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COI - Maggiora Bros. Drilling Inc. - Expires 2022-01-01Client#: 1567074 MAGGIBR01 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYM 1 /08/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Teresa Rose USI Insurance Services, LLC ac°"N , Ext:628 201-9001 610 537-2393 ac' "O 201 Mission St 11th FI E-MAIL usi.com.Rose _ADDRESS: Teresa @ San Francisco, CA 94105 628 201-9001 INSURER(S) AFFORDING COVERAGE NAIC t! INSURER A: National Fire Insurance Co. of Hartford 20478 INSURED Maggiora Bros. Drilling Inc. INSURER B . Continental Insurance Company 35289 595 Airport Boulevard INSURER C: Redwood Fire and Casualty Insurance Co. 11673 INSURER D : Nautilus Insurance Company 17370 Watsonville, CA 95076 INSURER E : Continental Casualty Company 20443 INSURER F : %,wr=KAsr t* CERTIFICATE NUMBER- D=%ficrf%ld A1111101000. VIYI• I•VI1Y�1\• 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 LTR TYPE OF INSURANCE ADDL,SUBR INSR_IWVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDD/YYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X U OCCUR i _ 4015556058 0110112021 01/01/202 I EACH OCCURRENCE DAMAGE TO RENTED PREMISES S Ea occurrence 151,000,000 $100 000 X PD Ded:5,000 MED EXP (Any one person) $15 000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 PRO- POLICY ECT I LOC GENERAL AGGREGATE 52,000,000 PRODUCTS - COMP/OP AGG 52,000,000 OTHER: 1/01/2021 01/01/202 $1,000,000 E AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS AUTOS ONLY X AUTOS ONLY X NON -OWNED AUTOS ONLY 4016912684 Ea a�aeMSINGLE LIMIT BODILY INJURY (Per person) S BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident S S S B X'I UMBRELLA LIAR X OCCUR 4016912670 1/01/2021 01/0112022 EACH OCCURRENCE $10,000,00Q AGGREGATE EXCESS LIAR CLAIMS -MADE $_1__0,000 QQ_Q_ DED K RETENTION $1 O 000 _- $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? �Y N/A MAWC232954 1/01/2021 01/01l202 X PER OTH- E.L. EACH ACCIDENT S1 ,000,000 _ E.L. DISEASE - EA EMPLOYEE S1,0001000 Mandatory In N (f yes, describe under I DESCRIPTION OF OPERATIONS below _ 3105/2020 03/05/2021 E.L. DISEASE - POLICY LIMIT S1,000,000 $1,000,000 Each Claim D _ Professional Liab _ _ _ CPP202831711 Pollution Liab $1,000,000 Each Occ $2,000,000 Aggregate DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Joanne C Maggiora, Vice President City of Gilroy, its officers, officials and employees is named as additional insured as respects general liability per endorsement attached. -- "`-" IrANLPr_LL.A 1 IUN City of Gilroy, its officers, officials and employees Attn: Sheila Castillo/Jeff Castro 7351 Rosanna Street Gilroy, CA 95020 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 ©'PA8-2015 ACORD CORPORATION_ All rinhfs rAcebrvArl ACORD 25 (2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S30918805/M30870999 PCCZP CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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 subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph 1. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. II1. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of. A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: I. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: UNA75079XX (10-16) Policy No: 4015556058 Page 1 of 2 Endorsement No: Insured Name: MAGGIORA BROS . DRILLING INC. Effective Date: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GNAM19XX (10-16) Policy No: 4015556058 Page 2 of 2 Endorsement No: Effective Date: Insured Name: MAGGIORA BROS . DRILLING INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. DNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE CONTRACT OR AGREEMENT TO WAIVE SUCH CONTRACT OR AGREEMENT: NAMED INSURED HAS AGREED IN WRITING IN A RIGHTS OF RECOVERY, BUT ONLY IF SUCH 1. IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS COVERAGE PART; AND 2. WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE OR PERSONAL AND ADVERTISING INJURY GIVING RISE TO THE CLAIM. (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75008XX (10-16) Page 1 of 1 Insured Name: MAGGIORA BROS . DRILLING INC. Policy No: 4015556058 Endorsement No: Effective Date: Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. r� w H CNA CNA PARAMOUNT General Aggregate Limit -Designated Projects Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction or Service Projects: EACH OF YOUR CONSTRUCTION PROJECTS LOCATED AWAY FROM PREMISES OWNED BY OR RENTED TO YOU Information required to complete this Schedule, if not shown above, will be shown in the Declarations. It is understood and agreed as follows: I. For each single designated construction or service project shown in the Schedule above, a separate Designated Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: A. all damages under Coverage A, except damages because of bodily injury or property damage included in the products -completed operations hazard; and B. all medical expenses under Coverage C; that arise from occurrences or accidents which can be attributed solely to ongoing operations at that designated project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the Designated Project General Aggregate Limit applicable to any other project. II. All: A. damages under Coverage B, regardless of the number of locations or projects involved; B. damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single designated project, except damages because of bodily injury or property damage included in the products -completed operations hazard; and C. medical expenses under Coverage C, caused by accidents which cannot be attributed solely to ongoing operations at a single designated project, will reduce the General Aggregate Limit shown in the Declarations. III. The limits shown in the Declarations for Each Occurrence, for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Project General Aggregate Limit or the General Aggregate Limit shown in the Declarations, depending on whether the occurrence can be attributed solely to ongoing operations at a particular designated project. IV. When coverage for liability arising out of the products -completed operations hazard is provided, any payments for damages because of bodily injury or property damage included in the products -completed operations hazard will CNA74826XX (1-15) Page 1 of 2 Policy No: 4015556058 Endorsement No: Effective Date: Insured Name: MAGGIORA BROS . DRILLING INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CNA CNA PARAMOUNT General Aggregate Limit -Designated Projects Endorsement reduce the Products -Completed Operations Aggregate Limit shown in the Declarations, regardless of the number of projects involved. V. If the applicable scheduled construction or service project has been abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, such project will still be deemed to be the same project. VI. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA74826XX (1-15) Policy No: 4015556058 Page 2 of 2 Endorsement No: Effective Date: Insured Name: MAGGIORA BROS . DRILLING INC. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc.. with its permission. POLICY NUMBER: 4016912684 SCA 23 500D (Ed. 10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT- BA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE A. Who Is An Insured The following Is added to Section 11, Paragraph B. A.1., Who is An.insured: 1. a. Any incorporated entity of which the Named Insured owns a majority of the voting stock on the date of Inception of this Coverage Form; provided that, b. The Insurance afforded by this provision A.I. does not apply to any such entity that is an "Insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of Its Inception date, whichever Is earlier. b. Does not apply to: (1) "Bodily Injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that is an "Insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are obligated to provide insurance where required by a written contract or agreement is an Insured, but only with respect to legal responsibility for acts or omissions of a person for whom liability Coverage is afforded under this policy. 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement In that "employee's" name, with your permission, while performing duties related to the conduct of your business. "Policy," as used in this provision A. Who Is An Insured, Includes those policies that were in force on the inception date of this Coverage Form but: C. 11. A. 1. Which are no longer In force; or 2. Whose limits have been exhausted. Ball Bonds and Loss of Earnings Section 11, Paragraphs A.2.a.(2) and A.2.a.(4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is Increased from $2,000 to $5,000, and 2. In a.(4), the limit for the loss of earnings is increased from $250 to $500 a day. Fellow Employee Section 11, Paragraph B.5 does not apply. Such coverage as Is afforded by this provision C. Is excess over any other collectible Insurance. PHYSICAL DAMAGE COVERAGE Towing Section 111. Paragraph A.2., is revised to Include Light Trucks up to 10,000 pounds C.V.W. B. Glass Breakage — Hitting A Bird Or Animal -- Falling Objects Or Missiles The following Is added to Section Ill, Paragraph A.3.: With respect to any covered "auto;' any deductible shown in the Declarations will not apply to glass breakage If such glass is repaired, In a manner acceptable to us, rather than replaced. C. Transportation Expenses Section Ill, Paragraph A.4.a. Is revised, with respect to transportation expense incurred by you, to provide: a. $60 per day, In lieu of $20; subject to b. $1,800 maximum, in lieu bf $600. D. Loss of Use Expenses Section III, Paragraph A.4.b. Is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600, E. Personal Property The following is added to Section ili, Paragraph A.4. SCA 23 5001) Copyright, CNA CoWoratlon, 2000. Page 1 of 3 (Ed. 10/11) Inctudes copytIghted motorfal of tho Insurance Sory m oiitco Mod Vft Its pormission. CNA SCA 23 500D (Ed. 10111) c. We will pay up to $500 for loss to Personal a. Any covered "auto" you lease, hire, rent or Property which is; borrow without a driver; and (1) Owned by an "insured"; and b. Any covered "auto" hired or rented by your (2) In or on the covered "auto." "employee" without a driver, under a contract In that Individual "employee's" This coverage applies only In the event of a total name, with your permission, while theft of your covered "auto." performing duties related to the conduct of This Insurance Is excess over any other your business. collectible insurance and no deductible- applies. c. The most we will pay for any one "accident" F. RentaI Reimbursement or "lass" Is the actual cash value, cost of repair, cost of replacement or $76,000 The following Is added to Section III, Paragraph whichever is less minus a $500 deductible AA.: for each covered auto. No deductible d. We will pay for rental reimbursement expanses applies to "loss" caused by fire or lightning. Incurred by you for the rental of an "auto" because of "loss" to a covered "auto." Payment d. The physical damage coverage as Is applies In addition to the otherwise applicable provided by this provision will be limited to amount of each coverage you have on a the types of physical damage coverage(s) covered "auto." No deductibles apply to this provided on your owned "autos." coverage. e. Such physical damage coverage for hired 1. We will pay only for those expenses "autos' will: Incurred during the policy period beginning 24 hours after the "loss" and ending, (1) Include loss of use, provided it is the "accident" regardless of the policy's expiration, with the consequence of an for which the Named Insured Is legally liable, and lesser of the following number of days: as a result of which a monetary loss is (a) The number of days reasonably sustained by the leasing or rental required to repair or replace the concern. covered "auto"; or, (2) Such coverage as is provided by this (b) 15 days. provision G.e.(1) will be subject to a 2. Our payment is limited to the lesser of the limit of $750 per "accident." following amounts: H. Alrbag Coverage (a) Necessary and actual expenses The following is added to Section Ill, Paragraph incurred; or, 8•3• (b) $25 per day subject to a maximum of The accidental discharge of an airbag shall not be $375. considered mechanical breakdown. 3. This coverage does not apply while there 1. Electronic Equipment are spare or reserve "autos" available to you for your operations. Section 111, Paragraphs B.4.c and B.4.d. are deleted and replaced by the following: 4. If "loss" results from the total theft of a covered auto of the private passenger c. Physical Damage Coverage on a covered "auto" "loss" type, we will pay under this coverage only also applies to to any permanently Installed electronic equipment that amount of your rental reimbursement including Its antennas and other expenses which is not already provided for accessories under the Physical Damage Coverage Extension. d. A $100 per occurrence deductible applies to G. Hired "Autos" the coverage provided by this provision. The following Is added to Section Ill. Paragraph A.: �• ,Iiminution In Value S. Hired "Autos" The following is added to Section III, Paragraph B.6. It Physical Damage coverage is provided under Subject to the following, the "diminution in value" this policy, and such coverage does not extend exclusion does not apply to: to Hired Autos, then Physical Damage coverage is extended to: SCA 23 500D Copyrlght, CIVA CoMorallon, aoao. Page 2 of 3 (Ed. 10/11) Includes copialghted matorial of the Insurance services office used wkh its permission. CNA a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee' without a driver for a period of 30 days or less, under a contract in that Individual "employee's' name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution In value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or incomplete maintenance or repairs; or the installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" In any one accident is the lesser of: (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV) Iil. Drive Other Car Coverage— Executive Officers The following is added to Sections 11 and III: 1. Any "auto" you don't own, hire or borrow Is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while In the care, custody or control of, any of your "executive of€icers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision will be: (1) Equal to the greatest of those coverages afforded any covered "auto"; and (2) Excess over any other collectible Insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws or any other slmilar SCA 23 500D (Ed. 10/11) governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are "insureds" while using a covered "auto" described In this provision. IV. BUSINESS AUTO CONDITIONS A. Duties in The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a. (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" Is known to you or If you are not an individual, to any of your executive officers or partners or your Insurance manager. The following is added to Section IV, Paragraph A2.b. (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless receipt of such documents Is known to you or If you are not an Individual, to any of your executive officers or partners or your insurance manager. B. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph 13.2. Your failure to disclose all hazards existing on the date of Inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omission is not intentional. C. Policy Period, Coverage Territory Section IV, Paragraphs 7.(5).(a). Is revised to provide: a. 45 days of coverage in lieu of 30 days V. DEFINITIONS Section V. Paragraph C. is deleted and replaced by the following: "Bodily Injury" means bodily injury, sickness or disease sustained by a person, including mental anguish, mental injury or death resulting from any of these SCA 23 500 D copyright. CNA Corparatfon, 2WD. Page 3 of 3 (Ed. 10/11) Includes copyrlphtod malarial of the Insurance Servloos office used Wth its permission. CNA WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MAGGIORA BROS. DRILLING INC. Endorsement Effective Date: 01 /01 /2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. Form No: CA 04 44 10 13 Policy No: BUA 4016912684 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: Endorsement No: 5; Page: 1 of 1 Policy Page: 54 of 151 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 0 Copyright Insurance Services Office, Inc., 2011 Cd a 0 C a� w a� a� a� a� too a W WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 0410 C (Ed. 01-19) 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 calculated by applying a factor of 2% to the total manual premium, with a minimum initial charge of $350, then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (prior to adjustments) All CA Operations 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: Policy No.: Insured: Insurance Company: Endorsement No.: Premium $ Countersigned by WC990410C (Ed. 01-19)