2021/02/01 Von Euw Backhoe, Inc.VONEUWB.Ol
CERTIFICATE OF LIABILITY INSURANCE
L N
10t't t2021
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMANON ONLY ANO CONFERS NO RIGHTS UPOI{ THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAT1VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certiflcate holdor ls an A0DlTlOt'lAL INSURED, tho pollcyll6s) must have ADOITIONAL INSURED provtstons or be ondorsect.lf SUBROGATION lS WAIVED, subJect to the terms and cond itlons of the potlcy, certain pollcios may roqulro ah endorsiemont. A gtatsment onorsemont(s).this cortiflcato does not confer rights to tho certificate holder in lieu of such end
Leo Roddguez lnsurance Agoncy
27174 Nowport RdSulte 3 and a
Mqnlfeo, CA 92584
fil Eacr Laura Burns
fI3)ri., enr, (esl ) 2a6 4oo3 212 [i6, ".,,iilnEss Laura@LeoRodriguezlns.com
INSURER(S) AFFOROING COVERAGE
rNsuRER A , Evanston lnsurance Company
rr,rsunen e,Travelers Casualty lnsurance Co of America
tNsuRER c.State Compensallon lnguaance Fund of Calltornla
INSURED
35378
19046
35076Von Euw Backhoo, lnc
P.O. Box 693
Wnchestor. CA 9259G
INSURER D
INSURER E
CERTIFICATE NUMBER REVISION NUMBER
TIIIS IS TO CERTIFY THAT THE POLCIES OF INSURANCE LISTED EELOW HAVE EEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOOINDICATED. NOTWTHS'TANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTI]ER DOCUMENT WTH RESPECT TO W,llICB THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFOROED 8Y THE POLICIES DESCRIEEO HEREIN IS SUBJECT TO ALL THE TERMSEXCLUSlONS ANO CONDITIONS OF SUCH POLICLES LIMITS SHOW\] MAY HAVE BEEN REDUCED BY PAID CLAIMS
POUCY EFF POLICY EXPIMM/OOTYYYYI IMWOOffYYYI L l\,1lTSA X coM MERcraL GENE RA L LtABtLtry
cLA MS,MADE X occuR X X 3AAs09317 101512021 1015t2022
EACHOCqUR!1ENCE I
OAMAGE TO RENIEO
PREM SES (EE oacuEllEel . I
MED ExP (Anyon6p6Bon) .1
PERSONALA AOV NJURY I
G ENE RAL AGGSEGATE ,I
PROOUCTS . COM P/OP AGG I
1,000,000
't00,000
5,000
1,000,000
2,000,000
2,000,000
GEN'L AGGREGATE LIM-TAPPLIES PER
"oL,c" i 353, Loc
OIHER SB lutoloeru uagrurv
X alv ruro
ovlNEoAUTOS ONLY
AIITOS ONLr
COM6INED SINGLE I IMIT
BOOILY TNJURY (P6r pqtroO
EOOILY INJURY lP€r 6@ternl
1,000,000
X 8A0N694947 2t21t2021 2t2112022
SCHEDULEDAUTOS
I$dafi9
UMERELLA UAB OCCUR
EXCE3S UAB CLAIMS.MAOE
OED FETENTONI
EACHOCCqRRENCE
AGGREGATE
S
5
I
WORXERS COMPENSANON
ANO EMPIOYERS' LIAEII.ITY
ANY PROPR ETOR]PARTNER/EXECUT VEOFFICER/MEMBER EXCLUDEDT
x EFI',..OTH
EBX 1863518-2'l 2t1t202't 2t1t2022 '1,000,000
'1,000,000
't,000,000
E L EACH ACCIOENT $
E L OISEASE . EA EMPLOYEE $
OESCRIPTlON OF OPERATION
oESCRIPIION Of OPERATION S / LCTCAiONS / vEH ICLES (ACORo 101 , Addhlo..l Romr*. Sch.dul., my b. rtt ch.d r mor. !p.c. r. r.qutdd)City of Menifee, 29844 Haun Rd
Certificato holdor i3 named as additlonal lnsured per attached blanket form MEGL 0009-01 09 18. Primary and Non-Contributory appties asrcquired psrwritten contract pe. attached blanketform CG 2001 0413. GL Waiver of Subrogation applies as required perwritten contract per attachedblank€tform MEGL 0241-01 05i6. AA Addltlonellnsured and Waiver ofSubrogatlon applies pe. blanketform CAT42O 0215. WC Waiver of SubrogationapplieB eB required per written contract per blanket form 10217 Rev 4-2018. '30 Days notice of cancellation applies to all llability; 1O days notice for non-payment of premium.
c
City of Monllee
298,14 Haun Road
Monlfeo, CA 92586
AUTHORIZEO REPRESENTAT]VE
{- /<",\ '': '
CA NC EL
O 1988-2015 ACORO CORPORATION. All rishts reserved
The ACORD name and logo are registered marks of ACORD
ACORO 25 (2016/03)
AC:C)fr'D
!
$
s
s
SHOULO ANY OF THE ABOVE OESCRIBEO POLICIES BE CANCELLEO BEFORETHE EXPIRATION DATE THEREOF, NOTICE WLL BE OELIVERED INACCORDANCE wlTH THE POLICY PROVISIONS,
ill COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 3AA5093i 7
IIIARIET EVANSTON INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMI\4ERCIAL GENERAL LIABILIry COVERAGE FORI\4
LIQUOR LIABILITY COVERAGE FORIV
OWNERS AND CONTRACTORS PROTECTIVE LIABILIry COVERAGE FORI\4
PRODUCTS/COiiIPLETED OPERATIONS LIABILITY coVERAGE FoRM
SCHEDULE
Additional Premium: $lncluded (Check box if fu y earned X)
Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsementmay or may not be defined in all Coverage Forms.
A. Vvho ls An lnsured is amended to include as an additional insured any person or entity to whom you are required byvalid written contract or agreement to provide such coverage, but only with respect to "bodily injury", "property damage;,(including "bodily iniury" and "property damage" included in the "products-compteted operatiilnd hizar'0"1, and ,,perso-nat
and advertising iniury" caused, in whole or in part, by the negligent acts or omissions of the Named lnsured and onlywith respect to any coverage not otheMise excluded in the policy.
Howeverl
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. The insurance afforded to such additional insured will not be broader than that which you ere required by the validwritten contract or agreement to provide for such additional insured.
O1]r agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptanceof any other provisions of such contract or agreement or the contract or agreement in total.
\Men coverage does not apply for the Named lnsured, no coverage or defense will apply for the additional insured.
No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named lnsuredor to any obligation of the additional insured to indemnify another because of damages arising out of such injury ordamage
B. Wth respect to the insurance afforded to these additional insured, the following is added to limits of insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required bythe valid written contract or agreement; or
2. Available under the applicable limits of insurance shown in the Declarations;
whichever is less.
This 6ndorsement shall not increase the applicable limits of insurance shown in the Declarations.
All other terms and conditions remain unchanged.
lncludes copydghted material of lnsurance Services Office, lnc.,
w(h its permission.
MEGL 0009-01 09 18 Page 1 oI 1
POLICY NUMBER: 3AA509317 COMMERCIAL GENERAL LIABILITY
cG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT GAREFULLY.
PRIMARY AND NONCONTRIBUTORY _ OTHER INSURANCE CONDITION
This endorsement modifles insurance provided under the iollowing
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETEO OPERATIONS LIABILITY COVERAGE PART
Th€ following is added to the Other lnsurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory lnsuranco
This insurance is primary to and will not seek
contribution from any other insurance availableto an additional insured under your policy
provided that:
(1) The additional insured is a Named lnsured
under such other insurance: and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
prlmary and would not seek contribution
from any othar insurance available to the
additional insured.
cG 20 01 04 13 O lnsurance Services Offlce, lnc., 2012 Pags 'l ot 1
ill
TTIARKET
This endorsement modifies insurance provided under the foltowing
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
All other terms and conditions remain unchanged
lncludes copyrighted material of lnsurance Services OfIlce, Inc.,
with its permission
COMMERCIAL GENERAL LIABILITY
POLICY N Ull BERr 3AA509317
EVANSTON INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAO IT CAREFULLY.
BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
Name Of Person Or Organlzatlon:
Any person(s) or organization(s) with whom the Named lnsured agrees, in a written contract
executed prior to the "occurrence", to waive rights of recovery
Additional Premium: $ lncluded
The following is added to condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section lV -Commercial General Liability Conditions:
We waive any right of recovery we may have against any person or organization shown in the Schedule ot thisendorsement. This waiver applies only to the person or organization shown in the Schedule of this endorsement.
MEGL 024't-01 05 16 Page 1 of 1
ill COMMERCIAL GENERAL LIABILITY
POLICY NUMBER: 3AA50931 7
TITARIET
EVANSTON INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CoNSTRUCTtON pROJECT(S) GENERAL AGGREGATE LtMIT
This endorsement modifles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
Maximum Annual Lrmit Of lnsurance $5,000,000
The following changes are subject to the Maximum Annual Limit Of lnsurance shown in the Schedule of this endorsement.
ln no event will we be liable for damages in excess of the Maximum Annual Limit Of lnsurance shown in the Schedule ofthis endorsement.
A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under SectionI - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can beattribut6d only to ongoing operations at a single designated construction project:
1. A separate Construction Project General Aggregate Limit applies to €ach construction project, and that limit is
equal to the amount of the ceneral Aggregate Limit shown in the Declarations.
2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under
Coverage A, except damages because of "bodily injury" or "property damage" included in the ,,products-
completed operations hazard", and for medical expenses under Coverage C regardless oI the number of:
a. lnsuredsi
b. Claims made or "suits" brought; or
c. Persons or organizations making cla ms or bringing "suits"
3. Any payments made under Coverage A for damages or under Coverage C for medical expenses will reduce the
Construction Project General Aggregate Limit for that construction project and the Maximum Annuat Limit Of
lnsurance shown in the Schedule of this endorsement. Such payments will not reduce the General Aggregate
Limit shown in the Declarations nor will they reduce any other Construction Project General Aggregate Limit for
any other construction project.
4. The limits shown in the Declarations for Each Occurrence, Oamage To Premises Rented To You and Medical
Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the
Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit.
B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Sectionl- Coverage A, and for all medical expenses caused by accidents under Section l- Coverage C, which cannot be
attributed only to ongoing operations at a single construction project:
1. Any payments made under Coverage A for damages or under Coverage C for medical expenses will reduce the
amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,
whichever is applicable, and the Maximum Annual Limit Of lnsurance shown in the Schedule of this endorsement;
and
2. Such payments will not reduce any Construction Project General Aggregate Limit.
MEGL 0313 02 17 lncludes copyrighted material of lnsurance Services Otfice, lnc., Page 1 of 2
with its permission.
SCHEDULE
C. \ ftren coverage for liability arising out of the "products-completed operations hazard" is provided, any payments fordamages because of "bodily injury" or "property damage' included in the "products-complsted operations hazard,'will
reduce the Products-Completed Operations Aggregate Limit and Maximum Annual Limit Of lnsurance shown in the
Schedule of this endorsement, but not reduce the General Aggregate Limit nor the Construction Project GeneralAggregate Limit.
D. lf the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if theauthorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still
be deemed to be the same construction project.
E. The provisions of Section lll - Limits Of lnsurance not otheMise modified by this endorsement will continue to apply
as stipulated.
All other terms and conditions remain unchanged.
lncludes copyrighted material of lnsurance Services Offlce, lnc.,
with its permission
MEGL 03't3 02 17 Page 2 ot 2
POLICY NUMBER: 8A0N694947
A" BLANKET ADDITIONAL INSURED
The following E added to Paragraph A1,, Vvho 13
An lnsured, of SECTION Il - CO\GRED AUTOS
LIABILIry COVERAGE:
Any person or organization who b required under
a written contract or agreement between you andthat person or organization, that b signed and
execuled ry you before lhe "bodily injury" or'property damage" occurs and lhat b n effect
during the policy period, to be named as a addi-tonal insured b an 'insured for Covered Autos
L ability Coverage, but only for darrages to \vhich
this insurance applies and only b the extent thatperson or organl2ation qualiiles a6 an "insu.ed"
under the \A/ho b An lnsured provision contalnedn Section ll
B EI\,IPLOYEE HIRED AUTO
1. The following b added to Paragraph A,1.,
Vlho b An lnsured, of SECTIOII tl - @V-
EFED AUTGS LIABILIry COVERAGE:
An "employee' ol yours b an "insured" whileoperating a covered "aLrto" hlred or redledunder a contract or agreement m at ,em-
ployee's" name with your permission, whll€
H AUOIO, VISUAL AI.]D DATA ELECTRONIC
EQUIPMENT . INCREASED LIIIIIT
I WAIVER CF DEDUCTIBLE - GLASS
J, PERSONALPROPERTY
K AIRBAGS
L AUTO LOAN LEASE GAP
M BLANKET WAIVER CF SUBROGATION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ II CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
Thls endorsement modifies insurance provided under the following
BUSINESS AUTO COVERAGE FORI\,I
GENERAL DESCRIPTION CF COVERAGE - This endo.sement broadens coverage. However, coverage for anyinjury damage oI medical expenses described r'r any oFthe provisions of this endorsement may be eicluded orlirnited ry another endorsement to the coverage Part, and these coverage broadenng provisiofs do not apply to
the extent that coverage 6 excluded or limited by suc"h an endorsem€nt. The following listing b a general cover-age descnption only. Limitations and exclusions may apply to these coverages. Read all the provisions of lhis en-dorsemenl and the rest ofyour policy carefully to delermine rights, duties andwhatb and b not covered.
A BLANKET ADDITIONAL INSURED
B EMPLOYEE HIRED AUIO
C EMPLOYEES AS INSURED
D SUPPLEMENTARY PAV\,IENTS - INCREASED
LIMITS
E TRAILERS . INCREASED LOAD CAPACITY
F, HIRED AUTO PHYSICAL DAMAGE
G PHYSICAL DAMAGE . TPANSPORTATION
EXPENSES - INCREASED LIMIT
CA14'@15 O 2015 Tn6 lavelers Irdemnlty Company. A! nghts rcseNed.
lncludes copy.iqhted mslerial ol hsu.6nc6 Setutcss Oflico, tnc. with lts pBrmtssion.
Page 1 ol 3
COMMERCIAL AUIO
performing duties relaled to the conducl of
your business.
2, The following replaces Paragraph b. h 8.S.,
Other lnsurance, of SECTION M - BUSI.
NESS AUTO CONDMONS:
b, For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered "autos" you own
(1) Any covered 'auto" you lease, hrre
rent or bo(owt and
(2) Any covered "auto' hired or rented byyour "employee" under a conlract ha "ernployee's" narne, with your
permtssion, while performing dulies
related to the condlcl of your busl-
ness
However, any "auto" that s leased hired,
rented or borrowed with a driver is not a
covered "auto".
C EMPLOYEES AS INSURED
The lollowing b added to Paragraph A1., Who bAn lnsu.od, of SECTION tt - COVERED AUTOS
LIABILITY COVERAGE:
D
COMIVERCIAL AUTO
Any "employee" of yours 6 an "insured" while us-
ing a covered "auto" you don't oMn, hire oT bonow
n your busrness or your personal affairs.
SUPPTEMENTARY PAVIIENTS . INCREASED
LIMITS
1 The following l eFlaces Paragraph A2.a.(?) of
SECT]o|.I 11. COVERED AUTOS LIABILITY
COVEPAGE;
A up lo $3,000 lo. cost of bail bonds (in-
cluding bonds for related lraflic law viola-
tions) required because of an ,'accident,,
v€ mver. \ b do not have to fumish
these bonds.
2 The following replaces Paragraph A2.a.(4) of
SEC'IION I. COVERED AUTOS LIABILITY
COVERAGEI
(4) All reasonable expenses incurred by the
"insured" at our requesl, including actual
loss of earnings e to $500 a day be-
cause of time off from work
IRAILERS - INCREASED LOAD CAPACITY
The following replaces Paragraph C.1. of SEC
T]ON I. @VERED AUTOS:
1 "Trailers" with a load capacity of 3,000
pounds or less designed primarlly for travelm publc roads.
HIRED AUTO PHYSICAL DAMAGE
The following 6 added to Paragraph A"4,, Cover-
ag€ Ext€nslons, of SECTION l[ - PHYSICAL
DAMAGE COVERAGET
Hlred Auto Physicsl Ds.nsgo Coversge
lf hired "aulos' arc covered "a!los" tor Covered
Autos Liability Coverage but not covered "aulos"
for Physical Damage Coverage, and this policy
also provides Physical Damage Coverage for an
owned "aulo" lhen the Physical Darnage Cover-
8ge s extended to "autos" that you hire, rent or
borrow subjecl lo the following:
(1) The most ve wll pay for "loss" to any one"auto" lhat you hire, rent or borrow s lhe
lesser ot
(s) $
@) The aclual cash value of the damsged or
stolen property as of the lime of the
"loss"i or
(c) The cost of reparring q replacing thedamaged or stolen prope(y wilh otherproperty of like kind and qualily.
A An adjustrnent for depreciation and physical
condition will be made h delerm ning actual
cash value h the event of a lotal "loss".
(9 lf a repar or replacement results n better
than like kind or qualaty, Me will not pay tor lhe
amount of betlermenl.
(4) A deductible Bqual to the highest Physical
Damage deductible applicable to any owned
covered "aulo".
(q Ths Coverage Extension does not apply to:
(a) Any auto" thal B ht.ed, rented or bon
rowed with a drive[ or
(b) Any "auto" t11d 6 hired, renled or bor-
rowed from your "employee".
G PHYSICAL DAi'AGE . TRANSPORTATION
EXPENSES - INCREASED LIMIT
The following replaces the frst sentence n para-
graph A4,a., Transportetlon Expenses, of
SECTION III . PHYSICAL DAMAGE COVER-
AGEI
t,b will pay up to 950 per day to a maximlnr of
$1,500 for tempo.ary transpodation expense in-
curred by you because of ihe total thefl of a cov-
ered "auto" of lhe private passenger type.
H AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT - INCREASED LIMIT
Paragraph C.1.b. of SECTION tlt - PHYSICAL
DAMAGE COIGRAGE b deleted.
I WAIVER CF DEDUCTIBLE . GLASS
The following b added to Paragraph D, Deducll-
ble, of SECTION lll - PHYSICAL DAMAGE
COVERAGE:
l.lc deductible for a covered "auto" will apply bglass damage if the glass b repaired rather lhan
replac€d.
J PERSONAL PROPERTY
The following b added to Paragraph A4., Covsr-8ge Extenslons, of SECTON lll - PHYSICAL
DAMAGE COVERAGE:
Porsonal Property Covsrsge
V\h will pay l'p to $400 for "toss" to wearing ap-parel and other personal p.operty which is
(1) Owned by an 'insured"; and
(a h or crl your covered "auto".
This coverage only applies h the event of a total
theft of your covered "auto".
fb deductibles apply to Persohal Property cover-
age.
E
E
50,000
Page 2 of 3 @ 2015 The T,ave €rs lnd6mrlly Company. Ar rtghls reserved.
lnctudes copyighlBd matsnal ot lns!rance SeNicss Offce, tnc wilh ils pe,misston.
cAT4 20 @ 15
K AIRBAGS
The following '6 added to Paragraph 8.3,, Exclu-
slon6, of SECTION lll - PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a, does not apply to "loss" to one or
r.ore airbags h a covered 'auto" you own lhal in-
flate due to a cause other than a cause of "loss"
sel forth n Paragraphs A.1.b. and A.'1.c., blt
onlyl
a. lf that "auto" b a covered "auto" for Compre-he')s,ve Cove.age under tl.is ool,Cy
h Th€ airbags are not covered under any war-
ranly; and
c The arrbags were nol intentionally inflated.
V1,b wlll pay e to a rraximurn of $1 000 for any
one "loss".
L AUTO LOAN LEASE GAP
The followng s added to PaEgraph A4,, Cover-
606 Extenslons, of SECTION lll - pHyStCAL
DAMAGE COVERAGE:
Auto Loan L6a6o Gap Coverage for prlvale
Passonger Typs V€hlcles
ln the event of a total "]oss" to a covered ',auto', ol
the privale passenger type shown h the Scheduleor Declarations for which Physical Damage Cov-
erage b provided, we wll pay any unpaid amount
due m the lease or loan for such covered ,,auto,,
less lhe following:
(1) The amount paid under the Phystcal Damage
Coverage Section of the policy for that "auto"
and
COMMERCIAL AUTO
(a Anv
(a) Overdue lease or loan payments at the
lime of the "loss';
(b) FinEncial penalties irnposed under alease for excessive use, abnormal wear
ard tear or high m leage,
(c) Securlty deposits not returned by the les-
sol;
(d) Costs for extended warranlies, Credit Life
lnsurance, Health, Accident or Oisability
lnsurance purchased with the loan or
lease: and
(e) Caary-over balahces from prevtous loans
or leases_
M BLANKET WAIVER CF SUBROGATION
The following replaces Paragraph A5. Transrorof Rlghts Of Rscovery Against others To Us,of SECTION IV - BUSINESS AUTO CONDL
TIONS:
5 Transfer Ol Rlghts Of Recovery Agalnst
OlhorE To tb
We waive any right of recovery v€ may have
against any person or organlzation to the ex-
tenl required of you by a written contract exe-
cuted prior to any "accident,' or ,,loss,,, pro-
vided that the 'accident' or "loss" arises out ofthe operations contemplated by such coll-
kact. The waiver applies only to the person or
organization designated i'r such contract,
cAT4z)@15 @ 2015 the Traval€rs lndemn(y Company. Al dohrs rEsen/ed.
lncludes copy.ightad materldl ot lnsuranca Setuices Offic., lnc wlh iE Denissis.
Page 3 of 3
STATE
FUNtr,
COMPE NSAII()NINSURANC'
HOME OFFICE
SAN FRANCISCO
BLANKET BASIS
EFFECTIVE FEBRUARY 1.
AND EXPIRING PEBRUARY
2021 AT 12.01 A.r,r.L, 2022 Ar 12.01 A.r.{
ENDORSEMENT AGREEMENT
WAIVER OF SUBROGAT ION
r853518-21
RENEWAL
SP7-13-88-06PAGE 1 OF
ALL EFFECTIVE DATES AREAT'12:01 AM PACIFIC
STANDABO TIME OR THE
TIME INOICATED AT
PACIFIC STANOABD ?IME
VON EI'I{ BACKHOE.
PO BOx 693
I{INCHESTERI CA
INC.
92595
I.IE HAVE THE RIGHT TO RECOVER OT'R PAY}.TENTS FROI.I ANYONE
LIABLE FOR AN INJURY COVERED BY THIS POLICY. I.IE WILL
NOT ENFORCE OTIR RIGHT ACAINST THE PERSON OR
ORGA].IIZATION NAI,IED IN THE SCHEDULE.
THIS AGREE}-{ENT APPLIES ONLY TO THE EXTENT THAT YOU
PERFORI'I WORK IJNDER A WRITTEN CONTRACT TIiAT REQUIRES YOU
TO OBTAIN THIS AGREEI,TENT FROT US.
THE ADDITIONAL PREHIUH FOR THIS ENDORSEi'IENT SHALL BE
2.007 OF THE TOTAL POLICY PREHIUM.
SCHEDULE
PERSON OR ORGANIZATION JOB DESCR IPT ION
NOTHING IN THIS ENDONSEMENT COhITAINED SHALL SE HELO TO VARY, ALTER, WAIVE
OR EXTENO ANY OF THE TEFMS, CONDITIONS, AGREEMENTS, OB LIMITA'IONS OF THIS
POLICY OTHEB THAN AS STATED. NOTHING ELSEWHEBE IN THIS POLICY SHALL BE
HELO TO VARY, ALTEB, WAIVE OB LIMIT THE TERMS, CONOITIONS, AGBEEMENTS OR
LIMITATIONS OF THIS ENOORSEMENT.
B LA}'IKET WAIVER OF
SUBROCATION
2021
// ,,{/0.z,ta/,4,<_7z<r1a-'\!
PRESIDENT AND CEO
COUNTERSIGNED AND ISSUED AT SAN FRANCISCOT FEBRUARy 3
257 2
sc F FoRM 10217 lR€V.7-2014)oLo oP 217
BROKER COPY
I
ANY PERSON OR ORCA.II I ZAT ION
FOR WHOH THE NA},iED INSURED
HAS AGREED BY I{R ITTEN
CONTRACT TO FURNISH THIS
WAIVER
FIJND
COMPENSATIONINSTJRANCE
IN REPLY REFEB TO:
ocroBER 4, 2021
CITY OE MENIFEE
29844 HAUN RD
I,TENIFEE CA 92586-5539
CO},{PENSAT I ON INSURANCE
CANCELLAT ION WI THDRAWAL NOTICE
RE: CERTIFICATE DATED SEPTEMBER LL, 2021
THE CANCELLATION HAS BEEN WITHDRAWN FOR THE WORKERS' COMPENSATION
INSURANCE POLICY FOR TIIE EMPLOYER NAI.IED BELOW. THIS LETTER SUPERSEDES
THE NOTTCE OF CANCELLAT I ON SENT TO vOU ON OCTOBER r, 2021 .
THIS EI.{PLOYER'S T{ORKERS' CO},TPEI{SAT I ON INSURANCE COVERAGE CONTINUED
UN I NTERRUPTED .
EMPLOYER:
PLAT{WEST PARTIERS, INC
PO BOX 458r
ARCATA, CA 955T8POLTCY 1534262-2L
CUSTOUER SERVICE REPRESENTAT IVE
CUSTOI.'IER SERVICE CENTER(888) 782-8338
5860 Ow€ns Dr Pleasanton, CA 94544-3900
M.iling Address: P.O. Box 8192 Pleasanton, CA 945aa-9642
sctF 1910 2
STATE
CERTIFICATE OF WORKERS '
COVERAGES
I
ACAD'CERTIFICATE OF LIABILITY INSURANCE 08/02/2027
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORi.IATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR IEGATIVELY A END, EXTENO OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TH|S CERTIFTCATE Of TNSURANCE OOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSUI{G TNSURER(S), AUTI{ORIZED
REPRESET{TATIVE OR PRODUCER, AND THE CERTIFrcATE HOLDER,
IMPORTANT: f tho corlllicato hold.r ir 6n ADDITIONAL INSURED, tho policy(l.s) must hsvo ADDITIONAL INSURED provirion8 or b6 6ndor.od.
ll SUBROGATION lS WAIVED, lubject lo the t.rm! lnd condltlon. o, tho pollcy, certsin pollcl.t nay roqulro !n ondortement. A 3t tomant on
thit corllficelo does not conlor lo lho certlficrlo holdor in lieu of.uch
piooucER r,IC 't 5777 6 80 77-4550
IllrB hlornalloEal hauranc€ 6ervLc6. Inc.925 5 09 -65 00 92s 609- 55 50
P.O, Box {0{7
INSI'RER(S) AFFORDII{G COVERAGE
CoEcor(!, CA 9152{ Ugl l|lluRtR^: v LLEY POROa Il|8 CO 20508
NlUNEOgarrla t traocla!.. IDc,
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|XIURERB I CONIINENIAL CTA CO 20141
CONIINENTAI, INE CO 35289
tNluitRo, EF VELERIT PROP CIS CO Op lliEB 25571
coDcord, cA 9{520 us^IN
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CERTIFICATE HOLDER
cERT|F|CATE iIUMBER: 535104815 REVISION NUMBERT
CANCELLATION
@ 198&2015 ACORD CORPORATIOI{. All rlght! rolorvod.
Th. ACORD nrm. rnd logo !r. r.gbtarsd tnlrt. ol ACORD
160-0586 ( 2022 )
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Pu.bllc work. / Eagln..rlDg
29714 Bru.u Roadlx.all.c, cr 92596
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SHOULDAI{YOF THE ABOVE OESCRIBEO POLICIES 8E CAXCELLEO BEFORE
THE EXPIRANOT DAIE THEREOF, I{OTICE WILL BE DELIVERED IN
ACCORDANCEwlTHTHEPOLIGYPROVIgIONS,
AUTHORI.ZED REFPESEXIATIVE &*,mz-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEO BELOW HAVE BEEN ISSUEO TO THE INSURED NAMEO ABOVE FOR THE POLICY PERIOO
INDICATED, NOTWITHSTANOING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTTIER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUEO OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLLCIES DESCRIBED HEREIN IS SUEJECT TO ALL THE TERMS,
EXCLUSIONSAND CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE gEEN REDUCED BY PAIO CLAIMS.
EACH OCCU RRENCE t 1, 000,000
PRFMISFS rF mur.n..l t 1, 000,00 0
UEo ExP (Any on! FMn)r 1s,000
PERSONAL AADV INJURY t 1, 000, 000
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t 2,000,000
3 2, 000, 000
COMI'ERClAL 6ENERAL LIABILIII
x
GEN'IAGGREGATE L MIT APPLIES PER'
xx
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Dcd: 0
CLAIMS.MAOE
POLICY
OTHER
PRODUCIS . COMP/OP AGG
11,000,000
BODLLY INJURY 1P.. p.6@)
BODILY NJURY IPi TEId'NI)
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AUTOS ONLY
HIREO
AI]IOS ONLYDad: 0
AUTOSONLY
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SCHEOULEO
AUTOSNON.OWIEO
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AUTOllog[ELrA8[trY EUr 607 6 590 52 0 oatoL/21 0a/ott22
$
x 310,000,000
x EXCE I LnA
occrJR EACHOCCURRENCE
t 10,000,000
clE 50?5590551 oa/ot/21 oa/ot/22
$
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0E0 x RETENTONS 10' 000
OTH.
E,L EACHACC]OENI I 1,000,000
t L,000,000EI OISFASE . EA EMPLOYEE
D woR(ER!COTPEXIITIOI
ANO EIPIOYERE LABITTY
ANYPROPRIETO&PARINER/EXECUTIVE
OFFICER/MEM6EREXCIUOEO?
olgcRrPllol{ OF OPERTT oNS b.l
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oB-8xa56aag-21-a3-o oatott2t o8/ot/22
E.t. DlsE sE - POLICY !ri, T r 1,000,000
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1rrr591891s88 0810a/ 22 10,000, 000/cIrh,
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. wolk.rr ccq).DaatloD Doll.ey !xclud!. eEopoll.tlc .tat.. lfD, o8, rA, rY.
O.E.!r1 Ltlbtltty rnit Auto Li.biltty Addtllotul Iarur.al .!atu. grut.al, tf t.qu1r.d brr rrltt6E coalract/agr..E a!, D.r
altachcal lorE Ctl ?50?9Il 1016 rDit crt 53359XI 0112 (Dg. 1, I.r.3).
clty & It. ol!lc6r.. .!Dloy..., aq.rrr r ruthollr.d voluntc6!. ar. laldltlonll lE!ur.d. rd.r G.ncral Llablllty !!d luto
Lllblllly l! !.qulr.d by a rrlt!.ll contrac!.
Rr! oa-call Prot...lolal EdtllL.o.at t rlErl lbglDo.lhg 8e!vLc.€ (aA L1600586)
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Blanket Additional lnsured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement o
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This endorsemenl modifies insutance providsd under the lollowing:
COMMEBCIAL GENERAL LIABILIry COVERAGE PART
It is understood and agreed as lollows:
l. wHO lS AN INSURED is amended lo include as an lnsurod any person or organization whom you ars requirod
by wrltlon contracl to add as an additional insured on this covarrgo part, but only with rsspect to liability lor
bodlly inlury, propetty damage or p€rsonal and advonising lnlury caused in whole or in part by your acts or
omissions, or lhe acts or omissions of those acting on your behalf:
A. in the pedormance of your ongoing operations subject to such wrlton contract; or
B. in the performance of your work subiect to such wrltten conlract, but only with rospect to bodlly lnlury or
propsrty damago included in the productsromploted oporallons hazard, and only if:
l. the wrltten contract requires you to provide the additional insured such covorage; and
2. this covorags parl provides such coverage.
ll. But it lhe written contract requiros:
A. additional insurod coverage under the 'l 'l-85 edition, '10.93 edition, or 10.01 edition of CG2O1O, or under the
10-01 edition of CG2037i or
B. additional insurod coverage with "arising out of" language; or
C. additional insurod coverage to th€ greatest €Itent pemissible by law;
then paragraph l. abovo is deloted in its entirety and replaced by th6 following:
WHO lS AN lttlsuRED is amended to include as an lnsurod any person or organization whom you are required
by written conlract to add as an addilional insur€d on this coverago p8?t, but only with rsspoct to liability lor
bodily lnlury, proporty damago or prtonal and advertlslng lnlury arising out of your work that is subiect to
such w.ittan contract,
lll. Subject always to the torms and conditions of this policy, including the llmits of insurance, the lnsursr will not
provido such additional insured with:
A. coverag€ broader than requirod by lhe wrltt6n conttact; or
B. a higher limit ol insuranc€ than required by the written contract.
lV. Th€ insurance granted by this endors€ment to the additional insured does not apply to bodlly lnlury, proporty
damagB, or peisonal and advertising lnlury arising out of:
A. ths rendering of, orthe failure to render, any prolessional architectural, engineering, or survsying services,
including:
1. the preparing, approving, or failing lo prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and spocifications; and
2. supervisory, inspection, architectural or engineering activities; or
B. any premises or work lor which the additional insured is specilically listed as an additional insured on
anothar endorsgmont attached to this covorags part.
V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, ths Condition entitled othor lnsursnco is
amonded to add the lollowing, which suporsedes any provision to ths contrary in this Condition or elsewhsre in
this covorags part:
oNA75079XX (10.16)
Page 1 ol 2
lnsured Name: Harris & Associates lnc
Policy No: 6072176739
Etfective oate: 0810112021
Copyright CNA All Rights R6s6Ned. lnclld€s copyrighted matorialot tnsulance S€lvicos Otfce, lnc., with lB p€mission.
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Blanket Additional lnsured - Owners, Lessees or
Contractors - with Products-Completed
Operations Coverage Endorsement
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Prlmary and Noncontrlbulory ln3uranca
With respect to other insuranco available to tho additional insured undor which the additional insured is a named
insurod, this insurancB is primary to and will not s€ek contribution from such oth6r insurance, provid€d lhai a
wrltton contract requires the insurance provided by this policy to be:
1. primary and non-contributing with othor insuranc6 available to ths additional insursd; or
2. primary and to not seek contribution from any oth6r insurance available to the additional insursd.
But oxcept as spocilied above, this insurance will be €xcess of all other insuranc6 availabls to the additional
insur€d.
Vl. Solely with respect to the insurance granted by this endorsement, the section entitled COMiIERCIAL
GENERAL LIABILIrY CONDITIONS is amend€d as lollows:
The Condition entitlod Dullos ln The Evont ol Occurrenco, Otl6nso, Clalm or Sull is amended with th€
addition of the following:
Any additional insur€d pursuant to this endorssmsnt will as soon as practicabls:
1. give thg lnsuror wdtten notics of any clalm, or any occurrance or otfens€ which may result in a clalm;
2. send the lnsuror copies ol all legal papers received, and otherwise cooperate with lhe lnsuror in the
investigation, delense, or settlement of the clalm; and
3. make available any other insurancs, and tondsr the defense and indsmnity of any cl6lm to any other insurer
or soll-insurer, whos€ policy or program applies to a loss that the lnsurer covers und€r this covorago part.
However, il thg wrltten contract requiros this insurancs to b€ primary and non-contributory, this paragraph
3. does not apply to insurance on which the additional insured is a named insured.
Th6 lnsurer has no duty to dolond or indemnily an additional insured under this endorsement until the lnsu16r
receives written notice of a cltlm from the additional insur€d.
Vll. Sololy with rospect to tho insurance grantod by this endors€monl, tho section ontitled DEFINITIONS is am6nd6d
to add the following definition:
Wdtten contract means a written contract or written agrsement that requires you to mak€ a person or
organization an addilional insur6d on this covorage part, provided tho contract or agreemont:
A, is currsntly in etlect or becomes etfective during the torm of this policy; and
B. was sxecuted prior to:
1. the bodlly inlury or proporty damago; or
2. the ofl€nso that caused th6 personal and rdvertlslng lnlury;
for which the additional insursd se€ks coverage.
Any covorage grantod by this sndorsemsnt shall apply solely to the gxtent permissible by law.
All oth€r terms and conditions of th6 Policy r6main unchanged.
This endorsement, which lorms a part ol and is lor attachment to tho Poliry issusd by tho designated lnsur€rs, takes
etfect on ths etlective date ol said Policy at the hour stat€d in said Policy, unless another etfoctive date is shown
below, and expiros concurr€ntly with said Policy.
oNA75079XX (10-16)
PagB 2 ol2
lnsursd Nams: Harris & Associates lnc
Policy No; 6072176739
Efrective Date: 08/0'112021
Copyrighl CNA All Rights Ros€rved. lnclLides copyrighled matorialol lnsuranc€ Ssrvicos Ollic6, lnc., wlh its pormission
I
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CNA Architects, Engineers and Surveyors General Liability
Extension Endorsement
(6) of tho Osmage to Property Exclusion do nol apply to property damage that r€sults from lhs use ol
elevators.
B. Solely for lhe purpose of the coverage provided by this PROPERW OAMAGE - ELEVATORS Provision,
the Othor lnsurance conditions is amonded to add the lollowing paragraph:
This insurancs is excsss ov€r any of the othor insurance, whethsr primary, 6xc6ss, contingent or on any
other basis lhat is Proporty insurance covoring property of others damagod from tho us6 ol elevators.
23. RETIRED PARTNERS, UEMBERS, DIBECTOFS AND ETIPLOYEES
WHO lS INSURED is am€nded to includo as lnsuredt natural persons who ar€ rotired partners, memb€rs,
directors or employees, but only lor bodlly hlury, proporty damags or porsonal and advortising lnlury that
results lrom services p€rlormsd for the Namod lnsurod under th6 Namod lngurad'! diroct supsrvision. All
limitations thal apply to omployoes and volunlseI workarr also apply to anyone qualitying as an lnsurod
under this Provision.
24. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS - COVERAGES A AND B is amended as foltows:
A. Paragraph ,.b. is amendod to d€l€ls the $250 limit shown for tho cost ol bail bonds and rsplaco it with a
$5,000. limit; and
B. Paragraph 1,d. is amonded to delote the limit of $250 shown for daily loss ol €arnings and replace lt with a
$1 ,000. limit.
25. UNINTENTIONAL FAILURE TO OISCLOSE HAZARDS
ll ths Namod lnrurod unintontionally lails to discloso all existing hazards at ths inception dat€ of the Namgd
lnsured's Covorage Part, ths lnsurer rvill not deny coverag6 und€r this Covorage Pad b6cause ol such failure.
26. WAIVER OF SUBROGATION . BLANKET
Under CONDITIONS, th€ condition entitled TranstBr ol Right! O{ Rocovery Agalnst Ohors To Us is amonded
to add the lollowing:
The lnsurel waives any right of recovery the lnsurer may have against any person or organization because of
payments the lnsurer mak6s for injury or damage arising out of:
'L the Named lnsursd's ongoing operations; or
2. your work included in the product8-completed opsratlons hazard.
However, this waiver applies only when lhe Namod lnsurod has agroBd in writing to waive such rights ot
rocovery in a wdtlsn conlract or writlen agreement, and only if such contract or agreement:
f. is in ettect or becomes etlective during the term ol this Covor.ge Part; and
2. was executed prior to the bodlly lnlury, proporty damage or personal and advortlslng lnlury giving rise
to th6 clalm.
27. WFAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS
Note: The following provision does not apply to any public construction proiect in the stat6 of Oklahoma, nor to
any conslruction project in the state of Alaska, that is not permitted to be insured under a consolldatod (wr6p.
up) lnsurance program by applicable stale statute or r€gulation,
:
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cNA74858XX (1-15)
PagB 16 of l7
lnsured Name: Harris & Associates lnc.
Policy No:
Eflective oate
6072176739
0810112021
Copynghl CNA A nights Rosorvod. lncludos copyrighlod matadal ot lnsurance Ssryicos Ottico, tnc., with its pormiBsion.
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CNA Business Auto Policy
Policy Endorsement
I
THIS ENOORSEMENT CHANGES THE POTICY. PLEASE READ IT CAREFULLY,
This endorssm€nt modifies insuranco provid€d under tho following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE
A. Who ls An lnsurod
The following is added to Section ll. Parsgtaph A.1., Who ls An lnsurod:
1. a. Any incorporated sntity of which the Named lnsured owns a majority ol th€ voting stock on the
dat6 ot inc€ption o, this Coverago Form; providod that,
b. The insurance afford€d by this provision A.l. doss not spply to any such entity that is an
lnsured under 8ny other liability "policy'providing auto coveraga.
2. Any organization you n€wly acquiro or form, othsr than a limitod liability comp8ny, partn€rship or
joint venturs, and over which you msintain msjority ownership interest,
The insurance alforded by this provlsion A.2.:
8. ls effective on the acquisition or lormation dat€, and is afforded only until the end ot tho policy
period of this Coverage Form, or th6 next anniversary of its inception dat6, which€v€r is earlier.
b, Does not apply toi
(11 Bodlly lnjury or propcrty damags csusod by an accid$t thal occurred bsfore you scquired or
formed the organization; or
{21 Any such organization that is an insured under any other liability "policy" providing auto
coverage.
3. Any person or organizstion that you ara required by I written contract to name as an sdditional
insured is an insurod but only with respect to th€ir l6gal liability lor acts or omissions of I p8rson,
who qualifies 8s 8n ln3urod under SECTION ll - WHO lS AI{ INSURED and for whom Liability
Coverage is afforded under this policy. lf requirsd by written contract, this insursnca will be primary
and non-contributory to insurance on which the additionsl insurod is a Nsmed lnsur€d.
4. An employoo of yours is an insurod while operating an auto hirgd or rsnted under a contract or
8gr€sm6nt in thst omploy€€'3 name, with your permission, whil€ porforming duti€s rolst€d to th€
conduct of your busin€ss.
'Policy", as used in this provision A. Who ls An lnsurod, includes those policies that wero in force on
the incoption date ot this Covorage Form but:
1. Which are no longor in force; or
2. Whose limits have b6en exhsust€d.
B. Bail Bond! and Loss ol Esrnings
Soction ll, Paragraphs A.2. {2} and A.2. l4l ate revisod as follows:
1. ln a.(2), the limit lor the cost of bail bonds is changed from $2,000 to $5.00O; and
2. ln a.(4), the limit tor the loss o, earnings is changed Irom $250 to 9500 a d8y.
Form No: CNA6335gXX {04-2012)
Endorcom€nl Efl€ctivo 0at6: Endors€msnt Expitation Dat.l
Endors6ment Nor 13; Pager 1 ol4
Undorwriting Compsnyi Tho Continantal lnsuranc€ Company, 151 N Frsnklin St, Chicago, lL 60606
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CONTRACTORS EXTEI{DED COVERAGE EIIOORSEMENT . BUSII{ESs AUTO PLU6
o copyright CNA All Righb R63€rv€d. Includ6s copyright€d m6t6rial of the
ln3ursnc6 S€rvice3 Olfic€, lnc,, u!€d with its psrmis3ion.
Policy No: BtJA 6076590520
Policy Elf6ctiv6 Dst€: 08/012021
r
CIIA Business Auto Policy
P(rlicy Endorsenrent
C. Fellow Employee
Soctlon ll, Paragraph 8.5 does not apply.
Such coversgo as is afforded by this provision C. is €xc6ss ovsr sny othor coll€ctibls insurance.
PHYSICAL DAMAGE COVERAGE
A. Glass Breakage - Hifiing A Bird Or Animsl - Falling Obiscts Or Mblitss
The following is added to Section lll. Psragraph A.3.:
With respsct to any covered suto, any deductible shown in the Dsclarations will not apply to glsss
breakage if such glass is repaired, in a manner acceptsble to us, rather than replsc€d.
B, Transportation Exponsos
Ssction lll, Paragrsph A.4.8. is revised, with respect to transportation expense incurred by you, to
provide:
a. $60 per day, in lisu of 920; subject to
b. $ 1 ,800 maximum, in lieu of $600.
C. Loss of Ure Expenses
Soction lll, Paragraph A.4.b. is revis6d, with respect to loss of us€ expenses incurrad by you, to
provide:
o. $ 1 ,000 maximum, in lieu of $600.
D. Hired "Autos'
The Iollowing is add€d to Section lll. Paragraph A-:
5. Hksd "Autos"
lf Physical Damage coverage is provided under this policy, and such coverago do6s not extBnd to Hired
Autos. then Physical 0amage coverage is exlended to:
a. Any covered auto you lease, hire, rent or borrow without I driver; and
b. Any covered suto hired or rented by your omployse without a driver, und6r a contract in that
individual employss's name, with your permission, while perlorming duties related to the
conducl of your businass.
c. The most we will pay for any ofle accid€nt or lors is tha actual cash vslu€, cost of repair, cost
ot replacement or $75,000, whichever is less, minus a $5OO deductibls for sach covored auto.
No deductible applies to loss caused by fire or lightning.
d. The physical damage coverage as is provided by this provision is equal to the physical damage
covorage{s) provided on your own€d autos.
6. Such physical damage coverage for hired autos will:
(1) lnclude loss of use, provided it is the consequence of an accident for which the Named
lnsur€d is legslly liable, and 8s I result ot which a mon€tary loss is sustsined by the l€8sing
or rental concern.
(2) Such covsrage as is provid€d by this provision will bs subjsct to a limit of $750 per
accid6nt.
E. Airbag Covarag€
The following is added to Section lll, Paragraph B.3.:
Th6 accidental dischargs of an airbag shall not be considerod mechanical br€akdown.
Form No: CNA63359XX (04-2012)
EndoEoment Ellectivo Datst Ehdorsement Expiration Dsts:
Endorsoment No: t3; Pago:2 of4
Undorwriting Company: The Contin€ntsl lnsuranco Compsny, 151 N Franklin St, Chic6go, tL 60606
6 Copyright CNA All Riohts Res€rved. lnctudo3 copyrightod mst€riat of th€
Insuranc€ Soryices Office, lnc., ur€d with i$ psrmi3iion.
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Policy No: BUA 6076590520
Policy Ellsctiv. Oet6i 08U0t/2021
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Bueiness Auto Policy
Policy Endorsement
F. Electronic Equlpmont
Soctlon lll, Parsgrsphs B.4.c and 8.4.d. are deleted and replsc€d by th8 foliowing:
c. Physical Damag€ Covorag€ on a covsrad auto elso applies to loss to any perman€ntly instsllod
electronic equipment including its ant€nnas and other sccessories
d. A $100 per occurrence deductible appli€s to the cov€rage provided by this provision.
G. Diminution ln Valuo
Th6 following is added to Soctlon lll. Psragraph 8.6.:
Subject to the tollowing. the dlmlnution in value exclusion does not apply to:
a. Any covered auto oJ the privat8 passenger type you l6ase, hire, rent or borrow, without a drivBr
tor a poriod of 30 days or less, while porforming dutiss rslatsd to th6 conduct of your busin6ss;
and
b. Any cov€r€d auto oI ths private passongsr type hirod or rentsd by your smployoo without 8
driv€r for I period of 30 days or loss, undor a contract in th8t individusl omployoo's name, with
your permission, while perlorming duties r€lated to the conduct of your business.
c. Such coverage as is provided by this provision is limitBd to a diminution ln value loss arising
directly out of accidental damage and not as a result of the railure to maks repairs; faulty or
incomplete mointenance or repEirs; or the installation ol substandard parts.
d. The most we will pay for loss to a covered auto in any one accident is the lesser of:
(11 $5,000; or
(21 20% of the auto's actual cash value {ACV).
lll. Ddva Othsr C8r Covsrago - Exccutive Olffccrs
Th€ following is added to Sectlon3 ll and lll:
1. Any auto you don't own, hire or borrow is a cov€red suto for Liability Coverage while bsing us€d by,
and ,or Physical Damage Coverage while in the car6, custody or control of, any of your "Bx8cutive
otficers", oxcBpt:
a. An suto owned by that "€xgcutive oflic€r" or a m€mb€r ol that person's household; or
b. An auto used by that "executive olficer" while working in a businsss of selling, servicing, repairing
or parking autos.
Such Liability and/or Physical Damage Coverage as is aflorded by this provision,
(1) Equal to the gr€atest of those coveragos aflorded any covered auto; and
(2) Excess ov€r any othor collsctible insurance.
2. For purposes of this provision, "sxecutive officer' means a porson holding any of the officsr positions
cr8ated by your chartar. constitution, by-laws or any other similsr gov€rning document, and, while I
resident oI the same household, includes that person's spouse.
Such'exscutive officers" are insureds while using a covered auto described in this provision.
IV. BUSINESS AUTO CONDITIONS
A. Dutlos ln Th€ Evont Ol Accidont, Clalm, Suit Or Losg
The following is added to Soction lV, Paragraph A.2.4.:
CNA
Form Nor CNA63359XX {04-2012)
Endor3emont Effoctiv€ oat€: Endorsomcnt Exptatioh Ost6:
Endor66m6nt No: 13; Pag€: 3 ol 4
lJnd6rwriting Companyi Ths Continantel lnsuranc€ Compsny, 151 N Franklin Sr, Chicago, lL 60606
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o Copyright CNA All Bight3 Rolorved. lncludos copyrightod met€rial of th€
lnsursncs Sorvic€s Ottics, lnc., uled with i$ pelmission.
Policy No: BUA 8076590520
Policy Ellectiv€ Dsto: 08i/01/2021
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CNA Business Auto Policy
Policy Endorsoment
(4) Your employees may know ot an accidont or loss. Thjs will not mean that you hav6 such
knowl€dg€, unless such sccidont or lo33 is known to you or if you are not an individual, to any
of your executive officers or partners or your insurance manager,
Ths following is add8d to Ssction lV, Paragraph A.2.b.:
16) Your omploysos may know of docum€nts rocsived concsrning a claim or suit, This will not m6sn
that you hav€ such knowlodgo, unl8ss roceipt of such documents is known to you or iI you aro
not Bn individusl, to any of your 6xecutive officers or partners or your insurance m8na96r,
B. Transler Ol Rights Ol Rocovory Against Others To Us
The following is add€d to Seclion lV, Paragraph A.5. Transfor Of Rights Of Recovery Agalnrt Others To
Us:
We waivo any right ot r€cov€ry ws may have, because of paymants wo mako lor injury or damsg€,
sgainst any person or organizstion Ior whom or which you ars rsquirod by writt€n contract or
agreem€nt to obtain this waivar from us.
This injury or damage must arisa out ol your activiti€s und6r a contract with that parson or
organization.
You must sgree to thst requirement prior to an sccldent or losr.
C. Concealmont, Misropresontation or Frsud
The tollowing is add6d to S6ction lV, Paragraph B.2.:
Your failure to disclose all hazards existing on the date of inception ol this Coverag€ Form shall not
prejudic€ you with rsspoct to th€ cov€r8g€ affordBd provided such failur€ or omission is not intantional.
D. Oth€r lnrurance
The following is added to Soction lV, Psragraph 8.6.:
Regardless ot the provisions of Parsgraphs 5.a. and 5.d. abovo. the coverage provlded by this policy
shall be on a primary non-contributory basis. This provision is applicable only wh€n required by a
written contract.
That written contract must have been €ntored into prior to Accident or Loss.
E. Policy Poriod, Cov6r8go Teritory
Soction lV, Psragrsph B.7.(5).(E). is r8vis€d to providel
a. 45 days of coverage in lieu oI 30 days.
DEFINITIONS
Sectlon V. psragr8ph C. is deleted and r€placed by th6 following:
Bodlly iniury means bodily injury, sickness or disoaso sustained by a person, including mental anguish,
mental injury or death resulting from any ot these.
Form Nor CNA6335gXX 104-2012)
Endorsemsnt Efl€ctiv6 Dste: Endors6mant Expirstion Dst6:
Endors6m6nt Nor 13; Psg€:4 of4
Undsrwriting Comp6nyt The Contin€ntal lnsuranc€ Comp6ny, 151 N Franklin St, Chicdgo, lL 60606
. Copyright CNA All Rights R€3€rv€d. tnctudos copyrightod msterial oI the
lnsurancg Servico! Offic€, lnc., u36d with its permission.
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Policy Nor 8UA 6076590520
Policy Effsctive Dater O8/01/2021
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Businege Auto Policy
P0licy Endorsement
THIS ENDORSEMENT CHANGES THE POIICY. PTEASE READ IT CAREFULTY,
This sndors6ment modilios insursnc€ provid€d under ths following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provid€d by this Gndorsemsnl, the provisions of th6 Coverag€ Form spply unless
modifisd by tha endorsemsnt.
This endorsement chsngss tho policy effoctive on th€ inception date of the policy unless another dsts is
indicatad b6low.
Named lnsured: HARRIS & ASSOCIATES INC
Endorsom6nt Eftectivo 08t6: 0810112021
CNA
SCHEDULE
Namo{sl Ol Psrson(sl Or Organizationls):
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 required to complete this Sch6dule, it not shown above, will b6 shown in th€ Doclarations
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Form No: CA 04 44 10 13
Endorsem6nt Ell6ctiv6 Dat6: Endorsomont Expiration Datr:
EndorE6m6nt Nor 4; Pagor 1 of I
Und€rwrhing Companyr Th€ Continontal lnsuranco CompEny, 151 N Frsnklin St, Chic6go, lL 60806
WAIVER OF TRATTSFER OF RreHT8 OF RECOVERY
AGAI]TST OTHIRS TO US IWAIVER OF SUBROGATIOiII
Policy No: BUA 6078590520
Policy Effectivs oato: 08/01/2021
The Translor Ol Rights Ot R6cov6ry AgalNt Oth.rs To Us condition do6s not apply to th€ p€rson(s) or
organization{s) shown in ths Schedule. but only to the sxt€nt that subrogstion is waiv€d prior to the "accidonl'
or the "loss" under a contract with that person or orgsnizstion,
o Copyraght lnsur6nce S.ryicos Offic€, lnc,, 2011
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TRAYELERSJ
ONE TOWER SQUARE
HARTFORD CT O 5183
WORKERS COMPENSATION
AND
EMPLOYERS LIABILIW POLICY
ENDORSEMENT WC990376( A)- ool
POLICYNUMBER: UB{K458448.2I43-G
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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 additional premium for this endorsement shall be 2 .00 % of the California workers' compensation pre-
mium.
ANC PERSON OR ORGINIZATION TOR
WIICII TIIE INSURED I{AS AOREBD
BY HRITTEN COMIR.f,CT EXBCIXIED
PRIOR TO IJOSS TO FI'R}II6H THI6
I{AIVE&.
Person or Organization
Schedule
Job Description
This endorsement changes the policy to which it is attached and is effective on the date issued unless otheMise
stated.
(The information below is required only when this endorsement is issu€d subsequent to pr€paratlon of
the policy.)
Endorsement Effective Policy No. Endorsement No.lnsured premium
lnsurance Company Countersigned by
Page 1 of 1
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I HtlB lntarnrtionel Insur!n(e Sanices Inr,
P.O. Box 4047
Concord- CA 94524
Eliits
KEElectronic Service Requested
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trhiltll,,tlltlllt,lt,r;illrlll,lrrrr111llr,r,rrlrll1rrllll1rr(itv of llenifee l.lqPt71q HrItr/ RD
PUELI C L'ORKS / EN6INEERIN6NENIFEE " CA I? S6L.L5q O
Itr16 dlocument was blougbt to you by CGrtl f 1cats6st{ow.
Tho data included in this notice and in the attachod documont is confidentialto Ebix BPO
and tho party responsible for bringing you this informstion.
EBIX BPO 3
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If you bav€ quostl"oar !6gard1r1g tbe coataDt of thla dlocuEant, p16as6 coaEacE -
Ch€ Producer./AgoDE liated oa the c€rtlflcete of LDlularrc€ or tsh6 IDErursd Llsts€dl -
on Eh6 no!Ic6 of catrc€I1atiolr/ relnatat6tlaDt . -
To llnd out l-ow you can agnal arrd rccc:Lwc al]. of, your cartlflcate6 of l-nsuranc€-
€ltbe! by eal1, hlgh aD.edl fax or aCanalardl lnaLl, -
GD!l1 cusE@€rcar€CcoaflmDet. c@, o! w131ts our webslte at -
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