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JJR Construction - Insurance Certificates Client#:307587 JJRCONST ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)12/30/2011 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 CONTACT NAME: John Arents PHONE FAX LA/C,No,Ext):925-609-6500 WC,No): 925-609-6550 HUB Int'l Insurance Serv.Inc. E-MAIL P.O.Box 4047 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Concord,CA 94524-4047 INSURER A Wausau Underwriters Ins Co 26042 INSURED INSURER B:Liberty Insurance Corporation 42404 JJR Construction,Inc. Cypress Insurance Company CA 1120 9th Avenue INSURER C: YP I C P Y( ) 10855 San Mateo,CA 94402 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: AIGLAWU 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/Yl'YY) (MM/DD/YYYY) A GENERAL LIABILITY TBJZ91458282022 01/01/2012 01/01/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESO(Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 X PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X JECT LOC Project Agg $15,000,000 A AUTOMOBILE LIABILITY ASJZ91458282012 01/01/2012 01/01/2013 CBINE D SINGLE LIMIT 000 (EOMa accident) �1> >000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ B x UMBRELLA UAB X OCCUR TH7Z91458282032 01/01/2012 01/01/2013 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 _ DED X RETENTION$10000 $ C WORKERS COMPENSATION 3300060435121 01/01/2012 01/01/2013 X WC STAT AND EMPLOYERS'UABILITY y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Re:Sidewalk Improvement Project No.09-CDD-166 and Curb Ramp Improvement Project No.09-CCD-165. The City of Gilroy,its elected and appointed officers,officials,employees and volunteers as Additional Insured as respects General Liability,and coverage is Primary&Non-Contributory,per attached form LG 3180/0907(section 10).Auto Liability Additional Insured per CA2048/0299,primary wording per CA 00 01/0310.Workers Compensation Waiver of Subrogation per WC990410A.All as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Department ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy,CA 95020 AUTHORIZED REPRESENTATIVE E " PR ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1485724/M1471231 KM47 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIBERTY DirectSolutions for Contractors This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance by broadening the insurance provided by CG 00 01. Index of modified items: Item 1–REASONABLE FORCE Item 2.-NON-OWNED WATERCRAFT EXTENSION Item 3.-ALIENATED PREMISES Item 4.-PROPERTY IN YOUR CARE,CUSTODY OR CONTROL Item 5.-DAMAGE TO PREMISES RENTED TO YOU-EXPANDED COVERAGE Item 6.-BODILY INJURY TO CO-EMPLOYEES Item 7.-HEALTH CARE PROFESSIONALS AS INSUREDS Item 8.-NEWLY FORMED OR ACQUIRED ENTITIES Item 9.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—MANAGERS OR LESSORS OF PREMISES Item 10.-EXPANDED BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION(FOR INSTALLATION EXPOSURES) Item 11.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION–PERSON OR ORGANIZATION Item 12.-ADDITIONAL INSURED–ARCHITECTS,ENGINEERS OR SURVEYORS Item 13.-ADDITIONAL INSURED–STATE,MUNICIPALITY OR POLITICAL SUBDIVISION-PERMITS Item 14.-ADDITIONAL INSURED AND WAIVER OF SUBROGATION–LESSOR OF LEASED EQUIPMENT Item 15.-KNOWLEDGE OF OCCURRENCE Item 16.-UNINTENTIONAL ERRORS AND OMISSIONS Item 17.-BODILY INJURY REDEFINITION Item 18.-MOBILE EQUIPMENT REDEFINITION Item 19.-SUPPLEMENTARY PAYMENTS Item 20.-LIBERALIZATION These changes broaden the policy sections described unless differing language is separately endorsed to the coverage part. Item 1.-REASONABLE FORCE Exclusion a.of Coverage A 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 Subparagraph g.(2)of Exclusion g.of Coverage A(Section I-Coverages)is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 55 feet long;and (b) Not being used for public transportation or as a common carrier. Item 3.-ALIENATED PREMISES 1. Subparagraph j.(2) of Exclusions of Section I – Coverages – Bodily Injury And Property Damage Liability is replaced by the following. LG 3180 09 07 Page 1 of 8 (2) Premises you sell,give away,or abandon,if the"property damage"arises out of any part of those premises, and occurs from hazards that were known by you,or should have reasonably been known by you,at the time the property was transferred or abandoned. Item 4.-PROPERTY IN YOUR CARE,CUSTODY OR CONTROL 1. Subparagraphs(3)and(4)of exclusion j.of coverage A.do not apply except to (a) borrowed equipment,or (b) "property damage"to property in your care,custody and control while in transit. 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. 2. 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 1.,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 occurrences covered by this provision. Item 5.-DAMAGE TO PREMISES RENTED TO YOU-EXPANDED COVERAGE A.Fire,Lightning Or Explosion Damage The last paragraph of 2.Exclusions under Section I—Coverage A is replaced by the following: Exclusions c. through n. do not apply to damage to premises rented to you or temporarily occupied by you with permission of the owner when the damage is caused by fire, lightning, or explosion or subsequent damages resulting from such fire,lightning or explosion,including water damage. A separate limit of insurance applies to this coverage as described in Section III—Limits of Insurance. B.Limits for Damage to Premises Rented to You Paragraph 6.of Section III—Limits of Insurance is replaced by the following: Subject to 5.above,the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for any combination of: (a) damage caused by fire,lightning,or explosion or subsequent damages resulting from such fire, lightning or explosion,including water damage to premises rented to you,or temporarily occupied by you with permission of the owner,and (b) "property damage"(other than damage by fire)to premises,including the contents of such premises,rented to you for a period of 7 or fewer consecutive days. Item 6.-BODILY INJURY TO CO-EMPLOYEES 1. Subject to the Each Occurrence Limit and the General Aggregate Limit,Paragraphs 2.a.(1)(a),(b)and(c)of SECTION II—Who Is an Insured do not apply to your supervisory or management"employees"for"bodily injury"only. 2. Subject to the Each Occurrence Limit and the General Aggregate Limit,Paragraphs 2.a.(1)(a),(b)and(c)of SECTION II—Who Is an Insured do not apply to your"employees"or"volunteer workers"for"bodily injury" arising out of a Good Samaritan act to a co-"employee"or co-"volunteer worker." 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. Damages owed to an injured co-"employee"or"volunteer worker"will be reduced by any amount paid or available to the injured co-"employee"or"volunteer worker"under any other valid and collectible insurance. LG31800907 Page2of8 Item 7.-HEALTH CARE PROFESSIONALS AS INSUREDS Paragraph 2.a.(1)(d)of Section II–Who Is An Insured is deleted unless: (i) You are engaged in the occupation or business of providing or offering medical, surgical, dental, x-ray or nursing services,treatment,advice or instruction;or (ii) The"employee"has any other insurance that would also cover claims arising under this provision,whether the other insurance is primary,excess,contingent or on any other basis. Item 8.-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 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 i. the 180th day after you acquire or form the organization;or ii. separate coverage is purchased for the organization;or iii. 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 c. Coverage B does not apply to"personal and advertising injury"arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any past partnership, current or past joint venture or past limited liability company that is not shown as a Named Insured in the Declarations. Item 9.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—MANAGERS OR LESSORS OF PREMISES A. Section II–Who Is An Insured is amended to include as an insured any manager or lessor of premises leased by you in which the written lease agreement obligates you to procure additional insured coverage,provided that 1. the "bodily injury", "property damage" or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the agreement;and 2. the written agreement is in effect at the time of the "bodily injury", "property damage", "personal and advertising injury"for which coverage is sought. That person or organization shall be referred to as the additional insured. 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 "bodily injury", "property damage"or"personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured,except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence, then the coverage for the additional insured shall conform to that agreement;provided,however,that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. C. Exclusions This insurance does not apply to: 1. Any`occurrence"that takes place after you cease to be a tenant in that premises. LG 31 80 09 07 Page 3 of 8 2. Any construction,renovation,demolition or installation operations performed by or on behalf of the Additional Insured. 3. Any premises for which coverage is excluded by endorsement. D. Other Insurance The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage, including a defense,we shall share that right with the additional insured. Item 10.- EXPANDED BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION(FOR INSTALLATION EXPOSURES) A. Section II —Who Is An Insured is amended to include as an insured any person or organization to whom you are obligated by a written agreement to procure additional insured coverage,provided that: 1. the "bodily injury," "property damage," or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the written agreement;and 2. the written agreement is in effect at the time of the "bodily injury," "property damage," or "personal and advertising injury"for which coverage is sought That person or organization shall be referred to as the additional insured. The coverage afforded to the additional insured is limited to liability caused,in whole or in part,by the negligent acts or omissions of you,your employees,your agents,or your subcontractors,in the performance of your ongoing operations. This insurance does not apply to"bodily injury,"or"property damage,""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 the negligent acts or omissions of you,your employees, your agents,or your subcontractors. There is no coverage for the additional insured for "bodily injury", "property damage" or "personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured, except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence, then the coverage for the additional insured shall conform to that agreement;provided,however, that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. C. Exclusions With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: LG 31 80 09 07 Page 4 of 8 This insurance does not apply: 1.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 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. 2. to "bodily injury"or"property damage" that occurs during the ongoing operations of a project where you have purchased an Owners & Contractors Protective Liability or Railroad Protective Liability Policy for the additional insured. 3. when coverage is available under a consolidated(wrap up)insurance program in which you are involved. D.Other Insurance The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage, including a defense,we shall share that right with the additional insured. Item 11.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—PERSON OR ORGANIZATION A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization 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 those acting on your behalf: 1. In the performance of your ongoing operations;or 2. In connection with premises owned by you provided that: (a) the "bodily injury", "property damage" or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the agreement;and (b) the written agreement is in effect at the time of the"bodily injury", "property damage", "personal injury" or "advertising injury"for which coverage is sought. That person or organization shall be referred to as the additional insured. There is no coverage for the additional insured for "bodily injury", "property damage" or "personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured, except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence, then the coverage for the additional insured shall conform to that agreement;provided,however,that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. LG 31 80 09 07 Page 5 of 8 C. Exclusions This insurance does not apply to: 1. Any premises or equipment leased to you. 2. Any construction,renovation,demolition or installation operations performed by or on behalf of you,or those operating on your behalf. D.Other Insurance The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage,including a defense,we shall share that right with the additional insured. Item 12.-ADDITIONAL INSURED—ARCHITECTS,ENGINEERS OR SURVEYORS A. Section II—Who Is An Insured is amended to include as an additional insured 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: 1. In connection with your premises;or 2. In the performance of your ongoing operations. B. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: 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: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders,change orders or drawings and specifications;or 2.Supervisory,inspection,architectural or engineering activities. Item 13.-ADDITIONAL INSURED—STATE,MUNICIPALITY OR POLITICAL SUBDIVISION-PERMITS Section II—Who Is An Insured is amended to include as an additional insured any state, municipality or political subdivision with respect to any operations performed by you, or on your behalf, 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;or 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 14.-ADDITIONAL INSURED AND WAIVER OF SUBROGATION—LESSOR OF LEASED EQUIPMENT A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease equipment when you and such person or organization have agreed in a written agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured 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 or organization. There is no coverage for the additional insured for"bodily injury","property damage"or"personal and advertising injury" arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured. LG 31 80 09 07 Page 6 of 8 A person's or organization's status as an additional insured under this endorsement ends when the agreement with you for such leased equipment ends. B.Waiver of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for"bodily injury", "property damage" or "personal and advertising injury" caused,in whole or in part,by your maintenance, operation or use of MNIMMINO equipment leased to you by such person or organization. C. Other Insurance This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess, contingent or primary basis, unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event, this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage,including a defense,we shall share that right with the additional insured. Item 15.-KNOWLEDGE OF OCCURRENCE Subparagraph 2.a.,b. and c. of Condition 2. Section IV—Commercial General Liability Conditions are amended to add the following: As used in this paragraph,the word"you"refers to an"executive officer",partner,member or legal representative,and any other"employee"with insurance or risk management responsibilities. Item 16.-UNINTENTIONAL ERRORS AND OMISSIONS Paragraph 6.of Section IV—Commercial General Liability Conditions is amended to add the following: Any unintentional error or omission in the description of or failure to completely describe, any premises or operations intended to be covered by this policy will not invalidate or affect coverage for those premises or operations. However,you must report such 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 17.-BODILY INJURY REDEFINITION The definition of"bodily injury"in Section V-DEFINITIONS section is replaced by the following: "Bodily injury"means bodily injury,sickness or disease sustained by a person. It includes death or mental anguish, which results at any time from such physical harm,physical sickness or physical disease. Mental anguish means any type of mental or emotional illness or distress. Item 18.-MOBILE EQUIPMENT REDEFINITION Paragraph 12.f.(1) (a),(b)and(c)of Section V—Definitions does not apply to self-propelled vehicles of less than 1000 pounds gross vehicle weight. Item 19.-SUPPLEMENTARY PAYMENTS Section I - Coverages, Supplementary Payments - Coverages A and B,item 1. b. and 1. d., respectively, are replaced with: b. Up to$2,500 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. M 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. LG 31 80 09 07 Page 7 of 8 Item 20.-LIBERALIZATION Section IV-Commercial General Liability Conditions is amended to add the following: 10. Liberalization If we adopt a change in our forms or rule which would broaden your coverage without an extra charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such C broader coverage in your state. This endorsement is executed by the Premium $ Effective Date 01/01/2012 Expiration Date 01/01/2013 For attachment to Policy No. TBJZ91458282022 Audit Basis Issued To JJR Construction,Inc. SECRETARY t PRESIDENT Countersigned by Authorized Representative Issued Sales Office and No. End.Serial No. LG 31 80 09 07 Page 8 of 8 POLICY NUMBER: ASJZ91458282012 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 modi- fied 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 indicated below. Endorsement Effective: Countersigned By: 01/01/2012 Named Insured: JJR Construction, Inc. (Authorized Representative) SCHEDULE Name of Person(s)or Organization(s): Any person or organization where 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 • COMMERCIAL AUTO III b. Return the stolen property, at our ex- pense. We will pay for any damage that a. For any covered "auto" you own, this results to the "auto"from the theft; or coverage form provides primary insur c. Take all or any part of the damaged or ance. For any covered "auto" you don't stolen property at an agreed or appraised own, the insurance provided by this coy- value. erage form is excess over any other col- If we pay for the "loss", our payment will in- lectible insurance. However, while a cov- elude the applicable sales tax for the dam- ered "auto" which is a "trailer" is con- aged or stolen property. nected to another vehicle, the Liability Coverage this coverage form provides for 5. Transfer Of Rights Of Recovery Against the"trailer"is: Others To Us (1) Excess while it is connected to a mo- If any person or organization to or for whom tor vehicle you do not own. we make payment under this coverage form (2) Primary while it is connected to a has rights to recover damages from another, covered "auto"you own. those rights are transferred to us. That person or organization must do everything necessary b. For Hired Auto Physical Damage Cover- to secure our rights and must do nothing after age, any covered "auto" you lease, hire, "accident"or"loss"to impair them. rent or borrow is deemed to be a covered B. General Conditions "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with 1. Bankruptcy a driver is not a covered "auto". Bankruptcy or insolvency of the "insured" or c. Regardless of the provisions of Para- the "insured's" estate will not relieve us of any graph a. above, this coverage form's Li- obligations under this coverage form. ability Coverage is primary for any liability 2. Concealment, Misrepresentation Or Fraud assumed under an"insured contract". III This coverage form is void in any case of d. When this coverage form and any other fraud by you at any time as it relates to this coverage form or policy covers on the coverage form. It is also void if you or any same basis, either excess or primary, we other"insured", at any time, intentionally con- will pay only our share. Our share is the ceal or misrepresent a material fact concern- proportion that the Limit of Insurance of ing: our coverage form bears to the total of a. This coverage form; the limits of all the coverage forms and policies covering on the same basis. b. The covered "auto"; 6. Premium Audit c. Your interest in the covered "auto"; or a. The estimated premium for this coverage d. A claim under this coverage form. form is based on the exposures you told 3. Liberalization us you would have when this policy be- -= If we revise this coverage form to provide San. We will compute the final premium more coverage without additional premium due when we determine your actual ex- charge, your policy will automatically provide posures. The estimated total premium will be credited against the final premium due the additional coverage as of the day the re- and the first Named Insured will be billed vision is effective in your state. for the balance, if any. The due date for 4. No Benefit To Bailee – Physical Damage the final premium or retrospective pre- Coverages mium is the date shown as the due date We will not recognize any assignment or on the bill. If the estimated total premium grant any coverage for the benefit of any per- exceeds the final premium due, the first son or organization holding, storing or trans- Named Insured will get a refund. porting property for a fee regardless of any b. If this policy is issued for more than one — other provision of this coverage form. year, the premium for this coverage form Swill be computed annually based on our rates or premiums in effect at the begin- ning of each year of the policy. CA 00 01 03 10 © Insurance Services Office, Inc., 2009 Page 9 of 12 011387 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10A(Ed 07-07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2.00 %of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is$ 35n nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2012 Policy No. 3300060435-121 Endorsement No. 1 Insured JJR CONSTRUCTION, INC. Premium$ Insurance Company Countersigned by Cypress Insurance Company WC 99 04 10A (Ed 07-07)