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2022/03/01 VSS International, Inc.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 5/3/2022 Andreini &Company-San Mateo 220 West 20th Ave San Mateo CA 94403 Linda Reynolds 650-378-4258 650-378-4361 lreynolds@andreini.com Hartford Fire Insurance Co.19682 BASIC-1 Ironshore Specialty Ins.Co.25445VSSInternational,Inc. 3785 Channel Drive West Sacramento,CA 95691 640314062 A X 2,000,000 X 100,000 10,000 2,000,000 4,000,000 X Y 51CSEQU2541 3/1/2022 3/1/2023 4,000,000 A 2,000,000 X X X X X Y 51CSEQU2542 3/1/2022 3/1/2023 CA Self Insured Certificate#2106 A B Owned Auto Physical Damage Ded. Pollution Liability 51CSEQU2542 ICELLUW00120212 3/1/2022 3/1/2022 3/1/2023 3/1/2023 Comp/Coll Each Loss Aggregate $5,000 2,000,000 4,000,000 RE:VSSI Job No.22-039|AMR Slurry Seal PMP 22-01 The Menifee,its elected officers,officials,agents,representatives,consultants,contract employees,and volunteers are additional insured on a primary and non-contributory basis with regard to General and Auto Liability per attached policy provisions when required by written contract Additional Insured's shall be provided at least 30 days prior notice of cancellation or non-renewal,or at least 10 days notice of cancellation due to non-payment of premium City of Menifee City Hall 29844 Haun Road Menifee CA 92586 DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Policy Number: 51CSEQU2542 DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Designated Project(s) Or Location(s) Or Organization(s):Of Covered Operations: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A.(3)With respect to those person(s) or organization(s)In connection with "your work" for the shown in the Schedule above when you have additional insured at the project(s) or agreed in a written contract or written agreement location(s) designated in the Schedule to provide insurance such as is afforded under this and included within the "products- f. Any Otherpolicy to them, Subparagraph ,completed operations hazard", but only if: Party Additional Insureds When, under the (a)The written contract or writtenRequired By Written Contract, Written agreement requires you to provideAgreement Or Permit Section II –Paragraph of such coverage to such additionalWho Is An Insured is replaced with the following:insured at the project(s) or location(s) f. Any Other Party designated in the Schedule; and (b)Any other person or organization who is not This Coverage Part provides a.e.an insured under Paragraphs through coverage for "bodily injury" or above, but only with respect to liability for "property damage" included within the "bodily injury", "property damage" or "personal "products-completed operations and advertising injury" caused, in whole or in hazard". part, by your acts or omissions or the acts or The insurance afforded to the additional omissions of those acting on your behalf:insured shown in the Schedule applies: (1)In the performance of your ongoing (1)Only if the "bodily injury" or "property operations for such additional insured at damage" occurs, or the "personal and the project(s) or location(s) designated in advertising injury" offense is committed:the Schedule;(a)During the policy period; and(2)In connection with your premises owned (b)Subsequent to the execution of suchby or rented to you and shown in the written contract or written agreement;Schedule; or and Form HS 24 80 07 13 Page 1 of 2 © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F (c)When You Add Others As An AdditionalPrior to the expiration of the period of Insured To This Insurancetime that the written contract or written agreement requires such insurance (a) Primary Insurance When Required By be provided to the additional insured.Contract (2)Only to the extent permitted by law; and This insurance is primary if you have agreed (3)Will not be broader than that which you in a written contract or written agreement that are required by the written contract or this insurance be primary. If other insurance written agreement to provide for such is also primary, we will share with all that additional insured.other insurance by the method described in (c)Paragraph below. This insurance does notWith respect to the insurance afforded to the apply to other insurance to which theperson(s) or organization(s) that are additional additional insured in the Schedule has beeninsureds under this endorsement, the added as an additional insured.following additional exclusion applies: (b) Primary And Non-Contributory To OtherThis insurance does not apply to "bodily Insurance When Required By Contractinjury", "property damage" or "personal and advertising injury" arising out of the rendering This insurance is primary to and will not seek of, or the failure to render, any professional contribution from any other insurance architectural, engineering or surveying available to an additional insured under your services, including:policy provided that: (1)(i)The preparing, approving, or failing to The additional insured in the Schedule is prepare or approve maps, shop drawings,a Named Insured under such other opinions, reports, surveys, field orders,insurance; and change orders, designs or specifications;(ii)You have agreed in a written contract ororwritten agreement that this insurance (2)Supervisory, inspection, architectural or would be primary and would not seek engineering activities.contribution from any other insurance available to the additional insured in theThe limits of insurance that apply to the additional Schedule.insured shown in the Schedule are described in the (c) Method Of SharingLimits Of Insurance section. How this insurance applies when other insurance is If all of the other insurance permits available to the additional insured is described in the contribution by equal shares, we will follow Section IV –Other Insurance Condition in this method also. Under this approach, each Commercial General Liability Conditions, except as insurer contributes equal amounts until it has otherwise amended below.paid its applicable limit of insurance or none of the loss remains, whichever comes first.B.With respect to insurance provided to the person(s) or organization(s) that are additional If any of the other insurance does not permit When Youinsureds under this endorsement, the contribution by equal shares, we will Add Others As An Additional Insured To This contribute by limits. Under this method, each Insurance Othersubparagraph, under the insurer's share is based on the ratio of its Insurance Section IV – CommercialCondition of applicable limit of insurance to the total General Liability Conditions is replaced with the applicable limits of insurance of all insurers. following:All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 07 13 DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Form HS 24 50 12 20 © 2020, The Hartford Page 1 of 7 CONTRACTORS BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX 1. Alienated Premises Coverage ........................................................................................................................ 1 2. Damage To Your Work ................................................................................................................................... 1 3. That Particular Part ......................................................................................................................................... 1 4. Contractors Limited Professional Liability ....................................................................................................... 2 5. Per Project and Per Location General Aggregate Limits Of Insurance .......................................................... 2 6. Medical Payments Coverage - Including Products - Completed Operations .................................................. 3 7. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice ...................................... 3 8. Bodily Injury Employee Suits........................................................................................................................... 4 9. Consolidated Insurance (Wrap-Up) Programs. ............................................................................................... 4 10. Access Or Disclosure Of Confidential Or Personal Information And Data-Related Liability ......................... 5 11. Supplementary Payments ............................................................................................................................... 5 12. Two Or More Coverage Parts Or Policies Issued By Us ................................................................................ 6 13. Notice of Cancellation to Certificate Holders .................................................................................................. 6 14. Contractual Liability Coverage For Personal And Advertising Injury .............................................................. 6 15. Insured Contract Definition.............................................................................................................................. 6 1. ALIENATED PREMISES COVERAGE Exclusion j. Damage To Property of Section I - Coverage A is amended as follows: a. The following exception to the exclusion is deleted: Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. b. This exception is replaced by the following: Paragraph (2) of this exclusion does not apply if the premises are "your work". 2. DAMAGE TO YOUR WORK A. Section I - Coverage A - Bodily Injury And Property Damage Liability, Paragraph 1. Insuring Agreement is amended to add the following: f. Damages because of "property damage" include damages the insured becomes legally obligated to pay because of "property damage" to "your work" or caused by "your work", and such "property damage" shall be deemed to be caused by an "occurrence", if not intended or expected from the standpoint of the insured, regardless of whether the "property damage" arises from breach of contract. B.Exclusion l. Damage To Your Work of Section I - Coverage A is replaced by the following: l. Damage to Your Work "Property damage" to that particular part of "your work" that must be restored, repaired or replaced because "your work" was incorrectly performed and included in the "products-completed operations hazard". This exclusion does not apply if the damaged work or the work performed incorrectly was performed on your behalf by a subcontractor. This Paragraph 2.B. does not apply if Exclusion l. Damage To Your Work has been otherwise modified by endorsement. 3. THAT PARTICULAR PART This Paragraph 3. applies to Exclusion j. Damage to Property, subparagraphs (5), and (6), Exclusion k. Damage to Your Product, and Exclusion l. Damage to Your Work. DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Page 2 of 7 Form HS 24 50 12 20 When performing operations as a "general contractor", the term that particular part shall not mean the entire construction, improvement or renovation project. For purposes of this provision, the term "general contractor" means the contractor signing the prime construction contract for a construction, erection, improvement or renovation project and that has main responsibility for such project including hiring all of the subcontractors and suppliers. 4. CONTRACTORS LIMITED PROFESSIONAL LIABILITY The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,and to Paragraph 2.,Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. Professional services include: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (2) Supervisory or inspection activities performed as a part of any related architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. This exclusion does not apply to your operations in connection with construction work performed by you or on your behalf. However, this exception to the exclusion will not apply if you are in the business or profession of providing the professional services described above independent from the construction work performed by you or on your behalf. In the event this insurance applies to any injury, damage, loss, cost or expense covered by Professional Liability insurance issued by a company unaffiliated with us, then the insurance afforded under this Coverage Part is excess over such other valid and collectible Professional Liability insurance (including any deductible or self- insured retention portion thereof), and any other valid and collectible insurance available to the insured whether primary, excess, contingent or on any other basis. 5. PER PROJECT AND PER LOCATION GENERAL AGGREGATE LIMITS OF INSURANCE A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single "project" or a single "location"; 1. A separate Per Project General Aggregate Limit or a separate Per Location General Aggregate Limit applies to each "project" or "location", whichever is applicable. The Per Project General Aggregate Limit and Per Location Aggregate Limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Per Project General Aggregate Limit or the Per Location General Aggregate Limit, whichever applies, is the most we will pay for the sum of all damages under Coverage A. except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of; a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Per Project General Aggregate Limit for that "project" or the Per Location General Aggregate for that "location", whichever applies. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, the Per Project General Aggregate Limit for any other "project", or the Per Location General Aggregate Limit for any other "location". 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Form HS 24 50 12 20 Page 3 of 7 being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Per Project General Aggregate Limit if attributable only to ongoing operations at a single "project" or the Per Location General Aggregate if attributable only to ongoing operations at a single "location". B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A and for all medical expenses caused by accidents under Section I - Coverage C , which cannot be attributed only to ongoing operations at a single "project" or a single "location"; 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Per Project General Aggregate Limit or any Per Location General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit,or any Per Project General Aggregate Limit or any Per Location General Aggregate Limit. D. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. E. For the purposes of Paragraph 5., the following definitions apply: "Project" means a premises an insured does not own or rent and where such insured performs construction-related operations. Each "project" involving the same or connecting lots, or premises whose connection is separated by a street, roadway, waterway, railroad or right-of-way shall be considered a single "project". 1. If a "project" has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the "project" shall be considered a single "project". "Project" does not include a premises that is a "location". 2. "Location" means a premises an insured owns or rents and where such insured performs business operations other than construction-related operations. Each "location" involving the same or connecting lots, or premises whose connection is separated by a street, roadway, waterway or right-of-way railroad shall be considered a single "location." "Location" does not include a premises that is a "project". This provision does not apply if the Per Project and the Per Location General Aggregate Limit has been otherwise modified by endorsement. 6. MEDICAL PAYMENTS COVERAGE - INCLUDING PRODUCTS-COMPLETED OPERATIONS Paragraph 1.a. of the Insuring Agreement - Coverage C is replaced by the following: 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; (3) Because of your operations; or (4) Included within the definition of the "products-completed operations hazard;" provided that: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and reported to us within three years of the date of the accident; and (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. 7. INJURY TO EMPLOYEE'S REPUTATION WITH RESPECT TO INCIDENTAL MEDICAL MALPRACTICE A. The following is added to Paragraph 1.e. of the Insuring Agreement - Coverage A: (3) With respect to incidental medical malpractice, "bodily injury" includes damages claimed for injury to emotions or reputation of an "employee" arising out of the rendering or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic services. DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Page 4 of 7 Form HS 24 50 12 20 B. The following exclusion is added to Coverage B - Personal and Advertising Injury: "Personal and advertising injury arising out of the rendering or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic. 8. BODILY INJURY EMPLOYEE SUITS A. "Bodily injury" as listed in Paragraph 2.a.(1) of Section II -Who Is An Insured, does not apply to 2.a.(1)(a) through 2.a.(1)(c). B. Part a. of Paragraph 4. Nonowned Watercraft in Section II - Who Is An Insured does not apply. 9. CONSOLIDATED INSURANCE (WRAP-UP) PROGRAMS The following exclusion is added to Section I Coverage A: This insurance does not apply to any "bodily injury" or "property damage" arising out of any "wrap project or premises" where an insured under this policy is or was also an insured under one or more commercial general liability (CGL) policies (including any umbrella or excess policies that include the commercial general liability policy(ies) as underlying insurance) included within a "consolidated insurance (wrap-up) program." This exclusion applies even if the limits of insurance for such "consolidated insurance (wrap-up) program" are exhausted or not collected for any reason, including bankruptcy or insolvency of the insurer providing coverage for the "consolidated insurance (wrap-up) program". This exclusion also applies if the CGL coverage afforded under the "consolidated insurance (wrap-up) program" is narrower in scope than the coverage provided by this policy. This exclusion does not apply to: A. Products-Completed Operations Hazard Exception "Bodily injury" or "property damage" arising out of an “insured's operations” at or in connection with a "wrap project or premises" when such "bodily injury" or "property damage" commences after the "products-completed operations hazard" coverage or any completed operations extension coverage provided by the applicable "consolidated insurance (wrap-up) program" has ended or is no longer in effect. B. Off-Site Location Exception "Bodily injury" or "property damage" resulting from an “insured's operations” at or in connection with a "wrap project or premises" at a location to which the applicable "consolidated insurance (wrap-up) program" does not apply. C. Repair Work And Punch List Work Exception "Bodily injury" or "property damage" resulting from "repair work" or "punch list work" at a "wrap project or premises" but only when the applicable "consolidated insurance (wrap-up) program" does not apply or no longer applies to such "repair work" or "punch list work". This exception does not apply to the cost of performing such "repair work" or "punch list work", or to the "repair work" or "punch list work" itself. D. Additional Insured Extension "Bodily injury" or "property damage" for which you are solely an additional insured under the "consolidated insurance (wrap-up) program". The coverage provided under Paragraphs 9.A through 9.D. above is subject to all terms, conditions and exclusions of this policy. For purposes of Paragraph 9, the following definitions apply: "Consolidated insurance (wrap-up) program" means any agreement or arrangement, including any contractor-controlled, owner-controlled, project-specific or similar insurance program under which one or more contractor(s) working on a specified project are insured under one or more commercial general liability (CGL) policies (including any umbrella or excess policies that include the commercial general liability policy(ies) as underlying insurance) issued by a specified carrier for injury or damage arising out of operations conducted in connection with or necessary or incidental to the project. “Insured’s operations” means all operations performed by a named insured (and not sub- contracted or performed by others on the insured’s behalf). "Punch list work" means the “insured’s operations” at or in connection with a "wrap project or premises" in order to complete the work called for in an insured's contract for the "wrap project or premises". "Repair work" means the “insured’s operations” that are service, maintenance, correction, repair, replacement work, or periodic inspection performed by an insured at or in connection with a "wrap project or premises", in order to replace or repair an insured's completed work. ."Wrap project or premises" means any premises or construction, erection, improvement or renovation project subject to a "consolidated insurance (wrap-up) program". 10. ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA- RELATED LIABILITY DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Form HS 24 50 12 20 Page 5 of 7 A.Exclusion p. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: p. Access Or Disclosure Of Confidential Or Personal Information And Data- Related Liability Damages arising out of: (1) Any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or (2) the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in Paragraph (1) or (2) above. However, unless Paragraph (1) above applies, this exclusion does not apply to liability for damages because of "bodily injury". B.Exclusion w. of Section 1 - Coverage B - Personal and Advetising Injury is replaced by the following: : w.Access Or Disclosure Of Confidential Or Personal Information "Personal and advertising injury" arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information. This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of any access to or disclosure of any person's or organization's confidential or personal information. C. The following Paragraph is added to Section III - Limits Of Insurance: Subject to Paragraph 5.Each Occurrence Limit, the most we will pay under Coverage A for "property damage" because of all loss of "electronic data" arising out of any one "occurrence" is $100,000, unless modified by endorsement. D. The following definition is added to Section V - Definitions: "Electronic data" means information, facts or programs: a. Stored as or on; b. Created or used on; or c. Transmitted to or from; computer software, (including systems and applications software) hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. E. For the purposes of the coverage provided by this provision, the definition of "property damage" in Section V - Definitions is replaced by the following: "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. 11. SUPPLEMENTARY PAYMENTS In the Supplementary Payments - Coverages A and B provision: The limit for the cost of bail bonds is increased to $2,500. DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Page 6 of 7 Form HS 24 50 12 20 12. TWO OR MORE COVERAGE PARTS OR POLICIES ISSUED BY US If this policy and any other policy issued to an insured by us or any affiliated company provides coverage that applies to the same claim or damages, the maximum applicable limit(s) of liability or limit of insurance under all the policies will not exceed the highest applicable limit of liability or limit of insurance under any one policy. This condition does not apply to any policy issued by us or an affiliated company specifically written to apply as excess insurance over this policy. 13. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. 14. CONTRACTUAL LIABILITY COVERAGE FOR PERSONAL AND ADVERTISING INJURY Exclusion e. of SECTION I - COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY is replaced by the following: This insurance does not apply to: e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) That the insured would have in the absence of the contract or agreement; or (2) Assumed in a contract or agreement that is an "insured contract", provided the "personal and advertising injury" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "personal and advertising injury", provided: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract"; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 15. INSURED CONTRACT DEFINITION a. INSURED CONTRACT-CONSTRUCTION OPERATIONS AND MUNICIPAL WORK Paragraph d. of the definition of ''insured contract'' in Section V - Definitions is deleted and replaced by the following: An obligation, as required by ordinance, to indemnify a municipality. b. CONTRACTUAL LIABILITY Paragraph f. of the definition of "insured contract" is deleted and replaced by the following: That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury", "property damage", or "personal and advertising injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. includes that part of any contract or agreement that indemnifies a railroad for "bodily injury", "property damage", or "personal and advertising injury" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing. However, Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F Form HS 24 50 12 20 Page 7 of 7 (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. All other terms and conditions in the policy remain unchanged. DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS OFFICE OF SELF-INSURANCE PLANS 11050 Olson Drive, Suite 230 Rancho Cordova,CA 95670 Phone No. (916) 464-7000 FAX (916) 464-7007 TO WHOM IT MAY CONCERN: This certifies that Certificate of Consent to Self-Insure No. 2106-C was issued by the Director of Industrial Relations to: CERTIFICATION OF SELF-INSURANCE OF WORKERS' COMPENSATION VSS International, Inc. under the provisions of Section 3700, Labor Code of California with an effective date of August 1, 1988. The certificate is currently in full force and effective. Dated at Sacramento, California This day the 06th of January 2022 Lyn Asio Booz, Chief ORIG:Krissy Deleon Risk & Claims Coordinator Basic Resources, Inc. 928 12th Street, Ste. 700 Modesto, Ca 95354 Gavin Newsom, Governor DocuSign Envelope ID: 38225AA7-FF69-4E3A-AFD6-7CC781A0710F