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HomeMy WebLinkAboutCOI - A. Teichert & Son, Inc. - Expires 2023-03-31ACC: / ' CERTIFICATE OF LIABILITY INSURANCE �-w - DATE(MM/DDIYYYY) 3/28/2022 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). PRODUCER Edgewood Partners Insurance Center PO BOX 2110 Sacramento CA 95815 '� j ;) ��{% �� u .-V....�ad...✓L,...rLl V &�D j ry APR 06 L O i License ##:bB293f0 CONTACT PHONE Kayla Fritzberg FAX Ext): INC, No): 916-583-7613 E-MAILNo E-M ADDRESS: kayla.fritzberg@epicbrokers.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Allied World Assurance Company (U.S.) 19489 INSURED A. Teichert & Son, Inc.OFFICE DBA Teichert Construction PO Box 15002 Sacramento CA 95851 TEICO S GILROYCITYOF�CLERK'SI INSURER B : Travelers Prop Casualty Co of America 25674 INSURER C: INSURER D : INSURER E : INSURER F : A CERTIFICATE 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYYL POLICY EXP (MM/DD/YYYYL LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y VTJEXGL4R629671TIL22 3/31/2022 3/31/2023 EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE X LIMIT APPLIES FM:X PER: LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OP AGG $ 4,000,000 SIR $ 750,000 B AUTOMOBILE X X LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y Y VTJEAP4R629683TIL22 3/31/2022 3/31/2023 OaMBIaccideNEDnt) SINGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURYaccident) (Per $ PROPERTY DAMAGE (Per accident) $ SIR $ 500,000 A X UMBRELLA LIAB EXCESS LIAB X O OCCUR CLAIMS -MADE Y Y 03082614 3/31/2022 3/31/2023 EACH OCCURRENCE $23,000,000 AGGREGATE $ 23,000,000 DED RETENT ON $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A Y VTWXJUB4R62969522 3/31/2022 3/31/2023 X STATUTE 0TH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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) Re: Annual Moving Permit. Additional Insured: City of Gilroy. When required by written contract, additional insured status with primary coverage applies to General Liability and Automobile, and waiver of subrogation applies to General Liability, Automobile Liability and Excess Workers' Compensation, all per the attached endorsements. XCU, Contractual Liability, and "Broad Form Property Damage" are included per General Liability Form CG0001 04 13. Excess Liability is follow form. See Attached... ATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy CA 95020 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 11 Flat - 9x12 - 338 - 5278 AGENCY CUSTOMER ID: TEICCONS LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Edgewood Partners Insurance Center POLICY NUMBER CARRIER NAIC CODE NAMED INSURED A. Teichert & Son, Inc. DBA Teichert Construction PO Box 15002 Sacramento CA 95851 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE• CERTIFICATE OF LIABILITY INSURANCE Named Insured is a California qualified self -insurer registered under #1867. The Workers' Compensation Policy provides Excess Workers' Compensation / Employer's Liability coverage excess of a $750,000 SIR. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Flat - 9x12 - 338 - 5279 Policy Number: VTJ'EXGL-4R629871'T|L-22 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, �������� ����o�����U����� �n��� �����������d���� ��n �~n��� ENDORSEMENT FOR CONTRACTORS n�x�x�* n x�'nn`�� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 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 this Coverage Part, and those coverage broadening provisions do not apply to the extent that coverage in excluded or limited by ouch an endorsement. The following listing is o general coverage description only, Road all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what inand ionot covered. A. Who IsAnInsured — Unnamed Subsidiaries B. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION U —VVHQ IS AN|NSURED: Any cfyour subsidiaries, other than apartnership, joint venture or limited liability company, that is not shown as a Named Insured in the Declarations is a Named Insured if: a You are the sole owner of, o/ maintain an ownership interest of more than 50% in, such subsidiary onthe first day ofthe policy period; and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary in on insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" moonnd by an offense committed: o. Before you maintained an ownership interest ofmore than 5OY6insuch subsidiary; or b. After the dote' if any, during the policy period that you no longer maintain an ownership interest ofmore than 5096 in such subsidiary, For purposes ofParagraph 1.ofSection ||—Who Is An Insured, each ouoh subsidiary will be deemed tobodesignated inthe Declarations as: C. D. E. F. B. Incidental Medical Malpractice Blanket Waiver OfGubrogaUnn Contractual Liobi|hy—Rai|voedu Damage ToPremises Rented ToYou a. Anorganization other than npartnership, joint venture orlimited liability company; ur b. Atmet; as indicated in its name or the documents that govern its structure. BLANKET ADDITIONAL INSURED — GOVERNMENTAL E0_0T|E@ — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION ||— WHO |S AN|N0UF&ED: Any governmental entity that has issued o permit or authorization with respect to operations performed by you or on your behalf and that you are required byany ordinance, law, building code orwritten contract nragreement tninclude eoan additional insured on this Coverage Port in an innxred, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out nfsuch operations. The insurance provided to such governmental entity does not apply to: m. Any "bodily injury", "property damage" or ^pemnno| and advertising injury" eha|ng out of operations performed for the gnwammnnto| entity; or b. Any "bodily injury" or "property damage" included in the "prod ucts-oomp|etod operations hazard". @207The Travelers IndmnnityCn All rights reserved, Page1 of Flat - 9x12 - 338 - 5280 COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of Page 2 of 3 pharmaceuticals committed by, or with the knowledge or consent of, the insured. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. E. CONTRACTUAL LIABILITY — RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; © 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc,, with its permission. Flat - 9x12 - 338 - 5281 COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage" in the DEFINITIONS Section: "Premises damage" means "property damage" to: CG D3 16 0219 a. Any premises while rented to you or temporarily occupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. © 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Flat- 9x12 - 338 - 5282 Policy Number: VTJ-EXGL-4R629671-TIL-22 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. 5, Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: Page 16 of 21 a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. cc) 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Flat - 9x12 - 338 - 5283 Policy Number: VTJ-EAP-4R629683-TIL-22 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 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 CA T3 53 02 15 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 c) 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Flat - 9x12 - 338 - 5284 COMMERCIAL AUTO 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. Page 2 of 4 (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. © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. - 9x12 -338 - 5285 COMMERCIAL AUTO You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by |noa| |ovx Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable tothe same extent wewould 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 Gto(eo of Amorica, its tnrhiohnn and pnso*nsinno. Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the /ewm ofother countries relating to insurance. G. WAIVER OF DEQUCT|BLE—GLASG The following isadded to Paragraph D.' Deducti- ble, of SECTION ||| — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the g|omo in repaired rather than replaced. H. HIRED AUTO PHYS|CALDAPNAGE—LOSS OF USE — INCREASED LYK8|T The following replaces the |oot sentence of Para- graph A.4.b., Loss Of Use Expenses, ofSEC- TION |I|—PHY8|CAL8AN1AGECC)l/ERAGE: However, the most we will pay for any nxponnan for |ooa of use is QGS per day, to a maximum of $75Ofor any one "accident" |. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED UN1|T The following replaces the first sentence in Para- graph A.4.m.. Transportation Expenses, of SECTION |I| — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day tn o maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of cov- ered "euto"ofthe private passenger type. J. PERSONAL PROPERTY The following |n added to Paragraph A.4., Cover- age Extensions, of SECTION U| — 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 K. L. M. (2) |noronyour covered "auhƒ. This coverage applies only in the event of a total theft nfyour covered "auto". No deductibles apply to this Personal Property coverage. AIRBAGS The following is added to Paragraph B.3.' Exclu- sions, of SECTION U| — PHYSICAL DAMAGE COVERAGE: Exclusion 2.m. does not apply to "loss" to one or more airbags inacovered "auto"you own that in- flate due to o cause other than o cause of "loss" net forth in Paragraphs A.1.b. and A.1,c., but only: m. If that "auto" is o covered "auto" for Compre' hennivnCovorageunde[thinpoUoy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to e maximum of $1'000 for any one "loss". NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a.' of SECTION |V— BUSINESS AUTO CONDITIONS: Your duty togive usnrour authorized representa- tive prompt notion of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known (a) You (if you are enindividuo0; (b) Apartner (if you are opmrtnership}; (c) A member (if you one e limited liability com- pany); (d) An executive officer, director or insurance manager you are acorporation orother or- ganization); or (e) Any "employee" authorized byYou tn give no- tice ofthe "eooidont"o["|ono". BLANKET WAIVER OF SUBROGATION The following rnp|a000 Paragraph A.6.' Transfer Of Rights QfRecovery Against Others To Us, of SECTION |V — BUSINESS AUTO CONDI- TIONS: S. Transfer Of Rights Of Recovery Against Others ToUm VVewaive any right ofrecovery wmmay have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" o,"|noa"'provided that the "ovoidenY'or"|oss" aUooa out of operations contemplated by @o01sThe Travelers Indemnity Company. All rights reserved. Page 3of4 Flat- 9x12 - 338 - 5286 COMMERCIAL AUTO 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: Page 4 of 4 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. © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc, with its permission. Flat - 9x12 - 338 - 5287 Policy Number: VTJ-EAP-4R629683-TIL-22 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". CA T4 99 02 16 2. The following is added to Paragraph B.5., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is a named insured when a written contract or agreement with you, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non- contributory. 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Flat - 9x12 - 338 - 5288 TRAVELERS) ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: VTWXI-UB-4R629695-TIL-22 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.0 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: ST ASSIGN: Page 1 of 1 Flat - 9x12 - 338 - 5289 POLICY NUMBER: VTJ-EXGL-4R629671TIL-22 ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: SCHEDULE Number of Days Notice: Thirty (30) PERSON OR ORGANIZATION: Any person or organization to whom you have agreed in a written contract that notice of cancellation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or organization; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement. ADDRESS: The address for that person or organization included in such written request from you to us. PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. ILT4050519 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Rat- 9x12 - 338 - 5290 POLICYNUMBER: VTJ-EAP-4R629683-TIL-22 ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIG������U�������~���� ������*����� �n�� ORGANIZATION ������U���� ���� NATED PERSON ��x'� ��n'u��x�^n�om���U n»~*n� ~~ NOTICE o�*�~ ��n CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED |NTHIS POLICY SCHEDULE Number mfDays Notice. zlaizty (zo) PERSON OR ORGANIZATION: Any person or organization to whom you have agreed in a written contract that notice ofcancellation ofthis policy will begiven, but only if: 1.You send uoa written request toprovide such notice, including the name and address of such person ororganization; and 2.VVereceive such written request etleast 14days before the beginning ofthe applicable number ofdays shown inthis endorsement. ADDRESS: The address for that person or organization included in such written request from you to us. PROVISIONS |fwecancel this policy for any legally permitted reason other than nonpayment ofpremium, and anumber cfdays is shown for Cancellation in the 8ohodu|a above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail Such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in ouoh Gohodu/n before the effective date of cancellation. Cc) 2019 The Travelers Indemnity Company, All rights reserved. Page 1 of 1 . Flat - 9x12 - 338 - 5291 TRAVELERSJ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 R3 (00) POLICY NUMBER: VTWXI-UB-4R629695-TIL-22 NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX — CONDITIONS: Notice Of Cancellation To Designated Persons Or Organizations If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza- tion before the cancellation is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation. SCHEDULE Number of Name and Address of Designated Persons or Organizations: Days Notice Any person or organization to whom you have agreed in a written contract that 30 notice of cancellation of this policy will be given, but only if: 1. You send us a written request to provide such notice, including the name and address of such person or organization; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement. DATE OF ISSUE: - - ST ASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Flat - 9x12 - 338 - 5292