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HomeMy WebLinkAboutCOI - Precision Grade, Inc. - Expires 2022-04-251-P5260028002 ~ ,® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 06/09/2021 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 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 4IC #0M77949 1-888-845-2.248 CONTACT NAME: Mcsherry & Hudson, LLC Insurance Services ilJgN:o Ext\: 408-550-2130 I FAX IA/C Nol: 408-550-2119 160 West Santa Clara Street E-MAIL ADDRESS: Suite 715 San Jose, CA 95113 INSURER/SI AFFORDING COVERAGE NAIC# INSURERA: JAMES RIVER INS CO 12203 INSURED INSURER B: OHIO SECURITY INS CO 24082 Precision Grade, Inc. INSURER C : STATE COMPENSATION INS FOND 35076 P. o. Box 90 INSURER 0: San Juan Bautista, CA 95045 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 62454209 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. INSR ADDL SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE ,,_,~D WVD POLICY NUMBER IMM/DD/YYVY\ IMM/DD/YYVY\ LIMITS A GENERAL LIABILITY X X 00102289-1 04/25/2] 04/25/22 EACH OCCURRENCE $1,000,000 ,__ DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES /Ea occurrencel $50,000 ,__ 0 CLAIMS-MADE 0 OCCUR ,__ MED EXP {Any one person) $1,000 PERSONAL &ADV INJURY $1,000,000 -GENERAL AGGREGATE $2,000,000 -GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000 n POLICY fxl P,bW,: n LOC $ B AUTOIIIOBILE LIABILITY X X BAS58647981 04/25/2] 04/25/22 i~~~~~llNGLE LIMIT $1,000,000 ,__ X ANY AUTO BODILY INJURY (Per person) $ --All.OWNED SCHEDULED X BODILY INJURY (Per accident) $ AUTOS -AUTOS NON-OWNED r:.~:~~t~AMAGE $ HIRED AUTOS AUTOS ,__ I--$ A UMBRELi.A LIAS MOCCUR 00102390-1 04/25/2 04/25/22 EACH OCCURRENCE $4,000,000 -X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I I RETENTION $ $ C WORKE~S COMPENSATION X 9209210~21 04/25/2 04/25/22 x I T"XgJTf'Jgs I 10,m-AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ~ N/A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B Scheau.Led Equipment BKS58647981. 04/25/2 04/25/22 Ll.In.l.t 1,030,509 B Rented/Leased Equipment BKS58647981 04/25/2 04/25/22 Limit 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if mora space is required) BE: Service Agreement: Construction Services by Precision Grade Contractors on Las Animas Park Additional Insured: City of Gilroy, its officers, officials, and employees CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Its Officers, Officals, and Employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ~ I USA © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) sarahsj The ACORD name and logo are registered marks of ACORD 62454209 ---ml ..,., 00 ..,., 0 N ::£ M ,n > z [.1-1 --Q Q 0 :;; P5260028002 Policy Number: BAS58647981 COMMERCIAL AUTO AC 85 43 OS 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ !T CAREFULLY. CALIFORNIA BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUS!NESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the poHcy apply unless modified by the endorsement. If the policy to which this endorsement is attached aiso contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGE INDEX SUBJECT ACCIDENTAL AIRBAG DEPLOYMENT E_RJ)YISION .. NUMBER 12 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERM!T AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VlSUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BODILY INJURY REDEFlNED EMPLOYEES AS INSUREDS (Including Employee Hired Auto) EXTRA EXPENSE -BROADENED COVERAGE GLASS REPAIR-WAIVER OF DEDUCTlBLE HIRED AUTO COVERAGE TERRITORY HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) LOAN I LEASE GAP (Coverage Not Available !n New York) NEWLY FORMED OR ACQUIRED SUBSIDIARIES PARKED AUTO COLUS!ON COVERAGE (WAIVER OF DEDUCTIBLE} PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM PRIMARY AND NON~CONTRlBUTORY -WRITTEN CONTRACT OR WRITTEN AGREEMENT RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION Ii -UABIUTY COVERAGE is amended as follows: 1. NEWLY FORMED OR ACQUIRED SUBSIDIARIES 3 20 5 14 24 2 10 16 22 6 15 1 17 11 8 13 23 9 4 7 18 19 21 SECTION II -UAB!UTY COVERAGE, Paragraph t\.1. Who Is An Insured is amended to include the following as an "insured": d. Any lega!!y incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that {1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply in excess of this po!icy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. © 2018 liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 on -1 -o:l 00 c5 N '-0 (') ,r, ~ ~ I ~ P5260028002 Policy Number: BAS5864 7981 -= --= --= 2. Coverage under this provision ti. does not apply to "bodily occurred before you acquired or formed the organization. EMPLOYEES AS INSUREDS or "property damage" that SECTION ii -UABIUTY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their emp!oyment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". =**** 3. f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re!ated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT = --;;;:::;:= = "' ;:= g~ :e "' -= = """""""' SECTION II -LIAB!UTY COVERAGE, Paragraph A.1. Who Is An insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": {1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a c!aim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. 4. SUPPLEMENTARY PAYMENTS SECTION II -LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2} and (4) are replaced by the fo!!owing: {2) Up to $3,000 for cost of bail bonds (including bonds for related traffic vio!ations ) required because of an "accident" we cover. We do not have to furnish these bonds. {4} Ali reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. ~ 5. AMENDED FELLOW EMPLOYEE EXCLUSION 'S ~ In those jurisdictions where, by law, fallow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the fo!lowing provi-sion is added: SECTION Ii -UABiUTY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for al! of your "employees" at the time of "loss•. This coverage is excess over any other collectible insurance. SECTION m -PHYSICAL DAMAGE COVERAGE is amended as foHows: 5. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION m • PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": © 2018Uberty Mutual Insurance AC 85 43 0618 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 -iii µ., 00 µ., 0 ("') ;S (") <n > ffi :g 0 :::: ?5260028002 Policy Number: BAS5864 7981 a. You hire, rent or borrow; or b .. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "!oss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible wm be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. cl. Subject to a maximum of $1,000 per "accident", we wil! also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". 7. TOWING AND LABOR SECTION Iii -PHYSICAL DAMAGE COVERAGE, Paragraph A.'l.. Towing, is amended by the addition of the fo!!owing: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we wm pay up to $75 per disablement "Light trucks" are trucks that have a gross vehicle weight (GVW) of 10,000 pounds or !ess. c. For "medium trucks", we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDiTIONAl TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION m -PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500. 9. RENTAL REIMBURSEMENT SECTION m -PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex-penses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lesser vehicle, which in many cases may be substantially less than $75 per day, and wm only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other co!lectib!e insurance. © 2018 Liberty Mutual Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 1 _, o:i 00 6 C') \D -C') .,.., ffi r: ~ 0 ~ 0 ~ P5260028002 Policy Number: BAS5864 7981 ----=== === --"' :: === @!~ 0 --~ :g 0 ~ d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fili. e. !f "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension . f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11.B. 10. EXTRA EXPENSE -BROADENED COVERAGE Under SECTION m -PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we wm pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION Ill -PHYSICAL DAMAGE COVERAGE, A.. Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without appHcation of a deductib!e, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V -DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is wom or carried by an "insured." "Persona! effects" does not include tools, equipment, jewelry, money or securi-ties. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION !ll -PHYSICAL DA.MAGE COVERAGE, B. Exclusions is amended by adding the following: if you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other coHectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 13. PHYSICAL DA.MAGE DEDUCTIBLE • VEHICLE TRACKING SYSTEM SECTION !ll -PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 14. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION m -PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu-sions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c, and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de-signed soie!y for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and {3) Physical damage coverages are provided for the covered "auto•. if the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or rep!ace damaged or stolen property wm be reduced by a $100 deductible. © 2018 Liberty Mutua! Insurance AC 85 43 0618 !ncludes copyrighted material of Insurance Services Office, inc., with its permission. Pag~ 4 of 1 ----■ :;,, 00 f:3 'SI" :::S M V) > ai --:ll 0 "' " ?5260028002 Policy Number: BAS5864 7981 15. LOAN I LEASE GAP COVERAGE (Not Applicable In New York} A. Paragraph C. Limit Of Insurance of SECTION m -PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties imposed under a lease due to high mi!ea\;le, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur-ance purchased with the loan or !ease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a "Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the •total loss" of a covered "auto"; g. Security deposits not refunded by a !essor; h. Al! refunds payable or paid to you as a result of the early termination of a lease agreement or as a resu!t of the early termination of any warranty or extended service agreement on a covered "auto"; i. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition wm be made in determining the actual cash value at the time of the "!oss". This adjustment is not applicable in Texas. 8. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss". C. SECTION V -DEFINITiONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs pius the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment 16. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION m -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 17. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE} Paragraph D. Deciuctib!e of SECTION m -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry whi!e it is: a. In the charge of an "insured"; b. legally parked; and c. Unoccupied. © 2018liberty Mutua! Insurance AC 85 43 0618 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7 -co 00 5 7 '-0 "" .,., > z U-1 1-P5260028002 Policy Number: BAS58647981 -----= ==== ==== --= --;;;;;;;;;;;;;;; -~ g--~ "' " 0 The "loss• must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" lf the covered "auto" is in the charge of any person or organization engaged in the automobile business. 18. 1WO OR MORE DEDUCTIBLES Under SECTION m • PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible : a. !f the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. lf the applicable Business Auto deductible is not the smaller (or smallest) deductible , it wm be reduced by the amount of the smaller (or smallest) deduclib!e; or c. !f the "!oss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible wm be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. SECTION IV • BUSINESS AUTO CONDiT!ONS is amended as fo!!ows: 19. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDmONS , Paragraph B.2. is amended by adding the following: lf you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep-tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy wi!I not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 20. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS SECTION IV -BUSINESS AUTO CONDITIONS , Paragraph A.2.a. is replaced in its entirety by the follow-ing: a. in the event of "accident", claim, "suir or "!ossfi, you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took p!ace; {b) The "insured's" name and address; and (c} The names and addresses of any injured persons and witnesses. "' **** 21. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV • BUSINESS AUTO CONDITIONS , Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 22. HIRED AUTO COVERAGE TERRITORY SECTION lV • BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the foi!owing: f. For "autos" hired 30 days or less, the coverage territory is anywhere ln the world, provided that the "insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. © 2018Uberty Mutual Insurance AC 85 43 0618 !nciudes copyrighted materia! of Insurance Services Office, Inc., with its permission. Page 6 of 1 -a u.. 00 u.. 0 "' \0 ("') "' > z µ.i ro ro 0 ~ ., P5260028002 Policy Number: BAS58647981 This extension of coverage does not app!y to an "auto" hired, leased, rented or borrowed with a driver. ****23. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE-MENT The following is added to SECTION IV -BUSINESS AUTO COND!T!ONS, General Conditions, 8.5. Other Insurance 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 a written contract or written agreement that this insurance wou!d be primary and would not seek contribution from any other insurance available to such "insured". SECTION V -DEFINITIONS is amended as follows: 24. BODILY INJURY REDEFINED Under SECTION V • DEFINITIONS , Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. © 2018 Liberty Mutua! Insurance AC 85 43 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 -!:Q 00 5 .,., "' -<:') .,., > ~ Ii --~ ~ !.i.!i:l!if)\;/::.::.:.':::?\:'::,, si'~TE ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS BROKER COPY .· ···coM~!~iNs-"i10N } :N :_~: -i~j/~\~:.:. ~/~.::~ : F=W N CJ i}iJ}:i','··.· ·'·' HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EFFECTIVE APRIL 25, 2021 AT 12.01 A.M. AND EXPIRING APRIL 25, 2022 AT 12.01 A.M. PRECISION GRADE INC. PO BOX 90 SAN JUAN BAUTISTA, CA 95045 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 PERFOR.~ 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 ORGAi.~IZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NA.~ED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION REP 06 9209210-21 RENEWAL NA 9-82-95-95 PAGE 1 OF NOTHING !N THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POUCY 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: 2572 ~~q, APRIL 27, 2021 IL_.. .JI~~~ PRESIDENT AND CEO SCIF FORM 10217 {REV.7·2014) OLD DP 217 l ---~ co ~ 0 \0 \0 (") ,r, ;> z i:l-1 ---P5260028002 POLICY NUMBER: 00102289-1 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 UAB!UTY COVERAGE PART SCHEDULE Name Of Additional Insured Person{s) Location And Description Of Completed Opera-Or Organization(s): tions Where required by written contract All operations of the Named Insureds or written agreement Information required to complete this Schedu!e, if not shown above, wm be shown in the Declarations. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedu!e, 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 additionai insured and included in the "products-compieted operations hazard". CG 20 37 07 04 © !SO Properties, Inc., 2004 Page 1 of 1 □ co 00 "'"' 0 '-0 :S c<') ,,., > rE P5260028002 POLICY NUMBER: 00102289-1 COMMERCIAL GENERAL LIABILITY CG 20 HI 07 04 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 UABlUTY COVERAGE PART SCHEDULE Name Of Additional insured Perscm{s) Or Ori:;anization(s}: location(s} Of Covered Operations Where required by written contract All operations of the Named Insureds or written agreement Information required to comoiete 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 !njury", "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) desig-nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu-sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. A!l work, including materials, parts or equip-ment 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 in-tended use by any person or organization oth-er than another contractor or subcontractor engaged in performing operations for a princi-pal as a part of the same project CG 2010 07 04 © !SO Properties, Inc., 2004 Page 1 of 1 □ e~ 00 5 r-;S ("') .,., :> Gi 1·----P5260028002 POLICY NUMBER: 00102289-1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CA.REFUll Y. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s} Or Q_rganization{s): Where required by ;,,vritten contract or written agreement If no entry appears above, this endorsement applies to all Additional Insureds covered under this policv. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifica!ly requires that this insurance apply on a primary and noncontributory basis. All OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031US 04-10 Page i of 1 _, co 00 5 t"---0 -er, .,., > ti:i 1--~ I P5260028002 POLICY NUMBER: 00102289-1 COMMERCIAL GENERAL UABILiTY CG 2404 0509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL UABlUTY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS UABIUTY COVERAGE PART SCHEDULE Name Of Person Or Organization: Where required by written contract or written agreement Information required to complete this Schedule, if not shown above, wm be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Ccmditions: 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 lnjury or . damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "pmducts-comp!eted operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 2404 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 -. ~ ~ r.,., 00 0 00 "° -<'l In ~ ..LI □ .-P5260028002 SUPPLEMENT TO CERTIFICATE OF INSURANCE NAME OF INSURED: Precision Grade, Inc. Additional Description of Operations/Remarks from Page 1: Additional Information: Included: General Liability: Additional Insured per attached form CG20370704 and CG20l00704. Primary and Non-Contributory Wording per attached form AP5031US 04-10. Waiver of Subrogation per attached form AC85430618. Automobile Liability: Additional Insured, primary and non-contributory wording, and Waiver of Subrogation per attached form CA88100l13. Workers Compensation: waiver of Subrogation per attached form 10217 Rev. 7-2014. SUPP (05/04} DATE 06/09/2021 o:l C() '"-, 0 co '-0 -<'1 v; > Gi