2022/06/15 HDL Coren & ConeiQo"
TH CERTIFICATE S tsSUED ATTER oF IN FoR TION oNLY AND cONFERS No RIGHTS U ON THE cERTIF CATE HOLDER.TH sCERTIFICATEDOESNOTFFIRMATIVELYoRNETIVELYAMENDEXTENDORLTERTHECOVERAGEFORDEDBYTHEPOLIcESBELOW.TH ts ERTIFI CATE oF INSU RAN cE DoEs NOT coNSTITUTE cONTRACT BETWEEN THE SSU NG INS URER(s)UTHO RlzEoREPRESENTATIVEoRPRODUcER,AND THE cERTIF CATE HOLDER.
MPORTANT tf the certifi cate ho der s an ADDrTtON L NSURED the icy(i )t h ADDITIO NAL NSUREDes p n5 be ndorsedtfSUBROGATIONSAIVEDsubjecttothtermsndconditthepolirtainciesquiatatementsthrsrtifiatednotnferflhtstolhrtificateholduhendos
Woodruff Sawyer
2 Park Plaza. Suite 500
lrvine CA 926'14
Curlis
949 435,7345
INSU AFFORDING COVERAGE
lNsuRER A: Contrnental Ca Com 20443INSI,,REO
HdL Coren & Cone'120 S. State College Blvd., Suite 200Btea CA 92821
HOLCORE.Ol rNslrR€R B: Valley Forge lnsuranca Company 20508
COVERAGES CERTIFICATE NUMB ER: 437307164 REVIS'ON NUMBER:
HSIANDI
ICAIE ITIAY
STH TIS CoERTI TTHA ETH POLIC ES OF UINS LRANCE DSTE BELOW BEVEEN UESS TD THoE NSU NA[IEED L]ABOVE oF THE POL c ERIODOTWiTNNDITECADNGORTER[,4 DITcoN o OFN CONTRACT o DOCUOTHER ENTNI WITH TOESPECT ICH tsTHERCTIBEEDORTHEINSRANCUEAFFORDEDTNEBYPOLCDESESRBCDEEREH1SSU8ECTALLTOETHTERMs,coN TD o oNS S HUC IEPOLIC LSIM SHOWNTS VE B REDUCEN BYl)D C t1S.
L LIM TS
EACH OCCURRENCE s2
S1 ,000
MEO EXP r 10,000
PERSON}.!IADV INJlJRY s2 000
GENERAL A6GREGATE
PROOIJCTS . COMP/OP AGG 54 000 000
s4.000
X
X coMMERcIAL GENERAL LtABlLtry
GEN L AGGREGATE LlMllAPPUES PERI
X
CLA MS MAOE
LOCX poLrcv JECT
6t15t2022 6115t2023
s
t 1,000,000
EODILY lN.lURY (P.r pe6m)s
BODILY INJURY (Pd aeidenr)S
X E S
HIRED
SCHEDIJLEO
NON,OWNEDAUIOS ONLYX
AUTOMOSIfE LlAAILlTY 86025253592 6t15t2022 6t15t2023
S
X EACI]OCCURRENCE S1 000
EXCESS LIAB
OCCUR
s 1,000,000
DED x RETENI]ON
86025253611 6115t2022 611512023
s
OIF-
E L EACH ACCIOENT s 1,000 00
B WORKERS COMPEI{SATIOtI
ANO EMPLOYERS' LIABILIIY
ANYPROPRIETOF'PARTNER/EXECUTIVE
OFFICER/MEMAER EXCLUOEO'
DESCRlPI ON
wc625253608 6t1512022 6t15t2023
EA EMPLOYEEE L DISEASE
E L DISEASE
$ 1,000,000
t 1,000,000
652117A25 6t15t2022 611512023 $2,000,000
$2.000,000
lACoxD lOl,Addhlonll R.D.rI. Sch.dut., m.y b..fi.ch.d tf moo .p.c. t. r'qutrd)
and agentsare included as additional insured as respects Genoral Liabitity to the extent providod in theas respects Workors Compensation to the extent proi/id€d in the aflached iorm and as pdrmittea Uv tiw.
DESCRIPIION OF OPERATIONS / LOCATIONS /VEHICLES
City of L,len.fee rhe City, its ofllcels, enptoyeesatlacl'ed forms. Waiver of Subrogalion applies
CERTIFICATE HOLDER CANCELLATION
City of Menifee
297'14 Haun Road
Menifee CA 92586
SHOULOANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
@'1988-2015 ACORD CORPORATION. A riqhts reserved
The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)
CERT!FICATE OF LTABILITY INSURANCE 5t27 t2022
endorsement,may
REQUIREI\4ENT,
PERTAIN,
ANDEXCLUSIONS
86025253592
46GRE64TE
E
CNA 86025253592 s8146932G
(Ed. 10-19)
BLANKET ADDITIONAL INSURED AND LIAB!LITY EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the lollowing:
BUSINESSOWNEBS LIABILITY COVERAGE FOBIV
BUSINESSOWNERS COI/MON POLICY CONDITIONS
TABLE OF CONTENTSl. Blanket Additional lnsured ProvisionsA. Additional lnsured - Blanket VendorsB. MiscellaneousAdditionallnsureds
c Additional Provisions Pertinent to Additional lnsured Covera e
1 .a, Prima - Noncontributo rovrston1.b. Derinition ol "writen contracl"2. Additional lnsured - Extended Covell. Liabilit Exlension Covera esA. Bodi anded Derinitionlnu
B Broad Knowled e ol Occurrence
C. Estates al entatives and S uses
Fellow Em lo First Aid
E al Liabilit e to PremisesF. Personal and Advertisin - Discrimination or Humiliationlnu
G. Personal and Advertisin - Broadened Evictionlnu
H Waiver of Subro ation - Blanket
I. BLANKET ADDITIONAL INSURED PROVISIONS
A. ADDITIONAL INSUBED - BLANKET VENDORS
Who ls An lnsured is amended to include as an additional insured any person or organization (referred to below
ls r.e..ndgr) with whom you agreed under a "written contracl" to provide insuran.e, but only with respect to"bodily iniury" or "property damage" arising out ot "your productsi'which are distributed or s'old in the iegularcourse of the vendor's business, subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of theassumption of liabiltty.in a contract or agreement. This exclusion does noi aiply to liabiliiy for damagesthat the vendor would have in the absence of the contract or agreement;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor;
d. Bepackaging, except when unpacked solely for the purpose ol inspection, demonstration, testing, or thesubstitution of parls under instructions from the manufacturer, and then repackaged in the-originalcontainer;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to makeor normally undertakes to make in the usual course of business, in connection with the distn:bution or saleof the products;
l. Demonstration, installation, servicing or repair operations, except such operations performed at thevendoas premises in connection with the sale of the product;
g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container.part or ingredient of any other thing or substance by or for the vendor; or
s8146932G (10-19)Page 1 of 7
D.
Copyrighl, CNA All Rights Reserved.
860252s3592 s8146932G
(Ed. 10-19)
B
h. 'Bodily iniury" or "property damage" arising out of lhe sole negligence of the vendor for its own acts oromissions or those of its employees or anyone else acting on itsbehalf. However, this exclusion does notapply to:
(1) The exceptions contained in Subparagraphs d, or r.; or
(2) Such inspections, adjustments,. tests or servicing as the vendor has agreed to make or normallyundertakes to make in the usual course of business, in connection with tlie distribution or sale of thi;products.
2' This insurance does not apply to any insured person or organization, from whom you have acquired suchproducts, or any ingredient, part or container, entering into, accompanying or containing such products.
3. This provision_ 2- .do_es.not apply to any vendor included as an insured by an endorsement issued by us andmade a part of this Policy.
4. This provision 2..does not apply iI "bodity iniury" or "property damage" inctuded within the ,,products-
completed operations hazard" is excluded either by the provisions of the Policy or by endorsemeni.
MISCELLANEOUS ADDITIONAL INSUREDS
1. Who ls An lnsured is amend€d to include as an insured any person or organization (called additionalinsured) described in paragraphs 3.a. through 3.j. below whom you are requiied to add as an additionalinsured on this policy under a "written contract.',
2. However, subiect always to the terms and conditions ol this policy, including the limits ol insurance, we willnot provide the additional insured with:
a. A higher limit of insurance than required by such "wrinen contract;.,
b. Coverage broader than required by such "wrilten conlract" and in no event greater than that describedby the applicable paragraph a. through k. below; or
c. Coverage for "bodily injury" or "property damage,, included within the ,,producls-compleled
operations hazard." But this paragraph c. does not apply to the extent coverage for such liability isprovided by paragraph 3.i. below.
Any coverage granted by this endorsement shall apply only to the extent permitted by law.
3. Only the following persons or organizations can qualify as additional insureds under this endorsement:
a. Controllinglnterest
Any persons or organizations with a controlling interest in you but only with respect to their liability arising
out of:
(1) such person or organization's financial control of you; or
(2) Premises such person or organization owns, mainlains or controls while you lease or occupy thesepremises;
provided that the coverage granted to such additional insureds does not apply to structural alterations,
new construction or demolition operations performed by or for such additional insured.
b. Co-owner of lnsured Premises
A co-ownerof a.premises co-owned by you and covered under this insurance but only with respect to theco-owners liability for "bodily iniury," ,'property damage.or ,'personal and advertising injdry,, as co_
owner of such premises.
c. Grantor of Franchise
Any person or organization that has granted a franchise to you, but only with respect to such person ororganization's liability for "bodily inlury," "property damage," or "personal and;dvertising iniury,,asgrantor of a franchise to you.
s8146932G (10-19)
Copyrighl, CNA All Righls Reserved
Page 2 of 7
86025253592 s8146932G
(Ed. 1o-1s)
d, Lessor ol Equipment
Any person or organization from whom you lease equipment, but only with respect to liability for "bodilyiniury," "property damage" or "personal and advertising iniury" caused in whole or in bart by your
maintenance, operation or use of such equipment, provided that the "occurrence" giving rise to such"bodily inlury" or "property damage" or the offense giving rise to such "personai and advertising
iniury" takes place prior to the termination of such lease.
e. Lessor ol Land
Any person or organization from whom you lease land, but only with respect to liability for "bodily iniury,"
"property damage" or "personal and advertising iniury" arising out of the ownership, maintenance or
use of that specilic part of the land leased to you, provided that the "occurrence" giving rise to such'bodily injury" or "property damage" or the offense giving rise to such "personal and advertising
inlury," takes place prior lo the termination of such lease. The insurance hereby afforded to the additional
insured does not apply to structural alterations, new construction or demolition operations performed by,
on behalf of or for such additional insured.
l. Lessor ol Premises
An owner or lessor of premises leased to you, or such owner or lessois real estate manager, but only
with respect to liability for "bodily iniury," "property damage" or "personat and advertising inlury"
arising out of the ownership, maintenance or use of such part of the premises leased to you, andprovided that the "occurrence" giving dse to such "bodily iniury" or "property damage" or the offense
giving rise to such "personal and advertising injury," takes place prior to the termination of such lease.
The insurance hereby afforded to the additional insured does not apply to structural alterations, new
construction or demolition operations performed by, on behalf of or for such additional insured.
g. Mortgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or
receiver's liability for "bodily injury," "property damage" or "personal and advertising iniury" arising
out of the ownership, maintenance, or use of a premises by you.
This insurance does not apply to structural alterations, new construction or demolilion operations
performed by, on behalf of or for such additional insured.
h. State or Political Subdivisions
A state or government agency or subdivision or political subdivision that has issued a permit or
authorization, but only with respect to such government agency or subdivision or political subdivision's
liability for "bodily iniury," "property damage" or "personal and advertising injury" arising out of:
(1) The lollowing hazards in connection with premises you own, renl, or control and to which this
insurance applies:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising signs,
awnings, canopieS, cellar entrances, Coal holes, driveways, manholes, marquees, hoistaway
openings, sidewalk vaults, street banners, or decorations and similar exposures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance or use of any elevators covered by this insurance; or
(2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted
by this paragraph does not apply to:
(a) "Bodily iniury", "property damage" or "personat and advertising iniury" arising out of
operations performed for the state or government agency or subdivision or political subdivision;
or
(b) "Bodily iniury" or "properly damage" included within the "products.compteted operations
hazard."
With respect to this provision's requirement that additional insured status must be requested under a"written conlract," we willtreat as a "written contract" any governmental permit that requires you to add
the governmental entity as an additional insured.
s8146932G (1 0-19)
Copyright, CNA AllRighls Reserved
Page 3 of 7
s6025253592 s8146932G
(Ed. 10-19)
c
i. Trade Show Event Lessor
With respect to.your participation in a trade show event as an exhibitor, presenter or dlsplayer, anyperson or organization whom you are required to include as an additional insLjred, but only with rdspect t6such person or organizalion's liability for "bodily iniury,,' ,'property damage,', or',,personil andadvertising iniury" caused by:
a, Your acts or omissions; or
b. Acts or omissions of those acting on your behalf;
in the performance of your ongoing operations at lhe trade show premises during the trade show event.
i. Other Person or Olganization
Any.person or organization who is not an additional insured under paragraphs a. through i. above. Suchadditional insured is an insured solely for ,'bodily injury,,, ,,prbperty damage,, oi ',personal andadvertising iniury" for which such additional insured is liabl6 bec-ause of your acti or omislions.
The coverage granied by this paragraph does not apply to any person or organization:
(1) For."bodily inlury," "property damage,,, or ',personal and advertising injury,, arising out of therendering or failure to render any professional services;
(2) For "bodily iniury" or "qpperty damage" incruded in the "products-comprered operationshazard." But this provision (2) does not appty to such ,'bodity iniur|" or ,'property damage; if:
(a) lt is entirely due to your negligence and specifically results from your work for the additionalinsured which is the subject to the "wriflen contract,i; and
(b) The "written contract" requires you to make the person or organization an additional insured forsuch "bodily inlury" or "property damage,'; or
(3) Who is afforded additional insured coverage under another endorsement attached to this policy.
ADDITIONAL PFOVISIONS PERTINENT TO ADDITIONAL INSURED COVERAGE
1. With respect only to additional insured coverage provided under paragraphs A, and B. above:
a. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended to add lhe fotlowing to theCondition entitled Olher lnsurance:
This insurance is excess of all other insurance available to an additional insured whether primary,
excess, contingent or on any other basis. However, il a "written contract" requires thal this insurince beeither primary or primary and noncontributing, then this insurance will be piimary and non-contributoryrelative solely to insurance on which the additional insured is a named insured.
b. Under Liabilily and Medical Expense Definitions, the fo owing definition is added:
"written contract" means a written . contract or agreement that requires you to make a person ororganization an additional insured on this policy, provided the contract or agreement:
(1) ls currently in effect or becomes effective during the term of this policy; and
(2) Was executed prior to:
(a) The "bodily iniury" or "property damage;,,or
(b) The oflense that caused the "personal and advertising iniury,';
for which the additional insured seeks coverage.
2. Wth-respect to any additional insured added by this endorsement or by any other endorsement attached tothis Coverage Part, lhe section entitled Who ls An lnsured is amended io make the following natural persons
insureds.
lf the additional insured is:
a. An individual, then his or her spouse is an insured;
s8146932G (10- 19)
Copyright, CNA All Bights Reserved.
Page 4 ol 7
.
86025253592 s8146932G
(Ed. 1 0-1e)
b. A partnership or joint venture, then its partners, members and their spouses are insureds;
c. A limited liability company, then its members and managers are insureds;
d' An organ?ation other than a partnership, joint venture or limited liability company, then its executiveofficers, directors and shareholders are insureds; or
e. Any type ol entity, then its employees are insureds;
but.only with respect to locations and operations covered by the additional insured endorsement's provisions,and only with respect to.their respective roles within their organizations. Furthermore, erlloyees oiadditional insureds are not insureds with respect to liability arising 6ut of:
(1) "Bodily iniury" or "personal and advertising iniury" to any fellow employee or to any natural person
listed in paragraphs a. through d. above;
(2) "Property damage" to property owned, occupied or used by their employer or by any lellow employee; or
(3) Providing or failing to provide professional health care services.
LIABILITY EXTENSION COVERAGES
It.is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. lf anyother endorsement attached to this policy amends any provision also amended by this endorsementl then that otherendorsement controls with respect to such provision, and the changes made by thii endorsement to such provision donot apply.
A. Bodily injury - Expanded Detinitlon
Under. Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deteted and replaced bythe following:
"Bodily iniury" means physical injury, sickness or disease sustained by a person, including death, humiliation,shock, mental angulsh or mental injury by that person at any time which iesuits as a consequince oi the physicaiinjury, sickness or disease.
B. Broad Knowledge ol Occurrence
Under Bu-sinessowners Liability Conditions, the Condition entitled Duties ln The Event of Occurrence, Offense,Claim or Suit is amended to add the following:
Paragraphs.a, and b. above apply to you or to any additional insured only when such "occurrence," offense,claim or "suit" is known to:
(l) You or any additional insured that is an jndividual;
(2) Any partner, if you oran additional insured is a partnership;
(3) Any manager, if you or an additional insured is a limited liability company;
(4) Any "executive oflicer" or insurance manager, if you or an additional insured is a corporation;
(5) Any trustee, if you or an additional insured is a trust: or
(6) Any elected or appointed official, il you or an additional insured is a political subdivision or public entity.
This paragraph applies separately to you and any additional insured.
C. Estates, Legal Representatives and Spouses
The eslates, heirs, legal representatives and spouses of any natural person insured shall also be insured underthis policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses onlyfor claims.arising solely out of their capacity as such and, in the case of-a spbuse, where such ilaim seek!damages from marital common property, jointly held property, or property transferred from such natural personinsured to .such spouse. No coverage is provided for any act, enor-or omission of an estate, heiL legalrepresentative or spouse outside the. scope of such person's capacity as such, provided however that the ipouieol a natural person Named lnsured and the spouses of memberi or partners of joint venture or partnbrshipNamed lnsureds are insureds with respect to such spouses' acts, errors or omissions ln the conduct of ihe Nameblnsured's business.
s8146932G (10-19)
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Page 5 of 7
s8146932G
(Ed. 10-1s)
D. Fellow Employee First Aid Coverage
ln the section entitled Who ls An lnsured, paragraph 2.a.1. is amended to add the lollowing:
The limitations described in subparagraphs 2.a.1.(a), (b) and (c) do not apply to your ,employees,, lor',bodilyinjury".that results lrom providing cardiopulmonary resuscitation or other fiisi iid s6rvices to a 6o-'employee,, or"volunteer worker" that becomes necessary whil! your "employee" is performing duties in the conduct bl yourbusiness. .Your "employees" are hereby insureds ror such iervices. but the in-sured status conferred by'thisprovision does not apply to "employees" whose dulies in your business are to provide professional health careservices or health examinations.
E. Legal Liability - Damage To Premlses
1' Under B. Exclusions, 1' Applicable to Business Liability Coverage, Exclusion k. Damage To Property, isreplaced by the following:
k. Damage To Property
"Property damage" to:
1' Property you own, rent or occupy, including any costs or expenses incurred by you, or any otherperson, organization or entity, for repair, replacement, enhancement, restoration or maintenince ofsuch property lor any reason, including prevention of injury to a person or damage to another'sproperty;
2. Premises you sell, give away or abandon, il the "property damage" arises out ol any part of thosepremises;
3. Prope(y loaned to you;
4. Personal property in the care, custody or control of the insured;
5. That particular part of any real property on which you or any contractors or subcontractors working
directly or indirectly in your behalf are performing operations, if the "property damage" arises out oithose operations; or
6. That particular part.of any property that must be restored, repaired or replaced because "your work"was incorrectly performed on it.
Paragraph 2 ol this exclusion does not apply if the premises are "your work" and were never occupied,
rented or held for renlal by you.
Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fkeor explosion) to premises:
(1) rented to you:
(2) temporarily occupied by you with the permission oI the owner, or
(3) to the contents of premises rented lo you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D -Liability and Medical Expenses Limits of lnsurance.
Paragraphs 3,4, 5, and 6 ol this exclusion do not apply to liability assumed under a sidetrack agreement.
Paragraph.6 ot this exclusion does not apply to "property damage" included in the ,,producls-
compleled operations hazard."
2' Under B' Exclusions, 1. Applicable to Business Liability Coverage, the foltowing paragraph is added, andreplaces the similar paragraph, if any, beneath paragraph (14) of the exclusidn entiile; personal andAdvertising lnlury:
Exclusions c, d, e, l, g, h, i, k, l, m, n, and o, do not apply to damage by fire to premises while rented to you
or temporarily occupied by you with permission of the owner or to the contents oi premises rented to you for aperiod of-7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described inSection D. Liability And Medical Expenses Limits Ot lnsurance.
sB1469s2G (10-19)
Copyrighl, CNA All Rights Reserved.
Page 6 of 7
86025253592
H
s8146932G
(Ed. 10-1 e)
3' The first Paragraph under item 5. Damage To Premises Rented To You Limit of the section enti edLiability And Medical Expenses Limlts Ol lnsurance is replaced by the lollowing:
The most we. will pay under Business Liability for damages because of "property damage" to any onepremises, while rented to you or temporarily occupied by-you with the permisiion ot the o--wner, inciudingcontents of such premises rented to you for a period of 7 or fewer consecutive days, is the Eiamage toPremises Rented to You Limit. The Damage to premises Rented to you Limit is the greiter of:
a. $1,000,000; or
b. The Damage to Premises Rented to You Limil shown in the Declarations.
Personal and Advertising lnlury - Discrimination or Humiliation
1. Under Liability and Medical Expenses Delinitions, the definition of "personal and advertising inlury" isamended to add the following:
h' Discrimination or humiliation lhat results in injury to the leelings or reputation of a natural person, but onlyif such discrimination or humiliation is:
(1) Not done intentiona y by or at the direction of:
(a) The insured: or
(b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limitedliability company) of the insured; and
(2) Not directly or indirectly related to the employment, prospective employment, past employment or
termination of employment of any person or person by any insured.
2. Under B. Exclusions, 1, Applicable to Business Liability Coverage, the exclusion entitled Personal andAdvertising lnlury is amended to add the lollowing additional exclusions:
(15)Discrimination Relating to Room, Dwelling or premises
Caused by discrimination directly or indirectly related to the sale, rental, lease or sub-lease or prospective
sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured.
(1 6) Employment Related Discrimination
Discrimination or humiliation directly or indirectly related to the employment, prospective employment,past employment or termination ol employment of any person by any insured.
(17)Fines or Penalties
Fines or penalties levied or imposed by a governmental entity because of discrimination.
3. This provision (Personal and .Advertising lnjury - Discrimination or Humiliation) does not apply ifPersonal and Advertising lniury Liability is excluded either by the provisions oi the eolicy dr'byendorsernent.
Personal and Advertising lnjury - Broadened Eviction
Under. Liability and Medical Expenses Detinitions, the definition ol "Personal and advertising iniury,' is
amended to delete Paragraph c. and replace it with the following:
c. The wrongful eviction from, wrongful entry into, or invasion of lhe right of private occupancy of a room
dwelling or premises that a person or organization occupies commilted by or on behalf of its owner, landlordor lessor-
Waiver oI Subrogation - Blanket
We waive any right of recovery we may have against:
a. Any person or organization with whom you have a written contract that requires such a waiver.
All olher lerms and conditions of the Policy remain unchanged
F
G
s8146932G (10- 19)
Copyright. CNA All Rights Reserved.
Page 7 ol 7
86025253592
CNA Workers Compensation And Employers Liability lnsurance
Policy Endorsement
I BLANKET WAIVEB OF OUR BIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation lnsurance G. Recovery From Others and part Two -Employers' Liability lnsurance H. Recovery From others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to theextent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium 1orCalifornia exposure. The amount is 2%.
All other terms and conditions oI the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated lnsurers,takes eflect on the Policy Effective Date of said policy at the hour stated in said policy, unless anothereffective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G-19160-8 (11-1997)
Endorsement Elfectjve Oatoi Endorsement Expiration Oate:
Endorsement No: 2, Page: 1 of 1
Underwrating Company: American Casualty Company oI Reading, pennsylvania, 1Sl N Franklin Sr,
Chicago, lL 60606
o Copyright CNA All Rights Reserved
Policy No: WC 6 25253608
Policv Effective Oatet 06/1512022
Policy Pago: 31 of 47