2022/03/18 T Maus GRading & Paving, Inc.ACoRD"
CERTIFICATE NUMBER: 67221054COVERAGES REVISION NUMBER
3116t2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER. ANO THE CERTIFICATE HOLDER,
IMPORTANTi l{the certificate holder is an ADDITIONAL INSLJRED, lhe policy(ies) must have ADDITIONAL INSUREO provisions orbe endorsed.
lf SUBROGATION lS wAlVED, subject to the terms and conditions of th6 policy, certain policies may requir€ an endorsement. A statement on
this certificate does not confer rights to thc cartificate holder in lieu oI such endorsement(s)
PRooucER Patriol Risk & lnsurance Services
2415 Campus Drive, Suite #200lrvine CA 92612
coNlaci Annelte Romero
94S-486-79ru4 tA/c, No):
L risk.cornarome
AFFORDING COVERAGE
txslRERA: XL lnsurance Arnerica lnc 24554
rNsuRER B : Greenwich lnsurance C ny 22322T. Maus Gradino & Pavino. lnc
1953 N. Warren"Road
San Jacinto CA 525a2
rtsuEER c_: ,Clgellgpllqelgpgtty & Ca! A 15563
rNsuRERD, XLS pecialty lnsurance 37885
INSURER E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOO
INOICATEO, NOTWITHSTANDING ANY REOUIREMENT. TERIJ OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERI\4S,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REOUCED BY PAID CLAIMS.
s 100 000
3t18t2022 3t1Bl2O23 FACqoCcuRRE\cr-,/ COS ERCIALGEN--T-l .*,""-roo.f o""r"
S1 0,0q0
0,000s100
,0000s
1s
GEN'L AGGREGATE LIMIT APPLIES PER:
LOC PRODUCTS - CON,IP/OP AG G
PERSONAL & AOV INJURY
GENERAL AGGREGATE s2,000,000
JECT
EOOILY INJLJRY (P€r person)s
ED SINGLE L I,/II $1 000 000
OWNEO
AUTOS ONLY
urREo
AUTOS ONLY
Oed: $1,000
!l
r', r', NBA-1004551-01AUTOMOBILE LIABILITY
SCHEOULEO
NON,OWNEO
AUTOS ONLY
3nBt2A22
BO0ILY INJURY (P€. a@ldanl)
S
B NEC-6006420-01 311812022 3t18t2023
EXCESS LIAB
RETENTION
OCCUR
CLAIMS-MADE 000S
S 2.0,0,0'0_q0_
$
c WORKEFS COUPENSATION
AND EUPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUOEO?
DESCRIPTION OF OPERATIONS b€low
cs-wc- 002026 3118t2022 311 2023
1$
E L DISEASE - EA EMPLOYEE $
E L, OISE'SE. POLICY LIMIT 000$1 000
0
E L EACHACCIDENT
STATUTE OTH-
D Leased/Rented Equipment N \4-1004552-01 3t18t2422 3t18t2423 Limit: $250,000 / Ded $1,000
DESCRTPnON OF OPERAnONS / IOCATIONS / VEHICIES (ACORD l0l.Additionar R.m.rtr Sch.dul., h.y b. ettach.d ir more.p:c.l! r.qulEd)
Re:All California Operations as required by written contract
Certificate Holder is named as additional insur6d with respect to liability as requared by written contracl. See attached endorsements
3o-days notice of cancellation / 1o-days for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
Citv of Menifee
29714 Haun Rd.
N,4anifee CA 92586
SHOULO ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLEO BEFORE
THE EXPIRATION OATE THEREOF. NOTICE wlLL BE OELIVEREO IN
ACCOROANCE WITH THE POLICY PROVISIONS,
AI]THOR12E D REPRES ENTATIVE Y,, )"".u-Dave Jacobson
O 1988-2015 ACORD CORPORATION. All rights reserved
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
6122to.4 22/71 cr/AU/nB/wclrN I Annerre Ronero 1/15120:2 e:40,17 N lpDrr I Pae" I or "
CERTIFICATE OF LIABILITY INSURANCE
0K07568
7 7 NPC-1004550-01
311812A23
T Maus Grading & Paving, lnc
POLICY NUMBER NPC 1004550,01 CO ERCIAT GEI{ERAL LIABIUTY
cG 20 't0 't2 t9
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ]T CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
Thb ofibrlaflidrt rnodfllo!lnanlfE provld.d ud.r thc dbntrg:
@iIMERCIAL GENERAL LIABIUTY CO/ERAC€ PART
SCI{EDUI.E
N''na Ot Addltdlsl ln.l,rld P.r.on(3)
OrOlqrlhdonl.l Locatlon(3l Of Covorcd Oooratons
BIankeE a! regulred by vrllcan contrBqt.Blttrkst .! rcquLrad by rrltsgan
conEract,.
lnfu]maton rEquird to comDbb thls Sdredule, lf not shorm 8bo!/e, will ba ehown ln th€ Doda6tion&
A s.c{on ll - Who lr An lntlllrd ls aflErd.d b
Indud. aa sn sddiEonel lnanrd tle p.r!dl(3) or
orlEnErton(r) $ryn h lh. Sdl6dub, bd dly
wlth r€spad b tbully br lod[y hjl,lf, 'p.op€rty(hmage' or T€f3ond and edlr.rtslng lnjur:a
caurad, In wtrdg or in p8( b!,:
l. Your acB oa ombdon!; or
2. Thc lcB or ord$lons ol lhoaa ac ng on your
b€halt
ln tho porformanco of }!ur or|golm opeletlonr for
Ol9 rddluonal lns|rr€d(!) at th6 locatlon(s)
d6lgn ted abor6.
Hmra:
l. The tnrurarEe afunlad to 3tdr e(kfilonal
llBurrd ordy apdlos to th6 o)dEnl pcmfi'l€d by
larv; ard
z lf co\taraop prwidod lo lhe addtond insurld br!$,lr!d by a contlct or 8grlami , thc
lr8urlnco allodd b rudr add onal lngurcd
wm rut bo br!€d€r lhsn that whlcfi you a1!
r€qJlrBd by the confsct or agrrornont to
Fwldo for su{fi addilimal tlrlurrd.
B. Wth r€3psd b the lnsuranca aliordod b tholo
addlfdl8l lnaJl€ds, tha follo,uring addtonal
oxduslons appl),:
Thls lnarran@ d6s not apply to'bodlt lnjur}, or
'prcp.rly damq.' ocojnlng afts:
,. All wut, lndudlng matatlals, parts or
oqultrnant tmbhed ln conncc on wlth sudr
trvork. on th€ prolad (o&|gr than sarvlca,
malntenanco or ropolrs) to bo porfumod by or
on behalf of ths addlfonsl lnsrrBd(s) at $6
locaton of tho corrs€d opor8tons hG been
complaM: or
2. Th.t portm of .your sort'od of whl'$ tlo
lnlury or dermgo srbes hss bo3n pd b lts
intardad u8o by arry p€Gon or o(lEntssfon
olher Olgn enotlrer corlfsclo, or subconfebf
ongsgrd in p.rfomlng oporatons for I
p{lndpsl as r prn of tho s.rno proJoct
cG 20 10 12 10 @ lnsur8nca S6Mcsa Ofics, Inc., 2018
6122rat1 | 22/21 dL/^t)/irlB/rc/Lt1 | aserie Rohrlo \/\6/2022 e'aa:r1 M {pm) I Pase 2 of 22
Prgp t of 2
C. wlh rtapaci b tho lnruranc. elior# to Or.s.
eddltbn.l ln!ur€(l3, th€ bllrrlng b addad to
Socll,on lll - Llmlts Of lnrunnco:
lf cov€ragp provided b tho addlonal lnsur€d ls
l€qulr€d by I contsact 6 agrE€mmt, the rmgt re
wl[ psy oo balrElf of lhs addloonal in8ur€d b tho
4noulrt of lrcuranoB:
'1. R€quirsd by tha conEacl or 8gresn6nf or
Page 2 o, 2
2. At,rlbu. und.r lh. applcebb Imlb d
ln&nencs;
shhfiolrar b lass.
Thls erdorsdricnl sliall not lnc'€asa tho
spplhabb fimlts ol lnsranco.
O lnsuranca S€Mc€s Ofica, lnc., 2018
6122ra54 | 22/2. dt,/^o/Ng/.c/1il | tuette Rome.o | \/16/2022 e,4a,11 M {Pm) I P'qe r of 2'
cG 20 l0 12 t9
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
Thls endoGomont modtf,3s lnsuranco prolrldsd und€r the fdlevirEi
COMMERCIqL GENERAL LIABILTTY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILTTY COVEMGE PART
SCHEDULE
T lraus Grading & Paving, lnc.
Pol-tc/ NUMBER: NPc-1oo45so-01
A S.cdon ll - tvto b An ln urtd B amendd b
roLide s an addltdial lnsn8d tha p€rBon(!) or
oQEnizaton(3) lhown in E|e Sdr€dulo, but only
wldr €sp€ct to lhullv tuf 'bodlly inFrla or
hroperty dameg6' caus€d, in whoL or ln part bylour work' at tho bcatlon dBlgnabd end
do8crlb€d ln tha Sdredul€ of thl3 endorsoment
pqfiorm€d for that addldonal lnsul€d an.l lndudod
h the Trcducts.comdeEd o,pers6on3 hazatd'.
Hows!rci
1. Th€ inrurEnce atlodod to srJdr addllonal
iBn€d only appllos to Alg 6drnt permi[ad by
lar,: ard
2. f cor/era€e provldod to lhs addltlonal lnsursd b
requirld by a conbac{ or agr€€maflt, lht
insuBn6 afffiod to such additonal lnsured
will not bo broadsr lh8n that whlch you at€
rBqulGd by thc contract tr 8gmarnsnt to
pforrEa for snch sddltonal in$,rd.
cG 20 37 12 t0
B. Wth resoec't to the insurenca afiordsd to the3€
addition l insurads, the following is add6d to
S.cffon u - Llmllr Ot lnrrrurca:
lf cs€ragc prcvtscd to tho addlton€l ln8u.6d bra$lrld by a contac{ or agrconront tho mod rve
wll pey on b.half of ho addlf,oflal lnsrr€d ls the
smount ol lEurancs:
L Raqulr€d by tha odrtact or 8gr6dnont or
Z Aysllabb undsr tis applbauo lmlts ot
inlirranca;
wtrldt€rr€r lB la.
Thls ondoGrrnont shall rct lncr€ala lhe
appllcabb llmlts of kEurance.
COIUITERCI,AL GEI'IERAL LI,ABIU'Y
co 20 3, 12 r9
@ lnsuranca S€rvics3 OtrEe. lnc.. m18
Nan. Of Addltloarl lmurtd Por$n(3)
Or OrsItE tori(!)Locatlon And Dasctlpllon Ot ComploH Op.ra0ons
Blanket aa requLrcd by erLtlctr conEract,.Bhnk.t aa requlred by u?ltEan contrlct.
lrformston rrqulr€d to complets thls Schedul€, if not 3ho!r,n abol/e, wlll b€ shotyn in lha Decl8ralftIrs.
612210\4 22/23 cr,/AU/ur,{E/cc/IM I anncrr. RomEro 1/16/2022 e:4r:r1 M lpDr) I Paqe 4 o: ,,
Plg€ t of I
ENDORSEMENT #
This endcsemeng effective 12:01 a.m. , forms a part of Pollcy l{o.
NPC,1004550-01 bSued 0O T Maus Gradiryl Paving' lnc
THIS ENDORSEMEIIIT CHANGESTHE POLICY. PLEASE READ ITCAREFULLY
XLPtusA,dorsement
This andoB€msflt modifies insuranoo provided undar lho following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
GENERAL DESCRPnON OF COVERAGE - This endorsement broadens co\rerage. The
bllo\ring lisling is a geneBl coveftUe descJiption only. Limitations and e)clusions may apply
to thes€ coverages. Reed this endorsement cer€firlly to deErmine rights, duties, and what is
and is not covered.
A. Reasonable Force - Bodity lnjury or Propety Damage
B. Damage To Premises Rented To You Extension
r Perils of fire, llghhing, explosion, smoke, aircEft or vehicles, rlot or civil commoton,
vandalism, leakage from fire extinguishing equipment or weter damage
. Limlt increased to S300,000
C. Aircrafl Chartered with Crew
D. Non-O,vnedWatercrafi
E. PeBonal and Advertsing lnjury - Assumed by lnsured Confacl
F. lncreasedSupplementaryPaytrEnB
r Cost for bail bonds increased to $5,000
. Loss of eamings increased b $1,000 per day
G. Broadened Named lnsured
H. Blanket Additional lnsured - Manag€rs or Lessors of Premises
l. Bhnket Additional lnsured - Lessor of LeGed Equipment
J. lnlury to Co-Employees and Co-Volunteer Workers
K Knowledge and llotice of Occunance or OfiEnse
L. UnintentionalOmbsion
M. Liberalization
N. Blanket Waiver of Subrogation
O. lncidental Medical Melpractice lnjury
P. Extension of Coverage - Bodily lnjury
Q. Coverage Tenitory
Fom XlL436 1208 @ 2008, xLAmerics, lna
lnduder copydghtod matoirl ot lnluranca S€Mco. Omce, lnc,. with lb psmhslon.
6122L05t 22/21 oL/Au/\inB/Nc/ttt I a,nett€ Rmro \ 3/16/2022 e,tatl1 ^x (Pm) eage s of 22
Page 1 ol8
A REASOT{ABLE FORCE - AOULY TNJURY OR PROPERry DA IAGE
Excluslon .. Erpected Or lntend€d lniury of Parl 2., Excluslons of Coverage A. Bodily lniury
And Property Damage Liability ot Secdon I - Coverages ls deleted in tt8 sntrsty and replaced
by the lollowing:
ffhls lnsurance does not apply to:)
Erpoclod or lntondod lnJury or Damage
'Bodlly injury' or'property damage'expec{ed or intended from $e standpoint of the insured.
This exclusion does not apply to'bodily lnju4f or'pmperty damage'resul0ng from the use of
reasonable iorEe to protecl persons or property.
B. DASAGE TO PREUISES RET{TEO TO YOU EXTEI{SK'N
1. The last paragraph of 2, Exclusions ot Coverage A. Bodily lnjury And Property Damage
Llability ol Sec,tion I - Covarages i8 deleted ln iE ertirety ard replaced by the following:
Exclusions c. hrough n. do nol apply lo damage8 b premisss while rer ed lo you, or
temporarily occ{pied by you with pomlBsion of the owner, cau8sd by fire, llghhing,
exploEion, Emoke, aircralt or vehlcles, riot or civll commotion, vandallsm, leakage from
ffre extlngui8hing equipment or water damage. A separats limit of lnEurance appliss lo
thls @vsrage as descrlbed ln S€ction lll- Llmits of lnsurenc€.
2. This irBuranca does not apply to damage to premisee while renEd to you, or temporarily
occupied by you with PgrmlEslon of the os,ner, caused by:
a. RuptJre, bursting, or operation of pressure rBliet devicss:
b. RupfrJre or burBting duo lo expanBion or s.welling of he cor ont8 of any bulldlng or
sfucturs, caused by or rBsldtlng from watec or
c. Explo3lon of sbam boiloB, steam dpea, sleam engines, or stsam tutblneE.
3. Paragraph 0. o( Sec'tion lll- Limits of lneuranca i6 dele!6d in !b entirety and replacBd by
the bllowing:
0.a, Sub.lecl to Paragraph 5. above, the Damage To Premi3as Rsntad To You Limit i8 ths
most we wlll pay undor Coverage A for damages beceuse of 'prcperly damage' to
any one premlseE whlle rerted to you, or temporarily occupled by you witrr
psrmlselon of the owner, caused by fire, explosion, lighhlng, 8moke, aircran or
vshide, riot or cfull commoton, vandalism, leakage from ire sxtngui8hlng squipment
or waler damage. The Damage To PremisEs Rented To You Limit will apply lo all
damage proximalely causod by the same 'occurrenc6', whelher sudr damage results
frqn fre, exploslon, lightllng, smoke, alrcralt or vehicle or riot or civil cormolion,
vandallsm, leakago from fre axtnguishing equipmont or water damage or any
combination ot any ot lhsse.
b. The Oamag€ to Prsmires Rerted to You Llmll will be the hlgher ot
(l) $300,000; or
(2) Ths amourt shovvn on the Dechrations fur Damage b PrBmlsss Renled b You
Umlt
Form XIL 436 1208 O 2008, xL Amedca, lnc.
lndudG copyrlghtod mabrisl or lnsutanco Sorvlcao Ofic€, lnc., wllh lb permlsslon.
6122tosr | 22/2! cLlau/u!18/sclrrl I Anne*e Rd.!o | !/t5/2o22 s:tott1 ax rPDr) Pase 5 of 22
Page 2 of I
4. Paragraph 9.a. of the defnition of 'lnsurod contracl" under Section V- Defnitlons, ig
dslatsd in its entirety and replaced by lh€ following:
f lnsured c$ntaci' means:l
a. A contract for a lease of premlseg. Ho/vover, that portion of the contac,t for a lease of
prsmis€s that indemnlfies any perBon or organlzation br damage by fire, llghtning,
explosion, smoke, aircrai or vahicle, riot or civil commotion, vandalism, leakage from
fre extinguishing equipment or waler damage to premises while rented lo you, or
tomporarily occupied by you wlth the pemission of the owner ls nol an 'insured
conracf.
5. Thls Mlcle 8. does not apply tt covsrage for Damago to Prsmlsss Renbd to You of
Coverage A. Bodily lnjury And Property Damage Liabllity of Section I - Coverage8 iB
axduded by endorsement.
D. NOI{.OWT{EDWATERCRAFT
'1. The exceptlon conlained in Subparagraph (2) ol Exclu3ion g. Aircraff. Aulo or Watercraff
ln Part 2., Excluoions of Coverage A. Bodlly lnjury And Property Damage Llablllty of
Secton I - Coverages is deleted in its entlrety and replaced by the bllowing:
(2) A watercrafr you do not own that 18:
(a) 50 Eet long or less; and
(b) Not being used to carry psrsons or propetty for a dlargei
2. This Artido D. applies to any person who, wilh your expressed or implied consent, either
us€B or is respotrsible lor lhe use of the lretsrcraft.
3, Thls insurance provided by this Artire D. shall be sxces8 over any other valid and
collec{ibla inBurancs available lo lhe in8urcd, wtether primary, 6xcesE, cor ingert or on
any othsr basis, except for insurance purchased specilically by you to be excess of thi8
policy.
E. PER8O]{AL AI{D ADVERTISING INJURY - AI}SUiIIED BY I SURED COI{TRACT
l. Excluslon .. Contractual Llebllity ln Part 2., Excluslons of Coverag6 8. Porronal And
Advert8lng lnjury Llabllity of Soctlon I - Coverages l8 deleted in ib entlrBty and replac€d
by th€ following:
Form XIL 436 1208 @ 2008, XL Amedca, lnc.
lnclud€s oopyrighbd rn€t€risl ot tnsur9nc€ SeMcaa Ofica. IrE.. wlth lt8 pomls8lon.
6122tot4 1 22/21 GL/^u/wB/sc/ 4 | aserr. Rororo l./16/2022 e.ta,r1 ,x lPDr) | P's. ? of 22
Page 3 of 8
C. AIRCRAFI CHARTERED wlTH CREW
1. The following is added to the excEplions conlained in Exclusion 9., Airc.afr, Arto or
Watercran in Part 2., Exclusions of Coverage A Bodily ln ury And Property Damage of
Section I - Co\rerages:
ffhis exdusion does nol apply to:)
Aircrai drartered with crew to any insured.
2. This Artide C. does not apply ll ths chartsrBd aircraft is owned by any insur€d.
3. The insuranco providsd by thi8 Artcle C. shall be excess o\€r any valid and colleclible
in8urancs available to the insured, whsther primary, exc€8s, contingent or on any olher
be8i8, except tur insuranoe purctased specifcally by you to b€ excesB of this policy.
Fhls lnsurance does not apply to;)
e. Contractual Liablllty
'Personal and Adverttslng lniury' br which the insured has assumed liability in a conbacl
or agroement. Thls excluslon does not apply lo llablllty br damages:
'1. That the insured would have ln the absence of the contract or agroomed; or
2. Assumed in a written cortract or agreement thal is an "insured conlEc{'; provlded the
'personal and adwrtising lnju4/ ls caused by an offense which occurs subsequent to
the execulion ofthe contracl or agreement.
2. Subparagraph f. of th6 definitlon of "in8urBd cortracf Seclion v.- Dsfinltion8 18 delgted in its
entirety and r@lac€d by lhe iollowlng:
f. That part of any other conuac't or agrBemor pertainlng to your business, including an
indemnification ot a municipality in conneclion for work performed br a municipality,
under whicfi you a8sume tho tort liabllity of anlher patty to pay for 'bodily injuq/,
'property damage' or 'perBonal and advertsing inrury'to a lhird party or organization.
Tort liabllity mgans a liabiltty thal would be impo6ed by law in the absence of any
contract or agregment.
2. This Anide E. does not apply if Coverage B. Personal And Advenising lniury Liability is
excluded by endorsement.
F. INCREASED SUPPLEMENTARY PAYIUENTS
Subparagraphs {. b. and d. o, supplementary Payments - coverages A And B ot seclion I -
Coveragas are amended a8 ,ollows:
1. ln Subparagraph b., lho amountw6 willpay torthe costof bail bond8 is lncreassd up to
$5,000.
2. ln Subparagraph d., he amount we wlll pay br a loss ol Bamings is lncraased up to
$1,000 a day.
G. BROADET{ED NAMED IiISURED
l. Ths Namsd lnsur€d ln ltem l. ofthe Dec-latatons 18 as follows:
The peEon or organizallons nemed in lEm 1. of the Declarations and eny organizallon,
other than a partnership or joint venture, over which you maintain ownership or majority
inlerest on the effsctive date ot the policy. HowevBr, coverags lor any aucft organization
will c€as€ as of the date lhet you no longer mainlain ownership of, or maiority interost in,
sudr organization.
2. This &ticle G. does not spply b any peraon or organization lbr which coverage is
excludsd by endoEement.
Form XIL 4361208 @ 2008, XL Amedcs, lnc.
lndude! copydghtod mslorial ol lnslrsnc6 S€.vba8 Orfica, lnc., wlth lt8 p€ml8slon.
5122rO5. | 22/21 GrlAU/rr B/nclrM I aJh.rte Romero 1/t6/2a22 e:ao:l1 rrl rPDr) I Pase 3 of 22
Paga 4 ot 8
H. BLAI{KET ADDITIOI{AL INSURED - TTANAGERS OR LESSORS OF PREMISES
l. Sec'tion ll-Vvho ls An lnsur8d ls amgnded b includo as an lnsurgd any peEon or
organizalion with whom you have agraed ln a wrlttBn confact sxecutsd prior to loss (an
'additional lnsursd"), but only wlth raspect to liablllty arlslng out of ths ownsrship,
mainlanance or uss of that part of any pIemises leased to you, subiect to lhe bllowing
provislom:
a. Limib of lnsurance. The Limlts of lnsurance atrordsd lo ths'addltlonal insured" shall
be the limits you agrE8d to provide, or the llmits shown on the O6darations,
whidrever is less,
b. The lnEurance affordod to thB 'additlonal insured' does not apply to:
(l) Any "ocqinonc€' that takg3 placs afier you cease to bo a tenanl ln that
pr€mi3e8;
(2) Any pramises br whicfi coverago is excluded by en(bGemer : or
(3) Stuctrral altErallon8. ngvv consfuclion or dsmollton operations p€rbrmed by or
on behalf of such 'additional ln8ured'.
2. The insurance sfbrded to ths 'addltonal imurEd' is excess ovsr any valid and collecdblo
lnsurance availabls lo sucfi'addltonel insured', unless you havs agre€d ln a wrltten
conhac't br lhls lnsurancs to apply on a P]imary or confibulory basis.
I. BLANKET ADDITIOI{AL I SURED - LESSOR OF LEASED EQUIPIIIEI{T
1. seclion l!.Who ls An lnsured ls amended to induds an'sdditional in3ured'(as defined in
Arlicle H. abovs), but only with ro3pec{ to lhek liabilily arislng oul of makrtenance,
operation or use by you ot equlpmenl lsassd b you by 6uch'additional lnsurBd', s tied
to ths folloiving provBions:
a. Limits ot lnsurance. The Limib of lnsuEnce aflorded to the'additlonal lnsur€d" shall
be the limts which you agreed to provide, or lhe limitB sholrrn on lhe D€daralions,
whicrlever lB loss.
b, The insurance affoded to the 'addluonal in8ursd' dos8 not apply to:
('l ) Any "occunence' that bke8 place afier lhe equipment lease explresi or
(2) 'Bodily injury' or 'propsrly damage' ariElng out ot the sols nsgllgence of such
addltional insured.
2. The insurance provided to tho 'addltlonal insured" ls excess over eny valid and colleclibla
insurance available b Bwh 'addiuonal lngured', unless you have a writtsn corilract tor
lhis lmurance to apply on a pdmary or contibutory ba8i8.
J. II{JURY TO CO.E PLOYEES AI{D CO.VOLUNTEER WORKERS
l. Ssdim ll- \Ifio 18 An lnsurgd ls amended b include your'omplolres' a8 lnsur€ds wifr
respect b 'bodlly injunf to a co-'employ€e" in lhe couBe of ths co-'smployeg's'
empbyment by you, or to your'r,olur aer worterE rvhlte perfotming dudas relatsd lio the
conducl of your buslno8s, pmvid6d that this colrerage br your'employg€s' doos not
apply to acts outside tho scopo ottheir employment by you or whils porfoming dutioB
unrelated lo the conduct ot your bu3lng$.
Form xlL 436 1208 @ 2008, XL Alnerica, lnc
lndldes copydghlgd malorbl ol lnrurrnco Sowl@8 Ofics, loc., wlth lb pemlllhn.
6722\oe4 | 22/2! ct /a,r/rnB/rc/N | tuette Rm.ro | \/16/2022 e:1o:r1 Al{ (PDr) I Pase e or 22
Page 5 of I
2, Sec,tion ll - VWro ls An lnsursd is amendgd to include your'volunteer wortors" as
insureds with respecl to "bodily injuqf to a co-'volunteer workef while pertoming duties
related to ths conducl of your business, or to your 'employees' employment by you,
provided that this coverage ior your'volunteer tvorker8'does not apply wtlile perrorming
ddies unrelated to the condud of your business.
K. KNOIYLEDGE AND I{OTICE OF OCCU RRENCE OR OFFEI{sE
Ths followlng ls added to Paragraph 2., Duuer ln Tha Ev6r of OccunEnce, Ofisnss, Clalm or
Sult of the S3ction lV - Cormsrdal General Llablllly Cond[ions:
Notc€ of En'occunence'or of an offEnse whldr may result ln s clalm underthls lnsuranco
shall be glven a8 Boon as practicabls albr knowlsdge ol lho '@cunenca' o, ofrnse ha8
b€en rBported lo any insuGd llsled undsr Psregraph L of Sec,tion ll-Vvho ls An lnsured or
any'employee' (sudr aB insurance, loss contsol, dsk manager or adninFtrator) dosignabd
by you lo givo sudr notico.
Knowlodge ol any other 'smployee(s)' of an 'occurBnc6' or of an ofiense does not imply that
you also have such knorvledge.
Notica shall b6 deemed prompt if given in good hilh as soon as pEclicable to your workerB
compensauon insurer. This applies only if you subs8quently gi\rg nolico to us as soon as
praclicable &r any insurEd listed undsr Paregraph l. of Seclion tl - \ ho ls An lnsured or
an 'employoe' (such as an lnsurance, loss contol, or tisk manager or admlnisfator)
d$ignated by you to give sucfi no0ce discovera thal the 'occurlenca', ofiense or chim may
lnvolr€ this policy.
L. UNINTENTIONALOMISSION
The following is addad to Paragraph 6., Rspresentations, of Sec,Uon lV- Commerchl General
LlEbllity Conditions:
The unintrntional omission ot, or uninbntonal sno, ln, any inbrmation provided by you shall
not prajudlce you ighB under thb insu.encs. Ho,vover, thls Arucle L. does not af6ct our
right to colled additional Femium or to exsrclso ou lghl ol can@llation or nonrene{val in
sccordancs with applicable state ln8urance laws or 169ulatiom.
U. LIBERAUZATIOI{
Tho following 18 added b Section lv-Commerdal General Liablltty Conditiom:
LlbereltsaUon
AIbr 0le is8uancs ol this pollcy, if wo adopt a drange in our fotms or rules whlch would
broadsn the correrage prcvided by any brm lhal is a part of lhis policy wlthout a pr3mium
charge, lhe broadar coverage will apply to lhis pollcl. Thls exEnslon i8 efieclive upon lh€
approval of suc-tl brosder coverage ln your stab.
6122ta51 | 22/21 ct /^v/\nB/Nc/It I bnerr. Ro €ro | 1/16/2022 e:to:\1 ix (Pm) P.e. ro of 22
Page 6 or 8Form XIL 436 1208 @ 2008, XLAmerlca, lnc.
lndud63 copyrighled matorial of lmur.n.6 S€rvlcas Ofrca, lrE , witi 16 porml6sh.L
N. BLA KET WAIVER OF SUBROGATIOI{
ThB tollowing is added to Ses'don lv4ommercial General Liability Conditions:
Waiver of SubEgatlon
We waive any right of recovery w6 may have against any peGon or organlzalion becauae of
payment8 we make br lnjury or damago arising out of prsmiss8 ownsd or occuplod or rBnled
or loaned to you; ongoing operation8 perbrmed by you or on your behelf, done under a
cor ract wtth that pBrson or organizaton; 'your wolk'; or 'your products'. W9 waive this right
wh6ra you have agreod to do so as patt of a written conlracl, exscuted by yql prior lo los3.
O. INCIDENTAL MEDICAL MALPRACTICE II{JURY
l. For insuranca appllcable to thls Artcle O, the dellnition orbodlly lnluqf ln Sectbn V -
Definitions is amended to lnclude, 'lrEidental Medical Malpractico lnjuqf.
2 Th€ tollowing definltion iB added to Saclion V- Defnitions:
'lncldental medical malpractlce injuy means'bodily inju4f, menlal angulBh, Blckness or
diseass sustainsd by a pBrson, lncluding death r€sulting fom any ol thes6 at any time,
arising out of the rgndering ol, or fallure to render, the following sorvlces:
a. Medical, surgical, dental, laboratory, x-ray or nurBing servlco or treabnsnl, advice or
inslruclion, or lhs rslsbd fumishlng of food or b€voragss:
b. The tumishing or dispensing of drugs or medlcal, dental or surglcal supplies or
appllances:
c. First aid: or
d. 'Good Samaritan SeMces'. As us€d in this Article O., 'Good Samaritan SeMcss'
are thGe medical sarvicas renderad or ptovided in an smergency and for which no
remunsralion i8 demanded or received.
3. Paragraph 2,a.(1xd) ot Section ll -mo ls An lnsursd does nol apply lo any regist€red
nurse, licensed praclicalnur8e, emergency modical tschnidan or paramsdlc smploysd by
you, btlt only whila perfomlng lhs services desc-rlbed in Paregraph 2. abovo end while
acling wihln th8 scope of thsir employment by you. Any '6mployeeE' rendefng 'Good
Samaritan Services'will be deemsd to be acting within the scops ol lholr employment by
you.
4. The tollowing excluslon i8 added to Paragraph 2. Excluslons of Covsrage A. - Bodily
lnjury And Property Damage Liabillty ol Sec'tion I - Covsrages:
ffhis insuranc€ does not apply to:)
Wllltul Vlolatlon of Ponat Staluta
Liability arising out ot the wlllful violation of a penal statule or ordlnance rolating lo the
sale of pharmacsutc€ls by or t/vith the knowladge or consent of ths insurgd.
5. For the purpos€s of determining lhe appllcable Limlts o, lnsuranco, any acl or omission,
logether with all relatsd acls or omisalons in tha fumishing ot servlcas dBscribed in
Paragraph 2.a. lhough 2.d. abov6 to any ons psrson, will bs conaldered one
'occunence'.
6. This Artido O. does not apply if you arB in ths busineas or occupation of providing any of
lhs selvlces described ln Paragraph 2. above.
FormXlL436 1208 @2008, XL AmericE, lnc.
lncludos copFight d ntstsri.l of lrEuranoo S€Mce6 Ofi.o,lnc., with tB pcmlrsbn.
6122L05. 1 22/21 GL/Au/u'48/tttc/7t1 I Annetre R@!o | 3/16/2022 e:40:r1 Ax (Pm) | Pase 11 of 22
Pegs 7 of I
7. The insurance provided by lhis Ar0cle O. shall be excees over 8ny other valid and
colledible lnsurance available lo the lnsurod, whother primary, excess. conllngenl or on
any other basis, excopt ior imuranco purchased speclitcally by you lo bs oxcess of thls
poticy.
P. EXTEI{SION OF COVERAGE - BODILY INJURY
The dafinition of'bodily in urf S6ction V- Defnitiom ls deleted in its enlirety and replaced by
the follott/ing:
3. 'Bodily iniury" means bodily lnjury, mental anguish, mental injury, shock, fighl, disability,
humlliatm. slckness or disaase sustainsd by a person, induding death re8utting from
any d these at any lime.
Q. COVERAGE TERR]TORY
The definition of 'coverage lenitoq/ Secllon V- oefnltions ls deleted ln iti entirety and
rsplaced by the followirE:
4. "Coverage tenltory' means anywhrre ln the wortd.
This insurance does not apply to:
a. 'bodily inJury' or'property damege' that takes place; or
b. 'personal and advertising injury'caused by an oftense committed
oubide the United Slatas of America (including its poss8ssion8 and teritorie8),
Canada and Puerto Rico, unless a'guif on fie merits (to determlne the insuGd's
resposibillty to pay damages b which this insurance applies) is brought in the
United Stabs of America (including its posse$ions and tetritories), Canada or
Puerto Rico.
This insurance does not apply lo damage, Ioss, cost or expenses in connecdon with any
'suif broughl outside lhe United States d America (iBcludlng ib pos8e8sions and
tenitories), Canada or Puerto Rico.
Form XIL 436 1208 @ 2008, XL Am€rica, lnc.
lndud€! cgprriolrt6d .natorlal of lnsursnca Sorvcas ffice, lnc.. wl0| lb potml8llon.
61221a5. | 22/21 c1"/^'r/'rB/qc/ri I !tr€tte Rohero | \/t6/2o22 e,.o,\1 il4 (pDrr paqe l? of 22
Page 8 of 8
T. Maus Grading & Paving, lnc.
NPC-1004550-01
The following is added to the Othor ln3urance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory lnsurance
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
that:
('l) The additional insured is a Named lnsured
under such other insurance; and
COMiIERCIAL GENERAL UABILITY
cc 20 01 12 19
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILIry COVERAGE PART
CG 20 01 1219 @ lnsurancc SeNices Offce, |nc.,2018
6122La54 22/21 cL/^t/aB/Bc/1$ | tuerre Romero 1/16/2072 e:4a,r1 M lPDr) | Paqe 1r or 22
Page 1 of 1
T. [.4aus Grading & Paving, Inc.
POLICY NUMBER NPC-10045s0-01
A. For all sums which the lnsured becomes legally
obligaled to pay as damages caused by "occur-
rences" under Seciion I - Coverags A, and lbr all
nredical expenses caused by accldents under
Section I - Coverage C, whicfi can bo atlrlbutsd
only to ongoing op€rations at a single designatod
construcdon proj8ct shom in the scfiedule
abo\re:
l. A separate Designatod Construcfon Poject
General AggrEgate Limit app$es to oadr des-
ignated construc-tion project, and that limit i3
equal to lhe amount of the General Aggregate
Umlt shown in the oecle"a0om.
2. The Designated Consfuc-tion Prcjec-l Goneral
Aggregde Limft ls he mod we will pay br lhe
sum of all danrages utrder Coverage A, ex-
cepl damages because of "bodity injury" or
"proPorty dama96' lndudad in the "producb-
comdeEd operalions hazard'', and br medi-
cal expenses undor Coverage C regardless of
the number ot
a. lnsureds:
b, Claim3 made or "3uib" brought: or
c. Per8ons or organizaton8 making claim8 or
bringing "suiB".
CO ERCIAL GEIIERAL UABIUTYcc 25 03 05 09
3, tury payments made under Coversge A br
damages or under Cove6ge C br medlcal
expens€8 Bhall reduce ths O$ignahd Con-
stsuclion Projec't General Aggregate Limlt br
that de8ignated constuction projsct. Such
payments shall not reduce the General Ag-
gregeE Umit sho,vn ln the Dedaretons nor
shall they reduce any o0rer Deslgnated Con-
stsuciion Pmjec't General AggrBgat€ Limit br
any drer d$ignated constuc{on projec't
shown in lhe Schedule above.
4. The limiF shown ln the Docbralions for Each
Occurlenc€, Damag€ To Premb€s Rent8d To
You and Medical ExpenEe continue b apply.
tlowe\rer, lnstsad of belng rublect !o lha
General AggregEte Limit shown in ths Deda-
rations, such trmils win be subject b ths appli-
cable De8ignaEd Con8buc{on Prcrec-t Gen-
sral Aggregate Limit.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ]T CAREFULLY,
DESTGNATED CONSTRUCTTON PROJECT(S)
GENERAL AGGREGATE LIMIT
Thls endorsement modllls8 lnsurance provided under lhe tollowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Doslgnabd comtrucfon Prcrect(s): Policy aggregate limil applies per work site.
lnformatlon required to complete lhis Schodulo, lf not Bhown above, will be shown in the Dsclaralions
cG 25 03 05 09 @ lnsurance Services Office, lnc., 2008
6122tas4 22/2) cr,/Au/oB/r{c/i 1/76/2022 e,4a,t1 M (pDr) zaq. 14 of 22
Page l of2 O
B. For all sums which lhe insured becomes legally
obligat€d to pay a3 damages caused by 'occur-
rencas" under Section I - Corerage A, and lbr all
medical expenses caused by accider s under
Seclion I - Coverage C, vvhich cannol be at-
tributed only to ongoing op€ratons at a slngla
designated @nstruciion proJec't shown in the
Schedule above:
1, Any paymenb made urder Coverage A lbr
damages or und6r Covarage C for rnedical
expenses shall reduce the amounl available
under the General Aggregate Limit or the
Products-completed Operations Aggregate
Limlt, whichever is applicable; and
2. Such payments shall not reduc. arry De3i9-
nated Construslion Proiect General Aggre-
gate Limil
C. \rvlren @verage br liabiliv arising out of the
"Foduds-comdeted operafons hazard" ir prG
vided, any payments lbr damages b€cause of
"bodily injury" o. "property damage" induded in
the "producb-complebd opersliom ]Ezard" wlll
reducs the ProduclB-completBd OperatloG Ag-
gregate Umit, and not reduoe lhe General Ag-gregste Limil nor the Designated CoBtructlon
Project G€neral Aggregate LimiL
D. It the applicable designated con*ucton project
ha8 bgen abandoned, delayed, or abandoned
and lhen r6tarbd, or lf the authorized contract-
ing parlies deviate fom plan8, blueprlntr, d+
signs, specifEatons or timetebler, lha project will
slill be deern€d to be lhe same consfucdon pro-
ject.
E. The provisions of Seclion lll - UmiB Ot lnsur-
ance not otherwise modified by this endoEemEnt
shall continue b apply as stipulatsd.
Page 2 ol2 @ lmurance Services Offce, lnc., 2008
6122to54 22/21 eL/^!/tt4B/wc/ltr I Annerre Romero | 1/16/2022 e,4a,t1 N lpDr) I paqe 15 of 22
cG25030509 D
T. Maus Grading & Paving, lnc.
POLICY NUMBER: NBA-1oo4s5i -oi
Thls endorssmsnt modifis8 insuranco providsd under ths followlng:
BUSINESS AUTO COVERAGE FORM
COVERAGE DESCRIPTION
Tomporary Subsututo Auto Physlcal Dam.go
Who l3 An lnsurod
1. Broad Fom ln8ulrd
2, Employooa As lnsuitds
3, Addltlonal lnsurod By Co lact, AgEemontot Pomlt
4, Employeo Hlrod Autos
Supplomontary Prymonts
Amended Fellow Employoo Ercluslon
Phyolcal Damags covorago
1. Rental Relmburaomed
2. Exbr Erponso- Broadonod covorago
3. Porsonal E f€ct8 Covet?ge
4, Loasa Gap
5. clasa Ropalr- waiygI Of Deducdblo
Physlcal lrameg6 Coyolage Extsnslons
l. AddldonalTransportauonErpenlo
Z Hlred Auto Physbal Damago
BuslnosB Auto CondltlonB
t. Notlco O, Oocun€nc.
2. Walvorofsubrog.tion
3. Unlntenflonal Fallurc To DlBclose Hszard3
4. Prlmary lnsurence
BodlV lnjury Rodefined
Extended CancellaUon Condltlon
xtc 421 1013
THIS ENDORSE E]iITCHAT{GES THE POLICY. PLEASE READ IT CAREFULLY.
XL PLUS BUSINESS AUTO EXTEI{SION ENDORSEIEI{T
xlc 421 1013
E
A.
B.
c.
D.
H
t.
F
G
6122ros1 | 22/21 cL/^u/tllirB/Nclrt I Amet.e Rmro | 1/76/2022 e:40,t1 ar lpsr) | Pas. 16 0r 22
Page 1 of B@ 2013 X.L. America, lnc. AllRightB ReEewed.
May not be copied without permission.
tncludos copyrighted mat€rial ot lnsursnc€ Servic6 Offico, lnc., with its permbsion-
A. Temporary Substltuto Auto Phy8lcal Oamage
SECnO I - COVERED AUTOS, C, Cortlln TrrltcE, lllobtto Equtpmont And Temponry Sub.otute
Auto3 E drangad by adding lhe ft,lowlng:
lf Physical Damage coverage is pmvided by this Covsrage Form, lhe tolloiving types o, vehictes are atso
covered 'autos' for Physical Damage coverage:
Any'auto' you do not own while used wih the permilsion o, ils owner as a temporary subslituto for
a covercd 'auto' you own that is out of sorvice bocause of its:
Breakdown;
Repair:
Servicing;
'Loss': or
Destsuction.
B. Who b An lnaurrd
SECT|Oi{ ll - COVERED AUTOS LIABIL]TY COVERAGE, A. Cowrrgo, l. U,ho 18 An lnsuEd 13
changBd by adding ths followlng:
Broad Fotm lneul?d
,|
't.
2.
3.
xtc 42't 1013
a.
b.
c.
d.
o.
For any coversd 'auto', any subsidiary, afllllats or olganlzation, olher than a ParlnershlP of lolnl
venfure, a9 may now exist or hereaftor b€ cons0tulad over whlch you assumE ac-tive mansgament
or maintein o{unership or malority interest, provldod thet you nottly us wllhln nlnety (90) dayB from
the data that any sudr subsidiary or affiliete l3 acqulrsd o, brmed and that thsre i8 no slmllar
insurance available to that organization. However, coveEge do6g nol apply to'bodity lnJury'or
'propgrty damage'that occunsd bebr€ you ecqJlrod or iormed the olganization.
EmployeG As lnsuBds
Any'employee'of yours is an 'insured'while lJsing a covered'auto' you don't own, hire or bonow,
in your business or your pergonal afhirs.
Addl$onal lnsurod By Contract, Agr€smont Or Ponnh
Any person or organizalion with vvhom you have agreed in writing in a conlract agreemer or permil,
to provide insurance such as b pmvided un(br thls polkry, provided lhat the 'bodily inJury'or
'propsrty damage' occurs subsequent lo the execulion of lhe written contrac-t, agreement or permiL
4. Employoo HlEd Autos
An'amployee'of yours b an 'lmured'$h[o op6reting an "auto' hired o] rented under a contract or
agr66mer in that 'employe€'s' nams, wllh your pormission, whilo psrforming duues r€hlsd to lhe
conduct of your business.
@ 2013 x.L America, lnc. All Rlght6 Rsserved.
May not be copied without pormi3sion.
lnclude8 copyrightsd matsrial of lnsuranca Servic€s Oftce, lnc.. with its permission.
6722La54 22/2! OL/^'r/utls/rc/tn I as.t!. roh.lo | 1/\6/2022 e,4a:Lt ax lPml I P.9. 17 of 22
Pags 2 of 6
SECTION lV - BUSIIIESS AUTO COl{DlTlOt{S, B. Gsnoral Condluons, 5. Othor tnsur.noo, b.
is replaced with the bllowing:
b.For Hired Auto PhFical Oamage Coverege, 0le follolfling are deemod to bo covered
'aulos' you own:
(fl Any covered 'auto' you lsass, hire, rBntor borow;and
121 Any eovered'aub' hirod or 6nt6d by your 'employee' under a contrac-t ln lhat
individual 'employee's' namo, with your permission, while perbrmlng dutlss
relaled to the conduc,t of your buslno$.
Hot rever, any'auto' that is leased, hired, rented or bonowed wilh a driver ls not a covered
'aulo'.
c, SupplomontaryPaymon6
SECTIOI{ ll - COVERED AUTOS UABILITY COVERAGE, A. Covorage, 2. Covorago Erbn6lons, e.
Supplomentary Paymorta is cfianged as iollows:
Item (2) ls dslebd and replaced by the following:
Up to $3,500 for cost of bail bonds (including bonds lor related t"affic bw violatons) required
because of an 'accident'we covsr. We do not havs to tumish these bonds.
Item (4) iB deleted and replaced by the ,ollowing:
(4) All teesonabls expens€s lncuned by the'lnsur€d'at our ]equest including astual loss of eamingg
up to $500 a day b€cause ol timc off from work.
D. Amonded Fdlw Employeo Excluslon
SECTTON Il - COVERED AUToS UABIUTY COVERAGE, B. Exclu3lom, 5. Follow Employao doas not
apply.
E.
The lnsurance pmvided underthis Provision D, ls excess over any other colleclibte insurance.
Physlcal Damage covorago
SECTIOI{ lll - PHYSICAL DAUAGE COVERAGE, A. covorago is .rranged by adding the following:
1. RontalRelmbui8oment
We will pay for rental reimbursornont oxp€n8e8 lnqjned by you for the rental of an 'aulo'
bccaGe of 'loss' to a co\roGd'auto'. Payment applies in addition to the otherwise
applicablo amount ot each coverage you have on a oovered 'auto'. No deductibles apply
to lhis coverage.
We will pay only lor those expenss8 irrcunod during the policy period beglnning twenty-four
(24) hours afrer the'loss' and endlr€, rogardless ol the poticys expiration, with the losser
otlhe followlng numbor o, days:
xtc 421 1013 @ 20'13 X.L. America, lnc. All Rights R6erved.
May not bs copi6d wlthout p€rmlssion.
lnclu&a copyrighted materiel of lnsuranca Servlce8 Offce, lnc, with lts permbsion,
(21
a
b.
61221os1 | 22/2! ct /^v/!'n..B/Nc/rt I atu.t.e Rmro | 3/!6/2022 e'4a:t1 a,{ (Pm) | P.e. 13 of ,2
Page 3 ofo
c. Our payment is limilBd to the lesser of the follorrving emounB:
(1) Necessary and acfualexpenses lncuned
(21 $50 any ono day por private pessenger'aub"i
$100 any on6 day portuck:
$1,500 any ono psrlod p6r ptivats pa$eng6r'auto':
$3,000 any one perlod portruck; or
Higher limlts i, shown slservhere ln lhb pollcy.
This coverage does not apply while there are spare or reserve'aulot' available to you for
your operations.
o,lf 'loss' results frcm the trctal theft of a covered "aulo- ol the private pa$enger type, we will
pay under this coverage only that amount of your renlal reimbursernent expenses which is
not alroady providsd for under the Physical Damage Coverage Extension.
2. Extrs Exponso - Broadened Covorago
We will pay for the expsn3e of retuming a stolen covered 'auto' to you
3. PelBonal Effoct8 Covor"go
f you have purchased Comprohomive Coverage on this policy for an 'auto' yru orvn and that'eub'
is slolen, we wlll pay, withoul appflcatlon of a deducdbls, up to 0500 fur'psrsonal sffecls'stolsn
trom lhe 'aulo".
As used in this endors€ment, 'porronal efi6ct!' meens trnglble propslty that is n om or csnied by
an 'insured'. 'Personal effoctS'doss not inclu& tools, Jetvelry, money or securitles.
4, Loase Grp
ln the event of a total "loss'to a covorod'auto' shown in lhe D6claratioru, w€ wlll pay any unpald
amount du6 on the lease or loan tor a covered'aulo', less:
a.The amount paid undorths Phy8lcal Damago Coverage Sec,tion of 0!e pollcy; and
Any:
(f ) Ov6rdu6 leasa/loan paymentB at the time of lhe "loss':
(2)Financial penalues imposed undgr a lease br exce3sive use, abnormal wgar and
t6ar or high mileage;
S€qjrity dep6its not retumed by the lessor:(3)
(4)Costg br extended wanantios, Credit Lite lnauranc€, Health, Aocident or Disability
lnsurance purchaseswith lhs loan or lea8ei and
(51 Carry-over balanc$ from prevlous loans or leaseg
d
b.
xtc 421 1013 @ 2013 X.L. America, lnc. All RighB Reserved.
May not be copiod withoul pemi$ion.
lndude! copyrighted materisl of lnluran@ Sewic€a Ofrc6, lnc., with its permisslon.
6122tos4 | 22/21 el./^u/\r,.a/$c/rri I aEet!. ro.!o | ,/16/2022 e,4att1 Ar,r rpm) | p.g. 1e or 22
Pags 4 ofo
(1) Th6 number of days reasonably required b repair or replace tho cover€d 'auto'. It
"loss' b caus€d by thefi. lrris numbsr ol days is add6d to lhe number ot days it bke.
to locaie the covered 'auto' and retum it to you.
(21 Thiny (30) day8.
5. Gla3B Rapalr - Walvor Of Ooducdblo
No deduc{ible applies b glass damage If the glass is repaired rather lhan replacod.
PhyBlcal Damage Covorago Extenalona
SECTION lll - PHYSICAL DAIITAGE COVERAGE, A. Covorrgo,4. Covorsge Exbnslom is amended by
the following:
L Addltloml TEnapoftation Expenss
Soctlon3 a. and b. are amended to provlde E limlt ol $50 per day and a maxlmum flmit of 81,000.
2. Hlr€d Auto Physical Damago
The bllo,ving seclion is added:
Any'auto'you lease, hire, rEnt or bono/r, is deemed to be a covered 'aulo' for physical damage
coverage. The most we will pay fq each covered 'auto' b the lesser ol:
(1) the actJal cash valusi
l2l tho cost for repair or redacement or
(3) $50,000, or h'rgher limit if shown on he Declaralions for HirEd Auto Phy8lcal Damage
Coverage.
For each covered 'auto' a deduc'tible of 9100 lor Comprehansive Coverage and $1,000 for
Collision CoYerage will apply.
Busln$s Auto Corditons
SECTION lV - BUSINESS AUTO COI{OTIONS, A. Losg Condi$or|! is changed by the tollorving:
1. Notice of occurlonoo
Soction Z - Oudos ln The Eysnt Of Accldent, Cl.lm, Suit Or, Loss, a. is chEnged by adding lhe
following:
It you report an inury b an 'employse'to your norkeB' compeBatlon canier and if it ls
subseguently deErmined that the inlury is one to whic-h this lnsurance may apply, any failure to
comply with lhis conditlon wlll bo tvalvod if you provlde u8 wllh the roqulrod nouce as soon thenoalbr
as pEcticable after you know or reasonably should have knovvn that this insurance may apply.
2. Waivor Of Subrogauon
Soctlon 5. Trrnsfer Ot Rlghb Of RocovoBr Agalnst Olhsrr To lrs ls changsd by addlng the
folloring:
However, lhb Condition does not apply to any person(s) or organizatlon(s) wilh whom you have a
wd[en confac{, but only to the ertent that subrogation is walvad prior to the'accidenf or the 'loss'
under such contraci with that person or organization.
xtc 421 1013 @2013X.L. America, lnc" All Rights Reserved.
May not be copied without permisshn.
lncludB copyrighted materisl ol ln8urance Ssvicee Offce, lnc,, with its pomlssion
6122ta54 | 22/21 G1,/a!/.JN,a/qc/t$ | tunerre Rohe.o | 1/16/2022 s:4a't1 ,qx (pDr) paee 20 6f 22
Page 5 or o
F.
G.
H
t.
SECTION lV - BUSI ESS AUTO CONDITIOI{S, B. Genoral Condltlons b changed by the follolring:
3. Unlntendonal FallurE To DlBcloao Hazards
The following condition is added:
Your uninlenlional failure to disclose all hazards as ol th6 inception daE of the policy shall not
prajudics any insured with rosp€ct b the coverage afforded by this pollcy.
4. Prlmary ln8uranca
Condltlon 5. Other lnsur.neo is chengod by adding the tollowing:
For any covered 'auto' this insuranc€ shall apply as primary and not confibute with any other
lnsurance where such r€qulrement is agreed in a wrltten contract executed prbr lo a 'loss'.
Bodlly lnjury Rodofnod
SECTION V- DEFI}I]T|ONS, C. 'Bodily injurf is replaced by the follorving:
'Bodily injury' means bodily injury, sickness or dBease sustained by a porson including mentd anguish,
mental inlury, shock, fright or dealh resufting from any of lhe3e at any time.
Ertsnded Cancolleuon Condldon
coM gN POLICY COt{OlTlOlls (Fom lL 00 17), A. Cancollrtlon, 2.b. l8 replacod by tho bllowing:
The greater of sixty (60) days or the tima r€quirad by any appllceble 3tate amendatory endorsement befure
the effec'tive date ot c€flcellation if we can@l for any other reason.
All other tems and conditions ot this pollcy remaln unchanged.
xtc 421 1013 @ 2013 X.L Amsrlca, lnc. All RighB R6srved.
May not bs coplod wlthout permlsslon.
lnc.ludeo copydghisd mabrlal of lnEuranco Se lces Ofics, lnc., wllh lts permlsrlon
61221os4 22/21 cL/^r/@B/qc/1i 1/).6/2a22 e,4air1 N (rDa) | laqe 21 61 22
Pago 6 of 6
Irc0'lGl(E
(Ed. 444)
WAN'ER OF OUR RIGHT TO REOOI'ER FROT OTHERS ENDORSETET{T - CAUFORI{A
WG ha!r! lir rlgtrt b rrcoirsr our payrncnts frqrr .nyoo6 [6bb br an ln ury corBEd by thlr pollcy. We rv l nol
onfurca our dgfit agelnst 0l€ plrron or o(!8ntsatqr named ln lho Sciraduls. Otlr agrufit.fit eppllG only b the
od'ant thlt tDu porbm ryort underc srltlon cqlffi lhst rlquhB8 you lo obtah tits a0reofipnt fiom us.)
You mu3t nralntaln peyrdl t€cord! scqnately !€g'tgEttE th€ r€munoraliofl of llour emdoy€os whlc GrEEgsd ln
th. [,ort de3cfied h lhe Sdrcdule.
Th. addltbnal prardum for thh ondo.!6m.nt shall bo _0_% of tr6 Calllbmts worl(er!' cdnp.trlstlat plB rdum
o0ror1liso duo qr sudr I! runeElion.
Panon or Or!trnlzrdon
sffiulc
Job D.&rfptbn
Any Person or Organtsadon for wildl tho lnsursd
has agr€€d by wrltten contact oxoarted prior lo
loss to fuml$ thls wafuor.
becse6roy
Cta S,th! rrlFty Ed crsrlly Cwy
wG0aG0c
Gd. /r4a)
ColtrErligDd ty
Ib (ldagrd ct-!t tu ,olby ro llicl ll lt 6.i!d.fhctir! 6lhG rb ircd clcr drtlfirr iir&(Ibffitdowf rqrlrla nt trt ! atb EdrcrEt I h.d rO..Gd t',r!r{l.. dlt E fctJ
&&iEtd EtrtcdE 03/18/2022 poucy ilG CS,WC- 002026-02 Edq@rl,to m
IDruttd r. Mms Gradias & Prvins. lnc V-r lr-a
61221014 1 22/21 dt"/^o/'n.c/$c/rr I Ametre Ro@o 1 3/16/2012 e.tn,t1 Al rpDr) | prge 22 or 22
WORKERS' CO PENSATIOO{ AI{D EiTPLOYERS' LIAEIUTY INSURANCE POUCY