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COI - West Coast Arborists - Expires 2024-07-01$Holder Identifier : 7777777707070700077763616065553330773706456215556707453126663406310072640477147231020736041113063011207562051376234556071622775724767300736001337027231207104033170272332077727252025773110777777707000707007 6666666606060600062606466204446200622020406204020006222026042260022062002042622422000622000406026002006220006040062020060000242622400200620202624024000006022226060000622066646062240664440666666606000606006Certificate No :570100533380CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/22/2023 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). 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. PRODUCER Aon Risk Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 Los Angeles CA 90017-0460 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 38318Starr Indemnity & Liability CompanyINSURER A: 16109Starr Specialty Insurance CompanyINSURER B: 36056Navigators Specialty Insurance CompanyINSURER C: INSURER D: INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: West Coast Arborists, Inc. 2200 E Via Burton Anaheim CA 92806 USA COVERAGES CERTIFICATE NUMBER:570100533380 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.Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $2,000,000 $1,000,000 $5,000 $2,000,000 $4,000,000 $4,000,000 A 07/01/2023 07/01/2024 Y SIR applies per policy terms & conditions 1000100141231 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $2,000,000A07/01/2023 07/01/2024 COMBINED SINGLE LIMIT (Ea accident) 1000198198231 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE DED $5,000,000 $5,000,000 07/01/2023UMBRELLA LIABC 07/01/2024SE23EXCZ059NKIC RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT $1,000,000 X OTH- ER PER STATUTEB07/01/2023 07/01/2024 Workers Comp CA 1000004229A 07/01/2023 07/01/2024 $1,000,000 Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / AN Workers Comp AZ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below $1,000,000 1000004228 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Service Agreement: Tree Maintenance. The City of Gilroy, its officers, officials are included as Additional Insured in accordance with the policy provisions of the General Liability policy. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVECity of Gilroy its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 Excess Liability AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: Aon Risk Insurance Services West, Inc. 570000083713 570100533380 570100533380 Page _ of _ West Coast Arborists, Inc. Excess Liability 5m xs 5m Policy #03138990 Allied World National Assurance Company Term: 7/1/2023-7/1/2024 Limit: $5,000,000 Aggregate/Occurrence ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 POLICY NUMBER: 1000100141231 COMMERCIAL GENERAL LIABILITY Effective: 07/01/2023 CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – STATE OR GOVERNMENTALAGENCY OR SUBDIVISION OR POLITICALSUBDIVISION – PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: City of Gilroy, its officers, and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1.This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a.The insurance afforded to such additional insured only applies to the extent permitted by law; and b.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2.This insurance does not apply to: a."Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b."Bodily injury" or "property damage" included within the "products-completed operations hazard". B.With respect to the insurance afforded to these additional insureds, the following is added toSection III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 POLICY NUMBER: 1000100141231 COMMERCIAL GENERAL LIABILITY Effective: 07/01/2023 CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – DESIGNATEDPERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 Service Agreement: Professional Arborist Services performed by West Coast Arborists Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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 your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured 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 is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 Dallas, TX 1-866-519-2522 Earlier Notice of Cancellation Policy Number: 1000100141231 Effective Date: July 1, 2023 at 12:01 A.M. Named Insured: West Coast Arborists, Inc. It is agreed thirty (30) days notice of cancellation, except as respects non-payment of premium for which ten (10) days will apply, will be given as respects the following certificate holder(s): SCHEDULE City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Attn: Sheila Castillo/Bill Avila Email Address: Sheila.Castillo@ci.gilroy.ca.us Certificate holders include only those entities where thirty (30) days notice of cancellation is required by an "insured contract" but only with respects to an entity for which "you" are directly or indirectly performing "your work". It is further understood and agreed that "you" will provide a complete list of certificate holders including name(s) and physical addresses to "us" that require the notice of cancellation, and that "you" will provide "us" this list at the time of the notice of cancellation. All other terms and conditions of this Policy remain unchanged. Signed for the Company as of the Effective Date above: Steve Blakey, President Nehemiah E. Ginsburg, General Counsel MANUSCRIPT (06/10) Page 1 of 1 Includes copyrighted material of ISO Properties, Inc., used with its permission. . DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: 1000100141231 CG 20 10 04 13Effective: 07/01/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to 1. All work,including materials,parts or include as an additional insured the person(s) or equipment furnished in connection with such organization(s) shown in the Schedule, but only work,on the project (other than service, with respect to liability for "bodily injury", "property maintenance or repairs) to be performed by or damage"or "personal and advertising injury"on behalf of the additional insured(s) at the caused, in whole or in part, by:location of the covered operations has been completed; or1. Your acts or omissions; or 2. That portion of "your work" out of which the2. The acts or omissions of those acting on your injury or damage arises has been put to itsbehalf;intended use by any person or organizationin the performance of your ongoing operations for other than another contractor or subcontractortheadditionalinsured(s)at the location(s)engaged in performing operations for adesignated above.principal as a part of the same project. However:C. With respect to the insurance afforded to these1. The insurance afforded to such additional additional insureds, the following is added toinsured only applies to the extent permitted by Section III – Limits Of Insurance:law; and If coverage provided to the additional insured is2. If coverage provided to the additional insured is required by a contract or agreement, the most werequiredbyacontractoragreement,the will pay on behalf of the additional insured is theinsurance afforded to such additional insured amount of insurance:will not be broader than that which you are required by the contract or agreement to 1. Required by the contract or agreement; orprovide for such additional insured.2. Available under the applicable Limits of Insurance shown in the Declarations;B. With respect to the insurance afforded to these additional insureds,the following additional whichever is less. exclusions apply:This endorsement shall not increase the This insurance does not apply to "bodily injury" or applicable Limits of Insurance shown in the "property damage" occurring after:Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) Or Organization(s):Location(s) Of Covered Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: 1000100141231 CG 20 37 04 13Effective: 07/01/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE A. Section II – Who Is An Insured is amended to required by the contract or agreement to provide for such additional insured.include as an additional insured the person(s) or organization(s) shown in the Schedule, but only B. With respect to the insurance afforded to thesewithrespecttoliabilityfor"bodily injury"or additional insureds, the following is added to"property damage" caused, in whole or in part, by Section III – Limits Of Insurance:"your work"at the location designated and described in the Schedule of this endorsement If coverage provided to the additional insured isperformed for that additional insured and included required by a contract or agreement, the most wein the "products-completed operations hazard".will pay on behalf of the additional insured is the amount of insurance:However: 1. Required by the contract or agreement; or1. The insurance afforded to such additional insured only applies to the extent permitted by 2. Available under the applicable Limits oflaw; and Insurance shown in the Declarations; 2. If coverage provided to the additional insured is whichever is less.required by a contract or agreement,the This endorsement shall not increase the applicableinsurance afforded to such additional insured Limits of Insurance shown in the Declarations.will not be broader than that which you are CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Where Required By Written Contract Where Required By Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 COMMERCIAL GENERAL LIABILITYPOLICY NUMBER: 1000100141231 CG 24 04 05 09Effective: 07/01/2023 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Name Of Person Or Organization: Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 Dallas, TX 1-866-519-2522 Primary and Non-Contributory Condition Policy Number: 1000100141231 Effective Date: July 1, 2023 at 12:01 A.M. Named Insured: W est Coast Arborists, Inc. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV – CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insu rance be prim ary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel OG 107 (04/11) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 COMMERCIAL AUTOPOLICY NUMBER: 1000198198231 CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FORCOVERED AUTOS LIABILITY COVERAGE 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 end orsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the W ho Is An Insured provision 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 ind icated below. Named Insured:West Coast Arborists, Inc. Endorsement Effective Date: 07/01/2023 SCHEDULE Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 Name Of Person(s) Or Organization(s): Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 Dallas, TX 1-866-519-2522 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Policy Number: 1000198198231 Effective Date: 07/01/2023 at 12:01 A.M. Named Insured: West Coast Arborists, Inc. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM S e c t i o n I V - B u s i n e s s A u t o C o n d i t i o n s , A . - L o s s C o n d i t i o n s , 5 . - T r a n s f e r o f R i g h t s o fRecovery Against Others to Us, is amended to add: However , we will waive a n y right of r ec over y we h a ve agai nst any per son or or ganiza t io n withwhom you have entered into a contract or agreement becaus e of paym ents we m ak e under thisCoverage Form arising out of an "accident" or "loss" if: (1) The "accident" or "loss" is due to operations undertaken in accordance with thecontract ex ist ing bet ween you an d such per so n or organ izat ion; and(2) T he co ntr ac t or agr eem ent was ent er e d int o p r i or t o an y "a cc id e nt" or "l oss ". No wa i ve r of t h e r i gh t of r ecov er y w i l l d i r e c t l y or i n d i re c t l y ap p l y t o yo u r em p lo ye e s o r em ployees of the person or organization, and we res erve our rig hts or lien to be reimbursed from an y reco vered funds obtained b y an y inj ured em plo yee. All other terms, conditions and exclusions of the policy shall remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel SICA 1020 (03/12) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 POLICY NUMBER: 1000198198231 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 B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance – Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos LiabilityCoverage Form and supersedes any provision to Coverage and General Liability Coverages arethe contrary:primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under suchan "insured" under your policy provided that:other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract orother insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844 y: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA 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.) 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 2.0% of the California workers' compensation premiumotherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization to whom you become obligated to waive Where required by contract your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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: 07/01/2023 Policy No.: 100 0004228 Endorsement No.: Insured: W e s t C o a s t A r b o ri s ts , In c. Premium: Insurance Company: S t ar r S p e c ia lt y I n s u ra n c e C o m p a n y Countersigned by WC 04 03 06 (Ed. 04-84) Page 1 of 1 DocuSign Envelope ID: A7DE3697-07AC-44A5-8875-D0E86494E844