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HomeMy WebLinkAboutCOI - Crane Acquisition, Inc. dba Crane Pest Control - Certificate No. W32017095 | Start Date: 2024-01-01 | End Date: 2025-01-01ACORDD CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE(MM/DD/YYYY) 12/23/2023 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, If SUBROGATION IS WAIVED, subject to the terms and conditions this certificate does not confer rights to the certificate holder in lieu the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. of the policy, certain policies may require an endorsement. A statement on of such endorsement(s). PRODUCER Willis Towers Watson Southeast, Inc. Five Concourse Corporate Center, 18th Floor Atlanta, GA 30328 INSURED Crane Acquisition Inc dba Crane Pest Control 2700 Geary Blvd San Francisco, CA 94118 CONTACT Willis Towers Watson Certificate Center NAME: AHONNo EMI:1-877-945-7376 (FA/C,No): X 1-888-467-2378 ADDRIESS: L certificates@willis.com INSURER(S) AFFORDING COVERAGE INSURERA: Old Republic Insurance. Company NAIC H 24147 INSURERS: ACE Property & Casualty Insurance Company INSURERC: Indemnity Insurance Company of North Amerij 20699 43575 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: W32017095 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS ILT R LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY TYPE OF INSURANCE ADDL SUER; IPOLICY INSD LVVD : POLICY NUMBER MIDD YYYY) THE INSURED OR OTHER DESCRIBED PAID CLAIMS. (MM POLICY YYYY) NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i $ 3, 000, 000 A _I OCCURCoverageMEDEXP X I Pesticide/Herbicide$ DAMAGE TO RENTED 3, 000, 000 $ 0 I(Any one person) ! X Pest Control Professional Y Y MWZY 312034 24 01/01/2024 01/01/2025 PERSONAL & ADV INJURY j $ 3,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: x POLICY ! X EX ICJLO GENERAL AGGREGATE j $ 3,000,3,000,000 PRODUCTS - COMP/OP AGG $ 3,000, 000 ! OTHER: 'i $ AUTOMOBILE LIABILITY _._., X ANY AUTO COMBINED SINGLE LIMIT (Ea accident) I_$ 3,000,000 BODILY INJURY (Per person) $ A ! OWNED AUTOS ONLY ___1 SCHEDULED MWTB 312033 24 01/01/2024 AUTOS 01/01/2025 BODILY INJURY (Per accident) [ $ i HIRED ! AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) $ I. $ e UMBRELLAR _ X I. A LI Xj OCCUR � EACH OCCURRENCE $ 5,000, 000 EXCESS DED UAB I I RETENTIONS IICLAIMS-MADE XEU G27927683 009 01/01/2024 01/01/2025 AGGREGATE i$ 5,000,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER I EH- ! X STATUTE C ANYPROPRIETORPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) y ! N No N/A- WLR c50672207 01/01/2024 01/01/2025 E.L. EACH ACCIDENT $ 2, 000, 000 E.L. DISEASE - EA EMPLOYEE( $ 2,000, 000 II yes, describe under DESCRIPTION OF OPERATIONS Wow E.L. DISEASE - POLICY LIMIT j $ 2, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) Service Location: Pigeon Exclusion: 340 West 6th Street, Gilroy, CA 95020 City of Gilroy, its officers, officials, employees and volunteers are included as Additional Insureds as respects to General Liability but solely in regards to work performed by or on behalf of the Named Insured. General Liability policy shall be Primary and Non -Contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION City of Gilroy Attn: Dan Johnson 7351 Rosanna Street Gilroy, CA 95020 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 Patel, 94410110 ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID 25165821 BATCH: 3257218 3352: 2 ` of 10 AGENCY CUSTOMER ID: LOC #: ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Willis Towers Watson Southeast, Inc. NAMED INSURED Crane Acquisition Inc dba Crane Peet Control 2700 Geary Blvd San Francisco, CA 94118 POLICY NUMBER See Page 1 CARRIER See Page 1 NAIC CODE See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID:25165821 BATCH:3257218 CERT: W32017095 3352: 2 of 10 Rollins, Inc. et al Policy Term: 1/1/2024 to 1/112025 Workers' Compensation and Employers Liability Policies Coverage Policy Number Carrier WC Coverage EL Limits Work Comp Employers Liability WLR C50672207 Indemnity Insurance Company of North America States Covered: AL, AR, AZ, CA, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, NE, NH, NJ, NM, NV, NY, OK, OR, PA, RI, SC, SO, TN, TX, UT, VA, VT, WV Stop Gap Coverage for ND WA & WY Statutory $2,000,000 Bodily Injury by Accident - Each Accident $2,000,000 Each Employee Bodily Injury by Disease $2,000,000 Policy Limit Bodily Injury by Disease Work Comp Employers Liability SCF C50672293 ACE Fire Underwriters Insurance Company States Covered: WI Statutory $2,000,000 Bodily Injury by Accident - Each Accident $2,000,000 Each Employee Bodily Injury by Disease $2,000,000 Policy Limit Bodily Injury by Disease Excess Work Comp Employers Liability WCU C5067213A ACE American Insurance Company - States Covered: FL, GA, OH Statutory $2,000,000 Bodily Injury by Accident - Each Accident $2,000,000 Each Employee Bodily Injury by Disease $2,000,000 Policy Limit Bodily Injury by Disease 3352: 3 ' of 10 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 2010 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All Persons or Organizations as Required by Contract or Agreement All locations as required by Contract or Agreement 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. CG 20 10 12 19 CO Insurance Services Office, Inc., 2018 MWZY 312034 24 Rollins. Inc. 01/01/24 - 01/01/25 Page 1 of 2 3352: 3 of 10 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG20371219 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 As required by written contract As 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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 by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 MWZY 312034 24 Rollins, Inc. 01/01/24 - 01/01/25 Page 1 of 1 3352: 4 ' of 10 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 MWZY 312034 24 Rollins, Inc. 01/01/24 - 01/01/25 Page 1 of 1 3352: 4 of 10 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization against whom you have agreed to waive your rights of recovery in a written contract, provided such contract was executed prior to the date of loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 MWZY 312034 24 Rollins, Inc. 01/01/24 - 01/01/25 3352: 5 ' of 10 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSON(S) OR ORGANIZATION(S) - NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL CHANGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART/FORM SCHEDULE Number of Days Notice of Cancellation or Nonrenewal Other Than Nonpayment Of Premium: 30 Number of Days Notice of Cancellation Or Non renewal For Nonpayment of Premium: Number of Days Notice of Material Change: Person(s) or Organization(s): As required by written Contract 10 It is agreed that the Company shall give written notice to the Person(s) or Organization(s) with the Number of Days Notice shown in the Schedule above in the event of Cancellation. Nonrenewal or Material Change except for nonpayment of premium where 10 (ten) days written notice will apply. GL 299 009 0115 Page 1 of 1 MWZY 312034 24 Rollins. Inc. 01/01/24 - 01/01/25 3352: 5 of 10 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s): All persons or organizations where required by written contract With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured is changed with the addition of the following: Each person or organization shown in the Schedule for whom you are doing work is an "insured". But only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a covered "auto" by: 1. You; 2. an "employee" of yours; or 3. anyone who drives a covered "auto" with your permission or with the permission of one of your "employees". However, the insurance afforded to the person or organization shown in the Schedule shall not exceed the scope of coverage and/or limits of this policy. Not withstanding the foregoing sentence, in no event shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the contract or agreement. PCA 001 10 13 MWTB 312033 24 Rollins. Inc. 01/01/24 - 01/01/25 3352: 6 of 10 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AND PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Designated Person(s) or Organization(s): All persons or organizations as required by written contract A. SECTION II — COVERED AUTOS LIABILITY COVERAGE, paragraph 1. Who Is An Insured is amended to include the person(s) or organization(s) shown in the above Schedule as an additional "insured", but only with respect to "accidents" arising out of your work while being performed for such person(s) or organization(s). B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance — Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This policy's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to the "insured" person(s) or organization(s) shown in the above Schedule provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". PCA 048 09 19 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.. with its permission. MWTB 312033 24 Rollins, Inc. 01/01/24- 01/01/25 3352: 6 of 10 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person or Organization: All persons or organizations as required by contract or agreement (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition is changed by adding the following: We waive any right of recovery we may have against the person(s) or organization(s) shown in the Schedule because of payments we make for injury or damage. This waiver applies only to the person or organization shown in the Schedule. PCA 024 10 13 Page 1 of 1 MWTB 312033 24 Rollins. Inc. 01/01/24 - 01/01/25 3352: 7 of 10 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US SCHEDULE Number of Days Notice of Cancellation: 30 Person or Organization: As required by written contract Address: As required by written contract Provisions If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, and a number of days is shown for cancellation in the schedule above, we will mail notice of cancellation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of cancellation. PIL 028 05 10 MWTB 312033 24 Rollins. Inc. 01/01/24 - 01/01/25 3352: 7 of 10 Workers' Compensation and Employers' Liability Policy Named Insured ROLLINS, INC. 2170 PIEDMONT ROAD NE ATLANTA GA 30324 Endorsement Number Policy Number Symbol: WLR Number: C50672207 Policy Period 01-01-2024 TO 01-01-2025 Effective Date of Endorsement 01-01-2024 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Agent WC 00 03 13 (11/05) © Copyright 1983-2017 National Council on Compensation Insurance, Inc. All Rights Reserved. 3352: 8 ' of 10 Workers' Compensation and Employers' Liability Policy Named Insured ROLLINS, INC. 2170 PIEDMONT ROAD NE ATLANTA GA 30324 Endorsement Number Policy Number Symbol: WLR Number: C50672207 Policy Period 01-01-2024 TO 01-01-2025 Effective Date of Endorsement 01-01-2024 Issued By (Name of Insurance Company) INDEMNITY INS. CO. OF NORTH AMERICA Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. NOTICE TO OTHERS ENDORSEMENT— SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM, TX and WI. Authorized Representative WC 99 03 69 (01/11) Page 1 3352: 8 of 10 G. Omnibus Reconciliation Act - Government Access Clause We will make available this policy and all documents needed to confirm the premium paid by you if the Secretary of Health and Human Services or the Comptroller General of the United States find that the policy is a contractor described in Section 1861 of the Social Security Act, 42 U.S.C. Section 1395, or any amendment to it, and they or you ask for our documents. If the Secretary of Health and Human Services or the Comptroller General asks for access to our documents, we will immediately notify you and make these documents available to you, unless prohibited by law. The right to access will be determined by the above statute, or any amendment to it, or any rules or regulations established under it. H. Other Insurance If the Insured carries other valid insurance, reinsurance or indemnity with any other insurer covering a loss covered by this policy (other than insurance that is purchased to apply in excess of the sum of Your Retention and the Limit of Indemnity hereunder), we shall not be liable for a greater proportion of such loss than the applicable Limit of Indemnity of all valid and collectible insurance, reinsurance or indemnity against such loss. If the Insured carries other insurance with us covering a loss within the limit covered by this policy, the insured must elect which policy shall apply and we shall be liable under the policy so elected and shall not be liable under any other policy. I. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. Any amount recovered as a result of such proceedings, together with all expenses necessary to the recovery of any such amount, shall be apportioned as follows: 1. if there is insurance coverage in excess of Our Limit of Indemnity, that insurer shall first be reimbursed to the extent of its actual payment; 2. we shall then be reimbursed to the extent of our actual payment and then we will pay the balance, if any, to you. The expenses of all proceedings necessary to the recovery of any such amount shall be apportioned between you and us in the ratio of their respective recoveries as finally settled. If there should be no recovery in proceedings instituted solely on our initiative, the expenses thereof shall be borne by us. In the event of any payment under this policy for a Loss for which you have waived the right of recovery in a written contract entered into prior to the Loss, we hereby agree to also waive our right of recovery but only with respect to such Loss. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to give or receive notice of cancellation, accept indemnity, receive return premium or request changes in this policy. K. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. L. Unintentional Errors and Omissions Your failure or omission to disclose all hazards existing as of the inception date of the policy shall not prejudice you with respect to the coverage afforded by this policy provided such failure or omission is not intentional and you did not know about such hazards prior to the commencement of the policy period. CKE-1167M (01/15) © ACE AMERICAN INSURANCE COMPANY Policy No. WCU C5067213A 01 /01 /2024 - 01 /01 /2025 Page 10 of 11 3352: 9 of 10 1 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE NOTICE BY INSURED'S REPRESENTATIVE Named Insured Rollins, Inc. Endorsement Number 2 Policy Symbol WC U Policy Number C5067213A Policy Period 01 /01 /2024 to 01 /01 /2025 Effective Date of Endorsement Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out in this endorsement, to send written notice of cancellation, to the persons or organizations listed in the schedule that you or your representative create or maintain (the "Schedule") by allowing your representative to send such notice to such persons or organizations. This notice will be in addition to our notice to you or the first Named Insured, and any other party whom we are required to notify by statute and in accordance with the cancellation provisions of the Policy. B. The notice referenced in this endorsement as provided by your representative is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). The failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule will impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. C. We are not responsible for verifying any information in any Schedule, nor are we responsible for any incorrect information that you or your representative may use. D. We will only be responsible for sending such notice to your representative, and your representative will in turn send the notice to the persons or organizations listed in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. E. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This endorsement is not applicable in the states of AZ, FL, TX, ID, and NM. Authorized Representative WC 99 05 21 (01/11) Page 1 of 1 3352: 9 of 10 Workers' Compensation and Employers' Liability Policy Named Insured ROLLINS, INC. 2170 PIEDMONT ROAD NE ATLANTA GA 30324 Endorsement Number Policy Number Symbol: SCE Number: C50672293 Policy Period 01-01-2024 TO 01-01-2025 Effective Date of Endorsement 01-01-2029 Issued By (Name of Insurance Company) ACE FIRE UNDERWRITERS INS CO Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS. For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. Authorized Representative WC 00 03 13 (11/05) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation 3352: 10 of 1( Workers' Compensation and Employers' Liability Policy Named Insured ROLLINS, INC. 2170 PIEDMONT ROAD NE ATLANTA GA 30324 Endorsement Number Policy Number Symbol: SCF Number: C50672293 Policy Period 01-01-2024 TO 01-01-2025 Effective Date of Endorsement 01-01-2024 Issued By (Name of Insurance Company) _ACE FIRE UNDERWRITERS INS CO Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy, EARLIER NOTICE OF CANCELLATION AND NON This agreement applies only to the insurance provided by 3.A of the Information Page. A. EARLIER NOTICE OF CANCELLATION For any statutorily permitted reason, other than nonpayment required for notice of cancellation as provided in either amended by any applicable state cancellation endorsement If the state cancellation endorsement provides for more shown above, this provision does not apply. B. EARLIER NOTICE OF NON -RENEWAL If we decide not to renew this policy for any reason other number of days for notice of non -renewal as provided by increased to o days. -RENEWAL AGREEMENT - WISCONSIN the policy because Wisconsin is shown in Item of premium, the minimum number of days the Cancellation Condition of the policy or as is increased to 90 days. than the number of days notice of cancellation than nonpayment of premium, the minimum any applicable state non -renewal endorsement is than the number of days notice of non -renewal Rating Bureau (WCRB) this agreement is file. Failure to abide by this agreement of the Commissioner of Insurance. C. If the state non -renewal endorsement provides for more shown above, this provision does not apply. In accordance with instructions from the Wisconsin Compensation not to be filed with the WCRB but maintained in the underwriting may result in administrative action by the Wisconsin Office Authorized Agent WC 99 06 98 (11/05) 1 3352: 10 of 10