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HomeMy WebLinkAboutMARK THOMAS & COMPANY (4)A-2021-250-01 MAYOR Valerie Amezcua MAYOR PRO TEM Thai Viet Phan COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez David Penaloza Benjamin Vazquez CITY OF SANTA ANA INSURANCE ON FILE WORK MAY PROCEED PUBLIC WORKS AGENCY UNTIL INSURANCE EXPIRES 20 Civic Center Plaza . P.O. Box 1988 rrt I�I 2.� Santa Ana, California 92702 CICITY CLER wWw.santa-ana.orc DArE: J 0 6 2025 December 11, 2024 Mark Thomas & Company, Inc. Attn: Darin Johnson, Principal Engineer 2121 Alton Parkway, Ste. 210 Irvine, CA 92606 D-Viis i) Re: Extension of Agreement (A-2021-250) to Provide Grant Writing Services CITY MANAGER Alvaro Nunez CITY ATTORNEY Sonia R. Carvalho CITY CLERK Jennifer L. Hall Pursuant to Section 3 ("Tenn") of the above -referenced Agreement, entered into by Mark Thomas & Company, Inc. ("Consultant"), and the City of Santa Ana, dated December 21, 2021, the time period of the Agreement is hereby extended for a one-year period through December 20, 2025. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terns and conditions of the Agreement, as amended, remain unchanged and in full force and effect. Sincerely, i 1n��PE qr, �abil Saa, Executive Director, Public Works Agency CITY OF SANTA wlem- \ 1 Alvaro Nunez City Manager APPROVED AS TO FORM Kxt` Nellesen Assistant City Attorney ATTEST MARK THOMAS & COMPANY, INC. Darin Johnson Associate Principal SANTA ANA CITY COUNCIL Valens Amezwa Thai Viet Phan Benjamin Vazquez Jessie Lopez Phil Became Mayor Mayor Pm Tom, Waml i Word Ward Ward warasarda-mm.om loh ansanta-ana.om byazouezrAsanla-ana.oro lessielope,l sanla-ana.om obacema(Asanlaana.om Johnallhan Ryan Hernandez D.Ad Penah. Ward5 Ward6 r.rnheman1ez5samaana.om doenalozaOsanla-armor MARKTHO.01 SIIMMANR CERTIFICATE OF LIABILITY INSURANCE OAT91912OD/YYYY) 9/snoza 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 License # OE67768 cNRMP CT Jessica McDonald IDA Insurance Services 3875 Ho yard Road Suite 200 Pleasanton, CA 94588 PHONE FAX AIC, No, E# : 925) 9184535 A/c, No ; EMAIL Jessica.McDonald@ioausa.com DRESS: INSURERS AFFORDING COVERAGE NAIC N INSURERA: The Continental Insurance Company 35289 INSURED INSURERS: Continental Casual' Com ny 20443 INSURER C: Valle For - a Insurance Coany 20508 Mark Thomas 8 Company, Inc. INSURER D: Lloyd's NA 2833 Junction Avenue, Ste 110 San Jose, CA 96134 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NI NUIRPo- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE 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. DISK LTR TYPE OF INSURANCE ADDL INSD SUBR MD POLICY NUMBER POLICY EFF 1MNVDOiYYYYI POLICY UP (MMIDDYYYY)LIMITS A X COMMERCIAL GENERAL LABILITY CLAIMS -MADE OCCUR X X 7040185059 911612024 9/1512025 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 1,000,000 MEDEXP Anaone erson $ 15,000 PERSONAL B ADV INJURY $ 1,000,000 GENT X N AGGREGATE LIMITAPPLIES PER: POLICY❑za LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 OTHER: B AUTOMOBILELINBILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOSS X X 7040183912 9/16/2024 9/1512025 X BODILY INJURY Per erson $ BODILY INJURY Per accident $ Pe�aco dent AMAGE $ pp Ai1T05 ONLY AUTOS IN A X UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMSWADE 7040283234 9/1512024 9/15/2025 EACH OCCURRENCE S 9,000,000 X AGGREGATE $ 9,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYER$' WBILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y❑ KQ�.F.17R/MEMg�q EXCLUDED4 (mandatoryin NH) If yes, describe under DESCRIPTION OFOPERATIONSbebw N/A X 740274825 9/1512024 9115/2025 X PER 0:FF EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L.DISEASE - PODGY LIMIT $ 1,000,000 D Cyber Liability CS1284324 71112024 7/1/2025 Limit 6,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) 21-00208 Re: Job# 21-00208 - SAGS Grant Applications City of Santa Ana, its officers, employees, agents, volunteers and representatives as additional insureds. Umbrella follows form. The Workers Compensation I Employers Liability Deductible is none. City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .I. P.1 ACOHU 25 (ZU16IU3) ©1988-2015 ACORD CORPORABON, All rights reseored. The ACORD name and logo are registered marks of ACORD APPROVED BY C}mlhia A00ra at 3:54 arq Mx. D5, 2024 AC Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DN Y) 024 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 AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd Suite 230 Lafayette CA 94549 CONTACT NAME: Mandy Gu0 PHONE 510-272-1402 ac No: Ext)L EAtC.-MAINo ADDRESS: Certsoesi nPrO AssuredPartners.com INSURERS AFFORDING COVERAGE NAIC# INSURERA: XLSpecialty Insurance CO. 37885 License#: 6003745 INSURED MARKTHO-D3 Mark Thomas & Company, Inc. 2833 Junction Avenue, Suite 110 INSURER B INSURER C: INSURER D: San Jose CA 95134 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 2015017712 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLTYPE JNM SUER POLICY NUMBER MMID�Y� MMIDDYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE TORENTED PREMISES Ea occurrence) $ MED EXP Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICYRIE] PECT ❑ LOC PRODUCTS-COMP/OPAGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAB ICLAIMS-MADE DED I I RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUrE ER E.L. EACH ACCIDENT S ANYPROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED4 NIA E.L. DISEASE -EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICYLIMIT $ A Professional liability& DPR5031067 7/1/2024 7/1/2025 Per Claim $2,000.000 Cattle. Pollution Liab Included Aggregate Limit $2.000.000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job Number: 21-00208 - SAGS Grant Applications — City of Santa Ana 20 Civic Center Plaza Santa Ana CA 92702 CANCELLATION 30 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. APPROVED ACORD 25 (2016/03) The ACORD name and logo are registered By Cynthia Mora at 8:55 am, Nov 05, 2024 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement This endorsement changes the policy to which it is attached. It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two - Employers' Liability Insurance H. Recovery From Others are amended by adding the following: We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. CA Policy # 7 40274825 APPROVED All Other States Policy # 7040185157 By Cynthia Mora at 8:56 am, Nov 05, 2024 Form No: G-1916M (11-1997) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 9; Page: 1 of 1 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St, Chicago, IL 60606 0 Copyright CNA All Rights Reserved CNA CNA PARAMOUNT Primary and Noncontributory - Other Insurance Condition Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART It is understood and agreed that the condition entitled Other Insurance is amended to add the following: Primary And Noncontributory Insurance Notwithstanding anything to the contrary, this insurance is primary to and will not seek contribution from any other insurance available to an additional insured under this policy provided that: a. the additional insured is a named insured under such other insurance; and b. the Named Insured has agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GNA74987XX (1-15) Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: MARK THOMAS & COMPANY, INC. APPROVED By Cynthia Mora at 8:56 am, Nov 05, 2024 Policy -NO: 7040I85059 Endorsement No: 17 Effective Date: 09/I5/2023 Copyright CNA AV. Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permssion. CNA CNA PARAMOUNT Waiver of Transfer of Rights of Recovery Against Others to the Insurer Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ANY PERSON OR ORGANIZATION WHOM THE NAMED INSURED HAS AGREED IN WRITING IN A CONTRACT OR AGREEMENT TO WAIVE SUCH RIGHTS OF RECOVERY, BUT ONLY IF SUCH CONTRACT OR AGREEMENT: 1. IS IN EFFECT OR BECOMES EFFECTIVE DURING THE TERM OF THIS 2_ WAS EXECUTED PRIOR TO THE BODILY INJURY, PROPERTY DAMAGE ADVERTISING INJURY GIVING RISE TO THE CLAIM. COVERAGE PART; AND OR PERSONAL AND (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Under COMMERCIAL GENERAL LIABILITY CONDITIONS, it is understood and agreed that the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: With respect to the person or organization shown in the Schedule above, the Insurer waives any right of recovery the Insurer may have against such person or organization because of payments the Insurer makes for injury or damage arising out of the Named Insured's ongoing operations or your work included in the products -completed operations hazard. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: MARK THOMAS & COMPANY, INC. APPROVED By Cynthia Mora at 8:56 am, Nov 05, 2024 Policy NO: 7040185059 Endorsement No: 20 Effective Date: 0 9 / 15 /2 02 3 CopyrightCNAAt Rights Reserved. Includes ccpyrighted material of Insumnce Services Office, Inc., with its perrrmioa. CHA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, 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: A. in the performance of your ongoing operations subject to such written contract; or B. in the performance of your work subject to such written contract, but only with respect to bodily injury or property damage included in the products -completed operations hazard, and only if: 1. the written contract requires you to provide the additional insured such coverage; and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of CG2010, or under the 10- 01 edition of CG2037; or B. additional insured coverage with "arising out of" language; or C. additional insured coverage to the greatest extent permissible by law; then paragraph 1. above is deleted in its entirety and replaced by the following: WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, o field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance is amended to add the following, which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: CNA75079XX (10-16) Policy No: 70401a 5059 Page 1 of 2 Endorsement No: Is VALLEY FORGE INSURANCE COMPANY Insured Name: MARK THOMAS & COMPANY, INC. CopydgN CNAAt RightsReserved. Includes capydghted material of Insure APPROVED By Cynthia Mora at 8:56 am, Nov 05, 2024 CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products -Completed Operations Coverage Endorsement Primary and Noncontributory Insurance With respect to other insurance available to the additional insured under which the additional insured is a named insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured; or 2. primary and to not seek contribution from any other insurance available to the additional insured. But except as specified above, this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 3. make available any other insurance, and tender the defense and indemnity of any claim to any other insurer or self -insurer, whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory, this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily injury or property damage; or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GNA751079AA (IIJ-16) Policy No: 7040185059 Page 2 of 2 Endorsement No: is VALLEY FORGE INSURANCE COMPANY _ Insured Name: MARK THOMAS & COMPANY, INC. APPROVED Copyright CNA PJ'. Rights Reserved. Includes mpyrighted material of Insum By Cynthia Mora at 8.56 am, Nov 05, 2024 CNA WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) Business Auto Policy 'olicy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MARK THOMAS & COMPANY, INC. Endorsement Effective Date: 09115/2023 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. APPROVED By Cynthia Mora at 8:56 am, Nov 05, 2024 Form No: CA 04 44 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 4; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 7040183912 Policy Effective Date: 09/15/2023 Policy Page: 58 of 223 o Copyright Insurance Services Office, Inc., 2011 Business Auto Policy Policy Endorsement ADDITIONAL INSURED - PRIMARY AND NON-CONTRIB It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: SCHEDULE Name of Additional Insured Person Or Organization ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT TO NAME AS AN ADDITIONAL INSURED. 1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy. 2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident' for which the additional insured seeks coverage under this policy. All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. APPROVED By Cynthia Mora at 8:56 am, Nov 05, 2024 Form No: CNA71527XX 110-2012) Policy No: BUA 7040183912 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:09115/2023 Endorsement No: 15; Page: i of 1 Policy Page: 79 of 223 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 0 Copyright CNA All Rights Reserved