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2021/11/13 Consolidated Engineering LaboratoriesOAIElMM/OO,'YYYY) 11i12/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO}'I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OOES NOT AFFIPMATIVELY OF NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE AFFOROEO BY THE POLICIES aELOW. THIS CERTIFICATE OF TNSURANCE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSU|NG TNSUBEF(S), AUTHORTZEO REPBESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. lMPoRTANT:lfthoconi'icat9holderisanAoDlTloNALlNsUFE SUBROGATION lS WAIVED, subiect to tho terms and condillons ol the policy, certain policies may roquiro an 6ndoraemont. A statement on this corlificato doos not confor rlghts to lhe cortificate holdor in lieu ol such endorsoment(3). PFOOUCEF aon Risk Services Southwest, Inc Houston TX Office5555 5an Fe'lipe sui te 1500Hotlston TX 77056 USA fi3.xtEo. Ex1' r866) 28l - 7122 [ft 6.,. {aoor rei oror ADDNESS INSUFEF(S) AFFOFOING COVIFAGE INSUBED consol'idated Engi nee ri ng Laboratories 2001 crow Canyon Road, Suite 1.00san Ramon CA 94581 USA rt6uREs A: zurich american Ins co 16515 rrEuREB B: Steadfast rnsurance company .q,<:Qo'CERTIFICATE OF LIAB!LITY INSURANCE COVERAGES CERTIFICATE NUMBER: 570090286761 REVISION NUMBEB: r;,',:"I: E.E& .9 ! ! I 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEI'] ISSI]E6 TO THE INSUFED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANOING ANY BEOUIREMENT, TERM OR CONOITION OF ANY CONTAACT OR OTHER DOCUMENT WITH HESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEFTAIN, THE INSUBANCE AFFORDED BY THE POLICIES OESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMSEXCLUSIONS ANO CONOITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED AY PAID CLAIMS,Llmils shown 6re as requesled B COMMEFCIAL GEN€FAL IIASILITY GEN'L AGGFEGATE LIM IAPPL ES PEF FOLCY OIHEFI JECT LOC CPLU217OE5O6 L!/ )tJ/ aUt!Lt/ li / 4)t2 EACH OCCURBENCE $2,000,000 PBEMISES (Ea ecursnc6r 9100,000 MEO EXP (Any o.. p66on)s5,000 PERSONAL A AOV ]N.]L)RY 52,000,000 OENEAALAGGF€GATE $6,000,000 PFOOUCTS . COMP/OP AGG s4,000,000 AUTOfiOBILE LIABILITY OWNEO AUTOS ONLY SCHEOTILED AUrOS NON.OWNED EAP 0217109-06 tt/13 /2021 tt/73/2022 COMAINEO SINGLE LIM T $s ,000,000 BOoTLY NJUBY ( PerpoEon) BOOILY NJUqY lPor accdonll UMBREILALIAE EXCESS LIAB occrJF sxs021707705 11/1) /2027 11/13 /2022 EACI]OCCURRENCE $1,000,000 AGGAEGATE s1,000,000 0E0 FE':ENTON WOFKEFS COMPENSAIION ANO EMPLOYEgS' LIAEILITY ANY PAOPRIEIOR] PAFTNER T EXECUTIV€ OFFICEf]/MEMBER EXCLUOED? DESCRTPIION OF OPERAT ONS b6low wco21711106 AO5 wc730665100 WI rt/t3/2o2r tl/1)/2021 tL/ L3 /2022 tt/13 /2022 x oTrl E L EACHACCIOENT $1,000,000 E,I,, O SEASE.EA EI PLOYEE $1,000,000 E,L, DISEASE.POLICYLMlr $1,000,000 B E8,O-PL Prinary GP1021708506 CLAIMS MAO€ lt/t]/2027 tt/ l3/20?2 Each Tncidentaggregate 52,000$6,000 000 000 DESCElPllOrl OF OPEBATIOI€ / LOCATIOI{I r VEHICIES (lCOnO 1Or, lddrlon.r F.r!.rir Sch.dst , my b. .n ch.d r nor. .9.c. t r.qutr.d)city of Menifee..its office.s, employees, agehts and authorized volunteers, are additional insureds, on a primary and noncontri butory bas i s. --+ir Ed +-;+-.- f-Ge.J CERTIFICATE HOLDER CANCELLATION SHOULO ANY OF THE AAOVE DESCNIBED POLICIES BE CAI{CELIED BEfOBE THE EXPIFATION OAIE THEBEOF. NOIICE WILL EE OELIVEREO IN ACCOFDANCE WTH 'llE city of t',!enifee29714 Haun RoadM€nifee cA 92586 usa -M* %g*,*9"-x-,*t-f,, ALTHOPIZED PEPPESFNTATIVfr,;i:iI E}TE ACORD 2s (2016/03) ] c,-o,*rs.uroe I occun N l26Ju |- s I E!I E:l 01988-2015 ACOHD COBPORATION. All righls reserued. The ACORD name and logo are registered marks of ACOBD AGENCY CUSTOMER lD: 570000080236 LOC #:A,(-(rRi)*ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Southwest, Inc. NAMEO NSUFEO consol j dated Engi neeri ng Laboratori es see certi fi cate tumber: 570090286761 see certi f'i cate Number: 570090286761 NA|C COOE ADOITIONAL REMABKS THIS ADDITIONAL REMABKS FORM IS A SCHEDULE TO ACORD FORM, FOBM NUMBER: ACOBD 25 FORM TITLE: Certilicate oi Liability lnsurance INSUREB(S) AFFORDING COVEBAGE NAIC # tNsl rRt-tR tNst rt{ Hlt IN SLJRTJR INSIiI{ER AI)I)I1'IoNAI, PoI,I('IES ll a policy beJow does nol include limit information, refcr lo the corrrsponding policy on the ACORD ccftificatc form for policy Iimils. uttl( \t_I,I'R 'l\'t,u ot.tNsr R,\\( l:I t\ltl\ OTHER I Env Contr Poll cP1021708506 lt/ 73 /2027 t7/ 71/ 2022 Each rnc i dent 12,000,000 Aggregate $6,000,000 IIIIllIIIlIlIlllIrIlIlII II TIIII TII ACORD 101 (2008/01) Ths ACOFD name af,.l logo are regislered marks ol ACOFO O 2008 ACOFD COnPORArlOil. All rlghls reBsrusd. s700000802 36 o-G2*ADDITIONAL REMARKS SCHEDULE Page _ of - AGENCY Aon Risk services southwest, rnc, NAMEO INSUNED consol i dated Engineering Laboratolies POLICYNUMBER see Ce rti fi cate Number: 570090286761 see ce rt'i fi cate Number: 570090285761 NArC CO0E EFFECTIVE DATE ADDITIONAL BEMARKS AGENCY CUSTOMER IO: LOC #: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FOBM NUMBER: ACOBD 25 FORM TITLE: Certificale of Liability lnsurance ATLAS TECHNICAL CONSULTANTS HOLDINGS LP SCHEDULE OF NAMED INSUREDS Alta v'ista Enoineerino services AG Al ta v'ista solut'ions inc. Arrow ATC Hol diArrow Envi ronmeArrow Envi ronmeATc Associ ates ATC Assoc'i atesATc Associ ates, nqs,ntal n ta'lofNofOInc LLC Hol di ngs LP Ho'l d'i ngs , cP LLcorth carol i na, PCh'io, LP ATC AIC ATC ATC ATC ATC ATC ATC ATC ATC ATC constructl on serv] ces, Inc.rngi neeri ng of Mich'igan, LP Enqi nee ri ng, LLP Envi ronmental , rnc. Group Hol di ngs LLc Group Partners LLC Group Serv'i ces LLc Ho'l di ng, Inc. Leasr nq ComDany, LLC Itew engl and corporati on sol e Member LLCatlantic Enqineerinq Laboratories of New york, Inc,Atl anti c Enqineering Laboratories, tnc.Atlas rntermedi ate Holdinqs LLc At'l as Tc Holdings LLcAtl as rechnical consultants LLcAtlas Technical consultants sole Member LLc At'l as Technica'l consultants, rnc.Bananza rndust ri es, rnc. BcM Engi nee ri ng, rnc.Beest Express, LLCcai tcon, LLCcardno ATc (MA), rnc, CEL Consul t'i ng, LLC consol'i dated Enqi neeri nq LaboratoriesDexter ATC Field Services LLCDexter Field Servvices, LPEngineering & testing services LLc Engl neerr ng Servtces, LLC Env] ronmenta I Complrance SeTv]ce5, Inc. ETS-ESC Holdi nqs LLcGeosphere cons['l tants, lnc. HES Test inq, LLcLong Engi nee ri ng, Inc.Lonq Enqi nee ri nq, LLcvatErials Iestinq & lnspection, LLco'Ne'i'l servi ce Group, LLcori s sol ut'ions, LLceavetex engineering, LLc (dba PaveTex)pi edmont Geotechnical consultants, LLc Pi pe'l i ne Environmental Services Pl ant Servi ces Qual i ty Assurance Engineering, Inc.Rocky Mountar n Psr, LLc sage ATc Environmental consulting LLc saqe ATc Env'ironmental Holdinq LLcsaqe Arc Env'jronmental Holdinqs LLc Saqe Enqi nee ri ng, Inc.Sage Envi ronmental co!su'lting, LPsage Envr ronmenta I Holdrngs, LLC SCST, LLC South!,vest ceophysi cs, LLCThe Envi ronmental rnsti tute uni ted Testi ng, LLCI.{esTest, LLCrr/i'l ki ns Envi ronmental consul ti ng, 1nc. r..iit H$ E!I Rg Ei:)Xt ffi$ acoBD 101 (2008/01) The ACORD nam€ and logo ar€ registered marks oIACOBD O2008 ACOFO COBPOBATION. Allrlghts res€rved. oAdditional Insured-Automatic-Owners, Lessees Or Contractors Coverage Part One-Com mercial General Liability Coverage Part Two-Contractor's Pollution Liability GPL 02'17085-06 11t13/2021 11t13/2021 14340000 ZURICH a Named lnsured and Mailing Address: Atlas Technical Consultants, lnc. '13215 Bee Cave Pkwy, Building A, Suite 250 Austin, TX 78738 Producer: AON RISK SERVICES SOUTHWEST INC 5555 SAN FELIPE ST STE 15OO HOUSTON. rX 77056-2739 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Environmental Services Package Policy X covenace pART oNE-coMMERclAL GENERAL LtABtLtw [E cove naor pART TWo-coNTRACroR's poLLUTroN LrABrLrry 1. Who is an lnsured (Section l.) in the COMMON COVERAGE PROVISIONS is amended to include as an additional insured any person(s) or organization(s) whom you are required to add as an additional insured on this policy under a written contract or written agreement. 2. The insurance provided to the additional insured person(s) or organization(s) applies only to: a. "Bodily injury", "property damage" or "personal and advertising injury" under COVERAGE PART ONE- COMMERCIAL GENERAL LIABILITY, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B - PERSONAL AND ADVERTISING INJURY LlABlLlry caused, in whole or in part, by: ('l ) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; and resulting directly from: (a) Your ongoing operations performed for the additional insured, which is the subject of the written contract or written agreement; or (b) "Your work" completed as included in the "products-completed operations hazard", performed for the additional insured, which is the subject of the written contract or written agreement; and/or b. "Claims" arising out of a "pollution event" under COVERAGE PART TWO - CONTRACTOR'S POLLUTION LlABlLlry, caused, in whole or in part, by: (1) Your acts or omissions, or (2) The acts or omissions of those acting on your behalf, and resulting directly from: (a) "Covered operations" performed for the additional insured, which is the subject ofthe written contract or written agreement; or Policy No Eff. Date of Pol Exp. Date of Po! 1 t t13t2022 STF-ESP-101-F CW (04/13) Page 1 of 3 Eff. Dale of End. Producer *tr.rrn ""- -lT_Add'l Prem. (b) "Completed operations" of the "covered operations" performed for the additional insured, which is the subject of the written contract or written agreement. 3. However, regardless of the provisions of paragraphs I . and 2. above, the insurance afforded to such additional insured: a. Only applies to the extent permitted by lawi and b. Will not be broader than that which you are required by the written contract or written agreement to provide to such additional insured. 4. With respect to the insurance afforded to the additional insured under this endorsement, the following is added to Section lll - Limits Of lnsurance and Deductible: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement you have entered into with the additional insured; or b. Available under the applicable Limits of lnsurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations 5. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and adve(ising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: ('l) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, repo(s, surveys, field orders, change orders or drawings and specifications; and (2) Supervisory, inspection, 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 the failure to render any architectural, engineering or surveying services. 6. The additional insured must see to it that: a. We are notifled as soon as practicable of an "occurrence", offense or "pollution event", as applicable, that may result in a claim, b. We receive written notice of a claim or "suit" as soon as practicable: and c. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named lnsured, if the written contract or written agreement requires that this coverage be primary and non-contributory. 7. For the coverage provided by this endorsement: a. The following paragraph is added to Paragraph 8.a. Other lnsurance, Conditions (Section V.) in the COMMON COVERAGE PROVISIONS: Primary and Noncontributory lnsurance This lnsurance is primary to and will not seek contribution from any other insurance available to an additional insured under this endorsement provided that: (1) Theadditional insured is a Named lnsured under such other insurance; and (2) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. b. The following paragraph is added to Paragraph 8.b. Other lnsurance, Conditions (Section V.) in the COMMON COVERAGE PROVISIONS: This insurance is excess over: STF-ESP-101-F CW (04/13) Page 2 of 3 tr,'ii$Eirf;H:'84 a 1 3I Ba tr i:+ift l.:itHEl&.* Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named lnsured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. 8. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. STF-ESP-101-F CW (04/13) Page 3 of 3 a Additional Insured - Automatic - Owners, Lessees Or Contractors ZURICH THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PoljcyNo. cpl-021708s-06 Effective Date: tt /t3t202t This endorsement modifies insurance provided under the: Comme.cial General Liability Covorago Part Ono, Common Coverage Provisions A. Section l- Who ls An lnsurod is amended to include as an additional insured any person or organization whom you are required to add as an additional insured under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising iniury" and subject to the following: 1. lf such written contract or written agreement specificatly requires that you provide that the person or organization be named as an additional insured underone or both ofthe following endorsements: a. The lnsurance SeNices Office (lSO) ISO CG 20'10 (10/01 edition); or b. The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of: (1) Your ongoing operations, with respect to Paragraph 1.a. above; or (2) "Your work", with respect to Paragraph '1.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 1., insurance atforded to such additional insured: (a) Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. Solely with respect to this Paragraph (b), if the written contract or written agreement provides a minimum time period for providing such coverage, and such minimum time period ends prior to the end of the policy period, this insurance shall not apply to "bodily injury", "property damage" or a "personal and advertising injury" offense which occurs during the policy period and after the end of that minimum time period. 2. lf such written contract or written agreement specifically requires that you provrde that the person or organization be named as an additional insured under one or both of the following endorsements: a. The lnsurance Services Otfice (lSO) ISO CG 20 10 (07/04 edition); or b. The ISO CG 20 37 (07/04 edition), tri:+i*ffi I $ 5! Ea STF-ESP-IilAN-,I23 Page 1 of 4 t'.i;ftru such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, in the performance of: (a) Your ongoing operations, with respect to Paragraph 2.a. above; or (b) "Your work" and included in the "products-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2., insurance atforded to such additional insured: (i) Only applies if the'bodily inlury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (ii) Does not apply to "bodaly injury" or "property damage" caused by "your work" and included within the "productsrompleted operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. Solely with respect to this Paragraph (ii), if the written contract or written agreement provides a minimum time period for providing such coverage, and such minimum time period ends pnor to the end of the policy period, this insurance shall not apply to "bodily injury", "property damage" or a "personal and advertising inJury" otfense which occurs during the policy period and after the end of that minimum tjme period. 3. lf neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requlres that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 10 (04113 edition, any subsequent edition or if no edition date is specified); or b. With respect to ongoing operations (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part by: (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, in the performance of your ongoing operations, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3,, insurance afforded to such additional insured: (a) Only applies to the extent permitted by law; (bl Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c) Only applies af the "bodily injury", "property damage" or "personal and advertising iniury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4. lf neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a. Under the ISO CG 20 37 (04113 edition, any subsequent edition or if no edition date is specified)i or b. With respect to the "products-completed operations hazard" (if no form is specified), STF.ESP-MAN-123 Page 2 of 4 such person or organization is then an additional insured only to the extent that "bodily injury" or "property damage" is caused, in whole or in part by "your work" and included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4,, insurance afforded to such additional insured: (1) Only applies to the exlent permitted by lawi (2) Will not be broader than that which you are required by the written contract or wriften agreement to provide for such additional insured; (3) Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreementi and (4) Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operatrons hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. Solely with respect to this Paragraph (4), if the wriften contract or written agreement provides a minimum time period for providing such coverage, and such minimum time penod ends prior to the end of the policy period, this insurance shall not apply to "bodily injury" or "property damage" which occurs during the policy period and after the end of that minimum time period. B. Solely with respect to the insurance afforded to any additional insured referenced in Secfion A. of thas endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising iniury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2. Supervisory, inspection, architectural or engineenng 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 the failure to render any professional architectural, engineering or surveying services. C. Solely with respect to the coverage provided by this endorsement, the following is added to Common Coverage Provisions, Section lV - Claims Provisions, Paragraph 2: The additional insured must see to it that: (1) We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; (2) We receive written notice of a claim or "suit" as soon as practicable; and (3) A request for defense and indemnity of the clajm or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named lnsured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. Solely with respect to the coverage provided by this endorsement: 1. The following is added to the Other lnsurance Condition of Section V - Conditions, Paragraph 8: Primary and Noncontributory inaurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named lnsured under such other insurancei and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph Lb. of the Other lnsurance Condition under Section V -: Fd.EIT4 s a 888 ffi STF-ESP-MAN-123 Page 3 of 4 This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional jnsured is a Named lnsured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. E. This endorsement does not apply to an additional insured which has been added to this Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. Solely with respect to the insurance afforded to an additional insured under this endorsement, the following is added to Section lll - Limits Of lnsurance: Additional lnsured - Automatic - Ownera, Lessees Or Contractors Limit The most we will pay on behalf of the additional insured is the amount of insurance: 1, Required by the wntten contract or written agreement referenced in Section A. of this endorsement, or 2. Available under the applicable Limits of lnsurance shown in the Declarations, whichever is Iess. This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations. All other terms, conditions, provisions and exclusions of this policy remain the same STF.ES P.N,IAN.1 23 Page 4 of 4 o Waiver of Transfer of Rights of Recovery Against Others - Blanket as Required by Contract ZUR!CH Policy No Eff. Date of Pol Exp Date of Pol Eff. Date of End Producer Add'l Prem Return Prem GPL 0217085-06 11t1312021 11t13t2022 1111312021 lncluded Named lnsured and Mailing Address: Atlas Technical Consultants, lnc. 13215 Bee Cave Pkwy, Building A Suite 250 Austin, TX 78738 Producer: AON Risk Solutions 5555 San Felipe, Suite 1500 Houston, TX 77056 tri:isffi ffi THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, This endorsement modifies insurance provided under the following: Environmental Services Packag€ Policy IX1 COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY IX] COVERAGE PART TWO - CONTRACTOR'S POLLUTION LIABILITY tX] COVERAGE PART THREE - PROFESSIONAL LIABILITY ln consideration of the payment of premium and the Deductible by you and in reliance upon the statements in the Application made a part hereof, we agree with you, subject to all the terms, exclusions and conditions that with respect to the coverage parts indicated above Conditions (Section V.) of the COMMON COVERAGE PROVISIONS, Condition 14. Subrogation is amended by the addition of the following: We waive any right of recovery we may have against any person or organization whom you are required to waive your right of subrogation by a written contract or written agreement executed and effective prior to the performance of your services which is the subject of such written contract or written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. 3 5 S E E INTERNAL USE ON LY STF-ESP-248-A CW (04/10) Page 1 of 1 POLICY NUMBER: BAP-021 7109-06 COMMERCIAL AUTO cA 20 48 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Named lnaured: Atlas Technical Consultants, lnc. EndorEement Effective Date:'l1l'l3l202'l SCHEDULE Name Of Person(s) Or Organization(s): Any person(s) or organization(s) whom you are required by written contract. lnformation requi is Schedule, if not shown above, will be shown in the Declarations Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifiesas an "insured" under the Who ls An lnsured provision contained in Paragraph A.1. of Section ll -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section l- Covered Autos Coverages of the Auto Dealers Coverage Form. cA 20 48 10 13 @ lnsurance Services Office, lnc., 201 1 Page 1 of lWolters Kluwer Frnancial Se.vices lUnrform Forms'" Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who ls An lnsured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. o Coverage Extension Endorsement - Liability Only ZURICH Policy No Eff Date of Pol Exp. Date of Pol Eff Date of End Producer No Add'1. Prem Return Prem BAP 02'17109-06 11t13t2021 11t13t2022 1',t t13t2021 14 340000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Business Auto Coverage Form Motor Carrier Coverage Form A. Amended Who ls An lnsured '1. The following is added to the Who ls An lnsursd Provision in Section ll - Covered Autos Liability Coverage: The following are also "insureds": a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any "employee" of yours is also an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2. The following is added to the Other lnsurance Condition in the Business Auto Coverage Form and the Other lnsurance - Primary and Excess lnaurance Provlsions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or wratten agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B. Amendment - Supplementary Payments Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section ll - Covered Autos Liability Coverage are replaced by the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related trafflc law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to 9500 a day because of time off from work.Ei:;$B-.r+EIgi! E 8!I E INTERNAL UsE ONLY u-cA-428-A CW (02-14) Page '! of 3 tri:ii$ HS lncludes copyrighted material of lnsurance Services Ofiice lnc , with its permission C, Fellow Employee Coverage The Fellow Employee Exclusion contained in Section ll - Covered Autos Liability Coverage does not apply. D. Driver Safety Program Liability Coverage The following is added to the Racing Exclusion in Section ll - Covered Autos Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. E. Amended Dutios ln The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Outies ln The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. ln the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "lors". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liability company) or an executive officer or insurance manager (if you are a corporation). The failure of any agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insurance afforded by this policy. lnclude, as soon as practicable: (1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit' is brought, written notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; (2) The "insured's" name and addressi and (3) To the extent possible, the names and addresses of any injured persons and witnesses. lf you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violataon of these amended duties provided you give us notice as soon as practicable after the fact of the delay becomes known to you. F. Waiver of Transfer Of Righte Of Recovery Again6t Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or "loss", provided that the "accident' or "loss" arises out of operations contemplated by such contract. Thrs waiver only applies to the person or organization designated in the contract. G. Unintentional Failure to Disclose Hazards The following is added to the Concealment, MisreprBentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of "autos" or other misstatement of information. You must notify us as soon as possible afler the discovery of any hazards or any other information that was not provided to us prior to the acceptance of this policy. H. Hired Auto - World Wide Coverage Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, l. Bodily lnjury Redefined The definition of "bodily injury" in the Oefinitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish, resulting from any of these at any time. Mental angulsh means any type of mental or emotional illness or disease. INTERNAL USE ONLY u-cA-428-A CW (02,r4) Page 2 of 3 lncludes copy.ighted materialof lnsurance Services Office, lnc., with its permission J. Expected Or lntended lniury The Expected Or lntended lnjury Exclusion in Paragraph B. Exclusions under Section ll - Covered Auto Liability Coverage is replaced by the following: Expected Or lntended lnjury "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. All other terms, conditions, provisions and exclusions of thas policy remain the same u-cA-428-A CW (02-14) Page 3 of 3 tr;.:i,$i:iriifilr tr;iifrl:{ritEil1 3l s E 1 HI INTERNAL USE ONLY lncludes copyrighted materlalof lnsurance Servic€s Office, lnc., with its permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSUR.ANCE POLICY wc 00 03 13 (Ed 04-84) 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 obtaln this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person(s) or organization(s) whom you are required by written contract. This endorsement changes the policy to which it is attached and is effective on the dale issued unless otherwise slated. (The information below is required only when this endoraemont is issued subsequent to preparation of the policy.) Endorsement Elfeclive 11h312'l Policy No. WC 02171 1 1-06 lnsured: Atlas Technic€l Consultants, lnc. Endorsement No. Premium S Countersigned by Copyright 1983 National Councilon Compensation lnsurance, lnc Page 1 of 'l Uniform FoamsrM wc124 14-841 INTERNAtr'ESO@UIY 3 o a Designated Construction Project(s) Aggregate Limit ZURICH Coverage Part One - Commercial General Liability Policy No Efl Date of Pol Exp. Date of Pol Eff. Oate of End Producer Add'lPrem Relurn Prem 11t13t20?2 11t13t2021 143400009l! 021?08106 Named Insured and Mailing Address: Atlas Technical Consultants, lnc. 13215 Bee Cave Pkwy, Building A, Suite 250 Austin, TX 78738 Producer: AON RISK SERVICES SOUTHWEST INC 5555 SAN FELIPE ST STE 15OO HOUSTON,'l X 77 056-27 39 f/;r'lfli#*trII-r_ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Environmental Services Package Policy ln consideration of the payment of premium and the Deductible by you and in reliance upon the statements in the Application made a part hereof, we agree with you, subrect to all the terms, exclusions and conditions that the following provisions apply to COVERAGE PART ONE - COMMERCIAL GENERAL L|ABlLlry only. Schedule Designated Construction Project(s): Construction projects as required by a written contract or written agreement executed and effective prior to providing services. Total Designated Construction Project(s) Aggregate Limit: $6,000,000 For all sums which the insured becomes legally obligated to pay as "damages" caused by "occurrences" under COVERAGE A - BOOILY INJURY AND PROPERry DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY and for all medical expenses caused by accidents under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: a. A separate Designated Construction ProJect Aggregate Limit applies to each construction proiect, and that limit is equal to the amount of the Policy Aggregate Limit shown in the Declarations. b. The Total Designated Construction Proiect(s) Aggregate Limit, shown in the Schedule above, is the most we will pay for the sum of all "damages" caused by "occurrences" under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY and for all medical expenses caused by accidents under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY which can be attributed only to ongoing operations at designated construction projects. c. The Oesignated Construction Project(s) Aggregate Limit is the most we will pay for the sum of all "damages" under COVERAGE A - BODILY INJURY AND PROPERry DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY, except "damages" because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY regardless of the number of: (1) lnsureds; R g 8 9 E a,'ij-fi,litt*EJII} STF-ESP-148-B CW (01/04) Page 'l of 2 11t13t2021 2 (2) "Claims" made or "suits" brought, or (3) Persons or organizations making "claims" or bringing "suits". d. Any payments made under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY or "damages" or under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY for medical expenses which can be attributed only to ongoing operations at designated construction projects shall redu@ the Designated Construction Project Aggregate Limit for that designated construction project. Such payments shall also reduce the Total Designated Construction Project Aggregate Limit shown in the Schedule above. However such payments shall not reduce the Policy Aggregate Limit shown in lhe Declarations nor shall they reduce any other Designated Construction Prolect Aggregate Limit for any other designated construction project shown in the Schedule above. e. The limits shown in the Declarations for Each lncident, Damage to Premises Rented to You and Medical Expense continue to apply. However, instead of being subject to the Policy Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project Aggregate Limits. For all sums which the insured becomes legally obligated to pay as "damages" caused by "occurrences" under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY, and for all medical expenses caused by accidents under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY, which cannot be attributed only to ongoing operations at a single designated construction pro.lect shown in the Schedule above: a. Any payments made under COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE in COVERAGE PART ONE - COMMERCIAL GENERAL LIABILITY or "damages" or under COVERAGE C - MEDICAL PAYMENTS in COVERAGE PART ONE - COMMERCIAL GENERAL LlABlLlry for medical expenses shall reduce the amount available under the Policy Aggregate Limit shown in the Declarations; and b. Such payments shall not reduce any Designated Construction Project Aggregate Limit or the Total Designated Construction Prorect Aggregate Limit. 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 operataons hazard" will reduce the Products€ompletod Op€rations Aggregate Limit shown in the declarations and not reduce the Designated Construction ProJect Aggregate Limit. lf the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same conskuction pro.,ect. The provisions of Limits of lnsurance and Deductible (Section lll.) in the COMMON COVERAGE PROVISIONS not otherwise modified by this endorsement shall continue to apply as stipulated. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGEO. srF-ESP-14E-B CW (01/04) Page 2 ot 2 3 4 5 o t Blanket Notification to Others of Cancellation ZURICH Named lnsured and Mailing Address: Atlas Technical Consultants, lnc. 13215 Bee Cave Pkwy, Building A, Suite 250 Austin. TX 78738 Eff. Dale of End 11t1312021 Producer: AON RISK SERVICES SOUTHWEST INC 5555 SAN FELIPE ST STE ,I5OO HOUSTON, rX 77056-2739 Producer 14340000 Return Prem tr:i;iftt;!tst4Eit THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Agribusiness Pollution Liability lnsurance Policy - Claims Made and Reported Coverage Commercial Umbrella Liability Policy Commerclal Umbrella Liability Policy - Claims Made and Reported Coverage Contractor's Pollution Liability lnsurance Policy Contractor's Pollution Liability lnsurance Policy - Claims Made and Reported Coverage Environmental Cleanup and Liability lnsurance Policy - Claims Made and Reported Coverage Environmental lmpairment Liability lnsurance Policy - Claims Made and Reported Coverage Environmental Services Package Policy Excess Environmental lnsurance Policy - Claims Made and Reported Coverage Follow Form Excess Liability Policy Follow Form Excess Liability Policy - Claims Made and Reported Coverage Healthcare Pollution Liability lnsurance Policy - Claims Made and Reported Coverage Lender Environmental Collateral Protection and Liability lnsurance Outstanding Loan Balance - Claims Made and Reported Coverage Lender Environmental Collateral Protection and Liability lnsurance Policy - Claims Made and Reported Coverage Professional Consultant's Liability lnsurance Policy - Claims Made and Reported Coverage Professional Environmental Consultant's Liability lnsurance Policy Professional Environmental Consultant's Liability lnsurance Policy - Claims Made and Reported Coverage Public Entity Pollution Liability - Claims Made and Reported Coverage Real Estate Environmental Liability lnsurance Policy - Claims Made and Reported Coverage Remediation Stop Loss Z Choice Pollution Liability Z Choice@ Real Estate Environmental Liability - Glalms Made and Reported Coverage Z Choicer Pollution Liability - Claims Made and Reported Goverage Z Link@ Commercial General and Pollution Liabillty A. lf we cancel this policy by written notice to the first Named lnsured for any reason other than nonpayment of premium, we will deliver electronic notification that such policy has been cancelled to each person or organization shown in a Schedule provided to us by the First Named lnsured. Such Schedule: e 8 3 =R E f,.i:{$Elit,tn} SIF-ENVL-1632-A CW (1 1/10) Page 1 of 2 Policy No GPL 0217085-06 ffi11113t2021 11t13t2022 Add'l Prem. = 1, Must be initially provided to us within 15 days: a, After the beginning of the policy period shown in the Declarations; or b. After this endorsement has been added to policy; 2, Must contain the names and e-mail addresses of only the persons or organizations requiring notification that such Coverage Part has been cancelled; 3. Must be in an electronic format that is acceptable to us; and 4. Must be accurate. Such Schedule may be updated and provided to us by the First Named lnsured during the policy period. Such updated Schedule must comply with Paragraphs 2. 3. and 4. abov6. B. Our delivery of the electronic notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named lnsured. Oelivery of the notification as described in Paragraph A, of this endorsement will be completed as soon as practicable after the effective date of cancellation to the first Named lnsured. C. Proof of emailing the electronic notification will be sufficient proof that we have complied with Paragraphs A. and B. of this endorsement. D. Our delivery of electronic notification described in Paragraphs A. and B. of this endorsement is intended as a courtesy only. Our failure to provide such delivery of electronic notification will not: 1. Extend the Coverage Part cancellation date; 2. Negate the cancellation, or 3. Provide any additional insurance that would not have been provided in the absence of this endorsement. E. We are not responsible for the accuracy, integrity, timellness and validity of information contained in the Schedule provided to us as described in Paragraphs A. and B. of this endorsement. STF-ENVL-1632-A CW (1 1/10) Page 2 ol 2 ALL OTHER TERMS ANO CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. o Notification to Others of Cancellation ZURICH Policy No Eff Date of Pol Exp Date of Pol Eff. Date of End Producer No Add'1. Prem BAP-0217109-06 't't t1 3t2021 11t13t2022 11t13t2021 14340000 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. lf we cancel this Coverage Part by written notice to the first Named lnsured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation, as advised in our notice to the first Named lnsured, or the longer number of days notice if indicated in the Schedule below. B. lf we cancel this Coverage Part by written notice to the first Named lnsured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. lf notice as described in Paragraphs A. or B. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. H;)t ELT f,.isSffi SCHEDULE Name and Address of Other Person(s) / O.ganization(s): Any person(s) or organization(s) whom you are required by writlen contract.30 All other terms and conditions of this policy remain unchanged R ff 5:! a c INTERNAL USE ONLY Return Prem Number of Days Notice: u-cA-812-A CW (05/ro) Pago 1 of 1 lncludes copyrighted material of lnsurance Services Office, lnc., with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY wc 99 06 33 NOTIFICATION TO OTHERS OF CANCELLATION ENDORSEMENT This endorsement is used to add the following to Part Six of the policy PART SIX CONDITIONS A. lf we cancel this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. lf we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. lf notice as described in Paragraphs A. or B, of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. All other terms and conditjons of this policy remain unchanged. This endorsemenl changes the policy to which it is attached and is effective on the date issued unless otheMise slated. (The information balow iB roquirod only wh6n this endoraement is issued subsequent to preparation of the policy.) Endorsement Effective 11113121 Policy No. WC 02171 11-06 Endorsement No. rnsured: Premium $ *-*-- Atlas Technical Consullants, lnc. TNTERN{EUS0Or{O' wc 99 06 33 SCHEDULE Name and Address of Other Person(s) / Orqanization(s):Number of Oays Notice: Any person(s) or organization(s) whom you are required 30 by written contract. lncludes copyrighted material ol National Council on Compensation lnsurance, lnc. with its permission. Pagg 1 Of 1 I I