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Home My WebLink AboutPADILLA, DENNYS DIAZ (3)INSURANCE ON FILE WORT( MAY PROCEED UNTIL INSURANCE EXPIRES �I I I � 2ozw CITY CLERK DATE: D'. PPCSKF ('0 LS.ga„ d)AA' JUN 0 3 20A RECREATION SERVICES AGREEMENT N-2024-180 THIS AGREEMENT is made and entered into on this loth day of April, 2024 by and between Dennys Diaz Padilla, an individual ("Provider"), and the City of Santa Ana, a charter city and Municipal Corporation organized and existing under the Constitution and laws of the State of California ("City"). City and Provider are also referred to as "the Parties." RECITALS A. The City desires to retain a recreation service provider having, special skills, resources and knowledge to provide Danza Folklorico classes in the park for its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that he is knowledgeable in his field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. D. The Parties acknowledge that the City intends to provide recreational activities to the public but must balance the need to comply with all COVID-19 guidance and restrictions. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES a. Provider shall perform those services as set forth in Exhibit A to this Agreement b. All classes operated pursuant to this Agreement for conducting recreation classes at City facilities, including parks, will comply with all applicable guidance and public health orders, including those from the Centers for Disease Control ("CDC"), California Department of Public Health ("CDPH"), the Orange County Health Care Agency ("OCHCA") and the City itself for as long as those orders and guidance remain in place. Provider will remind participants of these guidelines. To the extent that Provider needs assistance with enforcing any rules or requirements, Provider will contact a City Parks' employee or City security for assistance. c. Provider shall not attend a class or teach any class if Provider is sick or has any symptom(s) associated with COVID-19 including but not limited to, fever above 100.4, chills, cough, shortness of breath loss of taste or smell, nausea, muscle or body aches, vomiting, headache, sore throat or diarrhea. d. Provider will not attend class or teach a class if Provider or any member of Provider's household has been asked to quarantine or self -isolate due to symptoms of COVID-19 or a positive test result for COVID-19. Page 1 of 11 e. Provider acknowledges that, to the extent that City is able to and chooses to conduct classes indoors, this Agreement will also cover classes conducted at one of City's recreational centers during the term of this Agreement. f. City reserves the right to change the location(s) at which the services contemplated by this Agreement are provided. g. Provider shall comply with the City's recreation classes policy manual and any other City rules and regulations regarding the operation of recreation classes. 2. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Twenty -Five Thousand Dollars and Zero cents ($25,000). b. Payment to Provider shall be made monthly within forty-five (45) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. c. City and Provider agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Provider agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Provider's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July 1, 2024 and end on June 30, 2025, unless terminated earlier in accordance with Section 14 below. The term of this Agreement may be extended for up to one (1) one-year period upon a writing executed by the City Manager and City Attorney. 4. INDEPENDENT CONTRACTOR Provider shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider Page 2 of l l shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. Provider is not an agent, representative or employee of City and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require subcontractors, if any, to obtain and maintain insurance, as described below, for the entire Term of this Agreement, against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied. Total cost of such insurance shall be borne by Provider. MINIMUM SCOPE AND LIMIT OF INSURANCE • Commercial General Liability (CGL): Insurance Services Office Form CG 00 0lcovering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. • Automobile Liability: Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with limits no less than $1,000,000 per accident for bodily injury and property damage. In the event Provider does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance as compliance with this requirement. • Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, policy or employee, for bodily injury or disease. Coverage is not required if Provider has no employees and signs request to waive. • Sexual Abuse or Molestation Liability (SAML): If the work will include contact with minors, and the CGL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, Permittee shall obtain and maintain a policy covering Sexual Abuse and Molestation with a limit of no less than $1,000,000 per occurrence or claim. If Provider maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Provider. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions. The above required insurance policies are to contain or be endorsed to contain the following provisions: • City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out Page 3 of 1 I of work or operations performed by or on behalf of the Provider including materials, parts, equipment, and personnel furnished in connection with such work or operations. • Provider's Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Provider under this Agreement. • For any claims related to this contract, Provider's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. • A severability of interest provision must apply for all the additional insureds, ensuring that Provider's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. • Insurance policy(ies) required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written shall be provided to City for policy cancellation or non -renewal due to non-payment. • Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: (Name of Responsible Staff), 20 Civic Center Plaza (M-XX — Responsible Staffs Department mail box), Santa Ana, CA 92701. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. Verification of Coverage. Provider shall famish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Special Events Coverage. Special events coverage is available and can be purchased by Provider. Use this link to learn more: www.2soarta.com. Special Risks or Circumstances. City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 6. INDEMNIFICATION Provider agrees to defend, and shall indemnify and hold harmless the City , its officers, agents, employees, Providers, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the Page 4 of 11 negligent operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, and farther agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Provider without reference to information disclosed by the City. 8. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COWD-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19, some people have become seriously ill requiring hospitalization and that some people have died from COVID-19. Provider acknowledges that persons over the age of 65 and persons with underlying health conditions are at greater risk of contracting COVID-19 and are potentially risking serious injury or death. Provider is agreeing to provide classes pursuant to this Agreement and does so of Provider's own free will. Page 5 of 11 Provider intends to be legally bound by this assumption of risk, release and waiver and to bind Provider's heirs, personal representatives, next of kin and anyone who may make a claim on Provider's behalf. Provider knowingly releases and waives any and all claims that Provider may have or could have in the future and includes any claims resulting from potential exposure or actual exposure to COVID-19, this includes claims for personal injury, transmittal of COVID-19 to others, and/or wrongful death. Provider agrees to hold harmless, defend and indemnify the City, its public officials, officers, employees, volunteers, and agents from any and all claims for liability or damages, including those for exposure to or diagnosis with COVID-19 as a result of providing services pursuant to this Agreement. 9. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 10. BACKGROUND CHECK Provider shall ensure that all employees, subcontractors, and any volunteers are fingerprinted and background checked prior to conducting any work pursuant to this Agreement. Provider shall not assign any employee, agent, subcontractor, volunteer or the Provider personally to provide services pursuant to this Agreement, if that employee, agent, subcontractor, volunteer, or the Provider personally are required to register as a sex offender under California Penal Code Section 290 et seq, have a conviction for any crime of moral turpitude, have a conviction for a sexual based crime, have a conviction for a violent felony as defined in California Penal Code Section 667.5(c), or has a conviction for a serious felony as defined in California Penal Code Section 1192.7(c). Disqualifying convictions include but are not limited to, violations of California Penal Code Sections 37, 128, 136.1 with Section 186.22, 187, 190-190.4 and 192(a), 205, 206, 207-209.5, 211, 212, 212.5, 213, 214, 215, 218-219, 220, 236.1(b) or 236.1(c), 243.4, 261, 261.5, 273.5, 262, 264.1, 266, 266c, 266h, 266i, 266j, 267, 269, 272, 273a, 273ab, 273d, 285, 286, 288, 288a, 288.2, 288.3, 288.4, 288.5, 288.7, 289, 290, 311.1, 311.2, 311.3, 311.4, 311.10, 311.11, 314, 347(a), 368, 417(b), 451(a),518 with 186.22, 647.6, 653f(c), 664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1) or (b)(2); Business and Professions Code Section 729. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988; Fax (714) 647-6956 Page 6 of I With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Provider: Dennys Diaz Padilla 203 Emerald Lane, Sp # 142 Santa Ana, California 92703 Phone: 714-809-8979 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmissionreport issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 14. TERMINATION a. This Agreement may be terminated by the City immediately pursuant to any federal, state, county or local health order related to or regarding COVID-19 making it impossible to hold Page 7 of 11 classes. For any other reason, this Agreement may be terminated by City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the Provider outside of Section 1 Lb. must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 15. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 16. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. Provider shall keep these and any other records in connection with the work to be performed under this Agreement and shall permit City, upon request, to review such records for a period of three (3) years from the date of final payment to Provider under this Agreement. 17. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 18. JURISDICTION —VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 19. LICENSES Provider shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder Page 8 of 11 and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies, 20. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or tmenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement, which shall be interpreted to carry out the intent of the parties hereunder. 21. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 22. AUTHORITY The person(s) executing this Agreement on behalf of the parties hereto warrant that they are duly authorized to execute this Agreement on behalf of said parties and that by so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. [signatures contained on following page] Page 9 of 11 SIGNATURE PAGE TO RECREATION SERVICES AGREEMENT IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the date and year first above written. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Iona an T. Martine Assistant City Attorney of Recreation Services Agency CITY OF SANTA ANA lvaro Nunez Acting City Manager PROVIDER: Dennys Diaz Padi a Page 10 of 11 Exhibit A SCOPE OF SERVICES A. Provider will conduct Danza Folkl6rico class for individuals 4yrs & Up B. Provider shall teach such or similar classes (1) at times below at facilities to designated by the city or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hour when classes will be held, and holidays to be observed, in accordance with City's needs. DANZA FOLKLORICO Come and learn the beauty of Mexico through the music and dances in a healthy environment, with kids and adults. Siempre con Orgullo (Always with Pride). INSTRUCTOR: Dennys Diaz Padilla, Substitute (Maricsa Secundo) LOCATION: El Salvador Center, 1825 W. Civic Center Dr., Santa Ana, (714) 647-6558 • Danza Folklorico (Beginning) class that will consist of monthly sessions, held I day per week, 1 hour per day. (4yrs+), 5:30pm-6:30pm Mon/Wed, $55 monthly; 12:00pm-I:OOpm Sat, $45 monthly. • Danza Folklorico (Intermediate) class that will consist of monthly sessions, held 1 day per week, 1 hour per day. (6-12yrs), 5:30pm-6:30pm Mon/Wed, $55 monthly. • Danza Folklorico (Adaptive Dance) class that will consist of monthly sessions, held 1 day per week, 1 hour per day. (5yrs+), 5:30pm-6:30pm Mon/Wed, $45 monthly. * For students of all ages and abilities. • Danza Folldorico (Advanced) class that will consist of monthly sessions, held I day per week, 1 hour per day. (12yrs+), 5:30pm-7:30pm Mon/Wed, $55 monthly. C. Provider will provide and be responsible for equipment, records, and personnel and cleanup of the facilities and materials necessary to ensure the safety and effectiveness of said instruction. CLASS SIZE/Registration 1) Each class must have a minimum of 2 paid students and no more than a maximum of 20. 2) No registration accepted after the second meeting of class. 3) In the event the minimum number of enrollees has not realized by the second meeting of the class, the class will be canceled. Consultant will be under no obligation to provide services and the City will have no obligations to pay Consultant compensation CLASS FEES • Each participant shall pay class registration fee as established by City • Provider may not waive class participation/registration fees. • Only registered participants may participate in class. • Any refunds to participants will be made in accordance with City policy. • Any material fee shall be established by mutual agreement of City and Provider shall be payable directly to Provider. Page 11 of 11 WDD ac`oiro® CERTIFICATE OF LIABILITY INSURANCE DATE (MOBI03120/2023r VYY) 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 endomement(s). NAME: Maguire Insurance Agency, Inc. FWI PHONI 1 Bala Piz Ste 100 Bela Cynwyd, PA 19004-1401 (A/c, N 610.61].]900 E-MAIL Digitally s ane INSURER(S) AFFORDING COVERAGE INSURED r' p Angie 7 43 F Diaz �JJ Y g ]143 Fulton Way 1 Stanton. CA 90680 _ Acevedo INSURER E: REVISION THIS IS TO CERTIFY THAT THE POLICIES JF'.ISURANCE L BE S THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMEt r. -cRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY ER, POLICY UP LTR TYPE OF INSURANCE INSp MD POLICY NUMBER (MWDD/YYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X PHPK2457612-001 09101/2023 09/1/2024 EACH OCCURRENCE $11000,000 CLAIMS -MADE �% OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100JMo X MED EXP(Any one person) $2,500 PROFESSIONAL LIABILITY PERSONAL B ADV INJURY $1,000,000 GEN'L GENERAL AGGREGATE $3,000,000 AGGREGATE LIMIT APPLIES PER POLICY ElPROJECT ❑ LOC X PRODUCTS - COMP/OPAGG $3,000,000 8 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Peracadem) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION PER OTHER AND EMPLOYERS' LIABILITY YIN STATUTE ANYPROPRIETORIPARTNER/EXECUTIVE NIA OFFICERIMEMBER EXCLUDED? E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached U more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respects) to the operators of the named insured except that liability resulting from me additional insured's sole negligence. CERTIFICATE HOLDER CANCELLATION Risk Management Division 20 Civic Center Plz Santa Ana, CA 927014058 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 'l V 4 "MlvugonentEltMipn REMEMEC&APPROVEDBY: 1 I e A+� Adw�cA " Risk Management Spedalist Of ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CITY OFSANTAANA R RISK MANAGEMENT a division of HUMAN RESOURCES Managing Risk &*avgv,PosltlHe Change nn '- Affidavit of Exemption for Workers' Compensation Insurance I, Dennys Diaz hereby affirm under penalty of perjury, the (Nome/Title) following declaration: I certify on behalf of City of Santa Ana that during the term (Consultant/Company Name) of my contract for Dance Instructor services with the City of Santa Ana, (Type of service provided) I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately.. Date: 5/1 /24 Print Name: ennvS Diaz Print Signatu Tele , Danc"structor WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. xmk no�g„meohia�n REVIEWED S APPROVED BY: A-fi A�aA4 '�' Ruk Management Speaalist I:\Risk Mgmt\Insurance Requirements\ Affidavit of Exemption for Workers Compensation Insurance Auto Liability (Non -Use Agreement) Date 5/1/24 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Dennys Diaz has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Dennys Diaz attests to the following: Dennys Diaz will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. 2 Dennys Diaz will not use any owned/rented/leased vehicles during thecourse and scope of the services provided in the agreement/contract. 3. Dennys Diaz consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I, Dennys Diaz attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Dennys Diaz is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $ I million per occurrence, the contract will be considered null and void andthe company will be held fully liable for any and all damages. Signature: Name: Dennys Diaz Job Title: Dancelnstructor Company Name: Contact Phone: 714-809-8979 Email Address: Dennysdiaz052@gmail.com Risk MamgmedDMsion REVIE &APPRO BY. - Risk Management Spedalist ' .•- •)hia Indemn' One Bala Plaza, Suite 100, 1-800-759-4961 Insurance Comoan Commercial Lines Policy THIS POLICY CONSISTS OF: - DECLARATIONS - COMMON POLICY CONDITIONS - ONE OR MORE COVERAGE PARTS. A COVERAGE PART CONSISTS OF: - ONE OR MORE COVERAGE FORMS - APPLICABLE FORMS AND ENDORSEMENTS _ Risk Mg.tDtWlan REVI mSAppR mRY: , ffliorm A+ja A"w44 Risk Management Specialist IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless signed by our authorized representative. 9)4- President & CEO Secretary Rink Mzmgvinmt Division REVIEWED&APPRO BY. �. ® Risk Management Spedalist PP 20 20 (02/20) ALL COMMERCIAL LINES PRIVACY NOTICE FOR COMMERCIAL LINES This notice is provided on behalf of Philadelphia Indemnity Insurance Company PURPOSE OF THIS NOTICE When you apply for or become an insured under, the insurance policies we issue, we gather certain non- public information or "NPI" about your business and its employees. We are committed to safeguarding the NPI you entrust to us. The purpose of this notice is, therefore, to let you know howwe collect, use, share and protect the NPI you provide to us in those contexts. That means this notice applies onlyto your business interactions with us involving your application for a quote or as a policy holder. NPI we may collectfrom you in connectionwith other interactions, such as when you or your employees visit one of our general interest, publicly accessible websites, is governed by the separate notices and policies we publish on those relevant sites or otherwise provide to you. When we refer in this notice to your"NPI", we mean non-public information as that term is generally defined and applied under the New York Department of Financial Services' Cybersecurity Regulation, the Gramm - Leach -Bliley Act and the National Association of Insurance Commissioners' Data Security Model Lawwhich includes non-public information about your business, such as financial information, account numbers, loss history, personal non-public information of your employees including social security number, address or medical information and any proprietary information we obtain about your business or your customers. Due to a variety of factors, including certain explicit exemptions they contain, this notice and the NPI we collect from you in connection with the above -described business interactions is not governed by the EU General Data Protection Regulation, its related EU and Swiss Privacy Shield or the California Consumer Privacy Act. COLLECTING YOUR NPI In the course of, or as part of a business interaction, we collect your NPI both directly from you, orfrom the agents, brokers or other intermediaries acting on your or our behalf, as well as from a variety of additional sources including: the applications or other forms you provide to us (these forms may contain your name, address, social security number, marital status, date of birth, gender, length of employment, prior insurance information, home ownership, residency history, vehicle type, vehicle use, or driving history) your transactions with us, our other affiI iates of the Tokio Marine Group as well as third parties (this information would incude, for example, premium payment and claims history) consumer or independent reporting agencies (for example your motor vehicle report, property inspection report, accident report or claim report) USING YOUR NPI We use your NPI in a variety of ways such as creating and issuing a quote, underwriting or otherwise processing and servicing your insurance policy, handling claims you may have and offering you additional products and services that we think may be of interest to you as well as for related re: purposes. Tg,�rt• e RiAMelagenadDIVierurt ;& RIME &APPROV®Br. PP 20 20 (02/20) " A*,p Acw44 Page t of Risk Management Specialist © Copyright 2020 Tokio Marine Management, Inc. 01 PP 20 20 (02120) SHARING YOUR NPI We do not disclose or share any NPI about our customers or former customers outside of the Tokio Marine Group, except as permitted by law. We do not sell or disclose or share your NPI for third party marketing purposes. We do, however, share your NPI with third parties that we use to service your account or process your insurance policy or your claim, or administer related transactions. These third parties may include: • your agent, broker or producer • independent claims adjusters, investigators, data processors or attorneys • persons or organizations that conduct scientific research, including actuarial or underwriting studies • an insurance support organization oranother insurer, to prevent or prosecute fraud or to properly underwrite the risk • another insurer, if you are involved in an accident with their insured • State insurance departments or other governmental or law enforcement authorities, if required by law, to protect our legal interests or in cases of suspected fraud or illegal activities • a court of law We also are required to disclose your NPI if we receive a subpoena, search warrant or other court order. RETAINING YOUR NPI The NPI we collect is kept in your policy and/or claim files for as long as needed in connection with your business interactions with you and, if longer, as required by law. HOW WE PROTECTYOUR NPI We have adopted and implemented a security and privacy program that includes technical, organizational, administrative, and other measures designed to protect, as required by applicable law and in accordancewith industry standards, against reasonably anticipated oractual threats to the security of your NPI. Our security program was created by reference to widely recognized standards such as those published by the International Standards Organization and National Institute of Standards and Technology. It includes, among many other things, procedures for assessing the need for, and as appropriate, either employing encryption and multi -factor authentication or using equivalent compensating controls. As part of our security program, we have specific incident response and management procedures that are activated whenever we become aware that your NPI was likely to have been compromised. CHANGES TO THIS NOTICE We may amend this notice from time to time and will inform you of these changes as required by law. QUESTIONS AND CONTACT INFORMATION If you have any questions about this notice or how we collect, use, share and protect your NPI, please contact the Chief Privacy Officer of TMNA Services, LLC, who acts as the privacy and data security administrator for most of the Tokio Marine Group in North America. The Chief Privacy Officers contact information is: Attn: Privacy Office TMNA Services, LLC 3 Bala Plaza East, Suite 400 Bala Cynwyd, Pennsylvania 19004 610-227-1300 PP 20 20 (02/20) Page 2 of 2 © Copyright 2020 Tokio Marine Management, Inc. RIek MUagemmtDMsian IiEm m&APPRcvm Br A+f, Apt• �. ® Risk Management Spedalist Philadelphia Indemnity Insurance Company One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 COMMON POLICY DECLARATIONS Policy Number: PHPK2457612-001 Named Insured and Mailing Address: Dennys Diaz 7143 Fulton Way Stanton, CA 90680- Producer: 125725 Maguire Insurance Agency, Inc. FWI 1 Bala Plz Ste 100 Bala Cynwyd, PA 19004-1401 CPD-PIIC (01/07) Policy Period From: 09/01/2023 To: 09/01/2024 at 12:01 AM. Standard Time at your mailing address shown above Business Description: Fitness Trainer Style/Art: Dance Instructor IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part $122.00 Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Commercial Auto Coverage Part Commercial Stop Gap Part Businessowners Workers Compensation Taxes/Fees/Surcharges $50.00 Total $172.00 FORM (S) AND ENDORSEMENT (S) MADE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Forms Schedule "Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations Countersignature Date 9)4- Authorized Representative RIA Dart Dmv imt REVIEW@&APPRovmBY: l A+-gc. A"W44 ® Risk Management Spedalist Forms Schedule — Policy Policy Number: PHPK2467612-001 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form/Edition Description CPD-PIIC (01/07) Common Policy Declarations - PHLY Indemnity Insurance Fees And Surcharge Schedule Fees and Surcharge Schedule Page 1 of 1 Risk M�ngawdDtwian Riw! v D & APPRovm Bv: A..gz, A,w44 ® Risk Management Spetlalist Fees and Surcharge Schedule Policy Number: PHPK2457612-001 RPGFEE Page 1 of 1 $50.00 MM & APPROVMelu. Ayr, Acavdo Risk M,11,ag,ment Specialist Philadelphia Indemnity Insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy Number: PHPK2457612-001 Agent #:125725 50 See Supplemental Schedule LIMITS OF INSURANCE $3,000,000 General Aggregate Limit (Other Than Products — Completed Operation) $3,000,000 Products/Completed Operations Aggregate Limit (Any One Person Or Organization) $1,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $100,000 Rented To You Limit $2,500 Medical Expense Limit (Any One Person) FORM OF BUSINESS:Individual Business Description: Fitness Trainer Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED AUDIT PERIOD, ANNUAL, UNLESS OTHERWISE STATED: Classifications Premium Basis Rates Prod./ Prem./Ops. Comp.Ops. Advance Premiums Prod./ Prom./Ops. Comp.Ops. SEE SCHEDULE ATTACHED TOTAL PREMIUM FOR THIS COVERAGE PART: $122.00 Included Retroactive Date(CG 00 02 Only) This insurance does not apply to "Bodily Injury', 'Property Damage", or "Personal and Advertising Injury" which occurs before the retroactive date, if any, shown below. Retroactive Date: FORM(S) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule Countersignature Date Authorized Representative Risk MwagemadDMsfun REVI &APPRcveo BY: ® Risk Management Speaalist Page 1 of 1 Forms Schedule — General Liability Policy Number: PHPK2457612-001 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form/Edition Description CG 00 01 04 13 Commercial General Liability Coverage Form CG 20 26 04 13 Additional Insured - Designated Person or Organization CG 2167 12 04 Fungi or Bacteria Exclusion CG 21 70 01 15 Cap On Losses From Certified Acts Of Terrorism CG 32 34 01 05 California Changes Commercial General Liability GL Coverage Part Declarations Page Coverage Part Declarations Commercial GL Supplemental Commercial GL Coverage Supplemental Schedule Schedule IL 00 17 11 98 Common Policy Conditions IL 02 70 09 12 California Changes - Cancellation And Nonrenewal IL N 177 09 12 California Premium Refund Disclosure Notice PI-ACL-001 01 20 ABSOLUTE CYBER LIABILITY AND ELECTRONIC EXCLUSION PI-BELL-1 11-09 Bell Endorsement PI-FW-001 (01/07) Coverage C- AthleticActivities Exclusion Deletion PI-FW-002 04 16 Fitness and Wellness Liability Insurance Exclusions PI-FW-003 (01/07) Fitness and Wellness Liability Insurance Extension PI-FW-004 04 16 Independent Contractors Providing Professional Training Services PI-FW-005 (01/07) Punitive Damages Exclusion PI-FW-007 (01/07) Specific Claimant Exclusion PI-FW-008 (01/07) Violation of Communication or Information Law Exclusion PI-FW-009(06/11) Blanket Additional Insured PI-GL-001 09 17 Exclusion - Lead Liability PI-GL-002 CA 02 08 Exclusion - Asbestos Liability PI-SAM-001 05 19 ABUSIVE CONDUCT COVERAGE SUBLIMITS DEFENSE WITHIN LIMITS Page 1 of 1 Risk M�sg.=dDivbion ^�L-;' REVIEWED&APPROVED BY: A A�w �. Risk Management Spedalist COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL SCHEDULE Policy Number: PHPK2457612-001 Agent #: 125725 Rates Advance Premiums Premium Prod/Comp Prod/Comp Classifications & Code No. Basis Prem/Ops Ops Prem/Ops Ops 44311 - Certified Fitness Each Included Included $122.00 Included Instructor TOTAL PREMIUM FOR THIS COVERAGE PART: $122.00 1 Included Page 1 of 1 Rink MnugahmtDhisimi �\ RE esm & APPROVED BY.- Il11' A--fr, ACW44 ® Risk Pdanagement Specialist COMMERCIAL GENERAL LIABILITY CG 00 01 0413 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations, and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and 'our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II — Who Is An Insured. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V —Definitions. SECTION I — COVERAGES COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit' seeking those damages. However, we will have no duty to defend the insured against any "suit' seeking damages for 'bodily injury" or 'property damage" to which this insurance does not apply. We may, at our discretion, investigate any 'occurrence" and settle any claim or "suit' that may result. But: (1) The amount we will pay for damages is limited as described in Section III — Limits Of Insurance; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments — Coverages A and B. b. This insurance applies to 'bodily injury" and "property damage" only if: (1) The 'bodily injury" or 'property damage" is caused by an 'occurrence" that takes place in the "coverage territory"; (2) The 'bodily injury" or 'property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1. of Section II — Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the 'bodily injury" or 'property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the 'bodily injury" or "property damage" occurred, then any continuation, change or resumption of such "bodily injury" or 'property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. 'Bodily injury" or 'property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1. of Section 11— Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim, includes any continuation, change or resumption of that 'bodily injury" or 'property damage" after the end of the policy period. d. 'Bodily injury" or 'property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. of Section II — Who Is An Insured or any "employee" authorized by you to give or receive notice of an 'occurrence" or claim: (1) Reports all, or any part, of the 'bodily injury" or 'property damage" to us or any other insurer; (2) Receives a written or verbal demand or claim for damages because of the 'bodily injury" or "property damage"; or (3) Becomes aware by any other means that "bodily injury" or 'property damage" has occurred or has begun to occur. e. Damages because of 'bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the 'bodily injury". ��- Riek M¢r aFmmtDisivion ReneumnAPPRO BY: ® Risk Managemen[Spetlalirt CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 16 2. Exclusions This insurance does not apply to: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" resulting from the use of reasonable force to protect persons or property. b. Contractual Liability "Bodily injury" or "property damage" 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 liability for damages: (1) That the insured would have in the absence of the contract or agreement; or (2) Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorneys' fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "bodily injury" or "property damage", provided: (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 attorneys' fees and litigation expenses are for defense of that parry against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. c. Liquor Liability "Bodily injury" or "property damage" for which any insured may be held liable by reason of: (1) Causing or contributing to the intoxication of any person; (2) The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or (3) Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in: (a) The supervision, hiring, employment, training or monitoring of others by that insured; or (b) Providing or failing to provide transportation with respect to any person that may be under the influence of alcohol; if the "occurrence" which caused the "bodily injury" or "property damage", involved that which is described in Paragraph (1), (2) or (3) above. However, this exclusion applies only if you are in the business of manufacturing, distributing, selling, serving or furnishing alcoholic beverages. For the purposes of this exclusion, permitting a person to bring alcoholic beverages on your premises, for consumption on your premises, whether or not a fee is charged or a license is required for such activity, is not by itself considered the business of selling, serving or furnishing alcoholic beverages. d. Workers' Compensation And Similar Laws Any obligation of the insured under a workers' compensation, disability benefits or unemployment compensation law or any similar law. e. Employer's Liability "Bodily injury" to: (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of Paragraph (1) above. This exclusion applies whether the insured may be liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to liability assumed by the insured under an "insured contract". Risk Management Spedallst 01 Page 2 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 f. Pollution (d) At or from any premises, site or location (1) "Bodily injury" or "property damage" arising on which any insured or any contractors out of the actual, alleged or threatened or subcontractors working directly or discharge, dispersal, seepage, migration, indirectly on any insured's behalf are release or escape of "pollutants": performing operations if the "pollutants" are brought on or to the premises, site (a) At or from any premises, site or location or location in connection with such which is or was at any time owned or operations by such insured, contractor occupied by, or rented or loaned to, any or subcontractor. However, this insured. However, this subparagraph subparagraph does not apply to: does not apply to: i roe damage" () "Bodily injury" or " try "property g "Bodily injury" (i) y 1 ry„ if sustained within a arising out of the escape of fuels, building and caused by smoke, lubricants or other operating fluids fumes, vapor or soot produced by or which are needed to perform the originating from equipment that is normal electrical, hydraulic or used to heat, cool or dehumidify the mechanical functions necessary for building, or equipment that is used to the operation of "mobile equipment" heat water for personal use, by the or its parts, if such fuels, lubricants building's occupants or their guests; or other operating fluids escape from (ii) "Bodily injury" or "property damage" a vehicle part designed to hold, store for which you may be held liable, if or receive them. This exception does you are a contractor and the owner not apply if the "bodily injury" or or lessee of such premises, site or "property damage" arises out of the location has been added to your intentional discharge, dispersal or policy as an additional insured with release of the fuels, lubricants or respect to your ongoing operations other operating fluids, or if such performed for that additional insured fuels, lubricants or other operating at that premises, site or location and fluids are brought on or to the such premises, site or location is not premises, site or location with the and never was owned or occupied intent that they be discharged, by, or rented or loaned to, any dispersed or released as part of the insured, other than that additional operations being performed by such insured; or insured, contractor or subcontractor; (Ili) "Bodily injury" or "property damage" (it) "Bodily injury" or "property damage" arising out of heat, smoke or fumes sustained within a building and from a "hostile fire"; caused by the release of gases, (b) At or from any premises, site or location fumes or vapors from materials which is or was at any time used by or brought into that building in for any insured or others for the connection with operations being handling, storage, disposal, processing performed by you or on your behalf or treatment of waste; by a contractor or subcontractor; or (c) Which are or were at any time (III) "Bodily injury" or "property damage" transported, handled, stored, treated, arising out of heat, smoke or fumes disposed of, or processed as waste by from a "hostile fire". or for: (e) At or from any premises, site or location (1) Any insured; or on which any insured or any contractors or subcontractors working directly or (ii) Any person or organization for whom indirectly on any insured's behalf are you may be legally responsible; or performing operations if the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". Risk MV&VMMdDMdm Benenm & APPRowo Br. ®' Rak Management Spea4ist 01 CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 3 of 16 (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". However, this paragraph does not apply to liability for damages because of "property damage" that the insured would have in the absence of such request, demand, order or statutory or regulatory requirement, or such claim or "suit" by or on behalf of a governmental authority. g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 26 feet long; and (b) Not being used to carry persons or property for a charge; (3) Parking an "auto" on, or on the ways next to, premises you own or rent, provided the "auto" is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any "insured contract" for the ownership, maintenance or use of aircraft or watercraft; or (5) "Bodily injury" or "property damage" arising out of: (a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of "mobile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b) The operation of any of the machinery or equipment listed in Paragraph C(2) or f.(3) of the definition of "mobile equipment". h. Mobile Equipment "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. i. War "Bodily injury" or "property damage", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j. Damage To Property "Property damage" to: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; (3) Property loaned to - Risk MotugnnedDMdon �L,'' Rtlne &APP20 Br. A+f A� ® RBk Management Specialist Page 4 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 04 13 (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the "property damage" arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III — Limits Of Insurance. Paragraph (2) of this exclusion does not apply if the premises are 'your work" and were never occupied, rented or held for rental by you. Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products - completed operations hazard". k. Damage To Your Product "Property damage" to "your product' arising out of it or any part of it. I. Damage To Your Work "Property damage" to 'your work" arising out of it or any part of it and included in the "products - completed operations hazard". This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. m. Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property" or property that has not been physically injured, arising out of: (1) A defect, deficiency, inadequacy or dangerous condition in 'your product' or "your work" or (2) A delay or failure by you or anyone acting on your behalf to perform a contract or agreement in accordance with its terms. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product' or "your work" after it has been put to its intended use. n. Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: (1) "Your product'; (2) "Your work"; or (3) 'Impaired property"; if such product, work, or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. o. Personal And Advertising Injury "Bodily injury" arising out of "personal and advertising injury". p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data. However, this exclusion does not apply to liability for damages because of "bodily injury". As used in this exclusion, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD- ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. q. Recording And Distribution Of Material Or Information In Violation Of Law "Bodily injury" or "property damage" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2) The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (I n yeah ruekn adrimaon REVIEWED 6 AeaRov® ar. °'. A.ju&w4ce Risk Management Specialist Of CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 5 of 16 (4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. Exclusions c, through n. do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits Of Insurance. COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "personal and advertising injury" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "personal and advertising injury" to which this insurance does not apply. We may, at our discretion, investigate any offense and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III — Limits Of Insurance; and (2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments — Coverages A and B. b. This insurance applies to "personal and advertising injury" caused by an offense arising out of your business but only if the offense was committed in the "coverage territory" during the policy period. 2. Exclusions This insurance does not apply to: a. Knowing Violation Of Rights Of Another "Personal and advertising injury" caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict "personal and advertising injury". b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral or written publication, in any manner, of material, if done by or at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral or written publication, in any manner, of material whose first publication took place before the beginning of the policy period. d. Criminal Acts "Personal and advertising injury" arising out of a criminal act committed by or at the direction of the insured. e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. f. Breach Of Contract "Personal and advertising injury" arising out of a breach of contract, except an implied contract to use another's advertising idea in your "advertisement". g. Quality Or Performance Of Goods — Failure To Conform To Statements "Personal and advertising injury" arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement". h. Wrong Description Of Prices "Personal and advertising injury" arising out of the wrong description of the price of goods, products or services stated in your "advertisement". - Risk Mmug..doi"[e %Memeo 6 APPRME) Sr. sJ �. '® A+,yu"44 Risk Management Specialist Page 6 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 1. Infringement Of Copyright, Patent, Trademark Or Trade Secret "Personal and advertising injury" arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights. Under this exclusion, such other intellectual property rights do not include the use of another's advertising idea in your "advertisement". However, this exclusion does not apply to infringement, in your "advertisement", of copyright, trade dress or slogan. j. Insureds In Media And Internet Type Businesses "Personal and advertising injury" committed by an insured whose business is: (1) Advertising, broadcasting, publishing or telecasting; (2) Designing or determining content of web sites for others; or (3) An Internet search, access, content or service provider. However, this exclusion does not apply to Paragraphs 14.a., b, and c. of "personal and advertising injury" under the Definitions section. For the purposes of this exclusion, the placing of frames, borders or links, or advertising, for you or others anywhere on the Internet, is not by itself, considered the business of advertising, broadcasting, publishing or telecasting. k. Electronic Chatrooms Or Bulletin Boards "Personal and advertising injury" arising out of an electronic chatroom or bulletin board the insured hosts, owns, or over which the insured exercises control. I. Unauthorized Use Of Another's Name Or Product "Personal and advertising injury" arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another's potential customers. m. Pollution "Personal and advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. n. Pollution -related Any loss, cost or expense arising out of any (1) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". o. War "Personal and advertising injury", however caused, arising, directly or indirectly, out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. p. Recording And Distribution Of Material Or Information In Violation Of Law "Personal and advertising injury" arising directly or indirectly out of any action or omission that violates or is alleged to violate: (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law; (2) The CAN-SPAM Act of 2003, including any amendment of or addition to such law; (3) The Fair Credit Reporting Act (FCRA), and any amendment of or addition to such law, including the Fair and Accurate Credit Transactions Act (FACTA); or (4) Any federal, state or local statute, ordinance or regulation, other than the TCPA, CAN-SPAM Act of 2003 or FCRA and their amendments and additions, that addresses, prohibits, or limits the printing, dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of material or information. CG 00 01 04 13 © Insurance Services Office, Inc., 2012 h9, ,; I$' xl WwaganaltI w A AR¢k Management Sp Page 7 of 16 COVERAGE C — MEDICAL PAYMENTS 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; or (3) Because of your operations; provided that: (a) The accident takes place in the "coverage territory" and during the policy period; (b) The expenses are incurred and reported to us within one year of the date of the accident; and (c) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. b. We will make these payments regardless of fault. These payments will not exceed the applicable limit of insurance. We will pay reasonable expenses for: (1) First aid administered at the time of an accident; (2) Necessary medical, surgical, X-ray and dental services, including prosthetic devices; and (3) Necessary ambulance, hospital, professional nursing and funeral services. 2. Exclusions We will not pay expenses for "bodily injury": a. Any Insured To any insured, except "volunteer workers". b. Hired Person To a person hired to do work for or on behalf of any insured or a tenant of any insured. c. Injury On Normally Occupied Premises To a person injured on that part of premises you own or rent that the person normally occupies. d. Workers' Compensation And Similar Laws To a person, whether or not an "employee" of any insured, if benefits for the "bodily injury" are payable or must be provided under a workers' compensation or disability benefits law or a similar law. e. Athletics Activities To a person injured while practicing, instructing or participating in any physical exercises or games, sports, or athletic contests. f. Products -Completed Operations Hazard Included within the "products -completed operations hazard". g. Coverage A Exclusions Excluded under Coverage A. SUPPLEMENTARY PAYMENTS — COVERAGES A AND B 1. We will pay, with respect to any claim we investigate or settle, or any "suit" against an insured we defend: a. All expenses we incur. b. Up to $250 for cost of bail bonds required 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 furnish these bonds. c. The cost of bonds to release attachments, but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. 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 $250 a day because of time off from work. e. All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. f. Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. Rick Mmagenseit DMs[an �\ f�ne�nMrRov®Br. ® Risk Management Speciahst Page 8 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 Page 8 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 g. All interest on the full amount of any judgment that accrues after entry of the judgment and before we have paid, offered to pay, or deposited in court the part of the judgment that is within the applicable limit of insurance. These payments will not reduce the limits of insurance. 2. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit", we will defend that indemnitee if all of the following conditions are met: a. The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract"; b. This insurance applies to such liability assumed by the insured; c. The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured in the same "insured contract" d. The allegations in the "suit" and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" and agree that we can assign the same counsel to defend the insured and the indemnitee; and f. The indemnitee: (1) Agrees in writing to: (a) Cooperate with us in the investigation, settlement or defense of the "suit" (b) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "suit"; (c) Notify any other insurer whose coverage is available to the indemnitee; and (d) Cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit"; and (b) Conduct and control the defense of the indemnitee in such "suit". So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I — Coverage A — Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II —WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of your business. c. A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. wok M�en� oa�� REvtE &APPROVED Sr. ,.',. Imo. - ® RBk Management Spedalirt CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 9 of 16 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) 'Property damage" to property: (a) Owned, occupied or used by; (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; 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 offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III — LIMITS OF INSURANCE 1. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the 'products -completed operations hazard" and c. Damages under Coverage B. Ride M�ag..dDwimt 11Ev Ewen 6 APPRov®aV: �'. 4#4 "44 ® Risk Management SpetlXist Page 10 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 3. The Products -Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "products -completed operations hazard". 4. Subject to Paragraph 2. above, the Personal And Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Subject to Paragraph 5. above, the Damage To Premises 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 in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7. Subject to Paragraph S. 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. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this Coverage Part. 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) 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 any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit" (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit" and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 3. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. Risle Msnsgemnt Division REVIEW &APPROV®9Y: 1 1tJ' AAA," ® Risk Management Specialist CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 11 of 16 CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 11 of 16 4. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: 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 all that other insurance by the method described in Paragraph c. below. b. Excess Insurance (1) This insurance is excess over: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis: (1) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (ii) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (iii) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; or (iv) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section I — Coverage A — Bodily Injury And Property Damage Liability. (b) Any other primary insurance available to you covering liability for damages arising out of the premises or operations, or the products and completed operations, for which you have been added as an additional insured. (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 Part. c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in accurate and complete xtekMougematto[wran REYIE &APPROVED BY. 1 Aft Acw4d. ® Risk Management Sped Hirt Page 12 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web sites, only that part of a web site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. 2. "Auto" means: a. A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. 4. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rico and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in Paragraph a. above; or c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in Paragraph a. above; (2) The activities of a person whose home is in the territory described in Paragraph a. above, but is away for a short time on your business; or (3) "Personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication; provided the insured's responsibility to pay damages is determined in a "suit" on the merits, in the territory described in Paragraph a. above or in a settlement we agree to. 5. "Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 6. "Executive officer" means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document. 7. "Hostile fire" means one which becomes uncontrollable or breaks out from where it was intended to be. 8. "Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a. It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or b. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by the repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling the terms of the contract or ai Rkk MMMS0 erdDh s4m R2AE &Av Rovafl By: '1MMTV _ L' A-. u A"V44 ® Risk Management Spedalirt CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 13 of 16 9. "Insured contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. 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 party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) 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, road -beds, tunnel, underpass or crossing; (2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities. 10."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". 11."Loading or unloading" means the handling of property: a. After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b. While it is in or on an aircraft, watercraft or "auto": or c. While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 12."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1) Power cranes, shovels, loaders, diggers or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers; f. Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. RiskMnnagemmt Dh Wan A-,gu Auvrdo ® Risk Management Spedalist.' Page 14 of 16 © Insurance Services Office, Inc., 2012 CG 00 01 0413 However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": (1) Equipment designed primarily for (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered "autos". 13."Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. 14."Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: a. False arrest, detention or imprisonment; b. Malicious prosecution; c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, committed by or on behalf of its owner, landlord or lessor; d. Oral or written publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; 16. "Products -completed operations hazard": a. Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1) Products that are still in your physical possession; or (2) Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a) When all of the work called for in your contract has been completed. (b) When all of the work to be done at the job site has been completed if your contract calls for work at more than one job site. (c) When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b. Does not include "bodily injury" or "property damage" arising out of: (1) The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2) The existence of tools, uninstalled equipment or abandoned or unused materials; or (3) Products or operations for which the classification, listed in the Declarations or in a policy Schedule, states that products - completed operations are subject to the General Aggregate Limit. e. Oral or written publication, in any manner, of 17."Property damage" means: material that violates a person's right of privacy; f. The use of another's advertising idea in your "advertisement"; or g. Infringing upon another's copyright, trade dress or slogan in your "advertisement". 15."Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this is not tangible property. RIekMowgnmtD[sielml Rtvlexm&APPRO mBr Risk Management speaalist 01 CG 00 01 04 13 © Insurance Services Office, Inc., 2012 Page 15 of 16 As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD- ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 18."Suit' means a civil proceeding in which damages because of 'bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies are alleged. "Suit' includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 19.7emporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short- term workload conditions. 20."Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. 21. "Your product': a. Means: (1) Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a) You; (b) Others trading under your name; or (c) A person or organization whose business or assets you have acquired; and (2) Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and (2) The providing of or failure to provide warnings or instructions. c. Does not include vending machines or other property rented to or located for the use of others but not sold. 22. "Your work": a. Means: (1) Work or operations performed by you or on your behalf; and (2) Materials, parts or equipment furnished in connection with such work or operations. b. Includes: (1) Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work": and (2) The providing of or failure to provide warnings or instructions. Riak Mm%pnent T)Msian REVIEWED&APPRO BY: A*k:, A"Vad Risk Management Speaallst Page 16 of 16 © Insurance Services Office, Inc., 2012 CG 00 010413 POLICY NUMBER: PHPK2457612-001 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Risk Management Division 20 Civic Center Piz Santa Ana CA 927014058 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 'property damage" or 'personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. RIA M.sgema DKul. RtviE &APPROVED BY: A+.g Acw.4 �. ® Risk Management SpeciMist CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 21 67 12 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2. B. The following exclusion is added to Paragraph 2. Exclusions of Section I — Coverage A — Bodily Exclusions of Section I — Coverage B — Per - Injury And Property Damage Liability: sonal And Advertising Injury Liability: 2. Exclusions 2. Exclusions This insurance does not apply to: This insurance does not apply to: Fungi Or Bacteria Fungi Or Bacteria a. 'Bodily injury" or "property damage" which would not have occurred, in whole or in part, but for the actual, alleged or threatened in- halation of, ingestion of, contact with, expo- sure to, existence of, or presence of, any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. b. Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. This exclusion does not apply to any 'fungi" or bacteria that are, are on, or are contained in, a good or product intended for bodily consump- tion. a. 'Personal and advertising injury" which would not have taken place, in whole or in part, but for the actual, alleged or threat- ened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed con- currently or in any sequence to such injury. b. Any loss, cost or expense arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. C. The following definition is added to the Definitions Section: "Fungi" means any type or form of fungus, includ- ing mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. *I`y gill 'd '. Risk MuagemmttDWwn REVIEIV &APPRO SY: A A ® Risk Management Spedallrt 01 CG 21 67 12 04 © ISO Properties, Inc., 2003 Page 1 of 1 13 COMMERCIAL GENERAL LIABILITY CG21700115 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY A. If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insurance Act exceed $100 billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a "certified act of terrorism" include the following: 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and 2. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. B. The terms and limitations of any terrorism exclusion, or the inapplicability or omission of a terrorism exclusion, do not serve to create coverage for injury or damage that is otherwise excluded under this Coverage Part. Risk Mnnagemmtonss ' • REVIEWED& APPRMED Ift ® Ruk Management SpeaAist CG 21 70 01 15 © Insurance Services Office, Inc., 2015 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 32 34 01 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY The term "spouse" is replaced by the following: Spouse or registered domestic partner under Califor- nia law. � ' Risk Management Diviaian REVIEWED & APPROVED BY: A+j�, Aew44 Risk P.1anayement Spedalie[ CG 32 34 01 05 © ISO Properties, Inc., 2004 Page 1 of 1 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declara- tions may cancel this policy by mailing or deliv- ering to us advance written notice of cancella- tion. 2. We may cancel this policy by mailing or deliver- ing to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancel- lation if we cancel for nonpayment of premi- um; or b. 30 days before the effective date of cancel- lation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is cancelled, we will send the first Named Insured any premium refund due. If we cancel, the refund will be pro rate. If the first Named Insured cancels, the refund may be less than pro rate. The cancellation will be ef- fective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us and made a part of this policy. C. Examination Of Your Books And Records We may examine and audit your books and rec- ords as they relate to this policy at any time during the policy period and up to three years afterward. D. Inspections And Surveys 1. We have the right to: a. Make inspections and surveys at any time; IL 00 17 11 98 b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to in- surability and the premiums to be charged. We do not make safety inspections. We do not un- dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes in- surance inspections, surveys, reports or rec- ommendations. 4. Paragraph 2, of this condition does not apply to any inspections, surveys, reports or recom- mendations we may make relative to certifica- tion, under state or municipal statutes, ordi- nances or regulations, of boilers, pressure ves- sels or elevators. E. Premiums The first Named Insured shown in the Declara- tions: 1. Is responsible for the payment of all premiums; and 2. Will be the payee for any return premiums we pay. F. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representa- tive. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. Risk Mmu$ematt Diviefan REmEWm6APPROVEDBY: ®' Ruk Management Sped Aist IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 p IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 p IL 02 70 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT -RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation if we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. (3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. .. Risk MmagmimtDi 9'= R6 exw 6 APPRO Hr A-p "a. Risk Management SpectAut IL 02 70 09 12 © Insurance Services Office, Inc., 2012 Page 1 of 4 IL 02 70 09 12 © Insurance Services Office, Inc., 2012 Page 1 of 4 (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: (i) Place us in violation of California law or the laws of the state where we are domiciled; or (ii) Threaten our solvency. (7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2) 30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B. The following provision is added to the Cancellation Common Policy Condition: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b. We may not cancel this policy solely because the first Named Insured has: (1) Accepted an offer of earthquake coverage; or (2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part — Causes Of Loss — Special Form; or (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes Of Loss — Special. Risk MonagmentDmslan RsAemeo 6 APPRO ft 1. ® Rnk Management Spetlalist Page 2 of 4 © Insurance Services Office, Inc., 2012 IL 02 70 09 12 C. The following is added and supersedes any provisions to the contrary: Nonrenewal 1. Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below. b. We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1) The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2) The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or (3) We have: (a) Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b) Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. c. We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. d. We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (d.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part — Causes Of Loss — Special Form; or (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes Of Loss — Special. 3. We are not required to send notice of nonrenewal in the following situations: a. If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. Risk MnwgemettDivis un RwEwED 6 APPRO BY. ® Risk Management Specialist IL 02 70 09 12 © Insurance Services Office, Inc., 2012 Page 3 of 4 b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph CA. c. If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f. If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph CA., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. Risk Mitragemait DMion REVIEWm 6 APP FD BY: A+14 A111044 _. Risk Management Specialist 01 Page 4 of 4 © Insurance Services Office, Inc., 2012 IL 02 70 09 12 PI-ACL-001 (01/20) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABSOLUTE CYBER LIABILITY AND ELECTRONIC EXCLUSION The following exclusion applies to all coverages afforded underthis policy: This insurance does not apply to any loss, cost, expense, fine, penalty, error and omission, or damage alleging, arising out of or from, attributable to, or giving rise to: (1) Any access to, collection or disclosure of, or failure to erase any person's or organization's confidential or personal information, including but not limited to patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information, biometrics, or any other type of nonpublic information; or (2) Business interruption or suspension of operations as caused by any access, unauthorized access, lack of access, delay in access, damage, manipulation, loss, or impairment to Electronic Data or Electronic Media; or (3) Cyber Extortion; or (4) A Privacy Breach; or (5) A Security Breach; or (6) Any fraudulent communication through Electronic Media that impersonates any person or organization, including but not limited to phishing or other social engineering techniques or otherwise; or (7) Any computer code, software, or programming, or (8) Any Security Breach that results in any electronic thing or device or Electronic Media malfunctioning, improperly functioning, non-functioning, failing to perform as the intended user desired, or being electronically manipulated to perform in a way that causes harm to the insured or others; or (9) The loss, loss of use, misuse, delay, manipulation, corruption, damage, alteration, destruction, distortion, erasure, ortheft of, or inability to access or manipulate Electronic Data or Electronic Media as a result of Cyber Extortion; or Privacy Breach; or Security Breach (10) Any fai I ure of uti I it ies based upon, adsingout of, o r attri butable to any mechanical or electrical failure, interruption, oroutage, however caused, including but not limited to any electrical power interruption or surge, brownout, blackout, short circuit, over voltage, or power fluctuation or outage to gas, water, telephone, cable, satellite, telecommunications, the internet, orany component thereof, including but not limited to hardware, software, or any other infrastructure as a result of Cyber Extortion; or Privacy Breach; or Security Breach. (11) This exclusion applies even if damages are claimed for notification costs, errors or omissions, credit monitoring expenses, forensic expenses, public relations expenses, or any other loss, cost, or expense incurred by the insured or others arising out of that which is described in Paragraphs (1) through (10) above. Page 1 of 4 @2020 Philadelphia Consolidated Holding Corp. PI-ACL-001 (01/20) Rlele MvDsagem�t Drvisiort RBAPim&ArrRovm By, (,sn l: )' A+ju Aga. ® Risk Management Specialist PI-ACL-001 (01/20) As used in this exclusion, the following definitions apply: Computer hardware means the physical components of any computer system including CPU's, memory storage devices, storage media, and input/output devices and other peripheral devices and components including but not limited to cable, connectors, fiber optics, networking equipment, electronic data storage devices, input and output devices, backup facilities, wire, power supply units, keyboards, display monitors and audio speakers. Computer system means an electronic, wireless, web or similar systems (including all computer hardware, computer programs and electronic data) used to process data or information in an analog, digital, electronic or wireless format, including but not limited to, associated input and output devices, data storage devices, networking equipment, wired or wireless peripherals, electronic backup facilities, and media libraries, that is owned or leased, operated and controlled by the insured or operated by an independent contractor authorized to provide Business Process Outsourcing services or outsourced Information Technology services for the insured. Corporate Information Breach means the public disclosure of an organization's non-public information. Cyber Extortion means any threat or connected series of threats communicated to the insured for the purpose of demanding money, securities, or property, including but not limited to threats to release, divulge, disseminate, corrupt, damage or destroy Electronic Data or Electronic Media; introduce malware or malicious code into the insured's computer system; electronically communicate with the insured's customers in order to fraudulently obtain personal information, money, securities or property; or restrict or hinder access to the insured's computer system, Electronic Data or Electronic Media, including but not limited to ransomware. Denial of service means unauthorized or unexpected interference or malicious attack by any person(s) or entity(ies) that restricts or prevents access to a computer system by persons or entities authorized to gain access to the computer system or electronic data. Electronic Data means information, facts, blockchain, crypto currencies, or computer programs stored as or on, created or used on, or transmitted to or from computer software, including but not limited to systems and applications software, hard or floppy disks, CD-ROMs, DVDs, external drives, USB sticks, tapes, drives, cells, microchip, data processing devices, or any other media which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of Electronic Data, means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve, or send data. Electronic Media means broadcast or storage media that take advantage of electronic technology. They include television, radio, Internet, fax, Bluetooth, GPS, audio beacons, electronic data, and any other medium that requires electricity or digital encoding of information. . Malicious code means unauthorized and corrupting or harmful computer code, including but not limited to computer viruses, spyware, Trojan horses, worms, logic bombs, and mutations of any of the preceding. Page 2 of 4 @2020 Philadelphia Consolidated Holding Corp. PI-ACL-001 (01/20) •'i. :.'-, Pink Mwwg..ADMsims Rtvierrm S APPRO BV: cl�� ® A+p Aavd- Risk Management Spetlalist PI-ACL-001 (01/20) Privacy Breach means a common law or statutory breach of confidence or violation of any common law or statutory rights to privacy, including but not limited to breach of a privacy policy, breach of a person's right of publicity, misappropriation of likeness, false light, intrusion upon a person's seclusion, or public disclosure of a person's or animal's private information. Privacy Breach will also include a Corporate Information Breach. Security breach means: 1. Unauthorized access of the insured's computer system or unauthorized use of computer systems including unauthorized access or unauthorized use resulting from the theft of a password from the insured's computer system, 2. A denial of service attack against your computer systems; or 3. Infection of the insured's computer system by malicious code or transmission of malicious code from the insured's computer systems, whether any of the foregoing is a specifically targeted attack or a generally distributed attack. Unauthorized access means the gaining of access to a computer system by an unauthorized person or persons. Unauthorized use means the use of a computer system by an unauthorized person or persons or an authorized person in an unauthorized manner. This Endorsement is an absolute exclusion for cyber liability, Electronic Data, Electronic Media and Security Breaches. This Endorsement applies except if coverage is specifically and affirmatively provided in the following coverage forms or endorsements issued by us and only in respect to the coverage afforded in those coverage forms or endorsements. In no event will this Endorsement broaden any coverage afforded in any coverage form or endorsement: • Cyber Security Liability Coverage Form • Cyber Security Liability Endorsement • Building and Personal Property Coverage Form • Fraudulent Inducement Insuring Agreement • Fraudulent Inducement Insuring Agreement - Broad Form • Fraudulent Impersonation • Fraudulent Impersonation Ultimate Cover • Business Income and Extra Expense Coverage Form • Computer Coverage Form • Exclusion -Access or Disclosure of Confidential or Personal Information and Data -Related Liability -With Limited Bodily Injury Exception • Changes -Electronic Data Page 3 of 4 @2020 Philadelphia Consolidated Holding Corp. PI-ACL-001 (01/20) Risk Management Division REVIEXED & APPROVED BY: ®•. ® Ruk Management Specialist PI-ACL-001 (01/20) All other terms and conditions remain unchanged. Page 4 of 4 RiskMenagemattD- i' @2020 Philadelphia Consolidated Holding Corp. �� Rw&ACPRt BY: A.y�9 Acw44 MMMM MR Rbk Management Speealist PI-ACL-001 (01/20) Philadelphia Indemnity Insurance Company PI-GL-001 (09/17) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - LEAD LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to paragraph 2., Exclusions of COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section 1 - Coverages) and paragraph 2., Exclusions of COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY (Section 1 - Coverages): This insurance does not apply to: 1. "Bodily injury," "property damage," or "personal and advertising injury" arising out of or caused by the actual or alleged: a. Exposure to or existence of lead, paint containing lead, or any other material or substance containing lead; b. Manufacture, distribution, sale, resale, rebranding, installation, repair, removal, encapsulation, abatement, replacement or handling of lead, paint containing lead, or any other material or substance containing lead; Whether or not the lead is or was at any time airborne as a particulate, contained in a product ingested, inhaled, transmitted in any fashion, or found in any form whatsoever. 2. Any legal obligation of any insured for indemnification or contribution due to damages arising out of "bodily injury," "property damage" or "personal and advertising injury' caused by lead, paint containing lead, or any other substance or material containing lead. 3. Any loss, cost, expense or damages, whether direct or consequential, arising out of any: (a) Request, demand or order that any insured or others test for, monitor, clean up, remove, abate, contain, treat or neutralize lead, paint containing lead, or any other substance or material containing lead, or in any way respond to, or assess the effects of lead; or (b) Claim or suit related to, testing for, monitoring, cleaning up, removing, abating, containing, treating PI-GL-001 (09/17) Page 1 of 2 ©2017 Philadelphia Consolidated Holding Corp. Includes copyrighted material of Insurance Services Office, Inc., with permission. Risk R E t By. a 1- A+.g A,w44 __21�wp Rtsk Management Speaaist Philadelphia Indemnity Insurance Company or neutralizing lead, paint containing lead, or any other substance or material containing lead or in any way responding to or assessing the effects of lead. PI-GL-001 (09/17) Page 2 of 2 ©2017 Philadelphia Consolidated Holding Corp. Includes copyrighted material of Insurance Services Office, Inc., with permission. Risk Mnw9eM0dDNbbn RE WM6APPROV®6Y. �. A--juA,w44 ---�� Risk Managemen[SpetlXist PI-GL-002 CA (02/08) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION -ASBESTOS LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., Exclusions of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (SECTION I — COVERAGES) and Paragraph 2., Exclusions of COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY (SECTION I — COVERAGES): This insurance does not apply to: "Bodily injury," "property damage,' and "personal and advertising injury" arising out of: 1. Inhaling, ingesting or prolonged physical exposure to asbestos or goods or products containing asbestos; 2. The use of asbestos in constructing or manufacturing any good, product or structure; 3. The removal of asbestos from any good, product or structure; or 4. The manufacture, sale, transportation, storage or disposal of asbestos or goods or products containing asbestos. The coverage afforded by this policy does not apply to payment for the investigation or defense of any loss or "suit," injury or damage or any cost, fine or penalty or for any expense or claim or "suit' related to any of the above. Page 1 of 1 Includes copyright material of the Insurance Services Office, Inc. used with it Risk Mnnagonznt D Msian REVIEWS &APPR m8y: ® Ruk Managemen[Spedalist PI-BELL-1 (11/09) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BELL ENDORSEMENT ALSO& in -r Unless otherwise stated herein, the terms, conditions, exclusions and other limitations set forth in this endorsement are solely applicable to coverage afforded by this endorsement, and the policy is amended as follows: I. SCHEDULE OF ADDITIONAL COVERAGES AND LIMITS The following is a summary of Limits of Liability or Limits of Insurance and/or additional coverages provided by this endorsement. This endorsement is subject to the provisions of the policy to which it is attached. COVERAGE LIMITS OF INSURANCE Business Travel Accident Benefit $50,000 Conference Cancellation $25,000 Donation Assurance $50,000 Emergency Real Estate Consulting Fee $50,000 Fundraising Event Blackout $25,000 Identity Theft Expense $50,000 Image Restoration and Counseling $50,000 Key Individual Replacement Expenses $50,000 Kidnap Expense $50,000 Political Unrest $5,000 per employee: $25,000 policy limit Temporary Meeting Space Reimbursement $25,000 Terrorism Travel Reimbursement $50.000 Travel Delay Reimbursement $1,500 Workplace Violence Counseling $50,000 Page 1 of 8 © 2009 Philadelphia Indemnity Insurance Company Risk Metsganatt Dhvian RenerrEo & APPRovm By: A..y�AA,:w4ta ® Risk Management Spedalist PI-BELL-1 (11/09) II. CONDITIONS A. Applicability of Coverage Coverage provided by your policy and any endorsements attached thereto is amended by this endorsement where applicable. B. Limits of Liability or Limits of Insurance When coverage is provided by this endorsement and another coverage form or endorsement attached to this policy, the greater limits of liability or limits of insurance will apply. In no instance will multiple limits apply to coverages which may be duplicated within this policy. Additionally, if this policy and any other coverage part or policy issued to you by us, or any company affiliated with us, apply to the same occurrence, offense, wrongful act, accident or loss, the maximum limits of liability or limits of insurance under all such coverage parts or policies combined shall not exceed the highest applicable limits of liability or limits of insurance under any one coverage part or policy. 2. Limits of liability or limits of insurance identified in Section I. SCHEDULE OF ADDITIONAL COVERAGES AND LIMITS above are not excess of, but are in addition to the applicable Limits of Liability or Limits of Insurance stated in the Declarations. C. Claim Expenses Coverages provided herein are not applicable to the generation of claim adjustment costs by you; such as fees you may incur by retaining a public adjuster or appraiser. III. ADDITIONAL COVERAGES A. Business Travel Accident Benefit We will pay a Business Travel Accident Benefit to the insured if a director or officer suffers injury or death while traveling on a common carrier for your business during the policy period. For the purpose of Business Travel Accident Benefit coverage, injury means: 1. Physical damage to the body caused by violence, fracture, or an accident that results in loss of life not later than one hundred eighty (180) days after the policy expiration, the date of cancellation or the date of non -renewal; 2. Accidental loss of limbs or multiple fingers; 3. Total loss of sight, speech or hearing. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. The Business Travel Accident Benefit shall not be payable if the cause of the injury was: 1. An intentional act by the insured; 2. An act of suicide or attempted suicide; 3. An act of war: or 4. A disease process. Page 2 of 8 © 2009 Philadelphia Indemnity Insurance Company RideMWAgeW=tDMelon APPRovm BY: Risk Management Spea Ant PI-BELL-1 (11/09) B. Conference Cancellation We will reimburse the insured for any business -related conference expenses, paid by the insured and not otherwise reimbursed, for a canceled conference that an employee was scheduled to attend. The cancellation must be due directly to a "natural catastrophe" or a "communicable disease" outbreak that forces the cancellation of the conference. With respect to a conference cancellation claim, it is further agreed as follows 1. The insured employee must have registered for the conference at least thirty (30) days prior to the cancellation; and 2. The cancellation must be ordered by a local, state or federal Board of Health or other governmental authority having jurisdiction over the location of the conference. The limit of insurance for this coverage is $25,000 per policy period for all insureds combined. No deductible applies to this coverage. C. Donation Assurance If the insured is a 501(c)(3) status non-profit organization as defined in the United States Internal Revenue Code, we will reimburse the insured for "failed donation claim(s)." With respect to any "failed donation claim," it is further agreed as follows: 1. The donor must not have been in bankruptcy, nor have filed for bankruptcy or reorganization in the past seven (7) years prior to the time said pledge was made to the insured; 2. For non -cash donations, our payment of a "failed donation claim" shall be based on the fair market value of said non -cash donation at the time of the "failed donation claim"; 3. In the case of unemployment or incapacitation of a natural person donor and as a condition of payment of the "failed donation claim": a. Neither the natural person donor nor the insured shall have had reason to believe the donor would become unemployed or incapacitated subsequent to the donation date; and b. The donor shall be unemployed for at least sixty (60) days prior to a claim being submitted by the insured; 4. No coverage shall be afforded for a written pledge of funds or other measurable, tangible property to the insured dated prior to the policy period; and 5. A donation amount which is to be collected by the insured over more than a twelve (12) month period shall be deemed a single donation. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. D. Emergency Real Estate Consulting Fee We will reimburse the insured any realtor's fee or real estate consultant's fr the insured's need to relocate due to the "unforeseeable destruction' of the location" listed in the Declarations during the policy period. The limit of ins Page 3 of 8 © 2009 Philadelphia Indemnity Insurance Company ..sm wekMongmwttDMdDn REvie&ED6 ArpR Sr A-fe Acw44 ® Risk Managemen[Spetlalist -a PI-BELL-1 (11/09) coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. E. Fundraising Event Blackout We will reimburse the insured for "fundraising expenses" that are incurred due to the cancellation of a fundraising event caused by the lack of electric supply resulting in a power outage, provided the fundraising event is not re -scheduled. The fundraising event must have been planned at least thirty (30) days prior to the power outage. The limit of insurance for this coverage is $25,000 per policy period for all insureds combined. No deductible applies to this coverage. F. Identity Theft Expense We will reimburse any present director or officer of the named insured for "identity theft expenses" incurred as the direct result of any "identity theft" first discovered and reported during the policy period; provided that it began to occur subsequent to the effective date of the insured's first policy with us. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. G. Image Restoration and Counseling We will reimburse the insured for expenses incurred for image restoration and counseling arising out of "improper acts" by any natural person. Covered expenses are limited to: 1. The costs of rehabilitation and counseling for the accused natural person insured, provided the natural person insured is not ultimately found guilty of criminal conduct; this reimbursement to occur after acquittal of the natural person insured; 2. The costs charged by a recruiter or expended on advertising, for replacing an officer as a result of "improper acts"; and 3. The costs of restoring the named insured's reputation and consumer confidence through image consulting. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. H. Key Individual Replacement Expenses We will pay "key individual replacement expenses" if the Chief Executive Officer or Executive Director suffers an "injury" during the policy period which results in the loss of life during the policy period. The limit of insurance for this coverage is the lesser of $50,000 or ten (10) times the annual premium paid for this policy. No deductible applies to this coverage. I. Kidnap Expense We will pay on behalf of any director or officer of the insured, reasonable fees incurred as a result of the kidnapping of them or their spouse, "domestic partner," parent or child during the policy period. Coverage will not apply to any kidnapping by or at the direction of any present or former family member of the victim. Reasonable fees will include: Page 4 of 8 © 2009 Philadelphia Indemnity Insurance Company Risk MvuganattDmainn `%.w, � f�+nevmiArrRov®Br. MIMIMM, Rnk Management Speaalist PI-BELL-1 (11/09) 1. Fees and costs of independent negotiators; 2. Interest costs for any loan from a financial institution taken by you to pay a ransom demand or extortion threat; 3. Travel costs and accommodations incurred by the named insured; 4. Reward money paid to an informant which leads to the arrest and conviction of parties responsible for loss covered under this insurance; and 5. Salary, commissions and other financial benefits paid by you to a director or officer. Such compensation applies at the level in effect on the date of the kidnap and ends upon the earliest of: a. Up to thirty (30) days after their release, if the director or officer has not yet returned to work; b. Discovery of their death; c. One hundred twenty (120) days after the last credible evidence following abduction that they are still alive; or d. Twelve (12) months after the date of the kidnapping. The limit of insurance for this coverage is $50,000 each policy period for all insureds combined. No deductible applies to this coverage. J. Political Unrest Coverage We will reimburse any present director, officer, employee or volunteer of the named insured while traveling outside the United States of America for "emergency evacuation expenses" that are incurred as a result of an incident of "political unrest." This "political unrest" must occur during the policy period. No coverage is granted for travel to countries in a state of "political unrest" at the time of departure of the travel. The limit of insurance for this coverage is $5,000 per covered person, subject to a maximum of $25,000 per policy period for all insureds combined. No deductible applies to this coverage. K. Temporary Meeting Space Reimbursement We will reimburse the insured for rental of meeting space which is necessitated by the temporary unavailability of the insured's primary office space due to the failure of a climate control system, or leakage of a hot water heater during the policy period. Coverage will exist only for the renting of temporary meeting space required for meeting with parties who are not insured under this policy. The limit of insurance for this coverage is $25,000 per policy period for all insureds combined. No deductible applies to this coverage. L. Terrorism Travel Reimbursement We will reimburse any present director or officer of the named insured in the event of a "certified act of terrorism" during the policy period which necessitates that he/she incurs "emergency travel expenses." The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. Page 5 of 8 © 2009 Philadelphia Indemnity Insurance Company w,3kM��„�eot�n ' . Ren &AvaRwm Or A,"p Acwuto ® Rak Management SpeaAnt PI-BELL-1 (11/09) M. Travel Delay Reimbursement We will reimburse any present director or officer of the named insured for any "non - reimbursable expenses" they incur as a result of the cancellation of any regularly scheduled business travel on a common carrier. The limit of insurance for this coverage is $1,500 per policy period for all insureds combined. A seventy-two (72) hour waiting period deductible applies to this coverage. N. Workplace Violence Counseling We will reimburse the insured for emotional counseling expenses incurred directly as a result of a "workplace violence" incident at any of the insured's premises during the policy period. The emotional counseling expenses incurred must have been for: 1. Your employees who were victims of, or witnesses to the "workplace violence"; 2. The spouse, "domestic partner," parents or children of your employees who were victims of, or witnesses to the "workplace violence"; and 3. Any other person or persons who directly witnessed the "workplace violence" incident. The limit of insurance for this coverage is $50,000 per policy period for all insureds combined. No deductible applies to this coverage. IV. DEFINITIONS For the purpose of this endorsement, the following definitions apply: A. "Certified act of terrorism" means any act so defined under the Terrorism Risk Insurance Act, and its amendments or extensions. B. "Communicable disease" means an illness, sickness, condition or an interruption or disorder of body functions, systems or organs that is transmissible by an infection or a contagion directly or indirectly through human contact, or contact with human fluids, waste, or similar agent, such as, but not limited to Meningitis, Measles or Legionnaire's Disease. C. "Domestic partner' means any person who qualifies as a domestic partner under the provisions of any federal, state or local statute or regulation, or under the terms and provisions of any employee benefit or other program established by the named insured. D. "Emergency evacuation expenses" mean: 1. Additional lodging expenses; 2. Additional transportation costs; 3. The cost of obtaining replacements of lost or stolen travel documents necessary for evacuation from the area of "political unrest"; and 4. Translation services, message transmittals and other communication expenses. provided that these expenses are not otherwise reimbursable. E. "Emergency travel expenses" mean: Page 6 of 8 © 2009 Philadelphia Indemnity Insurance Company Rbk Man,gemnanivivwn Ib_,VEWm&APPR m8Y: 2EE3=. ® R6k Management Spedalist PI-BELL-1 (11/09) 1. Hotel expenses incurred which directly result from the cancellation of a scheduled transport by a commercial transportation carrier, resulting directly from and within forty-eight (48) hours of a "certified act of terrorism "; and 2. The increased amount incurred which may result from re -scheduling comparable transport, to replace a similarly scheduled transport canceled by a commercial transportation carrier in direct response to a "certified act of terrorism"; provided that these expenses are not otherwise reimbursable. F. "Failed donation claim" means written notice to the insured during the policy period of: 1. The bankruptcy or reorganization of any donor whereby such bankruptcy or reorganization prevents the donor from honoring a prior written pledge of funds or other measurable, tangible property to the insured; or 2. The unemployment or incapacitation of a natural person donor preventing him/her from honoring a prior written pledge of funds or other measurable, tangible property to the insured. G. "Fundraising expenses" mean deposits forfeited and other charges paid by you for catering services, property and equipment rentals and related transport, venue rentals, accommodations (including travel), and entertainment expenses less any deposits or other fees refunded or refundable to you. H. "Identity theft" means the act of knowingly transferring or using, without lawful authority, a means of identification of any director or officer (or spouse or "domestic partner" thereof) of the named insured with the intent to commit, or to aid or abet another to commit, any unlawful activity that constitutes a violation of federal law or a felony under any applicable state or local law. I. "Identity theft expenses" mean: 1. Costs for notarizing affidavits or similar documents attesting to fraud required by financial institutions or similar credit grantors or credit agencies; 2. Costs for certified mail to law enforcement agencies, credit agencies, financial institutions or similar credit grantors; and 3. Loan application fees for re -applying for a loan or loans when the original application is rejected solely because the lender received incorrect credit information. J. "Improper acts" means any actual or alleged act of: 1. Sexual abuse; 2. Sexual intimacy; 3. Sexual molestation; or 4. Sexual assault; committed by an insured against any natural person who is not an insured. Such "improper acts" must have been committed by the insured while in his or her capacity - - '-- Ri kMv"mtvdD Wm K. "Injury" whenever used in this endorsement, other than in Section III. A. Br RpAeAtg] 6 APPROVED Br A*ju Aa+aa Page 7 of 8 �Mqwp Risk Management Spenkist © 2009 Philadelphia Indemnity Insurance Company or I PI-BELL-1 (11/09) means any physical damage to the body caused by violence, fracture or an accident. L. "Key individual replacement expenses" mean the following necessary expenses: 1. Costs of advertising the employment position opening; 2. Travel, lodging, meal and entertainment expenses incurred in interviewing job applicants for the employment position opening; and 3. Miscellaneous extra expenses incurred in finding, interviewing and negotiating with the job applicants, including, but not limited to, overtime pay, costs to verify the background and references of the applicants and legal expenses incurred to draw up an employment contract. M. "Natural catastrophe" means hurricane, tornado, earthquake or flood. N. "Non -reimbursable expenses" means the following travel -related expenses incurred after a seventy-two (72) hour waiting period, beginning from the time documented on the proof of cancellation, and for which your director or officer produces a receipt: 1. Meals and lodging; 2. Alternative transportation; 3. Clothing and necessary toiletries; and 4. Emergency prescription and non-prescription drug expenses. O. "Political unrest" means: 1. A short-term condition of disturbance, turmoil or agitation within a foreign country that poses imminent risks to the security of citizens of the United States; 2. A long-term condition of disturbance, turmoil or agitation that makes a foreign country dangerous or unstable for citizens of the United States; or 3. A condition of disturbance, turmoil or agitation in a foreign country that constrains the United States Government's ability to assist citizens of the United States, due to the closure or inaccessibility of an embassy or consulate or because of a reduction of its staff for which either an alert or travel warning has been issued by the United States Department of State. P. "Principal location' means the headquarters, home office or main location where most business is substantially conducted. Q. "Unforeseeable destruction" means damage resulting from a "certified act of terrorism," fire, collision or collapse which renders all of the insured's "principal locations' completely unusable. R. "Workplace violence" means any intentional use of or threat to use deadly force by any person with intent to cause harm and that results in bodily "injury" or death of any person while on the insured's premises. Page 8 of 8 © 2009 Philadelphia Indemnity Insurance Company Risk Managa nadDhisinn RwEWED&APPROV Br A4f, Aa*44 "—�� Ruk Management Speaelist PI-FW-001 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE C — ATHLETIC ACTIVITIES EXCLUSION DELETION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I - COVERAGES, COVERAGE C MEDICAL PAYMENTS, Subsection 2. Exclusions, Paragraph e. Athletic Activities, is deleted in its entirety. Page 1 of 1 Rick M11u�tgem�t Division REVlerreo 6 APPRovm RY: l�lltl A,.� Fl�w� ® Risk frlanagemen[Speci.alist PI-FW-002 (04/16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FITNESS AND WELLNESS LIABILITY INSURANCE EXCLUSIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusions are added to Paragraph 2. Exclusions of SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY; and Paragraph 2. Exclusions of SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: 2. Exclusions This insurance does not apply to: a. Services Furnished by Health Care Providers (1) 'Bodily injury," "property damage" or "personal and advertising injury" based upon or arising out of, in whole or in part, the rendering of or failure to render: (a) Medical, surgical, dental, x-ray, or nursing service, treatment, advice or instruction, or the related furnishing of food or beverages; (b) Any health or therapeutic service, treatment, advice or instruction; or (c) Any service, treatment, advice or instruction in chemical skin enhancement, laser hair removal or replacement. (2) The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; or (3) The handling or treatment of dead bodies, including autopsies, organ donation or other procedures. This exclusion does not apply to the rendering of first aid. Paragraph 2.a. (1)(b) above does not apply to a licensed physical therapist providing any health or therapeutic service, treatment, advice or instruction on behalf of the Named Insured. b. Vitamins, Supplements and Steroids (1) 'Bodily injury," "property damage" or "personal and advertising injury" based upon or arising out of, in whole or in part, the production, testing or manufacture of vitamins, minerals, herbal supplements, medicinal supplements or nutritional supplements. (2) 'Bodily injury," "property damage" and "personal and advertising injury' based upon or arising out of, in whole or in part, the production, recommendation, selling, testing, promotion, solicitation, or manufacture of steroids. PI-FW-002 (04/16) Page 1 of 2 Risk Mmuug.m ntDwlon Re PA6APPRWM 8Y ® Risk Management Spedzkst PI-FW-002 (04/16) c. Improper Fees, Dues and Expenses "Bodily injury," "property damage" and "personal and advertising injury" based upon or arising out of, in whole or in part, improper fees, dues, and expenses incurred or charged by an insured. d. Communicable Disease (1) "Bodily injury," "property damage" or "personal and advertising injury' arising out of any "communicable disease," including but not limited to the following: (a) Acquired Immune Deficiency Syndrome (AIDS); (b) Human Immunodeficiency Virus (HIV); or (c) Hepatitis. (2) This exclusion applies even if such damages arise or are alleged to arise as a result of the insureds' negligent hiring, placement, training, supervision, act, error or omission or alleged sexual and/or physical abuse. (3) For purposes of this exclusion, "communicable disease" means an infectious disease transmittable from person to person by direct contact with an affected person or that person's discharges or body fluids. e. Fungi or Bacteria (1) "Bodily injury," "property damage" or "personal and advertising injury" caused directly or indirectly by the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of, or presence of any: (a) "Fungi," "spores," or bacteria; or (b) Substance, vapor or gas produced by or arising out of any "fungi," "spores" or bacteria. (2) Loss, costs or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi," "spores" or bacteria, by any insured or by any other person or entity. (3) For the purposes of this exclusion, the following definitions are added: (a) "Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, "spores," scents or byproducts produced or released by "fungi." (b) "Spores" means reproductive bodies produced by or arising out of "fungi." This exclusion does not apply to any "fungi," "spores" or bacteria that are on, or are contained in, an edible good or edible product intended for human or animal consumption. PI-FW-002 (04/16) Page 2 of 2 Rlek Managaw�tDisisian frve &AppR By. �. ® Risk Managemen[Spedalist PI-FW-003 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FITNESS AND WELLNESS LIABILITY INSURANCE EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to Paragraph 1. Insuring Agreement of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: "Bodily injury" or "property damage" arising out of the rendering of or failure to render "professional training services" shall be deemed to be caused by an "occurrence." For the purpose of determining the Limits of Insurance for the coverage provided by this endorsement, any act or omission together with all related acts or omissions in the furnishing of these "professional training services' to any one person will be considered one "occurrence." C. For purposes of this endorsement, "professional training services" means any service, advice, or instruction relating to physical fitness. Page 1 of 1 RIA Mnssg..dniwaim RenE\vrD 6 APPRo Br. ® Risk Wnagem,,M Sp,.AA PI-FW-004 (04/16) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INDEPENDENT CONTRACTORS PROVIDING PROFESSIONAL TRAINING SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II — WHO IS AN INSURED, Paragraph 2. is amended to include the following: Any individual, other than an "employee," "volunteer worker" or "temporary worker," providing "professional training services" on behalf of the Named Insured. An individual's status as an insured under this endorsement ends when his or her services on behalf of the Named Insured are completed. B. SECTION I — COVERAGES, Paragraph 2. Exclusions, is amended to include the following additional exclusions: This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of services provided on behalf of any person or organization other than the Named Insured. b. "Bodily injury," or "property damage" occurring after all "professional training services" performed on behalf of the Named Insured have been completed. c. Any claim by an independent contractor who had a relationship with the Named Insured at the time of the alleged injury, regardless of whether that independent contractor was acting in his or her capacity as an independent contractor at the time of the injury. d. To any claim which is initiated, alleged, or caused to be brought about by any insured covered by this policy against any other insured covered by this policy. C. For purposes of this endorsement, "professional training services" means any service, advice or instructions relating to physical fitness. PI-FW-004 (04/16) Page 1 of 1 RAMauganatDMsbn Revie lm & AFPRf Sr Rak Management Speo Ant 01 zS PI-FW-005 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PUNITIVE DAMAGES EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2. Exclusions of SECTION I - COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY; and Paragraph 2. Exclusions of SECTION I - COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: 2. Exclusions This insurance does not apply to: Punitive Damages Any punitive, treble or exemplary damages, whether or not such punitive, treble or exemplary damages arise out of any obligation to share damages with or repay someone else who must pay damages. RA M..gem dDMiun Renerrm & APPaov® By., Muslim, Page 1 of 1 R.k Management Spetlalist PI-FW-007 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIFIC CLAIMANT EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusions are added to Paragraph 2. Of SECTION I — COVERAGES, COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY. 2. Exclusions This insurance does not apply to: Any actual or alleged "personal and advertising injury" asserted by or on behalf of Bikram Choudhury, Rajashree Choudhury, their corporations, subsidiaries, affiliates or other related business enterprises or successors in interest. Page 1 of 1 _ Risk Mnmgemeril DMetan Rtvi 6 APPROVm RY: ®, ® Risk Management Specialist PI-FW-008 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VIOLATION OF COMMUNICATION OR INFORMATION LAW EXCLUSION This endorsement modifies insurance provided under the: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to Exclusions of Section I — Coverage A — Bodily Injury and Property Damage Liability and Coverage B — Personal and Advertising Injury Liability, Paragraph 2.: 2. Exclusions: This insurance does not apply to: Violation of Communication or Information Law 'Bodily injury', "property damage or "personal and advertising injury" resulting from or arising out of any actual or alleged violation of: A. The federal Telephone Consumer Protection Act (47 U.S.C. § 227), Drivers Privacy Protection Act (18 U.S.C.§ 2721-2725) or Controlling the Assault of Non -Solicited Pornography and Marketing Act (15 U.S.C. § 7701, at seq.); or B. Any other federal, state, or local statute, regulation or ordinance that imposes liability for the: (1) unlawful use of telephone, electronic mail, internet, computer, facsimile machine or other communication or transmission device; or (2) unlawful use, collection, dissemination, disclosure or re -disclosure of personal information in any manner by any insured or on behalf of any insured. Page 1 of 1 Risk M-99—adDMsim Re e&Fn&APPROVED BY: �. ® Ruk Managemen[Speazlist PI-FW-009 (06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Blanket Additional Insured Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include the following as an additional insured, but only with respect to liability arising out of your operations, and in accordance with a required Certificate oflnsurance: 1. Managers, Owners or Lessors of the Premises Leased, Rented, or Loaned to You, but only with respect to that part of the premises leased, rented or loaned to you subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises; b. Structural alterations, new construction or demolition operations performed by or on behalf of the manager, owner or lessor of the premises; c. Any design defect or structural maintenance of the premises or loss caused by a premises defect. 2. Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s) subject to the following additional exclusions: This insurance does not apply to: Any "occurrence" which takes place after the equipment lease expires. 3. Sponsors, but only with respect to their liability as a sponsor to you. 4. Co -Promoters, but only with respect to their liability as a co — promoter to you 5. Subcontractors 6. Grantor of Franchise, but only with respect to their liability as grantor of franchise to you. With respect to any additional insured covered under this policy, this insurance does not apply to the sole negligence of such additional insured. Page 1 of 1 Risk MougemadDMsbn IZEm &APPRmmev: 2EE3=. ® Risk Management Specialist PI-SAM-001 (05/19) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ABUSIVE CONDUCT COVERAGE SUBLIMITS DEFENSE WITHIN LIMITS This endorsement modifies and is subject to the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Abusive Conduct Coverage Sublimits Each Abusive Conduct Incident Sublimit of Insurance: $ 100,000 Aggregate Sublimit of Insurance: $ 300,000 Notwithstanding any provisions elsewhere in this policy, and for the purposes of this endorsement only, the following coverage is added to SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY: A. Coverage 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as "damages" because of "bodily injury," including "defense costs" to which this insurance applies caused by: (1) "Abusive conduct"; (2) The negligent: (a) Employment; (b) Selection; (c) Investigation; (d) Supervision; (e) Reporting to the proper authorities, or failure to so report; or (f) Retention of any "employee," "volunteer worker" or any other person or persons for whom the insured is or ever was legally responsible and whose conduct would be covered by (1) above; RiA M.agemaitoMs bn -. PI-SAM-001 (05/19) t��p�gq,, Rene &APPRovmRr. Page 1 of f+fFeAcwufo ©2019 Philadelphia Consolidated Holding Corp. R6k Management spznalst Includes copyrighted material of Insurance Services Office, Inc., with pei PI-SAM-001 (05/19) (3) The negligent: (a) Placement of adoptive or foster children; (b) Selection or training of adoptive or foster parents; or (c) Supervision of adoptive or foster parents, that gives rise to "claims" of "abusive conduct"; (4) The negligent: (a) Design; (b) Control; (c) Maintenance; (d) Supervision; (e) Inspection; or (f) Investigation of prospective tenants of your premises; premises in your control; or premises you have leased to another that gives rise to "claims" of "abusive conduct"; or (5) The negligent failure to provide professional services or neglect of the therapeutic needs of a client, patient or other person because of "abusive conduct." Subject to the above provisions, we have the right and duty to defend any "suit" seeking "damages" to which this insurance applies. However, we have no duty to defend the insured against any "suit" seeking "damages" to which this insurance does not apply. We may at our discretion, investigate and settle any "claim" of "abusive conduct" and any "suit" that may result. But: (I) The amount we will pay for "damages" and "defense costs" combined, is limited as described in SECTION III — LIMITS OF INSURANCE; and (ii) Our right and duty to defend end when we have used up our applicable limit of insurance in the payment of "damages" or "defense costs." We will pay, with respect to any "claim" we investigate or "suit" we defend, any "defense costs" we incur. No other obligation or liability to pay sums or perform acts or services is covered. b. This insurance applies to "damages" and "defense costs" because of "bodily injury" only if: (1) The "bodily injury" is caused by "abusive conduct" that takes place in the "coverage territory"; and (2) The "abusive conduct" first occurs during the policy period. c. "Damages" because of "bodily injury" include "damages" claimed by any organization for care, loss of services or death resulting at any time from PI-SAM-001 (05/19) Page 2 of 5 ©2019 Philadelphia Consolidated Holding Corp. Includes copyrighted material of Insurance Services Office, Inc., with pei Risk Meuganad D[M[an km&APPRovm Sr A--p Acwa(a -mom Ruk Management Spedalist f PI-SAM-001 (05/19) Page 3 of 5 ©2019 Philadelphia Consolidated Holding Corp. Includes copyrighted material of Insurance Services Office, Inc., with pei PI-SAM-001 (05/19) injury." 2. Exclusions The following exclusions are added to Paragraph 2. Exclusions: We will not pay: a. Any "claim" or "suit" on behalf of any person who personally takes part in any "abusive conduct"; b. Any "claim" or "suit" on behalf of any person who intentionally fails to report "abusive conduct" committed by an "employee," "volunteer worker' or any other person for whom any insured is or ever was legally responsible; c. Any "claim" or "suit" on behalf of any person who commits an intentional or criminal act; d. Any "claim" or "suit" on behalf of any "employee," "volunteer worker" or any other person for whom any insured is or ever was legally responsible if at the time of this policy's inception any insured was aware of actual or alleged "abusive conduct" by such person; e. Liability assumed by the insured under any contract or agreement; f. Any obligation for which an insured, or any insurance carrier of the insured, may be held liable under a workers compensation, disability benefits or unemployment compensation law or any similar law; g. Any "claim" or "suit" arising out of matters which may be deemed uninsurable; h. Any "claim" made against an insured by another insured except a "claim" made by an insured who is an "employee" or "volunteer worker," subject to Exclusion i. below; i. Any "claim" made by or on behalf of your "employee" or "volunteer worker' except in the limited instance where that "employee" or "volunteer worker" is also your client and receiving services falling within the official scope of the services which you provide and the "claim" arises out of the provision of these services; j. Any "defense costs" associated with a criminal trial including appeals; k. "Abusive conduct" that predates the inception of this policy notwithstanding that such "abusive conduct" may continue into this policy period; I. Any "claim" arising out of, based upon or attributable to: (1) Any litigation or demand against an insured pending on or before the inception of this policy, including any future litigation or demand based on the pending or prior litigation that is derived from the same or essentially the same facts as alleged in such prior litigation; (2) Any "abusive conduct," fact, circumstance or situation which has been the subject of any written notice given under any other policy of insurance prior to inception of this policy; or (3) Any "abusive conduct," fact, circumstance or situation of which, as of the inception of this policy, the insured had knowledge and from which the insured could - - - - - "claim" to arise; or Risk MnuganmiDivieian � RE ewm 6 AP ROV BY: A+g-�, A,av44 �'. ® Risk Managemen[SpeaAist 01 PI-SAM-001 (05/19) m. Any "claim" or "suit" arising out of sexual discrimination and/or sexual harassment whether asserted under any federal or state statute or the common or civil law of any jurisdiction. B. Limits of Insurance The following is added to SECTION III — LIMITS OF INSURANCE The most we will pay for this coverage is the Sublimit of Insurance stated in this endorsement's SCHEDULE subject to the following: 1. The Each Abusive Conduct Incident Sublimit of Insurance listed in this endorsement applies to each "abusive conduct" incident, including "defense costs," regardless of the number of incidents involved; and 2. The Aggregate Sublimit of Insurance listed in this endorsement applies as an aggregate per policy period, including "defense costs." Multiple incidents of "abusive conduct" which take place over multiple policy periods for which this coverage is provided shall be deemed to constitute one "abusive conduct" and shall be deemed to occur only at the time of such first incident. Coverage for such "abusive conduct" shall be provided only under the policy, if any, which is in place at the time of the first such incident and shall be subject to the applicable limit of insurance in that one policy. Payment under this coverage shall be included in the General Aggregate Limit as stated in SECTION III — LIMITS OF INSURANCE, Paragraph 2. All other provisions of SECTION III — LIMITS OF INSURANCE do not apply to coverage defined in this endorsement. C. Definitions The following definitions are added to SECTION V — DEFINITIONS: 1. "Abusive conduct" means all actual, threatened or alleged acts of physical abuse, sexual abuse, sexual molestation, sexual misconduct, sexual exploitation, or sexual injury arising out of a single act, or continuous or repeated exposure of one person or two or more people to multiple acts of a sexual nature committed by: a. One person; or b. Two or more people acting together or in related acts or series of acts. Any act or multiple, continuous, related or repeated acts of "abusive conduct" by one person or two or more people acting together will be deemed one "abusive conduct" and will be deemed to occur only when the first "abusive conduct" takes place, regardless of: (1) The number of people injured; (2) The time period, including multiple policy periods, over which the "abusive conduct" took place; (3) The number of such acts; or (4) Whether, in the case of two or more people acting together, each such person participated in each act. Rlek Meug®nattilivi.lun PI-SAM-001 (05/19) RenEwFnn ArPRov®ar: Page 4 of 5 A- jj"e Acwulo ©2019 Philadelphia Consolidated Holding Corp. Risk Management Specialist - Includes copyrighted material of Insurance Services Office, Inc., with pei PI-SAM-001 (05/19) 2. "Bodily injury" For the purposes of this endorsement, the definition of "bodily injury' is superseded by: "Bodily injury' means bodily injury, sickness or disease sustained by a person. 'Bodily injury" includes mental anguish, mental injury, shock, fright or death resulting from physical injury or "abusive conduct." 3. "Claim" means any written demand for monetary relief. 4. "Damages" means a monetary: a. Judgment; b. Award; or c. Settlement, but does not include fines, sanctions, penalties, punitive or exemplary damages or the multiple portion of any damages. 5. 'Defense costs" means any costs to investigate a "claim" or defend a "suit' seeking "damages." These costs are included within the limits of insurance. PI-SAM-001 (05/19) Page 5 of 5 ©2019 Philadelphia Consolidated Holding Corp. Includes copyrighted material of Insurance Services Office, Inc., with pe 4 Risk moagenentlM on REVIE &APPROV®BV: O� Risk Management Spea Ant PI-TER-DN1 (1121) Policy Number: PHPK2457612-001 Named Insured: Dennys Diaz PHILADELPHIA INSURANCE COMPANIES A Member of the Tokio Marine Group Terrorism Premium (Certified Acts) $ One Bala Plaza, Suite 100 Bala Cynwyd, Pennsylvania 19004 610.617.7900 Fax 610.617.7940 PHLY.com DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE REJECTION OPTION You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses resulting fromacts of terrorism As defined in Section 102 (1) oftheAct. The term "act oftenorism' means any actor acts that are certified by the Secretary ofthe Treasury —in consultation with the Secretary ofHomeland Security, and the AttomeyGeneralof the United States --to bean act ofterrorism; to be a violent actor an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individualor individuals as part of aneffort to coerce the civilian population oftheUnited States or to influence the policy or affect the conduct of the United States Governmentby coercion. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAYBE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT'S FEDERAL SHARE OF TERRORISM LOSSES IS 80%OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILYESTABLISH D DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAYBE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BEII CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAYBE REDUCED. Your attached proposal (or policy) includes a charge for terrorism. We will issue (or have issued) your policywith terrorism coverage unless you decline by placing an "X" in the box below. NOTE 1: If "included" is shown on your proposal (or policy) for terrorism you W ILL NOT hake the option to reject the coverage. NOTE 2: You will want to check with entities that have an interest in your organization as they may require that you maintain terrorism coverage (e.g. mortgagees). EXCEPTION: If you have property coverage on your policy, the following Standard Fire Policy states do not permit an Insured to reject fire ensuing from terrorism: CA, CT, GA, HI, IA, IL, MA, ME, MO, NJ, NY, NC, OR, RI, VA, WA, WV, WI. Therefore, if you are domiciled in the above states and reject terrorism — charged for fire ensuingfrom terrorism as separately designated on your proposal. Risk Mmegemmt Page 1 of 2 Dlvistm Rwn 6 APPRovm BY: QMERFM, A+jj,A,4A4 ® Risk Management Spedarist PI-TER-DN1 (1/21) I decline to purchase terrorism coverage. I understand that I will have no coverage for losses arising from "certified" acts of terrorism, EXCEPT as noted above. You, as the Insured, have 30 days after receipt of this notice to consider the selection/rejection of "terrorism" coverage. After this 30 day period, any request for selection or rejection of terrorism coverage WILL NOT be honored. REQUIRED IN GA— LIMITATION ON PAYMENT OF TERRORISMLOSSES (applies to policies which cover terrorism losses insured under the federal program, including those which onlycover fire losses) The provisions of the Terrorism Risk Insurance Act, as amended, can limit our maximum liability for payment of losses from certified acts of terrorism. That determination will be based on a formula set forth in the law involving the national total of federally insured terrorism losses in an annual period and individual insurer participation in payment of such losses. If one or more certified acts of terrorism in an annual period causes the maximum liability for payment of losses from certified acts of terrorism to be reached, and we have satisfied our required level of payments under the law, then we will not pay for the portion of such losses above that maximum. However, that is subject to possible change at that time, as Congress may, under the Act, determine that payments above the cap will be made. INSURED'S SIGNATUR DATE Page 2 of 2 Risk Mw*ganwt D[viaiun REVIEWED 6 APPRavm BY: A+j�x AeWda ® Risk Managernent Spetlalist IL N 177 09 12 CALIFORNIA PREMIUM REFUND DISCLOSURE NOTICE In accordance with CAL. INS. CODE § 481.(c), we are notifying you that in the event that the first Named Insured cancels the insurance policy, we shall retain 10% of the unearned premium. The premium refunded to you will therefore be calculated as 90% of the pro rata unearned premium. But if cancellation takes place during the first year of a multiyear prepaid policy, we will return 90% of the pro rata unearned premium for the first year and the full annual premium for the subsequent years. If you have an Equipment Breakdown policy or your policy contains an Equipment Breakdown Coverage Part, then the following premium refund calculation applies instead of that provided in the preceding paragraph. For the Equipment Breakdown policy premium or for the premium attributable to the Equipment Breakdown Coverage Part, we shall retain 25% of the unearned premium. The premium refunded to you will therefore be calculated as 75% of the pro rata unearned premium. But if cancellation takes place during the first year of a multiyear prepaid policy, we will return 75% of the pro rata unearned premium for the first year and the full annual premium for the subsequent years. However, the penalties set forth in the preceding paragraphs will not apply under the following circumstances, even if the first Named Insured cancels the policy: 1. The Insured(s) no longer has a financial or insurable interest in the property or business operation that is the subject of insurance; 2. Cancellation takes place after the first year for a prepaid policy written for a term of more than one year; or 3. The policy is rewritten in the same insuring company or company group. IN Risk MOuEemmtDtxstnn - REVIEWED&AppR Sr OW� Risk Management speoarist Of IL N 177 09 12 © Insurance Services Office, Inc., 2012 Page 1 of 1 .r1 A6. _ CERTIFICATE OF LIABILITY INSURANCE DATE (M8/2024YYY) 08/28/2024 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 CONTACT Maguire Insurance Agency,Inc.FWI NAME: 1 Bala Piz Ste 100 PHONE FAX Bala Cynwyd,PA 19004-1401 (AIC,No,Ext): (AIC,No): 610.617.7900 E-VAN,• • • A DR INSURE S)AFFO G COVERAGE NAIC# INS ERA: PMladelphia demnitylnsuranceCo an 18058 INSURED Dennys Diaz 7143 Fulton Way i,'SURER C: Stanton,CA 90680 IN � } • ` • • • iN E t(C P Nit P . IN F COVERAG CE IC U .: — SIW UMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X PHPK2457612-002 09/01/2024 09/01/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 X PROFESSIONAL LIABILITY MED EXP(Any one person) $2,500 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 X POLICY ❑PROJECT ❑LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER SAM AGGREGATE $300,000 SAM OCCURENCE $100,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER AND EMPLOYERS'LIABILITY Y/N STATUTE ANYPROPRIETOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named insured except that liability resulting from the additional insured's sole negligence. The City of Santa Ana,its officers,officials,employees and volunteers are covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Permitee including materials,parts,or equipment furnished in connection with such work operations. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 Civic Center Piz EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Santa Ana,CA 92701 27 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Risk ManagmentDMsLcrn �?- REVIEWED&APPROVED BY: ® Risk Management Specialist ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CITY OF SANTA ANA RISK MANAGEMENT a division of HUMAN RESOURCES ' Managing Risk through Awareness and Action Agreement to Indemnify, Hold Harmless and Defend Title of Event/Activity: FDRnZ ci F-0I (-I CpYj G Event Date: 511 Description of Event/Activity: IYC L' IaK�Spr <`GI lu-.�Y7'ca Business or Organization Name: C� Full Name of Authorized Representative of Business/Organization; rl`(j S D Z_ Title of Authorized Representative: cC ,�-y In the event the above named Business or Organization does not maintain Improper Sexual Conduct a/k/a Sexual Molestation and Abuse Liability a/k/a Sexual/Physical Abuse/Molestation, or similar insurance coverage, it nevertheless is obligated to and agrees to indemnify, defend, and hold harmless, at its own expense, the City of Santa Ana, its City Council, officers, officials, agents, volunteers and employees from and against all suits or actions, claims, loss, damage, liability, cost or expense, including reasonable attorney's fees, against allegations of physical, emotional, sexual, and/or financial abuse, which may arise from the negligent or intentional actions of any of its contractors, sub-contractors, agents, employees, volunteers, or other persons acting on their behalf while participating in the above titled Event/Activity. By signing this document, the undersigned represents that he/she/they has fill authority to bind said Business or Organization named above. S D) c Z �� ,�z - Digitally signed Tu Tran by Tu Tran Authorized Representative signature of Authori d Re resentative Date Nguyen P P Nguyen 092042 00�3 of Business or organization(Print Name) of Business or Organization APPROVED By Tu Tran Nguyen at 9:20 am,Jun 03, 2025 CITY OF SANTA ANA ; Risk Management a division of Human Resources - , Managing Risk through Awareness and Action ,�.,��,. AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I, ("Representative"), attest that I am an authorized (Name and Ti too Vendor Representative) 1 representative of GI� &f 5-ki+ o ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement") to provide Dag n Z c i Fb)K 1 Py'1 C y _("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. ture Date 2 Pa 6', � Print Name Title Contact Information,i,e.,Telephone Number and/or Email Address. WA-RNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 11,12.2024 CALIFORNIA PROOF OF INSURANCE CARD LISTED VEHICLES ANCHOR GENERAL INSURANCE COMPANY 2004 INFINITI FX35 JNRAS08U74X100633 NAIC: 40010 LISTED DRIVERS POLICY,;: 9654132 DENNYS DIAZ PAD6LLA NAMED INSURED: DENNYS DIAZ PADILLA. EFFECTIVE DATE: 12/07/2024 EXPIRATION DATE: 12/07/2025 THIS POLICY MEETS THE REQUIREMENTS OF CALIFORNIA VEHICLE CODE 15056 SEE THE REVERSE 51DE FOR IMPORTANT INFORMATION Autonvo Ir�ura e =0.2Ox Dedaration REiNM - The po-!`ryrsi - _ 32iliAM iocW time at the Namedlinured '.'"`is 3AZFAFffiiA- _ YourPradtrcer ic-M i��AW Af-i8 LONG SW"I CA 908D6-=69 Totai Poiicy Premium including Fees, 5908.75 Outline of Coverage Cnverege — -_ - Praivuee SKie _".___------__- v ____- Pn—k el Summary -— —__----- Tuai Pofrcy —.—___. _