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BACKFLOW APPARATUS & VALVE COMPANY (2)
N-2018-200-01 MAYOR uel A. Pulido INSURANCE NOT ON FILE MAYOR PRO WORK MAY NOT PROCE Juan Villages COUNCILMEMBERS CLERK OF COUNCIL,. Cecilia Iglesias David Pension © DATEXT 1 0 2019 Vacant Vicente Sanniento O �uJ F1 Q Jose Solorio V,,`y'SCjTY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 w .santa-ana.om August 26, 2019 Backflow Apparatus & Valve Co. 20435 South Susana Rd. Long Beach, CA 90810-1136 Attn: Robert Purzycki CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez, MIMIC Re: Extension of Agreement No. N-2018-200 to Provide Testing and Inspection of Backflow Prevention Devices Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Backflow, Apparatus & Valve Co. and the City of Santa Ana, dated September 1, 2018, the time period of the Agreement is hereby extended for an additional one-year period, from September 1, 2019 through August 31, 2020. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, lILn� �+ Fuad S. Sweiss, PE, PLS 1111 Executive Director, Public Works Agency CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM n M. Funk Assistant City Attorney #8019vl ATTEST Daisy Gomez, MMC Clerk of the Council BACKFLOW A FARATUS & VALVE CO. Name: Robert Purzycki ` Title: Vice President F7DATE1MM:1DD/YYYY) ®CERTIFICATE OF LIABILITY INSURANCE 9/219 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERONTACT United A encies Inc.inCNAME; United Agencies Inc. 750 The Ety Drive South. Ste 450 PHONE FAx Orange, CA 9286$ aN 626-214-7902 NOY ADnREss kdumatol unfteda encies.com OG23764 INSURED Backflow Apparatus & Valve Company DBA BAVCO 20435 S. Susana Road Long Beach CA 90810 INSURERS AFFORDING COVERAGE NAIC INSURER A: Travelers Property Casualty Cc of America 25674 INSURER B INSURER C . INSURER D INSURER E. INSURERF: CC1VFRAnFS CFRTIFICATF NIIMRFR- rignannn REVISION NUMRFR! 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 11&A TYPE OF INSURANCE DL S R POLICY NUMBER POLICY EFF EXP POLIDNMI CY LIMITS f COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_v,1 OCCUR ✓ 630-8J664090 10/31/2018 10/31/2019 EACH OCCURRENCE $1000000 PREMISES tFa accurrerrx $ 100 000 MED EXP (Any one person) $ 5 000 PERSONAL & ADV INJURY $ 1 000 000 GEN'LAGGREGATE LIMIT APPLIES PER: PRCO-- 0LOC POLICY ✓� JE OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG s21000000 $ A AUTOMOBILE LIABILITY OWNED SCHEDULED .11 ANY AUTO AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BA-8J664090 10/31/2018 10/31/2019 COMOMd Dent SINGLEU IT $1 000000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PR51ERTY DAMAGE Per acGdenI $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE CUP-9J209005 10/31/2018 10/31/2019 EACH OCCURRENCE $5000000 ✓ H AGGREGATE $ 5,000,000 DED ✓ t RETENTION 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNERlEXECUTIVE YIN OFFICEMMEMBEREXCLUDED7 ❑Y (Mandatory In NH) If es, dascrlhe under IDfPWdIPTION u) OPE AT IONS below N/A UBOL941578 8/27/2019 8/27/2020 1/ STA7UTE OTH- E.L. EACH ACCIDENT $ 1,000 000 E.L. DISEASE - EA EMPLOYEE $ E,L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Santa Ana and its officers, employees, agents, volunteers and representatives are named as additional insureds in respects to the general liability policy only per the attached forms. Primary/non-contributory is included in the general liability policy only per the attached form. REVIEWED & APPROVED Ci#y of Santa Ana a T 0 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza 4th FL , A Santa Ana CA 92702 FRANCINE R. VILLARE, AUTHORi2EDREPRESENTATIVE % Gary Chem lin ©1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 1 of 13 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b) If, and only to the extent that, the 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 requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III — Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products -completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice RI_WMTb& APPROVED By Risk MANAGEMENT DIVISION CG D2 46 08 05 © 2005 The St. Paul Travelers nOJT O 1 019 Page 1 of 2 513B3140 1 18-19 GL, Auto, Dmb, 19-20 WC I Brigitte Leber I 9/2G/2019 7:51:27 AM (PDT) I Page ERANCINE R. VILLAREAL COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense. b) If a claim is made or "suit' is brought against the additional insured, the additional insured must: c) d) i. Immediately record the specifics of the claim or "suit' and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit' as soon as practicable. The additional insured must 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. The additional insured must tender the de- fense and indemnity of any claim or "suit' to Page 2 of 2 any provider of 'other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to 'other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. — DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. REVIEWED & APPROVED By RISk MANAGEMENT DIVISION OCT O 1119-t FRANCINE R. VILLAREAL © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 51383140 118-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 3 of 13 Backflow Apparatus %C"Tlh I�ted A end s Inc. 301 E. Colorado Blvd., Ste. 200 • Pasadena, CA 91101-1922 P.O. Box 7139 • Pasadena, CA 91109-7139 www.unitedagencies.com • CA License #0252636 INSURANCE POLICY CANCELLATION PROVISIONS THE "COMMON POLICY CONDITIONS" SECTION OF ALL COMMERCIAL INSURANCE POLICIES STATE THAT THE INSURANCE COMPANY WILL CANCEL THE POLICY BY GIVING WRITTEN NOTICE TO THE "FIRST NAMED INSURED" 10 DAYS BEFORE THE EFFECTIVE DATE OF CANCELLATION FOR NONPAYMENT OF PREMIUM AND 30 DAYS BEFORE THE EFFECTIVE DATE OF CANCELLATION FOR ANY OTHER REASON. ALSO, THE "FIRST NAMED INSURED" HAS THE RIGHT TO CANCEL THE POLICY IN WRITING AT ANYTIME WITH NO FURTHER NOTICE OF CANCELLATION. THE INSURANCE COMPANY DOES NOT GIVE NOTICE OF CANCELLATION TO ANY OTHER "NAMED INSURED" OR TO ANY "ADDITIONAL INSUREDS." CANCELLATION PROVISIONS IN A POLICY CANNOT BE ALTERED BY AN INSURANCE AGENT BECAUSE THEY ARE PART OF A LEGAL CONTRACT BETWEEN THE INSURANCE COMPANY AND THE INSURED. FURTHERMORE, POLICY FORMS MUST BE APPROVED BY THE STATE DEPARTMENT OF INSURANCE. THE CERTIFICATE OF INSURANCE ON AN ACCORD FORM 25 STATES THAT THE CERTIFICATE CANNOT AMEND, ALTER, OR EXTEND THE COVERAGE IN THE INSURANCE POLICY. THAT IS WHY THE CANCELLATION PROVISIONS ON THE CURRENT INSURANCE CERTIFICATE STATE THAT CANCELLATION "NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS." THE INSURANCE COMPANY WILL NOT PROVIDE YOU, THE ADDITIONAL INSURED, NOTICE OF POLICY CANCELLATION. HOWEVER, ACTING IN THE CAPACITY AS THE INSURED'S AGENT, WE WILL ENDEAVOR TO PROVIDE YOU WITH 10 DAYS NOTICE OF CANCELLATION BY THE INSURANCE COMPANY FOR NONPVM APPROVED PREMIUM AND 30 DAYS NOTICE OF CANCELLATION BY THE INS! CEMENT DiViSION COMPANY FOR ANY OTHER REASON. I OCT 01 2019 : 51383140 1 10-19 GL, Auto, Dmb, 19-20 WC I Brigitte Leber 9/26/2019 7:51.27 AM (gDT j P e 4 of 13 FRANCINE R. VILLAREAL Your Link wit �i Securtty United A encies Inc. 301 E. Colorado Blvd., Ste. 200 • Pasadena, CA 91101-1922 P.O. Box 7139 • Pasadena, CA 91109-7139 www.unitedegencies.com • CA License #0252636 INSURANCE POLICY CANCELLATION PROVISIONS THE "COMMON POLICY CONDITIONS" SECTION OF ALL COMMERCIAL INSURANCE POLICIES STATE THAT THE INSURANCE COMPANY WILL CANCEL THE POLICY BY GIVING WRITTEN NOTICE TO THE "FIRST NAMED INSURED" 10 DAYS BEFORE THE EFFECTIVE DATE OF CANCELLATION FOR NONPAYMENT OF PREMIUM AND 30 DAYS BEFORE THE EFFECTIVE DATE OF CANCELLATION FOR ANY OTHER REASON. ALSO, THE "FIRST NAMED INSURED" HAS THE RIGHT TO CANCEL THE POLICY IN WRITING AT ANYTIME WITH NO FURTHER NOTICE OF CANCELLATION. THE INSURANCE COMPANY DOES NOT GIVE NOTICE OF CANCELLATION TO ANY OTHER "NAMED INSURED" OR TO ANY "ADDITIONAL INSUREDS." CANCELLATION PROVISIONS IN A POLICY CANNOT BE ALTERED BY AN INSURANCE AGENT BECAUSE THEY ARE PART OF A LEGAL CONTRACT BETWEEN THE INSURANCE COMPANY AND THE INSURED. FURTHERMORE, POLICY FORMS MUST BE APPROVED BY THE STATE DEPARTMENT OF INSURANCE. THE CERTIFICATE OF INSURANCE ON AN ACCORD FORM 25 STATES THAT THE CERTIFICATE CANNOT AMEND, ALTER, OR EXTEND THE COVERAGE IN THE INSURANCE POLICY. THAT IS WHY THE CANCELLATION PROVISIONS ON THE CURRENT INSURANCE CERTIFICATE STATE THAT CANCELLATION "NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS." REVIEWED & APPROVED By Risk MANAGEMENT DIVISION OCT 012019 FRANCINE R. VILLAREAL 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 19/26/2019 7:51:27 AM (PDT) I Page 5 of 13 Vn-yar I;ziL- riirith Vo.—iirityi Backflow Apparatus & Valve Company 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. REVIEWED & APPROVED By RISK NIANAgEMEN7 DiviSiON OCT o 12019 FRANCINE R. VILLAREAL CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1 51363140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 6 of 13 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES 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 these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured J. Bodily Injury To Co -Employees And Co -Volunteer B. Blanket Additional Insured — Broad Form Vendors Workers C. Damage To Premises Rented To You • Perils of fire, explosion, lightning, smoke, water • Limit increased to $300,000 D. Blanket Waiver Of Subrogation E. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises F. Blanket Additional Insured — Lessors Of Leased Equipment G. Incidental Medical Malpractice H. Personal Injury — Assumed By Contract I. Amended Bodily Injury Definition PROVISIONS A. BROADENED NAMED INSURED 1. The following is added to SECTION II — WHO IS AN INSURED: Any organization, other than a partnership or joint venture, over which you maintain owner- ship or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such organization will cease as of the date during the policy pe- riod that you no longer maintain ownership of, or majority interest in, such organization. 2. The following replaces Paragraph 4.a. of SECTION II — WHO IS AN INSURED: a. 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, unless reported in writing to us within 180 days. K. Aircraft Chartered With Crew L. Non -Owned Watercraft — Increased From 25 Feet To 50 Feet M. Increased Supplementary Payments • Cost of bail bonds increased to $2,500 • Loss of earnings increased to $500 per day N. Medical Payments - Increased Limit O. Knowledge And Notice Of Occurrence Or Offense P. Unintentional Omission Q. Reasonable Force — Bodily Injury Or Property Damage B. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement; and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: REVIEWED & APPROVED By Risk MANACIEMENT ❑iViSiON CIS D4 58 07 13 © 2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc. widits pe tlsi a 51383140 1 18-19 GL, Auto, Dmb, 19-20 WC I Brigitte Leber 19/26/2019 7:51:27 AM (PDT) I Page 7 1 I / FRAN INE VILLAREAL COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in "your products" made intentionally by such vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (6) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your prod- ucts"; or (7) "Your products" which, after distribution or sale by you, have been labeled or rela- beled or used as a container, part or in- gredient of any other thing or substance by or for such vendor. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional insured specifically is scheduled by en- dorsement. C. DAMAGE TO PREMISES RENTED TO YOU JURY AND PROPERTY DAMAGE LIABIL- ITY: Exclusions c. through n. do not apply to dam- age to premises while rented to you, or tem- porarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Para- graph 6. of Section III — Limits Of Insurance. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pres- sure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from wa- ter; c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6. of SEC- TION III — LIMITS OF INSURANCE: Subject to 5. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning smoke resulting from such fire, explosion, or lightning; or wa- ter. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire; explosion; lightning; smoke resulting from such fire, ex- plosion, or lightning; water; or any combina- tion of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- COVERAGES — COVERAGE A BODILY IN- ises Rented To You Limit. Page 2 Of 7 © 2013 The Travelers Indemnity Company. All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 8 of 13 3. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or tempo- rarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, ex- plosion, or lightning; or (5) Water. is not an "insured contract'; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; D. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. E. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a premises owner, manager or lessor and that you have agreed in a written contract or agreement to name as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage', "personal injury" or "advertising injury" that: COMMERCIAL GENERAL LIABILITY a. Is "bodily injury" or "property damage" caused by an 'occurrence' that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have signed and executed that contract or agree- ment; and b. Arises out of the ownership, maintenance or use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is subject to the following pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations of this Coverage Part, whichever are less. b. The insurance provided to such premises owner, manager or lessor does not apply to: (1) "Bodily injury" or "property damage' caused by an `occurrence' that takes place, or "personal injury" or "advertising injury" caused by an offense that is com- mitted, after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, manager or lessor. c. The insurance provided to such premises owner, manager or lessor is excess over any valid and collectible other insurance available to such premises owner, manager or lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. F. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed in a written con- tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage', "personal injury" or "advertis- ing injury" that: a. Is "bodily injury" or "property damage' caused by an 'occurrence' that takes place, or "per- sonal injury" or "advertising injury" caused by an offense that is committed, after you have CG D4 58 07 13 © 2013 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 3 of 7 51383140 118-19 GL, Auto, Dmb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 9 of 13 COMMERCIAL GENERAL LIABILITY signed and executed that contract or agree- ment; and b. Is caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract or agreement, or the limits shown on the Decla- rations of this Coverage Part, whichever are less. b. The insurance provided to such equipment lessor does not apply to any "bodily injury" or .,property damage" caused by an 'occurrence" that takes place, or "personal injury" or "ad- vertising injury" caused by an offense that is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. G. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "oc- currence" in the DEFINITIONS Section: Unless you are in the business or occupation of providing professional health care services, ,.occurrence" also means an act or omission committed in providing or failing to provide "incidental medical services" to a person. 2. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances; c. First aid; or d. "Good Samaritan services". "Good Samaritan services" means any emer- gency medical services for which no compen- sation is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to any "bodily injury" arising out of any providing or failing to provide "incidental medical services" by any of your "employees", other than an employed doctor. Any such "employees" providing or failing to provide "incidental medical 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. 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- cals committed by, or with the knowledge or consent of, the insured. 5. The following is added to Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in the providing or fail- ing to provide "incidental medical services" to any one person will be considered one "oc- currence". 6. The following is added to Paragraph 4.b., Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: 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. H. PERSONAL INJURY — ASSUMED BY CON- TRACT 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE B PER- SONAL AND ADVERTISING INJURY LI- ABILITY: Page 4 of 7 © 2013 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 10 of 13 CG D4 58 07 13 N� A0 Y e. Contractual Liability "Personal injury" or "advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to: (1) Liability for damages that the insured would have in the absence of the contract or agreement; or (2) Liability for damages because of "personal injury" assumed in a con- tract or agreement that is an "insured contract", provided that the "personal injury" is caused by an offense com- mitted subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable at- torneys fees and necessary litigation expenses incurred by or for a party other than an insured will be deemed to be damages because of "personal injury", provided that: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract'; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this in- surance applies are alleged. 2. The following replaces the third sentence of Paragraph 2. of SUPPLEMENTARY PAY- MENTS — COVERAGES A AND B: Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily In- jury And Property Damage Liability or Para- graph 2.e. of Section I — Coverage B — Per- sonal and Advertising Injury Liability, such payments will not be deemed to be damages because of "bodily injury", "property damage" or "personal injury", and will not reduce the limits of insurance. 3. The following replaces Paragraph 2.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B: d. The allegations in the "suit" and the in- formation we know about the "occur- rence" or offense are such that no conflict appears to exist between the interests of COMMERCIAL GENERAL LIABILITY the insured and the interests of the in- demnitee; 4. The following replaces the first subparagraph of Paragraph If. of the definition of "insured contract" in the DEFINITIONS Section: If. That part of any other contract or agree- ment pertaining to your business (includ- ing an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury," "property damage" or "per- sonal injury" to a third person or organiza- tion. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. I. AMENDED BODILY INJURY DEFINITION The following replaces the definition of "bodily in- jury" in the DEFINITIONS Section: "Bodily injury" means bodily injury, mental an- guish, mental injury, shock, fright, disability, hu- miliation, sickness or disease sustained by a per- son, including death resulting from any of these at any time. J. BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Paragraph (1)(a) above does not apply to "bodily injury" to a co -"employee" in the course of the co - "employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business. K. AIRCRAFT CHARTERED WITH CREW The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exclusion does not apply to an aircraft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a charge. L. NON -OWNED WATERCRAFT The following replaces Paragraph (2) of Ex- clusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: CG D4 58 07 13 © 2013 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 5 of 7 51383140 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 11 of 13 COMMERCIAL GENERAL LIABILITY (2) A watercraft you do not own that is: (a) Fifty feet long or less; and (b) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any person or organization that, with your ex- press or implied consent, either uses or is re- sponsible for the use of a watercraft that you do not own that is: (1) Fifty feet long or less; and (2) Not being used to carry any person or property for a charge. M. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS — COVER- AGES A AND B of SECTION I — COVER- AGES: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. N. MEDICAL PAYMENTS — INCREASED LIMIT The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C. for all medical expenses because of "bod- ily injury" sustained by any one person, and will be the higher of: (a) $10,000; or (b) The amount shown on the Declarations of this Coverage Part for Medical Expense Limit. O. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known to you (if you are an individual), any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence" or offense. (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such "occurrence" or offense must be given as soon as practicable only after the "occurrence" or offense is known by: (a) Any individual who is: (i) A partner or member of any part- nership or joint venture; (ii) A manager of any limited liability company; (III) A trustee of any trust; or (iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence" or offense. (3) Notice to us of such "occurrence" or of- fense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as prac- ticable after any of the persons described in Paragraphs e.(1) or (2) above discov- Page 6 of 7 © 2013 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. 513B3190 1 18-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 12 of 13 CG D4 58 07 13 ers that the 'occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for "bod- ily injury" or "property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants" must be reported to us within a specific number of days after its abrupt commencement, this Paragraph e. does not affect that requirement. P. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional er- ror in, any information provided by you which we relied upon in issuing this policy will not prejudice COMMERCIAL GENERAL LIABILITY your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. ! I Q. REASONABLE FORCE — BODILY INJURY OR PROPERTY DAMAGE The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected or Intended Injury or Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the in- sured. This exclusion does not apply to "bod- ily injury" or "property damage" resulting from the use of reasonable force to protect any person or property. CG D4 58 07 13 © 2013 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc, with its permission. 51383140 118-19 GL, Auto, Umb, 19-20 WC I Brigitte Leber 1 9/26/2019 7:51:27 AM (PDT) I Page 13 of 13 Page 7 of 7 �� 1 71MINDU-01 JTALCtZ � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYY) 101912019 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, ANDITHE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder ie an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER A2365 Gold Meadow Way Ste 260 lliant Insurance Services, Inc. Gold River, CA 95670 NRATACT Tracy Dolan a/CCO t%, Ext: (916) 210.0317 (AID No):(916) 210.0343 E- IL .tracy.dolan@alliant.com INSURERS AFFORDING COVERAGE NAIC a INSURERA:Zurich American Insurance Company 16535 INSURED INSURER B: Great American Insurance Company 16691 INSURERC:As en American Insurance Company 43460 Zim Industries, Inc.; Bakersfield Well & Pump Co. INSURERD: 4532 E. Jefferson Ave. Fresno, CA 93725 INSURER E INSURER F: COVERAGES CFRTIFICATP NIIMRFR- RFVICInM NI IMRFR- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 TYPE OF INSURANCE A Dp SUBR POLICY NUMBER POLICY EFF POLICY UPLTR DfYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OOCCUR Employee Benefits Li GLO8311662.16 311/2019 3/112020 EACHOCCURRENCE $ 1,000,000 DAMAGE TO RENTED 10-010g0 X MED EXP An one rson 10,000 PERSONAL B ADV INJURY 1,000,000 EN'L AGGREGATE LIMIT I- APPLIES PER X POLICY El JEC'QT LOC GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 $ OTHER: A AUTOMOBILE MABILITY COMBINED SINGLE LIMIT acads"t) 1,000,000 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUUpTNNO{S�WµNNEEDp )( BAPS311663-16 311/2019 31112020 X BODILY INJURY Per Pmon) $ BOqDILY INJURY Per eccMenl $ PPe�aiu�nt AMAGE $ ARTOS ONLY AUTOSONLY E B UMBRELUI LIAR EXCESS LIAB X OCCUR CLAIMS -MADE TUU 302294500 3/1/2019 311/2020 EACH OCCURRENCE g 16,000,000 X AGGREGATE $ 16,000,000 DED I X I RETENTION$ 10,000 8 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY p5p5�tRNI IETOR/EXCLUDR/EXECUTIVE ❑ (manda�Ory in NN�EXCLUDEDi Dyes, describe antler DESCRIPTION OF OPERATIONS below NIA C8311661-15 3/1/2019 311/2020 X PER OTH- R E. .EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EMPLOYE 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Equipment Floater IMAC95D519 3/112019 3/1112020 Inst./Builders Risk 1,000,000 C Equipment Floater IMAC96D519 3/112019 3/112020 RBL $1003000 ; Schad 21,380,150 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD101,Additienel Remark$Scbedule,mayWaMcbedffmOMSPaceismquimdI Re: A-2016.311 The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers, and representatives are named as additional Insureds on the General Liability and Auto Liability per the attached forms. Coverage is primary and non-contributory and 30 days notice of cancellation applies, 10 days notice for nonpayment of premium in accordance with the policy provisions. City of Santa Ana Risk Management Division 20 Civic Center Plaza, , 4th Santa Ana, CA 92702 ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 201I 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN IL ♦ r� ACCORDANCE WITH THE POLICY PROVISIONS. L M. LAMBERT BERT AUTHORIZED REPRESENTATIVE ^� �. t.. ra,vul (01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Other Insurance Amendment — Contributory Primary And Non- 0 ZURICH Policy No. Eff. Date of Pol. Em. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. L08311662-15 1 3/1/2019 3/1/2020 3/1l2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: Zim Industries, Inc.; Bakersfield Well & Pump Co Address (Including ZIP Code): 4532 E. Jefferson Ave., Fresno, CA 93725 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part 1. The following paragraph is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. The additional insured is a (Named Insured under such other insurance; and b. You are required by a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy Providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. All other terms and conditions of this policy remain unchanged. �4 Includes copyrighted Itnal of Insurance Services Office, Inc., with its permission. U-GL-1327-B CW (04/13) Page 1 of 1 POLICY NUMBER: GLO8311662-15 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Any person or organization, other than an architect, engineer or surveyor, whom you are required to add as an additional insured under this policy under a written contract or written agreement executed prior to loss, except where such requirement is prohibited by law and where that contract specifically requires the ISO CG2010 04/2013 edition form or the equivalent of same. —_ Location(s) Of Covered Operations Any Location or project, other than a wrap-up or other consolidated insurance program location or project for which insurance is otherwise separately provided to you by a wrap-up or other consolidated insurance program. 1 information required to complete this Schedule if not shown above, will be shown i------------- n the Declarations A. Section II — Who Is An Insured is amended to 2. 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 CG 20 10 0413 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. j�2�r 1,- surance Services Office, Inc., 2012 1 Page 1 of 3 Wolters Kluwer Financial Services I Uniform FormsiM 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. Page 2 of 3 Insurance Services Office, Inc., 2012 CG 20 10 04 13 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: IT 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 CG 20 10 07 04 © ISO Properties, Ir, 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 2004 Page 3 of 3 ❑ POLICY NUMBER: GLO8311662-15 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization, other than an architect, engineer or surveyor, whom you are required to add as an additional insured under this policy under a written contract or written agreement executed prior to loss, except where such requirement is prohibited by law and where that contract specifically requires the ISO CG2037 Any Location or project, other than a wrap-up or other consolidated insurance program location or project for which insurance is otherwise separately provided to you by a wrap-up or other consolidated insurance program. 04/2013 edition form or the equivalent of same. 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: 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. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 10 Wolters Kluwer Financial Services I Uniform FormsTM 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © ISO Properties, Inc , 2004 CG 20 37 07 04 ❑ Policy No. GLO8311662-15 b. Those statements are based upon representations you made to us; and However, 'auto" does not include "mobile equipment". c. We have issued this policy in reliance upon your 3. "Bodily injury" means bodily injury, sickness or representations. disease sustained by a person, including death 7. Separation Of Insureds resulting from any of these at any time. Except with respect to the Limits of Insurance, and 4. "Coverage territory" means: any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this a. The United States of America (including its insurance applies: territories and possessions), Puerto Rico and Canada; a. As if each Named Insured were the only Named Insured; and b. International waters or airspace, but only if the injury or damage occurs in the course of travel b. Separately to each insured against whom claim is or transportation between any places included in made or "suit" is brought. Paragraph a. above; or 8. Transfer Of Rights Of Recovery Against Others To c. All other parts of the world if the injury or Us damage arises out of: If the insured has rights to recover all or part of any (1) Goods or products made or sold by you in payment we have made under this Coverage Part, the territory described in Paragraph a. above; those rights are transferred to us. The insured must do nothing after loss to impair them. At (2) The activities of a person whose home is in our request, the insured will bring "suit" or transfer those rights to the territory described in Paragraph a. above, but is us and help us enforce them. away for a short time on your business; 9. When We Do Not Renew or (3) "Personal and advertising injury" offenses that If we decide not to renew this Coverage Part, we will take place through the Internet or similar mail or deliver to the first Named Insured shown in electronic means of communication; the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. provided the insured's responsibility to pay damages is determined in a "suit" on the merits, in If notice is mailed, proof of mailing will be sufficient the territory described in Paragraph a. above or in a proof of notice. settlement we agree to. SECTION V— DEFINITIONS 5. "Employee" includes a "leased worker". "Employee" 1. "Advertisement" means a notice that is broadcast or does not include a'temporary worker". published to the general public or specific market 6. "Executive officer" means a person holding any of segments about your goods, products or services the officer positions created by your charter, for the purpose of attracting customers or constitution, bylaws or any other similar governing supporters. For the purposes of this definition: document. a. Notices that are published include material 7• "Hostile fire" means one which becomes placed on the Internet or on similar electronic uncontrollable or breaks out from where it was means of communication; and intended to be. b. Regarding web sites, only that part of a web site 8. "Impaired property" means tangible property, other that is about your goods, products or services than 'your product" or 'your work", that cannot be for the purposes of attracting customers or used or is less useful because: supporters is considered an advertisement. a. It incorporates 'your product" or your work" that 2. "Auto" means: is known or thought to be defective, deficient, a. A land motor vehicle, trailer or semitrailer inadequate or dangerous; or designed for travel on public roads, including b. You have failed to fulfill the terms of a contract or any attached machinery or equipment; or agreement; b. Any other land vehicle that is subject to a if such property can be restored to use by the compulsory or financial responsibility law or repair, replacement, adjustment or removal of 'your other motor vehicle insurance law where it is product" or 'your work" or your fulfilling the licensed or principally garaged. terms of the contract or agreement. CG 00 01 0413 0 Insurance Services Office, Inc., 2012 Page 13 of 16 Policy: BAP8311663-15 Paragraph a. above does not apply to fuels, 6. lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the covered "auto" or its parts, if: (1) The "pollutants" escape, seep, migrate or are discharged, dispersed or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pollutants"; and (2) The "bodily injury", "property damage" or "covered pollution cost or expense" does not arise out of the operation of any equipment listed in Paragraph 6.b. or 6.c. of the definition of "mobile equipment". Paragraphs b. and c. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (a) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (b) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. E. "Diminution in value" means the actual or perceived loss in market value or resale value which results from a direct and accidental "loss". F. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". G. "Insured" means any person or organization qualifying as an insured in the Who Is An Insured provision of the applicable coverage. Except with respect to the Limit of Insurance, the coverage afforded applies separately to each insured who is seeking coverage or against whom a claim or "suit" is brought. H. "Insured contract" means: 1. A lease of premises; 2. A sidetrack agreement; 3. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; 4. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; CA 00 01 10 13 ey� 6. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury" or "property damage" to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement; or That part of any contract or agreement entered into, as part of your business, pertaining to the rental or lease, by you or any of your "employees", of any 'auto". However, such contract or agreement shall not be considered an "insured contract" to the extent that it obligates you or any of your "employees" to pay for "property damage" to any "auto" rented or leased by you or any of your "employees". An "insured contract" does not include that part of any contract or agreement: a. That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; b. That pertains to the loan, lease or rental of an "auto" to you or any of your "employees", if the "auto" is loaned, leased or rented with a driver; or C. That holds a person or organization engaged in the business of transporting Property by "auto" for hire harmless for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by public authority. I. "Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". J. "Loss" means direct and accidental loss or damage. K. "Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: 1. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; 2. Vehicles maintained for use solely on or next to premises you own or rent; 3. Vehicles that travel on crawler treads; © Insurance Services Office, Inc., 2011 Page 11 of 12 POLICY NUMBER: BAP8311663-15 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGF 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 this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: ZIM INDUSTRIES, INC. Endorsement Effective Date: 3/1/2019 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW this Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 4 © Insurance Services Office, Inc., 2011 Tit Page 1 of 1 ,�,,;"CERTIFICATE OF LIABILITY ;.it INSURANCE DATE. (MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SIP Insurance Services NAAE FACT SIP Insurance Services.. ..- .. FAX 750 The Coy Drove South, Ste 450 PHONE A s) ._. _._.. 626-214-7902 A e Nc1:.�..... Change, CA 92t38 E-MAIL INSURED Backflow Apparatus & Valve Company DBA BAVN 20435 S. Susana Road Long Beach CA 99810 A: B: COVERAGE ICFRTIFICATF N1llMRr-R- rAQA1r90 KIlrMnnt:0. 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 THUS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE, POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ..,..._.._...._.,.... ADDL SUBR _....... .. _... POLICY EFF POLICY EXP .,-.._-___.. _.-... LTR TYPE OF INSURANCE ....... POLICY NUMBER IMMIDDrMa MMIDDFYYYY LIMITS A . ✓., COMMERCIAL GENERAL LIABILITY ryf 630-8J664090 1.0/31/2019 10131/2020 EACH OCCURRENCE $"Ii,.000,000__. �� CLAIMS-MADE.y l OCCUR ❑p,.MAGE TCS RENTEC%..... PREMISES Eaoccurrence8 $300,,000 ..... MED EXP (Any one person) $ 5,000 - _. PERSONAL & ADV INJURY $ 1,000,000 .mm--..._. AGGREGATE LIMIT APPLIES PER: GENT GENERAL AGGREGATE s 2,000,..000 ❑,...... 0 _ POLICY JECT LOC PRODUCTS - COMP/OP AGO $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY BA-7N173419 10131/2019, 10/31/2020 COMBINED tSINGLE LIMIT^ $1,000„000 ANY AUTO BODILY INJURY (Per person) $ ...... OWNEAUTOS ONLY AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ ✓,,,,,,,, HIRED I--.NION-OWNED ✓ PR6PERTY -DAMAGE .._�- ....... $ AUTOS ONLY _ AUTOS ONLY Per accidertCS A UMBRELLA LIAB N OCCUR CUP-9J209005 10131/2019 10/31/2020 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 EXCESS LIAR CLAIMS -MAIL DED ''�. ✓ RETENTION$0 ... ..�.. $ A WORKERS COMPENSATION UBOL941578 8/27/2019 8/27/2020 ✓ PE�TUTE ORH- AND EMPLOYERS" LIABILITY Y 1 N _.__-.-.... - .. - ........�.. ANYPROPRIETOR/PARTNEWEXECUTIVE E.L.EACHACCIDP;NT $1,000,000 OFFICERWEM®EREXCLUDED? NIA .. (Mandatory in NH) E.L. DISEASE EA (EMPLOYEE $1 000 ----�°Q-. If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION. OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule may be attached if more space ns required) City of Santa Ana and its officers, employees, agents, volunteers and representatives are named as additional insureds in respects to the general liability policy only per the attached forms. Primary/non-contributory is included in the general liability policy only per the attached form. 30 days notice of cancellation applies to the certholder in regards to the general liability policy only. ENSarl�r.;f�rr�:[r��•I�cIll€�r��Illlr��u�I�I°�rl�u�.. Risk ANAgf-mFtgr IVOIC)N City of Santa Ana SHOULD ANY QF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE .. Risk (Management DIVISIon 20 Civic Center Plaza 4th FL w THE EXPIRATION( DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS. NOTICE WILL BE DELIVERED IN Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE _t= r Gary Champlin CO 1968-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD s4841562 119-at, GL, AIAQ, thlb, wr I Kahtiri Datol 1 3/10/2e20 xro�ae:ie AM (PDT) I PaL+ a of 10 630-8J664090 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR MANUFACTURERS AND WHOLESALERS 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 tNs 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. 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 H. Blanket Additional Insured — Governmental B. Who Is An Insured — Employees And Volunteer Entities — Permits Or Authorizations Relating To Workers — Bodily Injury To Co -Employees And Operations Co -Volunteer Workers I. Blanket Additional Insured — Grantors Of Franchises C. Who Is An Insured — Newly Acquured Or Formed Limited Liability Companies. J. Incidental Medical Malpractice D. Blanket Additional Insured — Broad Form Vendors K. Medical Payments — Increased Lirrift E. Blanket Additional Insured — Controlling Interest L. Blanket Waiver Of Subrogation F. Blanket Additional Insured — Mortgagees, M. Contractual Liability —Railroads Assignees, Successors Or ReceIvers G. Blanket Additional, Insured — Governmental Entities — Permits Or Authorizations Relating To Premises PROVISIONS A. WHO IS AN INSURED — UNNAMED a. Before you maintained an ownership interest SUBSIDIARIES of more than 50% in such subsidiiary-, or The following is added to SECTION 11 — WHO IS b. After the date, if any, during the policy period AN INSURED: that you no longer maintain an ownership Any Of Your Subsidiaries, other than a partnership interest of more than 50% in such subsidiary. or joint venture, that is not shown as a Named For purposes of Paragraph 1. of Section 11 — Who Insured in the Declarations is a Named Insured if; Is An Insured, each such subsidiary wiH be a. You are the sole owner of, or maintain an deemed to be designated in the Declarations as: ownership interest of more than 50% in, such subsidiary on the first day of the policy period; a. A limited liability company; and lb• An organization other than a partnership, joint b. Such subsidiary is not an insured under venture or limited liability company, or similar other insurance. c. A trust; No Such subsidiary is an insured for "biodily injury" or "property damage" that occurred, or "personal as indicated in its name or the documents that and advertising injury" caused by arREW-W-D & APEW:structure. committed: By ffisk MANACIrMEISH- DiviSiON CG D4 68 02 19 02017 The Travelef,§Eld�-4�—L,&,'�,irght 'teserved. Page I of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission 54 8 _'_2 562, 1 19- 2 D Ot- Aut., U.b, WC I Kat her ine Dmiat ejl 1 3 /30/2020 19 - 3 B - 19 AM (PDT) I Pa�ga 2 (If 10 COMMERCIAL GENERAL LIABILITY B. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS The following is added to Paragraph 2.a.(I) of SECTION 11 — WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not apply to "bodily injury" to a co -"employee" while in the course of the cc -"employee's" employment by you or performing duties related to the conduct of your business, or to "bodily injury" to your other "volunteer workers" while performing duties related to the conduct of your business, C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES 4=701 a, 10 RNALIS ILI 6,11124ri Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 500/c, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provIslon is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 1180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organization, If you report Such organization in writing to us within 180 days after you acquire or form it; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization,, and c. Coverage B does not apply to "personal and advertising Injury" arising out of an a. A limited liability company; b. An organization, other than a partnership, joint venture or firnited liabillty company; or c. A trust; as indicated in its name or the documents that govern its structure. D. BLANKET ADDITIONAL INSURED — BROAD, FORM VENDORS The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liabilfty for ""bodily' injury" or "property damage" that: a. Occurs subsequent to the slgning of that contract or agreement-, and b. Arises out of "your products" that are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less, b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale, for a purpose not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the origilrial container; offense COMMILLed before you acquired or (4) Any failure to make such inspections, formed the organization, adjustments, tests or servicing as For the purposes of Paragraph I. of Section 11 vendors agree to perform or normally Wertake to perform in the regular — Who Is An Insured, each such erg 7L-MrED & APPROW will be deemed to be designate I 'Ivisoqvrse of business, in connection with the 'i, U, WANAqEMENr D I Declarations as: 3� distribution or sale of "your products"; 3,P ghts reserved. CG D4 58 02 19 Page 2 of 5 2017 The Traveri rr i Includes copyrighted rnaterial of Insurance Services Office, Inc, with its permission 54811569 1 19-20 GL, ALAo, Umb, 14C I M. thprLrle U,Mltol 1 3/30/2020 10:3a:19 AM (PD,T) I P.q3 of 10 �(5) Demmma8ration, installation, servicing or repair operations, except such operafionv performed at Such vendor's pme«nimao in connection with the sm|o of "your products"; or (8) ~Your prnducts" that, after distribution or sale by you, have been |obeXed or mm|ebm|ed or used as m container, part or Ingredient ofany other thing orsubstance byoronbmhe]fofsuch vendor, Coverage under this provision does not apply to� a. Any Person or organization from whom you have acquired "your pruducta~, or any |ngradiert, part or container entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional insured specifically iuscheduled by endorsement. E. BLANKET ADDITIONAL INSURED - CONTROLLING INTEREST' 1. The following imadded 10SECTION ||-WHO IS AN INSURED: Any Verson or organization that has financial control of you is an insured with respect to liability for ~bodNy injury", "property damage" or "personal and advertising injury" that ahnmu nutot a. Such financial control-, or b. Such pnnsVm's or or mnizedon's mwnemNp, maintenance or use of premises |emomd to or occupied by you. The insurance Pruv�ded to such person or organization does not apply to structural mberaUonm, new construction or demo|tion operations performed by or on behalf of such person nrorganization. G Z The following is added to Paragraph 4. of SECTION N -WHO IS AN INSURED-. This paragraph does not apply to any premises owmer, manager or lessor that has financial rnmtnn| nfvox/ COMMERCIAL GENERAL LIABILITY liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising inju0/'thet: u. Is ''bndNy injury" or "property damage" that occurs. or is "personal and advertising injury" nausod by an offense that is committed, pmbsequ*nt to the signing of that contract or agreement', and b. Arises out of the owmeruhip, maintenance or use ofthe prennisepfor which that mo�Qa$ee. essiOnee, successor o/ receiver is required under that contract or agreement to be |ncXuded as an additional insured on this Coverage Part, The insurance provided to such mortgagee, oam|gmen' successor or receiver is subject to the foUow�ngpro�miuns: a. The limits of 'insurance provided to such mortgagee, mosignmo, oumommsnr or necaivor will be the minimum limits that you agreed to provide in the written contract or agreement, shown the |ims ahun in the Declarations, whichever less. b. The insurance provided to such person or opgan�atnndoes not apply to: (1) Any "bodily injury"or~pm �y damage" thak noouvm, or any "personal and odve���ng injury" caused by an offense that is committed, after such contract or agreement isnolonger inmffeci�or (2) Any "bmdHyin]u�/'. "property damage" or "personal and advertising injury" arising out of any structural alterations, new oomntnuntium or demolition operations performed by or on behalf of such mortgagee, aoa�gnee, successor or receiver. BLANKET ADDITIONAL INSURED - GOVERNMENTAL ENTITIES - PERMITS OR AUTHORIZATIONS RELAT|NC�TD PREMISES The following is added to SECTION ||-V�HO IS �\N|NSUf�ED: --- --- - '-- Any governmental entity that has issued e perm4 F BLANKET ADDITIONAL INSURED - or authorization w4h respect to premises owned MORTGAGEES, ASSIGNEES, SUCCESSORS or occupied by, or rented or loaned to, you and OR RECEIVERS that you are n*Muinad by any ordinance, |aw. The foUmw�nQ is added to SECTION N _VVHO IS building code or written contract or agreement to AN|NSURED: include as anadditional insured anthis Coverage Pert is an immured, but only with respect to liability Any person or organization that is a mortgagee, for "bodily injury". "property damage" or "personal assignee, successor or receiver and that you and advertising injury' arising out of the have agreed in e wvN1on contract oragreement to existence, ownership,use maintenance, repm�r, ` include as an additional insured mnthis Coverage construction, erection or or removal of mm'of the `respectitsim ' Part an insured, but only with respect to � following forwhich that A t i -h CGD458U319 zo1rThe Travelers Indemnity Company. All rights rewmnem.BwRisk m*mm«CIF-MEm; Includes copyrighted material nrInsurance Services Office, Inc. with its permission 54811,e2 1 19-2o u+ uUt^. Umb, oc | ^atu°�n"~um°toz 1 3/20/2020 0,t zo COMMERCIAL GENERAL LIABILITY issued such permit or authorization: advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. H BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OP,ER- ATIONS The following is added to SECTION 11 — WHO IS 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", 1, BLANKET ADDITIONAL INSURED GRANTORS OF FRANCWISES The following is added to SECTION 11 — WHO IS AN INSURED: Any person or organization that grants a franchise to you is an insured, but only with respect to liability for "'bodily injury", "property damage" or "personal and advertising injury" arising out of your operations in the franchise granted by that person or organization. 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 11 — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "'employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech - language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: If a written contract or agreement exists between you and such additional insured, the lirrifts of insurance provided to such insured will be the 4. minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less, J. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services'" to any one person will be deemed to be one "occurrence". The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals definition of "'occurrence"" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or bi. An act or omission committed in providing ordinance relating to the sale of pharmaceuticals committed by, or with the or failing to provide ""incidental medical knowledg VIAWPP"D By Risk MANACI,Emow DiviSiON Page 4 of 5 2017 The Travelers Indemnity company, All rights reserved. CG,04 58 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its perm' 54841562 1 19 -2D 3L, All �0, Umb, WC I Katheacisiz Dun.tad 10 ; 3& 19 AM �FDTP I Page 5 of 10 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or L. instruction, or the related furnishing of food or beverages-, or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to, any person to the extent not Subject to Paragraph, 2,a,(I) of Section 11 — Who Is An Insured. The following replaces Paragraph 7. of SECTION III — LIMITS OF INSURANCE: 7, Subject to Paragraph 5, above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" Sustained by any one person, and will be the higher of: COMMERCIAL GENERAL LIABILITY b. The amount shown In the Declarations of this Coverage Pail for Medical Expense Limit. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8,T Transfer' Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed In a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a, "Bodily injury" or "property damage" that occurs" or b. "Personal and advertising Injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. M. 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; 2. Paragraph f.(I) of the definition of "insured contract"' in the DEFINITIONS Section is deleted, REVIEWED & APPROVED By Risk MANAqEMENT MiSiON CG D4 58 02 19 @ 2017 The Travelers Indemnity Cornpany. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 5 of 5 548-']562 1 19 20 GHQ, Auto, Uiyb, WC I KathPl'lzkF2 D—atol � 3/3D/2j20 10i38:19 AM (PDT) I Page 6 of 10 630-8J664090 COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED, (Includes Proiducts-Completed Operations If Required By Contract'. This endorsement modifies insurance prov�dedunder the foUmwing� COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS TUehzUmwing is added to SECTION |U — WHO IS AN INSURED: Any person or organization that you agree in e written contract or agreement to indude as an additional insured on this Coverage Part is an insured, but only: a. With respect to |ieb�i|dy for "bodily injury" or "property damage" that aocom' nrfor "personal inju0/' ooummd by an offense that is nommN±ad, subsequent to the signing of that contract or agreement and while that part of the omm1rao1 or agreement isineffoct�and b. If, and only to the extent that, such injury or denmage is caused by acts or omissions of you or your subcontractor in the performance of "your work" towhich the written contract or agreement applies. Such person or organization does not qualify as an additional insured v�th respect to the independent acts or omissions of such person nrorganization, The insurance provided tosuch additional insured is subject 1othe following provisions: a. If the, Umits of |mumnsnce of this Coverage Pad shown in the Declarations exceed the minimum limits required by the written contract or ogreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written ooninmct or agreement wU be considered to include the mlnimum |imdm of any Umbna||o or Excess, liability coverage required for the additional insured by that written oontnoo6 or agreement, This pnovia�on will not increase the limits of insurance described in Section }0 — Limits Of Insurance. (1) Any "body injury". "'property damage" or "personal injury" arising out ofthe ppov�ding. or [mi|una to provide, any professional architectural, engineering or surveying services, including: (a) The pnepahnA, appmving, or failing to prepare or approve, mapo, shop drawinga, ap�nionp, naportn, surveys, fie6d orders or change ordena, or the prepahmg, epprovinQ, or failing to prepare or opprove, drawings and mpemifioufimns;and (b) Supervisory, |nppection, architectural or engineering activities, (2) Any "bodily injuryy or "property damage" caused by "your mmdk^ and induded in the °pmducts-uomop|eted operations hazard" unless the written coninyn1 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 cluties: (i) Give us wrtten notice as soon as prectioabe of an "occurrence" or an offense which may result in a o|oiimn, To the extent poss�b|e, such motioeshouId |no|ude� (a)How, when and where the "occurrence' nroffense took place; (b) The names and addresses ofany injured persons and witnosmes� and (c) The nature and |uoa1iun of any injury or damage arising out of the "oocurrenoe" or offense. b. The insurance provided to such additional (2) If clIaim is made mr~surt" is brought against insured does not apply to: the MEW NW&APPROVED BvRiskMAmAqIEMEMmDivisiON CG O246 0419 @2018The Travelers Indemnity Company. All rights i of il;841562 1 1�1-2q = vut". Umb. nc | Kaue=*°�==z 1 3/3o*020 m.sa.muw (=m | P�Xq° 7 of 10 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim nr°sub"and the date roueiwed and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or°muit'ansoon ospracticable. (3) |mmedinte;y 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. Page 2 of 2 (4) Tender the defense and Indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for m loss we cover. However, this condition does not affect whether the insurance provIded to such additional insured is primary to other insurance evoBmb|e to such additional insured which covers that person or organization as e named insured as described in Pmragraph4^ Other Insurance, of Section |V— Commercial General Liability Conditions, By Risk MANAqEMEW Dh/WON @ 201eThe Travelers Indemnity cornpany, AH rights reserved. CG D2 46 014 19 54S4z56 2 | 19-20 = ^ut " Umb, °c | Kath°i ^ u | 3/3*2020 10.39.19^74 /ar' | V�qe 8 ot LO MOX9181*111011 4. Other Insurance If valid and collectible other insurance is available to the insured for a loss we cover Linder Coverages A or B of this Coverage Part, our obligations are limited as described in Paragraphs a. and b. below. As used anywhere in this Coverage Part, other insurance means insurance, or the funding of losses, that is provided by, through or on behalf of: (I) Another insurance company; (H) Us or any of our affiliated insurance companies, except when the Non cumulation of Each Occurrence Limit provision of Paragraph 5. of Section III — Limits Of Insurance or the Non cumulation of Personal and Advertising Injury Limit provision of Paragraph 4. of Section III — Limits of Insurance applies because the Amendment — Non Cumulafion Of Each Occurrence Limit Of Liability And Non Cumulation Of Personal And Advertising Injury Limit endorsement is included in this policy; (iii) Any risk retention group-, or (iv)Any self-insurance method or program, in which case the insured will be deemed to be the provider of other insurance. Other insurance does not include umbrella insurance, or excess insurance, that was bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part, As used anywhere in this Coverage Part, other insurer means a provider of other insurance. As used in Paragraph c. below, insurer means a provider of insurance. a. Primary Insurance This Insurance is, primary except when Paragraph b, below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with at that other insurance by the method described in Paragraph c. below, except when Paragraph d. below applies, b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (I) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"-, COMMERCIAL GENERAL LIABILITY (i i) That is insurance for "Premises damage"; (iii) If the loss arises out of the maintenance or use of aircraft, ,"autos"" or watercraft to the extent not subject to any exclusion in this Coverage Part that applies to aircraft, "autos" or watercraft; (iv) That is insurance available to a premises owner, manager or lessor that qualifies as an insured under Paragraph 4. of Section It — Who Is An Insured, except when Paragraph d. below applies; or (v) That is insurance available to an equipment lessor that qualifies as an insured under Paragraph 5. of Section 11 — Who Is An Insured, except when Paragraph d. below applies. (b) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured, or is any other insured that does not qualify as a named insured, Linder such, other insurance. (2) When this insurance is excess, we will have no duty, under Coverages A or B to defend the Insured against any "suit" if any other insurer has a duty to defend the insured against that "suit",, If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. (3,) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self - insured amounts under all that other insurance. (4) We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Pall. REVIEWED & APPROVED By RiskMANAC�EMENT DivkioN CG T1 00 02 19 0 2017 The Travelers Indemnity Company, All rights reserved. e 15 of 21 Includes copyrighted material of Insurance Services Office, Inc. with its pe fm s t9-20 cr.., AuLo, Umb, WC I Katherine DUmatol p 3/30/2020 10 : 38: 1,4 All, (PDV I Vage 9 of 10 COMMERCIAL GENERAL LIABILITY C. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurers 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 "properly 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 a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or Unintentional eirl'or in, any information provided by YOU which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does, not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations, 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies, a. As if each Named Insured were the only Named Insured-, and b.Separately to each insured against whom claim is made or "suit" is brought, 8,. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us, The insured must do nothiing after loss to impair them. At our request, the insured will bring "suit" or, transfer those rights to us and help us enforce thern. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice, 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: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication-, and as we may request. b. Regarding websltes, only that part of a webslte 6. Representations that is about your goods, products or services By accepting this policy, you agree: for the purposes of attracting customers or supporters is considered an advertisement. REVIEWED & APPROVED By RiskMANACiEMEN-r DivisiON Page 16 of 21 0 2017 The Travelers [ndernnity Company. All rights reserved, T — R Inctudes copyrighted material of Insurance Services Office, Inc, with its permission �, TO 54q415b2 11 19-20 GL, Auto, Umb, WC I Katherine Dumatol 1 3131/2020 10:39:19 AIM t11DT1 I Vaqu 1D of ao