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HomeMy WebLinkAboutCertificate of Insurance_Exp 2026 0518 0101e DATE IMWDDIYYYY) ACCORV CERTIFICATE OF LIABILITY INSURANCE 05/22/2025 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 cerfifiCateholder is an ADDI" nON AL INSURED, the policy(ies) must t have a ADDITIONAL INSURED provisions or be endorsed I 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 NAME: C43"ITACT Robert Manassero Manassero Insurance Agency, Inc. PHONE (209) 223-2551 1 FAk L (209) 223-1973 1 N fA/C, Mu United Valley Insurance Ser IENCA WL0 texts, ADDRESS: 255 New York Ranch Rd.,Suite A INSURERtS) AFFORDING COVERAGE NAIC III Jackson CA 95642 INSURER A : Travelers Indemnity Co of Connecticut 25682 INSURED INSURER B: Travelers Property Casualty Company of America 25674 Vinciguerra Construction Inc INSURER C: PO Box 157 tNsURFR 0 INSURER E: Sutter Creek CA 95685 INSURER F COVERAGES CERTIFICATE NUMBER: Master 25-26 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 6� INS U" R' A' N 6 E LISTE D B EL'O'W' H'AV"'E B E EN I S S'Ll E D TO"T'H' E, I N SU" 'RED N AM ED AB OV EFO'R­TH'E' PO 'L' I CY, PE RIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I N&K I 'AWL POLICY EFF POLICY1xP L TYPE OF INSURANCE INSD Wvo POLICY NUMBER RSMIOD A4N3iD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i's 1,000,000 -0A7xnrrTM I ED 300,000 E�Ngieggs'Fz 0=1110� CLAIMS -MADE OCCUR is _e ME D EXP (Anv one oerson', is 10,000 A Y Y 4T22-CO-7N862262-TCT-25 05/18/2025 05/18/2026 PERSOINAL&ADV INJURY Js 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY [�� J'E'COF 0 LOC PRODUCTS - COMPIOP AGG 1$ 2,000,000 OTHER Pollution Liability $ AUTOMOBILE LIABILITY ComBINEb SN-GLE OWT _&a amt;eon S 1,000,000 ANY AUTO BODILY INJURY fRer person) $ OWNED SCHEDULED Y Y 810-6N520866-25-2S-G 05/18/2025 05/18/2026 BODILY INJURY (Per accident) I$ AUTOS ONLY AUTOS HIRED X NON -OWNED _P­R_0PE­RrY DAMAGE $ AUTOS ONLY AUTOS ONLY Per awlen") x Uninsured motorist 111 1,000,000 UMBRELLA LIAB OCCUR EACH CiwCVRREraCE " I$ 4,000,000 EXCESS LIAB H CLADS.MADE CUP-3S134233-25-2S 05/18/2025 05/18/2026 AGGREGATE $ 4,000,000 L_ DED L .1RETENTiON S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPMETOPWARTNER(EXECUTIVE B OFFICERIMEMaBER EXCLUDED? MIA Y UB2N559456 (Mandatory In MR) If ves, dasi�roe under DESCRIPTION OF OPERATIONS teloiv $TATPER UTjOTHL_JR 0110112025 # 01/01/2026 -LL—F--ACHAC00EfqT S 1,000,000 EL DISEASE ,F-A EMPLOYEE 6 1,000,000 EL- DISEASE- POLICY LIMIT S 1,000,000 J_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re Project, SUOU 1 Waterline Replacement Project The South Tahoe Public Utility District, City of South Lake Tahoe, the design engineer(s), any independent engineer and its consultants ,County of El Dorado and each of their officers, elected officials, and employees (including, without firnifation permanent, femerary and contract employees) are included as Additional Insured with regard to the General Liability & Auto Liability as required by wntten contract- Primary & Non -Contributory Wording applies to the General Liability, Auto Liability. Waiver of Suorogation applies to the General Liability, Auto Liability & Work Como, per attached endorsements, Umbrella/Excess Liability follows form over GL. AL 30 days notice of cancellatton; 10 days notice for non-payment of premium, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Lake Tahoe Public Utility District ACCORDANCE WITH THE POLICY PROVISIONS. 1275 Meadow Crest Ct AUTHORIZED REPRESENTATIVE South Lake Tahoe CA 96150 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Igailliza='A i , 6 a a 1 11160014 0 "T_ 1_6 - 0 - - 0 WWI BONN W166611MINUMI - N - R M t* arr's the extent that coverage is excluded or limited by such an endorsement, The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured —Unnamed Subsidiaries B. Blanket Additional insured — Governmental Entities — Permits Or Authorizations Relating To Operations C. Incidental Medical Malpractice D. Blanket Waiver Of Subrogation E. Contractual Liability —Railroads F. Damage To Premises Rented To You A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES The following is added to SECTION 11 — WHO IS AN INSURED: Any of your subsidiaries, other than a partnership, B. joint venture or limited liability company, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in, such subsidiary on the first day of the policy period: and b. Such subsidiary is not an insured under similar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage" that occurred, or "personal and advertising injury" caused by an offense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or a. An organization other than a partnership, joint venture or limited liability company; or b. A trust, as indicated in its name or the documents that govern its structure. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION 11 — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: b. After the date. if any, during the policy period a. Any "bodily injury", "property damage' or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary, operations performed for the governmental For purposes of Paragraph 1. of Section 11 — Who entity; or is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage' deemed to be designated in the Declarations as: included in the "products -completed operations hazard". CG D3 16 02 19 2017 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office. Inc,, with its permission. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE 1. The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION It — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician or paramedic; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". pharmaceuticals committed by, or with the knowledge or consent of, the insured. S. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E. CONTRACTUAL LIABILITY — RAILROADS INJURY AND PROPERTY DAMAGE LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 Q 2017 The Travelers Indemnity Company. All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office. Inc., with its permission. 2. Paragraph f.(11) of the definition of "insured contract' in the DEFINITIONS Section is deleted. F. DAMAGE TO PREMISES RENTED TO YOU The following replaces the definition of "premises damage!' in the DEFINITIONS Section: "Premises damage!" means "property damage" to: COMMERCIAL GENERAL LIABILITY a. Any premises while rented to you or temporarily occupied by you with permission of the owner-, or b. The contents of any premises while such premises is rented to you, if you rent such premises for a period of seven or fewer consecutive days. CG D3 16 02 19 0 2017 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY BLANKET ADDITIONAL INSURED (includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION If — WHO IS AN INSURED: Any person or organization that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section fit — Limits Of Insurance. (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence!' or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence' or offense. b. The insurance provided to such additional (2) If a claim is made or "suit' is brought against insured does not apply to: the additional insured: CG D2 46 04 19 Q 2018 The Travelers indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit', cooperate with us in the investigation or settlement of the claim or defense against the "suit', and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit' to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional, insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. Page 2 of 2 0 2018 The Travelers Indemnity Company. All rights reserved. CG D2 46 04 19 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 4T-Co-7NS62262-TCT-25 ISSUE DATE: 05-21-25 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RIGHTSWAIVER OF TRANSFER OF (WAIVERAGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS Name Of Person(s) Or Organization(s): SOUTH TAHOE PUBLIC UTILITY DISTRICT 1275 MFJMWCREST DR. SOUTH LAZE TAHOE CA 96150 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Part. Such waiver by us applies only to the extent that Rights Of Recovery Against Others To Us of the insured has waived its right of recovery against Section IV — Conditions: such person(s) or organization(s) prior to loss. This We waive any right of recovery against the person(s) endorsement applies only to the person(s) or or organization(s) shown in the Schedule above organization(s) shown in the Schedule above. because of payments we make under this Coverage CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 4T-CO-7NS62262-TCT-25 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 05-21-25 • • ON If :Tffft 1:1 IN This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: SOUTH TAHOE PUBLIC UTILITY DISTRICT (CONTINUED ON CG TS 01) Location And Description of Completed Operations: SEE ON CG TS 01 RA Section It — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and desceibed in the schedule of this endorsement performed • that insured and .• in the "products -completed operations hazard". CG, D3 73 11 05 Includes the copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 POLICY NUMBER: 4T-CO-7NS62262-TCT-25 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 05-21-25 ADDITIONAL INSURED - OWNERS9 LESSEES i CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: SOUTH TAHOE PUBLIC UTILITY DISTRICT (CONTINUED ON CG TS 00) 1275 MEADOWCREST DR. SOUTH LAKE TAHOE CA 96150 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to such work, on the project (other than ser- include as an insured the person or organization vice, maintenance or repairs) to be per - shown in the Schedule, but only with respect to formed by or on behalf of the additional liability arising out of your ongoing operations per- insured(s) at the site of the covered op - formed for that insured. erations has been completed, or B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or or- ganization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 C ISO Properties Inc., 2000 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 4T-CO-7Ns62262-TCT-25 GENERAL PURPOSE ENDORSEMENT THIS B24MRSE14LW CHANGES THE POLICY. PLEASE READ IT CAREFULLY fr6)-@)** • k U: - 0 • .r ....-I THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART AJWDING SCHEDULE OF CG 20 10 10 01 "ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION®, W MP OF PERSON OR ORGANIZATION TO INCLUDE: SOUTH TAHOE PUBLIC UTILITY DISTRICT, CITY OF SOUTH LAKE TAHOE, COUNTY OF EL DORADO AND EACH OF THEIR OFFICERS, ELECTED OFFICIALS AND EMPLOYEES 1275 C7WCREST DR. SOUTH LAKE TAHOE, CA 96150 LOCATION AND DESCRIPTION OF COLLETED OPERATIONS: ANY PROJECT TO WHICH AN APPLICABLE WRITTEN CONTRACT DESCRIBED IN THE NAME OF ADDITIONAL INSURED PERSON(S) OR ORGANIZATION(S) SECTION OF THIS SCHEDULE APPLIED. CG T8 00 Page 1 so A HOUIDORVI IN 1 -.Ift Its] MATA k 9: This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM 1. The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". COMMERCIAL AUTO 2. The following is added to Paragraph B.S., Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part S. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is a named insured when a written contract or agreement with you, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non- contributory. CA T4 99 02 16 0 2016 The Travelers indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc- with its permission- This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. • r FORM NAMED INSUJF insured,The following is added to Paragraph A.1., Who Is An of • LIABILITY COVERAGE: Any organization acquire or « dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately s for Business Auto Coverage. Coverage under this provision is afforded only un- day after you. or ever is earlier. - _•• ., AUTOS -COVERAGE: Any person or organization who is required under a written contract or agreement - d that person or « executed by you- . -"bodily addi- tional"property damage" occurs and that is in effect , -:" for Covered Autos Liability..t but only for damages COMMERCIAL AUTO H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY rsoi7=1_Ec� NOTICEL. . KNOWLEDGE OF . OR LOSS M. BLANKET WAIVER OF - • • UNINTENTIONALV. •- OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.S., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "er loyee's" name, with your CA T3 53 02 15 0 2015 The Travelers Indemnity Company. Ail rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION If — COVERED AUTOS tions. LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- (ii) Neither you nor any other involved "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii) We may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured" against, or LIMITS in the settlement of. any claim or 1. The following replaces Paragraph A.2.a.(2), "suit'. of SECTION 11 — COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in - we cover. We do not have to furnish surd" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of SECTION 11 — COVERED AUTOS of SECTION 11 — COVERED AUTOS LIABIL- LIABILITY COVERAGE. ITY COVERAGE: (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for the reasonable expenses incurred "insured" at our request, including actual with our consent for your investiga- loss of earnings up to $500 a day be- tion of such claims and your defense cause of time off from work, of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE — INDEMNITY BASIS within the limit described in Para - The following replaces Subparagraph (5) in Para- graph C.. Limits Of insurance, of graph B.7., Policy Period, Coverage Territory, SECTION it — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to make such payments ends when we (S) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanction, em- insurance in payments for damages, bargo, or similar regulation imposed by the settlements or defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re - and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees". country outside the United States, its ter - partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 @ 2015 The Travelers indemnity Company. All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc, with its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,0 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident`' or "loss" ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". The following replaces Paragraph Of , Recovery Against Others of SECTION IV — BUSINESS AUTO CON I The following is added to Paragraph A.4., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay sap to $40 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 b' 015 The Traueiers Indemnity Company. AX rights, eser.,ed. Page 3 of 4 Includes copyrighted inaterial of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or • person or organization designated in such error in, any information given by you shall not contract. prejudice • rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to cot - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal, • IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 0 2015 The Travelers Indemnity Compa ny. All rights reserved . CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc. with its permission. AdNk WORKERS COMPENSATION TRAVELERSJ'AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-2N559456-25-2S-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS D •CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2. 00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company Policy No. Countersigned by Premiumdorsement No. DATE OF ISSUE: 12-26-24 STASSIGN: Page 1 of 1