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2019/08/01 Harris & Associates, Inc. Certificate of Liability InsuranceP526I1)28002 A ORLY CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDONM) 07/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementis). PRODUCER LTC #0757716 600•-977-4560 CONTACT HUB International Insurance Services Inc. PHONE nx rarr M.n.n• 925 609-6500 I rFem ..,. 925 609-6550 P.O. Box 4047 Concord, CA 94524 INSURED Harris & Associates Inc. Attn: Susan Mandilag 1401 Willow Pass Road, Suite 500 INSURM(SI AFFORDING CDYFJtAGE NAIC0 INDUR£RA: V0110Y Forge Insurance Company INSURERS: The Continental Insurance Company INSURERC: Travelers Property Casualty Co of Amer INSURERD: Continental Casualty Company INSURER E l Concord, CA 94520 _ 1INSURER F: _I f COVERAGES r:FRTIFIr:ATF NIIMRFR• 534799624 RFVICIAW NIIIIIIF►FR• 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 POLICY EFFPOLICY EXA LIMITS T TYPE OF INSURANCE POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx OCCUR 6072176739 08/01/19 08/01/20 EACH OCCUDAMMe.MRRENCE $ 1,000,000 $ 1,000,000 PRE RENTED MED EXP (My oneperson) X Ded: 0 $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEWLAGGREGATELIMIT APPLIES PER: POLICY JECT PRO F LOC LJ GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 $ OTHER B AUTOMOBILE LIABILITY BOA 6076590520 08/01/19 08/01/20 COMBINEDSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ PR DAMAGE a e I $ - x Dea: o B UMBRELLALIAB X OCCUR CUE 6076590551 08/01/19 08/01/20 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAR CLAIMS -MADE AGGREGATE $ 10, 000, 000 DIED I X I RETENTION 10,000 $ C AND EMPLOYERS'LIABILITY TION ANDWORKER YERS'LIAILIT Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUE N NIA UB-8X458448-19-43-G 08/01/19 08/01/20 X SATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 D PROFESSIONAL LIABILITY AEH591891588 08/01/19 08/01/20 Per Claim 10,000,000 Claims -Made Aggregate 10,000,000 Ded. Each Claim 3.50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) • Workers Compensation policy excludes monopolistic states ND, OH, WA, WY. General Liability and Auto Liability Additional Insured status granted, if required by written contract/agreement, per attached forma CNA75079XX 1016 and CNA63359XX 0412 (pg. 1, I.A.3). City & its officers, employees, agents & authorized volunteers are additional insureds under General Liability and Auto Liability if required by a written contract. RE: On -call Professional Entitlement & Final Engineering Services (HA #1600586) "K I It-1%,A I t HVI-Ut K GANCtLLAT ICIN 160-0586 (2022) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Allen Yun Public Works / Engineering AUTHORIZED REPRESENTATIVE 29714 Haun Road Menifee, CA 92586 � USA ACORD 25 (2016/03) dgarcia 534799624 01988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FM P5260028002 CERTIFICATE OF LIABILITY INSURANCE o�/18/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LTC #0757776 800-877-4560 CONTACT HSIH International Insurance Services Inc. yAM PHONE .925 609-6500 1W Nok 925 609-6550 E-MAIL P.O. Box 4047 A INSURER(SJ AFFORDING COVER"k NAIC F Concord, CA 94524 INSURERA: Valley Forge Insurance Company INSURED INSURER13:The Continental Insurance Company Harris & Associates Inc. Attn: Susan MandMandilag INSURERC: Travelers Property Casualty Cc of Amer 1401 Willow Pass Road, Suite 500 INSURERD: Continental Casualty Company INSURER E: Concord, CA 94520 INSURERF: COVERAGES f:FRTIFIC:ATF NIIMRFR• 534799696 orvicztniki killularp• 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. IL SUR TYPE OF INSURANCE R I EXP J LIMITS LTRPOLICYNUM13ER famm A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX 1 OCCUR 6072176739 08/01/19 08/01/20 EACH OCCURRENCE $ 1,000,000 DAMMF TO EN I PREMINS I $ 1,000,000 1t MED EXP (Anyone person) $ 15,000 Dad: 0 PERSONAL & ADV INJURY $ 1,000,000 GEN%AGGREGATE LIMIT APPLIES PER: POLICYn PRMLOC GENERALAGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BUA 6076590520 08/01/19 08/01/20 Oh181NE0SINGLE LIMIT snl $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE r $ _ $ g Dad. 0 B UMBRELLALIAB X OCCUR CUE 6076590551 08/01/19 08/01/20 EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB _ CLAIMS -MADE AGGREGATE $ 10, 000, 000 DF-D X RETENTION$ 101000 $ C WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANYPROARIETORtPARTNERIEXECUTIVE OFFICENMEMBEREXCLUDED7 N f A UB-8R458448-19-43-G * 08/01/19 OB/01/20 0711- X P A 7 7 ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE11 $ 1,000,000 (Mandatary In NHJ IF ea, describe under O SCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D PROFESSIONAL LIABILITY AEH591891588 08/01/19 08/01/20 Per Claim 10,000,000 Claims -Made Aggregate 10,000,000 Ded. Each Claim 150,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) * Workers Compensation policy excludes monopolistic states ND, OH, WA, WY. General Liability and Auto Liability Additional Insured statue granted, if required by written contract/agreement, per attached forme CNA75079XX 1016 and CNA63359XX 0412 (pg. 1, I.A.3). City & its officers, employees, agents & authorized volunteers are additional insureds under General Liability and Auto Liability if required by a written contract. RE: On -call Professional Entitlement & Final Engineering Services (HA #1600468) l.:=r%I Ir1L.HIr- nULUCK $,ASV[:LLLA I IVN 160-0468 (2021) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Allen Yun Public Works / Engineering AUTHORIZED REPRESENTATIVE 29714 Haun Road Menifee, CA 92586 � USA ACORD 25 (2016/03) dgarcia 534799696 ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD w w O 00 W P5260028002 CNFA Blanket Additional Insured - Owners, Lessees or w Contractors - with Products -Completed w Operations Coverage Endorsement ° Primary and Noncontributory Insurance 00 With respect to other insurance available to the additional insured under which the additional insured is a named > Insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effector becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising Injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10 16) Policy No: 6072176739 Page 2 of 2 Effective Date: 08/01/2019 Insured Name: Harris & Associates Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. P5260028002 POLICY NUMBER: BUA 6076590520 OVA CNA63359XX (Ed. 04/12) IIIIIIIIIIIII, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. w 0 CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - 00 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM w I. LIABILITY COVERAGE 4. An "employee" of yours is an "insured" A. Who Is An Insured while operating an "auto" hired or rented under a contract or agreement in that The following is added to Section II, "employee's" name, with your permission, Paragraph A.1., Who Is An Insured: while performing duties related to the 1. a. Any incorporated entity of which the conduct of your business. Named Insured owns a majority of the "Policy," as used in this provision A. Who Is An voting stock on the date of inception of Insured, includes those policies that were in this Coverage Form; provided that, force on the inception date of this Coverage b. The insurance afforded by this Form but: provision A.1. does not apply to any 1. Which are no longer in force; or such entity that is an "insured" under 2. Whose limits have been exhausted. any other liability "policy" providing "auto" coverage. B. Bail Bonds and Loss of Earnings 2. Any organization you newly acquire or Section II, Paragraphs A.2. (2) and A.2. (4) form, other than a limited liability company, are revised as follows: partnership or joint venture, and over which you maintain majority ownership interest. 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and The insurance afforded by this provision A.2.. 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a day. a. Is effective on the acquisition or C. formation date, and is afforded only Fellow Employee until the end of the policy period of this Section II, Paragraph B.5 does not apply. Coverage Form, or the next anniversary its inception date, Such coverage as is afforded by this provision whichever is earlier. a C. is excess over an y other collectible insurance. b. Does not apply to: II. PHYSICAL DAMAGE COVERAGE (1) "Bodily injury" or "property damage" caused by an "accident" that A. Glass Breakage — Hitting A Bird Or Animal — occurred before you acquired or Falling Objects Or Missiles formed the organization; or The following is added to Section III, (2) Any such organization that is an Paragraph A.3.: "insured" under any other liability With respect to an covered "auto," an Y Y "policy" providing auto coverage.P "P Y�� P 9 "deductible shown in the Declarations will not 3. Any person or organization that you are apply to glass breakage if such glass is required by a written contract to name as repaired, in a manner acceptable to us, rather an additional insured is an "insured" but than replaced. only with respect to their legal liability for B. Transportation Expenses acts or omissions of a person, who qualifies as an "insured" under Section II — Who Is Section III, Paragraph A.4.a. is revised, with An Insured and for whom Liability Coverage respect to transportation expense incurred by is afforded under this policy. If required by you, to provide: written contract, this insurance will be a. $60 per day, in lieu of $20; subject to primary and non-contributory to insurance on which the additional insured is a Named b. $1,800 maximum, in lieu of $600. Insured. CNA63359XX Copyright, cNA Corporation, 2000, Page 1 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. P5260028002 Ca'/c1 b. An "auto" used by that "executive officer" while working In a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us CNA63359XX (Ed. 04/12) CNA63359XX (Ed. 04/12) The following is added to Section IV, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written contract or agreement to obtain this waiver from us. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, -the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract. That written contract must have been entered into prior to "Accident" or "Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. Copyright, CNA Corporation, 2000. Page 3 of 3 Includes copyrighted material of the Insurance Services Office used with its permission. a, P5260028002 AW W P. N TRQ Y ELERS WORKERS COMPENSATION AND o ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER; UB41(458448-19-434 j z w WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium, Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. - This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by Page 1 of 1 W P5260028002 Cal/c1 Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named Insured, this Insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effector becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising Injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (10-16) Page 2 of 2 Insured Name: Harris & Associates Inc. Policy No: 6072176739 Effective Date: 08/01 /2019 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. N 0 M 00 z w P5260028002 CNA63359XX CNA POLICY NUMBER: BUA 6076590520 (Ed. 04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. w 0 CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - 00 This endorsement modifies insurance provided under the following: z BUSINESS AUTO COVERAGE FORM w I. LIABILITY COVERAGE 4. An "employee" of yours is an "insured" A. Who Is An Insured while operating an "auto" hired or rented under a contract or agreement in that The following is added to Section II, "employee's" name, with your permission, Paragraph A.1., Who Is An Insured: while performing duties related to the 1, a. Any incorporated entity of which the conduct of your business. Named Insured owns a majority of the "Policy," as used in this provision A. Who Is An voting stock on the date of inception of Insured, includes those policies that were in this Coverage Form; provided that, force on the inception date of this Coverage b. The insurance afforded by this Form but: provision A.I. does not apply to any 1. Which are no longer in force; or such entity that is an "insured" under 2. Whose limits have been exhausted. any other liability "policy" providing "auto" coverage. B. Bail Bonds and Loss of Earnings 2. Any organization you newly acquire or Section II, Paragraphs A.2. (2) and A.2. (4) form, other than a limited liability company, are revised as follows: partnership or joint venture, and over which you maintain majority ownership interest. 1. In a.(2), the limit for the cost of bail bonds is changed from $2,000 to $5,000; and The insurance afforded by this provision A.2.: 2. In a.(4), the limit for the loss of earnings is changed from $250 to $500 a day. a. Is effective on the acquisition or formation date, and is afforded only C. Fellow Employee until the end of the policy period of this Section II, Paragraph B.5 does not apply. Coverage Form, or the next anniversary of its inception date, Such coverage as is afforded by this provision whichever is earlier. C. is excess over any other collectible insurance. b. Does not apply to: If. PHYSICAL DAMAGE COVERAGE (1) "Bodily injury" or "property damage" caused by an "accident" that A. Glass Breakage — HittingA Bird Or Animal — occurred before you acquired or Falling ts l g Objects Or Missiles I formed the organization; or The following is added to Section III, (2) Any such organization that is an Paragraph A.3.: "Insured" under any other liability With respect to an covered "auto," an p Y Y "policy" providing auto coverage. "p Y�� p 9 '� 9 deductible shown in the Declarations will not 3. Any person or organization that you are apply to glass breakage if such glass is required by a written contract to name as repaired, in a manner acceptable to us, rather an additional insured is an "insured" but than replaced. only with respect to their legal liability for B. Transportation Expenses acts or omissions of a person, who qualifies as an "insured" under Section II — Who Is Section III, Paragraph A.4.a. is revised, with An Insured and for whom Liability Coverage respect to transportation expense incurred by is afforded under this policy. If required by you, to provide: written contract, this insurance will be a. $60 per day, in lieu of $20; subject to primary and non-contributory to insurance on which the additional insured is a Named b. $1,800 maximum, in lieu of $600. Insured. CNA63359XX Copyright, CNA corporation, 2000. Page 1 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. L.::�] P5260028002 b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision. (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other similar governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described in this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a.: (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. The following is added to Section IV, Paragraph A.2.b.: (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents is known to you or if you are not an individual, to any of your executive officers or partners or your insurance manager. B. Transfer Of Rights Of Recovery Against Others To Us CNA63359XX (Ed. 04/12) The following is added to Section IV, w Paragraph A.5. Transfer Of Rights Of o Recovery Against Others To Us: We waive any right of recovery we may have, because of payments we make for injury or damage, against any person or organization for whom or which you are required by written > contract or agreement to obtain this waiver from US. This injury or damage must arise out of your activities under a contract with that person or organization. You must agree to that requirement prior to an "accident" or "loss." C. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2.: Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. D. Other Insurance The following is added to Section IV, Paragraph B.5.: Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy shall be on a primary non-contributory basis. This provision is applicable only when required by a written contract. That written contract must have been entered into prior to "Accident" or "Loss." E. Policy Period, Coverage Territory Section IV, Paragraph B. 7.(5).(a). is revised to provide: a. 45 days of coverage in lieu of 30 days. V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these. CNA63359XX Copyright, CNA Corporation, 2000. Page 3 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. P5260028002 ■ ^�n r c A N 11'iQ�L LG p5 WORKERS COMPENSATION 11'i G G ii66 AND p ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 00 POLICY NUMBER; 1.113-81<458448-19434 z w WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by Page 1 of 1 s