2023/02/14 Leighton Consulting, Inc. (8)oiQo"CERTIFICATE OF LIABILITY INSURANCE
ITTPORTANT: lf the certitlcate holdor l! an AOOITIONAL I{SUREO, tho policy(io.) must hav6 AOOITIONAL INSURED provislons or bo endor6od.
ll SUBROGATION lS WAIVED, sublect to tho to.ms and conditlolrt ol th. pollcy, cortain pollclos may roqulrc an sndoBsmont. A stalomont on
this cortilicate d99s nol confer rightr to the cenlrlcato holdsr in llou of such sndo,semont(s).
PnoDUcER Rtsk Strateoies Comoanv
2040 NIain Street, Sdite 450
lrvine. CA 92614
www.risk-slralegies.com
Risk S ies Co
9240
tes.com
AFFOROIN G COVERAGE
Citizens lnsurance Com ofAmerica 31534
INSURED TNSURERB: Allmerica Financial Ben€fil lnsurance Co 41840
rNsuRERc: Travelers Property Casualty Co ofAmerica 2567 4
rNsuRERo Lexinoton lnsurance ComDanv 19437
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
CANCELLATION
O 1988-2015 ACORD CORPORATION. All righE reserved.
Tho ACORO namg and logo aro rqgirtorsd marks ot AcORD
Citv of l\ilenifee
29714 Haun Road
Menibe CA 92586
AIJTHORIZED REPRESENIATIVE
RSC lnsurance Brokeraqe
CERTIFICATE HOLDER
THiS IS TO CERTIFY THAT THE POLICiES OF INSURANCE LISTED EELOW HAVE BEEN ISSUEO TO THE INSUREO NAMED ABOVE FOR THE POLICY PERIOD
INDICATEO. NOTWTHSTANOING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY 8E ISSUEO OR MAY PERTAIN, THE INSURANCE AFFOROED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOwl,] MAY HAVE BEEN REDUCED 8Y PAIO CLAIMS
E^CH OCCURRENC€s1.000,000
s 1.000.000
MEO ExP (Any on€ p.r$n)$ 10.000
PERSONAL &AOV INJI-]RY $ 1 000,000
GENE RAL AGGRECA TE s2.000.000
PROOUCTS COMP/OP AGG s2 000 000
COMMERCIALCENERAL LIABILITY
GEN'L AGGREGATE LIMIT APPLIES PER
LOCJ€CT
o83J208488 11t112022 1't It 12023
S
NEDSINGLELMT
BOoILY INJURY (Por persor)
SOOILY INJURY (Per aerdont)
jl-qqo-qo!
S
5
s
s
At]IOSONLY
SCIIEDULEO
AIJTOS
AU TOMOAIfE LIAA ILITY AW3J208478 111112022 11t1t2023
s5.000 000
S
s5 000 000
0
OCCUR
EXCESSLIAB
o83J208488 111112023 EACHOCCURRENCE
STATUTE
$ 1.000,000E L EACHACCIDENT
E L OISEASE. EA EMPLOYEE
911t2022 911t2023
E L OISEASE. POLICY LIM]T
$1.000.000
$ 1,000,000
c WORI(ERS COflPENSANON
ANO ETPLOYERS' LIAAILITY
ANYPROPRIETOR/PARTNER/EXECIJTIVE
OFFICERAT€MBEREXCLUOED?
DESCRIPTION OF OPERATIONS b€le
ua1R5099812243G
Per Claim
Aggregate
Deductible
$2.000.000
$4.000.000
$100,000
D Probssional Liability/Pollution Liab
Claims Made
013001524 2t14t2023 2t1412024
oEscRrPTroN oF oPERATTOI'IS / LOCATIONS / VEHICLES IACORO lol, Addlrion.r R.m.rt. s.h.dur., m.y b. .n.ch.<t it mon .rrc. ir 6qui6d)
See Addilional Remarks Schedule
ACORD 25 (2016/03)
THIS CERNFEATE IS ISSUED AS A ATTER OF I}IFOR ATIO ONLY ANO CONFERS t{O RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE DOES NOT AFFIR']IATIVELY OR NEGATIVELY AMEID, EXTENO OR ALTER THE COVEFAGE AFFORDED BY THE POLICIES
BELOW TH|S CERTTFICATE OF IISURANCE DOES NOT COi{ST|TUTE A CONTRACT BETmEN THE tSSUtt{G TNSURER(SI, AUTHORTZEO
REPRESENTATIVE OR PRODUCER, A O THE CERTIFICATE HOLDER.
CA DOI Liconse No. 0F06675
LeiohtonConsultino lnc
26d0 Michelson Drive. Suite 400
lrvine CA 926'12
B
1111t2022
tr
SHOULO ANY OF THE ABOVE OESCRIAEO POLICIES BE CANCELLED AEFORE
IHE EXPIRATION DATE THEREOF. I{OTICE wlLL BE OELIVERED IN
ACCORDANCEwlTH THEPOLICYPROVISIONS,
r:!n3:85 11,(:t rr: :l cJ,-A!r?O-UttB-hr 23-?4 P! Sandr ttatono 2/3/2423 9r09rl9 AM (PsT) I Paqe 1 of B
<:()Rn'ADDITIONAL REMARKS SCHEDULE Page
O 2008 ACORD CORPORATION. All rights rsssrvsd.
Tho ACORD name and logo are rggistorod marks of ACORD ADDENDUM
ADDITIONAL REMARKS
ACORD r01 (2008/0r)
Risk Sl ralegies Company Leiohton Consullino lnc
26d0 Michelson Drive Suile 400
Irvine CA 92612
NAIC CODE
THIS AOOITIOT{AL REMARKS FORM IS A SCHEOULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: Certifcate of Liability (03/16)
HOLOER: CitY of Menifee
ADDRESS: 29714 Haun Road [4enifee CA 92586
Certificate is subjecL to policy limits, conditions and exclusions. Re: Proj #11051.007
PMP 20-02: QuaiI Val1ey Street Resurfacing Project, Menifee, City of Menifee and itsofficers, employees, agents, and authorj.zed vo-Iunteers are inc-Iuded as additional insuredas respects to General Liability and Comnercial Auto coverages as r:equired by rrrittenContract. General Liabj-lity and Auto Liability coverages are primary and noncontributoryas required by written contract. Waiver of Subrogation is included wlth respect Genera.ILiability, Auto Liability, workers Compensation as required by written contract. Umbr:ellaLlability is folloi, form subject to policy forms, terms, conditions, exclusions andendorsements. 30-Day Notice of Cancellation, Except for 1o-Days for Nonpalment of Premiumappl.ies to GeneraL Liabil-ity as required by i,rritten conLract.
i:!:1ri:35 1LC) 23 2{ pr, I Sdndi yox.na | ?/A/2017 9:09:rS Al, lpST) paqe: of 3
AGENCY CUSTOi'ER IO:
LOC *:
of
Architects and Engineers
The following policy language is from Businessowners General Liability Coverage Paft
NAMED INSURED: Leighton Consulting, lnc POLICY NUMBER: O83J208488
The following are mandatory forms on lhe policy identified on the Cerlificate of lnsurance:
391.1586 (08-16) BUSINESSOVVT'IERS GENERAL LIABILITY SUPPLEMENTARY ENDORSEMENT
Additional lnsured by Contracl, Agreement or Permit
A. Section ll - Liablllty, C - Vvio is an insured is amended to include as an additional insured any person or organization with
whom you agreed in a written contract, written agreement or permit but only 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 those acting
on your behalf, but only with respect to:(i) "Your work" for the additional insured(s) designated in the contract, agreement or permit including "bodily injury"
or "property damage" included in the "products - completed operations hazard" only if this Coverage Part provides
such coverage;(ii) Premises you own, rent, lease, or occupy; or(iiD Your maintenance, operation or use of equipment leased to you.
'Definition: "Yourwork'a. Means: (1)Work or operations performed byyou oron behalfi and(2) materials, parts or equipment
furnished in connection with such work or operations; b. lncludes (1) warranties or representations made at any time with
respect to the fitness, quality, durability, performance or use of "your work'; and (2) the providing of or failure to provide warnings
or instuctions.
This provision does not apply:
(1) Unless the written contracl or writlen agreement has been executed or permit has been issued prior to the "bodily
lnjury", 'properly damage", 'personal injury' or "advertising injury".
(2) T0 any person or organization lncluded as an lnsured by an endorsement lssued by us and made part ofthis Coverage
Part.
(3) To any lessor of equipment (a) After the equipment lease expires; or (b) lf the "bodily lnlury", "property damage",
"personal injury" or "advertising lnjury" arises out of sole negligence of the lessor.
(4) To any: (a) Owners or other lnterests from whom land has been leased which takes place after the lease for the land
expiresi or (b) Managers or lessors of premises if: (i) The occurrence takes place after you cease to be a lenant in that
premises; or (ii) The "bodily injury", 'property damage', 'personal injury'or "advertisirE injury'arises out of slructural
alterations, new construction or demolition operations performed by or on behalf of the manager or lessor.
(5) To "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to
render any professional services.
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 or for you.
Other lnsurance Primary & Non-Contributory
The following paragraph is added to SECnON lll - COMMON POLICY CONDITIONS, H - Other lnsurance: Additional lnsured
- Primary and Non-Contributory. lf you agree in a written contract, written agreement or permit that the insurance provided to
any person or organization included as an Additional lnsured under SECTION ll - Liability, C. Who is an lnsured is primary and
non-contribLitory, the following applies: lf other valid and collectible insurance is available to the Additional lnsured for a loss
covered under SECTION ll - LIABILITY of thas Coverage Part, our obligations are limited as follows:
(1) Primary lnsurance: This insurance is primary to other insurance that is available to the Additional lnsured which covers
the Additional lnsured as a Named lnsured. We will not seek contribution from any other insurance available to the
Additional lnsured except: (a) For the sole negligence of the Additional lnsured; (b) V\ihen the Additional lnsured is an
Additional lnsured under another primary liability policy; or (c) Vvhen b. below applies. lf this insurance is primary, our
obligations are not affected unless any of the other insurance is also primary.
(2) Excess lnsurance:
(a) This insurance is excess over any of the other insurarce, whether primary, excess, contingent or on any other basis:(D That is Fire, Extended Coverage, Buildeis Risk, lnstallation Risk or similar coverage for "your work",(ii) That is Fire insurance for premises rented to the Additional lnsured or tefiporarily occupied by the Additional
lnsured with permission of the owner,
No coverage is provided by this Notice, nor can it be conslrued to replace any provisions of the policy (including its endorsements). lf lhere is any conflrcl
between this Nolice and lhe policy (including the endorsemenls), the provisions oflhe policy (including its endorsements) shall prevail.
(iii) That is insurance purchased by the Additional lnsured to cover the Additional lnsured's liability as a tenant for
"property damage" to premises rented to the Additional lnsured or temporarily occupied by the Additional with
permission of the owner; or(iv) lf the loss arises out of the maintenance or use of aircraft, "autos" or watercraft lo the extent not suqect lo
Exclusion g. of SECTION ll - LIABILITY. B. Exclusions, 1. Applicable to Business Liability Coverage.(v) That is insurance available to you for your participation in any pasl or present "unnamedjoint venture".(vi) That is any insurance you may have that provides coverage for your professional services.
(b) Vvhen this insurance is excess, we will have no duty to defend the insured against any "suit' if any other insurer has
a duty to defend the insured against that "suit". lf no other insurer defends, we will undertake to do so, but we will be
entitled to the insured's rights against all those other insurers.
(c) Vvlen this insurance is excess over other lnsurance, we will pay only our share of the amount of the loss, if any, that
exceeds the sum of:
(i) The total amount that all such other insurance would pay for the loss in lhe absence of this insurance; and
(ii) The total of all deductible and self-insured amounts under all that other insurance.
We will share the remaining loss, if any, with any other insurance that is not described in this Excess lnsurance provision
and was not bought specifically to apply in excess of he Limits of lnsurance sho\ rn in the Declarations of this Coverage
part.
(3) Method Of Sharing
lf all of the other insurance permits contribulion by equal shares, we will follow this method also. Under this approach,
each insurer contributes equal amounts until it has paid its apdicab{e limit of insurance or none of the loss remains,
whichever comes llrst. lf any of the other insurance does not permit contribution by equal shares, we will contribute by
limits. Under this method, each insurer's share is based on the ratio of its applicable limil of insurance to the lolal
applicaue limits of insurance of all insurers.
Per Project Aggregate
The following changes are made to SECTION ll - LlABlLlry:
1. The following is added to SECTION ll - LIABILITY, D. Liability and Medical Expenses Limits of lnsurance, paragraph 4:
The Aggregate Limits of lnsurance apply separately to each of "your projects" or each "location" listed in the
Declarations.
2. For the purpose of coverage provided by this endorsement only, the following is added to SECTION ll - LlABlLlW, F. Liability
and Medical Expenses Definitions:
1. "Your project" means:
a. Any premises, site or "location" at, on, or in which "your work" is not yet comdetedi and
b. Ooes not include any "location" listed in the Declarations.
2. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a
street, road/vay, waterway or right-of-way of a railroad.
Separation Of lnsureds
Except with respect to the Limits of lnsurance, and any rights or duties speciflcally assagned in this Coverage Part to the first
Named lnsured, this insurance applies: a. As if each Named lnsured were the only Named lnsured; and, b. Separately to each
insured against whom claim is made or "suit" is brought.
Waiver Of Subrogation
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section lV - COMMERCIAL
GENERAL LIABILITY CONDITIONS) is amended by the addition of the fr3llowing:
We waive any right of recovery we may have against the person or organization where required by witten contract because of
payments we make for iniury or damage arisang out of your ongoing operations or 'your work" done under a contract with that
person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or
organization where required by witten contract.
Notice Of Cancellation
For any statutorily permitted reason other than non-payment of premium, the number of days required for notice of cancellation,
as provided in paragraph 2. of either the CANCELLATION Common Policy Condition or as amended by an applicable
state cancellation endorsement, is increased to 30 Oays.
AUTHORIZED REPRESENTATIVE
'From lL.tovo' Fotms: 3!r1-1axr3 (@/16); 391.144t (0U1q; 3e1.1584 (N/16), 391-1lXB (OEflA)
No coverage is provided by this Notice, nor can rl be constnEd to replace any provisions of the policy (including s endorsemenls). lf here is any confiict
between lhis Nolice and the policl (including the endorsements), lhe provisions ofthe policy (including its endorsements) shall prevail
POLICY No. : AW3J208478
Leighlon Consulting, lnc.
THIS ENOORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY,
BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. The following is added to SECTION ll -
LIABILITY COVERAGE, Paragraph A.1. Who ls
An lnsured:
Additional lnsured if Required by Contract
lf you agree in a written contract, wriften
agreement or written permit that a person or
organization be added as an additional "insured"
under this Coverage Part, such person or
organization is an "insured'; but only to the extent
that such person or organization qualifies as an
"insured" under paragraph A.'1.c. of this Section.
lf you agree in a written contract, written
agreement or written permit that a person or
organization be added as an additional "insured"
under this Coverage Part, the most we will pay on
behalf of such additional 'insured" is the lesser of:
(l) The Limits of lnsurance for liability coverage
specified in the written contract, written
agreement or written permit; or
(2) The Limits of lnsurance for Liability Coverage
shc,\,n in the Declarations applicable to this
Coverage Part.
Such amount shall be part of and not in addition to
the Limits of lnsurance shown in the Oeclarations
applacable to this Coverage Part. Regardless of
the number of covered "autos", "insureds",
premiums paid, claims made or vehicles involved
in the "accadert", the most we will pay for the total
of all damages and "covered pollution cost or
expense" combined resulting from any one
"accident" is the Limit of lnsurance for Liability
Coverage shown in the Declarations.
B. The follo,ving is added to SECTION lV -
BUSINESS AUTO CONOITIONS, Paragraph B.
General Conditions, subparagraph 5. Other
lnsulance:
Primary and Non-Contrlbutory
lf you agree in a written contract, written
agreement or written permit that the insurance
provided to a person or organization who qualilles
as an additional "insured" under SECTION ll -
LIABILITY COVERAGE, Paragraph A.1. Who ls
An lnsured, subparagraph Additional lnsured if
Requlred by Contract is primary and non-
contributory, the following applies:
The liability coverage provided by this Coverage
Part is primary to any other insurance available to
the additional "insured" as a Named lnsured. We
will not seek contribution from any other insurance
available to the additional "insured" except:
(1) For the sole negligence of the additional
'insured': or
(2) For negligence arising out of the ownership,
maintenance or use of any "auto" not owned
by the additional "insured" or by you, unless
that "auto" is a "trailer" connected to an "auto"
owned by the additional "insured" or by you, or
(3) \a,/hen the additional "insured' is also an
additional "insured" under another liability
policy.
C. This endorsement will apply only if the "accidenl"
occurs:
1. Ouring the policy periodi
2. Subsequent to the execution of the written
contract or writlen agreement or the issuance
of the written permit; and
3. Prior to the expiration of the period of time that
the written contracl, written agreement or
written permit requires such insurance to be
provided to the additional "insured".
D. Coverage provided to an additional "insured' will
not be broader than coverage provided to any
other "insured' under lhis Coverage Part.
ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED
161 .0478 12 ',12 lncludes copyrighted malerial ot ISO lnsurance Services Ofiice, lnc., with its permission
1:oc:19 N iPsTl raoe 5 of 3
Page 1 of 1
14 AUTO LOAN PHYSICAL DAMAGE
EXTENSION
The following is added to SECTION lll -
PHYSICAL DAMAGE COVERAGE, C.
Limit Of lnsurance provision:
When a "loss" results in a total loss to a
covered auto you own for which a Loss
Payee is designated in this policy, the most
we will pay for "loss" in any one "accident" is
the greater of:
The actual cash value of the
damaged or stolen property as ot
the time of the "loss"; or
2. The outstanding balance of the
initial loan, less any amounts for
taxes, overdue payments, overdue
payment charges, penalties,
interest , any charges for early
termination of the loan, costs for
Credit Life lnsurance, Health,
Accident or Oisability lnsurance
purchased with the loan, and
carry-over balances from prevtous
loans.
15. AUTO LEASE PHYSICAL OAMAGE
EXTENSION
The following is added to SECTION lll -
PHYSICAL DAMAGE COVERAGE, C.
Limit Of lnsurance provision:
imposed under a lease for excessive use,
abnormal wear and tear or high mileage,
security deposits not refunded by the Iessor;
cost for extended warranties, Credit Life
lnsurance, Health, Accident or Disability
lnsurance purchased with the loani and
carry over balances from previous leases.
SECTION IV - CONDITIONS
,I6 OUTIES IN THE EVENT OF
ACCIOENT, CLAIM, SUIT OR LOSS
The following is added to SECTION lV -
BUSINESS AUTO CONDITIONS, A. Loss
Conditions, 2. Duties ln The Event Of
Accident, Claim, Suit Or Loss;
d. Knowledge of any "accident",
claim, "suit" or "loss" will be
deemed knowledge by you when
notice of such "accrdent",
claim. "suit" or "loss" has been
received by:
('1) You, if you are an individual,
(2) Any partner or insurance
manager if you are a
partnership; or
(3) An executive officer or
insurance manager if you are
a corporation.
17, BLANKET WAIVER OF
SUBROGANON
Paragraph 5. Transfer Of Rights Of
Recovery Against Others To Us,
SECTION IV - BUSINESS AUTO
CONDITIONS, A. Loss Conditions rs
replaced by the following
lncludes copyrighled material of lnsurance Services Office, lnc. with its permission
Copyright, lnsurance Services Office, lnc., 1996461-01ss (9-97)
Insurcd: Leighton Consulting, lnc.
Policy'No.:
4W3J208478
lf. because of damaqe, destruction or lheft of
a covered "auto", which is a long{erm
leased "auto", the lease agreement between
you and the lessor is terminated, "we" will
pay the difference between the amount paid
under paragraph C. LIMIT OF INSURANCE
1. or 2. and the amount due at the time of
"loss" under the terms of the lease
agreement applicable to the leased "auto"
which you are required to payi less any fees
to dispose of the auto; any overdue
payments; financial penalties
This coverage applies only to the initial
lease for the covered "auto" which has not
previously been leased. This coverage is
excess over all other collectible insurance.
lnsurcd : Leighlon Consulting, lnc.
Policv No.:
AW3i208476
The following is added to SECTION lV
BUSINESS AUTO CONDITIONS. B.
General Conditions, paragraph 2.
Concealment, Misrepresentation Or
Fraud:
The following is added to SECTION lV -
Business Auto Conditions, B. General
Conditions, paragraph 7. Policy Period,
Coverage Territory provision:
e. Oulside the coverage teffitory
described in a., b., c., and d.
above for an "accident" or "loss"
resulting from the use of a
covered "auto" you hire, without a
driver, or your employee hires
without a driver, at your direction,
for the purpose of conduc{ing your
business, for a period of 30 days
or less, provided the suit is
brought within The United States
of America or its territories or
possessions.
SECTION V . DEFINITIONS
20, MENTAL ANGUISH
Paragraph C. "Bodily iniury", SECTION V -
DEFINITIONS is replaced by the followrng
C. "Bodily injury" means bodily injury,
sickness or disease sustained by a
person including death or mental
anguish resulting from any of these
,19 HIRED AUTO - WORLDWDE
COVERAGE
Your unintenlional error in disclosing, or
failure to disclose, any material fact
exrsting afrer the etfectve date of thrs
Coverage Form shall not prejudice your
rights under this Coverage Form.
However, this provision does not affect
our right to collect additional premium or
exercise our right of cancellation or
nonrenewal.
lncludes copyrighted material of lnsurance Services Office, lnc. with its permission
Copyright, lnsurance Services Office, lnc., 1996
461-0't s5 (9-97)
5. Transfer Of Rights Of Recovery
Against Others To Us
lf any person or organization lo or
for whom we make payment under
this Coverage Form has rights to
recover damages from another,
which have not been waived
through the execulion of an "insured
contracl", written agreement, or
permit, prior to the "accident" or
"loss" giving rise to the payment,
those rights to recover damages
from another are transferred lo us.
That person or organization must do
everything necessary to secure our
rights and must do nothing after the
"accident" or "loss" to impair them.
18, UNINTENTIONAL FAILURE TO
DISCLOSE INFORMATION
TRAYEtER6T WORXERS COUPENSATION
AND
EMPLOYERS LIABILITY POLICYolrB TowER sQuaxE
LI.RTFORD cr 05183
ENDORSEMENT WC 99 03 76 ( A). oo1
POLICY NUMBER: r-tD tR50e98t2243G
We have the riJht to recover our payments from anyqte liable for an hjury co\rered by this policy. We will not
enfqce our right against the perso or orgaizati(n named h the Schedule.
The additioal premium for this endorsement shall be 2.00 % of the Califomia wqrkers' compensation pre-
mtum.
Schcdule
PGrson or Organlzatlon
I.!fY PBRgON OR ORC}NIZATIO}I FOR
WHICH TIIE INSURCD TIA.S TGREED
BY WRITTEN COITTRTCT EXECUTAD
PRION TO I.OSS TO PURNISH THI6
WAIVER.
lnsur rce Company
'lrn!clcni l\opcn\ Casually Co ol Ameflca
Cotrltersigned by
DATE OF ISSUE:
Job Dcscdption
All Operations
This endorsement changes the policy to which it is attached and is effective on the date issued uless otherwise
stated.
(Thc lnformatlon bclow ls rcquired only whln thlr GndoElmGirt ls issu€d subsequent to prepatation of
the pollcy.)
Endo6ement Effective 09/01/:022 Policy No. t,BlR50e9st221tc Fn.lor<FmP.lr N.
lnsured 1.s|gh1on (.6n5u11fng.;nx
fu
sa3335 I (LCl 2:-21 6L-AUIO-lllB-ir:l-2a P! I sa.di lror.no I 2/3/2021 9:09:19 &, (lst) I E.g€ e of 3
Page 1 of 1
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT - CALIFORNIA
(BLANKET WATVER)
ST ASSIGN: