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HomeMy WebLinkAboutCOI - MGE Underground, Inc. - Expires 2024-10-01P5260028002 McSherry & Hudson, An Alera Group Company 1901 S. Bascom Avenue Suite 1190 Campbell, CA 95008 02310023917 Electronic Service Requested MIXED AADC 950 5237 2.0203 MB 0.558 11I ldialhirr1114191d6P 1implipli 1POh1111111111 Cityy of Gilroy Public Works Department, Engineering Division 7351 ROSANNA Si' GILROY, CA 95020-6141 EBIX BPO Ttlis document was brought to you by Cert;ificatesNow. If.you have questions regarding the content of this document, please contact - the Producer/Agent listed on the certificate of insurance or the Insured listed - on the notice of cancellation/reinstatement. CC: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. CA 0 N Certificate Delivery by CertlficatesNow - www.ConfirmNet.com - 877.669.8600 P5260028002. AcOR ff `„/ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/29/2023 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(les) 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 LIC #0L72977 1-888-845-2248 MoSherry & Hudson, An Alera Group Company 1901 S. BaaOom Avenue - Suite 1190 Campbell,- CA 95008 Charles M. Griswold CONTACT NAME: PHONE FAX (A/C No Exth 408-550-2130 (AIC,No): 408-550-2119 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: TRAVELERS PROP CAS CO OF AMER 25674 INSURED: MGE Underground, Inc. P.O. Box 4189 Paso Robles, CA 93447 - -. - INSURERB: AXIS SURPLUS INS CO 26620 Tokio Marine Specialty Y Insurance Company23B50 INSURERD: LEXINGTON INS CO 19437 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 69802446 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 ILTR - TYPE OF INSURANCE ADDL INSR SUBR WVD - POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) - LIMITS A GENERALLIABILITY X COMMERCIALGENERALLIABILITY X X - VTC2J-00-3K990510-TIL-23 10/01/2 10/01/24 EACHOCCURRENCE $2,000,000 PREMI ETORENTED PES (Ea occurrence}. REMIS $ 300,000 CLAIMS -MADE X OCCUR - MED EXP (Any one person) $ 5, 000.. - ' PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE —1 POLICY X LIMIT APPLIES�PER: M. I IILOC PRODUCTS -COMP/OP AGG $ 4,000,000 Emp Ben. $1,000,000 A AUTOMOBILELIABILITY X X A ANY AUTO ALLOWNED X SCHEDULED AUTOS. NON•OWNED AUTOS X X VTC2J-CAP-3K990522-TIL-2yd - 10/01/2 10/01/24 COMBINEDSINGLELIMIT- Meaccident) $2,000,000 BODILY INJURY (Per person) . $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident)) $ B X UMBRELLALIAB EXCESS LIAB X — OCCUR CLAIMS -MADE P-0017000445582704 10/01/2 10/01/24 EACHOCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENT ORS $ A WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yos, describe under DESCRIPTION OF OPERATIONS below YIN N NIA X UB-63664667-23.25-D - - -. 10/01/2 10/01/24 - X WCSTATU- TORYY LIMITS Si - ER E.L. EACH ACCIDENT $ 1,000,000.. E.L, DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMIT $ 1,000,000 C D A Prof. / Poll. Liability Excess Liability Scheduled Equipment PPK2608166-000 080878099 QT-660-4E989568-TIL-23 10/01/2 10/01/2 10/01/2 10/01/24 10/01/24 10/01/24 Per Claim/Agg 10M/10M single/Aggregate 4,000,000 Limit 12,788,900. DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,)( more space is required)" RE: Job#31377261; Laurel and 3rd St Gilroy, CA Additional Insured per written contract: City of Gilroy, its Officers, Officials, Representatives, Agents, Employees and Volunteers CERTIFICATE HOLDER CANCELLATION City of Gilroy Public Works Department, Engineering bivieion 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010/05) maggil2 69802446 USA 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 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 61 P526002S002 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/29/2023 NAME OF INSURED: MGE underground, Inc. Additional Description of Operations/Remarks from Pace 1: Additional Information: Includes: General Liability: Additional Insured per attached forme CGD2460419 Primary Wording per attached form CGT1000219 Waiver of Subrogation per attached form CGD3160219 Per Aggregate Limit per attached form CGD2110104 AutomobileLiability: Additional Insured per attached form CAT3530817, Waiver of Subrogation per attached CAT3530817 Primary wording per attached CA474 08-17 Workers Compensation: Waiver of Subrogation per attached form WC 990376(a)001 SUPP (05/04) P5260028002 202310023917 Policy Number: VTC2J-CO- 3K990510-TIL-23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURE (includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following:- COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS `. The following is added to SECTION 11 - WHO IS AN INSURED: Any person or organization that you agree in" a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage that occurs, or for "personal injury" caused by anoffense that is committed,; subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or. damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does hot qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this .Coverage Part shown in the Declarations exceed the minimum limits required ' by the written contract or agreement, the insurance provided to the additional insured will he Ilinited to such minimum required limits, For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered " to include the minimum limits of any Umbrella or Excess liability coveragerequired for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described .in Section 111 Limits Of Insurance. b. The insurance provided to such additional insured does not apply to: CG D2 46 0419 (1) Any "bodily" injury" "property dainage" or "personal injury" arising out of the providing, or failure to provide, ; any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, " approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury" or "property damage" caused by "your work" and included hi the "products -completed operations hazard" unless the written' contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period, c, The additional ` insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence'.' or an offense which may result in a claim, To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. (2) If a claim is made or "suit" is brought against the additional insured: Cr 2018 The Travelers Indemnity company. All rights reserved. Page 7 of 2 . 0 M P5260028002 Policy Number: VTC2J-00- 3K990510-TIL-23 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specificsof the claim or"suit" and the date received; and (b) Notify us as soon as practicable and see to It that we receive written notice of the claim or "suit" as soon as practicable. (3) 'Immediately : send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply' with all policy conditions. (4) Tender the defense and . indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. 02018 The Travelers Indemnity Company, All rights reserved, CG D2'46 0419 P5260028002 Policy Number; VTC2J-CO- 3K990510-TIL-23 *** COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, XTENb ENDORSEMENT FOR CONTRACTORS 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 th ese coverage broadening provisions do riot apply to the extent that coverage is excluded or limited . by such an endorsement. The following listing is a general coverage description only, Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An insured- Unnamed Subsidiaries B. Blanket Additional. Insured — Governmental Entitles — Permits Or Authorizations Relating To Operations' PROVISIONS A. WHO IS AN INSURED SUBSIDIARIES The following is added to SECTION I1— WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, 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, or maintain an UNNAMED ownership interest of more than 50% in, such subsidiary on the first day of the policy period; and b, such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense' committed: a, Before you maintained an ownership interest of more than 50% in such subsidiary; or After the date, if any, during the policyperiod that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1, of Section II - Who Is An Insured, each such subsidiary will be deemed to be designated In the Declarations as; b. CG D3 16 0219 C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability — Railroads P. Damage To Premises Rented To You a. An organization other than a partnership, joint venture or limited liability company; or b, A trust; as indicated in its name or the documents that govern its structure. B. BLANKET ADDITIONAL INSURED GOVERNMENTAL ENTITIES PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION it — WHO 1S AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance,: law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance . provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" ,or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard", 0 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 3 • PS260028002 Policy Number: VTC2J-CO 3K990510-TIL-23 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 !f — 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" byany 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 Itl 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 ar "Good Samaritan services" to anyone person will be deemed to be one "occurrence 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION 1 - 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 D. 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: Medical, surgical, dental, laboratory, x-ray or nursing service ar treatment, advice or instruction, or the related furnishing of food or beverages; or The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 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. 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: "Bodily injury" ` or "property occurs; or "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. Includes copyrighted material of Insurance Services Office, Inc., with its permission CG D316 0219 P5260028002 Policy Number;VTC2J-CO- 3K990510-TIL-23 2. ' Paragraph`f,(1) of the definition of "insured contract" In the DEFINITIONS Section is deleted. P. 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 02 19 COMMERCIAL GENERAL LIABILITY a Any premises while 'rented to you or temporarily' occupied by you with permission of the owner; or b. The contents of any premises whilesuch 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 lights reserved. Page 3 of 3 Includes copyrighted material of insurance Services Office, Inc., with Its permission 7,4 P5260028002 POLICY NUMBER: VTC2J-CO- 3K990510-TIL-23 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 10-01-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project(s): EACH "PROJECT" FOR WHICH YOU HAVE AGREED IN A WRITTEN CONTRACT THAT IS IN EFFECT DURING THIS POLICY PERIOD, TO PROVIDE A SEPARATE GENERAL AGGREGATE LIMIT, PROVIDED THAT THE CONTRACT IS SIGNED BY YOU BEFORE THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION I), and for all medical expenses caused by accidents un- der COVERAGE C (SECTION I), which can be attributed only to operations at a single desig- nated "project" shown in the Schedule abo ve: 1. A separate Designated Project General Ag- gregate Limit applies to each designated "pro- ject", and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations, unless separate Designated Project General Aggregate(s) are sched- uled above. 2, The Designated 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 "prop- erty damage" included in the "products - completed operations hazard", and for medi- cal expenses under COVERAGE C, regard- less of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits", CG D2 11 01 04 Designated Project General Aggregate(s): GENERAL AGGREGATE LIMIT SHOWN ON THE DECLARATIONS 3. Any payments made under COVERAGE A. for damages or under COVERAGE C. for medical expenses shall reduce the Desig- nated Project General Aggregate Limit for that designated "project". Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they re- duce any other Designated Project General Aggregate Limit for any other designated "project' shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, 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 Project General Ag- gregate Limit. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A. (SECTION I), and for all medical expenses caused by accidents un- der COVERAGE C. (SECTION I), which cannot be attributed only to operations at a single desig- nated "project" shown in the Schedule abo ve: Copyright, The Travelers Indemnity Company, 2004 Page 1 of 2 P5260028002 COMMERCIAL GENERAL LIABILITY . Any payments made under COVERAGE A vided, any :payments for damages because' of for damages or underCOVERAGE C. for medical expenses shall reduce the amount available under the General .Aggregate Limit or the Products -Completed Operations Ag- gregate:Limit, whichever is applicable; and C. 2. Such payments shall not reduce any ![Desig- nated Protect General Aggregate Limit Part 2. of SECTION III — LIMITS OP INSURANCE is deleted and rep laced by the following: following definition: 2. The General Aggregate: Limit is the most we "Project" means an area away from premises will pay for the sum of: ' owned, by or rented to you at which you are per a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of Insurance, each COVERAGE A (SECTION I) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting Tots, or premises whose con - under COVERAGE C (SECTION I) which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated "project" shown in the • considered a single "project". SCHEDULE above. F. The provisions' of SECTION III -- LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "!products -completed operations hazard" is pro- dorsement shall continue to apply as stipulated. "bodily injury" or "property damage" : included in the "products -completed operations hazard" will reduce the Products -Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gate Limit nor the Designated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini. tions Section is amended by the addition of the forming operations pursuant to a contract or ............... . Page 2 of 2 Copyright, The Travelers Indemnity Company, 2004 CG 1)211 01 04 PS260028002. PolicyNumber: VTC2J-CO 3K990510-TIL-23 COMMERCIAL GENERAL LIABILITY 6 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 conies 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, Premium Audit We will compute all premiums for this Coverage Partin 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. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based representations you made to us; and 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. 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 c. 8. Transfer Of Rights Of Recovery Against Others Tci 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 therm: 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:' upon 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. Pagel6of21 © 2017 The Travelers indemnity Company. All rights reserved. CG T1 00 0219 Includes copyrighted material of Insurance Services Office, Inc. with its permission. P5260028002 202310023917 Policy #: VTC2J-CAP-3K990522-TIL-23 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 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. 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 coverage description only. Limitations and exclusions may apply to these coverages: Read all the provisions of this endorsement 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 COVERAGE -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 LIABILITY COVERAGE: Any organization you newly acquire or form during 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 until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, that is signed by you before the "bodily injury" or"property damage" occurs and that is in effect during the policy period, to name CAT3530817 H. HIRED AUTO PHYSICAL DAMAGE LOSS OF USE INCREASED LIMIT PHYSICAL DAMAGE - TRANSPORTATION EXPENSES —INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS C. as an additional insured for 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". EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 1I -- LIABILITY COVERAGE An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV BUSINESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: © 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission rn 0 P5260028002 Policy #: VTC2J-CAP-3K990522-TIL-23 COMMERCIAL AUTO (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 that individual "employee's" name, with your permission, while performing duties related to the conduct of your business, 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 - LIABILITY COVERAGE: Any "employee" of yours is an "insured" while using 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, -LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) 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 11— LIABILITY COVERAGE: (4) All 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. F. HIRED AUTO - LIMITED WORLDWIDE COVERAGE — INDEMNITY BASIS The following replaces Subparagraph e. in Paragraph B.7., Policy Term, Coverage Territory, of SECTION IV - BUSINESS AUTO CONDITIONS: e. Anywhere in the world, except any country or jurisdiction while any trade sanction, embargo, or similar regulation imposed by the United States of America applies 10 and prohibits the transaction of business with or within such country or jurisdiction, for 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 Page2of4 liability company) or members of their households. (1) 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: (a) You must arrange to defend the "insured" against, and investigate or settle any such claim or "suit" and keep us advised of all proceedings and actions. (b) Neither you nor any other involved "insured will make any settlement without our consent. (c) We may, at our discretion; participate in defending the "insured" against, or in the settlement of, any claim or "suit". (d) We will reimburse the "insured": (i) For sums that the "insured" legally must '' pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "insured" pays with our consent, but only up to the limit described in , Paragraph C., Limit Of Insurance, of SECTION II - LIABILITY COVERAGE; (ii) For the reasonable expenses incurred with our consent for your investigation of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Paragraph C., Limit Of Insurance; of SECTION II - 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. (2) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess contingent or on any other basis. (3) This insurance is not a substitute for required or compulsory insurance in any country outside the United States, its © 2016 The Travelers Indemnity Company. All rights reserved. CA T3 53 08 17 Includes copyrighted material of Insurance Services Office, Inc. with Its permission P5260028002 Policy #: VTC2J-GAP-3K990522-TIL-23 territories and possessions, Puerto Rico and Canada. You agree to maintain all required or compulsory insurance in any such country up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory insurance requirements. (4) It is understood that we are not an admitted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Canada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deductible, of SECTION III - PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced: HIRED AUTO PHYSICAL DAMAGE LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Paragraph A.4.b., Loss Of Use Expenses, of SECTION III PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for Toss of use is $65 per day, to a maximum of $750 for any one "accident". PHYSICAL DAMAGE - TRANSPORTATION EXPENSES —INCREASED LIMIT The following replaces the first sentence in Paragraph A.4.a., Transportation Expenses, of SECTION III PHYSICAL DAMAGE COVERAGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. J. PERSONAL EFFECTS The following is added to Paragraph A.4., Coverage Extensions, of SECTION III PHYSICAL DAMAGE COVERAGE: CAT3530817 K. L. M. COMMERCIAL AUTO Personal Effects We will pay up to $400 for "loss" to wearing apparel and other personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. AIRBAGS The following is added to Paragraph B.3., Exclusions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or `. more airbags in a covered "auto" you own that inflate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that ".auto" is a covered "auto" for Comprehensive Coverage under this policy; b. The airbags are not covered under any warranty; and c. The airbags were not intentionally inflated. We will pay up to a 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 IV - BUSINESS AUTO CONDITIONS: 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: (a) - You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are : a limited company); (d) An executive officer, director or insurance manager (if you are a corporation or other organization); or (e) Any "employee" authorized by you to give notice of the "accident" or "loss". BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV BUSINESS AUTO CONDITIONS: 0 2016 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office; Inc. with its permission N P5260028002 Policy #: VTC2J-CAP-3K990522-TIL-23 COMMERCIAL AUTO 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract signed and executed prior to any "accident or "loss", provided that the "accident" or "loss" arises out of operations contemplated by 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., Concealment, Misrepresentation, Or Fraud, of SECTION IV - BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. However this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. Page 4 of 4 ©2016 The Travelers Indemnity Company. All rights reserved. CA T3 53 08 17 Includes copyrighted material of Insurance Services Office, Inc. with its permission P5260028002 Policy #VTC2J-CAP-3K990522-TIL-23 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II — LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, 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 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 74 08 17 The following isadded 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 the first' named insured' when the written contract or agreement between you and that person or organization, 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. P3260028002 202310023917 TRAVELERS J ONE TOWER SQWARE HARTFORD CT 06153 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) - 001 POLCY NUMBER: UB-6S664667.23-25-D 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 2.00 % of the California workers' compensation pre- mium. Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule Job Description �.�.., 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 ILlierarri the policy.) Endorsement Effective Insured:10/01/2023 Policy No.UB-6S664667-23-25-D Endorsement No. Premium Insurance Company : Travelers Property Casualty Company of America countersigned by DATE OF ISSUE: 10-1-23 ST ASSIGN: Page 1 of 1 001375 P5260028002 McSherry& Hudson, An Alera Group Company 1901 S. Bascom Avenue Suite 1190 Campbell, CA 95008 202310023917 Electronic Service Requested t1IXED AADC 950 5199 1.8304 f1B 0.558 'IIIIIII1IIll 11111 ll111'11"II1011PPII'III"IIIIdirddlill" 7351 Cityy of SANGilrNAoST yy 76 RO GILROY, CA 95020-6141 EBIX PO This document was brought to you by Certi£icatesNow. - If you have questions regarding the content of this document, please contact the Producer/Agent listed on the certificate of insurance or the Insured listed on the notice of cancellation/reinstatement. cc The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this Information. 00 O Certificate Delivery by CertfficatesNow - www.ConfirmNet.com - 877.669.8600 P5260028002 P5260028002 7- - A o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/29/2023 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(les) 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 LIC #0L72977 1-888-845-2248 McSherry & Hudson, An Alera GroupCompanyNAME: - - 1901 S. Bascom Avenue Suite 1190 Campbell CA 95008 Charles M. Griswold CONTACT PHONE 408-550-2130 FAX 408-550-2119 (AIC,.No. Ext); (A/C, NO E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: STARR IND & LIAB CO 38318 INSURED Ferule Corporation 6639 Smith Avenue Newark, CA 94560 1NSURERB: HOMESITE INS CO 17221 INSURERC: Tokio Marine Specialty Insurance Company23850 INSURERD: INSURERS: INSURER F COVERAGES CERTIFICATE NUMBER: 69795098 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 LTR ' TYPE OF INSURANCE ADDL INSR SUBR AND POLICY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X X 1000025823231 10/01/23 10/01/24 EACH OCCURRENCE $1,000,000 DAMAGE TO (a occurreDnce) PREMISES (Ea occurrence) $ 100, 000 CLAIMS -MADE X OCCUR MEDEXP (Any one person) $10,000 PERSONAL. $ADVINJURY - $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE —1 POLICY X LIMIT APPLIES 1261F PER: LOC PRODUCTS - COMP/OP AGG $ 2, 000, 000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED — X SCHEDULED AUTOS NON•OWNED AUTOS X X 1000198707231-, 10/01/23 10/01/24 C(EuaccidenOMBINEDSINGLEq LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE CXP-010622-01 10/01/23 10/01/24 EACHOCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION$ FOLLOW FORM $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) if yes, describe under DESCRIPTION OF OPERATIONS below YIN N N /A X 1000004374 10/01/22 10/01/24 X WCSTA TS ER E.L, EACH ACCIDENT $ 1, 000, 000 E.L, DISEASE- EA EMPLOYEE $ 1, 000, 000 E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 C C Pollution Liability Professional Liability PPK2609311-000 PPK2609311-000 10/01/22 10/01/2E 10/01/24 10/01/24 Single/Aggregate 1OM/10M Single/Aggregate 10M/10M DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Encroachment Permit. Additional Insured: City of Gilroy. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 USA 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 7,4(6 ACORD 25 (2010/05) yeseniasj 69795098 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P520028002 ffed ®`A SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/29/2023 NAME OF INSURED: perm Corporation Additional Description of Operations/Remarks from Page 1: Additional Information: Includes: General Liability: Additional Insured per forms attached CG20100413 and CG20370413. Coverage is Primary as required by written contract per from attached OG 107 (04-11). Per Project Aggregate per attached form CG25030509. Waiver of Subrogation as required by written contract per attached form CG24040509. Automobile Liability: Additional Insured per attached form SICK-1016 (0919). Primary and Non -Contributory Wording per attached form SICA-1017 (0919). Waiver of Subrogation per attached form CA04441013. Workers Compensation: Waiver of Subrogation per attached form WC040306 (Ed. 4-84). SUPP (05/04) P5260028002 02310023917 POLICY NUMBER: 1000025823231 COMMERCIAL GENERAL LIABILITY CG20370413` THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Wier e Requi r ed by W i t t en Cont tact Wier e Requi r ed by Witt en Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section I1 - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the Location ' designated and described in the Schedule of this endorsement performed for that additional insured and Included in the "products -completed operations hazard However: 1. The insurance afforded to such additional insuredonly 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required bythe contract or agreement; or 2. Available under the applicable Limits Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 w oo O M P5260028002 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 1000025823231 CG 2010 0413 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) Where Required by Written Contract Location(s) Of Covered Operations Where Required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service; maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 00 w O M CG 2010 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 P5260028002 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 Tess. This endorsement shall not increase the applicable Limits of Insurance , shown in the Declarations: Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 P5260028002 POLICY NUMBER; 1000025823231 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Wier e Requi red by Witt en Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" 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 des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodilyinjury" or "property damage" included in the "products- completed operations hazard", and for medi- cal 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 reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, 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 Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 P5260028002 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attrib- uted only to ongoing operations at a single des- ignated construction project shown in the Sched ule above; 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2.; Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit C. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate 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 restarted, or if the authorized contract- Ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated: Page 2 of 2 © Insurance Services Office, Inc., 2008 0 0 Crs P5260028002 Starr indemnity & Company Dallas, TX 1-866-519.2522 Primary and Non -Contributory Condition Policy Number: 1000025823231 Named Insured: Ferma Corporation This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Effective Date: 10/01/2023 A. SECTION IV — CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General gounsel OG 107 (04/11) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. P5260028002 POLICY NUMBER: 1000025823231 COMMERCIAL GENERAL LIABILITY CG24040509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following:: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of .Recovery Against Others To Us of Section IV Conditions: We waive any right of recovery 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. CG24040509 © Insurance Services Office, Inc., 2008 Page 1 of 1 P520028002 Starr Indemnity & Liability Company COMMERCIAL AUTO SICA-1017 (0919) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS AMENDATORY ENDORSMENT Policy Number: 1000198707231 Effective Date: 10/1/2023 Named Insured: FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully. BUSINESS AUTO COVERAGE FORM SECTION IV BUSINESS AUTO CONDITIONS, B. General Conditions, 5. Other Insurance, c., is amended by the addition of the following: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions of this Policy remain unchanged. SICA-1017 (0919) Copyright ©Starr Indemnity & Liability Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. w 1/40 PS260028002 Starr Indemnity & Liability Company COMMERCIAL AUTO SICA-1016 (0919) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS AMENDATORY ENDORSEMENT Policy Number: 1000198707231 Named Insured: FERMA CORPORATION This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorsement and respective policy(ies) carefully; AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Effective Date: 10/1/2023 It is hereby agreed that SECTION II COVERED AUTOS LIABILITY COVERAGE, A. COVERAGE, 1. Who Is An Insured of the Business Auto Coverage Form and Motor Carrier Coverage Form, and SECTION I - COVERED AUTOS COVERAGES, D. Covered Autos Liability Coverage, 2. Who Is An Insured of the Auto Dealers Coverage Form are amended to include the following: Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto However, the insurance provided will not exceed the less of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by such written contract or written agreement. All other terms and conditions of this Policy remain unchanged. SICA-1016 (0919) Copyright © Starr Indemnity & Liability Company. All rights reserved, Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ON 1-4 P5260028002 POLICY NUMBER: 1000198707231 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date Is indicated below. Named Insured: FERMA CORPORATION Endorsement Effective Date: 10/1/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): Where Requi red by, Witt en Cont r act Information required to complete this Schedule, if not shown above, will be shown in the Declarations, The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44.10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 P5260028002 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • CALIFORNIA 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule, The additional premium for this endorsement shall be 2. 0% of the California workers' compensation premium otherwise due on such remuneration, Schedule Person or Organization Any per son or or gani zat i on t o whom you becone obl i gat ed t o wei ve your r I ght s of r ecover y agal nst under any cont r act or agr eerrent you ent er I nt o pr i or t o t he occur r once of I oss, Job Description Wier a Required By Witt en Contract 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 thls endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective: 10/01/2023 Policy No.: 1000004374 Endorsement No.: Insured: Ferma Corporation Premium: Insurance Company: STARR INDEMNITY & LIABILITY CO Countersigned by: WC 04 03 06 (Ed. 04-84) Pagel oft i • wHIGNI 00 w 0 00 If)