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2018/07/01 R.J. Noble Company, Inc. Certicate of Liability Insurance DATE(MMIDD/YYYY) aCCWa CERTIFICATE OF LIABILITY INSURANCE ��. 2/12/2020 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). CT PRODUCER patriot Risk& Insurance Services NAME _ 2415 Campus Drive, Suite#200 ".No. 49 9 486-7900 a No): 949 486-7950 Irvine, CA 92612 E-MA$L Ana INSURERS AFFORDING COVERAGE NAIC/1 v"vv1-patrisk-com OK07568 INSURER A: Travelers Property Casualty Company of America 25674 INSURED INSURER B: Travelers Indemnity Company of Connecticut 25682 R.J. Noble Company, Inc. INSURER C: Evanston Insurance Company 15505 Lincoln Avenue P.O. Box 620 INSURER D: Orange CA 92856-9020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 54070216 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 015LTYPE OF INSURANCE INSD WVD POLICYNUMBER POLtQY YYY MM POLIO L7R /DD/YYYY LIMITS A ,/ COMMERCIAL GENERAL LIABILITY ,/ VTJ-EXGL-9F338142-TIL-19 7/1/2019 7/1/2020 EACH OCCURRENCE 1 $1000000 DAMAGE RENTED CLAIMS-MADE G OCCUR PREMISES Ea occurrence $300000 f $75,000 Deductible MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PI TI CT LOC PRODUCTS-COMP/OP AGG s2,000.000 OTHER; B AUTOMOBILE LIABILITY VTC2E-CAP-9F338154-TCT-19 7/1/2019 7/1/2020 COMOeIINED SINGLE LIMIT(Ea accidani) $2 000.000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY GE $ AUTOS ONLY AUTOS ONLY (Pef amdent A UMBRELLA LIAB H OCCUR CUP-8N148064-19-25 7/1/2019 7/1/2020 EACH OCCURRENCE $10.000.000 EXCESS LIAB CLAIMS-MADE Policy Follows Form Over AGGREGATE $10�000 000 Underlying General Liab. DED I RE B WORKERS COMPENSATION UB-7N939386-19-25-K 7/1/2019 7/1/2020 ,/ STATUTE OR TH- AND EMPLOYERS'LIABILITY Y/N No Deductible for Workers OF CERIMEMHEREXCLUDED9XECUTNE El N/A Compensation E.L.EACH ACCIDENT $1 000 O00 (Mandatary In NH) E.L DISEASE-EA EMPLOYEE $1 0 It gas,describa ureter I)E5CRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000 000 C Contractor's Pollution Liability MKLV5ENV101019 7/1/2018 7/1/2020 Each Occurrence:$5,000,000 General Aggregate:$5,000,000 C IM isc-Contractor's Professional Liab MKLV5ENV101019 1 7/1/2018 7/1/2020 Each Occurrence:$5.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:CIP 20-03 Goetz Road Asphalt Overlay Project /RJN#91724 City of Menifee,its officers,agents and employees,agents,representatives, consultants,contract employees and volunteers are hereby added as Additional Insured but only as respects for work done by,for on behalf of he named insureds-Coverage includes Primary and Non-contribulory as respects to General Liability per endorsement attached where required by written contract.Waiver of subrogation&Per Project Aggregate applies. Excess'Umbrella Liability follows form.30 days notice of cancellation, 10 days for non-payment of premium. 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 Attn:Margarita Cornejfl ACCORDANCE WITH THE POLICY PROVISIONS. Financial-Services Manager 29844 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 Dave Jacobson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 540102.16 119/20 - GL/Av/MC/WC/POLL/PROF Annette �.i:':�ro 12112Y2020 5:47-.57 AM (PST) I Page 1 of 14 This certificate cancels and suipersedieS ALL I,-reviously issued Certificates. VTJ-EXGL-9F338142-TI L-19 R.J.Noble Company,Inc. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS (1) Any "bodily injury", "property damage" or The following is added to SECTION II—WHO IS AN "personal injury" arising out of the providing, INSURED: or failure to provide, any professional Any person or organization that you agree in a architectural, engineering or surveying written contract or agreement to include as an services,including: additional insured on this Coverage Part is an (a) The preparing, approving, or failing to insured,but only: prepare or approve, maps, shop a. With respect to liability for "bodily injury' or drawings, opinions, reports, surveys, "property damage" that occurs, or for "personal field orders or change orders, or the injury" caused by an offense that is committed, preparing, approving, or failing to subsequent to the signing of that contract or prepare or approve, drawings and agreement and while that part of the contract or specifications; and agreement is in effect;and (b) Supervisory, inspection, architectural or b. If, and only to the extent that, such injury or engineering activities. damage is caused by acts or omissions of you or your subcontractor in the performance of "your (2) Any "bodily injury' or "property damage" work"to which the written contract or agreement caused by "your work" and included in the applies. Such person or organization does not "products-completed operations hazard" qualify as an additional insured with respect to unless the written contract or agreement the independent acts or omissions of such specifically requires you to provide such person or organization. coverage for that additional insured during The insurance provided to such additional insured is the policy period. subject to the following provisions: c. The additional insured must comply with the a. If the Limits of Insurance of this Coverage Part following duties: shown in the Declarations exceed the minimum (1) Give us written notice as soon as practicable limits required by the written contract or agreement, the insurance provided to the of an "occurrence" or an offense which may additional insured will be limited to such result in a claim.To the extent possible,such minimum required limits. For the purposes of notice should include: determining whether this limitation applies, the (a) How, when and where the "occurrence" minimum limits required by the written contract or or offense took place; agreement will be considered to include the minimum limits of any Umbrella or Excess (b) The names and addresses of any injured liability coverage required for the additional persons and witnesses;and Insured by that written contract or agreement. (c) The nature and location of any injury or This provision will not increase the limits of damage arising out of the "occurrence" insurance described in Section III — Limits Of or offense. Insurance. b. The insurance provided to such additional (2) If a claim is made or"suit" is brought against insured does not apply to: the additional insured: CG D2 46 0419 ®2018 The Travelers Indemnify company.All rights reserved. Page 1 of 2 54079216 119/20 - GL/AVJ RC/WC/POLL/PROF [ Annette Romero 12/12/20'.0 5;47:57 AN (PST) J Page 2 of This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the (4) Tender the defense and indemnity of any claim or"suit"and the date received;and claim or "suit" to any provider of other (b) Notify us as soon as practicable and see insurance which would cover such additional to it that we receive written notice of the insured for a loss we cover. However, this claim or"suit"as soon as practicable. condition does not affect whether the insurance provided to such additional (3) Immediately send us copies of all legal insured is primary to other insurance papers received in connection with the claim available to such additional insured which or "suit", cooperate with us in the covers that person or organization as a investigation or settlement of the claim or named insured as described in Paragraph 4., defense against the "suit', and otherwise Other Insurance, of Section IV—Commercial comply with all policy conditions. General Liability Conditions. Page 2 of 2 ®2018 The Travelers lndemnHy Company.All rights reserved. CG D2"04 19 9iQ7Q216 19/20 - GL/AV/9%C/WC/P0LL/PA0F a Annette Romero 1 2/12�2620 5;d7:57 AM (PST) I Page 3 of 14 This certificate cancels and superse es ALL previously issued certificates. R.J.Noble Company, Inc. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: VTJ-EXGL-9F338142-TIL-19 ISSUE DATE: 07/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - DESIGNATED ADDITIONAL INSUREDS - PRIMARY WITH RESPECT TO CERTAIN OTHERINSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE OF DESIGNATED ADDITIONAL INSUREDS PROVISIONS Designated Additional Insureds is primary to any of The following is added to Paragraph 4.a., Primary the other insurance, whether primary, excess, Insurance, of SECTION 1V — COMMERCIAL contingent or on any other basis, that is available to GENERAL LIABILITY CONDITIONS: such additional insured which covers such additional Insured as a named insured, and we will not share The insurance afforded under this Coverage Part to with that other insurance. any additional insured shown in the Schedule Of CG D4 26 02 19 0 2017 The Travelers Indemnity Company.Ali rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its pension. 51070216 119/20 - GL/AVISXC/WC/POLL/PROF' Q Anna[te Romero 12/12/2520 5:47:57 AM (PST) I Page 4 of 14 Thie certificate cancels and superse e8 ALL previously issued certificates. VTJ-EXGL-9F338142-TI L-19 R.J.Noble Company,Inc. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS 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 coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. Who Is An Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership,joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company;or SUBSIDIARIES b. A trust; The following is added to SECTION 11—WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: The following is added to SECTION II—WHO IS a. You are the sole owner of, or maintain an AN INSURED: ownership interest of more than 50% in, such subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for"bodily Injury' additional insured on this Coverage Part is an or"property damage" that occurred, or"personal insured,but only with respect to liability for"bodily and advertising injury' caused by an offense injury", "property damage" or "personal and committed: advertising injury"arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50%in such subsidiary;or entity does not apply to: b. After the date, if any,during the policy period a. Any "bodily injury', "property damage" or that you no longer maintain an ownership "personal and advertising injury"arising out of interest of more than 50%In such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II—Who entity;or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products-completed operations hazard". CG D3 16 02 18 ®2017 The Travelers Indemnity company.AN rights reserved. Page 1 of 3 Includes copyrighted material of Insurance services Office,Inc.,YAM its permission. ¢ 46a 16r 19/20 - GL/AU/el,XC/WC/POLL/PR.OF Q Annette RoMero 1 2/1R�7020 5147r57 AM (PST) l Page 5 of 14 . cetificate cancs and superse es ALL previously issued Certificates. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of,the insured. definition of "occurrence" in the S. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services"means: or failing to provide "incidental medical a. Medical,surgical,dental, laboratory,x-ray services,, first aid or Good Samaritan or nursing service or treatment, advice or services to a person, unless you are in the business or occupation of providing instruction, or the related furnishing of professional health care services. food or beverages;or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION 11 — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (e) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury' arising out of CONDITIONS: providing or failing to provide: This insurance is excess over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess,contingent or on any other basis,that assistant, emergency medical technician is available to any of your "employees" for or paramedic;or "bodily injury" that arises out of providing or (b) First aid or"Good Samaritan services" by failing to provide"incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to workers", other than an employed or Paragraph 2.a.(1) of Section 11 — Who Is An volunteer doctor. Any such "employees" Insured. or volunteer workers providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph B., Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph 5. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs;or services first aid or "Good Samaritan b. "Personal and advertising injury" caused by services"to any one person will be deemed to be one"occurrence". an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY—RAILROADS INJURY AND PROPERTY DAMAGE LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury' or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 ®2017 The Travelers Indemnity Company.All rights reserved. CG D316 0219 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 54070216 119/20 - GL/Au/ c/WC/POLL/PROF' [Annette Rob ro 1 2/12/2020 Sz47157 AM (PST) I Page 6 of 14 This certificate cancelR1[s and supersedes ALL previously iogued Certificates. COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contrail" in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner,or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of"premises premises is rented to you, if you rent such damage"in the DEFINITIONS Section: premises for a period of seven or fewer "Premises damage"means"property damage"to: consecutive days. CG D3 16 0219 ®2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,inc,.with its permission. 54070216 1 19/20 - GL/AV1FXC/WC/POLL/PROF [Annette RCmCro 12/11/2020 5eg7%57 AM (PST) I Page 7 of 14 This certificate cancels and superae es ALL previously issued certificates. R.J.Noble Company,Inc. COMMERCIAL GENERAL LIABILITY POLICY NUMBER:VTJ-EXGL-9F338142-TIL-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s): A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A. obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated"project"shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- Aggregate Limit for any other designated ject", and that limit is equal to the amount of "project"shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of"bodily injury" or"prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot b. Claims made or"suits"brought; or be attributed only to operations at a single desig- g nated project shown in the Schedule above: c. Persons or organizations making claims or bringing"suits". CG 0211 01 04 Copyright,The Travelers Indemnity Company,2004 Page 1 of 2 540/0216 19/20 - GL�AUMC/Wc/POLL/PROF Annette Rmero 1 2/12/2020 5:41:57 � �r ) 1 my o � This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit,whichever is applicable;and gate Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. Fpr the purposes of this endorsement the Defini- C. Part 2.of SECTION III—LIMITS OF INSURANCE tions Section is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay for the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B;and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1)which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated"project"shown in the considered a single"project". SCHEDULE above. F. The provisions of SECTION III — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright,The Travelers Indemnity Company,2004 CG D2 11 01 04 5.i070236 19/20 - GL/ALIM:C/WC/POLL/PROP Annette RME2 0 12/12/2020 5:47:57 AM (PST) I Page 9 of 14 This certificate cancels and supersedes ALL previously issued certificates. VTC2 E-CAP-9F 338154-TCT-19 R.J.Noble Company,Inc. 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 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 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 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 coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE—LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION C. EMPLOYEE HIRED AUTO EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL EFFECTS E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE LOSS COVERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G.WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED as an additional insured for Liability Coverage, The following is added to Paragraph A.1.,Who Is but only for damages to which this insurance An insured, of SECTION II — LIABILITY applies and only to the extent of that person's or COVERAGE: organization's liability for the conduct of another "Insured". Any organization you newly acquire or form C. EMPLOYEE HIRED AUTO during the policy period over which you maintain 50%u or more ownership interest and that is not 1. The following is added to Paragraph A.1., separately insured for Business Auto Coverage. Who Is An Insured, of SECTION II — Coverage under this provision is afforded only LIABILITY COVERAGE: until the 180th day after you acquire or form the An "employee" of yours is an "insured" while organization or the end of the policy period, „ operating an auto hired or rented under a whichever is earlier. contract or agreement in that employee s B. BLANKET ADDITIONAL INSURED name,with your permission, while performing The fallowing is added to Paragraph c. in A.1., duties related to the conduct of your Who Is An Insured, of SECTION II—LIABILITY business. COVERAGE: 2. The following replaces Paragraph b. in B.5., This includes any person or organization who you Other Insurance, of SECTION IV — are required under a written contract or BUSINESS AUTO CONDITIONS: agreement between you and that person or b. For Hired Auto Physical Damage organization, that is signed by you before the Coverage,the following are deemed to be "bodily injury' or "property damage" occurs and covered"autos"you own: that is in effect during the policy period, to name CA T3 53 08 17 ®2016 The Travelers Indemnity company.AU rights reserved. Page 1 of 4 Includes copyrighted material of insurance Services Office,Inc.with Its permission 5-0O'70216 119/20 - GL/AV/ESC/WC/POLL/PROF Annette Ri*Sro 12/12/2020 5:47:57 AM (PST) I Page 10 of 14 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL AUTO (1) Any covered "auto" you lease, hire, liability company) or members of their rent or borrow;and households. (2) Any covered"auto"hired or rented by (1) With respect to any claim made or "suit" your "employee" under a contract in brought outside the United States of that individual "employee's" name, America, the territories and possessions with your permission, while of the United States of America, Puerto performing duties related to the Rico and Canada: conduct of your business. (a) You must arrange to defend the However, any"auto"that is leased,hired, "insured" against, and investigate or rented or borrowed with a driver Is not a settle any such claim or "suit" and covered"auto". keep us advised of all proceedings D. EMPLOYEES AS INSURED and actions, The following is added to Paragraph A.1.,Who Is (b) Neither you nor any other involved An Insured, of SECTION II — LIABILITY "insured" will make any settlement COVERAGE: without our consent. Any "employee" of yours is an "insured" while (c) We may, at our discretion, participate using a covered "auto" you don't own, hire or in defending the"insured" against, or borrow in your business or your personal affairs. in the settlement of, any claim or E. SUPPLEMENTARY PAYMENTS — INCREASED "suit". LIMITS (d) We will reimburse the"insured": 1. The following replaces Paragraph A.2.a.(2), (i) For sums that the "insured" of SECTION II—LIABILITY COVERAGE: legally must pay as damages because of "bodily injury" or (2) Up to $3,000 for cost of bail bonds "property damage" to which this (including bonds for related traffic law insurance applies, that the violations) required because of an "insured" pays with our consent, "accident" we cover. We do not have to but only up to the limit described fumish these bonds. in Paragraph C., Limit Of 2. The following replaces Paragraph A.2.a.(4), Insurance, of SECTION II — of SECTION II—LIABILITY COVERAGE: LIABILITY COVERAGE; (4) All reasonable expenses incurred by the (ii) For the reasonable expenses "insured" at our request, Including actual incurred with our consent for your loss of earnings up to $500 a day investigation of such claims and because of time off from work. your defense of the "insured" F. HIRED AUTO — LIMITED WORLDWIDE against any such "suit", but only COVERAGE—INDEMNITY BASIS up to and included within the limit The following replaces Subparagraph e. in described in Paragraph C.. Limit Paragraph B.7., Policy Term, Coverage Of Insurance, of SECTION II — Territory, of SECTION IV — BUSINESS AUTO LIABILITY COVERAGE, and not CONDITIONS: in addition to such limit.Our duty e. Anywhere in the world, except any country or to make such payments ends jurisdiction while any trade sanction, when we have used up the embargo, or similar regulation imposed by the applicable limit of insurance in United States of America applies to and payments for damages, prohibits the transaction of business with or settlements or defense expenses. within such country or jurisdiction, for Liability (2) This insurance is excess over any valid Coverage for any covered "auto" that you and collectible other insurance available lease, hire,rent or borrow without a driver for to the "insured" whether primary, excess a period of 30 days or less and that Is not an contingent or on any other basis. "auto" you lease, hire, rent or borrow from (3) This Insurance is not a substitute for any of your"employees", partners (if you are required or compulsory insurance in any a partnership), members (if you are a limited country outside the United States, its Page 2 of 4 cif 2016 The Traverers Indemnity Company.All rights reserved. CA T3 53 08 17 Includes copyrighted material of Insurance services Office,Inc.with its permission 54070216 119e20 - GL/AV/L-AC/WC/POLL/PROF I Annette Rmero 12/1212020 5,07 57 AM (PST) I Page 11 of 14 This certificate cancels and supersedes ALL previously issued certificates. COMMERCIAL AUTO territories and possessions, Puerto Rico Personal Effects and Canada. We will pay up to $400 for "loss" to wearing You agree to maintain all required or apparel and other personal effects which are: compulsory insurance in any such (1) Owned by an"insured";and country up to the minimum limits required by local law. Your failure to comply with (2) In or on your covered"auto". compulsory insurance requirements will This coverage applies only in the event of a total not invalidate the coverage afforded by theft of your covered"auto". this policy,but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage. had you complied with the compulsory insurance requirements. K. AIRBAGS (4) it is understood that we are not an The following is added to Paragraph B.3., admitted or authorized insurer outside the Exclusions, of SECTION III — PHYSICAL United States of America, its territories DAMAGE COVERAGE: and possessions, Puerto Rico and Exclusion 3.a.does not apply to "loss" to one or Canada.We assume no responsibility for more airbags in a covered "auto" you own that the furnishing of certificates of insurance, inflate due to a cause other than a cause of"loss" or for compliance in any way with the set forth in Paragraphs A.1.b. and A.1.c., but laws of other countries relating to only: insurance. G. WAIVER OF DEDUCTIBLE—GLASS a. If that "auto" is a covered "auto" for Comprehensive Coverage under this policy; The following is added to Paragraph D., b. The airbags are not covered under any Deductible, of SECTION III — PHYSICAL warranty;and DAMAGE COVERAGE: No deductible for a covered "auto" will apply to c. The airbags were not intentionally inflated. glass damage if the glass is repaired rather than We will pay up to a maximum of $1,000 for any replaced. one"loss". H. HIRED AUTO PHYSICAL DAMAGE—LOSS OF L NOTICE AND KNOWLEDGE OF ACCIDENT OR USE—INCREASED LIMIT LOSS The following replaces the last sentence of The following is added to Paragraph A.Za., of Paragraph AA.b., Loss Of Use Expenses, of SECTION IV—BUSINESS AUTO CONDITIONS: SECTION III — PHYSICAL DAMAGE Your duty to give us or our authorized COVERAGE: representative prompt notice of the "accident" or However, the most we will pay for any expenses "loss"applies only when the"accident"or"loss" is for loss of use is $65 per day, to a maximum of known to: $750 for any one"accident". (a) You(if you are an individual); I. PHYSICAL DAMAGE — TRANSPORTATION (b) A partner(if you are a partnership); EXPENSES—INCREASED LIMIT (c) A member (if you are a limited liability The following replaces the first sentence in company); Paragraph A.4.a., Transportation Expenses, of (d) An executive officer, director or insurance SECTION III — PHYSICAL DAMAGE manager (if you are a corporation or other COVERAGE: organization);or We will pay up to $50 per day to a maximum of (e) Any "employee" authorized by you to give $1,500 for temporary transportation expense notice of the"accident"or"loss". incurred by you because of the total theft of a covered"auto"of the private passenger type. M. BLANKET WAIVER OF SUBROGATION J. PERSONAL EFFECTS The following replaces Paragraph A.G., Transfer The following is added to Paragraph AA., Of Rights Of Recovery Against Others To Us, Coverage Extensions, of SECTION III — of SECTION IV BUSINESS AUTO PHYSICAL DAMAGE COVERAGE: CONDITIONS: CA T3 53 0817 ®2016 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission 54070216 1 19/20 - GL/Al7�FSXC/WC/POLL/FR..OP Annette RWero 1 2/12/2020 5P4'1i57 AM (PST) I Page 12 of 14 This certificate cdriC 0la and supersedes ALL previously issued Certificates. COMMERCIAL AUTO 5. Transfer Of Rights Of Recovery Against N. UNINTENTIONAL ERRORS OR OMISSIONS Others To Us The following is added to Paragraph B.2., We waive any right of recovery we may have Concealment, Misrepresentation, Or Fraud, of against any person or organization to the SECTION IV—BUSINESS AUTO CONDITIONS: extent required of you by a written contract The unintentional omission of, or unintentional signed and executed prior to any "accident" error in, an information b you shall not or"loss", provided that the"accident"or"loss" y given y arises out of operations contemplated prejudice your rights under this insurance. p p by However this provision does not affect our right to such contract. The waiver applies only to the collect additional premium or exercise our right of person or organization designated in such cancellation or non-renewal. contract. Page 4 of 4 ®2016 The T rave le rs indemnity Comps ny.All rights reserved. CA T3 83 0817 Includes copyrighted material of Insurance services Offtce, Inc.with Its permission 54070216 i 19/20 - GL/Aul EXC/WC/POLL/PROF [ Annette ROM— 12/1212020 5T97:57 AM (PST) i Page 13 of 14 This certificate cancels and supersedes ALL previously issued certificates. TRAVELERS COMPENSATION AND ONE TONER SQUARE HARTFORD, CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13(00)-01 POLICY NUMBER: UB-7N939386-19-25-K WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS 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 any one not named In the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE:2/12/2020 ST ASSIGN: 54070216 119/20 - GL/AU/SXC/WC/POLL/?ROF Annette Romero 12/12/2020 5:47;57 AM (PST) I Page 14 of 14 This certificate canCels and supersedes ALL previously i88Ued certificates.