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Agreement - Maggiora Bros Drilling - Twoyear extension of thecontract with Maggiora Bros Drilling for pump and repair maintenance
City of Gilroy Agreement/Contract Tracking Today’s Date: September 30, 2024 Your Name: Izabela Cirloganu Contract Type: Services over $5k - Consultant Phone Number: X255 Contract Effective Date: (Date contract goes into effect) 10/17/2024 Contract Expiration Date: 10/17/2026 Contractor / Consultant Name: (if an individual’s name, format as last name, first name) Maggiora Bros Drilling Contract Subject: (no more than 100 characters) Two year extension of the contract with Maggiora Bros Drilling for pump and repair maintenance. Contract Amount: (Total Amount of contract. If no amount, leave blank) $99,000 By submitting this form, I confirm this information is complete: Date of Contract Contractor/Consultant name and complete address Terms of the agreement (start date, completion date or “until project completion”, cap of compensation to be paid) Scope of Services, Terms of Payment, Milestone Schedule and exhibit(s) attached Taxpayer ID or Social Security # and Contractors License # if applicable Contractor/Consultant signer’s name and title City Administrator or Department Head Name, City Clerk (Attest), City Attorney (Approved as to Form) Routing Steps for Electronic Signature Risk Manager City Attorney Approval As to Form City Administrator or Department Head City Clerk Attestation Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA LeeAnn McPhillips Andy Faber Jimmy Forbis Beth Minor TYPE OF PROCURMENT DOLLAR THRESHOLD / SIGNING AUTHORITY STAFF LEVEL DEPARTMENT HEAD CITY ADMINISTRATOR COUNCIL APPROVAL $0-$999.99 $1,000-$49,999.99 $50,000-$99,999.99 $100,000-Above EQUIPMENT /SUPPLIES/ MATERIALS Furniture, hoses, parts, pipe manholes, office supplies, fuel, tools, PPE items, etc… Vendor selection at discretion of staff Payment Method Purchase Card or Payment Request (if vendor does not accept credit cards) Informal bid/quotation – 3 quotes (verbal or written) Purchasing Summary form w/ Purchasing Approval Purchase Requisition Payment Method Purchase Order* Informal bid/quotation – 3 written quotes Purchasing Summary form w/ City Administrator Approval Purchase Requisition Payment Method Purchase Order Formal Bid Advertisement Council Approval Purchase Requisition signed by City Administrator Payment Method Purchase Order GENERAL SERVICES Janitorial, landscape maintenance, equipment repair, installation, graffiti abatement, service inspections, uniform cleaning, etc… Vendor selection at discretion of staff May require insurance documents depending on scope/ nature of work Payment Method Purchase Card (if incorporated) Signed Payment Request (if sole proprietor or partner) Informal bid/quotation – 3 quotes (verbal or written) Purchasing Summary form w/ Department Head Approval Standard Agreement Purchase Requisition Payment Method Purchase Order* Informal Bid/RFP quotation – 3 written quotes Purchasing Summary form w/ City Administrator Approval Standard Agreement Purchase Requisition Payment Method Purchase Order Formal Bid/RFP/RFQ Advertisement Council Approval Standard Agreement Purchase Requisition Payment Method Purchase Order PROFESSIONAL SERVICES Consultants, architects, designers, auditors, etc... Vendor selection at the discretion of staff Purchase Summary Form w/ Purchasing Approval Standard Agreement signed by Department Head Purchase Requisition Payment Method Purchase Order RFP/RFQ to at least 3 consultants Purchase Summary Form w/ Department Head Approval Standard Agreement Purchase Requisition Payment Method Purchase Order RFP/RFQ to a list of consultants Evaluation Spreadsheet w/ City Administrator Approval Standard Agreement Purchase Requisition Payment Method Purchase Order Formal RFP/RFQ Advertisement Council Approval Standard Agreement signed by City Administrator Purchase Requisition Payment Method Purchase Order Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA -1- 4845-8215-5540v1 MDOLINGER\04706083 FIRST AMENDMENT TO AGREEMENT FOR PUMP MAINTENANCE AND REPAIR SERVICES BETWEEN MAGGIORA BROS DRILLING INC AND THE CITY OF GILROY WHEREAS, the City of Gilroy, a municipal corporation (“City”), and Maggiora Bros Drilling Inc. entered into that certain agreement entitled Agreement for Pump Maintenance and Repair Services Between Maggiora Bros Drilling Inc and the City of Gilroy, effective on October 15, 2021, hereinafter referred to as “Original Agreement”; and WHEREAS, City and Maggiora Bros Drilling Inc. have determined it is in their mutual interest to amend certain terms of the Original Agreement. NOW, THEREFORE, FOR VALUABLE CONSIDERATION, THE PARTIES AGREE AS FOLLOWS: 1. ARTICLE 1. TERM OF THE AGREEMENT of the Original Agreement shall be amended to read as follows: “This Agreement will be effective on October 15, 2021, and will continue in effect through October 16, 2026.” 2. ARTICLE 4. COMPENSATION, Section A. (Consideration) the following sentence shall be added to the paragraph: “Final total amount expended for the entire duration of this Agreement, shall not exceed $99,000.” The final updated section for ARTICLE 4. COMPENSATION, Section A. (Consideration) shall read as follows: “In consideration for the services to be performed by CONTRACTOR, CITY agrees t o pay CONTRACTOR the amounts set forth in Exhibit “D” (“Payment Schedule”). In no event however shall the total compensation paid to CONTRACTOR exceed $30,000 per fiscal year. Final total amount expended for the entire duration of this Agreement, shall not exceed $99,000.” 3. This Amendment shall be effective retroactively on October 17, 2024. 4. Except as expressly modified herein, all of the provisions of the Original Agreement shall remain in full force and effect. In the case of any inconsistencies between the Original Agreement and this Amendment, the terms of this Amendment shall control. 5. This Amendment may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. IN WITNESS WHEREOF, the parties have caused this Amendment to be ex ecuted as of the dates set forth besides their signatures below. CITY OF GILROY Maggiora Bros Drilling Inc. By: By: [signature] [signature] Jimmy Forbis Mike Maggiora [employee name] [name] City Manager Maggiora Bros Drilling Inc. [title/department] [title] Date: Date: Docusign Envelope ID: 92B95332-2980-48A0-BDED-82E828B35690 10/22/2024 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA 11/5/2024 -2- 4845-8215-5540v1 MDOLINGER\04706083 Approved as to Form ATTEST: City Attorney City Clerk Docusign Envelope ID: 92B95332-2980-48A0-BDED-82E828B35690Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA -3- 4845-8215-5540v1 MDOLINGER\04706083 Docusign Envelope ID: 92B95332-2980-48A0-BDED-82E828B35690Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DocuSign Envelope ID: E5354ABE-5B08-4D33-ACCF-5C1B9B151CECDocusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Travelers Indemnity Company of CT Travelers Property Cas. Co. of America Nautilus Insurance Company 9/04/2024 USI Insurance Services, LLC Lic # OG11911 575 Market Street, Suite 3750 San Francisco, CA 94105 Teresa A Rose 628 201-9001 teresa.rose@usi.com Maggiora Bros. Drilling Inc. 595 Airport Boulevard Watsonville, CA 95076-2027 25682 25674 17370 A X X X PD Ded:5,000 X XCU Included X DT22CO3G412761TCT2 01/01/2024 01/01/2025 1,000,000 300,000 10,000 1,000,000 2,000,000 2,000,000 B X X X 8105X4190692426G 01/01/2024 01/01/2025 1,000,000 B X X X 10,000 CUP6X8229342426 01/01/2024 01/01/2025 10,000,000 10,000,000 B Y UB6X1219212426G 01/01/2024 01/01/2025 X 1,000,000 1,000,000 1,000,000 C C Professional Liab Pollution Liab CPP202831715 CPP202831715 04/05/2024 04/05/2024 04/05/2025 04/05/2025 2,000,000 Ea Claim 2,000,000 Ea Occ 4,000,000 Policy Agg Re: Contract #24PW 2000 - Well #1. City of Gilroy, its officers, officials and employees are named as Additional Insured as respects General Liability and Automobile Liability per endorsements attached. City of Gilroy, Utilities Department 7351 Rosanna St. Gilroy, CA 95020 1 of 1 #S46097266/M44302130 MAGGIBRO1Client#: 1567074 AAMZR 1 of 1 #S46097266/M44302130 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA This page has been left blank intentionally. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA DT22CO3G412761TCT2 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA THIS ENDORSEMENT CHA OLICY. PLEASE READ I EFULLYNGES THE P T CAR DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIALIABILCOGE P RT SCHEDULE Designated jectPro Designated Pro General Aggregate(s):ject(s): A.3.COVERAGE A.For al sums which the insured becomes legal Any payments made underl ly obligated to pay as damages caused by "occur-for da or under formages COVERAGE C. rences"under , and med e shall reduce the DesiCOVERAGE A. (SECT IION )ical xpenses g- for al med e s caused by accidents un-nated Projec General Aggregate L m forl ical xpense t i it der , which can be that designated "project". Such paymentsCOVERAGEC (SEC I I)T ON attr only to operations at a single desig-shall not reduce the General Aggregate Limibuted it nated "project shown in the Schedule abo e:"v shown in the Declarat nor shall they re-ions duce any other Designated Pro Generalject 1.A separate Designated Project General Ag- Aggregate Li it fo any other designatedmr gregate Li it app designated "pro-m lies to each "project"n in the dule abo e.show Sche vject"and that l m is equal to the amount of, i it the General Aggregate Li t shown in the The l m shown in the Declarations formiiits 4.Each Declarat unless separateions, Designated Occurrence, Damage T Premises Reonted Project General Ag T Yo and Me Expegregate(s)o u dical nseare sche continue tod- uled abo .ve apply.Howe instead o be subject tover,f ing the General Aggregate Li t shown in themi2.The Designated Project General Aggregate Declarat such li its will be subject to theions, mLiit is the most we will pay for the sum o almf l applicab Designated Project General Ag-le damages under , exceptCOVERAGE A. gregate Li itm.damages because of "bodil in "or "prop-y jury erty damage inc in the "products-For al sums which the insured becomes legal"luded l lyB. comp operations hazard , and for med obligated to pay as damages caused by "occur-leted "i- cal expenses under , regar rences"under , andCOVERAGE C COVERAGE A. (SECT Id-ION ) less of the onumberf:for al med e s caused by accidents un-l ical xpense der , which cannotCOVERAGEC. (SEC ON I)TIa.Insureds; be attribu only to operations at a sing desited le g-b.Clai made or "suits" brought; orms nated "project shown in the Schedule abo e:"v c.Persons or organizations m ing cla msaki or bringing "suits". CG D2 11 01 04 Copyright,Tra elers Inde ity mpany, 2004 Page 1 oThe v mn Co f 2 EACH "PROJECT" FOR WHICH YOU HAVE AGREED, IN GENERAL AGGREGATE A WRITTEN CONTRACT WHICH IS IN EFFECT DURING LIMIT SHOWN ON THE THIS POLICY PERIOD, TO PROVIDE A SEPARATE DECLARATIONS. GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. DT22CO3G412761TCT2 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERC GENERAL L ITYIAL IABIL 1.COVERAGE A.Any payments made under v ded, any pa ments for da because ofiymages for da or under for "bodily injury or "property damage"inmages "COVERAGE C. med e shall reduce the amount the "products-comp o erat hazard"willical xpenses leted p ions a ilab under the General Aggregate Lim reduce the Products Comp Operat Ag-va le it -leted ions or the Products Completed Operat Ag-gregate Li t, and not reduce the General Aggre--ions mi gregate Li it ver is applic bm, whiche a le; and gate Li it nor the Designated Pro Generalmject Aggregate Li itm.2.Such payments shall not reduce any Desig- nated Projec General Aggregate L m .t i it E.Defi i-For the purposes of this endorsement the n tio Sections n is amended by the addit of theion C.2.SEC ION I –LI T OFPartofTIIMIS INSURANCE fo lowing def itlinion:is deleted and rep folaced by the llowing: "Projec "means an area away fro pre isestm m2.The General Aggregate Li i is the most wemt owned by or rented to you at which you are per-will for o :pay the sum f for ing oper t pursuant to a contract ormaions a.Coverage BDamages under ; and agreement. For the purposes of deter ing themin b.Damages f m "occurrences"under applicab aggregate li t o insurance, eachrole mi f COVERAGE A (SECT I)ION and for al "project"that includes prem in l i thelises vo v ng med e caused by accidents same or connecting lots, or prem whose con-ical xpenses ises under which nection is interrupted only by a street, roadway,COVERAGE C (T I)SEC ION cannot be attr buted only to operat at waterway or right of way of a railroad shall beiions -- considered a single "projec ".ta single designated "project" shown in the SCHEDULE abo e.v F.SEC ION I –LIM T OFThe pro ons ofvisi T II I S D.INSURANCEWcoerage for liab li arising out o the not otherwise modi ied by this en-hen v i ty f f dorsement shall to applycontinue as stipulated."products-comple operations hazard is pro-ted " Page 2 o Copyright,Tra elers Inde ity mpany, 2004f 2 The v mn Co CG D2 11 01 04 included Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMM RCI L G NERAL IAB LI YEAELIT T IS ENDORSEMENT CHANGES T E POLICY.PL ASE READ IT CAREFULLY.H H E XTEND ENDORSEMENT FOR CONTRACTORS Thi e dorseme t m d fie i surance prov ded under he f l o ing:s n n o i s n i t o l w COMM RCI L G NERAL IAB LI Y COVERAG PA TEAELITER Thi endorsem nt broadens cov rage.Howev r cov rage fo anyseee,e r i ju y,dama e o me i al ex ense descri ed in any o the provnrgrdcpsbfi ion o th s e dorseme t may bssfinne ex luded orc l m ted by anothe endorsem n to this Cov rage Pa t,and the e ciiretersov rage broadening prov sions do no ap ly toeitp the ex en tha cov rage is ex l ded or lim ted by such an entttecuidorsem n .The fo lo ing li ti g i a getlwsnseneral cov rage de cript on only Read al the prov sions o thi endorsesi.l i f s em nt and the re t o y ur pol cy ca e ullesfoirfy to de erm ne r gh s,dut es,and wha i and s not cov red.t i i t i t s i e Wh I An Insured Unnam d Subsid arieoseis In i ental Med cal Mal racti ecdipc Bla ket Addit onal Insured Gov rnme talnien Bla ket Wa v r f Sub ogationnieOr En it e Pe m t Or Au ho iza ions Re ati g Totisristrtln Co tra tua Liab l ty Rai roadncliilsOpeatiosrnDaaeToPremseRenedo YoumgistT An o ganizat on o he than a pa tnership,jo ntritrri v nture or l m ted liab l ty company;oreiiii A rust;t The fol owing is ad ed told a indi a ed in i s nam o the docum n s thasctterett :gov rn it stru ture.e s c Any o yo r sub idiar e ,o her than a pa tnershi ,f u s i s t r p jo n v nture o lim ted liabil ty com any,that iiteriips no shown as a Nam d Insured in thete De la ation i a am d In ured f:c r s s N e s i The fol owing is ad ed toldYoarethesoeownero,o ma ntai anulfrin :ownership intere t o mo e than 50%in,suchsfr Any gov r men al enti y tha ha issued a perm tentttsisubsidiayonthefistdayothepolcyperio;r r f i d or authoriza ion wit re pe t to ope ationsthscrand pe fo med by yo or on your behal and that yourrufSuhsubsidiaryinotaninuredundecssrarerequiredbyanyodinance,law,buil ing coderdsiilaohernurance.m r t i s or written cont act or agreeme t to incl de a anrnus No such subsidiary i a insured fo "bodily inju ysnrr"addi ional i sured on thi Cov rage Pa t is atnsern or "property dama e"tha o curred,o "perso al i sured,but only wi h re pgtcrnntse t to liabi i y fo "bodilycltr i ju y","prope ty dam ge"or "perso al andnrranandavrtsingijuy"caused by an o fe sedeinrfn adv rti ing inj ry"ari ing ou o uch operatio s.e s u s t f s ncomited:m t The in uran e prov ded to such gov r men alscientBeoeyoumantaiedanownershipinteretfrins en ity doe not apply o:t s tomoethan50%i such ub idiary;orfrnss Any "bodi y inju y ,"property dama e olr"g "rAfethedate,i any duri g the poli y periotrf,n c d "pe sonal and adv rti ing injury"a i ing o t oresrsufthatyonolongermantainaownershiuinp operatio s perfo m d fo the gov r men alnrerentiteretoorehan50%n such subsi ia y.n s f m t i d r en ity ort;Fo purpose o Pa agraphrsfr o Se tionfc Who Any "bodily inj ry or "property dam geu"a "Is An Insured,ea h such subsidiary wil becl i clu ed in the "products-co ple edndmtdeemdtoedeignatedintheDeclaratona:e b s i s s operatio s hazard".n Pa e 1 o 3gf DT22CO3G412761TCT2 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMM RCI L G NERAL IAB LI YEAELIT pharma eut cal co m t ed by o wi h thecismit,r t k owledge o co sent o ,the n urednrnfis.The fo lo i g repla e Pa agraphlwncsr o thef de i i ion o "o cur en e in thefntfcrc"The fol owing i a ded to thelsd Se tion:c Se tio :c n An a t o om ssio com i ted i prov dincrinmtnig "In i ental m d cal se v ce "m a s:c d e i r i s e n or fa l ng to prov de "incidental me icaiiidl Med cal surgi al dental laborato y,x rayi,c ,,r -se v ce ",fi st a d o "Good Sam r tanrisrirai or nur ing se v ce or treatm n ,adv ce osrietirsevce"to a person,unle s yo are irissun i struction o the related fur i hi g on,r n s n fthebusinesorocupatonoprovdinscifig fo d or bev rages;oroeproesionalheathaesevce.f s l c r r i s The furni hing o di pensing o dru s osrsfgrThefolowigrepaesthelatparagrapholnlcsf m d cal dental o surgi al supplie oei,,r c s rPaagaphrrof appl a ce .i n s: The fol o ing i added to Parag aphlwsr ,Unle s yo a e in the business or o cupatiosurcn ,ofoprovdigproesionalhealtcaesevce,f i n f s h r r i s Pa ag aphsrr ,,and abov doe not apply to :"bodily injury"arising out of prov din o ai ing o rov de:i g r f l t p i Thi i surance i ex e s ov r any v li ansnscseadd "In i ental me ica se v ce "by any ocddlrisf col e ti le othe in urance whether prim ry,l c b r s ,a y ur "em loyee "who is a nu se,nurseopsr ex e s,conti gent o on any other ba is,thatcsnrs a sistant,em rgen y me i al techni iasecdccn i av ilab e to any o your "em loy es"fosalfper or arame ic;orpd "bo ily injury that ari e ou o prov ding od"s s t f i r fa l n to prov de "i cidental medi al serv ce "i i g i n c i sFrstaior"Good Sama itan se v ce "byidrris a y o y u "em loyee "o "to any perso to the ex ent notnforpsrnt subje t tocvlunteero Pa ag aphrr o Se t onfci Who Is Anworkers",other than an employed or v lunteer do tor.Any such "em loyee "o c p s In ured.s or "v lu teer wo kers"prov ding o fa l ngonririi to prov de fi st aid or "Good Sama i anirrt The fo lowing is a ded to Paragraphld ,se v ce "during thei work hou s fo yourisrrr ,wil be deem d to be a t ng wi hin thelecit ofscoeotheiemloymntbyyoopfrpeur pe fo m n dutie rela ed to the co du trrigstnc : o yo r busine s.f u s If the insured has a ree in a cont act ogdrr The fo lo i g repla e the la t se tence olwncssnf ag ee ent to waiv that i sured'righ ormenstf Pa ag aphrr of re ov ry against any person o o gan zat on,wecerrii :waiv our right o e ov ry again t uch pe son oefrcessrr organi ation,but only fo pay ents we ma ezrmkFothepurpoeodetemnintherssfrig be ause o :c fapplcableEahOccurrenceLimt,al relatedicil a t or om ssions com i ted i prov di g ocsimtninr "Bo ily i ju y"o "property dam ge"thatdnrra fa l n to prov de "inci ental me icaiigiddl o curs;ocr se v ce ",fi st a d o "Good Sam r tanrisrirai "Pe so al and adv rti ing inj ry"ca sed byrnesuusevce"to any one perso wil be deeme torisnld an o fe se hat i com it edfntsmt;be one "o currence".c The fo lowi g ex lu ion i added to subsequent to the ex cution o thelncssef cont a t orcr Pa ag aphrr ,,of ag ee ent.r m :The fol o ing repla e Pa agraphlwcsr o thef de i i ion o "insured cont act"i thefntfrn Se tion:c"Bo ily inju y or "property dama e"ari ingdr"g s ou o the v ola ion o a penal stat te otfitfur Any ea em nt or l cense agreem nt;s e i e ordi ance rela i g to the sale ontnf Pa e 2 o 3gf Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMM RCI L G NERAL IAB LITYEAELI Pa ag aphrr o the de init o o "i suredffinfn Any prem se whi e rented to yo oislur cont a t i therc"n Se tion is tem ora i y o cupied by you wi h pe m ssioncprlctri de eted.o he owne ;orlftr The co tent o any premi e whi e suchnsfssl prem se i rented to yo ,i y u rent suchissufoThefolowingreplaethedeiitiono"prem selcsfnfis prem se fo a period o sev n or feweisrferdamaeinheg"t Se tionc:conse utiv day .c e s "Pre i e dama e m a s "property dama e"to:m s s g "e n g Pa e 3 o 3gf Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA This page has been left blank intentionally. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read (1)The "bodily injury" or "property damage" is the entire policy carefully to determine rights, duties and caused by an "occurrence" that takes place what is and is not covered.in the"coverage territory"; Throughout this policy the words "you" and "your" refer (2)The "bodily injury" or "property damage" to the Named Insured shown in the Declarations, and occurs during the policy period; and any other person or organization qualifying as a Named (3)Prior to the policy period, no insured listedInsured under this policy. The words "we", "us" and under Paragraph 1.of Section II – Who Is"our" refer to the company providing this insurance.An Insured and no "employee" authorized The word "insured" means any person or organization by you to give or receive notice of an qualifying as such under Section II – Who Is An "occurrence" or claim knew that the "bodily Insured.injury" or "property damage" had occurred, in whole or in part. If such a listed insuredOther words and phrases that appear in quotation or authorized "employee" knew, prior to themarks have special meaning. Refer to Section V –policy period, that the "bodily injury" orDefinitions."property damage" occurred, then any SECTION I – COVERAGES continuation, change or resumption of such "bodily injury" or "property damage" duringCOVERAGE A – BODILY INJURY AND PROPERTY or after the policy period will be deemed toDAMAGE LIABILITY have been known prior to the policy period.1. Insuring Agreement c."Bodily injury" or "property damage" whicha.We will pay those sums that the insured occurs during the policy period and was not,becomes legally obligated to pay as damages prior to the policy period, known to havebecause of "bodily injury" or "property damage"occurred by any insured listed under Paragraphto which this insurance applies. We will have 1.of Section II – Who Is An Insured or anythe right and duty to defend the insured against "employee" authorized by you to give or receiveany "suit" seeking those damages. However,notice of an "occurrence" or claim, includes anywe will have no duty to defend the insured continuation, change or resumption of thatagainst any "suit" seeking damages for "bodily "bodily injury" or "property damage" after theinjury" or "property damage" to which this end of the policy period.insurance does not apply. We may, at our discretion, investigate any "occurrence" and d."Bodily injury" or "property damage" will be settle any claim or "suit" that may result. But:deemed to have been known to have occurred at the earliest time when any insured listed(1)The amount we will pay for damages is under Paragraph 1.of Section II – Who Is Anlimited as described in Section III – Limits Insured or any "employee" authorized by you toOf Insurance; and give or receive notice of an "occurrence" or (2)Our right and duty to defend end when we claim: have used up the applicable limit of (1)Reports all, or any part, of the "bodilyinsurance in the payment of judgments or injury" or "property damage" to us or anysettlements under Coverages A or B or other insurer;medical expenses under Coverage C. (2)Receives a written or verbal demand orNo other obligation or liability to pay sums or claim for damages because of the "bodilyperform acts or services is covered unless injury" or "property damage"; orexplicitly provided for under Supplementary Payments.(3)Becomes aware by any other means that "bodily injury" or "property damage" hasb.This insurance applies to "bodily injury" and occurred or has begun to occur."property damage" only if: CG T1 00 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved.Page1 of 21 Includes copyrighted material of Insurance Services Office, Inc. with its permission. DT22CO3G412761TCT2 Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a.The statements in the Declarations are accurate and complete;If all of the other insurance permits contribution by equal shares, we will follow this method also.b.Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c.We have issued this policy in reliance uponlimit of insurance or none of the loss remains,your representations.whichever comes first.The unintentional omission of, or unintentional errorIf any of the other insurance does not permit in, any information provided by you which we reliedcontribution by equal shares, we will contribute upon in issuing this policy will not prejudice yourby limits. Under this method, each insurer's rights under this insurance. However, this provisionshare is based on the ratio of its applicable limit does not affect our right to collect additionalof insurance to the total applicable limits of premium or to exercise our rights of cancellation orinsurance of all insurers.nonrenewalin accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, andagreement that the insurance afforded to an any rights or duties specifically assigned in thisinsured under this Coverage Part must apply on Coverage Part to the first Named Insured, thisa primary basis, or a primary and non-insurance applies:contributory basis, this insurance is primary to a.As if each Named Insured were the onlyother insurance that is available to such insured Named Insured; andwhich covers such insured as a named insured, b.Separately to each insured against whom claimand we will not share with that other insurance, is made or "suit" is brought.provided that: 8. Transfer Of Rights Of Recovery Against Others(1)The "bodily injury" or "property damage" for To Uswhich coverage is sought occurs; and If the insured has rights to recover all or part of any(2)The "personal and advertising injury" for payment we have made under this Coverage Part,which coverage is sought is caused by an those rights are transferred to us. The insured mustoffense that is committed;do nothing after loss to impair them. At our request,subsequent to the signing of that contract or the insured will bring "suit" or transfer those rightsagreement by you.to us and help us enforce them. 5. Premium Audit 9. When We Do Not Renew a.We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we willPart in accordance with our rules and rates.mail or deliver to the first Named Insured shown in b.Premium shown in this Coverage Part as the Declarations written notice of the nonrenewaladvance premium is a deposit premium only. At not less than 30 days before the expiration date.the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficientthe earned premium for that period and send proof of notice.notice to the first Named Insured. The due date SECTION V – DEFINITIONSfor audit and retrospective premiums is the date shown as the due date on the bill. If the sum of 1."Advertisement" means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured.supporters. For the purposes of this definition: c.The first Named Insured must keep records of a.Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request.b.Regarding websites, only that part of a website 6. Representations that is about your goods, products or services for the purposes of attracting customers orBy accepting this policy, you agree: supporters is considered an advertisement. Page16 of 21 ú 2017 The Travelers Indemnity Company. All rights reserved.CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA T3 53 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT Page 1 of 4© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. GENERAL DESCRIPTION OF COVERAGE – This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A.BROAD FORM NAMED INSURED B.BLANKET ADDITIONAL INSURED C.EMPLOYEE HIRED AUTO D.EMPLOYEES AS INSURED E.SUPPLEMENTARY PAYMENTS – INCREASED LIMITS F.HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS G.WAIVER OF DEDUCTIBLE – GLASS PROVISIONS A.BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B.BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H.HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT I.PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT J.PERSONAL PROPERTY K.AIRBAGS L.NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M.BLANKET WAIVER OF SUBROGATION N.UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C.EMPLOYEE HIRED AUTO 1.The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2.The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI- NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your 8105X4190692426G Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL AUTO CA T3 53 02 15Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D.EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E.SUPPLEMENTARY PAYMENTS – INCREASED LIMITS 1.The following replaces Paragraph A.2.a.(2), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE: (2)Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2.The following replaces Paragraph A.2.a.(4), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE: (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F.HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION IV – BUSINESS AUTO CONDI- TIONS: (5)Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a)With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i)You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii)Neither you nor any other involved "insured" will make any settlement without our consent. (iii)We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv)We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE. (v)We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b)This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c)This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL AUTO CA T3 53 02 15 Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d)It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G.WAIVER OF DEDUCTIBLE – GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III – PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H.HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III – PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I.PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III – PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J.PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1)Owned by an "insured"; and (2)In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K.AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a.If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b.The airbags are not covered under any war- ranty; and c.The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L.NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV – BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a)You (if you are an individual); (b)A partner (if you are a partnership); (c)A member (if you are a limited liability com- pany); (d)An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e)Any "employee" authorized by you to give no- tice of the "accident" or "loss". M.BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS : 5.Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA COMMERCIAL AUTO CA T3 53 02 15Page 4 of 4 © 2015 The Travelers Indemnity Compa ny. All rights reserved . Includes copyrighted material of Insurance Services Office, Inc. with its permission. such contract. The waiver applies only to the person or organization designated in such contract. N.UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV – BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA 8105X4190692426G Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA This page has been left blank intentionally. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA Alf, TRAVELERSJ ONE TOWER SQUARE HARTFORD, CT 06183 A)-- I WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -- CALIFORNIA (BLANKET WAIVER) ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. e plicy wic tth i ffi dte ls trws stated. Ed Effi Iur Ic py OF ISE Piy N. T ASSIG: Endorsement No. i P1 1 Countersigned by _ UB6X1219212426G Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA This page has been left blank intentionally. Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA Docusign Envelope ID: 2B16A56B-2912-47F6-A5CC-CD0F1C447BBA