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HomeMy WebLinkAboutCOI - Jensen Landscape Services, LLC - Expires - 2027-05-01ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD 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) 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 EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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 INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) 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 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) CERTIFICATE OF LIABILITY INSURANCE Lockton Companies, LLC DBA Lockton Insurance Brokers, LLC in CA CA license #0F15767 8110 E Union Ave., Ste. 100 Denver CO 80237 denver-certs@lockton.com Jensen Landscape Services, LLC Jensen Landscape Contractor, LLC; Jensen Landscape & Construction Company, LLC 1250 Ames Avenue, Milpitas, CA 95035 ACE American Insurance Company 22667 Indemnity Insurance Co of North America 43575 Starr Surplus Lines Insurance Company 13604 X X 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 X $2,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X 5,000,000 5,000,000 Prod-Comp Ops 5,000,000 N X $1,000,000 $1,000,000 $1,000,000 A ISA H11370822 5/1/2026 5/1/2027 A HDO G4938998A 5/1/2026 5/1/2027 C 100588967261 5/1/2026 5/1/2027 B WLR C72809853 5/1/2026 5/1/2027 5/1/2027 1554537 Y Y Y Y Y Y Y 4/29/2026 21518612 21518612 XXXXXXX City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 Certificate holder and any other entities as required by written contract are Additional Insured(s) as per the attached endorsement or policy language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsements or policy language. Waiver of subrogation applies as required by written contract as per the attached endorsements or policy language, where allowed by law. X X See Attachments Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required) ACORD 25 (2016/03) RE: JLS will provide Landscape Maintenance Services to The City of Gilroy at their parks, sound walls, street medians & islands, City buildings, downtown areas and water facility sites. These routine services include plant & tree care, weed/pest control, litter/debris removal, irrigation maintenance and general maintenance such as seasonal leaf removal. City of Gilroy, its officers, officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. Certificate Holder ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. All locations where you are performing ongoing operations for such additional insured pursuant to any such written contract. 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work,including materials,parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 POLICY NUMBER: HDO G4938998A COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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 Name Of Additional Insured Person(s) Or Organization(s)Location(s) Of Covered Operations Attachment Code: D661635 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 C. 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 limits of 2. insurance; whichever is less. Available This endorsement shall not increase the under applicable limits of insurance. the applicable the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 Attachment Code: D661635 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 POLICY NUMBER: HDO G4938998A COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Name Of Additional Insured Person(s) Or Organization(s)Location And Description Of Completed Operations Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. All locations where you perform work for such additional insured pursuant to any such written contract. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. 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. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Attachment Code: D661636 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: HDO G4938998A COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Attachment Code: D661758 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 POLICY NUMBER: HDO G4938998A COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Attachment Code: D661637 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Policy Symbol: HDO Policy Number: HDO G4938998A Policy Period 5/1/2026 to 5/1/2027 Effective Date of Endorsement: 5/1/2026 Issued By (Name of Insurance Company): ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A.If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the “Schedule”) by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B.The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C.We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D.We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E.This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of the Policy remain unchanged. Authorized Representative NOTICE TO OTHERS ENDORSEMENT – SCHEDULE NOTICE BY INSURED’S REPRESENTATIVE Named Insured: Jensen Landscape Services, LLC, Jensen Landscape Contractor, LLC;, Jensen Landscape & Construction Company, LLC Endorsement Number Attachment Code: D668819 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Policy Symbol: ISA Policy Number: ISA H11370822 Policy Period 5/1/2026 to 5/1/2027 Effective Date of Endorsement: 5/1/2026 Issued By (Name of Insurance Company): ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: B U S I N E S S A U T O C O V E R A G E F O R M A U T O D E A L E R S C O V E R A G E F O R M M O T O R C A R R I E R C O V E R A G E F O R M E X C E S S B U S I N E S S A U T O C O V E R A G E F O R M 1.Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. A.For a covered “auto,” Who Is Insured is amended to include as an “insured,” the persons or organizations named in this endorsement. However, these persons or organizations are an “insured” only for “bodily injury” or “property damage” resulting from acts or omissions of: 1.You. 2.Any of your “employees” or agents. 3.Any person operating a covered “auto” with permission from you, any of your “employees” or agents. B.The persons or organizations named in this endorsement are not liable for payment of your premium. Authorized Representative DA-9U74c (03/16)Page 1 of 1 ADDITIONAL INSURED – DESIGNATED PERSONS OR ORGANIZATIONS Named Insure: Jensen Landscape Services, LLC, Jensen Landscape Contractor, LLC;, Jensen Landscape & Construction Company, LLC Endorsement Number Attachment Code: D661638 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 Policy Number: ISA H11370822 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. Attachment Code: D661759 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS Named Insured: Jensen Landscape Services, LLC, Jensen Landscape Contractor, LLC;, Jensen Landscape & Construction Company, LLC Endorsement Number Policy Symbol Policy Number: ISA H11370822 Policy Period 5/1/2026 to 5/1/2027 Effective Date of Endorsement : 5/1/2026 Issued By (Name of Insurance Company): ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIERS COVERAGE FORM AUTO DEALERS COVERAGE FORM We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE. SCHEDULE Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. Authorized Representative DA-13115a (06/14)Page 1 of 1 Attachment Code: D661639 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 NOTICE TO OTHERS ENDORSEMENT – SCHEDULE NOTICE BY INSURED’S REPRESENTATIVE Named Insured: Jensen Landscape Services, LLC, Jensen Landscape Contractor, LLC;, Jensen Landscape & Construction Company, LLCJensen Landscape & Construction Company, LLC Endorsement Number Policy Symbol: ISA Policy Number: ISA H11370822 Policy Period 5/1/2026 to 5/1/2027 Effective Date of Endorsement: 5/1/2026 Issued By (Name of Insurance Company): ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A.If we cancel the Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the “Schedule”) by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B.The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C.We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D.We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E.This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of the Policy remain unchanged. Authorized Representative Attachment Code: D662031 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Workers' Compensation and Employers' Liability Policy Named Insured: Jensen Landscape Services, LLC Jensen Landscape Contractor, LLC; Jensen Landscape & Construction Company, LLC Endorsement Number Policy Period: 5/1/2026 to 5/1/2027 Effective Date of Endorsement : 5/1/2026 Issued By (Name of Insurance Company) : Indemnity Insurance Co of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule: Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. For the states of CA, TX, refer to state specific endorsements. Authorized Agent This endorsement is not applicable in KY, NH, and NJ WC 00 03 13 (11/05) Ptd. U.S.A.Copyright 1982-83, National Council on Compensation Insurance Attachment Code: D661640 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 11 Workers' Compensation and Employers' Liability Policy Named Insured: Jensen Landscape Services, LLC, Jensen Landscape Contractor, LLC;, Jensen Landscape & Construction Company, LLC Endorsement Number Policy Period: 5/1/2026 to 5/1/2027 Effective Date of Endorsement: 5/1/2026 Issued By (Name of Insurance Company) : Indemnity Insurance Co of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1.()Specific Waiver Name of person or organization: (X )Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: 3.Premium: The premium charge for this endorsement shall be ___1___ percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Minimum Premium: Authorized Representative WC 90 03 75 (05/18) Attachment Code: D661643 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Policy Period Effective Date of Endorsement 5/1/2026 5/1/2026 TO 5/1/2027 Issued By (Name of Insurance Company) Indemnity Insurance Co of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the schedule. Schedule 1.() Specific Waiver Name of person or organization: (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: Authorized Representative Workers' Compensation and Employers' Liability Policy Named Insured Jensen Landscape Services, LLC Jensen Landscape Contractor, LLC;Jensen Landscape & Construction Company, LLC Endorsement Number Policy Number Attachment Code: D661645 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Workers' Compensation and Employers' Liability Policy Named Insured: Jensen Landscape Services, LLC Endorsement Number Policy Number: WLR C72809853 Symbol: Number: WLR Policy Period: 5/1/2026 to 5/1/2027 Effective Date of Endorsement: 5/1/2026 Issued By (Name of Insurance Company): Indemnity Insurance Co of North America Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. NOTICE TO OTHERS ENDORSEMENT – SCHEDULE NOTICE BY INSURED’S REPRESENTATIVE A.If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the “Schedule”) by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B.The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C.We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D.We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E.This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. Authorized Representative WC 99 03 69 (01/11)Page 1 of 1 Attachment Code: D669830 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 AMENDMENT - INSURED Policy Number: 100588967261 Effective Date: 5/1/2026 at 12:01 A.M. Named Insured: Monarch Landscape Holdings, LLC I.Paragraph three of the Policy Introduction is deleted in its entirety and replaced with the following: The word Insured means the Named Insured and any person or organization qualifying as an Insured in the First Underlying Insurance Policy(ies), but only to the extent to which such person(s) or organization(s) qualify as an Insured in the First Underlying Insurance Policy(ies). Newly acquired or formed organizations must comply with SECTION IV. CONDITIONS, D. CHANGES in order to qualify for coverage. All other terms and conditions of this Policy remain unchanged. SL - 384 (01/12)Page 1 of 1 Copyright © Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Attachment Code: D661965 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Other Insurance – Primary and Noncontributory for Additional Insured Amendatory Endorsement Policy Number: 100588967261 Effective Date: 5/1/2026 at 12:01 A.M. Named Insured: Monarch Landscape Holdings, LLC This endorsement modifies insurance provided under the following: EXCESS LIABILITY POLICY It is hereby agreed that SECTION IV. CONDITIONS, I. Other Insurance is deleted in its entirety and replaced by the following: I.Other Insurance If other insurance applies to “Ultimate Net Loss” that is also covered by this Policy, this Policy will apply excess of, and will not contribute to, the other insurance. Nothing herein will be construed to make this Policy subject to the terms, conditions and limitations of such other insurance. However, other insurance does not include: 1.“Underlying Insurance”; 2.Insurance that is specifically written as excess over this Policy; or 3.Insurance held by a person(s) or organization(s) qualifying as an additional insured in “Underlying Insurance,” but only when the written contract or agreement that mandates such additional insured status: a.Requires a specific limit of insurance that is in excess of the Underlying Limits of Insurance; b.Requires that your insurance be primary and not contribute with that of the additional insured; and c.Is executed prior to the loss. In such case as described in subparagraph 3. above, we shall not seek contribution from the additional insured’s primary or excess insurance for which they are a named insured for amounts payable under this insurance. The Limits of Insurance afforded the additional insured pursuant to subparagraph 3. above shall be the lesser of the following: a.The minimum limits of insurance required in the contract or agreement; or b.The Limits of Insurance shown in the Declarations of this Policy. Other insurance includes any type of self-insurance or other mechanism by which an Insured arranges for the funding of legal liabilities. SL-373 (0219)Page 1 of 1 Copyright © Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Attachment Code: D661966 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 EXCESS LIABILITY SL-233 (0221) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Waiver of Subrogation Endorsement Policy Number:100588967261 Effective Date:5/1/2026 at 12:01 A.M. Named Insured:Monarch Landscape Holdings, LLC This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. EXCESS LIABILITY POLICY It is hereby agreed that SECTION IV. CONDITIONS, K. Transfer of Rights of Recovery Against Others to Us is amended to include the following: SCHEDULE Name Of Person(s) Or Organization(s): All as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Policy. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. All other terms and conditions of this Policy remain unchanged. SL-233 (0221)Page 1 of 1 Copyright © Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Attachment Code: D661967 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 Starr Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NONRENEWAL TO DESIGNATED ADDITIONAL INSURED Policy Number: 100588967261 Effective Date: 5/1/2026 at 12:01 A.M. Named Insured: Monarch Landscape Holdings, LLC This endorsement modifies insurance provided under the following: EXCESS LIABILITY POLICY FORM ADDITIONAL ENTITY RECEIVING NOTICE OF CANCELLATION OR NONRENEWAL NAME:Where Required By Written Contract ADDRESS:Where Required By Written Contract CANCELLATION:Number of Days Notice:30 WHEN WE DO NOT RENEW (Nonrenewal):Number of Days Notice:30 The following is added to the Cancellation Condition, When We Do Not Renew Condition or as amended by an applicable state cancellation/nonrenewal endorsement: If we cancel or do not renew the Named Insured's policy for any statutorily permitted reason, other than nonpayment of premium, we will mail written notice of such cancellation or nonrenewal to the additional person or organization designated in the Schedule above. The Number of Days Notice indicated in the Schedule above is the minimum number of days we will mail notice to the person or organization designated above before the effective date of such cancellation or nonrenewal All other terms, definitions, conditions and exclusions of this policy remain unchanged. SL 106 (04-11)Page 1 of 1 Copyright © Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Attachment Code: D672929 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0 City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 To whom it may concern: In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance, thus this is your final hard-copy delivery. To ensure electronic delivery for future renewals of this certificate, we need your email address. Please contact us via one of the methods below, referencing Certificate ID 21518612. • Email: mountainwestedelivery@lockton.com • Phone: 303-728-8060 If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed. In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above. The above inbox and phone number is for automating electronic delivery of certificates only. Please do NOT send future certificate requests to this inbox or contact the phone number below with email updates. Thank you for your cooperation and willingness in reducing our environmental footprint. Lockton Companies Lockton Companies 8110 E. Union Avenue, Suite 100 Denver, CO 80237 Attachment Code: D644713 Master ID: 1554537, Certificate ID: 21518612 Docusign Envelope ID: B3C9C376-627C-8CBF-830F-0A4C8C99A3E0