The URL can be used to link to this page

Home My WebLink AboutEmmett's Excavation, Inc. Contract Public Work Of Improvement - Bid - 12300361-12691- 6-22-23 CONTRACT CITY OF FRESNO, CALIFORNIA PUBLIC WORK OF IMPROVEMENT THIS CONTRACT is made and entered into by and between CITY OF FRESNO, a California municipal corporation (City), and EmmeWs Excavation, Inc., a California corporation, (Contractor) as follows: 1. Contract Documents. The"Notice Inviting Bids,""Instructions to Bidders,"`Bid Proposal,"and the"Specifications"including"General Conditions,"°Special Conditions,"and"Technical Specifications"for the following: PWO0926 Blackstone McKinley Transit Oriented Development Bid File No.12300361 - 12fi91 copies of which are annexed hereto, together with all the drawings, plans, and documents specifically referred to in said annexed documents, including Performance and Payment Bonds, if required, and are hereby incorporated into and made a part of this Contract, and shall be known as the Contract Documents. 2. Price and Work. For the monetary consideration of Two Million Six Hundred Forty-Nine Thousand Two Hundred Twenty-Two Dollars and Zero Cents 2 649 222.00 , as set forth in the Bid Proposal,Contractor promises and agrees to perform or cause to be performed, in a good and workmanlike manner, under the direction and to the satisfaction of the City's "Engineer," and in strict accordance with the Specifications, all of the work as set forth in the Contract Documents. 3. Payment. City accepts Contractor's Bid Proposal as stated and agrees to pay the consideration stated, at the times, in the amounts, and under the conditions specified in the Contract Documents. 4. Indemnification. To the furthest extent allowed by law including California Civil Code Section 2782, Contractor shall indemnify, hold harmless and defend City and each of its officers, officials, employees, agents and volunteers from any and all loss, liability, fines, penalties, forfeitures, costs and damages(whether in contract,tort or strict liability, including, but not limited to personal injury,death at any time and property damage) incurred by City, Contractor or any other person, and from any and all claims, demands and actions in law or equity(including attorney's fees and litigation expenses), arising or alleged to have arisen directly or indirectly out of performance of this Contract. Contractor's obligations under the preceding sentence shall apply regardless of whether City or any of its officers,officials,employees:agents or volunteers are passively negligent, but shall not apply to any loss, liability, fines, penalties, forfeitures, costs or damages caused by the active or sole negligence, or willful misconduct, of City or any of its officers, officials, employees, agents or volunteers. If Contractor should subcontract all or any portion of the work to be performed under this Contract, Contractor shall require each subcontractor to indemnify, hold harmless and defend City and each of its officers, officials, employees, agents and volunteers in accordance with the terms of the preceding paragraph. This section shall survive termination or expiration of this Contract. 5. Trench Shoring Detailed Plan. Contractor acknowledges the provisions of Section 6705 of the California Labor Code and, if said provisions are applicable to this Contract, agrees to comply therewith. 6. Worker's Compensation Certification. In compliance with the provisions of Section 1861 of the California Labor Code, Contractor hereby certifies as follows: I am aware of the provisions of Section 3700 of the California Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of work of this Contract and will make my subcontractors aware of this provision. [Signatures follow on the next page.] DPW 23.0/01-06-12 PW NO FED DIV I.pdf 1.19 rev 04-21 1- IN WITNESS WHEREOF, the parties have executed this Contract on the day and year here below written, of which the date of execution by City shall be subsequent to that of Contractor's, and this Contract shall be binding and effective upon execution) by birth parties. Emmett's Excavation, Inc. CITY OF F.?E5N"" a California P ration, a Californi r ICILY orporation f By- By: Y o s E Dame: G4fr&71¢ F"fo-m- r epa ent of Public Works (Type or print written signature.) Dated: 7��,zJ?.� �j Title:_ VICra�51l� T (If corporation or LLC, Board Chair, Pres. or Vice Pres.) ATTEST: Dated: 7"3 TODD STERMER, CMC City Clerk olr By. -7-1 3-2OZ3 By. D s,LgPVn Ma G Name: (Type or print written signature.) No signature of City Attorney required. Standard Document#DPW 23.0 has been used without Title: modifieal n as certified by the undersigned. (If corporation or LLC,CFO,Treasurer, 8y Secretary or Assistant Secretary) Debra McGary, Construction Compliance Specialist Dated: Department of Public Works City address: City of Fresno 1721 Van Ness Ave Fresno, CA 93611 DPW 23.0/01-06-12 DPW NO FED DIV I.pdf 1.20 rev.04-21 CITY OF FRESNO PAYMENT BOND Bond#9406112 PUBLIC WORK KNOW ALL MEN BY THESE PRESENTS:That Emmett's Excavation,Inc. as Principal(the Principal)and Fidelity and Deposit Company of Maryland as Surety(the Surety')are held and firmly bound onto the City of Fresno(the Obligee)in thejust and full sum of Two Million Six Hundred Forty- Nine Thousand Two Hundred Twenty Two($2,649,222.00)lawful money of the United States of America(said sum being equal to 100%under $10M of the estimated amount payable by the terms of the hereinafter described contract),for the payment of which,well and truly to be made,we hereby bind ourselves and ours,and each of our,heirs,executors,administrators,successors,and assigns,jointly and severally firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH,That WHEREAS,the Principal has been awarded a contract for the following described work of improvement and is required by Obligee to give this bond in connection with the execution of the written contract therefor(insert brief description of work of improvement): PWO0926 Blackstone McKinley Transit Oriented Development (Bid File No.12300361 -12691) NOW,THEREFORE, if the Principal or subcontractors of the Principal shall fail to pay any of the persons named in the Section 9100 of the Civil Code, or amounts due under the Unemployment Insurance Code with respect to work or labor performed by any such claimant, or prevailing wages due and penalties incurred pursuant to Sections 1774, 1775, 1813. or 1815 of the Labor Code, or for any amounts required to be deducted,withheld,and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code,with respect to the work and labor,the Surety will pay for the same, in an amount not exceeding the sum specified above,and also, in case suit is brought upon this bond,will pay, in addition to the face amount thereof,costs and reasonable expenses and fees,including reasonable attomey's fees,incurred by the Obligee in successfully enforcing this obligation,to be awarded and fixed by the court,and to be taxed as costs and to be included in the judgment therein rendered.The benefit of this bond shall inure to any of the persons named in Section 9100 of the Civil Code so as to give the right of action to those persons or their assigns in any suit brought upon this bond. Should the condition of this bond be fully performed, then this obligation shall become null and void, otherwise it shall be and remain in full force and effect. No extension of time granted to the Principal and no change,alteration or addition in any of the terms of the contract or any of the contract documents or the work to be performed thereunder, whether made after notice or not, shall release or otherwise affect the obligations of the Surety hereunder,and the Surety waives notice of any such extension,change,alteration or addition.The Surety,by the execution of this bond,represents and warrants that this bond has also been duly executed by the Principal and proper authority,and the Surety hereby waives any defense which it might have by reason of any failure of the Principal to execute or properly execute this bond. In witness whereof,this instrument has been duly executed by the Principal and the Surety above named, on the 27 day of June 2023 Emmett's Excavation, Inc. Fidelity and Deposit Company of Maryland PRINCIPAL Bonnie donzalez,Attorney in Fact U No signature of City Attorney required. APPROVED: Standard Document#DPWS 32.0 has been used City Manager,or designee without modification,as certified by the undersigned. By: t' By:4 1*d V ?T1 QQ% Title: 1� Title:Principal Risk Analyst Department of Public Works' Cn I l [2� Date: � DPW-S 32.0103-2017 DPW NOFED DIV I.pdf 1.23 rev.04-21 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ) } ss County of Fresno } On L4ry,'� �� , before me, Lyn Genito, Notary Public, personally appeared Bonnie Gonzalez , who proved to me on the basis of satisfactory evidence to be the persons} whose named is/a+e subscribed to the within instrument and acknowledged to me that 4e/she/t4ey executed the same in #Fs/her/theFF authorized capacity4e&}, and that by 4i-s/her/+"�signature{s} on the instrument the personk4, or the entity upon behalf of which the person{&} acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. LYN GENITO ^ aN NOTARY PUBLIC-CALIFORNIA cG' MISSION#2435271 � Signature: FRESNO COUNTY (Sear [viy comm.Exp.January2112 _7 Lyn Genito, otary jblic ZURICH ANIERICAN INSURANCE CONIPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT CONIPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois(herein collectively called the"Companies"),by Robert D. Murray,Vice President, in pursuance of authority granted by Article V, Section 8,of the By-Laws of said Companies.which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof. do hereby nominate, constitute, and appoint Steven P. EDWARDS, Kim WILSON.Lyn GENITO, Bonnic GONZALEZ,Trey BUSCH, and, of Fresno,California, EACH. its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New,York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V. Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF. the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL ANIERICAN CASUALTY AND SURETY CONIPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND.this 22nd day of April,A.D.2022. `�„„tllllrll/�, N,,Wltlrylrrrrr dlrllllrll,,rrr ih TIY �f4� ` W C. yS5 J 9 � �'SEALm "SEALS` x"� "SEALm'a= 61 r4Nhlllll,ttta'� +r4vnIr111n�5Na °"rullmll�'` ATTEST: ZURICH ANIERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND B_v: Robert D. tl furra1, 17ce Presideni By Dawn E:Brown Secretary State of Maryland County of Baltimore On this 19th day of April, A.D. 2022, before the subscriber.a Notary Public of the State of Maryland,duly commissioned and qualified.Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations, IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. j. Constance A.Dunn,Notary Public My Commission Expires:July 9,2023 Authenticity of this bond can be confirmed at bondvalidator.zu rich na.com or 410-559-8790 7 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8, The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto:and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE 1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate: and I do further certify that Article V, Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the I Oth day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter. wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. 1 TESTIMONY WI1EREOr.I have hcreLlnu bscribed my name and affixed she ctrrporale seals ofthe said Con p n es. this day of_, Sc4r-ie SEAL 951oSEALms'= ggYuSEAL�$6ps• ��' ` 'Mxl�� Ilfl1111N•� all�hl Hll�� By: Mary Jean Pethick Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg, IL 60196-1056 repo rts fe I ai rn Qzurichna.cotn 800-626-4577 Authenticity of this bond can be confirmed at bondvalidator.zu rich na.com or 410-559-8790 CITY OF FRESNO Bond# 9406112 PERFORMANCE BOND PUBLIC WORK KNOW ALL MEN BY THESE PRESENTS:That Emmett's Excavation,Inc. as Principal(the Principal)and Fidelity and Deposit Company of Maryland as Surety(the Surety)are held and firmly bound onto the City of Fresno(the Obligee)in the just and full sum of Two Million Six Hundred Forty-Nine Thousand Two Hundred Twenty Two($2,649,222.00)lawful money of the United States of America(said sum being equal to 100%under$10M of the estimated amount payable by the terms of the hereinafter described contract),for the payment of which,well and truly to be made,we hereby bind ourselves and ours,and each of our,heirs,executors,administrators,successors,and assigns,jointly and severally firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH,That WHEREAS,the Principal has been awarded a contract for the following described work of improvement and is required by the Obligee to give this bond in connection with the execution of the written contract therefor(insert brief description of work ofimprovernenf): PWO0926 Blackstone McKinley Transit Oriented Development (Bid File No.12300361 -12691) NOW,THEREFORE,if the Principal shall well and truly do and perform each and all of the covenants,conditions,and agreements of said contract on the Principal's past to be done and performed,and any and a€I alterations thereof made as therein provided, at the time and in the manner therein specified, and shall indemnify and save harmless the Obligee, its officers, officials, agents, employees and volunteers,as therein stipulated,then this obligation shall be null and void;otherwise,it shall remain in full force and effect. As a part of the obligation secured hereby and in addition to the face amount specified therefor,there shall be included costs and reasonable expenses and fees, including reasonable attorney's fees,incurred by Obligee in successfully enforcing such obligation,all to be taxed as costs and included in any judgment rendered, No extension of time granted to the Principal and no change,alteration or addition in any of the terms of the contract or any of the contract documents or the work to be performed thereunder, whether made after notice or not, shall release or otherwise affect the obligations of the Surety hereunder,and the Surety waives notice of any such extension,change,alteration or addition.The Surety,by the execution of this bond,represents and warrants that this bond has also been duly executed by the Principal and proper authority,and the Surety hereby waives any defense which it might have by reason of any failure of the Principal to execute or properly execute this bond. In witness whereof,this instrument has been duly executed by the Principal and the Surety above named,on the 27 day of June ,2023 Fidelity and Deposit Company of Maryland Emmett's Excavation Inc. &T/AFORINCIPAL Bonnie enzalez,Attorney in Fact ETY No signature of City Attomey required. APPROVED: Standard Document#DPW-S 22.0 has been used City Manager,or designee without modification,as certified by the undersigned. Title W�fPublico '� Title: Principal Risk Analyst Department Date: DPW-S 22.0I03-2017 1 7d Illl\AI I.IlICCI'1 Ill\I 1-Ji CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT Civil Code § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California ss County of Fresno ) On U �.1Q� , before me, Lyn Genito, Notary Public, personally appeared Bonnie Gonzalez who proved to me on the basis of satisfactory evidence to be the person{&-} whose nameko is�af subscribed to the within instrument and acknowledged to me that #e/she/thy executed the same in 4+s/her/the4 authorized capacityoe&s, and that by 4i"s/her/the+Fsignature44 on the instrument the persons}, or the entity upon behalf of which the persons} acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. I LYN GENITO NOTARY PUBLIC-CALIFORNIA COMMISSION 21135:27'I r I' FRESNU�UI!i.'"I'i Signature: ' ✓ My Comm.Ex anuur�21,2027 (Seal) r �` y �;,`_-- T- Lyn Genito, Notary Pu l ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois(herein collectively called the"Companies"),by Robert D.Murray,Vice President, in pursuance of authority granted by Article V. Section 8.of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute. and appoint Steven P. EDWARDS, Kim WILSON, Lyn GENITO, Bonnie GONZALEZ. Trey BUSCH, and,of Fresno,California,EACH. its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver, for,and on its behalf as surety,and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New,York.New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 22nd day of April.A.D.2022, N110111!•, a` r a�,*ry .er" _au'e�'�,= - SEAL I SEAL I SEAL AX dr ry A.p y"'+l11111N1"a "ay�Zvllrorxw a•!ollnnpM ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND BY: Roberl D. +Yhu'rav Tice President Bv: Dawn E. Brown Secretary State of Nlaryland County of Baltimore On this l9th day of April, A.D. 2022. before the subscriber.a Notary Public of the State of Maryland,duly commissioned and qualified, Robert D. Murray,Vice President and Dawn E. Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. iuo pr Constance A Dunn,Notary Public My Commission Expires:July 9,2023 Authenticity of this bond can be confirmed at bondvalidator.zu rich na.com or 410-559-8790 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attomevs-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto:and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned. Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate:and I do further certify that Article V. Section 8.of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May. 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 1 Oth day of May. 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary. or Assistant Secretary of the Company. whether made heretofore or hereafter. wherever appearing upon a certified copy of any power of attorney issued by the Company.shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN '1 STIMON ' ' EREOF. I have!h4r�ubscribed rny name and affixed the corporate seals of the said Companies, tkris day of ,x �Nr �,rnrlAry ,,.rrrrinrrrrr. .ate'U'Ni°y y aP yN :/ y�i CDM•�$ UoM sF ° POq*��o �`6PPARq '-o's SEAL = SEAL }p;; -` SEAL r >rlrrr rrlre" ry�G,'r4 „�'� +Merrr r kk e By: Mary Jean Pethick Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 re oi4sfclaims 2urichna.ccm 800-626-4577 Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790 Job of File No.PWO09261 Bid File 1230 361 -12691 Clay of Name or Title of Job. Blackstone McKintey Transit Oriented ICQ I♦■��I/ Development Department No.NIA FAIR EMPLOYMENT PRACTICES COMPLIANCE REPORT [2. Name and Address of Contractor PRIME[ SUB[ ] €•��TTS EkcAV97r -Ti'✓L IT 77 1t'�FIvtU /TvFdL40 ", ,' Yes No Have you established a company-wide employment policy to assure that equal employment opportunity is given to all / persons without regard to race,religious creed,color,national origin,ancestry,physical disability,mental disability,medical V condition,marital status,sex,age,sexual orientation or on any other basis prohibited by law? 3. Have you notified all supervisors,foreman and other personnel officers in writing of the contents of the anti-discrimination clause and their responsibilities under it? 4. Have notices setting forth the provisions of the Fair Employment Practice Section used in City of Fresno Contracts been ✓ posted in conspicuous places available to employees and applicants for employment on this Project? 5. Have each of the Company's employee referrals including unions,employment agencies,advertisements,Department of Employment,etc.,been notified of the contents of the anti-discrimination clause? 5a. Has this been done in writing? 6. Has each employee referral advised the Company that it will refer all qualified applicants for employment to the Company without regard to race,religious creed,color,national origin,ancestry, physical disability.mental disability, medical condition,marital status,sex,age,sexual orientation or on any other basis prohibited by law? 7. Has a collective bargaining agreement or other contract or understanding been made with a labor union(or unions)which covers the performance of any work or supplying of any materials under this Contract? 7a. Do you operate under an Association Master Labor Agreement? f �s If your answer is'yes",state the name of the Association. G"mFn/r^04Sn^1s Are copies of those agreements on file with the City? [IryFs [ ]No With whom? 7b. If you do not operate under an Association Master Labor Agreement then indicate what steps you have taken to attempt to develop an agreement which will: (1) Spell out responsibilities for nondiscrimination in hiring,referral,upgrading and training. (2) Otherwise implement an affirmative anti-discrimination program in terms of the unions'specific area of skill and geography,to the end that qualified minority workers will be available and given an equal opportunity for employment. In addition,if you have reached such an agreement,attach a copy of the provisions thereof which bear on(1)and(2)above. 8. Have you encountered any opposition to the anti-discrimination clause by individuals,firms or organizations? If your answer to No. 8 is"Yes",identify the individual,firm or organization and briefly describe the nature of the opposition. 9. Check principal sources DEPT OF EMP EMP. AGENCIES DIRECT HIRING UNION OTHER for employee referrals. 15. Const. Workers b. Other Workers 10. The following person or persons are responsible for determining whom to hire or whether or not to hire workers on this particular Project: QUESTIONS 11 THROUGH 13 TO BE FILLED OUT BY PRIME CONTRACTOR ONLY: 11. Have you awarded any subcontracts for work covered by your Contract? 12. Have the anti-discrimination provisions been included in each of said subcontracts? ✓ 13. Have all such Subcontractors been instructed to file compliance reports and have they been furnished with report forms? 14. Dated this S day of 1 20Z; at (City and State) 15. 1 declare nder of perjury u er gshe State of Calif is that the foregoing is true and come . nt DPW NOFED DIV I.pdf 1.21 rev.04-21 FAIR EMPLOYMENT PRACTICES COMPLIANCE REPORT (continued) INSTRUCTIONS TO CONTRACTORS This Compliance Report is required by the Fair Employment Practices provisions of City of Fresno Contracts for the supplying of work, materials, or both. This report is to be completed in its entirety for each prime Contract and all first tier subcontracts. The reports shall be submitted to the City after award of the Contract and prior to Notice to Proceed. Additional sheets of paper may be attached if necessary to submit explanations or further information. If the answers to any of the questions indicate non-compliance with the anti-discrimination provision of the Contract, a brief explanation of such answer must accompany the report. It shall be the further responsibility of the Contractor to keep the information contained in the compliance report current and should there be changes in the Contractor's agreements with employee referrals, including unions or in the individuals responsible for hiring, etc., which would change the answers submitted by the Contractor in his or her original questionnaire,the Contractor should file a supplementary report containing revised answers to the applicable questions. Such changes from the original report are to be submitted in duplicate. Upon completion of the Contract the Contractor must submit a final statement of compliance including statements that the original compliance report was submitted,that any changes in the original report were reported,and that the requirements of the Fair Employment Practices section were complied with during the Contract. If such a statement cannot be submitted in its entirety, a statement along the same lines with the exceptions noted must be submitted. The City may require submission of additional information or reports on compliance at any time. FINAL STATEMENT OF FAIR EMPLOYMENT PRACTICES COMPLIANCE PWO0926 Blackstone McKinley Transit Oriented Development Bid File 12300361 - 12691 The undersigned is responsible to see that the Contractor has complied with the Fair Employment Practices section of the City of Fresno Contract indicated above. The original compliance report was submitted and no changes or additions to the original report became known to the Contractor or the undersigned except as noted below. The Contractor, in performance of the Contract,to the best of my knowledge,complied with said section of the Contract,except as noted below. Dated this day of 20 , at City and State Changes or additions to the original compliance report City By Title Deviations from compliance Contractor By Title DPW NOFED DIV I.pdf 1.22 rev.04-21 EMMEEXC-01 NLIMON 'q��►2� CERTIFICATE OF LIABILITY INSURANCE DAT s 12912srDDIYYYY) ' 2023 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 endvrsement(s). PRODUCER cD .cT Fresno CSG-Alliant insurance Services,Inc. PHONE AC No.Fxtl; 559 374-3560 FAX Na 9 E River Park Place East Ste 310 Fresno,CA 93720 ni S AFFOROINGCOVERAGE NAIC! INSUPERA:Travelers indemni Corn an of Connecticut 25682 INSURED INSURERB.Travelers Property Casualty Company of America 25674 Emmetts Excavation Inc. INSUrrERc: 1477 Menlo INSURERD: Clovis,CA 93611 INSURER E: INSU RER F: COVERAGES CERTIFICATE NUMBER- 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_ NSR TYPE OF INSURANCE AD6L R POLICY NUMBER POLILY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY F H . URR i 2,D00,DDO CLAIMS-MADE ❑X OCCUR X DT72COOK406874TCT23 3/112023 31112024 p1''"A r0 RENTED s 300,000 MEP EXP JAny ono S 10,000 REVIEWED r,�A►r� PERSONAL 6 Anv INJURY Y 2,0T10,000 G£NT.AGGREGATE LIMB APPLIES PER: r ■v r GENEIiALAGGREGAlE 5 4,000,000 POLICY ❑LOC By Megan Trovato at 11:28 am, Jul 1,1, 2023 PRCOUCTS-COW PAGG : 4,000,000 OTHM BL AGGREGATE S 2,000,000 A AUTOMOBILE LIABILITY COWINEDSINGLELIMTr = 1,000,006 X ANY AUTO X 81ORL2994772326G 3/112023 31112024 SOOLYINJLIRY OWNED SCHEDULED 800ILYINJURY ftracckfoll S AUTOS ONLY AUTOS IIqq�� PROPERTY GE X AUTO50NLY N N%O era[+xre+11 S S B UMBRELLA UAB X OCCUR EACH OCCURRENCE S 1t1,D00,00D X EXCESS LIAR CLAIMS4AADE CUP6K4742072326 311/2023 31112024 AGGREGATE ; 10,000,000 DED I X I RETENTIONS 10,000 wOR�RS COMPFTFSATION P OT}F AND EMPLOYER,LIABILFTY Y ANY PROPRIETORIPARTNEMEXECUT€VE ❑ NIA E.L.ERCH ACCI ENT cry m 1 EXCLUOESS7 Mr. DISEASE-EA EMPLOYEE S Ns 4escnbewk!er E DISEASE- IGY LIMrr S QE CTi 1-IP-n CIF OPERAT€CwS below DESCRPT?OH OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.AdWonal Remarks SchedUk,"Y he atw1wd H mat SPaw Is required) RE.PWO0926 Blackstone and McKinley Transit Oriented Development The City of Fresno,its officers,officials,employees,agents and volunteers are additional insureds as respects to General Liability and Auto Liability insurance.This insurance Is primary,and our obligations are not affected by any other insurance carried by such *ddhional Insured whether primary, excess,contingent, or on any other basis.Waiver of subrogation for Workers' Compensation insurance as respects to the City of Fresno,It officers. officials,employees,agents and volunteers. Endorsements attached: 5EE ATTACHED ACORD101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. Construction Management Division 1721 Van Ness Avenue Fresno,CA 93721 AUTHORRED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:EMMEEXC-01 NLIMON LOC#: 0 ACC?RIC! ADDITIONAL REMARKS SCHEDULE Page 1 of 1 r AGENCY NAMED INSURED =resno CSG-Alliant Insurance Services,Inc. Emmaus Excavation Inc. _ 1477 Menlo POLICY NUMBER Clovis,CA 93611 SEE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEE P 1 E�EcrIVEDarE S E PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate at Liabifily Insurance Description of Operations/Locations/Vehicles: Attached endorsements: General Liability Additional Insured General Liability Completed Operations General Liability Primary General Liability Ongoing Auto Primary&Non-Contributory Cancellation J ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY#8 1 08L2994772226G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights,duties,and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE— LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT 1. PHYSICAL DAMAGE — TRANSPORTATION C. EMPLOYEE HIRED AUTO EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION 11—COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.S., Who Is An Insured, of SECTION 11— COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered"autos" you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity Company All 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 11—COVERED AUTOS tions. LIABILITY COVERAGE: Any "employee"of yours is an "insured"while us- (ii) Neither you nor any other involved ing a covered "auto" you don't own, hire or borrow "insured will make any settlement without our consent. in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii)in may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II— 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 sured" 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 of SECTION 11— COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COW "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 II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. 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 COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto'. local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto' you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto"for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one'loss". No deductible for a covered "auto' will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE —LOSS OF SECTION IV— BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or 'loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident' or 'loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident'. (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager(if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the"accident'or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered"auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., 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 up to $400 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 ©2015 The Travelers Indemnity Company All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc with its permission COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- 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. SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 ©2015 The Travelers Indemnity Company All rights reserved. CA T3 53 02 15 Includes copyrighted material or Insurance Services Office,Inc.with its permission Policy Number: 8108L2994772226G THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES CANCELLATION AND NONRENEVVAL 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 Com- currence,after the effective date of the policy, mon Policy Condition are replaced by the follow- of one or more of the following: Ing: (1) Nonpayment of premium, including pay- 2. All Policies In Effect For 60 Days Or Less ment due on a prior policy we issued and If this policy has been In effect for 60 days or due during the current policy term cover- less, and is not a renewal of a policy we have ing the same risks, previously issued, we may cancel this policy (2) Discovery of fraud or material misrepre- by mailing or delivering to the first Named In- sentation by: sured, at the mailing address shown in the (a) Any insured or his or her representa- policy, and to the producer of record,advance tive in obtaining this insurance;or written notice of cancellation, stating the rea- son for cancellation,al least: (b) You or your representative in pursu- 1ng a claim under this policy. a. 10 days before the effective date of can- cellation if we cancel for: 13J A judgment by a court or an adminlstra- of premium;or live tribunal that you have violated a Cali- (1) Nonpayment Y fornia or Federal law,having as one of its (2) Discovery of fraud by: necessary elements an act which materi- (a) Any Insured or his or her repre- ally increases any of the risks Insured saniative in obtaining this insur- against. once;or (4) Discovery of willful or grossly negligent (b) You or your representative In acts or omissions, or of any violations of pursuing a claim under this poi state laws or regulations establishing Icy safety standards, by you or your repre- sentative, which materially increase any b. 30 days before the effective date of can- of the risks insured against. cellation If we cancel for any other rea- (5) Failure by you or your representative to son. implement reasonable loss control re- 3. All Policies In Effect For More Than 60 pays quirements. agreed to by you as a candi- a. If this policy has been In effect for more than lion of policy issuance, or which were 60 days,or is a renewal of a policy we issued, conditions precedent to our use of a par- we may cancel this policy only upon the oc- llcular rate or rating plan, if that failure IL 02 70 09 12 C Insurance Services Office, Inc.,2012 Page 1 of 3 materially increases any of the risks in- b. We may not cancel this policy solely be- sured against. cause the first Named Insured has: (6) A determination by the Commissioner of (1) Accepted an offer of earthquake cov- Insurance that the: erage;or (a) Loss of, or changes in, our reinsur- (2) Cancelled or did not renew a policy ance covering all or part of the risk Issued by the California Earthquake would threaten our financial Integrity Authority (CEA) that included an or solvency;or earthquake policy premium sur- (b) Continuation of the policy coverage charge. would: However,we shall cancel this policy if the (1) Place us In violation of California first Named Insured has accepted a new law or the laws of the state where or renewal policy Issued by the CEA that we are domiciled;or Includes an earthquake policy premium (0) Threaten our solvency. surcharge but fails to pay the earthquake policy premium surcharge authorized by (7) A change by you or your representative in the CEA. the activities or property of the commer- c. We may not cancel such coverage solely cial or industrial enterprise, which results because corrosive soil conditions exist on in a materially added, increased or the premises. This restriction(c.) applies changed risk, unless he added, in- only if coverage Is subject to one of the creased or changed risk is included in the following, which exclude loss or damage ploy caused by or resulting from corrosive sou b. We will mail or deliver advance written notice conditions: of cancellation, stating the reason for cancel- (1) Commercial Property Coverage Part lation,to the first Narned Insured,at the mail- —Causes Of Loss—Special Form;or ing address shown in the poky. and to the producer of record,at least: (2) Farm Coverage Part — Causes Of (1) 10 days before the effective dale of can- Loss Form — Farm Properly, Para- graphcellation if we cancel for nonpayment of special. Q. Covered Causes Of Loss— premium or discovery of fraud;or (2) 30 days before the effective date of can- C. The following is added and supersedes any pro- visions to the contrary: cellation if we cancel for any other reason listed In Paragraph 3.a. Nonrenewal B. The following provision is added to the Cancella- 1. Subject to the provisions of Paragraphs C.2 tlon Common Policy Condition: and C.3. below, If we elect not to renew this 7. Residential Property policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first This provision applies to coverage an real Named Insured shown in the Declarations, property which is used predominantly for and to the producer of record, at least 60 residential purposes and consisting of not days, but not more than 120 days,before the more Than four dwelling units, and to cover expiration or anniversary date. age on tenants' household personal property We will mall or deliver our notice to the first In a residential unit, if such coverage Is writ- Named Insured, and to the producer of re- ten under one of the following: cord, at the mailing address shown in the pol- Commercial Property Coverage Part icy. Farm Coverage Part—Farm Property—Farm 2. Residential Property Dwellings, Appurtenant Structures And This provision applies to coverage on real Household Personal Property Coverage Form property used predominantly for residential a. If such coverage has been in effect for 60 purposes and consisting of not more than four days or less,and is not a renewal of cov- dwelling units, and to coverage on tenants' erage we previously issued,we may can- household property contained in a residential cel this coverage for any reason, except unit,if such coverage Is written under one of as provided In b.and c.below. the following: Page 2 of 3 0 Insurance Services Office, Inc.,2012 IL 02 70 09 12 Commercial Property Coverage Par( to the changes in our reinsurance po- Farm Coverage Part—Farm Property—Farm sition. Dwellings, Appurtenant Structures And c. We will not refuse to renew such cover- Household Personal Property Coverage Form age solely because the first Named In- a. We may elect not to renew such cover- sured has cancelled or did not renew a age for any reason,except as provided in policy, Issued by the California Earth- b.,c.and d. below. quake Authority, that included an earth- quake policy premium surcharge. ag t e solely because the first Named In- b. will not refuse t renew such cover- d We will not refuse to renew such cover- ag sured has accepted an offer of earth- age solely because corrosive soil oondk quake overage, lions exist on the premises. This restric- lion (d.) applies only if coverage is sub- However, the following applies only to in- ject to one of the following,which exclude surers who are associate participating in- loss or damage caused by or resulting surers as established by Cal. Ins. Code from corrosive soil conditions: Section 10089.16. We may elect not to (1) Commercial Property Coverage Part renew such coverage after the first Named Insured has accepted an offer of —Causes Of Loss—Special Form;or earthquake coverage, If one or more of (2) Farm Coverage Part — Causes Of the following reasons applies: Loss Form — Farm Property, Para- (1) The nonrenewal is based on sound graph D. Covered Causes Of Loss— underwriting principles that relate to Special. the coverages provided by this policy 3. We are not required to send notice of nonre- and that are consistent with the ap- newal in the following situations: proved rating plan and related docu- a. If the transfer or renewal of a policy, witty ments filed with the Department of out any changes in terms, conditions or Insurance as required by existing law; rates,Is between us and a member of our (2) The Commissioner of Insurance finds insurance group. that the exposure to potential losses b, If the policy has been extended for 90 will threaten our solvency or place us days or less, provided that notice has in a hazardous condition, A hazard- been given In accordance with Paragraph ous condition Includes, but Is not lim- C.1. Iced to, a condition in which we make claims payments for losses resulting c. If you have obtained replacement cover- from an earthquake that occurred age, or if the first Named Insured has within the preceding two years and agreed, in writing, within 60 days of the that required a reduction In policy- termination of the policy. to obtain that, holder surplus of at least 25% for coverage. payment of those claims;or d. If the policy is for a period of no more (3) We have: than 60 days and you are notified at the (a) Lost or experienced a substantial ln of issuance That it will not be re- (a) reduction in the availability or e. If the first Named Insured requests a scope of reinsurance coverage; or change in the terms or conditions or risks Experienced a substantial in- covered by the policy within 60 days of (b) P the end of the policy period. crease in the premium charged f. If we have made a written offer to the first for reinsurance coverage of our residential property insurance Named Insured, In accordance with the policies;and timeframes shown in Paragraph CA., to renew the policy under changed terms or the Commissioner has approved a conditions or at an Increased premium plan for the nonrenewals that Is fair rate,when the Increase exceeds 25%. and equitable,and that is responsive It,.02 70 09 12 0 Insurance Services Office, Inc.,2012 Page 3 of 3 Policy#:8108L2994772226G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph c. in A.1., Insurance of SECTION IV — BUSINESS AUTO Who Is An Insured,of SECTION II— COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement, that is signed by you before the applicable other insurance under which an "bodily injury" or "property damage" occurs and additional insured person or organization is a that is in effect during the policy period, to name named insured when a written contract or as an additional insured for Covered Autos agreement with you, that is signed by you before Liability Coverage, but only for damages to which the "bodily injury" or "property damage" occurs this insurance applies and only to the extent of and that is in effect during the policy period, that person's or organization's liability for the requires this insurance to be primary and non- conduct of another"insured". contributory. CA T4 99 02 16 u 2016 The Travelers Indemnity Company All rights reserved Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc with its permission Policy Number:DT22CO6K406874TCT23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAL➢FORNIA 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 Com- currence,after the effective dale of the policy, mon Polley Condition are replaced by the follow- of one or more of the following; ing: (1) Nonpayment of premium, including pay- 2. All Policies In Effect For 60 Days Or less ment due on a prior policy we issued and If this policy has been in effect for 60 days or due during the current policy term cover- less,and is not a renewal of a policy we have ing the same risks, previously issued, we may cancel this policy (2) Discovery of fraud or material misrepre- by mailing or delivering to the first Named In- sentation by: sured, at the mailing address shown in the (a) Any Insured or his or her represenla- policy,and to the producer of record,advance live In obtaining this Insurance:or written notice of cancellation, stating the rea- (b) You or your representative in pursu- son for cancellation,at least: ing a claim under this policy. a. 10 days before the effective dale of can- (3) A judgment by a court or an administra- cellation If we cancel for. i Nonpayment of premium;or live tribunal that you have violated a Cali- (1) fomia or Federal law, having as one of its (2) Discovery of fraud by: necessary elements an act which materi- (a) Any insured or his or her repre- ally Increases any of the risks insured sentative in obtaining this insur- against. ance:or (4) Discovery of willful or grossly negligent (b) You or your representative in acts or omisslons, or of any violallons of pursuing a claim under this pot- state laws or regulations establishing icy. safety standards, by you or your repre- sentative, which materially increase any b, 30 days before the effective date of can- of the risks Insured against. collation If we cancel for any other rea- son. (5) Failure by you or your representative to Implement reasonable loss control re- 3. All Policies In Effect For More Than 60 Days quirements, agreed to by you as a condi- a. If this policy has been in effect for more than lion of policy issuance, or which were 60 days,or is a renewal of a policy we issued, conditions precedent to our use of a par- we may cancel this policy only upon the oc- Gcular rate or rating plan, if that failure IL 02 70 0912 0 Insurance Services Office, Inc.,2012 Page 1 of 3 materially increases any of the risks in- b. We may not cancel this policy solely be- sured against, cause the first Named insured has: (6) A determination by the Commissioner of (1) Accepted an offer of earthquake cov- Insurance that the: erage;or (a) Loss of, or changes in, our reinsur- (2) Cancelled or did not renew a policy ance covering all or part of the risk issued by the California Earthquake would threaten our financial integrity Authority (CEA) that Included an or solvency;or earthquake policy premium sur- (b) Continuation of the policy coverage charge. would: However,we shall cancel this policy If the (1) Place us in violation of California first Named Insured has accepted a new law or the laws of the stale where or renewal policy issued by the CEA that we are domiciled;or Includes an earthquake policy premium surcharge but fails to pay the earthquake (11) Threaten our solvency. policy premium surcharge authorized by (7) A change by you or your representative In the CEA. the activities or property of the commer- c. We may not cancel such coverage solely cial or industrial enterprise, which results because corrosive sail conditions exist on in a materially added, increased or the premises. This restriction(c.) applies changed risk, unless the added, in- only If coverage is subject to one of the creased or changed risk is included in the following, which exclude loss or damage policy. caused by or resulting from corrosive soil b. We will mail or deliver advance written notice conditions: of cancellation, stating the reason for cancel- 1 lation, to the first Named Insured,at the mail- ( ) Commercial Property Coverage Part ing address shown in the policy, and to the —Causes Of Loss—Special Form;or producer of record,at least: (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Para- (1) 10 days before the effective date of can- graph D. Covered Causes Of Loss— celiallon If we cancel for nonpayment of Special. premium or discovery of fraud;or C. The following is added and supersedes any pro- (2) 30 days before the effective date of can- visions to the contrary: cellation If we cancel for any other reason Nonrenewal listed In Paragraph 3_a_ B. The following provision is added to the Cancella- 1- Subject to the provisions of Paragraphs C.2. tion Common Policy Condition: and C.3. below, If we elect not to renew this 7. Residential Property policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first This provision applies to coverage on real Named Insured shown in the Declarations, property which is used predominantly for and to the producer of record, at least 60 residential purposes and consisting of not days,but not more than 120 days, before the more than four dwelling units, and to cover- expiration or anniversary date. age on tenants' household personal property We will mail or deliver our notice to the first in a residential unit, if such coverage is writ- Named Insured, and to the producer of re- ten under one of the following: cord,at the mailing address shown In the pol- Commercial Property Coverage Part icy, Farm Coverage Part—Farm Property—Farm 2. Residential Property Dwellings, Appurtenant Structures And This provision applies to coverage on real Household Personal Property Coverage Form property used predominantly for residential a. If such coverage has been in effect for 60 purposes and consisting of not more than four days or less, and is not a renewal of cov- dwelling units, and to coverage on tenants' erage we previously issued, we may can- household property contained in a residential cel this coverage for any reason, except unit, if such coverage is written under one of as provided in b.and c.below. the following: Page 2 of 3 0 Insurance Services Office, Inc.,2012 IL 02 70 09 12 Commercial Property Coverage Part to the changes in our reinsurance po- Farm Coverage Part--Farm Property—Farm sition. Dwellings, Appurtenant Structures And c. We will not refuse to renew such cover- Household Personal Property Coverage Form age solely because the first Named in- a. We may elect not to renew such cover- sured has cancelled or did not renew a age for any reason,except as provided in policy, issued by the California Earth- b.,c.and d,below. quake Authority, that included an earth- b. age quake policy premium surcharge. will not refuse to renew such cover- d. We will not refuse to renew such cover- age solely because the first Named In- age solely because corrosive soil condi- queke coverage.ured has accepted an offer of earth- tions exist on the premises, This restrtc- lion (d.) applies only If coverage is sub- However,the following applies only to In- ject to one of the following,which exclude surers who are associate participating In- loss or damage caused by or resulting surers as established by Cal. Ins. Code from corrosive soil conditions: Section 10089.16, We may elect not to (1) Commercial Property Coverage Part renew such coverage after the first —Causes Of Loss—Special Form;or Named Insured has accepted an offer of earthquake coverage, if one or more of (2) Farm Coverage Part — Causes Of the following reasons applies: Lass Form — Farm Property, Para- (1) The nonrenewal is based on sound graph D.Covered Causes Of Loss— underwriting principles that relate to Special. the coverages provided by this policy 3. We are not required to send notice of nonre- and that are consistent with the ap- newal in the following situations: proved rating plan and related docu- a. If the transfer or renewal of a policy, wlth- ments filed with the Department of out any changes in terms, conditions or Insurance as required by existing law; rates,is between us and a member of our (2) The Commissloner of Insurance finds insurance group. that the exposure to potential losses b. If the policy has been extended for 90 will threaten our solvency or place us days or less, provided that notice has in a hazardous condition. A hazard- been given in accordance with Paragraph ous condition Includes, but is not lim- C.1. ited to,a condittan in which we make C. If you have obtained replacement cover- claims payments for losses resulting age, or if the firs! Named Insured has from an earthquake I occurred agreed, In writing, within 60 days of the within the preceding twoo years and that required a reduction in policy- termination of the policy, to obtaln that holder surplus of at least 25% for coverage. payment of those claims;or d. If the policy is for a period of no more (3) We have: than 60 days and you are notified at the time of issuance that it will not be re- (a) Lost or experienced a substantial newed. reduction in the availability or e, If the first Named Insured requests a scope of reinsurance coverage; change in the terms or conditions or risks or covered by the policy within 60 days of Jb) Experienced a substantial in- the end of the policy period. crease in the premium charged f. If we have made a written offer to the first for reinsurance coverage of our Named Insured, in accordance with the residential property insurance Gmeframes shown in Paragraph C.1., to policies:and renew the policy under changed terms or the Commissioner has approved a co.11dalons or at an increased premium plan for the nonrenewals that is fair rate,when the increase exceeds 25%. and equitable, and that is responsive IL 02 70 09 12 0 Insurance Services Office, Inc.,2012 Page 3 of 3 Policy#DT22CO6K406874TCT23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Aircraft Chartered With Pilot H. Blanket Additional Insured — Lessors Of Leased B. Damage To Premises Rented To You Equipment C. Increased Supplementary Payments 1. Blanket Additional Insured — States Or Political D. Incidental Medical Malpractice Subdivisions—Permits E. Who Is An Insured — Newly Acquired Or Formed J. Knowledge And Notice Of Occurrence Or Offense Organizations K. Unintentional Omission F. Who Is An Insured — Broadened Named Insured L. Blanket Waiver Of Subrogation —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT ABILITY: The following is added to Exclusion g., Aircraft, Exclusions c, and g. through n. do not apply Auto Or Watercraft, in Paragraph 2.of SECTION to "premises damage". Exclusion f.(1)(a) I — COVERAGES — COVERAGE A BODILY IN- does not apply to "premises damage" caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (a) Chartered with a pilot to any insured: c. Lightning, (b) Not owned by any insured; and d. Smoke resulting from such fire, explosion, (c) Not being used to carry any person or prop- or lightning; or erty for a charge. e. Water; S. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f, of Section I— Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion —All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted, clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III -- LIMITS OF IN- SURANCE. CG D3 16 11 11 C)2011 lhe'I ravelers lndernr1Ity .Ccnieany.All dgnls reserved, Page t of 6 1 t COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6, of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.1b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of ball bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies.We do not have to fur- fire; explosion; lightning; smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or 2• The following replaces Paragraph 1.d. of any combination of any of these causes. SUPPLEMENTARY PAYMENTS — COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D, INCIDENTAL MEDICAL MALPRACTICE 4. The fallowing replaces Paragraph a. of the 1. The following is added to the definition of"oc- definition of "insured contract" in the DEFINI- currence" in the DEFINITIONS Section: TIONS Section: "Occurrence" also means an act or omission a. A contract for a lease of premises, How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services"to a person. person or organization for "premises 2. The following is added to Paragraph 2.a.(1) of damage" is not an "insured contract"; SECTION II—WHO IS AN INSURED: 5. The following is added to the DEFINITIONS Paragraph (1)(d) above does not apply to Section: "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age"to: (i) "Incidental medical services" by any of a. Any premises while rented to you or tem- your "employees" who is a nurse practi- porarily occupied by you with permission tioner, registered nurse, licensed practical of the owner; or nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic; or premises is rented to you,if you rent such (rr First aid or"Good Samaritan services" by premises for a period of seven or fewer ) any of your "employees" or "volunteer consecutive days. workers", other than an employed or vol- 6. The following replaces Paragraph 4.b.(1)(b) unteer doctor. Any such "employees" or of SECTION IV — COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or "Good Samaritan ser- (b) That is insurance for "premises damage"; vices" during their work hours for you Wit or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 t 2011 The Travelers Indemnity Company.All rights reserved. CG 03 16 11 11 i COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE: other than a partnership, joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that Or- son will be deemed to be one"occurrence". ganization. However, 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Excluslons, of SECTION I — COV- only: ERAGES—COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (1) Until the 180th day after you acquire or Sale Of Pharmaceuticals form the organization or the end of the policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of, the insured. that date is later than 180 days after you 5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means; within 180 days after you acquire or form a. Medical, surgical, dental, laboratory,x-ray it, and we agree in writing that it will con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages; or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, denial, or surgical supplies or you acquired or formed the organization; and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received, formed the organization. 6. The following is added to Paragraph 4.1b., Ex- F. WHO IS AN INSURED —BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- The following is added to SECTION II — WHO IS TIONS: AN INSURED: The insurance is excess over any valid and collectible other insurance available to the in- Any of your subsidiaries, other than a partnership, sured, whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions Is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period, vices", first aid or "Good Samaritan services" No such subsidiary is an insured for"bodily injury" to any person to the extent not subject to or "property damage" that occurred, or "personal Paragraph 2.a.(1) of Section II — Who Is An injury" or "advertising injury" caused by an of- Insured, fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- The following replaces Paragraph 4. of SECTION sidiary II—WHO IS AN INSURED: CG D3 16 11 11 J 2011 The Travelers Indemnity Company Al!rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS; H. BLANKET ADDITIONAL INSURED —LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II —WHO IS The following is added to SECTION II —WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clUee as an additional insured on this Coverage this Coverage Part is an insured, but only with re- I Part is an insured, but only with respect to liability spect to liability for"bodily injury", "property dam- for "bodily injury", property damage", personal age", " u or"advertising injury"that: injury"or"advertising injury"that: g � personal injury" g in i ry, a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, or is personal injury" or advertising , injury" caused by an offense that is commit- injury' caused by an offense that is commit- ted, subsequent to the execution of that can- ted, subsequent to the execution of that con- tract or agreement; and tract or agreement; and b. Is caused, in whole or in part, by your acts or b. Arises out of the ownership, maintenance or omissions in the maintenance, operation or use of that part of any premises leased to use of equipment leased to you by such you. equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on =. vide in the written contract or agreement, or the Declarations,whichever are less. the limits shown on the Declarations, which- b. The insurance provided to such equipment ever are less. lessor does not apply to any"bodily injury" or b. The insurance provided to such premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury"or"advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is,committed, after the equipment j that occurs, or"personal injury"or"adver- lease expires. tising injury" caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises; or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to; or c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS—PERMITS the written contract or agreement that this in- The following is added to SECTION 11 — WHO IS surance must be primary to, or non- AN INSURED: contributory with, such other insurance, in which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 n 2011 The Travelers Indemnity'Corn parry.All rights reserved. CG D3 16 11 11 s COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include (h) A manager of any limited liability as an additional insured on this Coverage Part is company; or an insured, but only with respect to liability for (III)An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury" or"advertising injury"arising out of such op- erations. that is your partner, joint venture member or manager, or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury" or"advertising injury"arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision; or (3) Notice to us of such "occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as eluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., DVties In of the "occurrence" ar offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. (1) or(2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply. surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. However, if this Coverage Part includes an en- of Section Il —Who Is An Insured: dorsement that provides limited coverage for (1) Notice to us of such "occurrence" or of- "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of"pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- t is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual (if you are a limited liability K. UNINTENTIONAL OMISSION ! company), any of your "executive offi- cers" 1 cers"or directors (if you are an organiza- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL or limited liability company) or any "ern- GENERAL LIABILITY CONDITIONS; ployee" authorized by you to give notice The unintentional omission of, or unintentional of an "occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company, and none of your dice your rights under this insurance, However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence" or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations, rence"or offense is known by; L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership orjoint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 ©2011 Tie Travelers Indemnity Company,All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily Injury, mental ment to waive that insured's right of recovery anguish, mental injury, shock,Fright, disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Pa agraph c. of the b. "Personal injury" or "advertising injury" definition of"insured con;rao:" in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION aontracl" in the DEFINITIONS Section is de- leted. The following replaces the definition of bodily injury"in the DEFINITIONS Section: Page 6 of 6 CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY P01 1(.V NI IMgFR: DT22CO6K406874TCT23 ISSUE DATE: 3 -1 -23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ fr CAREFULLY DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Project Designated Project(s): General Aggregate(s); Each"project"for which you have agreed, in a written contract which is in effect during General Aggregate Umit shown on the Declarations. this policy period,to provide a separate General Aggregate Limit,provided that the contract is signed and executed by you before the"bodily injury"or'property damage"occurs. A. For all sums which the insured becomes legally 3. Any payments made under COVERAGE A obligated to pay as damages caused by "occur- for damages or under COVERAGE C. for rences" under COVERAGE A. (SECTION 1), and medical expenses shall reduce the Desig- for all medical expenses caused by accidents un- nated Project General Aggregate Limit for der COVERAGE C (SECTION 1), which can be that designated "project". Such payments attributed only to operations at a single desig- shall not reduce the General Aggregate Limit nated"project"shown in the Schedule above: shown in the Declarations nor shall they re- 1. A separate Designated Project General Ag- duce any other Designated Project General gregate Limit applies to each designated"pro- Aggregate Limit for any other designated ject', and that limit is equal to the amount of "project"shown in the Schedule above. the General Aggregate Limit shown in the 4. The limits shown in the Declarations for Each Declarations, unless separate Designated Occurrence, Damage To Premises Rented Project General Aggregate(s) are sched- To You and Medical Expense continue to uled above. apply. However, instead of being subject to 2. The Designated Project General Aggregate the General Aggregate Limit shown in the Limit is the most we will pay for the sum of all Declarations, such limits will be subject to the damages under COVERAGE A., except applicable Designated Project General Ag- damages because of"bodily injury" or"prop- gregate Limit. erty damage" included in the "products- B. For all sums which the insured becomes legally completed operations hazard", and for medi- obligated to pay as damages caused by "occur- cal expenses under COVERAGE C, regard- rences" under COVERAGE A. (SECTION 1), and less of the number of: for all medical expenses caused by accidents un- a. Insureds; der COVERAGE C. (SECTION 1), which cannot b. Claims made or"suits"brought; or be attrtbuted only to operations at a single desig- nated project shown in the Schedule above: c. Persons or organizations making claims or bringing"suits'. CG D2 1101 04 Copyright,The Travelers Indemnity Company,2004 Page 1 of 2 COMMERCIAL GENERAL LIABILITY 1. Any payments made under COVERAGE A. vided, any payments for damages because of for damages or under COVERAGE C. for "bodily injury" or "property damage" included in medical expenses shall reduce the amount the "products-completed operations hazard" will available under the General Aggregate Limit reduce the Products-Completed Operations Ag- or the Products-Completed Operations Ag- gregate Limit, and not reduce the General Aggre- gregate Limit, whichever is applicable;and gats Limit nor the Designated Project General 2. Such payments shall not reduce any Desig- Aggregate Limit. nated Project General Aggregate Limit. E. For the purposes of this endorsement the Defini- C. Part 2. of SECTION III—LIMITS OF INSURANCE dons Sectlon is amended by the addition of the is deleted and replaced by the following: following definition: 2. The General Aggregate Limit is the most we "Project" means an area away from premises will pay For the sum of: owned by or rented to you at which you are per- forming operations pursuant to a contract or a. Damages under Coverage B; and agreement. For the purposes of determining the b. Damages from "occurrences" under applicable aggregate limit of insurance, each COVERAGE A (SECTION 1) and for all "project" that includes premises involving the medical expenses caused by accidents same or connecting lots, or premises whose con- under COVERAGE C (SECTION 1)which nection is interrupted only by a street, roadway, cannot be attributed only to operations at waterway or right-of-way of a railroad shall be a single designated"project"shown in the considered a single "project". SCHEDULE above. F. The provisions of SECTION III — LIMITS OF D. When coverage for liability arising out of the INSURANCE not otherwise modified by this en- "products-completed operations hazard" is pro- dorsement shall continue to apply as stipulated. Page 2 of 2 Copyright,The Travelers Indemnity Company, 2004 CG D2 111 01 04 COMMERCIAL GENERAL LIABILITY DT22CO6K406874TCT23 c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares,we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us;and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However,this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured; and which covers such insured as a named insured, and we will not share with that other insurance, b. Separately to each insured against whom claim provided that: is made or"suit"is brought. (1) The"bodily injury" or"property damage"for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us.The insured must subsequent to the signing of that contract or do nothing after loss to impair them.At our request, agreement by you, the insured will bring "suit" or transfer those rights to us and help us enforce them. S. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part,we will Part in accordance with our rules and rates, mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only.At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured.The due date for audit and retrospective premiums is the date SECTION V—DEFINITIONS shown as the due date on the bill. If the sum of 1. "Advertisement'means a notice that is broadcast or the advance and audit premiums paid for the published to the general public or specific market policy period is greater than the earned segments about your goods, products or services premium, we will return the excess to the first for the purpose of attracting customers or Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication;and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services By accepting this policy,you agree: for the purposes of attracting customers or supporters is considered an advertisement Page 16 of 21 ©2017 The Travelers Indemnity Company.All rights reserved CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc with its permission Policy#DT22CO6K406874TCT23 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART t. WHO IS AN INSURED — (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by "your work" to include as an additional insured on this Cover- and included in the "products-completed op- age Part, but: erations hazard" unless the "written contract a) Only with respect to liability for "bodily injury", requiring insurance" specifically requires you "property damage"or personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ante" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier_ or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", the in- "written contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- avlailablerance is primary to "other to the additional assured which covers ovens surance . This endorsement shall not in- crease the limits of insurance described in that person or organization as a named insured Section III—Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured bY this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such "other insur- i. The preparing, approving, or failing to ante". prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- rence" or an offense which may result in a ii. Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the 'occurrence" any provider of"other insurance"which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to 'other insur- damage arising out of the"occurrence"or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or"suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above. must; 5. The following definition is added to SECTION V. 1. Immediately record the specifics of the —DEFINITIONS: claim or"suit"and the date received;and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a receive written notice of the claim or"suit"as person or organization as an additional in- sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the"personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or"suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect; and fense and indemnity of any claim or "suit"to c. Before the end of the policy period. Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 -� OP ID:CO A' DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06127M023 THISAND CONFERS NO RIGHTS UPON THE CERTIF CERT F CATECATE DOES NOT A FIRMAT VE YIS ISSUED AS AEOR NEGATIVELY AMENDOF INFORMATION ONL,EXTEND OR ALTER THE COVERAGE A FORDE(DATE BY THE POLIC EIS 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 ceRifleate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, if SU9ROGAT[ON 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). coNSACT P NAM : Steve Mahlum PRODUCER MVP Premier Insurance Agency PHorIE 559-324-7333 we No),559.324-7338 1843 E.Fir Avenue Suite 102 E MpIL Fresno,CA 93720 sieve InsurancernV .Cant Steve Mahlum PiRlo5T4gJ .EMMET-1 INSURE S AFFORDING COVERAGE fFAiC N INSURED Emmetts Excavation Inc INSURERA:State Com ensation Ins.Fund 35076 1477 Menlo Ave INSURERS. Clovis,CA 93611 INSURERC: INSURER D: SNSU RER E- IN R F COVERAGES CERTIFICATE NUMBER: 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. ADDL SUB PDLICY EFF POLICY EXP DMA ILf TYPEOFINSURANCE POLiCYNLASBER M D ❑ TR GENERAL LIABILITY EACH O"WRRENCE S commERCIAL GENERAL LWBILITY PREMISES EaOa`v<rcnce $ CLAIMS40ADE OCCUR MEDEXP aneperton] S PERSONAL&ADV INJURY S GENERAL AGGREGATE S PRODUCTS-COMP/OP AGG S GEN'L AGGREGATE LIMIT APPLIES PER: $ PDLf'Y PRO• LDC COMBINED SINGLE LIMIT S AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S (PER ACCIDENT) HIRED AUTOS 5 NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACHaCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5 DEDUCTIBLE S RETENfICN 5 X WO5TRTU- OTH• WORXERSCOMPENSATION AND EMPLOYERS'LIABILITY YIN 1,000,00 A ANYPROPRIMPJPARTNEWE%ECuTwE gt 963'22 10/0112022 10101/2023 E.L,£p,CHRCG7aEN'F $ NIA X OFF1 S"EM9ER EXCLUUEW' E.L.p15EASE-EA EMPLOYE $ 1,000,OD (Mandatory In His) 1,000 00 ya rWla un E.L.DISEASE-POLICY U1Si7 S r bIf E aSCR. IsengTIONo OF OderPERATI gCti1S tlflWOW DESC RIP11ON OF OPERATIONS I LOCATIONS I VEHICLES y(Aniach ACORD 101.Additional Renurks Schtdule.If mare space Is required) JOProject Blac stonPWOAvenue ve ue Fie fMcKin%Avenue Transit oriented Development Blanket waiver of subrogation applies as per form#2572 attached. CERTIFICATE HOLDER CANCELLATION CITYFR2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF FRESNO,CONSTRUCTION MANAGEMENT DIVISION IAUTHORIZED REPRESENTATIVE ATT. MARYANN LEWIS 1721 VAN NESS AVE iFRESNO.CA 93721 91988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS Page 1 HOME OFFICE SAN FRANCISCO 9143965-22 ALL EFFECTIVE DATES RENEWAL AT 12:01 AM PACIFIC STANDARD TIME ORTHE TIME INDICATED ATT EFFECTIVE October 1, 2022 AT 12 :01 AM. Central Valley Fresno PACIFIC STANDARD TIME AND EXPIRING October 1, 2023 AT 12 :01 AM 2444308 EMMETT'S EXCAVATION,INC 1477 MENLO AVE CLOVIS,CA 93611 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. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2 . 00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF SUBROGATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY,ALTER,WAIVE OR EXTEND ANY OF THE TERMS,CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED.NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY,ALTER,WAIVE OR LIMIT THE TERMS,CONDITIONS,AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT COUNTERSIGNED AND/ISSUED AT SAN FRANCISCO:September 30,2022 AUTHORIZED REPRESENTATIVE PRESIDENT AND CEO 2572 SCIF FORM 10217(REV.4-201B) OLD DP 217 EMMEEXC-01 NLIMON A�oRo CERTIFICATE OF LIABILITY INSURANCE DATE 1 / DIY 710/210/2023 3 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. 1 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 NAM ACT _ Fresno CSG-Alliant Insurance Services,Inc. PHONE 9 E River Park Place East Ste 310 AIG He,Ex 559 374-3560 F4AlC,Ha Af Fresno,CA 93720 NI�DRes INSUPERJSI AFFORDING COVERAGE NAM 0 INSURER A:Westchester Surplus Lines Insurance Corn a 10172 INSURED INSURER B: Emmetts Excavation Inc INSURERC: 1477 Menlo INSURER D: Clovis,CA 93611 INSURER E INSURER F: COVERAGES CERTIFlCATE NUMBER: 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 TYPE OF INSURANCE INSD AUDLIWURR POLICY NUMBER PO EFF PQLICY E%P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. s CLAIMS-MADE OCCUR PJ..�Tp1t RENTED e .S MED EXP JAnY one PI PERSQNAL& INJURY S GEN'LA[3GREGATE LIMIT APPLIES PER: GENFIRALAGGREGATE POLICY PRO- JECT LOC PRODUCTS-CQMp_t0PAGG S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S ANY AUTO BODiLY INJURY Per neon S OWNED I SCHEDULED AUTOS ONLY AUTOS BODILY]NJURY I Per acdoeml S HIRED NON-OWNED yRRO=I MAGE S AUTOS ONLY ;AUTOS ONLY UMBRELLA LIAR OCCUR EACH OCCURR NCE s EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ WORKERS COMPENSATION PER 'NE AND EMPLOYERS'LiASRJTY Y f N ANY F{{PROPRiETgO�"ARTNEWEXECUTIVE NIA E.L.EACH ACCIDENT S [Marldatary�n NFt) C{UDEO7 E-L DISEASE-EA EMPLQVE15 S Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY-ima 5 A :Pollution Liability X I X 674395430001 71512023 715/2024 �Aggr$2,000,00010cc 1,000,000 I DESCRIPTION OF OPERATIONS+LOCATIONS/VEHICLES(ACORD 101.Additional Remarks Schedule,maybe attached if more space is required) Re:PW00926 Blackstone and McKinley Transit Oriented Degelopement he City of Fresno,its officers,officials,employees,agents and volunteers are additional insureds as respects to Pollution Liability.This insurance is primary, and our obligations are not affected by any other insurance carried by such additional insured whether primary,excess,contingent,or on any other basis. Endorsement attached: Pollution Additional Insured-Ongoing Operations SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. Construction Management Division 1721 Van Ness Avenue Fresno,CA 93721 AUTHORIZED REPRESENTATIVE( ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:EMMEEXC-01 NLIMON LOC#: A Da — ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY ( NAMED INSURED Fresno CSG-Alliant Insurance Services,Inc. 1477 M s Excavation Inc 477 Menlo POLICY NUMBER Clovis,CA 93611 SEE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: Pollution Completed Operations Pollution Primary Pollution Waiver of Subrogation ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Westchester A Chubb Company ADDITIONAL INSURED ENDORSEMENT- PRODUCTS-COMPLETED OPERATIONS HAZARD Named Insured Endorsement Number Emmetts Excavation Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW I G74395430 001 07/05/2023 to 07/05/2024 07/05/2023 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Q anintion s: As required by written contract,prior to a loss to which this insurance applies. (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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for injury or damage, to which this insurance applies, caused by or resulting from your work performed for that additional insured and included in the products-completed operations hazard, and only to the extent that such injury or damage is caused,in whole or in part,by your negligence or the negligence of those acting on your behalf. However: I. 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: i. 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. All other terms and conditions of this policy remain unchanged. ENV-3251(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 1 (221012.2) Westchester A Chubb Company ADDITIONAL INSURED ENDORSEMENT—ONGOING WORD OR OPERATIONS Named Insured Endorsement Number Emmetts Excavation Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G74395430 001 07/05/2023 to 07/05/2024 ' 07/05/2023 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE: Name of Persons)or 0 Mn ization(s):As required by written contract,prior to a loss to which this insurance applies. (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 include as an additional insured the persons or organizations shown in the Schedule,but only with respect to liability for injury or damage,to which this insurance applies,caused in,whole or in part,by: 1. Your acts or omissions;or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insureds. However: i. 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 exclusion is added: Exclusions This insurance does not apply to injury or damage occurring after: a. All work or operations,including materials,parts or equipment furnished in connection with such work or operations, on the project (other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed; or b. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the additional insured as a part of the same project. ENV-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 2 (221012.1) Westchester A Chubb Company C. 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. All other terms and conditions of this policy remain unchanged. ENV-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 2 of 2 (22ioi2.1) Named Insured Endorsement Number Emmetts Excavation Inc Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW j G74395430 001 07/05/2023 to 07/05/2024 07/05/2023 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization:As required by written contract, prior to a loss to which this insurance applies. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143(03-05) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 1 Westchester A Chubb Company PRIMARY AND NONCONTRIBUTORY—OTHER INSURANCE CONDITION Named Insured Endorsement Number Emmetts Excavation Inc Policy Symbol Policy Number F07105/2023 licy Period Effective Date of Endorsement CPW G o ooi to 07 ❑ 2❑ o. ❑ 20 Issued By(Name of Insurance Company) Westchester Su lus Lines Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This policy 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 a written contract or agreement that this insurance would: (1) act as primary insurance;and (2)would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. ENV-3�53(iz-i8) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of i (266562.2) ❑ Illinois Union Insurance Company ®Westchester Surplus Lines Insurance Company Insured: Emmetts Excavation Inc Attached To Policy No.: G74395430 001 Effective Date: 07/05/2023 CALIFORNIA SURPLUS LINES NOTIFICATION IMPORTANT NOTICE: i. The insurance policy that you (have purchased) (are applying to purchase) is being issued by an insurer that is not licensed by the State of California. These companies are called "nonadmitted" or "surplus line" insurers. 2. The insurer is not subject to the financial solvency regulation and enforcement that apply to California licensed insurers. 3. The insurer does not participate in any of the insurance guarantee funds created by California law. Therefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised. 4. The insurer should be licensed either as a foreign insurer in another state in the United States or as a non- United States (alien) insurer. You should ask questions of your insurance agent, broker, or "surplus line" broker or contact the California Department of Insurance at the toll- free number 1-8oO-927-4357 or internet website www.insurance.ca.gov. Ask whether or not the insurer is licensed as a foreign or non-United States (alien) insurer and for additional information about the insurer. You may also visit the NAIC's internet website at www.naic.org. The NAIC—the National Association of Insurance Commissioners—is the regulatory support organization created and governed by the chief insurance regulators in the United States. 5. Foreign insurers should be licensed by a state in the United States and you may contact that state's department of insurance to obtain more information about that SL-17888 (Ed 01/20) Page 1 of insurer. You can find a link to each state from this NAIC internet website: https://naic.org/state_web_map.htm. 6. For non-United States (alien) insurers, the insurer should be licensed by a country outside of the United States and should be on the NAIC's International Insurers Department (IID) listing of approved nonadmitted non- United States insurers. Ask your agent, broker, or "surplus line" broker to obtain more information about that insurer. 7. California maintains a "List of Approved Surplus Line Insurers (LASLI)." Ask your agent or broker if the insurer is on that list, or view that list at the internet website of the California Department of Insurance: www.insurance.ca.gov/o i-consumers/i2o-company/o7- lasli/lasli.cfm. 8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker's fee charged for this insurance will be returned to you. NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, OR LIMITATIONS OF THE POLICY TO WHICH THIS NOTICE IS ATTACHED OTHER THAN AS STATED ABOVE. Applicant Signature SL-17888 (Ed.01/20) Page 2 of 2 i Binder— G74395430 001 Date: July 6, 2023 Producer: Insured: AMWINS INSURANCE BROKERAGE OF CALIFORNIA LLC Emmetts Excavation Inc 444 S FLOWER ST, SUITE 4500 1477 Menlo Avenue LOS ANGELES, CA 90071 Fresno, CA 93611 Attention: Jenifer Oshita Email: jen.oshita@amwins.com Please read this binder carefully, as the limits, coverage and other terms and conditions may vary significantly from those requested in your submission and/or from the expiring policy. Terms and conditions that are not specifically mentioned in this binder are not included. The terms and conditions of this binder supersede the submitted insurance specifications and all prior proposals and binders. Actual coverage will be provided by and in accordance with the policy as issued. The insurer is not bound by any statements made in the submission purporting to bind the insurer unless such statement is reflected in the policy or in an agreement signed by someone authorized to bind the insurer. This binder has been constructed in reliance on the data provided in the submission. A material change or misrepresentation of that data voids this binder. Company: Westchester Surplus Lines Insurance Company -AM Best Rating A++XV Coverage: Contractors Pollution Liability Coverage Form-Occurrence Limits of Liability: Deductible: Deductible Basis: Retroactive ` Date: Contractors Pollution Each Pollution Not Liability—Each Pollution $1,000,000 $2,500 Condition Applicable Condition _ General Aggregate: $2,000,000 (The most the insurer will pay for the sum of damages under all Coverag Parts) Policy Period: 07/05/2023-07/05/2024 Exposure: $2,649,222 Premium: $2,796 Rate: Flat/Non Auditable TRIA Premium—Charge-, $0 Total Premium: $2,796 TR/A has been accepted. Commission: 10% California Premium: $2,796.00 Non-Taxable Fees: $75.00 Covered Locations: Not Applicable Taxable Fees: Surplus Lines Tax: $83.88 Stamping Fee: $5.03 Insurance Company Forms: SL-17888 (01/20) California Surplus Lines Notification ENV-1200 (03/10) Contractors Pollution Liability Insurance Policy-Occurrence- Elite ENV-1231 (04/18) Non-Owned Disposal Site(s) Coverage Endorsement-Occurrence ENV-3103 (12/10) All Known or Reported Incidents Exclusion ENV-3121 (08/04) Limitation To Designated Project Endorsement ENV-3130 (11/13) Prior Operations Exclusion ENV-3137 (08/04) Separate Defense Limit Endorsement-Contractors Pollution Liability Coverage ENV-3143 (03/05) Waiver of Transfer of Rights of Recovery Against Others to Us ENV-3146 (09/22) Transportation Pollution Liability Coverage Endorsement ENV-3147 (10/12) Global Program Solutions Amendatory (Foreign Indemnity) Endorsement ENV-3190 (07/06) Policy Period Amended - For Products-Completed Operations Hazard Coverage Only ENV-3213 (04/20) Mold Sublimit Endorsement-Contractors Pollution Liability ENV-3236 (03/15) Professional Liability Exclusion Amendment Endorsement ENV-3239 (10/21) Policy Changes Endorsement ENV-3244 (04/18) Catastrophe Management Coverage Endorsement ENV-3250 (12/18) Additional Insured Endorsement-Ongoing Work Or Operations ENV-3251 (12/18) Additional Insured Endorsement- Products-Completed Operations Hazard ENV-3253 (12/18) Primary And Noncontributory-Other Insurance Condition ENV-5100 (06/11) Asbestos Amendatory Endorsement ENV-5102 (10/04) Nuclear Hazard Liability Exclusion ENV-5521 (09/04) Earned Premium Endorsement- 100% Minimum Earned ALL-21101 (11/06) Trade or Economic Sanctions Endorsement ENV-9970 (01/15) Cap on Losses From Certified Acts of Terrorism ENVM-484 (03/22) Designated Country Limitation Endorsement SL-34255b (04/23) Service of Suit Endorsement TR-45231 a (08/20) Policyholder Disclosure- Notice of Terrorism Insurance Coverage The bound coverage is subject to the receipt and satisfactory review of the following information within thirty(30)days unless otherwise noted: Additional Terms and Conditions: 1. The producer shall be responsible for all applicable surplus lines filings and taxes (Amwins will handle). 2. Premium is due (20) days from the effective date of coverage. 3. The proposed coverage shall be 100% minimum earned at inception. 4. PLEASE NOTE THAT FOR POLICIES EFFECTIVE JULY 21, 2011 AND SUBSEQUENT,WE REQUIRE THE PRODUCER TO PROVIDE THE "HOME STATE"AS DEFINED IN THE NONADMITTED AND REINSURANCE REFORM ACT(NRI;A) UPON BINDING OF THIS PLACEMENT 5. Please be advised that we do not review Certificates of Insurance issued by you, or by any party, relating to this policy of insurance either for content or accuracy. Accordingly, we request that you do not provide copies of certificates to us for review or for our records. Authority is granted to you for the limited purpose of issuing unmodified ACORD Certificates (ACORD 25). It is your responsibility to see that any Certificate provides an accurate representation of the coverage form and endorsements applicable to this policy at the time the Certificate is issued. Any modification of the approved ACORD forms specifically set forth above, or the issuance of a non-approved Certificate of Insurance (ACORD or other) is prohibited. Certificates of Insurance may only be issued as a matter of information. You have no authority by virtue of a Certificate or otherwise, to amend, extend or otherwise alter coverage afforded under this policy. Certificates of Insurance are never recognized as endorsements or policy change requests. You must submit a separate written request if an endorsement or policy change (including but not limited to adding additional insureds or loss payees and/or alteration of notice requirements for cancellation) is requested. In the event a policy change is requested, the underwriter will advise if the request is acceptable to the Company. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM Named Insured Endorsement Number Emmetts Excavation Inc Policy Symbol rPoricy Number Policy Period Effective Date of Endorsement CPW I G74395430 001 07/05/2023 to 07/05/2024 07105/2023 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. With respect to any "terrorism", "hostile acts"or"war" exclusions contained in this Policy, or attached to this Policy by endorsement, as applicable, such exclusions do not apply to a "certified act of terrorism", as defined in Paragraph C. below. B. 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. C. Certified act of terrorism means an act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security and the Attorney General of the United States, to be an act of terrorism pursuant to the federal Terrorism Risk Insurance 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: D. The provisions contained in Paragraphs A., B., and C. above, of this endorsement will no longer be applicable commencing on the date when any one or more of the following first occurs. But if your Policy(meaning the Policy period in which this endorsement applies) begins after such date, then the provisions of this endorsement become applicable on the date your Policy begins. 1. The federal Terrorism Risk Insurance Program ("Program"), established by the Terrorism Risk Insurance Act, has terminated with respect to the type of insurance provided under this Coverage Part or Policy, as applicable; or 2. A renewal, extension or replacement of the Program has become effective without a requirement to make terrorism coverage available to you and with revisions that: (a) Increase our statutory percentage deductible Lander the Program for terrorism losses. (That deductible determines the amount of all certified terrorism losses we must pay in a calendar year, before the federal government shares in subsequent payment of certified terrorism losses.); or (b) Decrease the federal government's statutory percentage share in potential terrorism losses above such deductible; or (c) Redefine terrorism or make insurance coverage for terrorism subject to provisions or requirements that differ from those that apply to other types of events or occurrences under this Policy. All other terms and conditions of this Policy remain unchanged. ENV-9970 (01-15) ©Chubb 2016.All rights reserved. Page 1 of 1 Emmetts Excavation Inc Policyholder POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is included in your policy. You are hereby notified that under the Terrorism Risk Insurance Act, as amended, the definition of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act or acts that are certified by the Secretary of the Treasury---in consultation with the Secretary of Homeland Security, and the Attorney General of the United States---to be an act of terrorism; to be a violent act or 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 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. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. 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 generally reimburses 80% of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The Terrorism Risk Insurance Act, as amended, contains a $100 billion 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 exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed$100 billion, your coverage may be reduced. The portion of your term premium that is attributable to coverage for acts of terrorism is $0, and does not include any charges for the portion of losses covered by the United States government under the Act. TR-45231 a(08/20)