERAGE.. (V) :Wo.,will re.O.,burse the "insured" for the' reasonable expenses incurred with our consent for your investiga- ......t.ion:..Of-.such .'elai.ms and your defense of.'. th e'.."i.ns..0 red" against any such ...'suit" but only up to and included .,wifhJ,n, the limit described in Para- graph, C.., Limits Of Insurance, of .SECTION 11 COVERED AUTOS LIABILITY COVERAGE and not in addition to such limit. Our duty to Mahe such- payments ends when we .:.haveused up the applicable limit of insurance -in. payments for damages, settleme'nts'or defense expenses. (b} This: insurance is, excess over any valid and - collectible other insurance available to the ..'.'insu red" whether primary, excess, contingent- or on any other basis. (c) This insurance is not. a substitute for re- quired or co M'pufsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada.. Page 2 of 4 @ 2015 The Travelers (ndemnity Company.. All .rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office Inc. with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance- in any such coun- This covers e applies onlyin the event of a total g pp t u to the minimum limlits required b try p q Y theft of your covered "auto". "" local law. Your failure to comply with compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. 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- cions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: {d} It is understood that we are not an admit- I Exclusion. 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in - United States of America,. its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth: in Paragraphs A.I.b. and A.I.c., but ada. we assume no responsibility for the only: furnishing of certificates of ' insurance, or a'. If that. "auto" is a covered "auto" for Com pre - for compliance in any way with the laws hensive Coverage under this policy; of other countries relating..to insurance. b. The airbags are not covered under an - . g Y war G. WAIVER OF DEDUCTIBLE -- GLASS ranty; and The following is added to Paragraph ,a., Deducti- c.- The airbags were not intentionally inflated. ble, of SECTION. III - PHYS.ICAL- DAMAGE we will a u to a maximum of $1,000 for an pay p Y COVERAGE: ", one loss . No deductible for a covered 'auto"" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The. following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF SECTION IV.— BUSINESS AUTO CONDITIONS: USE -- INCREASED LIMIT Your dut to ive us or our authorized re resenta- Y g p The following replaces the -last sentence .of Para- tive prompt notice of the "accident" or "loss" ap- graph AA,b., Loss Of Use Expenses,,. of SEC- plies. only when the "accident" or "loss" is known TION III — PHYSICAL DAMAGE Co10ERAGE: to: However, the most we will pay for any expenses () You {if you are an individual}; for loss of use is $65 per day, to a maximum of (b) A.partner (if you are a partnership); $750 for any one "accident". A�n�err�ber if ou are a limited liab'lit com- (c) { Y liability I. PHYSICAL DAMAGE - .. TRANSPORTATIONpuny}; EXPENSES — INCREASED LIMIT ` (d): d An. executive officer, director or insurance The following replaces the first sentence in . Para- manager (if you are a corporation or other or - graph A.4..a., Transportation. Expenses, : of g.anization); or SECTION III — PHY 1CAL DAMAGE COVER- (e) Any "employee" authorized by you to give no AGE: tice of the "accident" or "loss". We will pay up to '$56 per: day to a., maximum of M.* BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- . following replaces Paragraph A.5., Transfer curre.d by you because of the tota.li. theft of a cov- , ,The of Ri hts Of Recovery Against Others To Us g � g Bred ""auto'" of the private passenger~ typo. p _ of SECTION IV BUSINESS AUTO CONDIINS J. PERSONAL PROPERTY TIONS::: The following is added. to Paragraph AA., Cover- 5. Tran' sfer Of Rights Of Recovery Against age Extensions, of SECTION III - PHYSICAL Others To Us DAMAGE COVERAGE: W.e. waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for -'loss"' to wearing ap- signed and executed prior to any "accident" panel and other personal property which is:or "loss" provided that the ""accident'" or "loss" (1) Owned by an "insured""; and arises. out of operations contemplated by CA T3 53 02 15 @ 2015 The Travelers Indemnity Company, All rights reserved. Page 3 of 4 Includes copyrighted material of :Insurance Services Office, Inc. with its permission. ENDORSEMENT NO:O This endorsement, effective 12:01 am, -03/15/2026 forms part RUN II® ent to � with (D) If the Insurer cancels this Policy, unearned premium shall* be calculated on a pro rata basis. If the Named Entity cancels this Policy, unearned premium s.h ll be calculated. at -the Insurer's customary short rates. Payment of any unearned premium shall not be a condition precedent to the effectiveness of a cancellation. The Insurer shall make payment of any unearned prernium which.it received from the Named Entity as soon as practicable. . CHANGES IN EXPOSURE Solely with respect to all Liability.* c era aParts: 4A) or Created. .. a r created ie extent t only for available )n, or for WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 r. (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROMOTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly .to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization: Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Prermi:urn All Other States Operations 9.00 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 onlywhen this endorsement 'is issued subsequent to preparation of the policy.) Endorsement Effective: 03/15/2026 Policy No:: FOWC725735 Endorsement No.: Insured: Premium Insurance Company: Berkshire Hathaway Homestate Ins Co WC 00 03 13 Countersi ned b g y (Ed. 4-84) ©1983 National Council on Compensation Insurance WORKERS COMPENSATION AND EMPLOYERS -LIABILITY. INSU.RANC,E POLICY WC 99 06 07 E .(Ed. 01-22) CALIFORNIA..GANCIELLrATION .END.ORSEiVIENT.. This endorsement applies only to the insurance ,' provided by- the policy because California is shown in Item 3.A, of the Information Page. The cancellation condition in Part Six ,(Conditions) of the policy is replaced by these conditions: Cancellation: 1. You may cancelfihis policy. You must rail or deliver advance.wntten notice to us stating when the cancellation is to take effect. 2. We may cancel this policy for one. or more of`the -following reasons: a. Non-payment of. premium; b. Failure .to report payroll c. Non-payment of deductible billing; d. Failure to permit us to audit payroll asj-rega.ired- by the terms of this :policy, or of:. a: previous policy issued by us; e. Failure to pay any additional premiume- s- .ulting from an audit 'of payroll required by the. terms of this policy or any. previous policy issued by us f. Material misrepresentation made by ,you.. or your, agent; g. Failure to cooperate with us in the inve'stigation*of a claim; h. Material failure to comply with Federal or State safety orders; L Material failure to comply with written recommendations of our designated loss control .representatives; j. The occurrence of a material change in the ownership of your.business; k. The occurrence of any change in. 'your bu`siriess or operations that materially increases the hazard for frequency or severity of loss; I. The occurrence of any change in you r.business or, operation. that.req.u'ires additional or different classification for premium calculation; m. The occurrence of any change in your business or operation which'. contemplates. an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons, listed. in (a) through..(g), we will give you. 10. days advance written notice, stating when the cancellation is to take effect. Mailing that, notice to you., -at. -your mailing address shown in Item 1 of the Information Page will be sufficient to provide notice. If we.can.cei,you.r policy for a.ny of the reasons.listed in Items (h) through (m), we will give you 30 days advance written notice;. however, we agree that in`the event of cancellation and reissuance of a policy effective upon a material change in ownership or operations; notice will not be provided. 4. If we mail the notice to you, the stated periods of notice and your .right to, remedy :the condition will be extended by 5 days if the place of mailing and your mailing address is within California' 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing. or`your mailing address. is. outside. of the United States. 5. The policy period will end on the day and hour stated in. the cancel lation notice. 6. A short rate penalty applies if you cancel this policy or if we cancel. due to non-payment of .premium, failure to report or non-payment of deductible billing. First, the standard premium; defined- as the. base premium (computed in payroll, g .. accordance with Part 1, Section 2, Subsection 2 of the. WCIRB's California Basic Underwriting Manual) adjusted for the experience modification factor and all other pricing factors except for premium discount and. expense constant, will be multiplied by the quotient of the. number of days for which the policy was written divided by the number of days the policy remained in force to produce the full.standard premium. Second, the extended number of days will be determined by dividing the number of days the policy was in force by the number of days for which the'polic' written and multiplying the quotient by 365 days. When the policy is written for a one-yearperiod, the extended number of days will equal the number of days the policy remained in force. Third, the short rate per corresponding to the extended number of days will be obtained from the short rate cancellation table. Fourth, the shortrate'premium will be equal to the product of the full standard premium times the short. rate percentage. The short rate table below will. be used in' computing the short ragepremium. In no event will the final earned premium be less than the policy.minimum premium. WC 99 06 07 E page 1 of 2 (Ed. 01-22) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Short Rate Table WC 99 06 07 E (Ed. 0 1 -22) Extended Number of Das Percent of Full Policy Premium Extended. Number of Das Percent of Fu11 Policy Premium Extended Number of Das Percent of Full Policy Premium 1 ...... 5% 95-98 ...... 37% 219-223 ...... 69% 2 ...... 6% 99-102 ...... 38% 224-228 ...... 70% 3-4 ...... 7% 103-105 ...... 39% 229-232 ...... 71% 5-6 ...... 8% 106-109 ...... 40% 233-237 ...... 72% 7-8 ...... 9%. 110-113 ....... 41% 238-241 ......73% 9-10 ...... 10% 114-116 ...... 42% 242-246 (8 mos.) 74% 11-12 ...... 11% 117-120. ...... 43% 247-250 ...... 75% 13-14 ...... 12% 121-124 (4 mos.) 44% 251-255 ...... 76% 15-16 ...... 13% 125-127 ...... 45% 256-260 ...... 77% 17-18 ...... 14% 128-131 ....:. 46%' 261-264 ...... 78% 19-20 ...... 15% 132-135, ...... 47%0 265-269 ...... 79% 21-22 ...... 16% 136-138 ........ 48% 270-273 (9 mos.) 80% 23-25 ...... 17% 139-142 ....:. .49% 274-278 ...... 81% 26-29 ...... 18% 143-146 ...... 50% 279-282 ...... 82% 30-32 (1 mo.) 19% 147-149.. ...... 51% 283-287 ...... 83% 33-36 ...... 20% 150-153 .(5 mos.) 52% 288-291 ...... 84% 37-40 ...... 21% 154-156 ...... 53% 292-296 ...... 85% 41-43 ...... 22% 157-160 ..:..: 54% 0 297-301 ...... 86% 44-47 ...... 23% 161-164 ...... 55% 302-305 00 mos.) 87% 48-51 ...... 24% 165-167 ...... 56% 306-310 ...... 88% 52-54 ...... 25% 1.68-171 ...... 57% 311-314 ...... 89% 55-58 ...... 26% 172=175 ...... 58%.315-319 ...... 90% 59-62 (2 mos.) 27% 176-178 . ...... -59% 321-323 ...... 91% 63-65 ...... 28% 179-182: (6 mos.) . -60% 324-328 ...... 92% 66-69 ..... 296/o- 183487 ...... 6�1% 329-332 ...93% 70-73 ...... ° 30/o �. 188-191 ...... 62% 333-3.37 (11 mos.) 94% 74-76 ...... 31% 192-196 ...... 63% 338-342 ...... 95% 77-80 ...... 32% 197-200 ...... 64% 343-346 ...... 96% 81-83 ...... 33% 201-205 ...... 65% 347-351 ...... 97% 84-87 ...... 34% 206-209 ...... 66% 352-355 ...... 98% 88-91 (3 mos.) .35% 210-214 (7 mos.) 67% 356-360 ...99% 92-94 ...... 36% .215-218 ...... 68% 1 361-365 .02 mos. 100% 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: 03/15/2026 Policy No.: FOWC725735 Endorsement No.: Insured: Premium $ Insurance Company: Berkshire Hathaway Homestate -Ins Co Countersign e*d. by WC 99 06 07 E Page 2 of 2 (Ed. 01-22)