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SCRWA - Auburn Construction - Insurance Certificate (2013)
1`52.XQW102 ' 1 ® DATE(MMIDDIYYYYI A� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0726293 1 -415- 391 -1500 CONTACT NAME: Gallagher Construction Services/ Arthur J. Gallagher & Co. Insurance Brokers of CA Inc. LA/CNNo,Exy: 415- 391 -1500 (A/C,No): 415- 391 -1882 1 Market St., Spear Tower #200 E -MAIL ADDRESS: 9 csafcerta @ajg.com San Francisco, CA 94105 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: WAUSAU UNDERWRITERS INS CO 126042 INSURED INSURER B: COMMERCE & INDUSTRY INS CO 119410 Auburn Constructors, Inc. INSURER C: 730 West Stadium Lane INSURERD: Sacramento, CA 95834 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 29524090 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 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. INSR TYPE OF INSURANCE �IADOL'SUBR POLICY NUMBER MM DDIYYYY MMIDDIYYYY LIMITS LTR A GENERAL LIABILITY X X TBJ -Z91- 460046 -022 10 /O1 /1 �i 10/01/13 1,000,000 'EACH OCCURRENCE $ X GENERAL LIABILITY ! DAMAGE TO RENTED !i 300, 000 $ I COMMERCIAL !: CLAIMS -MADE I X I OCCUR !, PREMISES (Ea occurrence) MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO- POLICY JECT $ A AUTOMOBILE LIABILITY X X ASJ -Z91- 460046 -012 10 /O1 /1 10/01/131 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) '.., $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED 'I AUTOS (AUTOS III ! I'' BODILY INJURY (Per accident) $ X X NON - OWNED' PROPERTY DAMAGE $ HIRED AUTOS AUTOS, (Per accident) COMP /COLL Ded $ 1,000 UMBRELLA LIAR OCCUR �'� :EACH OCCURRENCE $ i I EXCESS LIAB CLAIMS -MADEi ' AGGREGATE $ Ali DED !RETENTION $ $ WORKERS COMPENSATION B X WC STATU OTH -', 21417654 01 /01 /1 01 /01 /131 X'TORYLIMITS, ER AND EMPLOYERS' LIABILITY YIN I ANY PROPRIETOR/PARTNERIEXECUTIVE ' � E.L. EACH ACCIDENT $ 1, 000, 000 .. OFFICER/MEMBER EXCLUDED? NIA; ❑ (Mandatory in NH) I E L. DISEASE - EA EMPLOYEE $ 1,000,000 I( yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) RE: SRCSD Advanced Treatment Technology Pilot Project Prism Project Number 141212 Additional Insured(s): SCRWA, SCRWA•s employees , officers, design consultants, elected officials, construction Manager, agents and Subconsultants GtK 1 WIGA I t HULUtK South County Regional Wastewater Authority 1500 Southside Drive Gilroy, CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Pravegcs 29524090 w 0 u. O N ono' z W P52WN 28(N12 Policy# ASJ- Z91460046 -012 Effective Date: 10/01/2012 Named Insured: Auburn Constructors, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Liberty EXPRESSSM Auto Enhancement Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Newly Acquired or Formed Organizations II. Employees as Insureds III. Lessor - Additional Insured and Loss Payee IV. Supplementary Payments - Increased Limits V. Fellow Employee Coverage VI. Personal Property of Others VII. Additional Transportation Expense and Cost to Recover Stolen Auto VIII. Airbag Coverage 1X. Tapes, Records and Discs Coverage X. Audio, Visual and Data Electronic Equipment Coverage XI. Physical Damage Deductible - Single Deductible XII. Physical Damage Deductible - Glass XIII. Physical Damage Deductible - Vehicle Tracking System XIV. Duties in Event of Accident, Claim, Suit or Loss XV. Unintentional Failure to Disclose Hazards XVI. Worldwide Liability Coverage - Hired and Nonowned Autos XVII. Hired Auto Physical Damage XVIII. Auto Medical Payments Coverage Increased Limits XIX. Drive Other Car Coverage - Broadened Coverage for Designated Individuals XX. Rental Reimbursement Coverage XXI. Notice of Cancellation or Nonrenewal XXII. Loan /Lease Payoff Coverage XXIII. Limited Mexico Coverage XXIV. Waiver of Subrogation NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words you and your also refer to any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership of more than 50 percent interest, provided_ A. There is no similar insurance available to that organization; B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until: 1. The 90th day after you acquire or form the organization, or 2. The end of the policy period, whichever is earlier; and C. The coverage does not apply to an "accident' which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS Paragraph A. 1. Who Is An Insured of SECTION II - LIABILITY COVERAGE is amended to add: Your "employee" is an insured while using with your permission a covered "auto" you do not own, hire or borrow in your business or your personal affairs. AC 84 07 05 09 Copyright 2008 Liberty Mutual. All rights reserved. Page 1 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 N N 00 z w P52(AA)2M)2 XXIII. LIMITED MEXICO COVERAGE WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. A. Coverage Paragraph B. 7 of SECTION IV - BUSINESS AUTO CONDITIONS is amended by the addition of the following: The coverage territory is extended to include Mexico but only if all of the following criteria are met: a. The "accident" or "loss" occurs within 25 miles of the United States border; and b. While on a trip into Mexico for 10 days or less; 2. For coverage provided by this Section of the endorsement, Paragraph B.S. Other Insurance in SECTION IV - BUSINESS AUTO CONDITIONS is replaced by the following: The insurance provided by this endorsement will be excess over any other collectible insurance. B. Physical Damage Coverage is amended by the addition of the following: If a "loss" to a covered "auto" occurs in Mexico, we will pay for such 'loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value, of such "loss" at the nearest United States point where the repairs can be made. C. Additional Exclusions The following additional exclusions are added: This insurance does not apply: If the covered "auto" is not principally garaged and principally used in the United States. 2. To any "insured" who is not a resident of the United States. XXIV- WAIVER OF SUBROGATION Paragraph A.S. in SECTION IV- BUSINESS AUTO CONDITIONS does not apply to any person or organization where the Named Insured has agreed, by written contract executed prior to the date of accident, to waive rights of recovery against such person or organization. AC 84 07 05 09 Copyright 2008 Liberty Mutual. All rights reserved. Page 10 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 N 0 M 0, w �1'S2(MN12lG")2 g POLICY NUMBER: ASJ -Z91- 460046 -012 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS 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" under the Who Is An Insured Provi- sion 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 indi- cated below. Endorsement Effective: 10/1/2012 Countersigned By: Authorized Representative) Named Insured: Auburn Constructors, Inc SCHEDULE Name of Person(s) or Organization(s): Any person or organization from whom the Named Insured has agreed by written contract to include such person or organization as a designated insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ 4 0 u. O M 00 z w I P526W28(02 Policy Number: TBJ- Z91- 460046 -022 Issued by: WAUSAU UNDERWRITERS INS CO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON - CONTRIBUTORY — SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: Any person or organization as required by written contract. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule that is an additional insured on this policy, this policy will apply solely on the basis required by such written agreement If the applicable written agreement does not specify on what basis the liability insurance will apply, this insurance shall be excess over any other valid and collectible insurance available to the additional insured, whether such insurance is on an excess, contingent or primary basis. Condition 4 Other Insurance of Section IV is revised accordingly. LD 2410 0611 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. w 0 N w 0 -, 00 z w M Q P5261N128002 S WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US N L+. O d' This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 00 PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART Z SCHEDULE w Jame Of Person Or Organization: Any person or organization as required by written contract. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. This endorsement is cxccutcd 11 the Premium $ Fttecthv Dale 10!1/2012 For attachment Audit Ki'sis ExPiram,n Date 10/1/2013 t,sned To Auburn Constructors, Inc CG 24 04 05 09 Countcraigncd by SA, s ofhcc and No © Insurance Services Office, Inc., 2008 A.11 in,. Rcl -sc, -tier t:nd. sine./ \- Page 1 of 1 P52(AM28002 Policy Number TBJ- Z91- 460046 -022 Issued by WAUSAU UNDERWRITERS INS CO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY ENHANCEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Index of modified items: Item 1. Reasonable Force Item 2. Non -Owned Watercraft Extension Item 3. Damage To Premises Rented To You - Expanded Coverage Item 4. Bodily Injury To Co- Employees Item 5. Health Care Professionals As Insureds Item 6. Knowledge Of Occurrence Item 7. Notice Of Occurrence Item 8. Unintentional Errors And Omissions Item 9. Bodily Injury Redefinition Item 10. Supplementary Payments — Increased Limits Item 11. Property In Your Care, Custody Or Control Item 12. Mobile Equipment Redefinition Item 13. Newly Formed Or Acquired Entities Item 14. Blanket Additional Insured Where Required By Written Contract Lessors of Leased Equipment Managers or Lessors of Premises Mortgagees, Assignees or Receivers Owners, Lessees or Contractors Architects, Engineers or Surveyors Any Person or Organization Item 15. Blanket Additional Insured — Grantors Of Permits Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement Item 17. Other Insurance Amendment Item 18. Contractual Liability - Railroads Item 1. Reasonable Force Exclusion a. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Item 2. Non -Owned Watercraft Extension Paragraph (2) of Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: (2) A watercraft you do not own that is: LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 1 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. hi. a N G�. v0 z w r526(X)28(X)2 (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge; Item 3. Damage To Premises Rented To You - Expanded Coverage A. The final paragraph of 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. B. Paragraph 6. of Section III — Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You Limit is the greater of: a. $300,000; or b. The Damage To Premises Rented To You Limit shown on the Declarations. C. Paragraph 9.a. of the definition of "insured contract" in Section V — Definitions is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'. D. The paragraph immediately following Paragraph (6) of exclusion j. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage) to premises, including the contents of such premises, rented to 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 III — Limits of Insurance. Item 4. Bodily Injury To Co- Employees A. Paragraph 2. of Section II - Who Is An Insured is amended to include: Each of the following is also an insured: Your supervisory or management "employees" (other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company)) are insureds while in the course of their employment or while performing duties related to the conduct of your business with respect to "bodily injury": (1) To you; (2) To your partners or members (if you are a partnership or joint venture); LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Nszearzsaiz (3) To your members (if you are a limited liability company); or (4) To a co- "employee" or "volunteer worker" while that co- "employee" or "volunteer worker" is either in the course of his or her employment by you or while performing duties related to the conduct of your business (including participation in any recreational activities sponsored by you). 0 N w 0 10 Your "employees" (other than either your "executive officers" (if you are an organization other than a 00 partnership, joint venture or limited liability company) or your managers (if you are a limited liability company)) or "volunteer workers" are insureds while in the course of their employment or while performing duties related w to the conduct of your business for a Good Samaritan Act that results in "bodily injury": (1) To you; (2) To your partners or members (if you are a partnership or joint venture); (3) To your members (if you are a limited liability company); or (4) To a co- "employee" or "volunteer worker" while that co- "employee" or "volunteer worker" is either in the course of his or her employment by you or while performing duties related to the conduct of your business (including participation in any recreational activities sponsored by you). A Good Samaritan Act means an attempt to rescue or aid a person in imminent or serious peril, provided the attempt is not recklessly made. However, none of these "employees" (including supervisory or management "employees ") or "volunteer workers" are insureds for the providing or failure to provide professional health care services. B. The insurance provided by this Item 4. will not apply if the injured person's sole remedy for such injury is provided under a workers' compensation law or any similar law. C. Other Insurance The insurance provided by this Item 4. is excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis. Item 5. Health Care Professionals As Insureds A. Paragraphs 2.a.(1)(a) and (d) of Section II - Who Is An Insured do not apply to "bodily injury" or "personal and advertising injury" arising out of the providing of or failure to provide professional health care services by any "employee" or "volunteer" of the Named Insured who is a "designated health care provider" if the "bodily injury" or "personal and advertising injury' occurs in the course and scope of the "designated health care provider's" employment by the Named Insured. B. With respect to "employees" and "volunteer workers" providing professional health care services, the following exclusions are added to Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability and Paragraph 2. Exclusions of Section I — Coverage B — Personal And Advertising Injury Liability: This insurance does not apply to: (1) Liability assumed under an "insured contract" or any other contract or agreement; (2) Liability arising out of the providing of professional health care services in violation of law; (3) Liability arising out of the providing of any professional health care services while in any degree under the influence of intoxicants or narcotics; (4) Liability arising out of any dishonest, fraudulent, malicious or knowingly wrongful act or failure to act; or LC 04 43 05 12 © 2012 Liberty Mutual Insurance. All rights reserved. Page 3 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P526""28(X)2 (5) Punitive or exemplary damages, fines or penalties. C. The following definition is added to Section V - Definitions: "Designated health care provider" means any "employee" or "volunteer worker" of the Named Insured whose duties include providing professional health care services, including but not limited to doctors, nurses, emergency medical technicians or designated first aid personnel. D. Other Insurance The insurance provided by this Item 5. is excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis. Item 6. Knowledge Of Occurrence Knowledge of an "occurrence" by your agent, servant or "employee" will not in itself constitute knowledge by you unless your "executive officer" or "employee" or other third party designated by you to notify us of "occurrences" has knowledge of the "occurrence ". Item 7. Notice Of Occurrence For purposes of Paragraph 2.a. of Section IV - Conditions, you refers to an "executive officer" of the Named Insured or to the "employee" designated by the insured to give us notice. Item 8. Unintentional Errors And Omissions Unintentional failure of the Named Insured to disclose all hazards existing at the inception of this policy shall not be a basis for denial of any coverage afforded by this policy. However, you must report such an error or omission to us as soon as practicable after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. Item 9. Bodily Injury Redefinition The definition of "bodily injury" in Section V - Definitions is replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time; and b. Mental anguish, shock or humiliation arising out of injury as defined in Paragraph a. above. Mental anguish means any type of mental or emotional illness or distress. Item 10. Supplementary Payments - Increased Limits Paragraphs 1.b. and 1.d. of Section I - Supplementary Payments - Coverages A And B, are replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit" including substantiated loss of earnings up to $500 a day because of time off from work. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 4 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. w 0 N w 0 00 z w P52(AX)28(K)2 g - Item 11. Property In Your Care, Custody Or Control 0 N A. Paragraphs (3) and (4) of exclusion j. of Section I — Coverage A — Bodily Injury and Property Damage Liability o only apply to: 1. "Property damage" to borrowed equipment, or v, 2. "Property damage" to property in your care, custody and control while in transit. z w B. This insurance does not apply to any portion of a loss for which the insured has available any other valid and collectible insurance, whether primary, excess, contingent, or on any other basis, unless such other insurance was specifically purchased by the insured to apply in excess of this policy. C. Limits of Insurance Subject to Paragraphs 2., 3., and 5. of Section III — Limits Of Insurance, the most we will pay for insurance provided by Paragraph A., above is: $10,000 Each Occurrence Limit $25,000 Aggregate Limit The Each Occurrence Limit for this coverage applies to all damages as a result of any one "occurrence" regardless of the number of persons or organizations who sustain damage because of that "occurrence ". The Aggregate Limit is the most we will pay for the sum of all damages under this Item 11. Item 12. Mobile Equipment Redefinition The definition of "Mobile Equipment" in Section V — Definitions is amended to include self - propelled vehicles with permanently attached equipment less than 1000 pounds gross vehicle weight that are primarily designed for: (1) Snow removal; (2) Road Maintenance, but not construction or resurfacing; or (3) Street cleaning. Item 13. Newly Formed Or Acquired Entities Paragraph 3. of Section II — Who Is An Insured is replaced by the following: 3. Any organization, other than a partnership or joint venture, you newly acquire or form and over which you maintain majority ownership or majority interest will qualify as a Named Insured if there is no other similar insurance available to that organization. a. Coverage under this provision is afforded only until: (1) The 180th day after you acquire or form the organization; (2) Separate coverage is purchased for the organization; or (3) The end of the policy period, whichever is earlier. b. Coverage A does not apply to "bodily injury' or "property damage" that occurred before you acquired or formed the organization; and LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 5 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. F.,..... c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. Item 14. Blanket Additional Insured Where Required By Written Contract Paragraph 2. of Section II - Who Is An Insured is amended to add the following: e. Additional Insured by Written Contractor Written Agreement The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). (2) Managers or Lessors of Premises: Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent acts or omissions of you, your "employees ", your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land; or (b) Any premises for which coverage is excluded by endorsement. (3) Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4) Owners, Lessees or Contractors: any person(s) or organization(s) to whom you are obligated by a written agreement to procure additional insured coverage, 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 your "employees ", your agents, or your subcontractors, in the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage ", or "personal and advertising injury" arising out of "your work" included in the "products- completed operations hazard" unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused, in whole or in part, by your acts or omissions or the acts or omissions of your "employees ", your agents, or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 6 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P52(AX)2W12 If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if N the applicable law would allow you to indemnify the additional insured for liability arising out the additional o insured's sole negligence. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or oo surveying services, including: - Z `17 (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. (5) Architects, Engineers or Surveyors: any architect, engineer, or surveyor engaged by you 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: (a) In connection with your premises; or (b) In the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: . (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. (6) Any Person or Organization Other Than a Joint Venture: Any person or organization (other than a joint venture of which you are a member) for whom you are obligated by a written agreement to procure additional insured coverage, 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: (a) In the performance of your ongoing operations; or (b) In connection with premises owned by you. This insurance does not apply to: 1. Any construction, renovation, demolition or installation operations performed by or on behalf of you, or those operating on your behalf; 2. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs, specification or the performance of any other professional services by such person or organization; or 3. Any person or organization more specifically covered in Paragraphs e.(1) through (5) above. The insurance afforded to any person or organization as an insured under this Paragraph 2.e.: (1) Applies only to coverage and minimum limits of insurance required by the written agreement or written contract, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 7 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P52Ng211"12 (2) Does not apply to any person or organization for any "bodily injury", "property damage" or "personal and advertising injury' if any other additional insured endorsement attached to this policy applies to that person m 0 or organization with regard to the "bodily injury', "property damage" or "personal and advertising injury'; w 0 00 (3) Applies only if the "bodily injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed, subsequent to the execution of the written agreement; and 0, (4) Applies only if the written agreement is in effect at the time the "bodily injury" or "property damage" occurs, or at the time the offense giving rise to the "personal and advertising injury" is committed. z w Item 15. Blanket Additional Insured — Grantors Of Permits Paragraph 2. of Section II - Who Is An Insured is amended to add the following: Any state, municipality or political subdivision with respect to any operations performed by you or on your behalf, or in connection with premises you own, rent or control and to which this insurance applies, for which the state, municipality or political subdivision has issued a permit. However, this insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury" or "property damage" included within the "products - completed operations hazard ", except when required by written contract or agreement initiated prior to loss; or 3. "Bodily injury", "property damage" or "personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf. Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery because of payments we make under this policy for injury or damage arising out of your ongoing operations or "your work" included in the "products- completed operations hazard" that we may have against any person or organization with whom you have agreed in a written contract or agreement to waive your rights of recovery but only if the "bodily injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed subsequent to the execution of the written contract or agreement. Item 17. Other Insurance Amendment If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV — Conditions will not apply. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence ", claim or "suit ". Item 18. Contractual Liability — Railroads Paragraph 9. of Section V - Definitions is replaced by the following: 9. "Insured Contract" means: LC 04 43 05 12 © 2012 Liberty Mutual Insurance. All rights reserved. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P526W28W2 a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily o occupied by you with permission of the owner is not an "insured contract'; o a, b. A sidetrack agreement; c. Any easement or license agreement; 00 d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a w municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failing to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 9 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date Is Indicated below. (The following' attaching clause' need be completed only when this endorsement is issued subsequent to preparation of the pdcy). This endorsement, effective 12:01 AM 0110112012 forms a part of Pollcy N o . 21417654 Issued to Auburn Constructors, Inc. By Commerce & Industry Insurance Company We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2 % of t)e total estimated workers compensation premium for this policy. WC 04 03 61 (Ed.11 -90) Countersigned by Aulhorized Representative CO C N LL. O z w r— V5261M12X(X12 SUPP (05/04) EK DA SUPPLEMENT TO CERTIFICATE OF INSURANCE to /o /2012 NAME OF INSURED: Auburn Constructors, Inc. Additional Description of Operations /Remarks from Page 1: The Producer will endeavor to mail 30 days written notice to the Certificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose n obligation or liability of any kind upon the Producer or otherwise alter the policy terms. Additional Information: General Liability: Blanket Additional Insured Contractors - Form LC 04 43 05 12 Primary and Non Contributory Form LD 24 10 06 11 Blanket Additional Insured Lessor of Leased Equipment - Form LC 04 43 05 12 Blanket Waiver of Subrogation - Form CG 24 04 05 09 AUTO LIABILITY Blanket Additional insured - Form CA 20 48 02 99 Blanket Waiver of Subrogation - Form AC 84 07 05 09 WORKERS' COMPENSATION Waiver of Subrogation - Form WC 04 03 61 (Ed. 11 -90) Statutory State(s): California SUPP (05/04) EK P52MIU2WX)2 Gallagher Construction Services/ Market St., Spear Tower #200 San Francisco, CA 94105 Electronic Service Requested MIXED ADC 950 1685 3.8783 MB 1.237 11i11111111111111 Jill 1111 Jill Jill 111i Jill Noll 11111111i111111INIII South County Regional 84 Wastewater Authority 1500 SOUTHSIDE DRIVE GILROY, CA 95020 -7042 This document was brought to you by Gallagher Construction Services in San Francisco, CA. via CertificatesNow. The data included in this notice and in the attached document is confidential to Ebix and Gallagher Construction Services in San Francisco, CA.- Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate. - If you have questions regarding the content of this document, please contact: Gallagher Construction Services Main Phone:(415) 391 -1500 Email: gcssfcerts @ajg.com- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ContirmNet.com - 877.669.8600 WANI w 0 N w 0 z w Nsxialsool 1 ® DATE(MMIDDIYYYY) A� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0726293 1- 415- 391 -1500 CONTACT NAME: Gallagher Construction Services/ PHONE 415 - 391 -1500 FAX 415 - 391 -1882 Arthur J. Gallagher & Co. Insurance Brokers of CA Inc. (AR;, No, fxt): (AIC, No): 1 Market St., Spear Tower #200 E -MAIL csafcerts @a com ADDRESS: g jg• San Francisco, CA 94105 INSURER(S) AFFORDING COVERAGE NAICR THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT INSURERA: WAUSAU UNDERWRITERS INS CO .26042 INSURED INSR ! ADDLI,SUBR': POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY ! INSURERB: National Union Fire Ins CO Of Pitts '19445 Auburn Constructors, Inc. 10/03/13 EACH OCCURRENCE $ 1,000,000 INSURER C: COMMERCE & INDUSTRY INS CO 19410 i 730 West Stadium Lane COMMERCIAL GENERAL LIABILITY INSURER D: PREMISES (Ea occurrence) $ Sacramento, CA 95834 ! INSURER E:' MED EXP (Any one person) $ 5,000 INSURER F: Cr1VFRAr:FR CFRTIFICATF NIIMRFR• 29524258 RFVISION NIIMRFR- !! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 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. INSR ! ADDLI,SUBR': POLICY EFF LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY ! POLICY EXP i LIMITS MMIDDIYYYY A GENERAL LIABILITY X X TBJ -Z91- 460046 -022 10 /O3 /1� 10/03/13 EACH OCCURRENCE $ 1,000,000 g ! DAMAGE TO RENTED I 300, 000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ I,I CLAIMS -MADE X OCCUR ! MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: !! PRODUCTS - COMP /OP AGG $ 2,000,000 EC POLICY � X 1 PRO- I LOC ! $ A AUTOMOBILE LIABILITY X �!, X ASJ -Z91- 460046 -012 10/01/1 10/01/131 COMBINED SINGLE LIMIT 1,000,000 I (Ea accident) $ X ANY I BODILY INJURY (Per person) $ ALL OWNED. SCHEDULED j !BODILY INJURY (Per accident), $ ! AUTOS AUTOS X '. NON -OWNED III X ! PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Comp /Coll Ded: $ 1,000 B X UMBRELLA LIAR X OCCUR ICI X 11 �BE 14505387 10/Ol/l71 10/01/131 EACH OCCURRENCE i $ 2,000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 2,000,000 i DIED , X RETENTION $ 10, 000 - $ WORKERS COMPENSATION C AND EMPLOYERS' LIABILITY X !21417654 O1 /O1 /1 01 /Ol /13i X' WC STATU- ' !OTH -. TORY LIMITS, ER YIN ANY PROPRIETORIPARTNER/EXECUTIVE '.. E.L. EACH ACCIDENT $ 1,000,000 OFFICERNEMBER EXCLUDED? ❑ INIA (Mandatory in NH) !! '�, 11 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 !, If yes, describe under ! DESCRIPTION OF OPERATIONS below ! E L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Reclamation and West Generators Replacement, Project No 12 -PW -193 ADDDITIONAL INSURED : SCRWA, SCRWA's employees , officers, design consultants, elected officials, construction Manager, agents and Subconsultants GtK I RIGA 1 It HULUtK South County Regional Wastewater Authority 1500 Southaide Drive Gilroy, CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Pravegcs 29524258 0 N O N u^, z w P52(0028W2 Policy# ASJ -Z91- 460046 -012 Effective Date: 10/01/2012 Named Insured: Auburn Constructors, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Liberty EXPRESSSM Auto Enhancement Endorsement This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. Newly Acquired or Formed Organizations II. Employees as Insureds 111. Lessor - Additional Insured and Loss Payee IV. Supplementary Payments - Increased Limits V. Fellow Employee Coverage VI. Personal Property of Others VII. Additional Transportation Expense and Cost to Recover Stolen Auto VIII. Airbag Coverage IX. Tapes, Records and Discs Coverage X. Audio, Visual and Data Electronic Equipment Coverage XI. Physical Damage Deductible - Single Deductible XII. Physical Damage Deductible - Glass XIII. Physical Damage Deductible - Vehicle Tracking System XIV. Duties in Event of Accident, Claim, Suit or Loss XV. Unintentional Failure to Disclose Hazards XVI. Worldwide Liability Coverage - Hired and Nonowned Autos XVII. Hired Auto Physical Damage XVIII. Auto Medical Payments Coverage Increased Limits XIX. Drive Other Car Coverage - Broadened Coverage for Designated Individuals XX. Rental Reimbursement Coverage XXI. Notice of Cancellation or Nonrenewal XXII. Loan /Lease Payoff Coverage XXIII. Limited Mexico Coverage XXIV. Waiver of Subrogation I. NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words you and your also refer to any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership of more than 50 percent interest, provided: A. There is no similar insurance available to that organization; B. Unless you notify us to add coverage to your policy, the coverage under this provision is afforded only until: 1. The 90th day after you acquire or form the organization, or 2. The end of the policy period, whichever is earlier; and C. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS Paragraph A. 1. Who Is An Insured of SECTION 11 - LIABILITY COVERAGE is amended to add: Your "employee" is an insured while using with your permission a covered "auto" you do not own, hire or borrow in your business or your personal affairs. AC 84 07 05 09 Copyright 2008 Liberty Mutual. All rights reserved. Page 1 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. M 0 N N oo z w P526002K(X)2 XXIII. LIMITED MEXICO COVERAGE WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE LAWS OF MEXICO ONLY - NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR BEYOND 25 MILES FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. A. Coverage 1. Paragraph B. 7 of SECTION IV - BUSINESS AUTO CONDITIONS is amended by the addition of the following: The coverage territory is extended to include Mexico but only if all of the following criteria are met: a. The "accident" or "loss" occurs within 25 miles of the United States border; and b. While on a trip into Mexico for 10 days or less; 2. For coverage provided by this Section of the endorsement, Paragraph B.S. Other Insurance in SECTION IV - BUSINESS AUTO CONDITIONS is replaced by the following: The insurance provided by this endorsement will be excess over any other collectible insurance. B. Physical Damage Coverage is amended by the addition of the following: If a "loss" to a covered "auto" occurs in Mexico, we will pay for such 'loss" in the United States. If the covered "auto" must be repaired in Mexico in order to be driven, we will not pay more than the actual cash value, of such "loss" at the nearest United States point where the repairs can be made. C. Additional Exclusions The following additional exclusions are added: This insurance does not apply: 1. If the covered "auto" is not principally garaged and principally used in the United States. 2. To any "insured" who is not a resident of the United States. XXIV- WAIVER OF SUBROGATION Paragraph A.S. in SECTION IV- BUSINESS AUTO CONDITIONS does not apply to any person or organization where the Named Insured has agreed, by written contract executed prior to the date of accident, to waive rights of recovery against such person or organization. AC 84 07 05 09 Copyright 2008 Liberty Mutual. All rights reserved. Page 10 of 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 N 0 M 00 w �P521�N12N/N12 POLICY NUMBER: ASJ -Z91- 460046 -012 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS 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" under the Who Is An Insured Provi- sion 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 indi- cated below. Endorsement Effective: 10/1/2012 Countersigned By: Authorized Re resentative Named Insured: Auburn Constructors, Inc SCHEDULE Name of Person(s) or Organization(s): Any person or organization from whom the Named Insured has agreed by written contract to include such person or organization as a designated insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ w 0 N Q M C P52WX)28(XJ2 Policy Number: TBJ -Z91- 460046 -022 Issued by: WAUSAU UNDERWRITERS INS CO o N THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. O e PRIMARY AND NON - CONTRIBUTORY — SCHEDULED ADDITIONAL INSURED 0, This endorsement modifies insurance provided under the following: w COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: Any person or organization as required by written contract. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule that is an additional insured on this policy, this policy will apply solely on the basis required by such written agreement If the applicable written agreement does not specify on what basis the liability insurance will apply, this insurance shall be excess over any other valid and collectible insurance available to the additional insured, whether such insurance is on an excess, contingent or primary basis. Condition 4 Other Insurance of Section IV is revised accordingly. LD 2410 0611 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. QP52UM2MX)2 E WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US N FL 7 This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART 10 SCHEDULE w Name Of Person Or Organization: Any person or organization as required by written contract. nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. Tim endorsement is , m cuu.d bs the Premium 5 Eftecuve Date 10/1/2012 For attachment Audit Ilasis Fxplrauun rhlt 10/1!2013 I� nedT<, Auburn Constructors, Inc CG 24 04 05 09 (.ountcraigncd by SA, ORic, and \u_ © Insurance Services Office, Inc., 2008 \.,I,( Rcprescn'A, h1d. Scrial Ate. Page 1 of 1 V5241X)21M1"2 Policy Number TBJ- Z91- 460046 -022 k 1 Issued by WAUSAU UNDERWRITERS INS CO N w THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY ENHANCEMENT FOR CONTRACTORS 00 This endorsement modifies insurance provided under the following: w COMMERCIAL GENERAL LIABILITY COVERAGE PART Index of modified items: Item 1. Reasonable Force Item 2. Non -Owned Watercraft Extension Item 3. Damage To Premises Rented To You - Expanded Coverage Item 4. Bodily Injury To Co- Employees Item 5. Health Care Professionals As Insureds Item 6. Knowledge Of Occurrence Item 7. Notice Of Occurrence Item 8. Unintentional Errors And Omissions Item 9. Bodily Injury Redefinition Item 10. Supplementary Payments — Increased Limits Item 11. Property In Your Care, Custody Or Control Item 12. Mobile Equipment Redefinition Item 13. Newly Formed Or Acquired Entities Item 14. Blanket Additional Insured Where Required By Written Contract Lessors of Leased Equipment Managers or Lessors of Premises Mortgagees, Assignees or Receivers Owners, Lessees or Contractors Architects, Engineers or Surveyors Any Person or Organization Item 15. Blanket Additional Insured — Grantors Of Permits Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement Item 17. Other Insurance Amendment Item 18. Contractual Liability - Railroads Item 1. Reasonable Force Exclusion a. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Item 2. Non -Owned Watercraft Extension Paragraph (2) of Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: (2) A watercraft you do not own that is: LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 1 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. �PSZ�xizxui2 (a) Less than 55 feet long; and (b) Not being used to carry persons or property for a charge; Item 3. Damage To Premises Rented To You - Expanded Coverage A. The final paragraph of 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits Of Insurance. B. Paragraph 6. of Section III —Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner. The Damage To Premises Rented To You Limit is the greater of: a. $300,000; or b. The Damage To Premises Rented To You Limit shown on the Declarations. C. Paragraph 9.a. of the definition of "insured contract" in Section V — Definitions is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or subsequent damages resulting from such fire, lightning or explosion including water damage to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract'. D. The paragraph immediately following Paragraph (6) of exclusion j. of Section I — Coverage A — Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning or explosion or subsequent damages resulting from such fire, lightning or explosion including water damage) to premises, including the contents of such premises, rented to 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 III — Limits of Insurance. Item 4. Bodily Injury To Co- Employees A. Paragraph 2. of Section II - Who Is An Insured is amended to include: Each of the following is also an insured: Your supervisory or management "employees" (other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company)) are insureds while in the course of their employment or while performing duties related to the conduct of your business with respect to "bodily injury": (1) To you; (2) To your partners or members (if you are a partnership or joint venture); LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 0 P5261X12K1X12 (3) To your members (if you are a limited liability company); or u. 0 (4) To a co- "employee" or "volunteer worker" while that co- "employee" or "volunteer worker" is either in the o course of his or her employment by you or while performing duties related to the conduct of your business (including participation in any recreational activities sponsored by you). Your "employees" (other than either your "executive officers" (if you are an organization other than a 1, partnership, joint venture or limited liability company) or your managers (if you are a limited liability company)) `O or "volunteer workers" are insureds while in the course of their employment or while performing duties related > to the conduct of your business for a Good Samaritan Act that results in "bodily injury": z w (1) To you; (2) To your partners or members (if you are a partnership or joint venture); (3) To your members (if you are a limited liability company); or (4) To a co- "employee" or "volunteer worker" while that co- "employee" or "volunteer worker" is either in the course of his or her employment by you or while performing duties related to the conduct of your business (including participation in any recreational activities sponsored by you). A Good Samaritan Act means an attempt to rescue or aid a person in imminent or serious peril, provided the attempt is not recklessly made. However, none of these "employees" (including supervisory or management "employees ") or "volunteer workers" are insureds for the providing or failure to provide professional health care services. B. The insurance provided by this Item 4. will not apply if the injured person's sole remedy for such injury is provided under a workers' compensation law or any similar law. C. Other Insurance The insurance provided by this Item 4. is excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis. Item 5. Health Care Professionals As Insureds A. Paragraphs 2.a.(1)(a) and (d) of Section II - Who Is An Insured do not apply to "bodily injury" or "personal and advertising injury" arising out of the providing of or failure to provide professional health care services by any "employee" or "volunteer" of the Named Insured who is a "designated health care provider" if the "bodily injury' or "personal and advertising injury' occurs in the course and scope of the "designated health care provider's" employment by the Named Insured. B. With respect to "employees" and "volunteer workers" providing professional health care services, the following exclusions are added to Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability and Paragraph 2. Exclusions of Section I — Coverage B — Personal And Advertising Injury Liability: This insurance does not apply to: (1) Liability assumed under an "insured contract" or any other contract or agreement; (2) Liability arising out of the providing of professional health care services in violation of law; (3) Liability arising out of the providing of any professional health care services while in any degree under the influence of intoxicants or narcotics; (4) Liability arising out of any dishonest, fraudulent, malicious or knowingly wrongful act or failure to act; or LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 3 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P526W29(X)2 (5) Punitive or exemplary damages, fines or penalties. C. The following definition is added to Section V - Definitions: "Designated health care provider" means any "employee" or "volunteer worker" of the Named Insured whose duties include providing professional health care services, including but not limited to doctors, nurses, emergency medical technicians or designated first aid personnel. D. Other Insurance The insurance provided by this Item 5. is excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis. Item 6. Knowledge Of Occurrence Knowledge of an 'occurrence" by your agent, servant or "employee" will not in itself constitute knowledge by you unless your "executive officer" or "employee" or other third party designated by you to notify us of "occurrences" has knowledge of the "occurrence ". Item 7. Notice Of Occurrence For purposes of Paragraph 2.a. of Section IV - Conditions, you refers to an "executive officer" of the Named Insured or to the "employee" designated by the insured to give us notice. Item 8. Unintentional Errors And Omissions Unintentional failure of the Named Insured to disclose all hazards existing at the inception of this policy shall not be a basis for denial of any coverage afforded by this policy. However, you must report such an error or omission to us as soon as practicable after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. Item 9. Bodily Injury Redefinition The definition of "bodily injury" in Section V - Definitions is replaced by the following: "Bodily injury" means: a. Bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time; and b. Mental anguish, shock or humiliation arising out of injury as defined in Paragraph a. above. Mental anguish means any type of mental or emotional illness or distress. Item 10. Supplementary Payments - Increased Limits Paragraphs 1.b. and 1.d. of Section I - Supplementary Payments - Coverages A And B, are replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit" including substantiated loss of earnings up to $500 a day because of time off from work. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 4 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. w 0 N CL W) 00 �o z w P52MK72WKR Item 11. Property In Your Care, Custody Or Control w 0 N A. Paragraphs (3) and (4) of exclusion j. of Section I — Coverage A — Bodily Injury and Property Damage Liability o only apply to: 1. "Property damage" to borrowed equipment, or 00 2. "Property damage" to property in your care, custody and control while in transit. ° z B. This insurance does not apply to any portion of a loss for which the insured has available any other valid and w collectible insurance, whether primary, excess, contingent, or on any other basis, unless such other insurance was specifically purchased by the insured to apply in excess of this policy. C. Limits of Insurance Subject to Paragraphs 2., 3., and 5. of Section III — Limits Of Insurance, the most we will pay for insurance provided by Paragraph A., above is: $10,000 Each Occurrence Limit $25,000 Aggregate Limit The Each Occurrence Limit for this coverage applies to all damages as a result of any one "occurrence" regardless of the number of persons or organizations who sustain damage because of that "occurrence ". The Aggregate Limit is the most we will pay for the sum of all damages under this Item 11. Item 12. Mobile Equipment Redefinition The definition of "Mobile Equipment" in Section V — Definitions is amended to include self - propelled vehicles with permanently attached equipment less than 1000 pounds gross vehicle weight that are primarily designed for: (1) Snow removal; (2) Road Maintenance, but not construction or resurfacing; or (3) Street cleaning. Item 13. Newly Formed Or Acquired Entities Paragraph 3. of Section II — Who Is An Insured is replaced by the following: 3. Any organization, other than a partnership or joint venture, you newly acquire or form and over which you maintain majority ownership or majority interest will qualify as a Named Insured if there is no other similar insurance available to that organization. a. Coverage under this provision is afforded only until: (1) The 180th day after you acquire or form the organization; (2) Separate coverage is purchased for the organization; or (3) The end of the policy period, whichever is earlier. b. Coverage A does not apply to "bodily injury' or "property damage" that occurred before you acquired or formed the organization; and LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 5 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FP524 ... c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. Item 14. Blanket Additional Insured Where Required By Written Contract Paragraph 2. of Section II - Who Is An Insured is amended to add the following: e. Additional Insured by Written Contract or Written Agreement The following are insureds under the policy when you have agreed in a written contract or written agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: The person(s) or organization(s) from whom you lease equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). (2) Managers or Lessors of Premises: Any manager or lessor of premises leased to you in which the written lease agreement obligates you to procure additional insured coverage. The coverage afforded to the additional insured is limited to liability in connection with the ownership, maintenance or use of the premises leased to you and caused, in whole or in part, by some negligent acts or omissions of you, your "employees ", your agents or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if the applicable law would allow you to indemnify the additional insured for liability arising out the additional insured's sole negligence. This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant in that premises or to lease that land; or (b) Any premises for which coverage is excluded by endorsement. (3) Mortgagees, Assignees or Receivers: Any person(s) or organization(s) with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of your premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. (4) Owners, Lessees or Contractors: any person(s) or organization(s) to whom you are obligated by a written agreement to procure additional insured coverage, 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 your "employees ", your agents, or your subcontractors, in the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage ", or "personal and advertising injury' arising out of "your work" included in the "products - completed operations hazard" unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused, in whole or in part, by your acts or omissions or the acts or omissions of your "employees ", your agents, or your subcontractors. There is no coverage for the additional insured for liability arising out of the sole negligence of the additional insured or those acting on behalf of the additional insured, except as provided below. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 6 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P526W2XW2 (b) Supervisory, inspection, architectural or engineering activities. (5) Architects, Engineers or Surveyors: any architect, engineer, or surveyor engaged by you 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: (a) In connection with your premises; or (b) In the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: - (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. (6) Any Person or Organization Other Than a Joint Venture: Any person or organization (other than a joint venture of which you are a member) for whom you are obligated by a written agreement to procure additional insured coverage, 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: (a) In the performance of your ongoing operations; or (b) In connection with premises owned by you. This insurance does not apply to: 1. Any construction, renovation, demolition or installation operations performed by or on behalf of you, or those operating on your behalf; 2. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs, specification or the performance of any other professional services by such person or organization; or 3. Any person or organization more specifically covered in Paragraphs e.(1) through (5) above. The insurance afforded to any person or organization as an insured under this Paragraph 2.e.: (1) Applies only to coverage and minimum limits of insurance required by the written agreement or written contract, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 7 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. If the written agreement obligates you to procure additional insured coverage for the additional insured's sole negligence, then the coverage for the additional insured shall conform to the agreement, but only if o the applicable law would allow you to indemnify the additional insured for liability arising out the additional Cq o insured's sole negligence. This insurance does not apply to "bodily injury', "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: z (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, w surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. (5) Architects, Engineers or Surveyors: any architect, engineer, or surveyor engaged by you 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: (a) In connection with your premises; or (b) In the performance of your ongoing operations. This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: - (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. (6) Any Person or Organization Other Than a Joint Venture: Any person or organization (other than a joint venture of which you are a member) for whom you are obligated by a written agreement to procure additional insured coverage, 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: (a) In the performance of your ongoing operations; or (b) In connection with premises owned by you. This insurance does not apply to: 1. Any construction, renovation, demolition or installation operations performed by or on behalf of you, or those operating on your behalf; 2. Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of the preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs, specification or the performance of any other professional services by such person or organization; or 3. Any person or organization more specifically covered in Paragraphs e.(1) through (5) above. The insurance afforded to any person or organization as an insured under this Paragraph 2.e.: (1) Applies only to coverage and minimum limits of insurance required by the written agreement or written contract, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 7 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P5261M121NN12 (2) Does not apply to any person or organization for any "bodily injury", "property damage" or "personal and advertising injury' if any other additional insured endorsement attached to this policy applies to that person o or organization with regard to the "bodily injury', "property damage" or "personal and advertising injury"; w 0 (3) Applies only if the "bodily injury" or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed, subsequent to the execution of the written agreement; and 00 (4) Applies only if the written agreement is in effect at the time the "bodily injury" or "property damage" occurs, or at the time the offense giving rise to the "personal and advertising injury" is committed. z w Item 15. Blanket Additional Insured — Grantors Of Permits Paragraph 2. of Section II - Who Is An Insured is amended to add the following: Any state, municipality or political subdivision with respect to any operations performed by you or on your behalf, or in connection with premises you own, rent or control and to which this insurance applies, for which the state, municipality or political subdivision has issued a permit. However, this insurance does not apply to: 1. "Bodily injury', "property damage" or "personal and advertising injury" arising out of operations performed for the state, municipality or political subdivision; 2. Any "bodily injury" or "property damage" included within the "products - completed operations hazard ", except when required by written contract or agreement initiated prior to loss; or 3. "Bodily injury", "property damage" or "personal and advertising injury", unless negligently caused, in whole or in part, by you or those acting on your behalf. Item 16. Waiver Of Right Of Recovery By Written Contract Or Agreement The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery because of payments we make under this policy for injury or damage arising out of your ongoing operations or "your work" included in the "products - completed operations hazard" that we may have against any person or organization with whom you have agreed in a written contract or agreement to waive your rights of recovery but only if the "bodily injury' or "property damage" occurs, or offense giving rise to "personal and advertising injury" is committed subsequent to the execution of the written contract or agreement. Item 17. Other Insurance Amendment If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV — Conditions will not apply. Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence ", claim or "suit ". Item 18. Contractual Liability — Railroads Paragraph 9. of Section V - Definitions is replaced by the following: 9. "Insured Contract" means: LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. P526""284"12 a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily o occupied by you with permission of the owner is not an "insured contract'; o b. A sidetrack agreement; c. Any easement or license agreement; 10 d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a > Z municipality; W e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failing to render professional services, including those listed in Paragraph (1) above and supervisory, inspection, architectural or engineering activities. LC 04 43 0512 © 2012 Liberty Mutual Insurance. All rights reserved. Page 9 of 9 Includes copyrighted material of Insurance Services Office, Inc., with its permission. �P52G......X12 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is Indicated below, (the following' attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 0110112012 forms a part of Policy N o . 21417654 Issued to Auburn Constructors, Inc. By Commerce & Industry Insurance Company We have a right to recover our payments from anyone liable for an irqury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2 % of tie total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by (Ed.11 -90) Authorized Representative l P52o(e)28(9)2 SUPP (05/04) 50 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/04/2012 NAME OF INSURED: Auburn Constructors, Inc. Additional Description of Operations /Remarks from Pale 1: The Producer will endeavor to mail 30 days written notice to the Certificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date. Failure to do so shall impose n obligation or liability of any kind upon the Producer or otherwise alter the policy terms. Additional Information: When required by Written Contract GENERAL LIABILITY: Blanket Additional Insured Contractors - Form LC 04 43 05 12 Primary and Non Contributory Form Form LD 24 10 06 11 Blanket Additional Insured Lessor of Leased Equipment - Form LC 04 43 05 12 Blanket Waiver of Subrogation - Form CG 24 04 05 09 AUTO LIABILITY: Blanket Additional Insured - Form CA 20 48 02 99 Blanket Waiver of Subrogation - Form AC 84 07 05 09 WORKERS' COMPENSATION: *Waiver of Subrogation - Form WC 04 03 61 (Ed. 11 -90) Statutory State(s): California SUPP (05/04) 50 P5260028(X)2 Gallagher Construction Services/ I Market St., Spear Tower #200 San Francisco, CA 94105 20121W91414 Electronic Service Requested MIXED ADC 950 1685 3.8783 MB 1.237 Irl11111111111llunlllllll1llllll1 fill Niel llllll11ifIfIIIII��ll South Countyy Regional 84 Wastewater Authorit 1500 SoUTHSIDE DRIVE GILROY, CA 95020 -7042 EBIX BPO This document was brought to you by Gallagher Construction Services in San Francisco, CA. via CertificatesNow. The data included in this notice and in the attached document is confidential to Ebix and Gallagher Construction Services in San Francisco, CA.- Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate. - if you have questions regarding the content of this document, please contact: Gallagher Construction Services Main Phone:(415) 391 -1500 Email: gcssfcerts @ajg.com- cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ConfirmNet.com - 877.669.8600 0 N w 0 00 w