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2018/11/09 Willdan Engineering Certificate of Liability InsuranceCERTIFICATE OF LIABILITY INSURANCE DATEI10112018YYY) 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 AOn Risk Insurance Services West, Inc. LOS An el es CA Office 707 Wilshire Boulevard Suite 2600 City of Menifee CONTACT NAME: AX (A/C. No. Ext): (866) 283-7122 (A/C. No.): (800) 363-0105 EMAIL ADDRESS: LOS Angeles CA 90017-0460 USA Cit Clerk y INSURER(S) AFFORDING COVERAGE NAIC # INSURED NOV�] INSURERA: Travelers Property cas CO Of America 25674 willdan Enqineerinq YY 2L 02�18 2401 East Katella Avenue, Suite 300 Anaheim CA 92806 USA INSURER B: Lexington Insurance Company 19437 INSURER C: Received INSURER D: INSURER E: INSURER F: CUVtKAUt5 CERTIFICATE NUMBER: 570D7375gHR8 RFVIRIr1M MIIMRFR• 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. Limits shown are as requested INSR LTR TypE OF INSURANCE AD INSD SUBR WVD POLICY NUMBER P I Y EFF MWDDIYYYY P LI P MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY P6307i3bb56bTIL16 11 1 11709/2019 EACHOCCURRENCE $1,000,000 CLAIMS -MADE —1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 X MED EXP (Any one person) $15 , 000 Employee Benefits Liability X Contractual Liability Included PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMPIOPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY P-810-73365332-TIL-18 11/09/2018 11/09/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident HIREDAUTOS NON -OWNED ONLY AUTOS ONLY UMBRELLA LIAR EACH OCCURRENCE EXCESS LIAB HOCCUR CLAIMS -MADE AGGREGATE DED RETENTION A WORKERS EMPLOYERSOLIABILTYTIONAND YIN ANY PROPRIETOR I PARTNER/ EXECUTIVE OFFICERIMEMBER EXCLUDED? N I A PJUB9355881918 11/09/2018 11/09/2019 X STATUTE ERH 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 $1,000,000 B Archit&Eng Prof 028174912 11/09/2018 11/09/2019 Aggregate $2,000,000 SIR applies per policy terns & conditions Per Claim $1,000,000 SIR $250:000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: FY 17/18 Traffic Engineering Support Services. The City of Menifee is included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non -Contributory to other insurance available to an Additional Insured, but only in accordance with the policy's provisions. A waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and workers' compensation policies. CERTIFICATE HOLDER 0 U Q m w .c m d v O S .NIFI- N . ti r� _F SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE r� POLICY PROVISIONS. City of Meni fee AUTHORIZED REPRESENTATIVE �— Attn: Administration/Risk Manager 29714 Haun Road tin i er101fG �7lGIlGtLlylCG e/Gfil/�tYD /tJna Menifee CA 92586 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CANCELLATION COMMERCIAL GENERAL LIABILITY L How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b. If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. The additional insured must immediately send us copies of all legal papers received in con- nection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and oth- erwise comply with all policy conditions. d. The additional insured must tender the de- fense and indemnity of any claim or "suit' to any provider of other insurance which would cover the additional insured for a loss we cover. However, this condition does not affect whether this insurance provided to the addi- tional insured is primary to that other insur- ance available to the additional insured which covers that person or organization as a named insured. 4. The following is added to the DEFINITIONS Sec- tion: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or or- ganization as an additional insured on this Cover- age Part, provided that the "bodily injury" and "property damage" occurs and the "personal in- jury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 0 2008 The Travelers Companies, Inc. CG D4 14 04 08 COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense F. HIRED AUTO — LIMITED WORLDWIDE COV- of the "insured" against any such "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Policy Number: P6307J366586TIL18 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS INDUSTRYEDGE sm ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured B. Incidental Medical Malpractice C. Reasonable Force — Bodily Injury Or Property Damage D. Non -Owned Watercraft — Increased To Up To 75 feet E. Aircraft Chartered With Pilot F. Extension Of Coverage — Damage To Premises Rented To You G. Personal Injury —Assumed by Contract H. Increased Supplementary Payments I. Additional Insured — Owner, Manager Or Lessor Of Premises J. Additional Insured — Lessor Of Leased Equip- ment K. Additional Insured — State Or Political Subdivisions — Permits Relating To Premises L. Additional Insured — State Or Political Subdivisions — Permits Relating To Operations PROVISIONS A. BROADENED NAMED INSURED — UNNAMED SUBSIDIARIES The Named Insured in Item 1. of the Declarations is amended as follows: The person or organization named in Item 1. of the Declarations and any organization, other than a partnership, joint venture, limited liability com- pany or trust, of which you are the sole owner or in which you maintain the majority ownership in- terest on the effective date of the policy. How- M. Who Is An Insured — Newly Acquired Or Formed Organizations N. Injury To Co -Employees And Co -Volunteer Workers O. Medical Payments Limit P. Knowledge And Notice Of Occurrence Or Offense Q. Other Insurance Condition R. Unintentional Omission S. Waiver Of Transfer Of Rights Of Recovery Against Others To Us When Required By Contract T. Amended Bodily Injury Definition U. Amended Insured Contract Definition — Rail- road Easement V. Additional Definition — Written Contract Re- quiring Insurance ever, coverage for any such additional organiza- tion will cease as of the date, if any, during the policy period, that you no longer are the sole owner of, or maintain the majority ownership in- terest in, such organization. B. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission CG D4 15 05 08 (Rev. 10-08) © 2008 The Travelers Companies, Inc. Page 1 of 8 COMMERCIAL GENERAL LIABILITY E. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; and (b) Not owned by any insured. F. EXTENSION OF COVERAGE — DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAM- AGE LIABILITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to this coverage as described in SECTION III — LIM- ITS OF INSURANCE 2. The insurance under this Provision F. does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE of the owner, caused by: fire; explosion; light- ning; smoke resulting from such fire, explo- sion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same 'occurrence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or light- ning; or water; or any combination of any of these causes. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown for the Damage To Premises Rented To You Limit in the Declarations for this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract' in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water is not an "insured contract"; G. PERSONAL INJURY — ASSUMED BY CON- TRACT The following replaces Exclusion e., Contractual Liability in Paragraph 2. of SECTION I — COV- ERAGES — COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: "Advertising injury" for which the insured has as- sumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. H. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: Subject to 5. above, the Damage To Prem- b. Up to $2,500 for cost of bail bonds re- ises Rented To You Limit is the most we will quired because of accidents or traffic law pay under Coverage A for the sum of all violations arising out of the use of any damages because of "property damage" to vehicle to which the Bodily Injury Liability any one premises while rented to you, or Coverage applies. We do not have to fur - temporarily occupied by you with permission nish these bonds. CG D4 15 05 08 (Rev. 10-08) © 2008 The Travelers Companies, Inc. Page 3 of 8 COMMERCIAL GENERAL LIABILITY 3. This Provision J. does not apply on any basis to any person or organization for which cov- erage as an additional insured specifically is added by another endorsement to this Cover- age Part. K. ADDITIONAL INSURED — STATE OR POLITI- CAL SUBDIVISIONS — PERMITS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit in connection with premises owned or oc- cupied by, or rented or loaned to, you, is an in- sured, but only with respect to "bodily injury", "property damage", "personal injury" or "advertis- ing injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of advertising signs, awnings, cano- pies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, side- walk vaults, elevators, street banners or decora- tions for which that state or political subdivision has issued such permit. L. ADDITIONAL INSURED — STATE OR POLITI- CAL SUBDIVISIONS — PERMITS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit is an insured, but only with respect to "bod- ily injury", "property damage", "personal injury" or "advertising injury" arising out of operations per- formed by you or on your behalf for which that state or political subdivision has issued such permit. However, no such state or political subdi- vision is an insured for: 1. "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of op- erations performed for that state or political subdivision; or 2. "Bodily injury" or "property damage" included within the "products — completed operations hazard". M. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4.a. of SEC- TION II — WHO IS AN INSURED: riod, whichever is earlier. Any such newly ac- quired or formed organization that you report in writing to us within 180 days after you ac- quire or form the organization will be covered under this provision until the end of the policy period, even if there are more than 180 days remaining until the end of the policy period. N. INJURY TO CO -EMPLOYEES AND CO - VOLUNTEER WORKERS The following is added to SECTION II — WHO IS AN INSURED: 1. Your "employees" are insureds with respect to "bodily injury" to a co -"employee" in the course of the co -"employee's" employment by you, or to your "volunteer workers" while per- forming duties related to the conduct of your business, provided that this coverage for your "employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Your "volunteer workers" are insureds with respect to "bodily injury" to a co -"volunteer worker" while performing duties related to the conduct of your business, or to your "employ- ees" in the course of the "employee's" em- ployment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the con- duct of your business. 3. Subparagraphs 2.a.(1)(a), (b) and (c) and 3.a. of SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which insur- ance is provided by paragraph 1. or 2. above. O. MEDICAL PAYMENTS LIMIT The following replaces paragraph 7. of SECTION III — LIMITS OF INSURANCE: Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sus- tained by any one person, and will be the higher of: a. $10,000; or b. The amount shown on the Declarations for Medical Expense Limit. P. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE a. Coverage under this provision is afforded only The following is added to Paragraph 2. Duties In until the 180th day after you acquire or form The Event of Occurrence, Offense, Claim Or the organization or the end of the policy pe- CG D4 15 05 08 (Rev. 10-08) © 2008 The Travelers Companies, Inc. Page 5 of 8 COMMERCIAL GENERAL LIABILITY (2) The total of all deductible and self -insured amounts under that "other insurance". We will share the remaining loss, if any, with any 'other insurance" that is not described in this Excess Insur- ance provision. c. Method Of Sharing If all of the 'other insurance" permits contribution by equal shares, we will follow this method also. Under this approach each provider of insurance contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, which- ever comes first. If any of the 'other insurance" does not permit contribution by equal shares, we will contribute by limits. Under this method, the share of each provider of insurance is based on the ratio of its applicable limit of insur- ance to the total applicable limits of insurance of all providers of insur- ance. 2. The following definition is added to SECTION V — DEFINITIONS: "Other insurance": a. Means insurance, or the funding of losses, that is provided by, through or on behalf of: (1) Another insurance company; (2) Us or any of our affiliated insurance companies, except when the Non cumulation of Each Occurrence Limit section of Paragraph 5. of LIMITS OF INSURANCE (Section III) or the Non cumulation of Personal and Advertis- ing Injury limit sections of Paragraph 4. of LIMITS OF INSURANCE (Sec- tion III) applies; (3) Any risk retention group; Insurance shown on the Declarations of this Coverage Part. R. UNINTENTIONAL OMISSION 1. The following is added to Paragraph 6. Rep- resentations of SECTION IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or uninten- tional error in, any information provided by you which we relied upon in issuing this policy shall not prejudice your rights under this in- surance. 2. This Provision R. does not affect our right to collect additional premium or to exercise our right of cancellation or nonrenewal in accor- dance with applicable insurance laws or regu- lations. S. WAIVER OF TRANSFER OF RIGHTS OF RE- COVERY AGAINST OTHERS TO US WHEN REQUIRED BY CONTRACT The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others to Us of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: 1. Premises owned by you, temporarily occu- pied by you with permission of the owner, or leased or rented to you; 2. Ongoing operations performed by you, or on your behalf, under a contract or agreement with that person or organization; (4) Any self-insurance method or pro- gram, other than any funded by you and over which this Coverage Part T applies; or (5) Any similar risk transfer or risk man- agement method. 3. "Your work"; or 4. "Your products". We waive these rights only where you have agreed to do so as part of a "written contract re- quiring insurance" entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense or "advertising injury" offense is committed. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily injury" in the DEFINITIONS Section: b. Does not include umbrella insurance, or "Bodily injury" means bodily injury, mental an - excess insurance, that you bought spe- guish, mental injury, shock, fright, disability, hu- cifically to apply in excess of the Limits of miliation, sickness or disease sustained by a per- CG D4 15 05 08 (Rev. 10-08) © 2008 The Travelers Companies, Inc. Page 7 of 8 POLICY NUMBER: P6307J366586TIL18 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: 2 However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this 3 Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 TRAVELER5A.1, WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — POLICY NUMBER: PJUB9J55881918 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FUNISH 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 11/09/2018 Policy No. PJUB9J55881918 Endorsement No. Insured Premium Insurance Company Countersigned by Travelers Property Casualty Company of America DATE OF ISSUE: - - ST ASSIGN: Page 1 of 1