2022/04/01 Helix Environmental Planning, Inc. (5),ACORD'
x
OEO X RETENIION $
Helix Environmsntal Planning, lnc
7578 ElCajon Blvd., Suit6 200
La Mesa, CA 9'1942
xsuRER(s) AFFOROING COVEFIAGE
NsuRERA Everesl lndemnity lnsurance co
NsuRERB Everesl Denali lns. co
HELIENV.Ol
CERTIFICATE OF LIABILITY INSURANCE 312312022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TIIIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BYTHEPOLICIESBELOW, THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER,
IMPORTANT: lf the certiUcate holder is an AODITIONAL INSURED, the policy(ies) musl have AODITIONAL INSURED provisions or be endorsed.lf SUBRoGATION lS WAIVEo, subiect to the terms and conditions oflhe policy, certain policies may require an endoEement. Astatementon
this certificate does not conter ri hts lo the certificate holder in lieu of such endorsemen
iRil[acr StePhanie Zuniga
Assured Parlners of CA lnsurance Servrces, LLC dba: Wateridge lnsurance '.FoNtservtces - ac. ro. Erri (858) 888-7819 lil. x.r {858) sss-7820
10717 Sorrento Valley Rd, Ste 200
San Oiego, CA 92121 ftmEss szuniga@wateridg e.com
t tc|
10851
't 6044
lNSllq€R E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I]AVE BEEN ISSU ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECI TO WHICI] THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TE RMS
EXCLUSIONS AND CONDITIONS OF SUCI] POLICIES. LIMITS SHOWN MAY HAVE EEEN REDUCED BY PAID CTAIMS
COVERAGES
Ax
GEN'L AGGREGAIE LIMITAPPLIES PER-- 0o.,.-" Xl P,&o; f l,oc_l
OTHER
B lutouogtLe LtletLtwT l o*" o,ro
- owrueo - scHEDuLED_ ]AUrOSONLY , lAUrOSX lffio's o"., x l Xgi68"s,',?X cor 1100 X co tr.000
CERTIFICATE NUMBER
X EF4ML06406-221
EF4CA00376-221
EF 4CU01451 -221
8EvlslortNu!{EEL. _
POLICY EFF POLICY EIP
41112022 4t112023 OAMAGE TO RENTED
BINED S]NGLE LIMIT
x
x
COM"ERCIAL GENERAL LIABILIIY
cla MS MADE X ocrjrr {
Contractor Pollution
Deductible $5,000
PREMISES rE. oe!tr6n61 S
MEO E_XP lAnv6..6.rs.nr SE;;^.;""^,,* T;Er-;-.^""-.*;l;L.*;'*r".*G
1,000,000
50,000
10,000
1,000,000
2,000,000
2,000,000
1,000,000
EXCESS LIAB
X occun 9,000,000
9,000,000
0
4t1t2022 411t2023 EELOIqIJRRENCE
AGGREGATE
WORKERS COMPENSATIOI{AllO Ei/IPLOYERS' LIABILIIY
ANY PROP RIETOR/PARTNER]EXE C I]1IV€
OESCRIPTLON OF OPERATIONS belo*A Professional Liab
A Ded: $10k Per Claim
City oI Menilee
29714 Haun Road
Sun City, CA 92586
ER
EF4ML rongfulAct
EF4ML06406-221 41112022 4/1/2023 Aggregate
OE SCRIPTION OF OPE RATIONS / LOCATIONS , VEITICLE S (ACORO l0l Add{'onll R.6rt. Sch.<rul. i.y b. .lEch.d " doo ro.c. i. roqu'od,Ercess Liability policy follows the G€neral Liability. Cont.acloB Pollution Liability. Professional Liability. Auto Liability & Employers Liability
30 Days Notice ol Cancollation wlth '10 Oays Notlce for Non-Payment of Premium in accordance with the policy provisions.
Professional Liability Rotroactiv€ Oat€ 10/01/1991
RE: Evans Park Proiect
SEE ATTACHED ACORO 101
T N ELLAT NCEFICATE HOLDER
1,000,000
2,000,000
SHOULO ANY OF IHE ABOVE OESCRIBEO POLICIES AE CANCELLEO BEFORETHE EXPIRATION OATE THEREOF, NOTICE WILL BE OELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS-
AUTHOR12ED REPRESENTAIIVE
o 1988-2015 ACORD CORPORATION
The ACORD name and logo are registered marks of ACORD
ACORD 25 (2016/03)All rights reserved
I
CEFtTa
s
41'll2t22 4/1/2023 aoo.r y rr,uuqr rpe oqsor 1
AOO.LY ItJURY lP6'a@d6.lt $
PROPERTY DAMAGElP6r3!9Eq! !
$
$
P€R
-SIA'LUIE
-
E L E,ACII ACCIOENT -il
AGENCY CUSTOMER tD. HELIENV-01
LOC #: 1
ADDITIONAL REMARKS SCHEDU LE
CERT2
ACORD'Page 1 of 1
Assurod Partnors of CA lnsu.ance Sorvicos, LLC dba: lvateridgs hsuranc€ S6ryices
SEE PAGE 1
SEE P ,1EE PAGE 1
Helix Environm6ntal Plannino. lnc7578 ElCaion Blvd.. Sui(e 20ULa Mesa, CA 91942
ADDITIONAL REMARKS
THIS AODITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
Description of Operations/Locationsly'ehicles:
City of Menifee and ils officers, employees, agents, and autho.ized volunteers are named Additional lnsured's wilh respects toGeneral Liability per altached. Coverage is Primary and Non-Contributory.
ACORD 101 (2008/01)
FORM NUMBER: ACORD 25 FORM TITLE: Conificato ofliability lnsurance
O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY NUIVIBER EF4MLO64O6-221 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 20 640 02 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION - ONGO!NG OPERATIONS
This endorsement modifies insurance provided under the following:
EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE PART
SCHEOULE
Blanket where required by wfltten contract
A. Solely with respect to coverage provided under Coverages A, B, and C, Section ll - Who ls An Insured 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 acts or omissions or the acts or omissions of those acting on your behalf:
'1. ln the performance of your ongoing operations, or
2. ln connection with your premises owned by or rented to you.
Howevel
1. The ansurance afforded to such additional insured only applies to the extent permitted by law, and
2. lf coverage provided to the additional insured is required by a contract or agreement, the rnsurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured
B. With respect to the insurance afforded to these additional insureds, the following is added to Section lll -Limits Of lnsurance And Dsductible:
lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is the amount of insurance:
'l . Required by the contract or agreement, or
2. Available under the app|cable Limits of lnsurance shown in the Declarations,
whichever is less
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations
All other terms and conditions of this Policy remain unchanged
Copynght Everest Rernsurance Company 2019
lncludes copynghted material of lnsurance Services Office, lnc ,
used wrth ts permrssron.
Name Of Additional lnsured Person OrO an izations s
lnformation re uired to com ete this Schedule, if not shown above, will be shown in the Declarations.
ECG 20 640 02 19 Page 1 of 1
POLICY NUMBER: EF4M 106406-221 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 24 743 05 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS _ COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE PART
SCHEDULE
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 a "pollution incident" caused, in whole or in part by "your work" at the location designated and described in
the Schedule of this endorsement performed for that additional insured and included in the "products-
completed operations hazard".
However:
1 . The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. 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 requared by the contract or
agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to
Section lll - Limits Of Liability and Deductible:
lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is the amount of insurance:
'I Required by the contract or agreement; or
2. Available under the applicable Limits of lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations.
All other terms and conditions of this Policy remain unchanged
Copyright, Everest Rernsurance Company 2019
lncludes copyrighted matenalof lnsurance Services Office, lnc
used wrth its perniss,on
Name Of Additional lnsured Person(s) Or
Organization(s):
Location And Oescription Of Completed
Operations
Any owner, lessee or contractor whom you have
agreed to include as an additional insured under a
written contract, provided such contract was executed
prior to the date of the loss
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
ECG 24 743 05 19 Page 'l of 'l
POLICY NUIlIBER: EF4lvlL06406-22 1 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 24 698 09 't8
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
EVEREST CONTFACTORS ENVIRONMENTAL PLUS COVERAGE FORM
SCHEDULE
Designated Person or Organization
lnformation required to complete this Schedule, lf not shown above, will be shown in the Declarations
The following is added to the Other lnsurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and we will not seek contribution from any other insurance available to the person
or organization designaled in the Schedule above which you have agreed to insure under this Policy provided
that:
(1) Such person or organization is an insured under this Policy; and
(2) An "insured contract" requires this insurance to be primary.
All other terms and conditions of this Policy remain unchanged
Copyriqht, Everest Reinsurance Company, 2018
lncludes copyrighted material of lnsurance Services Office, lnc.,
used wrth rts permrssron.
ECG 24 698 09 18 Page 1 of 1
.-l,ACORD'HELIENV-01
CERTIFICATE OF LIABILITY INSURANCE
-fi8}E^cr Stephanie zuntga
Assured Pafiners of cA rnsurance services, LLc dba: wateridge rnsurance ll3x,f.. E() (g5g) ggg-7g19
1071? Sonenlo Valley Rd, Ste 200
San Diego, CA 92121 ftmEss szuniga@wateridge.com
tNsu RE R(S) AFF OROt NG COVERAGE
s8) 888-7820
INSURERA Everest lndemnily lnsurance co
lrsuRERs Everesl Denali lns. co.
1085'l
16044
Helix Environmental Planning, lhc
7578 El Cajon Blvd., Suite 200
La Mesa, CA 91942
lNSUREqC
[rsuRER o
INSURER €
3123t2022
THIS CERTIFICATE IS ISSUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER. THIS
CERTIFICATE OOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEO BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURAI{CE OOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHOR|ZEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: lf the certificate holder is an ADOITIONAL INSURED, the policy(ies) must have ADDITIONAL INSU RED provisions or be endorsed.lf SUBROGATION lS wAlvED, subject to the terms and conditions oflhe policy, certain policies may require an ondorsernent. A statement on
aghts to the certificate holder in lieu of such endorsement(s)this certificale does not confer r
x
D€O X nererrror s
REr Evans Park CEOA
SEE ATTACHEO ACORD 101
X . occuc
EF 4CU01451 -221
POLICY EFF POLICY EXP
411t2022 11112023
CANCELLATION
REVISION NUMBER
EACH OCCURRENCE 3E-."^" l;
TIFICATE N BER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TOWHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFOROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
9,000,000
9,OOO,OOO
0
A Professional Liab
A Oed: $10k Per Claim
EF4ML06406-221
EF4ML06406-221
4t112022
at112022
411t2023
41112023
Any One Wronglul Act
Aggregate:
1,000,000
2,000,000
OESCRIPnON OF OPER TlotlS LOCAIIO,{S/ VEHICLES (ACORO 101 Add'lionsl R.mlrtr Sch.dul., mry b..tbch.d itmor..p.c. '! r.quiEd)
Ercess Liability policy follows the G€n€ral Liability. Contractors Pollution Liability, Profossional Liability. Auto Liability & Employers Liability
30 Oays l{olice of Cancellation with 10 Oays Notics for Non-Payment of Premium in accordance with the polacy provisions-
Professional Liability Retroactive Date 10/01/1991
CERTIFICATE HOLDER
GENEEAL AqERES4IE L!
x
x X EF4ML06406-221 4t112022 u1t2023
PRODI]CIS COMP/OP AGG S
GEN'LAGGRE GATE LIMlTAPPL ES PER
Loc
PERSONAL 6 ADV NJURY
1,000,000
50,000
COMTIERCIAL GENERAL !IABIIIIY' - c.r'vs.uroe X- occun-C;ntractor Pollution
2,000,000
2,0oo,ooo
X Deductible $5,000
10,000
1,OOO,OOO
xl !c3;
DAMAGE TO RENTEO
-faEUlSES 1Eloaqr!!4!d
COMAINEO SINGLE L'MITrEs aErdenu I
AODILY rN-IURY rP6. ods6.r I
BOOILY NJURY (P6'A@d6NI) S
aPRoFERTY oIMicE T{Peracodsno !T-x
1,000,000
411t2022
x
X EF4CA00376-221 41112023
AUTOS ONLY
NIREDAUTOS ONLYColL$100
SCHEDI]LEDAL]TOSx ISiaBH,i?X cor $r.000
B -lwouoetLe rnetrtrY
X nr.rv aurO
WORKERS COT/lPENSATION
OFFICER/MEMAER ETCLUDED'
DESCRIPIION OF OPERATTONS below
OTN.
E L EACH ACC OENT
EL OISE,A€E : EA EMPIOYEE S
E L OISEASE. IDLICY LIMIT !
SIAIUTE
AUIHOR ZEO REPRESENIATIVE
SHOULO ANY OF fHE ABOVE OESCRTBED POLICIES BE CANCELLEO AEFOR€
THE EXPIRAIION DATE THEREOF, NOIICE IflILL BE DELIVERED IN
ACCOROANCE WITH THE POLICY PROVISIONS.C ity of Menifee
29714 Haun Road
Sun City, CA 92586
O 1988-2015 ACORD CORPORATION. Allrights reserved
The ACORO name and logo are registered marks of ACORD
ACORD 2s (2016/03)
COVFRAGFS
ll@el
AGENCY CUSTOMER rO HELtENV4l
ADDITIONAL REMARKS SCHEDULE
CERT2
ACORD'Page I of ,l
sured Partnors ol CA lnsurance Sorvicss, LLC dba: Wateridge lnsuranco Se.vices
EE PAGE 1
PAGE,l SEEPl
Helix Environmental Plannino. lnc7578 ElCaion Blvd., Suite 20[La Mesa, CA 9'1942
ADDITIONAL REMARKS
THIS ADDITIOTIAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORo 25 FORM TITLE Cartificate o{ Liability hsurance
Description of Operations/Locationsly'ehicles:
City of Menifee and its officers, employees, agents, and authorized volunteers are named Additional lnsured's wilh respects to
General Liability and Aulo Liability per attached. Coverage is Primary and Non-Contributory.
@ 200E ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
ACORD 101 (2008/01)
LOC #: I
POLICY NUMBERT EF4lvlL06406-221 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 20 640 02 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION - ONGOING OPERATIONS
This endorsement modifies insurance provided under the followingl
EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE PART
SCHEDULE
Name Of Additional lnsured Person OrO anizations S
Blanket where required by written contract
A. Solely with respect to coverage provided under Coverages A, B, and C, 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 liabilaty for "bodily inlury", "property damage" or "personal and advertising inJury" caused, in
whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf:
'1. ln the performance of your ongoing operations, or
2. ln connectron with your premises owned by or rented to you
However:
'1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. 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 additaonal insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to Section lll -Limits Of lnsurance And Oeductible:
lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional rnsured is the amount of insurance:
1. Required by the contract or agreement, or
2. Available under the applicable Limits of lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations.
All other terms and conditions of this Policy remain unchanged
Copynght, Everest Rernsurance Company 2019
lncludes copynghted material of lnsurance Services Office, lnc
used wth rts permissron
lnformahon uired to com lete this Schedule if not shown above will be shown in the Declarations
ECG 20 640 02 19 Page I of 1
POLICY NUMBER EF4M106406-221 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 24 743 05 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED _ OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
Thrs endorsement modifies insurance provided under the foilowing.
EVEREST CONTRACTORS ENVIRONMENTAT PLUS COVERAGE PART
SCHEDULE
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 a "pollution incident" caused, in whole or in part, by "your work" at the location designated and described in
the Schedule of this endorsement performed for that additional insured and included in the "products-
completed operatrons hazard"
However:
'1. The insurance afforded to such additional insured only applies to the extent permfted by law, and
2. 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 additional insured.
B. With respect to the insurance afforded to these additional insureds, the following is added to
Section lll - Limits Of Liability and Deductible:
lf coverage provided to the additional insured is required by a contract or agreement, the most we will pay on
behalf of the additional insured is the amount of insurance:
'l Required by the contract or agreement, or
2. Available under the applicable Limits of lnsurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of lnsurance shown in the Declarations
All other terms and conditions of this Policy remarn unchanged
Copynght, Everest Rernsurance Company 20'19
lncludes copynghted matenal of lnsurance Servlces Office, lnc.
used wtth rts Permlssron
Name Of Additional lnsured Person(s) Or
Orqanization(s):
Location And Description Of completed
Operations
lnformation required to complete thrs Schedule,f not shown above will be shown in the Declarations
ECG 24 743 05 19 Page 'l of I
I Any owner lessee or contractor whom you have
I agreed to rnclude as an addrtronal rnsured under a
written contract, provrded such contract was executed
I
pnor to the date of the loss.
I
I
POLICYNUMBER: EF4M106406-221 EVEREST CONTRACTORS ENVIRONMENTAL PLUS
ECG 24 698 09 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
EVEREST CONTRACTORS ENVIRONMENTAL PLUS COVERAGE FORM
SCHEDULE
Designated Person or Orqanization:
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations
The following is added to the Other lnsurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and we will not seek contribution from any other insurance available to the person
or organization designated in the Schedule above which you have agreed to insure under this Policy provided
that:
('l) Such person or organization is an insured under this Policy, and
(2) An "insured contract" requires this insurance to be primary.
All other terms and condilions of this Policy remain unchanged
Copyright, Everest Reinsurance Company, 2018
lncludes copyrighted material of lnsurance Services Office, lnc.,
used with its permrssion.
ECG 24 698 09 18 Page 1 of 'l
POLICY NUMBERT EF4CAO0376-221 COMMERCIAL AUTO
cA 20 48 10't3
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Ljability Coverage
under the Who ls An lnsured provision of the Coverage Form This endorsement does not alter coverage
provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named lnsured:
Endorsement Effective Oate:
SCHEDULE
Name Of Person(s) Or Organization(s):
ALL ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED TO BE NAMED
AS AN ADDITIONAL INSURED ON THIS POLICY WIIH REGARD TO THEIR OPERAIION, MAINTENANCE, OR USE OF
A COVERED'AUTO", THE WRITTEN CONTRACT MUST BE SIGNED PRIOR TO THE DATE OF THE "ACCIDENT,,.
lnformation requared to complete this Schedule, if not shown above will be shown rn the Declarataons
Each person or organization shown rn the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies
as an "insured" under the Who ls An lnsured
provision contained in Paragraph A.1. of Section ll -
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I - Covered Autos
Coverages of the Auto Dealers Coverage Form.
O lnsurance Services Office lnc ,2O11 Page 1 of 'l
This endorsement modifies insurance provided under the following
cA 20 48 10'13
Policy N umber: EF 4C AO037 6-221
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION - BLANKET
This endorsement modifies insurance provided under the following
BUSINESS AUTO COVERAGE PART
Paragraph c. of the Other lnsurance General
Condition is replaced by lhe following:
c. Regardless of the provisions of Paragraph a.
above, this Coverage Form's Liability Coverage is
primary and we will not seek contribution from any
other insurance for any liability assumed under an"insured contract" that requires liability to be
assumed on a primary noncontributory basis.
Additionally, only the coverage and limit of
insurance requirements of the "insured contracl"
shall apply, and in no event shall those
requirements exceed the coverage and limits of
insurance provided under this policy.
Copyright, Everest Reinsurance Company, 2014
lncludes copyrighted material of lnsurance Services Office, lnc.,
used wrlh ils permission
COMMERCIAT AUTO
ECA 24 509 04 't4
ECA 24 509 04 14 Page 1 of 'l