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Home My WebLink AboutPAG WEST, LLC - 2014A -2014 -056 fl v f✓ "'nR.� MAY PAXEE -! /RIGHT OF ENTRY AND LICENSE AGREEMENT V 4� 1.1-IIS RIGHT O / F ENTRY �AND LICENSE AGREEMENT ( "Agreement") is made and entered into this k day of r , 2014 by and between the CITY OF SANTA ANA, a S charter city and municipal corporation organized and existing under the Constitution and laws of the State of California, (hereinafter referred to as the "CITY "), and PAG West LLC, a Delaware limited liability company (herein referred to as "LICENSEE "), with respect to the following: RECITALS A. LICENSEE owns that certain property located at 1405 Auto Mall Drive, Santa Ana, CA (hereinafter "Premises I "), on which LICENSEE operates an auto dealership. B. LICENSEE is the lessee of that certain property located at 1350 Auto Mall Drive, Santa Ana, CA (hereinafter "Premises 2 "), on which LICENSEE operates an auto dealership. C. LICENSEE is the sole shareholder of PAG Santa Ana 131. Inc.; a Delaware Corporation (hereinafter referred to as "PAG "). D. PAG owns that certain property located at 1500 Auto Mail Drive, Santa Ana, CA (hereinafter "Premises 3 "), on which PAG owns and operates an auto dealership. E. PAG owns that certain property located at 1455 Auto Mall Drive, Santa Ana, CA (hereinafter "Premises 4 "). F. CITY owns or has an easement for public utility purposes along, above and under the public street commonly known as Auto Mall Drive (hereinafter "Street'), which abuts Premises 1, 2, 3 & 4. G. LICENSEE desires a license to install, maintain and repair a fiber optic cable from Premises I to Premises 2 (License Area 1), and maintain and repair an existing fiber optic cable frorn Premises 3 to Premises 4 (License Area 2), both of which are below the surface of a portion of Auto Mall Drive (hereinafter referred to as "License Areas"), as described in Exhibit A and depicted in Exhibit B, attached hereto and incorporated by reference. NOW, THEREFORE, for good and valuable consideration, LICENSEE and CITY do hereby agree as ibllows: Right of Entry and License. Provided that all of the terms and conditions of this Agreement are fully satisfied, as of the Effective Dale of this Agreement CITY hereby grants to LICENSEE and its employees, agents and contractors the nonexclusive, non - assignable, personal, revocable right and license to install under the Street surface, a 4" conduit with the capacity to run a fiber optic cable from Premises i to Premises 2. It is expressly understood that this Agreement does not in any way whatsoever grant or convey any rights of possession, easement or other cognizable property interest in said Street. Said License shall include the right to install, maintain and repair said fiber optic cable in License Area 1, and maintain/repair said fiber optic cable in License Area 2. 2. Licensee's Duties By execution of this Agreement, LICENSEE agrees for itself and on behalf of its employees, agents, consultants and contractors as follows: a. All work shall comply with the current edition of the Standard Specifications for Public Works Construction (Green Book) and all applicable City Ordinances, Standards and Specifications currently in effect. The work, including method of installation and limits of construction of the fiber optic cable shall be depicted on a plan and shall be subject to review inspection and approval by the City Engineer. Any contractor performing work shall first obtain an excavation permit from the CITY. The LICENSEE shall endeavor to maintain and repair the License Areas from private property owned or controlled by LICENSEE, if practical. Any maintenance or repair of the conduit or its contents via Auto Mall Drive right of way shall require the LICENSEE to apply for and obtain an excavation permit from the City. b. LICENSEE accepts full responsibility for all damages and restoration and agrees to reimburse CITY for performing all work and furnishing all materials to correct any failure to comply with the rules and terms hereof and all applicable City regulations. Failure to pay any bills due under any permission issued by CITY may result in rendering LICENSEE ineligible for any additional Public Works Agency permit until such bill is paid. C. All work shall be done by a State Licensed Contractor with the appropriate classification. In addition, the contractor shall possess a current City Business License. d. Traffic Traffic control shall comply with City Standard Plan No. 1125F and the Work Area Traffic Control Handbook (WATCH). Amber lights must be maintained at night. Any street closure shall comply with City Standard Plan No 1125F. e. Fire Hydrant permits shall be obtained from the Public Works Agency before water is obtained from any public hydrant. f. LICENSEE or its contractor shall patch all authorized street cuts to City Standards, including backfilling with 90 percent relative compaction and temporary AC pavement. LICENSEE or its contractor shall place permanent patch within 30 days of placing the temporary patch. A City Street Construction Inspector must be present to inspect placement of backfill and both temporary and permanent patches. g. Refuse, rubble, gravel, dirt or unused materials shall be removed on a daily basis and final cleanup shall take place within 3 days after completion of the work. If not so removed, CITY will remove such refuse, rubble, gravel, dirt or unused materials at LICENSEE's expense, including the current call -out charge. h. UTILITY MARKINGS. Upon completion of the installation work, or any necessary service work, LICENSEE shall require that its contractor shall remove all painted utility markings using the removal method acceptable to the inspector. LICENSEE or its contractor shall register the fiber optic cable with, and maintain its presence in the Underground Service Alert (Digalert) database. i. LICENSEE shall provide plans for the project on City Standard Sheets and shall provide as -built plans when installation is complete. j. CITY's grant of this License Agreement does not authorize entry onto, or commencement of work at any Premises described herein. LICENSEE shall be solely responsible for obtaining all necessary authorizations of the property owner(s) of any such Premises, to install, maintain and repair fiber optic cable at that Premises. LICENSEE shall be solely responsible to indemnify said property owner(s) for any and all liability arising from the installation, maintenance or repair of such fiber optic cable on Premises. 3. General Terms and Conditions. a. Insurance. Prior to undertaking performance of work under this Agreement, LICENSEE shall obtain, and maintain for the duration of this Agreement, and shall require its Contractor to obtain and maintain Commercial General Liability Insurance, which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of LICENSEE's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, $2,000,000 in the aggregate. Such insurance shall be endorsed to (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self - insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. i. The following requirements apply to the insurance to be provided by LICENSEE pursuant to this section: LICENSEE, shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. If LICENSEE fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish CITY with required proof that insurance has been procured and is in force and paid for, CITY shall have the right, at its election, to forthwith terminate this Agreement. b. LICENSEE shall not permit any mechanics, materialman's or other liens of any kind or nature ( "Liens ") to be filed or enforced against the License Areas in connection with this Agreement. LICENSEE shall indemnify, defend and hold harmless CITY, its officers, employees and agents, from all liability for any and all liens, claims and demands, together with costs of defense and reasonable attorneys' fees, arising from any Liens. CITY reserves the right, at its sole cost and expense, at any time and from time to time, to post and maintain on the License Areas, or any portion thereof, or on the improvements on the License Areas, any notices of non - responsibility or other notice as may be desirable to protect CITY against liability. In addition to, and not as a limitation of CITY's other rights and remedies under this Agreement, should LICENSEE fail, within ten (10) days of written request from CITY, either to discharge any Lien or to bond for any Lien, or to defend, indemnify, and hold harmless CITY from and against any loss, damage, injury, liability or claim arising out of a Lien, then CITY, at its option, may elect to pay such Lien, or settle or discharge such Lien and any action or judgment related thereto and all costs, expenses and attorneys' fees incurred in doing so shall be paid to CITY, as applicable, by LICENSEE upon written demand. C. LICENSEE shall not have any interest in the License Areas or be entitled to any reimbursement or repayment for any work performed upon the License Areas pursuant to this Agreement d. LICENSEE may not encroach upon the License Areas for any other purpose or business than that specified in paragraph 1, above, other than pedestrian purposes already available to members of the general public, without obtaining the prior written consent of the City's Executive Director of the Public Works Agency. e. CITY will not be held responsible for loss of, or damage to, any improvements made by LICENSEE in the License Area. f This License is made subject and subordinate to the prior and continuing right of CITY to use the public right -of -way. 4. Indemnity. LICENSEE hereby agrees to defend, indemnify and hold the City of Santa Ana and its officers, officials, members, employees, agents and representatives, harmless from and against any and all loss, damage, injury, liability, claim, cost or expense (including, without limitation, reasonable attorneys' fees, expert witness fees, court costs, and expenses) arising from or attributable to the activities of LICENSEE or any of its employees, agents, consultants or contractors upon the License Areas pursuant to this Agreement. All use of and entry upon the License Areas shall be at the sole cost, risk and expense of LICENSEE. LICENSEE acknowledges and understands that should this Agreement be deemed by the County of Orange to create a possessory interest subject to property taxation, that LICENSEE shall be subject to the payment of property taxes levied on such interest, and that it shall defend, indemnify and hold the City of Santa Ana and its officers, officials, members, employees, agents and representatives, harmless from and against any and all such claims. 5. License Fees. At the time of the street work permit issuance, all outstanding fees associated with the license processing, street improvement plan-check and street work permit shall be paid in full by LICENSEE. 6. Revocation. CITY may revoke this License, at will, upon thirty days notice in writing to the LICENSEE. Notices. Any notice to be given by either party shall be deemed to be properly served if deposited with the United States Postal Service, or other acceptable mailing service, postage prepaid, to the addresses below: TO CITY: Clerk Of The Council City of Santa Ana 20 Civic Center Plaza (M -30) P.O. Box 1988 Santa Ana, California 92702 With courtesy copy to: TO LICENSEE: PAG West, LLC Executive Director of the Public Works Agency City of Santa Ana 20 Civic Center Plaza (M -21) P.O. Box 1988 Santa Ana, California 92702 8. Termination of Occupancy. 7015 E. Chauncey Lane Phoenix, AZ, 85054 a. LICENSEE accepts the License Areas in an "as is" condition and upon termination or revocation of this License, LICENSEE shall, at its own cost and expense, remove any improvements installed and maintained by LICENSEE and surrender possession of the License Areas to the CITY in good order and repair and as nearly practicable to the state and condition in which it existed prior to the grant of this License, to the satisfaction of CITY. b. In the event LICENSEE fails, neglects or refuses to remove said improvements and restore the License Areas, such removal and restorations may be performed by CITY, at LICENSEE's expense, which expense LICENSEE agrees to pay to CITY upon demand. C. LICENSEE shall provide to CITY along with this Agreement, a performance bond issued by a corporate surety duly authorized to transact business in the State of California or cash deposit in an amount approved by the CITY to guarantee performance of LICENSEE's termination obligations. LICENSEE shall maintain a performance bond in full force, unless released by the CITY by written communication to the Surety. 9. Miscellaneous. a. Choice of Law. This Agreement is to be governed by, and construed in accordance with, the laws of the State of California. b. Remedies. Either party shall, in addition to all other rights provided herein or as may be provided by law, be entitled to the remedies of specific performance and injunction to enforce its rights hereunder, except to the extent expressly provided to the contrary in this Agreement. All rights and remedies under this Agreement are cumulative and no one of them shall be exclusive of any other, and each party shall have the right to pursue any one or all of such rights and remedies or any other remedy which may be provided by law, whether or not stated in this Agreement, except to the extent expressly provided to the contrary in this Agreement. C. Counterparts. This Agreement may be executed in two (2) or more counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument. d. Non - Liability of Public Officials. No officer, employee, member, agent or representative of CITY shall be personally liable to LICENSEE, or any successor in interest, in the event of any default or breach by CITY, or for any amount which may become due to LICENSEE or its successor, or for any breach of any obligation of the terms of this Agreement. C. Effective Date. This Agreement shall become effective on the date first set forth above. f. Assignment. LICENSEE shall not record, hypothecate, assign or attempt to record, hypothecate or assign this personal License. Any attempt by LICENSEE to record, hypothecate or assign this License shall automatically terminate this License Agreement and render this License void and invalid for all purpose. IN WITNESS WHEREOF, the parties hereto have entered into this Agreement as of the date first set forth above. Attest: Maria D. Huizar Clerk of the Council Approved as to form: aura Sheedy Assistant City Attorney Recommended for ro 1: Edwin "William" Gal 4z Interim Executive Director - PWA [a] I Wall =fAU1111 111r\0 /1 I Z __j y David Cavazos City Manager PAG West, LLC Geor Secretary an re surer PAG West, LLC. � ....�.._._ -_ P a_rn. 'C'AL FCgL�� 7MDE NAG vnn xo�u MAFIO up C[1fJNTY My ownm. Eqm ee nnc. 9, 2n 14 EXHIBIT "R" LEGAL DESCRIPTION FOR LICENSE AREAS LICENSE AREA 1: BEING THAT PORTION OF AUTD MALL DRIVE ABUTTING PARCELS 1 AND 4 IN THE CITY OF SANTA ANA, COUNTY OF ORANGE, STATE OF CALIFORNIA, AS SHOWN ON MAP FILED IN BOOK 210, PAGE 45, OF PARCEL MAPS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. DEPICTED AS 'LICENSE AREA P ON EXHIBIT 'B'. LICENSE AREA 2: BEING THAT PORTION OF AUTD MALL DRIVE ABUTTING PARCELS 6 AND 8 IN THE CITY OF SANTA ANA, COUNTY OF ORANGE, STATE OF CALIFORNIA, AS SHOWN ON MAP FILED IN BOOK 210, PAGE 45, OF PARCEL MAPS IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. DEPICTED AS "LICENSE AREA 2' ON EXHIBIT 'B'. E-1XHIBIT "B" SKETCH TO ACCOMPANY Ll(')AL DESCRIPTION FOR LICENSE AREA I EXISTING BUILDING COMMONWEALTH PRE -OWNED I'L DEALERSHIP 1350 AUTO MOLL DRIVE EXIS - IN G / 3JIL c'110 LICENSE— AREA I COMMONWEALTH PRE-OWNED DEALERSW' OA,N GURNEY OR VOLVO OF ORANGE COUNTY rr AUTO MALL DP COMMONWEALTH CREVIER VW I BMW to "9 FT I� > c 4 0 U 1405 AUTO 0 0 MALL LI MALL DRIVE DRIVES R 1 V E EXISTING 0 BUILDING OMMONWEALTH C COMMONWEALTH HYUNDAI AUDI DEALERSHIP rr AUTO MALL DP COMMONWEALTH CREVIER VW I BMW EXHIBI F B SKETCH TO ACCOMPANY LEGAL DESCRIPTION FOR LICENSE-_ AREA 2 qOT 9<< O,p LICENSE AREA 2 CREVIER f BMW DEALERSHIP EXISTING 9UILDING T CREVIER MINI �FTQ DEALERSHIP /" ,�/r O� 1455 AA EXISTING MALL DPIVE� BUILDING F, 15x7 r � 15C0 AUTO MALL DRIVE ExtSr[Nc BUILDING EDINGER AV D c 0 3 v r r 0 FREEWAY HONDA N Z i1CbR'L7 CERTI i I 1L1TY INSURANCE ontelaMix��o a rn THIS CERTIFICATE IS ISSUED AS A W R O L ANO 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, kKD,THE CERTIFICATE HOLDER. TYPE JF INSURANCE MSV IMPORTANT: If the certificate holder , AIIDITIONALdNSL)i �P„t policy(ies) must be endorsed. If SUBROGATION 15 WAIVED, subjoct to the terms and conditions of the policy C. Lain 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 Ann Risk Services Ce ^Val, Inc. Southfield MI office CONTACT NAME. _ 'IIAVn�6) 283 -7122 F'u 800- 363 -0105 INC. Dp. EXO: F-MAL ADDRESS'. 3000 Town Center Suite 3000 INSURERIBI AFFORDING COVERAGE NAICS Southfield MI 48075 USA INSURED INSURERA: ACE American insurance Company 22667 INSURER W. Indemnity Insurance Co of North America ,43575 Penske Aut.MQtl Ve Group. Inc. 2555 Telegraph Road Bloomfield Hills NI 48302 -0954 USA INSURER C: INSURER 0: D 550,000 INSURER E: X COMMERCIAL GENERAL LIABILITY I INSURER F: COVERAG E5 CPRTIFICATE NUMBER: 570052365845 REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVRHSTANDING 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. Limits shown are as requested MRI LTR TYPE JF INSURANCE MSV WAD POLICY NUMBER r1MIDlIr1 �Y— Y LIMITS GENERAL LIABILITY GAR H C—M813987 U�1U1/ZUIqUWUWZU1a EACHOCCURRENCE 5S10001000 Garage Liability D 550,000 X COMMERCIAL GENERAL LIABILITY I PREMLES IFS ncwnnncn MED EXP(My one Person) Excluded CLAIMS -MADE ❑OCCUR PERSONAL A ADV INJURY $51000,000 m X Car., Li.WIC, m b GENERALAGGREGATE 510,000,000 o PRODUCTS- CDMPgP AGO Included GENL AGGREGATE LIMIT WPLIE$PER ' X POLICY PRO LOC ^ m A GAR NO 8815987 01/01/'2014 01/01/2011 COMBINED BINGLEUmff $5,000,000 (AUTOMOBILE LIABILITY Garage Liability j GODLY INJURY (Per Perapnl 0 X ANY AUTO ALL OWNED SCHEOULED BODILY INJURY (Per amdent) .d+ AUTOS AUTOS PROPERTYCAMAGE IS HIRED AUTOS NOW.VNNED fPencddenll r- AUTOS x GALL$1.dao mn UMBRELLA LIAR OCCUR EACH OCCURRENCE U AGGREGATE EXCESS LIPS CLAIM &.MADE, 'OED RETENTIDN B WCRNEPS DOMPEN$ATIDN nNO `NLRC4787701 01/O1/1014iU1/01/2U15 X WC $TATU- OLH. TORY UNITS PP • EMPLOYERS' LIABILITY YIN WLRC47877003 01/01/201401/01 /2015 EL. EACH ACGOENT 51,000,000 N AFFIcER ylq Workers COmD /CA EL. DIBEASE- EA EMPLOY_E 51,000,000 EMSERIPARTHEP!EXEGVTIbE OFFnd.l EMBER :%CLUDEDT (Nmdeloryin NHl WLRC47377027 01/01/2 01401 /01/2015 • 1 1 )ra AU under pW Au [Om0 [1 ve — EL CISEASEYOLICY UMIL 11.000,000 pE54RIPTIDN GF (1YEMnrIGNS hnlow — �J DESCRIPTION OF OPERATIONS( LOCATIONS VEHICLES(AHecH ACORD Im,AddaipnalRemaMe Scnedale, if men apau is required) •,� Addi ci onal Named insured: PAG west, LLC. City of Santa Ana, M -93 is included as an Additional Insured with respect to the General Liability policy, as required by 'written contract. �J �7 �.J CERTIFICATE HOLDER City of Santa Ana, M -93 20 Civic Center Plaza Santa Ana CA 92702 USA ACORD 25 (2010105) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 01988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACE American Insurance Company Garage Declaration$ im 436 Walnut Street Philadelphia PA 19106 I POLICY NUMBER: GAR H08815987 RENEWAL Expiring Policy Number: GAR H08711641 INSURED Named Insured: Penske Automotive Group, Inc. Address: 2555 Telegraph Road Bloomfield Hills MI 48302 PRODUCER Producer Number: 121514 Producer Name: AON RISK SERVICES CENTRAL INC Producer Address: 3000 TOWN CENTER SUITE 3000 SOUTHFIELD MI 48075 ITEM ONE - POLICY INFORMATION Form of Business: ® Corporation ❑ Limited Liability Company ❑ Other: Named Insured's Business: Car Dealers Policy Period: Policy covers from 01/01/2014 to 01101/2015 12.01 am standard time at the named insured's address stated above, Audit Period: Annual, unless otherwise stated: ❑ Seml- Annual ❑ Quarterly ❑ Total Advance Premium( Including taxes and surcharges): $855,995.00 Refer to Surcharge Schedule for surcharge amounts and rates it In return for the payment cf premium and subject to all the terms of this policy we agree with you to provide the insurance as stated in this policy. P eI ^f' DA -25874 (10;08) Copyrignt, Insurance Services Office, Inc. 2007 Pa ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT Endorsement Number Nmn6d Insur"d Penske Automotive Group, Inc. 41 Policy Penod Effective Date of Endorsement Policy Symbol Policy Number GAR H08815987 01/01/2014 TO 01 /0112 01 5 Issued By (Nhme of Insurance Company) ACE American Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: GARAGE LIABILITY COVERAGE FORM The following Is added to subparagraph b. of Section 11.3 —Who Is An Insured: (3). Any person or organization that you are required to Include as an additional Insured under this policy because of a written contract that: a) Is In effect during this policy period; and b) Was executed prior to the occurrence of the "bodily Injury" or "proparty damage "; and c) Qualifies as an "Insured contract" as defined In this policy. Such person or organization is an additional Insured only for: d) Coverage under Section II.A.1. "Garage Operations" —Other Than Covered "Autos "; and e) Liability arising out of "work you performed" or your "products" for that additional Insured; and f) For the period of time required by the written contract and In no event beyond the expiration of this policy. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance requlred by the written contract: 7) The Insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract; and 8) This endorsement shall not Increase the Limits of Insurance stated In the Declarations pertaining to the coverage provided herein. Any coverage provided by this endorsement to an additional Insured shall be excess over any other valid and collectible Insurance available to the additional Insured whether primary, excess, contingent or on any other basis unless the written contract specifically requires that this Insurance apply on a primary or non-contributory basis. In accordance with the terms and conditions of the policy and as more fully explained In the policy, as soon as may result Intac I additional claim, fo rward all legal papers Must i papers to us, cooperrat prompt n In the defense any actions, alnd otherwise comply with all of the policy's terms and conditions. 11 Page' of MS -25759 11113 coprr9nzoti. GAR 1 HO8815987 01/01/2014 TO 01101/2015 ACE Amnc ean Insurance Company Inver/ the polity numM1xr TM1a remxi,nlar n( the inrnrmaliun is in M1x complelnq only whin /his w+Mtsemenl Is issued sASxywr::o Iha pmparaliun of F8 paliry. SIGNATURES THE ONLY SIGNATURES APPLICABLE TO THIS POLICY ARE THOSE REPRESENTING THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS, By signing and delivering the policy to you, we state that it is a valid contract. INDEMNITY INSURANCE COMPANY OF NORTH AMERICA (A stock company) BANKERS STANDARD FIRE AND MARINE COMPANY (A stock company) BANKERS STANDARD INSURANCE COMPANY (A stock company) ACE AMERICAN INSURANCE COMPANY (A stock company) ACE PROPERTY AND CASUALTY INSURANCE COMPANY (A stock company) INSURANCE COMPANY OF NORTH AMERICA (A stock company) PACIFIC EMPLOYERS INSURANCE COMPANY (A stock company) ACE FIRE UNDERWRITERS INSURANCE COMPANY (A stack company) WESTCHESTER FIRE INSURANCE COMPANY (A stock company) 436 Walnut Street, P.O. Box 1000, Philadelphia, Pennsylvania 19106 -3703 CARMINE A. GIGANTI, Secretary CC -1K11g (OV11) JOHN J. LUPICA. President Authorized Representative Page 1 of 1 ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT Auffiorizad Representative MS -25759 110 3 Copyright 2011 u Page 2 of 2