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HomeMy WebLinkAboutSafety Network Traffic Signs - Insurance Certificate (2019)AC6R� DATE (12 /2018 Y) CERTIFICATE OF LIABILITY INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR 06/12/2018 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 pc icy(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). PRODUCER CONTACT Sandy Imhoff NAME: Cal-Valley Insurance Services, Inc. (559) 225-1300 FAX, (559) 225 -8966 NNo A/C Ext : No 5070 N. Sixth SL #155 E -MAIL Salldvi (cDcalvallevinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # License #0733383 Fresno CA 93710 INSURERA : Everest National Insurance Co 10120 INSURED INSURER B : Philadelphia Indemnity Insurance Company 18058 Safety Network, Inc., Safety Network Traffic Control Services, Inc. INSURERC : Endurance Risk Solutions Assurance Co. 43630 Safety Network Traffic Signs, Inc. INSURER D : State Compensation Ins Fund 35076 2310 N. Larkin Ave INSURER E: Fresno CA 93727 -8644 INSURER F: COVERAGES CERTIFICATE NUMBER: 18 /19GL /AU /EX; 18/19 WC 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. LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY 7351 Rosanna Street Gilroy CA 95020 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I OCCUR UAIMA G O PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 10.000 PERSONAL & ADV INJURY $ 1,000,000 A CF2GL00035181 06/06/2018 06/06/2019 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY [g jECT F—] LOS PRODUCTS- COMP /OPAGG $ 2,000,000 OTHER: BOdlly Injury Ilmlt(S) $ AUTOMOBILE LIABILITY CCU BINED SINGLE LIMIT Ea accident $ 1.000,000 BODILY INJ URY(Per person) $ X ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS PHPK1828111 06/06/2018 06/06/2019 BODILY INJURY(Peraccid -l) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Peraccident $ combined single limit $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,OK000 C X EXCESS LIAB CLAIMS -MADE EXC30000041102 06/06/2018 06/06/2019 AGGREGATE $ 5.000,000 DIED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in Ni N/A 909439718 04/01/2018 04/01/2019 X STATUTE EOTT E.L. EACH ACCIDENT $ 1.0K000 E. L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT 1 .000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 16- RFP -PW -390 Regulatory Sign Inventory and Retroerelectivity Assessment GL: ADDITIONAL INSURED perform CG2010 & CG2037; PRIMARY & NONCONTRIBUTORY perform CG2001; WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US perform CG2404; DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE limitwith Cap $5,000,000 per form ECG25529. Auto: Blanket Additional Insured perform PI-CA-003; Auto Primary perform CA0001, Blanket Waiverof Subrogation perform PI -CA -001 WC: Blanket Waiver of Subrogation per form 10217 30 Day Cancellation except 10 days for Non Payment of Premium. ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 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 City of Gilroy, its officers, officials, employees ACCORDANCE WITH THE POLICY PROVISIONS. and volunteers AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy CA 95020 y y A. p__ _ i ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CF2GL00035181 COMMERCIAL GENERAL LIABILITY CG 2010 04 13 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) Locations Of Covered Operations ANY PERSON OR ORGANIZATION THAT ENTERED INTO A WRITTEN CONTRACT WITH THE NAMED INSURED REQUIRING SUCH PERSON (S) OR ORGANIZATION(S) TO BE NAMED AS AN ADDITIONAL INSURED WITH RESPECT TO THE NAMED INSURED'S PERFORMANCE OF OPERATIONS AT ANY LOCATION ON BEHALF OF SUCH PERSON(S) OR ORGANIZATION 5 . 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 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 0413 © Insurance Services Office, Inc., 2012 Page 1 of 3 INSURED =-y 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 insureds) 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. Page 2 of 3 Q Insurance Services Office, Inc., 2012 CG 2010 04 13 IMUREO COPY 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 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 10 0413 © Insurance Services Office, Inc., 2012 Page 3 of 3 ❑ INSURED COPY POLICY NUMBER:( CF2GL00035181 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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 /COM PLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION ANY LOCATION FOR WHICH THE THAT ENTERED INTO A WRITTEN NAMED INSURED'S 'WORK WAS CONTRACT WITH THE NAMED PERFORMED FOR SUCH PERSON(S) INSURED REQUIRING SUCH PERSON OR ORGANIZATIONS) FOR ANY (S) OR ORGANIZATIONS) TO BE COMPLETED OPERATIONS. NAMED AS AN ADDITIONAL INSURED. 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 world' 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 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 04 13 b Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED COPY 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: I. 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. Page 2 of 2 Q Insurance Services Office, Inc., 2012 CG 20 37 0413 ❑ INSURED COPY Policy # CF2GL00035181 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. PRIMARYAND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional Insured under your policy provided that; (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 0413 (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. V Insurance Services Office, Inc., 2012 INSLRED COPY Page 1 of 1 POLICY NUMBER; CF2GL00035181 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsernent modifles Insurance provided under the following, COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Gilroy, its officers, officials, employees & volunteers 7351 Rosanna St, Gilroy, CA 95020 The following is added to Paragraph 8. Transfer Of Rights Of Racovery Against Others To Us of Section W — Conditlons: 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 0 insurance Services Office, Inc., 2008 Page 1 of 9 U NSL"m rMy Policy # CF2GL00035181 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT WITH CAP This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: ANY PROJECT FOR WHICH THE NAMED TNSURED PERFORMS WORK OR OPERATIONS. Designated Construction Project General Aggregate Limit Cap: 5,000,000 (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as appiicable to this enaorsement.) A. For all sums which the Insured becomes legally obligated to pay as damages caused by "occurrences" under SECTION I — Coverage A, and for all medical expenses caused by accidents under SECTION I - Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construc- tion project, and that limit Is equal to the amount of the General Aggregate Limit shown In the Declarations. However, the separate Designated Construction Project General Aggregate Limits) are subject to a Desig- nated Construction Project General Aggregate Limit Cap in the amount shown in the above Schedule of this endorsement. The Designated Construction Project General Aggregate Limit Cap is the most we will pay under the Designated Construction Project General Aggregate Limit for all designated construction pro- jects combined. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard ", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing ''suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall re- duce the Designated Construction Project General Aggregate Limit for that designated construction project and the Designated Construction Project General Aggregate Cap. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construc- tion Project General Aggregate Limit for any other designated construction project shown in the Schedule above. However, such payments for damages and medical expenses included in the Designated Construc- tion Project General Aggregate Limit for all designated construction projects combined will reduce the Des- ignated Construction Project General Aggregate Limit Cap. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage To Premises Rented To You and Medical Expense continue to apply. However, Instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. ECG 25 529 0110 Copyright Everest Reinsurance Company, 2010 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSIJREO COPY B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under SECTION I —Coverage A and for all medical expenses caused by accidents under SECTION I -- Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall re- duce the amount available under the General Aggregate Limit or the Products- Completed Operations Ag- gregate Limit, whichever is applicable, and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products- completed operations hazard" is provided, any pay- ments for damages because of "bodily injury" or "property damage" included in the "products- completed opera- tions hazard" will reduce the Products - Completed Operations Aggregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then re- started, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or time- tables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. F. if this policy contains any retained limits, Self Insured Retentions, deductibles or similar provisions, such provisions shall also apply to this endorsement. ECG 25 529 0110 Copyright Everest Reinsurance Company, 2010 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED COPY Policy # PHPK1828111 PI -CA -003 (04114) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. SECTION II —COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended by adding the following: The following are also "insureds ": Any person or organization for whom you are required by an "insured contract' to procure "bodily injury" or "property damage" liability insurance arising out of the operation of a covered "auto" with your permission. However, this additional insurance does not apply to: 1. The owner or anyone else from whom you hire or borrow a covered "auto." This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own; 2. Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household; 3. Anyone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours; 4. Anyone other than your "employees," partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees," while moving property to or from a covered "auto`; or 5. A partner (if you are a partnership), or a member (if you are a limited liability company) for covered "auto" owned by him or her or a member of his or her household. B. The "insured contract" must be in effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or "property damage ". C. This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that "insured ", whether the work is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by you or one of your employees. D. There is no coverage provided to this person or organization for "bodily injury" to its employees or for "property damage" to its property. E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault. F. The defense of any claim or "suit" must be tendered by this person or organization as soon as practicable to all other insurers which potentially provide insurance for such claim or "suit ". G. A person's or organization's status as an "insured" under this endorsement ends when your operations for that "insured" are completed, Page 1 of 2 PI -CA -003 (04114) H. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any "insured," or to procure insurance. I. The following additional exclusions apply: The insurance afforded to any person or organization as an "insured" under this endorsement does not apply to "loss ": 1. Which occurs prior to the date your contract is effective with such person or organization; 2. Arising out of the sole negligence of any person or organization that would not be an "insured" except for this endorsement; or 3. Which occurs after you returned the leased or rented "auto' to the lessor or the policy period ends, whichever occurs first. Page 2 of 2 Policy # PHPK1828111 7 PI -CA -001 (09115) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE ELITE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART Following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Who is An Insured Board Members Newly Acquired Entities Designated Insured Lessor of Leased Autos Included Included Included Included 2 Cost of Bail Bonds $5,000 2 Reasonable Expenses — Loss of Earnings $500 per day 2 Fellow Employee Coverage Amended 3 Towing $100 oer disablement 3 Glass Breakage Windshields and Windows No deductible applies 3 Transportation Expenses $100 per day / $3,000 maximum 3 Hired Auto Physical Damage — Loss of Use $100 per day 1$1,000 maximum 3 Hired Auto Physical Damage ACV or repair or replacement of the vehicle whichever is less 4 Personal Effects $500 4 Rental Reimbursement $100 per day 130 days 4 Accidental Discharge — Air Bag Amended 4 Electronic Equipment $1000 5 Original Equipment Manufacturer Parts Replacement Included 5 Auto Loan / Lease Gap Coverage Amended 5 One Comprehensive Coverage Deductible Per Occurrence Amended 6 Notice of and Knowledge of Occurrence Amended 7 Blanket Waiver of Subrogation Amended as r2_quired_by written contract 7 Unintentional Errors or Omissions Amended 7 Mental Anguish — Bodily Injury Redefined Amended 7 Coverage extensions under this endorsement only apply in the event that no other specific coverage for these extensions is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted in this endorsement. Any deductible listed in the Auto Declarations Page will apply unless specific deductible provisions are set forth under a coverage enhancement below. Page 1 of 7 O 2015 Philadelphia Indemnity Insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. PI -CA -001 (09115) III. BUSINESS AUTO CONDITIONS A. Notice and Knowledge of Occurrence SECTION IV -- BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit Or Loss, Paragraph a. is deleted in its entirety and replaced with the following; a. In the event of "accident," claim, "suit" or "loss," you must give us, or our authorized representative, prompt notice of the "accident" or "loss." Include; (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Your duty to give us or our authorized representative prompt notice of the "accident" or "loss" applies only when the "accident" or "loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; or (3) An executive officer or insurance manager, if you are a corporation. B. Blanket Waiver Of Subrogation SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us, is amended by adding the following exception: However, we waive any right of recovery we may have against any person or organization because of payments we make for "bodily injury" or "property damage" arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract." C. Unintentional Errors or Omissions SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, 2. Concealment, Misrepresentation, Or Fraud is amended by adding the following: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non - renewal. IV. DEFINITIONS A. Mental Anguish SECTION V — DEFINITIONS, C. "Bodily injury" is amended by adding the following: "Bodily injury" also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness, or disease. Page 7 of 7 © 2015 Philadelphia Indemnity insurance Company Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy # PHPK1828111 COMMERCIAL AUTO CA 00 01 03 10 BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" re- fer to the Named Insured shown in the Declarations. The words "we ", "us" and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning, Refer to Section V — Definitions, SECTION I — COVERED AUTOS Item Two of the Declarations shows the "autos" that are covered "autos" for each of your coverages. The following numerical symbols describe the "autos" that may be covered "autos ". The symbols entered next to a coverage on the Declarations designate the only "autos" that are covered "autos ". A. Description Of Covered Auto Designation Symbols Symbol Description Of Covered Auto Designation Symbols 1 An "Auto" 2 Owned "Autos" Only those "autos" you own (and for Liability Coverage any "trailers" you don't own Only while attached to power units you own). This includes those "autos" you acquire ownership of after the policy begins. 3 Owned Private Only the private passenger "autos" you own. This includes those private Passenger passenger "autos" you acquire ownership of after the policy begins. "Autos" Only 4 Owned Only those "autos" you own that are not of the private passenger type (and for "Autos" Other Liability Coverage any "trailers" you don't own while attached to power units you Than Private own). This includes those "autos" not of the private passenger type you acquire Passenger ownership of after the policy begins. "Autos" Only 6 Owned "Autos" Only those "autos" you own that are required to have no -fault benefits in the state Subject To where they are licensed or principally garaged. This includes those "autos" you No -fault acquire ownership of after the policy begins provided they are required to have no- fault benefits in the state where they are licensed or principally garaged. 6 Owned "Autos" Only those "autos" you own that because of the law in the state where they are Subject To A licensed or principally garaged are required to have and cannot reject Uninsured Compulsory Motorists Coverage, This includes those "autos" you acquire ownership of after the Uninsured policy begins provided they are subject to the same state uninsured motorists Motorists Law requirement. 7 Specifically Only those "autos" described in Item Three of the Declarations for which a Described premium charge is shown (and for Liability Coverage any "trailers" you don't own "Autos" while attached to any power unit described in Item Three). a Hired "Autos" Only those "autos" you lease, hire, rent or borrow. This does not include any "auto" Only 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. 9 Non -owned Only those "autos" you do not own, lease, hire, rent or borrow that are used in "Autos" Only connection with your business, This includes "autos" owned by your "employees ", partners (if you are a partnership), members (if you are a limited liability company) or members of their households but only while used in your business or your personal affairs. CA 00 01 03 10 0 Insurance Services Office, Inc., 2009 Page 1 of 12 ❑ B. General Conditions 1. Bankruptcy Bankruptcy or insolvency of the "insured" or the "insured's" estate will not relieve us of any obli- gations under this coverage form. 2. Concealment, Misrepresentation Or Fraud This coverage form is void in any case of fraud by you at any time as it relates to this coverage form. It is also void if you or any other "in- sured", at any time, intentionally conceal or misrepresent a material fact concerning: a. This coverage form; b. The covered "auto'; c. Your interest in the covered "auto "; or d. A claim under this coverage form. 3. Liberalization If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the addi- tional coverage as of the day the revision is ef- fective in your state. 4. No Benefit To Bailee — Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any person or organization holding, storing or transporting property for a fee regardless of any other pro- vision of this coverage form. 5. Otherinsurance a. For any covered "auto" you own, this cov- erage form provides primary insurance. For any covered "auto" you don't own, the in- surance provided by this coverage form is excess over any other collectible insurance. However, while a covered "auto" which is a "trailer" is connected to another vehicle, the Liability Coverage this coverage form pro- vides for the "trailer" is: (1) Excess while it is connected to a motor vehicle you do not own. (2) Primary while it is connected to a cov- ered "auto" you own. b. For Hired Auto Physical Damage Coverage, any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto ". c. Regardless of the provisions of Paragraph a. above, this coverage form's Liability Coverage is primary for any liability as- sumed under an "insured contract ". d. When this coverage form and any other coverage form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our coverage form bears to the total of the limits of all the coverage forms and policies covering on the same basis. 6. Premium Audit a. The estimated premium for this coverage form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures, The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the bal- ance, if any. The due date for the final pre- mium or retrospective premium is the date shown as the due date on the bill. If the es- timated total premium exceeds the final premium due, the first Named Insured will get a refund. b. If this policy is issued for more than one year, the premium for this coverage form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. 7. Policy Period, Coverage Territory Under this coverage form, we cover "accidents" and "losses" occurring: a. During the policy period shown in the Dec- larations; and b. Within the coverage territory. The coverage territory is: (1) The United States of America; (2) The territories and possessions of the Unit- ed States of America; (3) Puerto Rico; (4) Canada; and (5) Anywhere in the world if: (a) A covered "auto" of the private passen- ger type is leased, hired, rented or bor- rowed without a driver for a period of 30 days or less; and (b) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. CA 00 01 0310 O Insurance Services Office, Inc., 2009 Page 9 of 12 0 HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION RT.AWWVT RARTR BROKER COPY REP 04 9094397 -18 RENEWAL NE 3- 13 -74 -07 EFFECTIVE APRIL 1, 2018 AT 12,01 A.M. PAGE 1 OF AND EXPIRING APRIL 1, 2019 AT 12.01 A.M. SAFETY NETWORK, INC. 2310 N LARKIN AVE FRESNO, CA 93727 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUTHORIZED REPRESENT 1VE SCIF FORM 10217 IREV.7 -20141 MARCH 7, 2018 PRESIDENT AND CEO 2572 OLD DP 217 1