OMI - Insurance Certificate (2020)P5260028002
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""''�,... CERTIFICATE OF LIABILITY INSURANCE I
06/06/2019
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 have ADDITIONAL INSURED provisions or 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 #0437153 1-212-948-1306 CONTACT
NAME:
Marsh Risk & Insurance Services PHONE FAX 1-212-948-1306
CIRTS_SupportCaj acobs . com (A/C, No, W: (A/C. No):
E-MAIL
633 W. Fifth Street ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
Los Angeles, CA 90071 INSURER A:ACE AVER INS CO 22667
INSURED INSURER B :
OPERATIONS MANAGEMENT INTERNATIONAL, INC.
INSURER C :
9191 South Jamaica Street INSURERD:
INSURER E :
Englewood, CO 80112-5946 INSURERF:
COVERAGES CERTIFICATE NUMBER: 56406539
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 ADDL SUBR POLICY EFF
LTR TYPE OF INSURANCE I= WVD POLICY NUMBER (MM/DD/YYYY)
POLICY EXP
(MWDDNMI
I LIMITS
A X COMMERCIAL GENERAL LIABILITY HDO G71565129 07/01/19
07/01/20
EACH OCCURRENCE
$ 7,000,000
DAMAGE
CLAIMS -MADE � OCCUR
I PREMISESS (RENTED
PREMISESEa occurrence)
$ 500, 000
X CONTRACTUAL LIABILITY
I MED EXP (Any one person)
$ 5,000
_
I PERSONAL & ADV INJURY
$ 7,000,000
GENI AGGREGATE LIMIT APPLIES PER:
I GENERAL AGGREGATE
$ 10, 000, 000
X
POLICY PRO- ❑
JECT LOC
I PRODUCTS - COMPlOP AGG
$ 10, 000, 000
OTHER:
$
A AUTOMOBILE LIABILITY ISA H25295511 07/01/19
07/01/20
COMBINED SINGLE LIMIT
(Ea accidentl
$ 2,000,000
X ANY AUTO
I BODILY INJURY (Per person)
$
OWNED SCHEDULED
_ AUTOS ONLY AUTOS
I BODILY INJURY (Per accident)
$
HIRED NON -OWNED
PROPERTY DAMAGE
$
- AUTOS ONLY AUTOS ONLY
(Per accident)
UMBRELLALIAB
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$
EXCESS LIAR
I AGGREGATE
$
DED I I RETENTION $
I
$
WORKERA
SCF C65892327 (WI) 07/01/19
07/01/20
X I STATUTE I I ERER H
YERS'LSATIONILIT
AND EMPLOYERS' LIABILITY
AND
A ANYPROPRIETORIPARTNER/EXECUTIVE WCUC65892285
07/01/20 I
1,000,000
(AX,LA,OH,T:{Q'F/01/19
OFFICER/MEMBEREXCLUDED? IN I NIA
A (Mandatory In NH) WLR C65892248 (AOS) 07/01/19
E.L. EACH ACCIDENT
07/01/20 I 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 / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
LOCATION: Englewood, CO. CONTRACT ADMINISTRATOR: Brett Rester. RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER.
IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN
CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. *$2,250,000
SIR for states of: LA, OH, TX. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL
NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.*
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE
GILROY, CA 95020 lz;��
USA C '
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Cert_Reneval
56406539
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TM H. THE MM PMN:.RUD It CAMFULLY.
F-fit r .. 1�: `•
Nam of* Penn or Orpnizadafts Any girth or nit r whom any .� u fir .b ;
or a,�.t t pmd ire tred:' t� .: �... a tie 018yeement do"
not I is a palletgarIMOMIWe Sw&,e Orpnization. FQ ) to W APPW to twr Mwitww immnd Suto.
.Who U.. (... incf anti i Whowmil the "edule, but
the instmoa. shall not ex : Nope of wyeragen4j. limits 0.41his ft� NoMthswnding the :f d n t ,
Ih to id s at the trtt n e s �d �n surer moo th s of the nd Wits
g ,.
by � n rut r ro to and t �: � m, , ON OCe of ap t ;mot t in.. . t
or Wit, en & � �, .6 limited to the: ai ��t�� �«� �� ��� .j �� ty to the mat d.►medy ca. ed by
the Naowd Insured'. � 4oft the Named. InwtvOls ongoiag operadom. This hmur ,w shad.
minft to tht, . t r t by d trad ,t, ri an r w n or f�� UCe I' t4ned. by
VA a' to .il. b r t1w hi.prance ktm.nr t tw tt :P i Sid
.trail A . ea
Me the comma or agpeeml provida that. the aftional insured's wope of cavemp Is for
Indeniftity abliptiont, andtrsuh ttr or L thatt tUOhCOVOI%&oli be hwt 1-t : ttw aunt ouch in4mnky
NOW14standing.f0mgOing MAtenw, in no amut Shall Insured
ri
Notwiffistanding. anything to khe co the a n sadwanal Mwrej Under We en&rftment shall be
Emoted. to the Wr4mr U e: ti :: uired to be pro the Kmed fmiinider the Witten wntrad or
P5260028002
A00110NAL MUM - DESIGNATED PERSONS OR ORGAMWONS
.. . .......... . ...... . . ......
s Enginewing Group :Inc. L. asamed Nuntwu
. ... . ......
Wiftf No
Dow 4.1 Ermdanett*t
io 0710:V2020
issued so ter fir A& 0.
ACE American krisuransce Company
..........
THM ENDORSEMENT CHANCES THE POUCY. PLEASE READ IT CAMPMLY,
THIS ENDORUMM MODM$ INSURANCE PROVIDED UNDER THE FOLLOWINO;
FMWI�
Addilloln:al [naurtm*), Anyperson or Whom yw hav
to Mckid o as an additionas, irlaured-, v .4
write cc n* -act, vovWed such contf act was. execulk pdbt' -to thil date of loss'-projed— anor cord.ram, Ali Pfcom anor
onleacts where you porf0m. work lof Such additional insured pars es to arty such wfiften eoftad.
A
'Orgft n 'named i
vft 15 For: a.
n
Ws endomerr*n11 Howmr, these petgloAs -w b%anktabons :ate an InsurW on'ty -faf. 'bAdy ir4*ut.y*" or *propssty
I YICW
2.
3, Any pat W "ling a covered:'4auW vwb pernission It= yoga anv of your "Oovloyagents,
C With Mpect to 11he iosarance affix*d.ter thm additi-wout-1 insLffadg� the foillowing oes;
if merage provWed to the ad"innal Inswed. is fequired: by a wwracj or agreenwi, the ov4%1. we wol pay on
be-holf: of the additions] 1A6LO-ed is the am vuM4. -of inguraAeff.
1, Requiredll by th* contract ov agasm. wi.,t; -or
Z, Available undof the PI"-ble Livift -d has miance.-shomn-in the Decla' aLion s,
wtkchevef is less.
if such additional inswod's. scopo of C-Wirs": is not expfes9(kded: in, a contract or agrah emont, thin sW4
Wyamp is Nmiced to the addibarW insured's vitMms hability to the -sxtorl &e*r catud by the Nerrmd
lrftreds neghganco d1wM0 #* Named loswedB orgoirq Wersbarn s, This insurance. &hall *bapdr-ri-ormjrance
to the went requWed by said conlrad or a0rosmant, a0d: Ony rAhef insivrance or self -in, sufance nminWned by
I Pom-on or oroanizablon shM be nonconlributary #Alh We insurame. prowed he M-un., der 10 #* 04". t
specAed in said contract ag(eament.
MOO IhO 000act -or agifftmerit WM. es 1hat the jaddlWIrml. msvrod's sco -, of: t-v-vv(aqe i f r he :"ame .
.0 - s 9 t d
ured's in -do. mr My obligati -oft undAr SuOh* contrac.l. Or then: such cow..rage shaft to fimijw to .11ho
Wdent awch inderrmity Wigatorm are enforceable: undes apf"bla law.
MS-606-21: (0-17flfi) CC.N*4. '"wlo' ml figmt faerm.w. Plage 1 of I
P5260028002
1
E NUW9 III
AGAINST OTHERS TO US
Memo Of w. Or R,, v pown or owobWo apint wbomyou r<r. 'a;,' to
tight dmewotyE: w Waal omb watad was executed pdor to the w.* o. low
CC 24 04 0 0$
Page I of 1
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P5260028002
WANER dry TRANSFER
Rp N RECOVERY A yH
HERIS
Mimim
kA 0 :...:.
18 2901I
r�
ACE
nsuranm
This ErWorsemeM modifts Irourince pfoijWW under the faIloMs
any fight of (W"sFy we owv hmag*w ow
��pear O a hear 1 . 0 60`tear c u * of
payments we make bfinjW -or dama" `g
Iry the '6 ..,
WHED «:
you h* d to waive your fl.gt'tt d reo7my In a WfAten roaftld, prowded
such CWfaa wn "muted pnof b the date of IIS.
DA 31'*'
P5260028002
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Workers' Compensation and Employers' Liability Policy
Named Insured Endorsement Number
JACOBS ENGINEERING GROUP INC.
1000 WILSHIRE BOULEVARD SUITE 1000 Policy Number
LOS ANGELES CA 90017 Symbol: WLR Number: C65892248
Policy Period Effective Date of Endorsement
07-01-2019 TO 07-01-2020 07-01-2019
Issued By (Name of Insurance Company)
ACE AMERICAN INSURANCE COMPANY
Insert the ;olio nunter_ The reminder of tt* €r:forrnation is to be completed on �ern this endorseavnt is issued subseq
uent to she preparation of the policy.
CALIFORNIA WAIVER OF OUR. RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
:This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.Ar of
the Information Page.
.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 Sehedulej but this waiver applies only with respect
to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract
to obtain this waiver from us,
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the
work described in the Schedule,.
Schedule
Specific Waiver
Name of person or organization:
.) Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this
waiver,
2. Operations:.
ALL OPERATIONS CONDUCTED BY AN INSURED PURSUANT TO SUCH WRITTEN CONTRACT
.: Premium.
The premium charge for this endorsement shall be 2.0 percent of the California premium developed on
payroll in connection with work performed for the above person(s) or organization(s) arising out of the
operations described,
4.. Minimum Premium: ;i O_,_.....,,.,„a
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P5260028002
NOTICE TOOTRERS ENDORSEMENT— SCHEDULE— EMAIL ONLY H.
IRWIN, 771"I"i''111 n
A. If f**. ca-rical... the RI prior lo its ex. ion... Me by nobcato. you, w the first Kamoj;wswa, . fix soy mg
d 01
Pital
nonpayment of premium, we will erideavof, as, set otit below, to *and wrMen notice of cancellation, , such elsocnic
adifiegimi as we 6jidsfm", to tl powsms or ergon-Ltaboa i1stedift the schadole. that., yo or oyotit mptowt. u we
pnN.j.d.e or have pmwded to us (Ift 'Sclhedt We), You or: Y
ovir representafin nAst praWde us with the eq"'l address
of such pwson,4 or organizat'ws.ano we will size such &-mg address that you: ix your ropreorialAm provided:,to
!44 01) etoult
8. D* &-hoWle MLW:bo IndiallY Ptovided to us AI 16 days 016r.
LThe WginnWq ofthe Porway qwW, dMendwsem. erdis ave as of such date; or
it.. *TNO Wd0MfMn1t hag bMn added to. If* P011C , 4' Ibis, onI Wr 'S e
r P*y p&.tW
Ve %
CAI The Schodulemustbairk: an and mUS060murate,
D. Our delivery of the notffixation as. described in. Pars h A. of IN's end'o.sement aril ad Mo i t)e bas oo nmr en
9TV rec t
Sd,odula in our,towds as of the dAe ft notiCe of concelMon is ruiled or dekwmd lo the firm Named hisutod.
:to E.
the Schedule at lea. 30 day% pfiat to ft w(*k*jjon:da1q opplicable to tW Policy,
F. Thenotice rekre. Inced in the erW=I is iftaded only to be. a coudesy natilleafion to: the. per* .. on.
orgamiration(t) �amsd in ft "edole in Ile everot of a perKling cancellation of cavvap, We hoo no *ol
obligafim of any kind to any such: peis*s) or Ixgandzadw(s). Out'failure to pmvWs advawo now.0,fiDn of
ta000labon to the :PaMW($) or 0fq6Nz#i*r(Q SNW in ft Schedulle shall impose noobi shon of habft of any
kind upon us, our &Wts or f"sent *ves. will wit e4and any Polky cmu*aon, date and will W negate. my
C.W$_WlWi0" or#* Poll.
G. We are W responsible for voe*ng any Iftionaafion P*vdW to us in any 80hedule, nor are. we rewonsible for any
J r4oaod inbnotion I hot -yov at ywr rop rewtafte p rovide. to �tm . 0 yw, - or gout re preu- ntafive ckan vio p *w0e U.- s
with a Srhedule. wo have no repY for Wing any Adon undaithis ONorument, In acid.lition, # neAhm- you.
nor your (epr6sentative pmvidea us wAh e-mail addrow intbnmilan w4h feVect to a: parCcuW "moo or
annizalloft, Own Wo Shall hoo.. IV t.0%WsU14. -W tAing actionactionnth mpid Io such persm or entity under I.I.M.S
endarsement.
H. We may arrartge with )vur reptesenWwo to send timh Wice, in the evW of arty such, cane D.Nion,
1. You it coopetale Mb us -in pr ing ths SEWOU14, & in- eft- 61%%your tep m.- sentafive la p rq.VWa If* Sobedule..
J, Ibis endomemaInt dm:rwt ap* in the evem that you cancel ft Poficy,
ALL4268.5 (OtIll 1)
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P5260028002
ALL : .(tlll) Pap 2 Of
P5260028002
NOr]E TOT14OTsOHER$ 5DRSEMENT SCHWULE EMAIL ONLY 0
in , sumo Gfo I i I # w --
;3 CN
6A M
2-1 f
1-DIM-12019 10 .0 U112020.
ACE Ao"twinsviranos Cwparry
OtAwd L*4 WOOD *4"dM, IM40 is wow 646.5wom 10 *w of V* 004
A It., we -Canwl the Policy p4or 4.0 Its-awpirejon d by- Aoke-- to you or.#*.. fim - w ''m
ed .Insureqj tv re onother than.
rftpayqwt d W&MM. we wix ermiewar, as silt out below, to SwW wMan motto
A014110Wbfi as WO 4d6ft0w, to lh# p6rions or orpoz V.ia S-pCh 1predro(k,
Wign$ 1196d 00 the schodWe that you: i>r yoLij reprent -Vq
ptovide or have providdd to us pfaftW 1&
uW), YOU: W YOUt -rWeseftMe. flit p ' M.v,40 us With thOl 014hikil adth-en..
U0 such:per-sons Cw organizabOns,And we WA Utilize such O-MOR address that you, w ptepr M�.ur %64;,g pfovi , t.
. 0 an Sclodute,
'Thy Sdhed0la:nw84.ba-Jh10a .0 V 6 da 6 W. , ter.
... Ry- provklsd t W.-INA 1
y
bevitwifl.0 of the pqk,.y parkAif this ondow .1 emeM.— is. a ffao.ja @ .S 7 U.
11- ThiO 0nWr*W*fit: he$ been added to the Poair y, ff jhfS andomegWrA jS effecUft 0(fWr the p0goy patiodi
WnMeACOS,
Ck The Schedule rnust,00 in an# r f0mlim that if# 0ocWab*, to ws; *ad ow# be amwgo,
0, Ow dOlw" Of #W Wfik*lm as de=ibed In Rwbgraph &at this endoftement will be: 1336ed On tha moll pe, cent
Scheduloiri our meatdtfix' qfttW djt6t4*jDQNQG ofganCeWaa 43, MaNd or dieWeted to th e . firgt hinted Wwrod,
E. We Will "mdoftnar to send sugh rwtire to the, 6-jrah 44dra*$ Corr goporid ing I-$ agwh perW or wglaf-448hort liusted j"
the Schodulo at hmst 3o d&Vg pf.jor to thg.,caticall
able to.# w
F. The. hefico rate.." w-ed in . jo . 1h . eadOMOM861 irftrdad nt* to bO a 'GOufl"Y ndkaWn 10 tt* Peison(s) or
OfWizdfi*VARMW in Om Schedule In. the qvtnj of a Pending cancelWon, of c go,, W6. hava no l"Al
Oblotion of a Wfiw(15.) Cw organizabw4s), Our wwe 10 proviftad.v&." no"
Ity kirw to: any Such, ,Colon
oncolligim to the pia iwnVia)'Of lxpnizakh(s) .00'wn in th6 64heduleshaff ipnpos im of 53 i.
tadUP011 ut,,,OW* agenU w mpmeN e no objigs�t b, of, any
AM, wW TO exMrtd MY P064- OrWeRaWn date and wig not n6ple any
CammHaw: of the Poo,
0, We &to not mspons4ble brwo4is* my wom*�w povided to us in arvy. 60edUAr , or $to We tg$'Dn 0W .p -6e f.W.Jy
incortact intp m.0lan that you ox your mpnmntq"'- pmvidb toij , if rApr
wnt"tpro.
with Wulo, wamitt to - nslbkot taking Aq acfan mrdwthis eVmemart. 1haAlom, if aejtW you
new VOW t"- NOntoWe pfavides vo Wth. 0-metill addnm hilkAM01104 wNh te.Weet to U mor) of
-019aflizOWN VW WO ShO have no reepamiNity #or tgjdng: attion v art C lat pe, ,
4h reprd to- such: w000 or 0 -th
ip "gly jur�dgt �is
V% may wrapp wo pug rwasentalwoto MW twh .110lice -in . any such G w-4-wtian,
YOU w4h 000POrWe with U4 in Providing th# Schadul . e, or lilt cau$ing Your M.Pr"Iertlotivie W prowi-de tw $aod uov.
,4 IN$ ondwmgymwt dog$ poigpply in . yl2u cwg* ljV pdiry.
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P5260028002
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P5260028002
aid! fimpkjo.rsl UaNfity Pphoy
'N'UMtW
JACOBS ENGINEERM GROUP INC,
1000 MLISMAE SOULEVI SUFTE I DDO
LOS ANGELESCA 90017
symw: VVLR Numbm., C65892248
..........
07-0-14011 TO.- (17-014020 107-0t.2019
..... . ... .. . . . ....... .....
ACE AMERICA,N INSURANCE 0004PAW
Th*q.IVM
...........
A. lif we cancel this Poky print to b apitration date hy AWO to you or the first Named iftwreo for any resson ofhier Flan
nanvarment of premium, we "I ondeavor, as set out Wow, to send wrfte.n notice of cancallallion,Via, such elloWv nic
of canon as wo: determine, to the persons or otgarlizalion a lists in the schWtde tho-
yrou at: youl representafive
p m.Ode or have provided to ais #h-o 14-bedule), YOU 4.X y0of .m mi w1th the 0-Mail Oddress
of $..UC.h pemoas or organeadons, and we, wel vtiles -such.. e-ftmd addto" 1W yop or your reptesen(Wva Provided to
us on. ruch Schedule,,
days. aflet.
e., TheScIhedule-mustbe' I -
1. 11"bo Wgianniq if 4his eadorsernent, is effeam as ots-och date', or
11� This endw-,sem.tmt has. been added to the ltxojLq, if, this en—dmtaisnt ki Oective aftr the Policy Period
C, The Schedule must bd is Ort olic tomml: that is actoptobte to uc;, and must be ar"40tateI
0. oar kvery of the noffiI as describW in P"raph. A. of this andorgiernant will be be*ed on tho -most reorkk
Schedole in otw teraids a4 of the date the ftofica of cancellown is ryWed or d-erlivered to lbe-fir at NaModkiagired,
wgank-Mido indicated in
I address oarreVarAft to each pemon or
W VM1 onftavor to sendsvchriofice I to M .6-ty'all
the Sohadijle at lessi. 30 days p4of tothe cancehawtin: date apok. ablo to the Pdicy,
F, The jn� reWenced in this eadotse"rit is �n�a only to �'be a couftsy notficalion lo V* person(s) or
argai*aWa(s) home in 'the Schedule in the "ant of a pending cantL4afioh Of Iowa age. We hove* . no leg -al
obil : lion of arW kirW to any uch porson(3) of 0rg8n&3jj0n(t), Otjr failvre to rwavAe. advame, notificalian of
csncellatic n to ma perwofs) or organizahonM sho" in the Schedule shal Impose no obligation, or RaWlRy of any
koW,xvgeftrprw% M[:not et.n anelatima- tI not and.
C-atmalliatioll 04 the Poky,
0, 0�e are not, responsfile fat vort(ytog, any jpfmn toitto us in any Schodiule, riot art wa
,com%i Worm*on that you o your reprenr4ative provide 19 ut. 11 you or your IrWeserI d",sook pmvWt us
Wer this endos - In aftfim, 4 tiaither you.
nedule, vg* t�ave no responsWity for taking arry actiQn un
Wt y*W representative provides with a-maA addtasa Womefto Oreqlect 1,0 a particular pemon or
mtganizalkn,. then we, shalt have no, fft-. ponsibWAY. for tvoMng action with mqard' to petsDn, of 0 M. Uft of - fi soc OAAY d th 6
M. We may artange with your fepresenl4ve townd such nobee in the mnt of any such. can-aftfion.
t, You Mll cooperate nth us. in tie
ptovi. jing 1UWI 0, of io S'r Q.; "-,r repm Sent to pfav a ft. S-clvdUI
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J. This andorsemnent d W.S. W. apply kn itha -Ove ti t you -cancel -tho. P0410y.
All nth ertatm arx! conditions of this Poliq remain onchanged,
This Endorwmat Ls fwt applicahle in the states of AZ f L, IDO MECK., Nip NMjX and W1,
AuthddtW Repres-entaw
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P5260028002
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N DATE
SUPPLEMENT TO CERTIFICATE OF INSURANCE 06/06/2019
NAME OF INSURED: OPBRATIONB MANAGmmn INTERNATIONAL, INC.
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SUPP (10/00)