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2019/02/01 Railpros Field Services, Inc. Certificate of Liability Insurance (20)
enen0za002 CERTIFICATE OF LIABILITY INSURANCE 02/0ATE /20I19 ,acoRr� 02/05/2019 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 I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. wo IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. rq 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 endorsements). PRODUCER 1-303-534-4567 FONT vo IRA, Inc. - Colorado Division pHOHE FAX 1705 17th Street City of Menifee n8R41 UeaaaeauntteehBAimacorp.com w Suite 100 City Clerk iNeurls}AFFOR➢INGCOVERAGE _ NAIC# Denver, CO 80202 INSURERA:LIBERTY MUT FIRE INS CO 23035 INSURED FEB 19 2019 1NSURERB:WESTCHESTER SURPLUS LINES INS CO(ACE 10172 Railpros Field Services, Inc INSURERC:LIBERTY INS CORP 42404 1705 West Northwest Hwy, Suite 150 INSURER➢:ALLIED WORLD SURPLUS LINES INS CO Received INSURER E: Grapevine, TX 76051 INSURERF: COVERAGES CERTIFICATE NUMBER:55308766 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INW TYPE OF INSURANCE 'ADDtSUBRF poLICYNUMBER MOLtCY Yy PWDDN XPJIM LIMITS A X COMMERCIAL GENERAL LIABILITY TB2Z91470138029 02/01/19 02/01/20 EACH OCCURRENCE _ S 1,000,000 JCLAIMS-MADE J X I OCCUR PAREMSESfEeocgi-r-ce) $ 100,000 X BI/PD Ded: $5,000 MEDEXP(AnYonaperson) $ 15,000 PERSONAL&ADV INJURY $ 1.000,000 G_ENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE S 2,000,000 POLICY f X 1 jE U LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AS2Z91470138019 02/01/19 02/01/20 B0JE0�1 xEI, $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSONLY AUTOS ..X HIRED .X NON-OWNED PROFIERrYD $ AUTOS ONLY AUTOS ONLY .IPotow4Pn1) $1,000 Coll. Ded. $ $1,000 Comp. nit B UMBRELLALIAS X I OCCUR G71488573001 02/01/19 02/01/20 EACH OCCURRENCE $ 9,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 9,000,000 E C i RETENTION$ EWORKERSCOMPENSATIN WC7Z91470138039 - AOS 02/01/19 02/01/20 y 1.ER C ANYPROPRIETORPARTNER/EXECUTIVE E $ ' N/A WC7Z91470138039 - CA 02/01/19 02/01/20 E L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E,L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF-GPERATONlibelow E I DISEASE-POLCY LIMIT $ 1,000,000 D Professional Liability 03105773 02/01/19 02/01/20 SIR 1350,000 Each Claim :1010001000 Aggregate I10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is requiredl City of Menifee and its officers, employees, agents, and authorized volunteers are included as Additional Insureds an the General Liability including Ongoing and Completed Operations, Automobile and Umbrella Liability Policies if requir by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. A Waiver of Subrogation is provided in favor of Additional Insureds on the General, Automobile, Umbrella Liability and Workers Compensation Policies if required by written contract or agreement and with respect to work performed by Insured subject to the policy terms and conditions. This Insurance is Primary and Non-Contributory on the General Liability Policy subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION 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. 29714 Haun Road AUTHORIZED REPRESENTATIVE / f� Menifee, CA 92568 / /f��/1 I USA 11 �/� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD michael.sheinberg 55308766 PS%(i"02SOU% w M (a) Less than 55 feet long;and o M (b) Not being used to carry persons or property for a charge; Item 3. Damage To Premises Rented To You-Expanded Coverage M I > A. The final paragraph of 2. Exclusions of Section I-Coverage A-Bodily Injury And Property Damage Liability is w replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III-Limits Of Insurance. B. Paragraph 6.of Section III—Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You Limit is the greater of: a. $300,000;or b. The Damage To Premises Rented To You Limit shown on the Declarations. C. Paragraph 9.a.of the definition of"insured contract"in Section V—Definitions is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner is not an"insured contract". D. The paragraph immediately following Paragraph (6)of exclusion j. of Section I—Coverage A —Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to"property damage" (other than damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage) to premises, including the contents of such premises, rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III—Limits of Insurance. Item 4. Bodily Injury To Co-Employees A. Paragraph 2.of Section II-Who Is An Insured is amended to include: Each of the following is also an insured: Your supervisory or management "employees" (other than either your "executive officers" (if you are an organization other than a partnership,joint venture or limited liability company)or your managers(if you are a limited liability company)) are insureds while in the course of their employment or while performing duties related to the conduct of your business with respect to"bodily injury": (1) To you; (2) To your partners or members(if you are a partnership or joint venture); LC 04 43 0512 0 2012 Liberty Mutual Insurance.All rights reserved. Page 2 of 9 Includes copyrighted material of Insurance Services Office,Inc., with its permission. wxteoora>n: w m (5) Punitive or exemplary damages,fines or penalties. o C. The following definition is added to Section V-Definitions: I "Designated health care provider"means any"employee"or"volunteer worker"of the Named Insured whose duties include providing professional health care services, including but not limited to doctors, nurses, > emergency medical technicians or designated first aid personnel. w D. Otherinsurance The insurance provided by this Item 5.is excess over any other valid and collectible insurance available to the insured,whether primary,excess,contingent or on any other basis. Item 6. Knowledge Of Occurrence Knowledge of an "occurrence" by your agent, servant or"employee"will not in itself constitute knowledge by you ,unless your"execulive officer" or"employee" or other third party designated by you to notify us of"occurrences" has knowledge of the"occurrence". Item 7. Notice Of Occurrence For purposes of Paragraph 2_a. of Section IV - Conditions, you refers to an "executive officer" of the Named Insured or to the"employee"designated by the insured to give us notice. Item 8. Unintentional Errors And Omissions Unintentional failure of the Named Insured to disclose all hazards existing at the inception of this policy shall not be a basis for denial of any coverage afforded by this policy. However,you must report such an error or omission to us as soon as practicable after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non- renewal. Item 9. Bodily Injury Redefinition The definition of"bodily injury"in Section V-Definitions is replaced by the following: "Bodily injury"means: a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any trine;and b. Mental anguish, shock or humiliation arising out of injury as defined in Paragraph a. above. Mental anguish means any type of mental or emotional illness or distress. Item 10. Supplementary Payments-Increased Limits Paragraphs 1.b. and 1.d. of Section I - Supplementary Payments - Coverages A And B, are replaced by the following: b. Up to$3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit"including substantiated loss of earnings up to$500 a day because of time off from work. LC 04 43 0512 ©2012 Liberty Mutual Insurance.All rights reserved. (Page 4 of 9 includes copyrighted material of Insurance Services Office,Inc., with its permission. w c. Coverage B does not apply to"personal and advertising injury"arising out of an offense committed before you acquired or formed the organization. In Item 14. Blanket Additional Insured Where Required By Written Contract Paragraph 2,of Section II-Who Is An Insured is amended to add the following: m e. Additional Insured by Written Contract or Written Agreement w The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment; The person(s) or organization(s)from whom you lease equipment, but only with respect to liability for "bodily injury'. "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s). (2) Managers or Lessors of Premises: Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional Insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused,in whole or in part,by some negligent acts or omissions of you, your"employees",your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured,except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the addilional insured shall confoinn to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out of the additional insured's sole negligence. This insurance does not apply to: (a) Any"occurrence"which takes place after you cease to be a tenant in that premises or to lease that land;or (b) Any premises for which coverage is excluded by endorsement. (3) Mortgagees, Assignees or Receivers:Any person(s) or organization(s)with respect to their liability as mortgagee,assignee or receiver and arising out of the ownership,maintenance or use of your premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4) Owners, Lessees or Contractors: any person(s) or organization(s) to whom you are obligated by a written agreement to procure additional insured coverage, but only with respect to liability for "bodily injury","property damage"or"personal and advertising injury'caused,in whole or in part, by your acts or omissions or the acts or omissions of your "employees", your agents, or your subcontractors, in the performance of your ongoing operations. This insurance does not apply to"bodily injury', "property damage", or"personal and advertising injury' arising out of"your work"included in the"products-completed operations hazard"unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused, in whole or in part, by your acts or omissions or the acts or omissions of your"employees",your agents,or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured,except as provided below. LC 04 43 0512 D 2012 Liberty Mutual Insurance.All rights reserved. Page 6 of 9 Includes copyrighted material of Insurance Services Office,Inc., with its permission. r5z6[n;noox mum 1 (2) Does not apply to any person or organization for any"bodily injury', "property damage"or"personal and M advertising injury"if any other additional insured endorsement attached to this policy applies to that person or organization with regard to the"bodily injury',"property damage"or"personal and advertising injury"; I (3) Applies only if the "bodily injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury"is committed,subsequent to the execution of the written agreement;and (4) Applies only if the written agreement is in effect at the time the"bodily injury"or"property damage"occurs, w or at the time the offense giving rise to the"personal and advertising injury'is committed. Item 15. Blanket Additional Insured—Grantors Of Permits Paragraph 2.of Section II-Who Is An Insured is amended to add the following: -Any state,municipality or political subdivision with respect to any operations performed by you or on your behalf,or in connection with premises you own, rent or control and to which this insurance applies, for which the state, municipality or political subdivision has issued a permit, However,this insurance does not apply to: •1. "Bodily injury", "property damage"or"personal and advertising injury"arising out of operations performed for the state,municipality or political subdivision; :2. Any"bodily injury" or"property damage" included within the "products-completed operations hazard", except when required by written contract or agreement initiated prior to loss;or 1. "Bodily injury", "property damage"or"personal and advertising injury", unless negligently caused, in whole or in part,by you or those acting on your behalf. Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions; We waive any right of recovery because of payments we make under this policy for injury or damage arising out of ,your ongoing operations or"your work"included in the"products-completed operations hazard"that we may have against any person or organization with whom you have agreed in a written contract or agreement 10 waive your frights of recovery but only it the"bodily injury"or"property damage"occurs,or offense giving rise to"personal and advertising injury"is committed subsequent to the execution of the written contract or agreement. Item 17. Other Insurance Amendment If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent,or any other basis for any person or organization that qualifies as an additional insured on this policy, this policy will .apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV- -Conditions will not apply. Where the applicable written agreement does not specify an what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions wit govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same"occurrence",claim or"suit". Item 18. Contractual Liability—Railroads Paragraph 9,of Section V-Definitions is replaced by the following: 9. "Insured Contract"means: LC 04 43 0512 ©2012 Liberty Mutual Insurance.All rights reserved. Page 8 of 9 Includes copyrighted material of Insurance Services Office,Inc., with its permission. Policy Number AS2Z91470138019 .; Issued by 'f 2/1/19-2/1/20 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. AUTO ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Newly Acquired or Formed Organizations II. Employees as Insureds III. Lessor.-Additional Insured and Lass Payee IV. Suppiemenlary Payments-Increased Limits V. Fellow Employee Coverage VI. Personal Property of Others VII. Additional Transportation Expense and Cost to Recover Stolen Auto Vill. Airbag Coverage IX. Tapes,Records and Discs Coverage X. Physical Damage Deductible-Single Deductible XI. Physical Damage Deductible-Glass XII. Physical Damage Deductible-Vehicle Tracking System XIII. Duties in Event of Accident,Claim,Suit or Loss XIV. Unintentional Failure to Disclose Hazards XV. Worldwide Liability Coverage-Hired and Nonowned Autos XVI, Hired Auto Physical Damage XVII. Auto Medical Payments Coverage Increased Limits XVIII. Drive Other Car Coverage-Broadened Coverage for Designated Individuals XIX. Rental Reimbursement Coverage XX, Notice of Cancellation or Nonrenewal XXI. Loan/Lease Payoff Coverage XXII. Limited Mexico Coverage XXIII. Waiver of Subrogation L NEWLY ACQUIRED OR FORMED ORGANIZATIONS r Throughout this policy,the wards you and your also refer to any organization you newly acquire or farm,other than a partnership or joint venture,and over which you maintain ownership of more than 50 percent interest, provided: A. There is no similar insurance available to that organization; B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until: 1. The 90th day after you acquire or form the organization;or 2. The end of the policy period,whichever is earlier;and r C. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. 1AC 94 07 07 13 0 2013 Liberty Mutual Insurance.All rights reserved. Page t of 11 Includes copyrighted material of Insurance Services Office,Inc., with its permission. V52000180N Policy Numbers Issued by "Temporary substitute" means an "auto"that'is furnished as a substitute for a covered"auto"when the covered"auto"is out of service because of its breakdown,repair,servicing,'loss"or destruction. IV. SUPPLEMENTARY PAYMENTS-INCREASED LIMITS Subparagraphs A.2.a.(2)and A.2.a.(4)of SECTION II - LIABILITY COVERAGE are deleted and replaced by the following: (2) Up to$3,000 for the cost of ball bonds(including bonds for related traffic law violations)required because of an"accident"we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the"insured"at our request,including the actual loss of earnings up to$500 a day because of time off from work. V. FELLOW EMPLOYEE COVERAGE A. Exclusion B.S.of SECTION II-LIABILITY COVERAGE does not apply. B. For the purpose of Fellow Employee Coverage only, Paragraph B.5, of BUSINESS AUTO CONDITIONS is changed as follows: This Fellow Employee Coverage is excess over any other collectible insurance. VI. PERSONAL PROPERTY OF OTHERS Exclusion 6.in SECTION II-LIABILITY COVERAGE for a covered"auto"is amended to add: I This exclusion does not apply to"property damage"or"covered pollution cost or expense"involving"personal f property" of your "employees" or others while such property is carried by the covered "auto". The Limit of Insurance for this coverage is $5,000 per "accident". Payment under this coverage does not increase the Limit of Insurance. For the purpose of this secli❑n of this endorsement,"personal property"is defined as any property that is not used in the individual's trade or business or held for the production or collection of income. VII,ADDITIONAL TRANSPORTATION EXPENSE AND COST TO RECOVER STOLEN AUTO A. Paragraph AA.a.of SECTION III-PHYSICAL DAMAGE COVERAGE is amended as follows: The amount we will pay is increased to$50 per day and to a maximum limit of$1,000. B. Paragraph A.4.a.of SECTION III-PHYSICAL DAMAGE COVERAGE is amended to add the following: If your business Is shown in the Declarations as something other than an auto dealership,we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen covered "auto"from the place where it is recovered to its usual garaging location. Vill. AIRBAG COVERAGE Exclusion B.3.a.in SECTION III-PHYSICAL DAMAGE COVERAGE is amended to add: This exclusion does not apply to the accidental discharge of an airbag. fAC 84 07 07 13 0 2013 Liberty Mutual Insurance.All rights reserved. Page 3 of 11 includes copyrighted material of Insurance Services Office,Inc., with its permission. P52MW25W2 Policy Number Issued by w (2) The"insured's"name and address;and o ON (3) To the extent possible,the names and addresses of any injured persons and witnesses. 00 Knowledge of an "accident", claim, "suit" or "loss" by your agent, servant or "employee" shall not be > considered knowledge by you unless you, your insurance manager or any other person you designate z w has received notice of the"accident", claim,"suit"or"loss"from your agent,servant or"employee". b. Additionally,you and any other involved"insured"must: (1) Assume no obligation, make no payment or incur no expense without our consent, except at the "insured's"own cost. (2) Immediately send us copies of any request,demand,order, notice, summons or legal paper received concerning the claim or"suit". (3) Cooperate with us in the investigation or settlement of the claim or defense against the"suit". (4) Authorize us to obtain medical records or other pertinent information. (5) Submit to examination, at our expense, by physicians of our choice, as often as we reasonably require. XIV. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Paragraph B.2.in SECTION IV-BUSINESS AUTO CONDITIONS is amended to add the following: Any unintentional failure to disclose all exposures or hazards existing as of the effective date of the Business Auto Coverage Form or at any time during the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However,you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery XV. WORLDWIDE LIABILITY COVERAGE-HIRED AND NONOWNED AUTOS Condition B.7.in SECTION IV-BUSINESS AUTO CONDITIONS is amended to include the following: For"accidents"resulting from the use or operation of covered "autos"you do not own,the coverage territory means all parts of the world subject to the following provisions: a. If claim is made or "suit" is brought against an "insured" outside of the United States of America, its territories and possessions, Puerto Rico and Canada, we shall have the right, but not the duty to investigate,negotiate,and settle or defend such claim or"suit". If we do not exercise that right, the "insured" shall have the duty to investigate, negotiate, and settle or defend the claim or "suit" and we will reimburse the "insured"for the expenses reasonably incurred in connection with the investigation, settlement or defense. Reimbursement will be paid in the currency of the United States of America at the rate of exchange prevailing on the date of reimbursement. The"insured"shall provide us with such information we shall reasonably request regarding such claim or "suit"and its investigation,negotiation,and settlement or defense. The"insured" shall not agree to any settlement of the claim or"suit"without our consent. We shall not unreasonably withhold consent. AC 84 07 0713 ©2013 Liberty Mutual Insurance,All rights reserved. (Page 5 of 11 Includes copyrighted material of Insurance Services Office,Inc., with its permission, r,zrauzaou Policy Number , Issued by w M_ 0 However,the most we will pay under this coverage is$30 per day,subject to a maximum of$900. XVII. AUTO MEDICAL PAYMENTS COVERAGE-INCREASED LIMITS 00 cV M For any covered"loss",the Limit of Insurance for Auto Medical Payments will be double the limit shown in the > z i Declarations if the "insured" was wearing a seat belt at the time of the "accident". This is the maximum w amount we will pay for all covered medical expenses, regardless of the number of covered "autos", "insureds",premiums paid,claims made,or vehicles involved in the"accident". If no limit of insurance for Auto Medical Payments is shown on the Declarations,this paragraph Section XVII of this endorsement does not apply. XVIII.DRIVE OTHER CAR COVERAGE-BROADENED COVERAGE FOR DESIGNATED INDIVIDUALS f A. This endorsement amends only those coverages indicated with an "X"in the Drive Other Car section of the Schedule to this endorsement, B. SECTION II-LIABILITY COVERAGE is amended as follows: I 1. Any"auto" you don't own, hire or barrow is a covered "auto"for Liability Coverage while being used by any individual named In the Dr[ve Other Car section of the Schedule to this endorsement or by his or her spouse while a resident of the same household except: a. Any"auto"owned by that individual or by any member of his or her household;or b. Any"auto" used by that individual or his or her spouse while working in a business of selling, servicing,repairing or parking"autos". 2. The following is added to Who Is An Insured: Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her spouse, while a resident of the same household, are "insureds"while using any covered "auto" described in Paragraph B.1.of this endorsement. C. Auto Medical Payments, Uninsured Motorist, and Underinsured Motorist Coverages are amended as follows: The following is added to Who Is An Insured: Any individual named in the Drive Other Car section of the Schedule to this endorsement and his or her "family members" are "insured" while "occupying" or while a pedestrian when struck by any "auto" you don't own except: Any"auto"owned by that individual or by any"family member". D. SECTION III-PHYSICAL DAMAGE COVERAGE Is changed as follows: Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care, custody or control of any individual named in the Drive Other Car section of the Schedule to this endorsement or his or her spouse while a resident of the same household except: 1. Any"auto"owned by that individual or by any member of his or her household;or AC 84 07 07 13 0 2013 Liberty Mutual Insurance.All rights reserved. Page 7 of 11 Includes copyrighted material of Insurance Services Office,Inc., with its permission. P i;,,On2HIlU? 1 Policy Number Issued by (1) 60 days; c (2) The number of days shown in the Cancellation and Non-renewal Schedule;or ~ (3) The number of days specified in any other Cancellation Condition attached to this policy, m prior to the effective date of the cancellation or non-renewal. z w B. All other terms of Paragraph A. of the COMMON POLICY CONDITIONS, and any amendments thereto, remain in full force and effect. XXI, LOAN/LEASE PAYOFF COVERAGE The following is added to Paragraph C. Limit of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE: J In the event of a total 'loss" to a covered "auto" of the private passenger type shown in the schedule or i declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto", less: 1. The amount paid under the PHYSICAL DAMAGE COVERAGE SECTION of the policy;and 2. Any: a. Overdue leaselloan payments at the time of the"loss'; i b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; c. Security deposits not returned by the lessor; d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease;and e. Carry-over balances from previous loans or leases. This coverage is limited to a maximum of$1500 for each covered"auto". XXII. LIMITED MEXICO COVERAGE AC 84 07 0713 V 2013 Liberty Mutual Insurance.All rights reserved. (page 9 of 11 Includes copyrighted material of Insurance Services Office,Inc., with its permission. P5260028002 Policy Number rz� Issued by M_ w iSchedule O Premium Liability Physical Damage Total Premium w V. Fellow Employee Schedule of Employees: XVIII. Drive Other Car LIAB MP 11M Ulm COMP COLL Name of Individual KX Notice of Cancellation or Nonrenewal Name and Address ;Number of Days i IAC 84 07 0713 0 2013 Liberty Mutual Insurance.All rights reserved. Page 11 of 11 Includes copyrighted material of Insurance Services Office,Inc., with its permission. rsx.on:xmx Policy#WC7Z91470138039 211/19-2/1120 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT w m_ ti. O We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work sander a written contract that requires you to obtain this agreement from us.) N This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. w Schedule Where required by contract or written agreement prior to loss and allowed by law Issued by: For attachment to Policy No Effective Date Premium$ Issued to: ;WC 00 0313 0 1983 National Council on Compensation Insurance,Inc. iPage 1 of 1 Ed.4/1/1984 P5260028002 IMA,Inc.-Colorado Division - 1705 17th Street Suite 100 Denver,CO 80202 Electronic Service Requested E B f"J� B^O I �^' w O SINGLE PIECE �- 328 2.7791 SP 0.800 1111111111"1 Jill 111111�1��r�11111�111�1�1��lll�l���� Cityy of Menifee 2 29714 HAUN RD MENIFEE, CA 92586-6540 W If you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance. If you have any question or need changes please resend the certificate received along with your requirements to DenAccountTechegimacorp.com for processing.- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow-www_ConfirmNet.com-877.669.8600