2021/08/01 Harris & Associates, Inc. (3)COVERAGES
I
GERTIFICATE OF LIABILITY INSURANCE DAIE (UI/DD/YYYY}
08 t 02/202L
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO}'IFERS NO RIGHTS UPOI{ THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES I{OT AFFIRMATIVELY OR NEGATIVELY A ENO, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TH|S CERTTFTCATE OF |NSURAT{CE DOES NOT CONSTTTUTE A COr{TRACT BETWEEN THE TSSUTNG TNgURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER.
IMPORTANT: lf tho c.rtlticato hold.r i. !n ADoITIONAL INSURED, th. policy(io.) mult havo ADDITIONAL INSURED p.ovl.lonr or bo 6ndo..od.
ll SUBROGATION lS WA|VEo, rubroct to th. terma lnd condltlona of the pollcy, cartsln pollclos nay roqulro !n endorashont. A datom€nt on
thir cortlflcele do6s not confor ohls lo lho certiflcrto holdor ln llou ot luch .ndorlomant(B).
piooucER LXC *0757776 800-817-{550
firrB lDt.lutloDil hiur6nc. s.rvlc.. tnc.
P,0. Box {047
coocord, cl 9452{ os,l
Tar
92s 6 09 -6500 925 509-5550
ll{3URER(S) AFFOROTNG COVERAOE
rxluiER^, vaIrI/8Y EOAga ItlS CO 205 08
INSURERS, COIIIINEITTI! CIS CO 20]t41
c, cotatrNENrrl, rNs co 35289
Dt!uiEosfil. & lr.oclit.. IDc.
at!D! au.an to.trllllag
1{01 rtIlol. Pa.. Roaal, 8ult. 500
corcord, cA 94520 usr
tNluREnD. tRtvELlRg PROP C-A8 CO Ol IXER 25611
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cERTtF|CATE NUtigER: 53510{185 REVISION NUMBER:
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOD
INOICATEO. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER OOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFOROED 8Y THE POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE EEEN REOUCED BY PAIO CLAIMS,
x COHTERCl T GENEFAL LIABILITY
OCCUR
x D.d! 0
GEN'L AGGREGATE L]MIT APPLIES PER:
JECT x LOC
x
x
6072t7 57 39 ogtoL/2t I 08lo:.l22 t 1,000,000
OAMAGE IO RENTEO
PRE[.!ISES lE. @urin6)31,000,000
MEo EXP (aiy on. p.tun)I 15,000
3 1,000,000PERSONAL&AOV NJURY
PRODUCTS . COMP/OP AGG
t 2,000,000
12.000,000
I
B AIJTOXOBI(EI.IABILIIY
x
AUTOSONLY
HratE0
D.d: 0
SCHEOULED
x
EUA 5076590520 oa t 0l t2r oa I oll22 COMBINEO SNG!€ LIM T
EODTLY TNJURY (P.r p.6on)
11,000,000
t
BOoILYI|JURY(F adir.nt)I
I
c
x ElcEla !46
x OCCUR cu! 6076590551 os/ot/27 0a / 01/ 22 r 10,000,000
310,000'000
DED x RETENTIoNt 10' 000 I
D tvoFkEitcoxPErll TroN
Al,tD ExPIOYEi!' LAllllTY
Ai'IYPROPRIEToRTPARTNEREXECUTIVE
OFFICER/MEMAEREXCLUOED?
DESCRLPTION OF OPERATIONS bd*
uB-88456{48-21-{3-O .0a /oLt2L 08toa/22 x I OTH.
E.L EACHACC1OENI t 1,000,000
E.! DISEASE . EA EMPIOYEE 31,000,000
E.L O SEASE - POLICY LIMIT i 1,000,000
B PROPISAIO!'A! LIIAIIITT
c lal.[r -Xadl.
aEH991891588 oa/oL/21 oB/07/22
oEtcrupior{ of opER nonartocanoit/vExrcLla {acoro 101, aldld.n r im.,t llci.d!|., 'n y !..n&h.d It nm.t 6l.,tqohd)
r tfolhcla c(@anaattoa DoLlcy arclual.t DDogo1iatlc .tatGa lfD, oE, fA, raa.
OcD.!.] Ll.btlity rad Auto Liabluty MtllElo!.] IE ur.ll r!.tu. grrat.<!, If roquir.d 00, ttlt!.o coDtract/tlrr.@rt, I'Gr
artach.d !oro. qNA?50?9n 1016 .nd cxr53359)c 0{12 (09. 1. t'r.3).
ctry i 1!. offlcGr., qloy..., rs.!t. & .uthorlz.d wotunt..r. tr. ldd1llonll tE.ur.dr uDd.r Cr.n.r.1 IJllblllly lnd Auto
LI.bUtty lt r.qulrld by a rrllt.n codtradt.
Rar Oll-call Prof..6lodr1 EatlEl@.Et & Alrttl Ergir..rlng A.rvic.. (EA l+1600{68)
CERTIFICATE HOLOER
160-ort58 ( 2 021)
clty o! l,l.D1f..
,n1.o liuDItbltc Xork. / bgla..llEg
2971a tlru! Roadtl.rlt.., Cl 92 585
I'SA
3HOULD AXY Of THE ASOVE OESCRIBED POLICIES 8E CAT{CELLEO EEFORE
THE EXPIRATIOI{ DATE THER€OF. I{OIICE WLL BE OELryERED IN
ACCOROANCE WIT}I TH€ POLICY PROVISIONS,
AUIHONEED AEPRE6EI{'ATIVE
&*,m*z-
CANCE N
O 1988-2015 AcoRD CORPORATIoN. All rlghts ro!6wod
Th. ACORD ngmo 8nd logo.ra ragllt.rad mr*. of ACORD
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10, OOO, OOO/cl!I!, 10,000,00019
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ACORD 2s (20r6103)
bboga!t
53510a185
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CT{A
Blanket Additional lnsured - Owners, Lessees or
Contractors . with Products.Completed
Operations Coverage Endorsement o
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This ondorsement modifies insurance provided under the lollowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
It is understood and agreed as follows:
I' wHO lS AN INSUFED is amend€d to include as an lnsurod any person or organization whom you are required
by written contract to add as an additional insured on this coverago part, but only with r€spgct to liability lor
bodily inlury, proporty damago or peraonal and adver slng lnlury caused in whol€ or in part by your acts or
omissions, or the acts or omissions of those acting on your behall:
A. in the performance ofyour ongoing operations subject to such written contract; or
B. in the pertormance of your work subject to such wrlttsn contract, but only with rsspect to bodlly lnlury or
property damago included in ths products-comploted oporatlons hazard, and only if:
1. the lyritton contract requires you to provide th€ additional insured such coverage; and
2. thls coverage part provides such coverage.
ll. But if the written contract requires:
A. additional insured coverage under the 11-85 6dition, 1O-93 edition, o|l O-Ol sdition of CG2O1O, or under th€
10-01 edition ol cG2037: or
B. additional insured covorage with "arising out of" languags; or
C. additional insured coverags to the greatesl extent permissible by law;
then paragraph l. above is dslsted in its entir6ty and rsplac€d by ths following:
WHO lS AN INSURED is amendsd to include as an lnsursd any person or organization whom you are required
by wrltton conlracl to add as an additional insured on this covsrago part, bul only with respoct to liability lorbodily lnlury, proPony damags or p€rsonal 8nd advartlslng lnlury arising out of your work that is subjoct to
such written conlract.
lll. Subject always to the terms and condilions of lhis policy, including lhe limits ol insuranc€, the lnsurer will not
provido such additional insured with:
A. covgrage broader than required by the wrltten controct; or
B, a higher limit of insurance than required by the written controcl.
lV. Tho insulance grantsd by this endorssment to th6 additional insured does not apply to bodlly lnlury, property
damage, or porsonal and advertislng lnrury arising out of:
A' the rendering or, ol the failure lo render, any professional architectural, engineering, or surveying services,
including:
l. the preparing, approving, or failing to prepare or approv6 maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
2. supervisory, inspection, architectural or engineering activities; or
B' any premises or work lor which the additional insured is spscifically lisled as an additional insured on
another endorssment attachsd to this coveraga part.
V. Under COiIMERCIAL GENERAL LlABlLffY CONDITIONS, th6 Condition entitled Othor tnsursnce is
amended to add the following, which supsrsedes any provision to the contrary in this Condition or elsewhore tn
this covorage pad:
cNA75079XX (10-16)
Page 1 of 2
lnsured Name: Harris & Associates lnc.
Policy No: 6072170739
Etlective Dat6: OBlO1l2O2l
copyrighr cNA Arr Fights R6s€N6d. rncludes copyrighrgd matsriar ot lnsunncg ssrylcss oflc€. lnc., with irs pormission
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CNA
Blanket Additional lnsured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
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Prlmary and Noncontrlbutory lnsurenca
With respect to other insuranco availabls to tho additional insured und€r which the additional insured is a named
insurod, this insurance is pimary to and will not so6k contribution lrom such other insurance, providod that a
wrltlon contract requires lhe insurance provided by this policy to be:
1. primary and non-contributing with othsr insurance available to the additional insured; or
2. primary and to not seek contribution from any other insurance available to the additional insur6d.
But sxcept as specilied above, this insuranco will be excoss of all other insurance availabls to the additional
insured.
Vl, Solely with respect to the insurance granted by this endorsement, the section entitlsd COMMERCIAL
GENERAL LIABILITY COt{DlTlO S is amended as follows:
Tho Condition entitled Dutlss ln The Evont ol Occurronco, Otfense, Clalm or Sult is amend€d with the
addition ol the lollowing:
Any additional insured pursuant to this endorsemsnt will as soon as prac,licable:
1. givo the lnsurer written notice o, any clalm, or any occurrence or otfense which may result in a clalm;
2. sendthe lnsursr copies ol all lsgal papers rsceived, and othen /is€ cooperate with the lnsurerin the
invostigation, delense, or settlement ot the clalm; and
3. make available any other insurance, and tender lhe defense and indemnity of any clalm to any other insurer
or soll-insursr, whos€ policy or program applios to a loss that the lnsursr covsrs und€r this covotage part.
However, il the w tten contract requiros this insuranca to be primary and non-contributory, this paragraph
3. does not apply to insurance on which the additional insured is a named insured.
The lnsu16r has no duty to delsnd or indsmnify an additional insur6d under this endorsemenl until the lnsurer
rec€ives written notice ol a clalm from the additional insured.
Vll. Solsly with rospoct to th6 insurance granted by this ondorsement, the section sntitlod DEFINITIONS is amendod
to add tho following definition:
Wrlttgn contract means a writtsn contract or written agreement that requires you to make a porson or
organization an additional insurod on this covorago part, provided the contract or agresmsnt:
A. is curr€ntly in etlect or becomes eflectiv€ during lho term of this policy; and
B. was €xocuted prior to:
1, the bodlly lnlury or propcrty drmagc; or
2. the otlonse that caused th€ porronal and advsrtlslng lnlury;
for which the additional insur8d seeks coverage.
Any coverage grant€d by this endorsemsnt shall apply solely to the extent permissible by law.
All other terms and conditions ol the Policy remain unchanged
This endorsement, which forms a pan of and is lor attachm€nt to the Policy issuod by lhs dssignated lnsurors, tak€s
etfoct on the 6tf6ctive dat6 of said Policy at th6 hour stat€d in said Policy, unless another etfective date is shown
belo$/, and expires concurrently with said Policy,
cNA75079XX (10-16)
Page 2 ol2
lnsurod Nams: Harris & Associateg lnc
Policy No:
Etfective Date
6072176739
08t0112021
Copynohl CNA All Rights R63oN€d. lncludos copyrighlod mat€rialol lnsuranc€ S€rvic€s Ofllc€, lnc., with its p€rmisEion.
I
CNA Architects, Englneers and Surveyors General Liability
Extension Endorsement
(6) of the Damage to Property Exclusion do not apply to property damage lhat results from the use ol
elevators.
B. Solely for the purpose of the cov€rage provided by this PROPERTY OAMAGE. ELEVATOBS Provision,
the Othor lnsurancg conditions is amond€d to add the lollowing paragraph:
This insurance is oxcess ovsr any of th€ othsr insurance, whother primary, excess, contingenl or on any
othBr basis lhat is Property insurance covering property of oth€rs damagsd from the us6 of elevators.
23. RETIBED PARTNERS, MEMBERS, DIFECTORS ANO EMPLOYEES
WHO lS INSUFED is amsnded to include as lnrursds natural persons who are retired parlners, members,
direclors or employees, but only for bodlly lnlury, proporty damage or porsonal and advortlslng lnlury that
r€sulls from s€rvices performod for th€ Namod lnsurod under th6 Named lnlurod's direct supsrvision. All
limitations thal apply to employo€t and volunteor workors also apply to anyone qualitying as an lnsursd
under this Provision.
24. SUPPLEMENTARY PAYMENTS
The section entitled SUPPTEMENTARY PAYMENTS - COVEBAGES A AND I is amended as follows:
A. Paragraph 1.b. is amended to delete ths S250 limit shown for the cost of bail bonds and replace it with a
$5,000. limit; and
B. Paragraph 1.d. is amendsd to d€lete the limit of $250 shown for daily loss ol earnings and roplace it with a
$1 ,000. limit.
25. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
ll ths Nemed lnsurod unintenlionally lails to discloso all existing hazards at ths incsption date of ths Named
lnsurad's Coverage Part, tho lnsurer will not d€ny coverag€ under this Coverago Parl because ol such failure.
26. WAIVER OF SUBROGATION . BLANKET
Under COI{D|T|ONS, the condition €ntitlod Transtor ot Hights Ol Fecovory Agalnst Others To U8 is amsndsd
to add the follorYing:
The lnsuler waives any ght of aecovery the lnsurer may have against any person or organization because of
paym€nts ths lnsurer makes for iniury or damag€ arising out of:
l. the Namsd lneur€d's ongoing oporations; or
2. your work includsd in the producls-completed opsratlons hazard.
However, this waiver applios only whsn the NamBd lnsursd has agroed in writing to waive such rights of
recovery in a written contract or written agreemsnt, and only if such contract or agresment:
1. is in eifect or becomes ettective during lhe term of this Coverago Parl; and
2. was executed prior to the bodlly lnlury, proporty damago or porsonal and advertlslng lnlury giving rise
to the clalm,
27. WRAP.UP ExTENSION: OCIP, CCIP, OB CONSOLIDATED (wHAP-UP) INSURANCE PROGRAMS
Nots: The following provision does not apply to any public construction pro,ect in the stat€ of Oklahoma, nor lo
any construction project in the state of Alaska, that is not permitted to be insured under a conrolldated (wrap-
up) lnsurance program by applicable stats statute or regulation.
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CNA74858XX (1-15)
Pag€ '16 of 17
lnsured Name: Harris & Associatos lnc
Policy No:
Etlsclive Date:
6072176739
0810112021
Copynghl CNA All HightB R6s6rvod. lncludes copyrilhtod matodal o{ lngulance Selvicos Ollic€, Inc., with it8 psmission
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CNA Business Auto Policy
l?riliey Indors*lllenl
THIS ENDORSEMENT CHANGES THE POLICY. PTEASE READ IT CAREFULTY.
This endorssment modiries insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I, IIABILITY COVERAGE
A. Who ls An lnsured
The tollowing is added to Scctlon ll, Paragraph A.1., Who ls An lnsured:
1. 8. Any incorporated ontity ol which the Nam6d lnsurad owns a msjority of the voting stock on the
date ot inc€ption ol this CoverEg6 Form; providBd that,
b. The insuranco afforded by this provision A.1. does not apply to any such sntity that is an
insurod und€r any other liability 'policy' providing aulo coverage.
2. Any organization you newly acquire or form, other than a limitod liability company, partnorship or
joint venturs, and ovor which you maintain msjority ownership interest.
The insurance aftorded by this provision A.2.:
a. ls effective on the acquisition or formation date, and is alforded only until the end of the policy
period ot this Coverage Form, or the next anniversary oI its inception date, whichever is earli6r.
b. Does not apply to:
ll l Bodlty fniury or proprrty damrgr crused by an accidont that occurred b€for6 you scquirod or
formed the organization; or
(21 Any such organization that is an insurod under any other liability "policy' providing auto
cov€rage.
3. Any person or orgsnizstion that you are required by a written contrsct to name as an additional
insured is an insursd but only with respect to their logal liability for acts or omissions ol a person.
who qualifi€s as an lnsurod under SECTION ll - wHO lS AN INSURED and for whom Liability
CovBrage is afforded under this policy. lf required by written contract, this insurance will be primary
and non-contributory to insurance on which the additional insured is I Named lnsured,
4. An omploye6 of yours is an insured while oporating an auto hirsd or ranted undar I contract or
agreement in that employee's name, with your permission, while performing duti6s related to th€
conduct of your business,
"Policy", as usod in this provision A. Who ls An lnsured, includes thoss policies that were in force on
the inception date of this Coverage Form but:
1. Which are no longer in torce; or
2. Whose limits hsve been exhausted.
B. Bail Bonds and Loss ot Esrnings
Section ll, Paragrephs A.2. (2) and A.2. (4) are revised as rollows:
1. ln a.l2), th€ limit for the cost ol bail bonds is changed Jrom $2.000 to 95,000; and
2. ln a.l4), the limit tor the loss of earnings is changed from $250 to S500 a day.
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Form No: CNA63359XX (04-2012)
Endors6mont Efloctive Dater Endorsement Expiration Date:
Endors6ment Noi 13; PEge: 1 of 4
Underwriting Company: Th6 Continontal lnsursnco Comp8ny, 151 N Fraoklin St, Chic8go, lL 60606
o Copyright CNA All Rights n€s6ru6d. lncludss copyrightod m8torial ot the
lnsuranc€ S6rvic€s Oflice, lnc., u3ed with its psrmission.
Policy No: BUA 6076690520
Policy Elfoctive Oater 08/01/2021
CONTRACTORS EXTENDED COVEftAGE ETIIDORSEMET{T . BUSINE$S AUTO PLUST
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CNA Business Auto Policy
Policy Endorsement
C. Fellow Employoe
Section ll, Paragraph 8.5 does not apply.
Such coverage as is afforded by this provision C. is excess over any oth€r collectible insurance.
PHYSICAL DAMAGE COVERAGE
A. Glass Broakago - Hitting A Bird Or Animal - Falling Objocts Or Migsiles
The following is added to Section lll, Paragraph A.3.:
With respect to any covered auto, any deductible shown in the Doclarations will not apply to glass
breakage if such glsss is repaired, in a manner acceptable to us, rather than r€placed.
B. Transpo.tation Expensss
Section lll, Paragraph A.4.a. is revised, with respect to transportation expense incurred by you, to
provide:
a. $60 per day, in lieu o, $20; subject to
b. $ 1 ,800 maximum, in lieu of $600.
C. Loss of Use Exponses
Soction lll, Paragraph A"4.b. is revised, with respect to loss of use expenses incurred by you, to
provide:
a. S 1 ,000 maximum, in lieu of $600.
O. Hired "Autos"
The following is added to Section lll. Paragraph A.;
5. Hlrod "Autos"
lf Physical Damage coverage is provided under this policy, and such coverage does not extend to Hired
Autos. then Physical Damage coverage is extended to:
a. Any covered auto you lease, hire, rent or borrow without a driver; and
b. Any covered suto hired or rented by your employog without a driver, under a contract in that
individual employee's name, with your permission, while performing duties related to the
conduct of your business.
c. The most we will pay for any one accidont or loss is tho actual cash value. cost of repair, cost
ol replacement or $75,000, whichever is less, minus a $500 deductiblo for esch covered 8uto.
No deductible applies to loss caused by fire or lightning.
d. The physical damage coverage as is provided by this provision is equal to th€ physicsl damage
coverage{s) provided on your owned autos.
e. Such physical damage coverage for hired autos will:
(11 lnclude loss of use, provided it is the consequence of an accidont lor which the Named
lnsursd is legally liable, and as a lesult of which a monatary loss is sustained by the leasing
or rental concern,
12) Such coverage as is provided by this provision will be subject to a limit of $7SO per
accident.
E. Airbag Coverag6
The following is added to Section lll, Parggraph 8.3.;
The accidental discharge of an airbag shall not be considered mechanical br6akdown.
Fom No: CNA6335gXX I04-2012)
Endorsement Eflective Date: Endorsement Expiration Dat€:
Endors6mant No: 13; Pag6t 2 of 4
Und€rwriting Company: Th6 Continental lnsuranc€ Company, 151 N Frsnklin St, Chic€go, lL 00606
a Copyright CNA All Rights R€served. lncludos copyrightod materist oI th€
lnsuranc€ S€rvicss Offico, lnc., used with its pormission.
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Policy No: BUA 6076590520
Policy Effoctive Dste: 08/01/2021
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CTIA Business Auto Policy
Policy Endorsement
F. ElsctronicEquipmant
Section lll, Paragraphs B.4.c and B.4.d. are deleted and replacsd by the following:
c. Physicsl Damage Covorags on a covared auto also applies to loss to 8ny permanently installed
electronic oquipmsnt including its Entsnnas snd other sccessories
d. A $100 per occurrence deductible applies to the coverage provided by this provision.
G. Diminution ln Valu6
The following is added to Section lll. Paragraph 8.6.:
Subject to the following, the diminution in value exclusion does not apply to:
a. Any covered auto oi the private passenger type you lease, hire, rent or borrow, wilhout a driver
Ior a poriod of 30 days or loss, while performing duties r€lated to th6 conduct of your busin€ss;
and
b. Any covered auto of the privat€ passeng€r type hired or rented by your omployoo without a
drivsr for a period of 30 days or less, under a contract in that individual omployoo's nam€. with
your permission, while performing duties 16lated to the conduct of your business.
c. Such coverage as is provided by this provision is limited to a diminution in value loss arising
directly out of accidental damage and not as a result oI the failure to maks repairs; faulty or
incomplete mainlenance or repairs; or the installation of substandard parts.
d. The most we will pay for loss to a covered auto in any one accident is the lesser orl
lll $5.000; or
l2l 20o/o ot lhe suto's actual cash value (ACV).
lll. D vo Oth6r Car Covorags - Exocutive Olllcerg
The lollowing is added to Soctions ll and lll:
1. Any auto you don't own, hire or borrow is a covered auto lor Liability Coverage whil6 being usBd by,
and lor Physical Damage Coverage whilo in the care, custody or control of, any of your "ex€cutive
officers", except:
a. An auto owned by that "€xecutive officer" or a member of th8t person's hous€holdi or
b. An auto used by that "executive officer" while working in a business of selling, servicing, repairing
or parking autos,
Such Lisbility and/or Physical Damage Coverage as is aflorded by this provision.
{1) Equal to the greatest o, those coverages afforded any covered auto; and
{2) Excess over any othsr coll6ctiblo insurance.
2. For purposss of this provision, "executive officor" m€ans a person holding any ol the olficer positions
created by your charter. constitution, by-laws or any other similar governing document, and. while a
resident of the same household, includes that person's spouse.
Such "executive officers" are insureds while using a covered 0uto described in this provision,
IV. BUSINESS AUTO CONDITIONS
A. Dutlos ln Tho Ev6nt Ol Accidont, Claim, Suil Or Loss
The following is added to Section lV, Paragraph A.2.s.:
Form Noi CNA63359XX (04-20121
Endorsement Effective Dater Endorsement Expiration Dste:
Endorsement No: 13; Pager 3 ot 4
lJndorwriting Company: Th6 Continontal lnsurancs Company, 151 N Franklin St, Chicago, lL 60606
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o Copyright CNA All Right3 Rgserv€d. lncludos copyrighted materiol of the
lnsurance S€rvic€s Offics, lnc., us€d with its permission,
Policy No: BUA 6076590520
Policy Eftectivo Date: 08/01/2021
I
CNA Business Auto Policy
Policy Endorsemont
14) Your employees may know of an accidont or loss, This will not m€an that you have such
knowledge, unless such accidont or loss is known to you or if you are not an individual, to any
of your executive officers or partners or your insurance manager.
The following is added to Soction lV, Paragraph A.2.b.:
(6) Your employ€es may know of documents rgcoived concerning a claim or suit. This will not mean
that you hav€ such knowledgs, unless receipt of such documents is known to you or iI you aIe
not an individual, to any ol your executive otficers or partners or your insurance manager.
B. Transfor Of Rights Ot Recovery Against Others To Us
The following is added to Section lV, Parsgraph A.5. Transfer Ol Rights Of Rocovely Against Othors To
Us:
We waivo any right of recovery w6 may have, b€cause of psym8nts we make for injury or damage.
against any person or organizstion for whom or which you ar8 requir€d by written contract or
agrsement to obtain this waiver from us.
This injury or damag€ must srise out of your activities under a contract with thst person or
organization.
You must agree to that requirement prior to an accident or loss.
C, Concoalment, Misloplosontation or Flaud
The following is added to Soction lV, Psrsgraph B.2.:
Your lailure to disclose all hazards existing on the date oI inception of this Coverage Form shall not
prsjudice you with respect to the coverage aftorded provided such ,ailure or omission is not intentional.
D. Oth6r lnsuranca
The following is added to Section lV, Paragraph 8.5.:
Regardless of the provisions of Psragraphs 5.a. and 5.d. above, the coverage provided by this policy
shall be on a primary non-contributory basis. This provision is applicable only when required by a
written contract.
Thst written contract must have been entered into prior to Accidsnt or Loss.
E. Policy P6riod. Coveraga Toritory
Soction lV, Paragraph B. 7.(5l.la). is revised to provide:
a. 45 days of cov€rag8 in lieu of 30 days.
DEFINITIONS
Ssction V. paragraph C. is deleted and replac€d by the Iollowing:
Bodily injury means bodily injury, sickness or disease sustained by a person, including mental anguish.
mental injury or death resulting Irom any of these.
a!
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I Form No: CNA6335gXX (04-2012)
Endorsement Elf€ctiv6 Dater Endorsement Expiration Date:
Eodorsem€nt Nor 13; Psger 4 of 4
Underwriting Companyi Ths Conlinentsl lnsurance Compsny, 151 N Franklin St, Chacago, lL 60606
B Copyright CNA All ni€hts R€serued. lncludos copyright€d mat€rialof ths
lnsuranco Ssrvices Offic6, lnc., us€d with its permission.
Policy Nor BUA 6076590520
Policy Effectiv€ Date: 08/01/2021
3
CNA Businasg Auto Policy
Policy Endorsement
I
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This sndors€mant modifiss insursnce provid€d und6r th€ following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this €ndorssmont, the provisions of the Coverage Form apply unless
modified by th6 €ndorsement,
This 6ndorsement chsngos the policy eflectlve on lhe inc€ption date of the policy unless anoth€r date is
indicated below.
Namod lnsurod: HARFIS & ASSOCIATES lNC.
Endorsomont Effectivo D8t6: 08101 12021
SCHEDULE
Nam6(sl Ol Porson(sl 01 Organization{3):
ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REOUIRED BY WRITTEN CONTRACT
OR AGREEMENT TO OBTAIN THIS WAIVER FROM US, YOU MUST AGREE TO THAT REOUIREMENT PRIOR
TO LOSS.
lnformation requir6d to comp l6t6 this Schodule, iI not shown above, will be shown in th€ Declarations
ThB Transfer OI Rights Of Rocovery Against Oth€]s To U! condition doos not spply to the porson(sl or
organization(s) shown in th€ Schedule, but only to tho ext6nt that subrogation is waived prior to the "accidsnt"
or the 'loss' under a contract with thst psrson or organizslion.
ttr !
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Form No: CA 04 44 10 13
Endors6mont Etloctiv6 Oslo: €ndorsamEnt Expiration Dato:
Endor66mont Nor 4; Psg€: 1 of 1
lJndorfiiting Companyi Tho Continontal lnsuranco Company, 151 N Franklin St, Chicago, lL 60606
. Copyright lnrurance Soruicss Otfice, lnc., 201 1
Policy No: BUA 6076590520
Policy Effoctiv€ oalo: 08/01/2021
WAIVER OF TRAI{SFER OF RIGHTS OF RECOVERY
AGAII{ST OTHERS TO US IWAIVER OF SUBBOGANO l
a
E I
,-.
IRAYELERSJ WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC990376( A), oo1
POLICY NUMBERi U8.8K458448-21.{3.c
Schedule
Job Description
Policy No
acil
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WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT _ CALIFORNIA
(BLANKET WAIVER)
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.
The addltional premium for this endorcement shall be 2.00 o/0 of the California workers, compensation pre-
mium,
ONE TOIIER SQUARE
HAI,TFORD CT 05183
Person or Organization
Endorsement Effective
lnsured
ANY PENSON OR ORGANIZATION FOR
WHICTI THE INST'RED IIAS AOREED
BY WRITTEN CONIRACT EXECUIED
PRIOR TO IJOSS TO FI'RITISH THIS
WAIVER.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwisestated.
(The iniormation below is required only when this endors€ment is issued subsequent to preparatlon odthe pollcy.)
Endorsement No
Premium
lnsurance Company
Page 1 of 1
I
Countersigned by_
STATE
FUND
COMPENSATIONINSIJRANCE
IN BEPLY NEFES IO
ocToBER 15, 202L
CITY OF MENIEEE
29844 HAUN RD
MENIFEE CA 92586-5539
CERTIFICATE OE WORKERS '
COMPENSATION INSURANCE
CANCELLATION IfI THDRAWAL NOTICE
RE: CERTIFICATE DATED JANUARY I, 2O2L
THE CANCELLATION HAS BEEN VI I THDRAWT FOR THE WORKERS. COMPENSATION
I}ISUNANCE POLICY FOR THE EIi{PLOYER NAI{ED BELO},. THIS LETTER SUPERSEDES
THE NOTICE OE CANCELLAT I ON SENT TO YOU ON OCTOBER 7, 2O2L.
THIS EMPLOYER'S TTORKERS' COMPENSAT I ON INSURAXCE COVERAGE COI{T I NUED
UN I NTERRUPTED .
EMPLOYER:
ND CONSTRUCTION COMPANY ,
1OO W BROADWAY STE 3OOO
LONG BEACH, CA 90802POLTCY t066062-21
INC.
CUSTOMER SERVICE REPRESENTAT IVE
CUSTOMER SERVICE CEXTER(888) 782-8338
sctF 1910 2
5860 Owens Dr Pleasanton, CA 94588-3900
Mailing Address: P.O. Box 8'192-Pleasanton, CA 94544-9642
Phone: (951)723-3754
CERTIFICATE OF LIABILITY INSURANCE 10118t2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE OOES 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 HOLOER,
IMPORTANT: lf the cortificate holder is an ADDITIONAL INSIJRED, the policy(ies) must have ADOITIONAL INSURED provisions or be endorsed
lf SUBROGATION lS WAIVED, subject to the terms ahd conditions of the policy, certain policies may require an endorsement- A statement on
lhis certificate does not confer rights to the certificate holder in lieu of such endorsem€nt(s).
DFI - Dicerolamo Family lnsurance Services ,l 5-5335 I 735-37582027 Hamner Ave
Norco, CA 92860
License #: 0D26889
anne@df iinsurance.com
rNsuRER{S) aFFOROTNG COvERAGE
profits lnsurance Alliance of CA
lnsurance Alliance of California
From the Lord
1650 S. Juanita St.
San Jacinto, CA 92583
COVERAGES
CERTIFICATE HOLDER
CERTIFICATE NUMBER: 99010s25-28411s REVISION NUMBER: 13
CANCELLATION
THIS IS TO CERTIFY TTiAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMEDABO\E FOR THE POLICY PERIOD
INDICATED NOIWTHSTANDING ANY REOUIREMENI IERM OR CONDITION OF ANY CONIRACT OR OTHER DOCUMENT U,ITH RESPECIIO WTIICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFOROEO 8Y THE POLICIES DESCRIBED ).]EREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWI.] MAY HAVE BEEN REDUCED BY PAIO CLAIMS
2021-24323-NPO 1110112021A
000$2
11t0112022
2,000,000
1,000,
GEN ERAL AGGREGATE
PROOIJCTS. COMP/OP AGG
CEN L AGGRE6ATE LIMIT APPLIES PERi -u., f lil& I.o.
I
I OIHER
000
000
PREM SES (E. o-urene)
MEO El(P (Any one poren)
PERSONAL A AOV INJURY
500,000
20,000
lx li3?53"uoI I NoN-o!9{ED
] ]
AUrosoNLY
s
S
S
I
,000Y 2021-24323-AUTO ! 1,OOOB Auiorio6rLe Lrasrlrfi
Ior .o
i1to1t2o21 11to1t2o22 I E?T""J51;'"." u'''
I
sOorLY lNruRY {Pe p€..6)
AOOIIY INJURY {Ps lcods0
5
RETENTIONSt-
IEACH OCCIJRRENCE
499!E94!E_
ANO EIJPLO YERB' LIABILIfY
ANY PROPR ETOR/PARTNER/EXECIJTIVEOFFICER/MEMSER EXCLUDED'
NFSCRIPIION OF OPERATIONS &IE
I PEF I totr!L- SIATIJLE-L-I EL.I
I e a eoc, occ,oe"t
E. "**. *^.,,".".{
I a,- o,"*"a- "o.'a".,u',
$
],
5
OESCRIPTION Oa OPERATIONS / LOCATIONS / VEHICtES IACORO 101 , addilionrl R.turr. o- .p.c. r. -qurodlCertiricate holder named as addtional insured.
SHOULD ANY OF THE ABOVE OESCRIBED POLICIES AE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE I/YITH THE POLICY PROVISIONS-
NN
City of Menifee
297'14 Haun Rd
Menifee, CA 92586
ACORO 25 (2016/03)
@ 1988-2015ACORD cORPoRATloN. All rights resewod
Tho ACORO name and logo aro .egistsrgd markg of AcoRD
Pnnled by ANN on October 18, 2021 at 12r58PM
f]:i:ilil::'r,r-I";
, s 1,Q!Q000
lr
POLICY NUMBER: 2021-24323 COMMERCIAL GENERAL LIABILITY
Named lnsured: From the Lord CG 20 26 1219
THIS ENOORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional lnsured Person(s) Or Organization(s):
Any person or organization that you are required to add as an additional insured on this policy, under a wri(en
contract or agreement currently in effect, or becoming effective during the term of this policy. The additional
insured status will not be afforded with respect to liability arising out of or related to your activities as a real
estate manager for that person or organizalion.
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acls or
omissions or the acts or omissions of those acting
on your behalf:1. ln lhe performance of your ongoing operations;
or2. ln connection with your premises owned by or
rented to you.
However:1. The insurance afforded to such additional
insured only applies to lhe extent permitled by
law; and2. lf coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such addilional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the addilional insured is
required by a conlract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:1. Required by the contract or agreementi or2. Available under the applicable Limits oI
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of lnsurance shown in the
Declarations.
cG 20 26 12 19 o lnsurance Services Office, lnc.,2012 Page 1 of 1