Loading...
COI - Bigge Crane and Rigging Co. - Expires 2023-04-01P5260028002 202204013915 CO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/29/2022 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 bo 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 CA LIC 0B29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) (San Ramon - Branch ID 14394] P. 0. Box 5003 San Ramon, CA 94583 INSURED Bigge Crane and Rigging Co. 10700 Bigge Avenue San Leandro, CA 94577 COVERAGES CERTIFICATE NUMBER: 64925277 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY CONTACT Certificates Department ADDRESS: ERICoerts@apicbrokers.com (A, Nol: 925.901. 0671c A(ANo. Ext925.244.7700 INSURER(S) AFFORDING COVERAGE INSURER A: SAFETY NAIL CAS CORP INSR LTR A X TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X I PRO. LOC OTHER: A AUTDMOBILELIABILITY X - ANY -AUTO - - - - OWNED AUTOS ONLY SCHEDULED AUTOS X HIRED NON -OWNED _ AUTOS ONLY AUTOS ONLY UMERELLALIAB EXCESS LIAR A OCCUR CLAIMS -MADE DEO I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN IN INSURER B : INSURER C : INSURER D : I INSURER E : I INSURER F NAIL # I15105 REVISION NUMBER: THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 3 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 'AID CLAIMS. ADDL'SUUR POLICY EFP INSDWVD POLICY NUMBER (MMIDDIYYYY) X X GL4064593 04/01/22 X X CA6675900 NIA X LDS4064592 POLICY EXP (MM/DDIYYYY) 04/01/23 04/01/22 04/01/23 04/01/22 LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS-COMP/OPAGG I $ $ 5,000,000 1,000,000 10,000 5,000,000 5,000,000 5,000,000 COMBINED SINGLE LIMIT I $ 5,000,000 (Ea accident) BODILY INJURY (Per person) 1 $ BODILY INJURY (Per accident) I $ PROPERTY DAMAGE $ /Per accident) EACH OCCURRENCE IAGGREGATE 04/01/23 X STATUTE I I OTH- ER I E.L. EACH ACCIDENT $ 2,000,000 I E,L,DISEASE- EAEMPLOYEEI $ 2,000,000 EL DISEASE- POLICY LIMIT $ 2, 000, 000 I$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Permits for Bigge Crane and Rigging Co. ADDITIONAL INSURED: City of Gilroy CERTIFICATE HOLDER City of Gilroy 7351 Rosanna St. Gilroy, CA 95020 ACORD 25 (2016/03) SHo-arc 64925277 CANCELLATION 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 USA O 1988-2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD P5260028002 SUPPLEMENT TO CERTIFICATE OF INSURANCE NAME OF INSURED:Rigge Crane and Rigging Co. Additional Description of Operations/Remarks from Paae 1: Additional information: DATE 03/29/2022 P526111128002 Policy Number: GL4064593 COMMERCIAL GENERAL LIABILITY CG20381219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional Insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above, Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This Insurance does not apply to: 1. "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. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, If the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG20381219 © Insurance Services Office, Inc., 2018 Page 1 of 2 P5260028002 3000 Executive Parkway Suite 325 San Ramon, CA 94583 Phone 925.244,7700 Fax 925,901,0244 To: From: Named Insured: Policy Number(s): RE: Whom it may concern EPIC Insurance Brokers & Consultants Bigge Group, Inc. GL4064593; CA6675900; LDS4064592 Notice of Cancellation Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Carel/CO i44J Senior Account Manager 925-244-7700 www.apIcbrokars,com I C,A License 0f329370 P3260"28002 Policy Number: GL4064593 COMMERCIAL GENERAL LIABILITY CG20401219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT (COMPLETED OPERATIONS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" performed for the additional insured described In Paragraph 1. or 2. above and included in the "products -completed operations hazard". However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured, B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, 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. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. CG 20 4012 19 O Insurance Services Office, Inc., 2018 Page 1 of 2 P526110281103 MIN no b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 0 Insurance Services Office, Inc., 2018 CG 20 38 12 19 P5260028002 POLICY NUMBER: GI, 4064593 COMMERCIAL GENERAL LIABILITY CG 20 01 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this Insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 P326U028UO2 C. With respect to the insurance afforded to these additional insureds, the following Is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable limits of insurance; whichever is less, This endorsement shall not increase the applicable limits of Insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 40 1219 P3260028002 POLICY NUMBER: GL4064593 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction ProJect(s): All of your "construction projects". However, the total Designated Con- struction Project General Aggregate Limit under this endorsement combined with the total Designated Location General Aggregate Limit under endorsement CG 25 04 attached to this policy, is capped at a maximum amount of $10,000,000 for the policy term. For the purposes of this endorsement, "construction project" means a jobsite (which is away from premises owned, rented or leased by the Named Insured) including premises Involving the same or connecting lots, or premises which connection is separated only by a road, street, waterway, or railroad easement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown In the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Protect General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown In the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. ENV 3570 6 OF 10 B CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 El '5200028002 OA POLICY NUMBER: GL 4064593 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Person(s) or Organization(s) as required by written contract when such written contract is executed prior to an occurrence, offense or loss to which this endorsement applies. Any individually scheduled Waivers shall not be construed to override nor negate this blanket Waiver. Information 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 0412 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 P32600271I1112 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED This endorsement modifies Insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Person(s) or Organization(s) as required by written contract, Any individually scheduled Designated Additional. Insured shall not be construed to override nor negate this blanket Designated Additional Insured, CHANGE The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: (1) Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury" or "property damage" arising out of your operations and resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are on premises owned or leased by the above scheduled Additional Insured(s). (2) The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (a) If the "accident" takes place subsequent to the execution and effective date of such written contract: and, (b) While such written contract is in force, or until the end of the policy period, which ever occurs first. (3) How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (a) The limits of insurance specified In the written contract or written agreement; or, (b) The Limits of Insurance provided by the Coverage Form. The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form, (4) Exclusions (a) This endorsement does not apply to liability of the Additional Insured which arises out of the ownership of transportation operating rights granted to the Additional Insured by public authority. (b) This endorsement does not apply to the liability of the owner or anyone else from whom you hire or borrow a covered auto. SNCA 026 10 13 Safety National Casualty Corporation Page 1 of 2 P4260028002 B. For all sums which the Insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included In the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned,delayed, or abandoned and then restarted, or If the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Pag0 of 2 O Insurance Services Office, Inc., 2008 CG 25 03 05 09 ❑ t'3260028002 POLICY NUMBER: CA 6675900 COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following; AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary; This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that; 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing In a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition In the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". CA 04 4911 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 P3260028002 (5) Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form, This endorsement does not alter coverage provided in the Coverage Form. 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 04/01/2022 Policy No. CA 6675900 Endorsement No. Named Insured Bigge Group, Inc. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By Page 2 of 2 Safety National Casualty Corporation SNCA 026 10 13 0 co z P5260028002 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recorder 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 °/0 of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE. Person or Organization Job Description Where a waiver of our right to recover from others is required by written contract, such additional entities shall be considered automatically scheduled by the Company. Individually scheduled waivers shall not be construed to override nor negate this blanket waiver, This endorsement changes the policyto which it is attached and is effective on the date issued unless otherwisestated. (1'he information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04/01/2022 Policy No, LDS4064592 Endorsement No. Insured BIGGE GROUP, INC. Insurance Company Safety National Casualty Corporation Countersigned By Premium $ Included INC 04 03 06 (04 84) 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Pagel of 1 P526(1028002 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS O.F RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE Name Of Person Or Organization: Person(s) or Organization(s) as required by written contract when such written contract is executed prior to an accident to which this endorsement applies. Any individually scheduled Waivers shall not be construed to override nor negate this blanket Waiver. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CHANGE 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 "bodily injury" or "property damage" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto", This waiver applies only to the person or organization shown In the Schedule above. 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 04/01/2022 Policy No. CA 6675900 Endorsement No. Named Insured Bigge Group, Inc. Premium $ Included. Insurance Company Safety National Casualty Corporation Countersigned By ENV 3570 9 OF 10 F SNCA 027 10 13 Safety National Casualty Corporation . Page 1 of 1 P52(,{10280112 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 000313 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT, SUCH ADDITIONAL ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED BY THE COMPANY. INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE THIS BLANKET WAIVER. This endorsementchanges the policyto which it is attached and is effective on the date issued unless otherwisestated. (1'he information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04/01/2022 Policy No, LDS4064592 Endorsement No. Insured BIGGE GROUP, INC. Premium $ Included InSUranCeCOMpany Safety National Casualty Corporation Countersigned By WC 00 03 13 (04 84) Page 1 of 1 © 1983 National Council on Compensation Insurance, M I 0