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25-003 Thermal Mechanical Inc for On-call heating, air conditioning and ventilation services at various City facilitiesOn-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 1 of 12 ON-CALL PUBLIC WORKS CONTRACT WITH THERMAL MECHANICAL, INC 1. PARTIES This On-Call Public Works Contract (“Contract”) is made by and between the City of Cupertino, a municipal corporation (“City”), and Thermal Mechanical, Inc (“Contractor”) a Corporation for On- call heating, air conditioning and ventilation services at various City facilities, and is effective on the last date signed below (“Effective Date”). 2. SCOPE OF WORK 2.1 Scope of Work. Contractor will perform and provide all labor, materials, equipment, supplies, transportation and any other items or work necessary to perform and complete the work described in the Scope of Work (“Work”), attached and incorporated here as Exhibit A, on an as- needed basis. The Work must comply with this Contract and with each Service Order issued by the City’s Project Manager or his/her designee, in accordance with the following procedures, unless otherwise specified in Exhibit A. Contractor further agrees to carry out its work in compliance with any applicable local, State, or Federal order regarding COVID-19. 2.2 Service Orders. Before issuing a Service Order, the City Project Manager will request that Work be done in writing and hold a meeting with Contractor to discuss the Service Order. Contractor will submit a written proposal that includes a specific Scope of Work, Schedule of Performance, and Compensation, which the Parties will discuss. Thereafter, City will execute a Service Order Form for the Work, attached and incorporated here as Exhibit B. The Service Order will specify the Scope of Work, Schedule of Performance, Compensation, and any other conditions applicable to the Service Order. Issuance of a Purchase Order is discretionary. The City Project Manager is authorized to streamline these procedures based on the City’s best interests. In particular, in emergency situations, the City Project Manager may execute a Service Order for emergency work based on oral conversations with the Contractor, without adhering to the full process outlined in this section. Contractor will not be compensated for Work performed without a duly authorized and executed Service Order. 3. TIME OF PERFORMANCE 3.1 Term. This Contract begins on the Effective Date and ends on June 30, 2027 (“Contract Time”), unless terminated earlier as provided herein. The City’s appropriate department head or City Manager may extend the Contract Time through a written amendment to this Contract, provided such extension does not include additional contract funds. Extensions requiring additional contract funds are subject to the City’s purchasing policy. 3.2 Schedule of Performance. Contractor must complete the Work within the time specified in each Service Order, and under no circumstances should the Work go beyond the Contract Time. On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 2 of 12 3.3 Time is of the essence for the performance of all the Work required in this Contract and in each Service Order. Contractor must have sufficient time, resources, and qualified staff to deliver the Work on time. Contractor must respond promptly to each Service Order request. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work based upon actual costs and capped so as not to exceed $60,000.00 (“Contract Price”), based upon the Scope of Work in Exhibit A and the budget and rates included. The maximum compensation includes all expenses and reimbursements and will remain in place even if Contractor’s actual costs exceed the capped amount. 4.2 Per Service Order. Compensation for Work provided under a Service Order will be based on the rates set forth in the Service Order, which shall not exceed the capped amount specified in the Service Order. 4.3 Invoices and Payments. Contractor must submit an invoice on the first day of each month, describing the Work performed during the preceding month, itemizing labor, materials, equipment, and any incidental costs incurred. Contractor will be paid ninety-five percent (95%) of the undisputed amounts billed within thirty (30) days after City receives a properly submitted invoice. Any retained amounts will be included with Contractor’s final payment within sixty (60) days of City’s acceptance of the Work pursuant to a specific Service Order as complete. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee, partner, or joint venture of City. Contractor is solely responsible for the means and methods of performing the Work and for the persons hired to work under this Contract. Contractor is not entitled to health benefits, worker’s compensation, or other benefits from the City. 5.2 Contractor’s Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Work as required by law and have procured a City Business License, if required by the Cupertino Municipal Code. Contractor shall possess a California Contractor’s License in good standing for the following classification(s): C20, which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor’s employees are authorized to work under this Contract. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials, and Equipment. Contractor will supply all tools, materials, and equipment required to perform the Work under this Contract. On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 3 of 12 5.6 Payment of Benefits and Taxes. Contractor is solely responsible for the payment of employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and any of its employees, agents, and subcontractors shall not have any claim under this Agreement or otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off, overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability, unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to Contractor’s business including, but not limited to, federal and state income taxes. City shall have no obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. In the event that Contractor or any employee, agent, or subcontractor of Contractor providing services under this Agreement is determined by a court of competent jurisdiction, arbitrator, or administrative authority, including but not limited to the California Public Employees Retirement System (PERS) to be eligible for enrollment in PERS as an employee of City, Contractor shall indemnify, defend, and hold harmless City for the payment of any employee and/or employer contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on such contributions, which would otherwise be the responsibility of City, and actual attorney’s fees incurred by City in connection with the above. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor’s request for a change order must specify the proposed changes in the Work, Contract Price, and Contract Time. Each request must include all the supporting documentation, including but not limited to plans/drawings, detailed cost estimates, and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign, hypothecate, or transfer this Contract or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs, successors, and permitted assigns. 8. PUBLICITY / SIGNS Any publicity generated by Contractor for the Project during the Contract Time, and for one (1) year thereafter must credit City contributions to the Project. The words “City of Cupertino” must be displayed in all pieces of publicity, flyers, press releases, posters, brochures, interviews, public service announcements, and newspaper articles. No signs may be posted or displayed on or about City property, except signage required by law or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces, except that Contractor may hire On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 4 of 12 qualified subcontractors to perform up to 25% of the Work under any give Service Order, provided that each subcontractor is required by contract to be bound by the provisions of this Contract and any applicable Service Order. Contractor must provide City with written proof of compliance with this provision upon request. 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor’s Work falls short of the requirements of this Contract or constitutes grounds for rejection under the Public Contract Code. If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor’s Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within fifteen (15) days after City accepts the Work under a particular Service Order if the Work involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Work pursuant to a Service Order. The reports must describe the Work and specific tasks performed, the number of workers, the hours, the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the reports, but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical, electrical and plumbing work; HVAC systems; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail, and the location of all main runs, piping, conduit, ductwork, and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles, which must be available for City review and audit, kept separate from other records, and maintained for four (4) years from the date of City’s final payment. 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants, volunteers, and Contractors (“Indemnitees”), through legal counsel acceptable to City, from and against any and all liability, damages, claims, actions, causes of action, demands, charges, losses, costs, and expenses (including attorney fees, legal costs, and expenses related to litigation and dispute resolution proceedings), of every nature, arising directly or indirectly from this Contract or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the C ontract by On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 5 of 12 Contractor, its employees, agents, servants, or subcontractors; (c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and (d) Personal injury, property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim, in accordance with California Public Contract Code Section 9201. At City’s request, Contractor will assist City in the defense of a claim, dispute, or lawsuit arising out of this Contract. 11.3 Contractor’s duties under this entire Section 11 are not limited to Contract Price, Workers’ Compensation, or other employee benefits, or the insurance and bond coverage required in this Contract. Nothing in the Contract shall be construed to give rise to any implied right of indemnity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor’s payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract, a purchase order or other transaction. 11.5 Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in this Section 11 from each and every subcontractor, or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this Contract. Failure of City to monitor compliance with these requirements imposes no additional obligations on City and will in no way act as a waiver of any rights hereunder. 11.6 This Section 11 shall survive termination of the Contract. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit C, and must maintain the insurance for the Contract Time, or longer as required by City. City will not execute the Contract until City approves receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance for Contractor and deducting the costs from Contractor’s compensation or terminating the Contract. 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all local, state, and federal laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor’s ability to perform. Contractor is responsible for verifying the employment authorization of employees performing the Work, as required by the Immigration Reform and Control Act. 13.2 Labor Laws. a. The following provisions apply to any Service Order of $1,000 or more: On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 6 of 12 i.In General. For purposes of California labor law, this is a public works contract subject to the provisions of Part 7 of Division 2 of the California Labor Code (Sections 1720 et seq.). In accordance with Labor Code Section 1771, Contractor and all subcontractors shall pay not less than current prevailing wage rates as determined by the California Department of Industrial Relations (“DIR”) to all workers employed on this project. In accordance with Labor Code Section 1815, Contractor and all subcontractors shall pay all workers employed on this project 1 ½ the basic rate of pay for work performed in excess specified hour limitations. The work performed pursuant to this Contract is subject to compliance monitoring and enforcement by the Department of Industrial Relations. ii.Registration. Contractor and all subcontractors shall not engage in the performance of any work under this Contract unless currently registered and qualified to perform public work pursuant to section 1725.5 of the California Labor Code. Contractor represents and warrants that it is registered and qualified to perform public work pursuant to section 1725.5 of the Labor Code and will provide its DIR registration number, along with the registration numbers of any subcontractors as required, to the City. iii.Posting. Contractor shall post at the job site the determination of the DIR director of the prevailing rate of per diem wages together with all job notices that are required by regulations of the DIR. iv.Reporting. Contractor and any subcontractors shall keep accurate payroll records in accordance with Section 1776 of the Labor Code and shall furnish the payroll records directly to the Labor Commissioner in accordance with the law. v.Report on Prevailing Rate of Wages. The City has obtained the general prevailing rate of per diem wages in the vicinity of the project for each type of worker needed, a copy of which is on file at the City of Cupertino City Hall, and shall be made available to any interested party upon request. vi.Employment of Apprentices. Contractor’s attention is directed to the provisions in Sections 1777.5 and 1777.6 of the Labor Code concerning the employment of apprentices by the Contractor or any subcontractor. It shall be the responsibility of the Contractor to effectuate compliance on the part of itself and any subcontractors with the requirements of said sections in the employment of apprentices. Information relative to apprenticeship standards, wage schedules, and other requirements may be obtained from the Director of Industrial Relations, ex-officio the Administrator of Apprenticeship, San Francisco, California, or from the Division of Apprenticeship Standards and its branch offices. vii.Penalties. Contractor’s attention is directed to provisions in Labor Code Sections 1775 and 1813. In accordance with Labor Code Section 1775, Contractor and subcontractors may be subject to penalties for Contractor’s and subcontractors’ failure to pay prevailing wage rates. In accordance with Labor Code Section 1813, Contractor or subcontractors may be subject to penalties for Contractor’s or subcontractors’ failure to pay overtime pay rates for hours worked by workers employed on this project in excess specified hour limitations. b. Contractor must compensate workers who are paid less than prevailing wages or required to work more than a legal day’s work. Contractor will also be required to pay City a penalty of $200.00 per worker for each day of violation. c. As required by Labor Code Section 1861, by signing this Contract Contractor certifies as follows: “I am aware of the provisions of Section 3700 of the Labor Code which require On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 7 of 12 every employer to be insured against liability for workers’ compensation or to undertake self- insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the work of this contract.” 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race, religious creed, color, ancestry, national origin, ethnicity, handicap, disability, marital status, pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS), or any other protected classification. Contractor shall comply with all anti-discrimination laws, including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777, and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor’s employees or subcontractors will not be tolerated. Contractor agrees to provide records and documentation to the City on request necessary to monitor compliance with this provision. 13.4 Conflicts of Interest. Contractor, its employees, subcontractors, servants, and agents, may not have, maintain, or acquire a conflict of interest in relation to this Contract in violation of law, including Government Code section 1090 and Government Code section 81000 and their accompanying regulations. No officer, official, employee, consultant, or other agent of the City (“City Representative”) may have, maintain, or acquire a “financial interest” in the Contract, as that term is defined by state law, or in violation of a City ordinance or policy while serving as a City Representative or for one year thereafter. Contractor, its employees, subcontractors, servants, and agents warrant they are not employees of City nor do they have any relationship with City officials, officers, or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity, as defined in Section 18700 of Title 2 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of this Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursements, or terminating this Contract. City reserves all other rights and remedies available under the law and this Contract, including the right to seek indemnification under Section 11 of this Contract. 14. BONDS For any Service Order of $25,000 or more, Contractor must obtain a payment bond and a performance bond, each in the penal sum of 100% of the compensation pursuant to the Service Order, using the Bond Forms attached and incorporated here as Exhibit D. Each bond must be issued by a surety admitted in California, with a financial rating from A.M. Best Company of Class A- or higher, or as otherwise acceptable to City. If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a surety acceptable to City within seven (7) calendar days after written notice from City. If Contractor fails to do so, City may in its sole discretion and without prior notice, purchase bonds at Contractor’s expense, deduct the cost from payments due Contractor, or terminate the Service Order or Contract. City will not authorize work under a Service Order until the required bonds are submitted. On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 8 of 12 15. UTILITIES, TRENCHING, AND EXCAVATION 15.1 Contractor must call the Underground Service Alert (“USA”) 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits, City’s Service Center must be called at (408) 777- 3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing, and wait for instructions if one of the conditions below is found at the worksite. City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believed to be hazardous waste under Health and Safety Code Section 25117, and which requires removal to a Class I, Class II, or Class III disposal site pursuant to law; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor; and (c) Unknown physical conditions at the Project worksite of any unusual nature, materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For Service Orders where compensation is $25,000 or higher that require excavation or involve trenches five feet or more in depth, Contractor must submit a detailed plan for City approval, per Labor Code Section 6705, prior to commencing work. The plan must show the design of shoring, bracing, sloping, and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards, it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal, state, and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets, gutters, and storm drains. Prior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of storm drains, and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at the end of construction and completion of the Work. Such controls must include, but will not be limited to, the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences, and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season, October 15 through June 15, storm drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum saw-cut slurry and remove from the Work site; (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 9 of 12 (c) Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain and at the end of each work day. When the Work is completed, wash the streets, collect and dispose of the wash water offsite in lawful manner; (d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; (e) Maintain a clean work area by removing trash, litter, and debris at the end of each work day and when Work is completed. Clean up any leaks, drips, and other spills as they occur. These requirements must be used in conjunction with the California Stormwater Quality Association and California Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor’s failure to comply with this Section will result in the issuance of noncompliance notices, citations, Work stop orders and regulatory fines. 17. PROJECT COORDINATION City Project Manager. The City assigns Nathan Vasquez as the City’s representative for all purposes under this Contract, with authority to oversee the progress and performance of the Scope of Work. City reserves the right to substitute another Project manager at any time, and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Wayne Shipley as its single Representative for all purposes under this Contract, with authority to oversee the progress and performance of the Work. Contractor’s Project manager is responsible for coordinating and scheduling the Work in accordance with City instructions, service orders, and the Schedule of Performance. Contractor must regularly update the City’s project manager about the status, progress and any delays with the work. City’s written approval is required prior to Contractor substituting a new Representative which shall result in no additional costs to City. 18. ABANDONMENT AND TERMINATION 18.1 City may abandon or postpone the Work or parts thereof at any time. Contractor will be compensated for satisfactory Work performed through the date of abandonment and will be given reasonable time to close out Work under a Service Order. With City’s pre-approval in writing, the time spent in closing out Work under a Service Order will be compensated up to ten percent (10%) of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment will not be made until Contractor delivers the Work and provides records documenting the Work, products, and deliverables completed. 19. GOVERNING LAW, VENUE, AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public Contract Code Section 20104, et seq., incorporated here by reference, apply to this Contract and On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 10 of 12 Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and include detailed written findings of law and fact. 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. 21. SIGNS/ADVERTISEMENTS No signs may be displayed on or about City’s property, except signage which is required by law or by the Contract, without City’s prior written approval as to size, design and location. 22. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City’s waiver of a breach shall not constitute waiver of another provision or breach. 24. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality, and free from defective workmanship and materials, and that the Work will be free from material defects not intrinsic in the design or materials. All Work, materials, and equipment should pass to City free of claims, liens, or encumbrances. Contractor warrants the Work and materials for one year from the date of City’s acceptance of the Work as complete (“Warranty Period”), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor’s Warranty Work, except any wear and tear or damage resulting from improper use or maintenance. 25. ENTIRE AGREEMENT This Contract and the attachments, documents, and statutes attached, referenced, or expressly incorporated herein, including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If there is any inconsistency between any term, clause, or provision of the main Contract and any term, clause, or provision of the attachments or exhibits thereto, the terms of the main Contract shall prevail and be controlling. On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 11 of 12 26. SEVERABILITY/PARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal, invalid, or unenforceable, the legal portion of said provision and all other contract provisions will remain in full force and effect. 27. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all provisions regarding warranties, indemnities, payment obligations, insurance, and bonds, shall remain in full force and effect after the Work is completed or Contract ends. 28. INSERTED PROVISIONS Each provision and clause required by law for this Contract is deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. The Parties will collaborate to implement this Section, as appropriate. 29. HEADINGS The headings in this Contract are for convenience only, are not a part of the Contract and in no way affect, limit, or amplify the terms or provisions of this Contract. 30. COUNTERPARTS This Contract may be executed in counterparts, each of which is an original and all of which taken together shall form one single document. 31. NOTICES All notices, requests and approvals must be sent in writing to the persons below, which will be considered effective on the date of personal delivery or the date confirmed by a reputable overnight delivery service, on the fifth (5th) calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino Office of the City Manager 10300 Torre Ave. Cupertino, CA 95014 Attention: Nathan Vasquez Email: NathanV@cupertino.org To Contractor: Thermal Mechanical, Inc 425 Aldo Ave. Santa Clara, CA 95054 Attention: Wayne Shipley Email: wshipley@thermalmech.com On-call heating, air conditioning and ventilation services at various City facilities On-Call Public Works Contract/ April 2024 Page 12 of 12 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation, signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. This Contract may be executed in counterparts, each one of which is deemed an original and all of which, taken together, constitute a single binding instrument. IN WITNESS WHEREOF, the parties have caused the Contract to be executed. CITY OF CUPERTINO A Municipal Corporation By Name Title Date THERMAL MECHANICAL, INC By Name Title Date APPROVED AS TO FORM: CHRISTOPHER D. JENSEN Cupertino City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date David Rood David Rood President 01/02/2025 Christopher D. Jensen Chad Mosley Director of Public Works 01/06/2025 1/6/2025 Exhibit B CITY OF CUPERTINO MASTER AGREEMENT CONSULTANT SERVICES SERVICE ORDER NO. Master Agreement Contract #: MA Date: Maximum Compensation: MA End Date: Consultant: Firm Name: Address: Contact: Ph: Project Name: Description: (simple project description if appropriate) Attachment A: Includes Description of Project, Scope of Service, Schedule of Performance and Compensation City Project Management Managing Department: Public Works Project Manager: ---------------- Fiscal/Budget : SO Acc't #: Project#: Approvals Signatures: Consultant/ Contractor Manager/ Supervisor: Master Agreement Maximum Compensation: ----------- Total Previously Encumbered to Date: ----------- Encumbrance this Service Order: ----------- Master Agreement Unencumbered Balance: ----------- PO#: Date: Date: Date: Appropriation Certification: I hereby certify that an unexpended appropriation is available in the above fund for the above contract as estimated and that fund are available as of this date of signature City Finance: Date: Management Analyst City of Cupertino Master Agreement Service Order Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 1 Contractor shall procure and maintain for the duration of the contract, and for five years following the completion of the Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: 1. Commercial General Liability (“CGL”): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an “occurrence” basis, written on a comprehensive general liability form, and must include coverage for liability arising from Contractor’s or Subcontractor’s acts or omissions, including Contractor’s protected coverage, blanket contractual, products and completed operations, vehicle coverage and employer’s non-ownership liability coverage, with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all liability for personal injury, death, property damage or destruction, and personal and advertising injury. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO CG 20 10 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO Form CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers’ Compensation: As required by the State of California, with Statutory Limits, and Employer’s Liability Insurance of no less than $1,000,000 per accident for bodily injury or disease, or as otherwise required by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, duly authorized by the DIR. ☐ N/A if box checked (Contractor provides written verification it has no employees). 4. Professional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. ☒ N/A if box checked (Contract is not design/build).. 5. Builder’s Risk. Course of Construction insurance utilizing an “All Risk” (Special Perils) coverage form, with limits equal to the completed value of the project and no coinsurance penalty provisions. ON-CALL PUBLIC WORKS CONSTRUCTION CONTRACTS Insurance Requirements: Exhibit C Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 2 ☒ N/A if box checked (Project does not involve construction or improvements/installations to property). 6. Contractors’ Pollution Legal Liability and/or Asbestos Legal Liability and/or Errors and Omissions with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 policy aggregate. ☒ N/A if box checked (Project does not involve environmental hazards) If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. Self-Insured Retentions. Self-insured retentions must be declared to and approved by City. At City’s option, either: (1) Contractor shall cause the insurer to reduce or eliminate self-insured retentions as respects City, its officers, officials, employees, and volunteers; or (2) Contractor shall provide a financial guarantee satisfactory to City guaranteeing payment of losses and related investigations, claim administration, and defense expenses. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or the City. OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL and automobile liability policies with respect to liability arising out of the Services performed by or on behalf of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used. Primary Coverage For any claims related to this Project, Contractor’s insurance coverage shall be “primary and non-contributory” and at least as broad as ISO CG 20 01 04 13 with respect to City, its officers, officials, employees and volunteers, and shall not seek contribution from City’s insurance. If the limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a “primary and non-contributory” basis for the benefit of City. Notice of Cancellation Each insurance policy required shall provide that coverage shall not be canceled, except with notice to the City. Each certificate of insurance must state that the coverage afforded by the policy is in force and will not be reduced, cancelled or allowed to expire without at least 30 days advance written notice to City, unless due to non-payment of premiums, in which case ten days advance written notice must be provided to City. Such notice must be sent to City via certified mail and addressed to the attention of the City Manager. Builder’s Risk Contractor may submit Builder’s Risk insurance in the form of Course of Construction coverage, which shall name the City as a loss payee, as its interest may appear. The Builder’s Risk policy must be issued on an occurrence basis, for all-risk coverage on a 100% completed value basis on the insurable portion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstruction, City may elect, acting in its sole discretion, to accept an Installation Floater policy instead of Builder’s Risk. For such projects, the Property Installation Floater shall include improvement, remodel, modification, alteration, conversion or adjustment to existing buildings, structures, processes, machinery and equipment, and shall provide property damage coverage for any Insurance Requirements for On-Call Public Works Construction Contracts Version: August 2024 3 building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the performance of the Work, including during transit, installation, and testing at the City’s site. Waiver of Subrogation Each required policy must include an endorsement providing that the carrier agrees to waive any right of subrogation it may have against City. Contractor agrees to waive rights of subrogation which any insurer of Contractor may acquire from Contractor by virtue of the payment of any loss. Contractor agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation. The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors. Acceptability of Insurers Insurance shall be placed with insurers admitted in the State of California and with an AM Best rating of A- VII or higher. Verification of Coverage Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences. The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time. Subcontractors Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a form at least as broad as CG 20 38 04 13. Surety Bonds As required by Contract and described in the Contract Documents. The Payment and Performance Bonds shall be in a sum equal to the applicable Service Order Price. If the Performance Bond provides for a one-year warranty a separate Maintenance Bond is not necessary. If the warranty period specified in the Contract is for longer than one year a Maintenance Bond equal to 10% of the Contract Price is required. Bonds shall be duly executed by a responsible corporate surety, authorized to issue such bonds in the State of California and secured through an authorized agent with an office in California. Special Risks or Circumstances City reserves the right to modify these requirements, based on the nature of the risk, prior experience, insurer, coverage, or other circumstances. COMMERCIAL INSURANCE A Custom Insurance Policy Prepared for: Presented by: Report Claims Immediately by Calling* 1-877-828-4132 Speak directly with a claim professional 24 hours a day, 365 days a year Written*Unless Your Policy Requires Notice or Reporting THERMAL MECHANICAL, INC. 425 ALDO AVENUE SANTA CLARA CA 95054 RSC INS BROKERAGE INC COUNTERSIGNED BY: Authorized Representative DATE: TRAVELERS CORP. TEL: 1-800-328-2189 PLUMBING & MECHANICAL COMMON POLICY DECLARATIONS ISSUE DATE: 04/03/24 POLICY NUMBER: DT22-CO-8G80535A-TCT-24 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT 1. NAMED INSURED AND MAILING ADDRESS: THERMAL MECHANICAL, INC. (AS PER IL T8 00) 425 ALDO AVENUE SANTA CLARA, CA 95054 2. POLICY PERIOD: From 04/01/24 to 04/01/25 12:01 A.M. Standard Time at your mailing address. 3. LOCATIONS Premises Bldg. Loc. No. No. Occupancy Address SEE IL T0 03 4. COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: COMMERCIAL GENERAL LIABILITY COV PART DECLARATIONS CG T0 01 11 03 TCT EMPLOYEE BENEFITS LIABILITY COV PART DECLARATIONS CG T0 09 09 93 TCT 5. NUMBERS OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY: SEE IL T8 01 10 93 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions: Policy Policy No. Insuring Company SEE CALCULATION OF PREMIUM COMPOSITE RATES ENDORSEMENT 7. PREMIUM SUMMARY: Provisional Premium $ 157,412 Due at Inception $ 15,743 Due at Each 1 MONTH $ 15,741 NAME AND ADDRESS OF AGENT OR BROKER: RSC INS BROKERAGE INC (HE839) 1350 OLD BAYSHORE HWY STE 125 BURLINGAME, CA 94010 IL T0 02 11 89(REV. 09-07) PAGE 1 OF 1 OFFICE: WALNUT CREEK POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: IL T8 01 10 93 DT22-CO-8G80535A-TCT-24 04-01-24 04-03-24 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL T0 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL T0 01 01 07 COMMON POLICY CONDITIONS IL T0 03 04 96 LOCATION SCHEDULE IL T3 02 07 86 CALCULATION OF PREMIUM-COMPOSITE RATE(S) IL T8 00 GENERAL PURPOSE ENDORSEMENT GENERAL LIABILITY - CONTRACTORS CG T0 01 11 03 COML GENERAL LIABILITY COV PART DEC CG D3 05 07 08 DEDUCTIBLE LIABILITY INSURANCE CG T0 07 09 87 DECLARATIONS PREMIUM SCHEDULE CG T0 08 11 03 KEY TO DECLARATIONS PREMIUM SCHEDULE CG T0 34 02 19 TABLE OF CONTENTS - COM GEN LIAB COV CG T1 00 02 19 COMMERCIAL GENERAL LIABILITY COV FORM CG T8 00 GENERAL PURPOSE ENDORSEMENT CG T8 01 GENERAL PURPOSE ENDORSEMENT CG T8 02 GENERAL PURPOSE ENDORSEMENT CG T8 03 GENERAL PURPOSE ENDORSEMENT CG T8 04 GENERAL PURPOSE ENDORSEMENT CG T8 05 GENERAL PURPOSE ENDORSEMENT CG T8 06 GENERAL PURPOSE ENDORSEMENT CG T8 07 GENERAL PURPOSE ENDORSEMENT CG T8 08 GENERAL PURPOSE ENDORSEMENT CG T8 09 GENERAL PURPOSE ENDORSEMENT CG D3 61 03 05 ADD'L INSURED-OWNERS,LESSEES,CONTRACTORS CG D3 73 11 05 ADD'L INSURED,OWNERS,LESSEES,CONTRACTORS CG D4 26 02 19 OTHER INS-DESIG ADDL INS-PRIMARY CG D9 10 09 21 AMENDMENT OF INTELLECTUAL PROPERTY EXCL CG 20 10 10 01 ADDL INSD-OWNER/LESSEE/CONTRACTOR B CG 20 37 07 04 ADD INSURED-OWNRS,LESSEES,CONT COMPL OPS CG D2 03 12 97 AMEND-NON CUMULATION OF EACH OCC CG D2 11 01 04 DESIGNATED PROJECT(S) GEN AGGR LIMIT CG D2 46 04 19 BLANKET AI-W/COMP OPS IF REQ BY CONTRACT CG D3 16 02 19 XTEND ENDORSEMENT FOR CONTRACTORS CG D2 43 01 02 FUNGI OR BACTERIA EXCLUSION CG D2 93 11 03 EXCL-CONSTRUCT MANAGE ERRORS & OMISSIONS CG D3 22 10 20 EXCL-CLMS OR SUITS BY NAMED INSUREDS CG D5 46 10 11 EXCL - ARCHITECT/ENG/SURVEY PROF SERV CG D6 18 10 11 EXCL-VIOLATION OF CONSUMER FIN PROT LAWS CG D9 44 01 23 EXCL-VIOLATIONOFBIOMETRICINFOPRIVACYLAWS CG 21 54 12 19 EXCL-DESIG OPS CVRD BY A CONTROLLED IP CG D0 76 06 93 EXCLUSION-LEAD CG D1 42 02 19 EXCLUSION-DISCRIMINATION CG D1 73 02 19 AMEND-POLL EXCL-INCL LTD COV POLL COST PAGE: 1 OF 2 POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: IL T8 01 10 93 DT22-CO-8G80535A-TCT-24 04-01-24 04-03-24 GENERAL LIABILITY - CONTRACTORS (CONTINUED) CG D2 04 12 17 EXCL-EXTERIOR INSULATION & FINISH SYSTEM CG D2 40 06 01 EXCLUSION - SILICA CG T4 81 11 88 EXC-HAZARD-CONNECTED DESIGNATED EXPOSURE CG T0 09 09 93 EMPLOYEE BENEFITS LIAB COV PART DEC CG T0 43 01 16 EMPLOYEE BENEFITS LIAB TABLE OF CONTENTS CG T1 01 01 16 EMPLOYEE BENEFITS LIABILITY COV FORM CG D9 48 01 23 EXCL-VIOLATIONOFBIOMETRICINFOPRIVACYLAWS INTERLINE ENDORSEMENTS IL T3 68 01 21 FED TERRORISM RISK INS ACT DISCLOSURE IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 21 CAP ON LOSSES FROM CERT ACTS OF TERRORIS IL 00 21 09 08 NUCLEAR ENERGY LIAB EXCL END-BROAD FORM IL 02 70 07 20 CALIFORNIA CHGS - CANC AND NONRENEWAL PAGE: 2 OF 2 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: during the policy period and up to three yearsA.Cancellation afterward.1.The first Named Insured shown in the Decla- D.Inspections And Surveysrations may cancel this policy by mailing or delivering to us advance written notice of 1.We have the right to:cancellation.a.Make inspections and surveys at any2.We may cancel this policy or any Coverage time;Part by mailing or delivering to the first b.Give you reports on the conditions weNamed Insured written notice of cancellation find; andat least: c.Recommend changes.a.10 days before the effective date of can- cellation if we cancel for nonpayment of 2.We are not obligated to make any inspec- premium; or tions, surveys, reports or recommendations and any such actions we do undertake relateb.30 days before the effective date of can-only to insurability and the premiums to becellation if we cancel for any other rea-charged. We do not make safety inspections.son.We do not undertake to perform the duty of3.We will mail or deliver our notice to the first any person or organization to provide for theNamed Insured’s last mailing address known health or safety of workers or the public. Andto us.we do not warrant that conditions: 4.Notice of cancellation will state the effective a.Are safe or healthful; ordate of cancellation. If the policy is cancelled,b.Comply with laws, regulations, codes orthat date will become the end of the policy standards.period. If a Coverage Part is canceIIed, that date will become the end of the policy period 3.1.2.Paragraphs and of this condition apply as respects that Coverage Part only.not only to us, but also to any rating, advi- sory, rate service or similar organization5.lf this policy or any Coverage Part is can-which makes insurance inspections, surveys,celled, we will send the first Named Insured reports or recommendations.any premium refund due. If we cancel, the re- fund will be pro rata. If the first Named In-4.2.Paragraph of this condition does not apply sured cancels, the refund may be less than to any inspections, surveys,reports or rec- pro rata. The cancellation will be effective ommendations we may make relative to certi- even if we have not made or offered a re-fication, under state or municipal statutes, or- fund.dinances or regulations, of boilers, pressure vessels or elevators.6.If notice is mailed, proof of mailing will be sufficient proof of notice.E.Premiums B.Changes 1.The first Named Insured shown in the Decla- rations:This policy contains all the agreements between you and us concerning the insurance afforded.a.Is responsible for the payment of all pre- The first Named Insured shown in the Declara-miums; and tions is authorized to make changes in the terms b.Will be the payee for any return premi-of this policy with our consent. This policy's terms ums we pay.can be amended or waived only by endorsement 2.We compute all premiums for this policy inissued by us as part of this policy. accordance with our rules, rates, rating plans,C.Examination Of Your Books And Records premiums and minimum premiums. The pre-We may examine and audit your books and mium shown in the Declarations was com-records as they relate to this policy at any time puted based on rates and rules in effect at IL T0 01 01 07 (Rev. 09-18)Page 1 of 2Includes the copyrighted material of Insurance Services Office, Inc. with its permission. the time the policy was issued. On each re-acting within the scope of duties as your legal newal continuation or anniversary of the ef-representative. Until your legal representative is fective date of this policy, we will compute appointed, anyone having proper temporary cus- the premium in accordance with our rates tody of your property will have your rights and and rules then in effect.duties but only with respect to that property. F.Transfer Of Your Rights And Duties Under G Equipment Breakdown Equivalent to Boiler.This Policy and MachineryYour rights and duties under this policy may not be transferred without our written consent except On the Common Policy Declarations, the term in the case of death of an individual named in-Equipment Breakdown is understood to mean sured.and include Boiler and Machinery and the term Boiler and Machinery is understood to mean andIf you die, your rights and duties will be trans-include Equipment Breakdown.ferred to your legal representative but only while This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium,we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be prov ided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy,and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company (COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casualty Insurance Company of America (ACJ) Secretary President Page 2 of 2 (Rev. 09-18)IL T0 01 01 07Includes the copyrighted material of Insurance Services Office, Inc. with its permission. LOCATION SCHEDULE POLICY NUMBER: This Schedule of Locations and Buildings applies to the Common Policy Declarations for the period to . Loc.Bldg. Address OccupancyNo.No. IL T0 03 04 96 Page DT22-CO-8G80535A-TCT-24 04-01-24 04-01-25 1 1 425 ALDO AVENUE MAIN SANTA CLARA, CA 95054 2 2 437-439 ALDO AVE OFFICE/WAREHOUSE SANTA CLARA, CA 95054 1 (END) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM - COMPOSITE RATES A.SCHEDULE 1. 2.to 3. 4. 5.PREMIUM BASECOVERAGE ESTIMATED ADVANCE EXPOSURE RATE PREMIUM $ 1. 2. 3. IL T3 02 07 86 (Rev. 12-08)Page 1 of 1 POLICY NUMBER:ISSUE DATE: This endorsement modifies insurance provided under the following Coverage Part(s): 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. Definition of Premium Base (Bases): Exceptions (if any) to compositing of premium calculation: Premium Schedule B.PROVISIONS Referring to the Schedule above,the premium for the Coverage Parts shown in item 1,except with respect to any exceptions shown in item 4, shall be computed in accordance with the premium base (bases)and rate (rates)desig- nated in item 5. premium shall be computed in accordance with the policy and this endorsement.If the earned premium thus computed exceeds the estimated advance premium paid,you shall pay the ex- cess to us;if less,we shall return to you the unearned paid portion.Rates and premiums for any subsequent Declarations Periods shall be determined at the inception date of those respective periods and shall be specified in en- dorsements to be added to the policy.After termination of each period,the earned premium shall be computed in accordance with the policy and this endorsement.The advance premium stated above is an es- timated premium for the Declarations Period. Upon termination of this period,the earned This endorsement applies to the Declarations from (If no entry appears above, information required to complete this endorsement will be shown in te Declarations as applicable to this endorsement.) The premium for the excepted hazards shall be computed in accordance with the rates and rules filed by us or on our behalf. POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT Page DT22-CO-8G80535A-TCT-24 ITEM 1 NAMED INSURED TO READ: THERMAL MECHANICAL, INC. 425 ALDO ASSOCIATES A CALIFORNIA LP THERMAL MECHANICAL 401K PROFIT SHARING PLAN IL T8 00 1 GENERAL LIABILITY CONTRACTORS GENERAL LIABILITY CONTRACTORS COMMERCIAL GENERAL LIABILITY POLICY NO.: COVERAGE PART DECLARATIONS ISSUE DATE: INSURING COMPANY: DECLARATIONS PERIOD:From to 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Commercial General Liability Coverage Part consists of these Declaration s and the Coverage Form shown below. 1. COVERAGE AND LIMITS OF INSURANCE: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIMITS OF INSURANCE General Aggregate Limit $ (Other than Products-Completed Operations) Products-Completed Operations Aggregate Limit $ Personal & Advertising Injury Limit $ Each Occurrence Limit $ Damage To Premises Rented To You Limit (any one premises)$ Medical Expense Limit (any one person)$ 2. AUDIT PERIOD: 3. FORM OF BUSINESS: 4. NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART ARE ATTACHED AS A SEPARATE LISTING. COMMERCIAL GENERAL LIABILITY COVERAGE IS SUBJECT TO A GENERAL AGGREGATE LIMIT CG T0 01 11 03 Page 1 of 1 PRODUCER:OFFICE: COMMERC GENERAL L LIAL IABI ITY POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEDUCTIBLE LIABILITY INSURANCE This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT PRODUCTS PLETED PERA ONS LI TY COVERA PART/COM O TI ABILI GE SCHEDULE Coverage Amount uctiof Ded ble PER OCCURRENCE Property Da iabi ty,includ m ted Co erage $mage L li ing Li i v For Pol ion Costs (i licab and associated "allocalutf app le),ted loss adjustment xpense s", onlye OR Bodil jury l y andy In Liabi it Property Da ge L li includ Li i v For $ma iabi ty,ing m ted Co erage Pol ion Costs (i licab and associated "allocalutf app le),ted loss adjustment xpense s", coembined (I no entry appear s above in ma ion required to comp th endor sement will be shown in the Declarationsf , for t lete is as applicable is endorsement.)to th PROVI ONS b.SI Under the Lim ted Co For Po lutiverage l ion Costs (i appl to pay "m ted co redf icable) li i veAPPLICATIOENDORSTON F EMEN (Enter below pollut costs"and "allocated loss adjust-ion any l m ions on the appl ion o endorsement.i itat icat f this ment xpense s" on behal f insured;e f o the I l m tion the deductib lies to:f no i ita is entered, le app applies only to the a o da "l m tedmount f mages,i iA.Damages for a l "property mage" and to al "ildallm- co pol ion costs"(if appl le) and "allo-vered lut icabited co " (i appl ; orvficable) cated loss adjustment expenses"in excess of anyB.Damages for a "bodi in "and "propertyllly jury deductible a stated in the Schedule abovemount damage"and to al "m ted co ered l li i v as applicable verages.to such cocosts" (i icabf appl le); 2.The deductible a stated in the Schedulemount however caused):abo ies as fove appl llows: a.Under Property Damage Liabil ty Coiverage, includ Li i Co rage For ing m ted ve Costs (if icable)y, llappl, onl to a : (1)Damages because of "property "damage ; (2)"Li ited co ered costs"(i applmvf i- cable); and (3)Associated "al loss adju stmentlocated expenses"; as the result o "occurrence";f any one or1. b.Under Bodily Injur Liab i and Propertyy il ty a.Under the Bodily In L l and Propertyjury iabi ity Damage Liabi ity Co erage, Li ilvmtedDamage L li Co to pay daiabityverages mages Co For Costs (i applicabverage f le),and "allocated loss adjustment e s"onxpense comb to al :ined, lbehalffinsured; andothe (1)Damages because of "bodi in "ly jury ; CG D3 05 07 08 Tr avelers Companies, Inc.Page 1 o 3f ered pollution costs pollution © 2008 The including Pollution Our obligation: pollution Pollution COMMERC GENERAL L ITYIAL IABIL (2)Damages because of "property "damage ;not satisfied by contribut made toward pay-ions ment o any or "suit", or any "al lossf located (3)"Li ited co costs"(i applmveredf i-adjustment e s"incurred, by other insurersxpensecable); and or any other ent y.it(4)Associated "al loss adju stmentlocated 7.I you fa to re mburse us for any a as re-f il i mounts expenses";quired by this endor sement, we may cancel thisas the result o ne "occurrence".f any o policy by mai ing or deli er to the first Nalving med Insured written notice o at least 10f 3.The ter o th insurance, those withms f is days before the e f ct v date ofeie frespect to: 8."Al loss adjustment e ":located xpensesa.Our right and duty with resp ect to the defense of "suits"; and a.Means any of the fol fees, costs or ex-lowing penses which can be direct a located to aly lb.Your duties in v o "occurrence",the e ent f an "suit ;or " (1)Fees of attorneys, or other a uthorizedapply ir v o the appl ion o the de-respecti e f icat f representati where permit legalves ted, for ductib mount.le a serv whether by outside or sta f rep-ices, f4.The applicable l m of insurance (including ag-i its resentati ves;gregates) shall be reduced by the amount of any (2)Court, A Dispute Resolution,andlternatedamages (or "l m co ered po tion costs", iiited v llu f other speci ite o e whetherficms f xpense, applicab within the deductib amount The ap-le) le . incurred by an outside vendor or by oneplicablmof insurance (including aggregates)le i its of mp luding:our e loyees, incshall not be reduced by the amount o any "allo-f cated loss adju stment e "within the de-xpenses (a)Medical e m ions of a claixainat mant toductibmount.le a determ the ex o in degreeine tent f jury, of manency, or o isabil ;per length f d ity5.The lowing is added to the Transfer of Rfol ights of Reco Against ion:very Others To Us Condit (b)Exper med or o monyt ical ther testi ; Any reco ies hereunder shall be applied in thever (c)Autopsy;fo lowing order:l (d)W t s and suminessemonses;a.Any in the insured) that mayterest (e)Copies of documen such as birthts ha paid any a with respect to l lve mount iabi ity and death certi tes and medicalficain e the m t o our iabi ityxcess of li i f l l hereunder;treat records;ment b.Us for mount pathe a id hereunder; and (f)Arbitra fees;tionc.Al other interests (including the insured), withl (g)Fees or cost s for sur ivellance or otherrespect to the residue, fi any.professional in estigat which arevions W we ha elec to par cipate in the e r-hen ve ted ti xe conducted as part of handling o af cise of the insured's right of reco ery, reasonablev or "suit";expenses re sulting there m shall be appor-fro (h)Fees or costs for loss prevent andion tioned among al the interests in the ratio of theirl engineering person nel, and fees orrespectirecoeries.ve v costs for rehabil tion nurses or otherita6.W may pay any part or a l o the deductelf ible nurses, for ser ices which are con-vamount to e fe pay o any or "suit"f ct ment f ducted as part of handl o a cla ming f iand you shall re mburse us from youri or "suit";andownfunds for such part of the deductible amount (i)Appeal bond costs and appeal f lingias we have paid regardless of any , fees; ortowardpayment of any or "suit"m byade (3)Al Supple Pay as de-l mentary ments other insurers or any other entity and regardles s, of any deductib o wed or paid by you to other scribed and incl uded in the applicableles insurers for the "oc ".Co rage Partsamecurrenceve . b.Does not include:Only pay made by you will satisf your obli-ments y gation to rei us for payments we makemburse (1)Salaries, o rhead and trave ing ex-ve lwithin the deduct le a Your toibmount.penses of our e e f employees, xcept or m-rei u s for such payments made by us ismburse Page 2 o 3f Tr avelers Companies, Inc.CG D3 05 07 08 pollution cancellation cancellation. claim obligation © 2008 The claim including claim,particular claim or "suit": (including claim claim contributions promptly COMMERC GENERAL L LIAL IABI ITY ployees while doing pre iously can be made o the causevf listed as al xpenses; or or extent o , or respon sibil for the in-located e f ity , jury, or d amage, (2)Fees paid to independent clai profes-ms e luation and o co redvaf vesionals or attorneys (hired to per m thefor claims.func o in igat nor lytion f vest ion mal perfor by for de l-med ve oping and in ing a clai so that avestigatm CG D3 05 07 08 Tr avelers Companies, Inc.Page 3 o 3f disease settlement © 2008 The adjusters), claim claim determination including activities DECLARATIONS PREMIUM SCHEDULE POLICY NUMBER: This Schedule applies to the Declarations for the period of to It shows all of your known rating classes as of the effective date. Any except ions will be so noted. This includes all locations you own, rent or occupy. LOC/CLASS PREMIUM OPN ADVANCEBLDGDESCRIPT/BASE/ SUBLINE RATESNO.PREMIUMNO.CODE NO.EXPOSURE *This class is subject to the prem/ops transition program. If an "X" is entered in this box, these Declarations are completed on the Premium Schedule Extension CG T0 12. CG T0 07 09 87 PAGE KEY TO DECLARATIONS PREMIUM SCHEDULE ABBREVIATIONS: CLASS DESCRIPT – means CLASS DESCRIPTION LOC/BLDG NO.– means LOCATION/BUILDING NUMBER OPN NO.–means OPERATION NUMBER PREM/OPS – means PREMISES/OPERATIONS PROD/C-OPS – means PRODUCTS/COMPLETED OPERATIONS PREMIUM BASE: Key Letter Premium Base How Rates Apply a Area per 1,000 square feet c Total Cost per $1,000 of total cost m Admissions per 1,000 admissions o Total Operating Expense per $1,000 of total operating expendi tures p Payroll per $1,000 of payroll s Gross Sales per $1,000 of gross sales t (see note* below)(see note* below) u Units per unit *Premium base t applies for a number o rarely used premium bases.f The specific base and how rates apply are shown with the Class D scriptione on the DECLARATIONS-PREMIUM SCHEDULE. CG T0 08 11 03 Copyright, The Travelers Indemnity Company, 2003 Page 1 of 1 TA LE OF CONT NTBES COMMERCIAL GENERA LIABILITY COVERA E FORMLG CG T1 00 02 19 SE TIO I –COV RAGES Be inning on ageCNEgP C ov rage –e A Bo ily Injury an Propertydd In uring gr ee ent .......................................................1sAm Da a e Liabili ymgt Ex lusions ....................................................................2c Cov rage B –e Pe s onal and Adv r isingret In uring gr ee ent .......................................................6sAm In ury iabil tyjLi Ex lusions .....................................................................c 6 Cov rage C –e Med cal Paym ntsie In uring gr ee ent .......................................................9sAm Ex lusions ....................................................................9c Su plem ntar y Pay e ts .........................................................................................p e m n ..........01 SE TIO I –WHO I A NS RED ...............................................................................C N I S N I U ........11 SE TIO I I –LIM TS F NS RANCE ......................................................................C N I I O I U .............13 SE TIO I –COMME CIAL ENERAL IAB LITY CO DITI NS ........................................13CNVRGLINO Ba krupt y ..............................................................................................................n c ...........31 Dut es In h e v nt O ccurrenc e f e se laim O Suit ..............................i T E e f O ,O f n ,C r .................13 Leg al A tio Ag a nst s .....................................................................................c n i U ................14 Ot e lnsur ance ......................................................................................................h r ...........15 Prem um A dit .........................................................................................................i u ..........16 Re re en tatio s ..............................................................................................p s n ...................16 Se arat on O nsureds ........................................................................................p i f I ..............16 Tran fe f Rig ts O e ov ry g ai st Ot ers To Us ...................................s r O h f R c e A n h ....................16 16Whn e Do o enew .........................................................................................e W N t R .......... SE TIO V –DEFI ITI NS .........................................................................................C N N O ...........16 CG T0 34 02 19 COMM RCI L G NERA L IAB LI YEAELIT COM MERCIA GENERA LIA ILITY COVERA E FORMLLBG in thi Re dsa (1)The "bo i y in ur "o "pro e ty da a e idljyrprmg"s th e t re po i y ca e ul y to de e m n ri ht , dut e a d byenilcrfltriegsisn a th t n "a t k s pl ceaea wha s a d s no co e e .i hetinitvrdnt Thro g o t th s po i y th wo ds "y u a d "y ur"re euhuilcero"n o f r (2)The "bo i y in u y o "pro e ty da a edljr"r p r m g " to th Na e Insure sho n i the a d o cur d ri gemddwnncsun t e p l cy pe i d;a dhoiron a y o he pe so o o g n z t o qua i y ng a a Na entrrnrraiainlfismd (3)Pri r to th pe i d,no in ure l steoerosdidInureundrthipoiyThewods"we ,"us"a dsdeslc.r "n un e Pa a ra hdrrgp 1.of II –Who Is"o r re e o t e co pa y p o i i g hi i sura ceu"f r t h m n r v d n t s n n .An In ure a d no "e pl y e a t o i esdnmoe"u h r z d The wo d "i sure "m a s a y o ga i a i n by y u torndennrnztoo gi e o ovrf an qu l fy ng a such undeaiisr II –Who Is An o kn w tha the "bo i y"r e t d l I sure .i j r "o "pro e ty da a e handnuyrprmg"d i who e o in If such a li te i surenlr.s d n dOtewods a d phr se tha a p a in quo a i nhrrnastpertto "e pl y e k e ,to themoe"n wmrkhaemaig.Re e toasvennfr V –pe i d th t the "bo i y i j ry oro,a d l n u "rDeiiins.f n t o "pro e ty da a e ,th n a yprmg"e n SE TI N I –CO ERA ECOVGS co ti u t o o re um ti n o suchnnainrspof "bo i y in ur "o "pro e ty da a edljyrprmg"CO ERA E A –B D L IN U Y A D P O E TYVGOIYJRNRPR o a t r th pe i d wi l be de m d torfeeroleeDMAGELAIITAIBLYhaeben no n pri r t h p l cy pe i dvekwooteoiro.1.I su i g A reem nnrnget c."Bo i y i j ry o "pro e ty da a edlnu"r p r m g "a.We wi l pa th se sum tha th i surelyostend duri g th pe i d a d wa no ,n e r o n s tbcoelealolgaetopaadaaeemsglybitdysmgsprirtothepeidknwtohaeoro,o n vbcaseo"bo i y i j ry o "pro e ty da a eeufdlnu"r p r m g "by a y i sure l ste n e a a ra hnndidudrPrgptothsinuraceapis. W e wi l ha eisnplelv 1.of II –Who Is An Insure o a ydrnthrigtad du y to de e d the i sure a a nstehntfnndgi "e pl y e a t o i e by y u to gi e omoe"u h r z d o v ray"sui "se k n th se da a e . Ho e e ,n t e i g o m g s w v r o a o , a yfn"r nwewilhaenoduttodeed the i surelvyfnnd co ti u t o , o re um t o o thannainrspinftaanst a y "sui "se k n da a e fo "bo i yginteigmgsrdl "bo i y i j ry o "pro e ty da a e a t r thdlnu"r p r m g "f e eijryo"pro e ty da a e to thinu"r p r m g "s e d f he p ri d.n o t e oisuracedos no a p y We m y a o rnnetpl.a ,t u in e t ga e a y "wi l bevsitnl"d."Bo i y i j ry o "pro e ty da a edlnu"r p r m g "a dn se t e a y cl i r "sui "th t a e ul .Bu :t l n a m o t a m y r s t t de m d to ha e be n kn wn to ha e o curr deeveovce a the e rl e t ti e whe a y in ure l stetaismnnsdid(1)The a o n we wil pa fo da a e ismutlyrmgs un e Pa a ra hdrrgp 1.of II –Who Is AnlmteadecrieiiidssbdnIII–Li i smt In ure o a y "e pl y e a t o i e by y u tosdrnmoe"u h r z d oOfIsurnendnac;a gi e o o a ovrfn"r cl i :a m(2)Our right and duty to defend end when we ha e use up th li i ovdemtf (1)Re o t a l o a y pa t o the "bo i yprsl,r n r ,f d lithepamntojdmns onyefugetr i j ry o "pro e ty da a e to us o a ynu"r p r m g "r nsetlmnsundr t e e t e A or B or o h r i sure ;t e n rmdcaxeseuneoeaeeilepnsdrCvrgC. (2)a wri t n o de a d otermnrNooheolgtoolaiiytopasumotrbiainribltysrclifodaaeothe"bo i yamrmgsfdlosevceiunlssrrisseijryo"pro e t a a e ; rnu"r p r y d m g "oeplcilproiefoundr Sup l m n a yxityvddrepeetr (3)Payments.a a e by a y o he m a s thawrntrent "bo i y in ur "o "pro e ty da a e hadljyrprmg"sb.Thi in ura ce a p i s to "bo i y i j ry a dssnpledlnu"n o curre o a t ccurcdrhsoo."pro e ty d m ge o l fpraa"n y i : CG 1 0 02 1T09 Pa e 1 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Various provisions policy restrict Declarations, person or Section special Section caused "occurrence policy Section receive notice "occurrence claim occurred, part or authorized prior policy occurred , change during which which discretion,occurrence Section applicable insurance Coverages perform acts covered policy which occurs policy policy occurred Section receive notice "occurrence claim includes change policy Section receive notice "occurrence Receives verbal because Becomes begun coverage. "coverage territory"; COMM RCIAL E ERAL IAB LITYEGNLI e.Da a e o "bo i y i j ry i cl demgsfdlnu"n u (3)An sta u e o di a ce o e u a i n e a i gytt,r n n r r g l t o r l t n da a e cla m d by a y pe so r rga i a i n to the sa e gi t,dimgsienrnoonztol,f str bu i n o usitore of fo ca e l ss o se v ce o de th re ul i g arr,o f r i s r a s t n t a y t m ro he "bo i y i j r ".n i e f m t d l n u y T hi e cl sio a p i s o l i y u a e in thesxunplenyfor 2.Ex l si ncuos bu i e s o m n f ct r ng di tri u i g se l n ,s n s f a u a u i ,s b t n ,l i g se v ng o furn shi g a co o i be e a e .F rririnlhlcvrgsoThiisuracedenoplosnnostapyt:th pur o e o thi e cl sio , pe m t i g aepssfsxunritna.Ex ec ed O I te d d I j ryptrnnenu pe so to bri g a co o i be e a e o y urrnnlhlcvrgsno pre i e , fo co sum timssrnpo o y u prennorm se ,i s i t nd d fro th sta d o n o th i sure .whe he o noneemenpitfendtrrt a fe is cha g d o aerer is Thi e cl sio do s no a pl to "bo i y in u y re u re fo such s x u n e t p y d l j r "q i d r is no by it e f,t s l o "pro e ty da a e re ul i g fro the use o co si e e th bu irprmg"s t n m f n d r d e s ne s o se l n ,ssflige v n origr b Co trac u l L ab l t d Wo ke s'Co p n a i n An i il r L w.n t a i i i y .r r m e s t o d S m a a s "Bo i y i j ry o "pro e ty da a e fo An o l g t o o thedlnu"r p r m g "r y b i a i n f i sure un e anddr wo k r 'r e s th i sure is o l ga e to pa da a e by co p nsa i n di a iendbitdymgsmeto,s b l t be e i s oriynft re so o th a sum t o o l a i i y i a un m l y e t co peanfespinfibltnepomnmn a i n l w o astoarn sim l ryia co tr ct o a r e e t.Thi e cl sio do s no l w.n a r g e m n s x u n e t a a pl o l a i i y f r a a e :p y t i b l t o d m g s e.Em l yer's i b l tpoLaiiy (1)Tha t e i sure o l a e i t e a se cethndwudhvnhbn "Bo i y i j r "todlnuy: (1)An "e pl y e o the i sure a i in o t omoe"f n d r s g u f(2)Assum d in a co tr ct o a re m nt th t ienargeea s a d n th co r e o :n i e u s fa"i sure , pro i e th t thnndvddae (a)Em l y e t y th i sure ;opomnbendr"bo i y in u y o "pro e ty da a edljr"r p r m g " (b)Pe f r i g dut e re a e to theromnisltd o a r e e t.So e y fo th purp se orgemnllreosf l a i i y a sum d in a "i sureibltsennd (2)The spo se chi d pa e t bro h r o sisteu,l ,r n ,t e r rresoalatrnes'fe s a danbetoyen o tha "e pl y e a a oftmoe"s fltgtinepnseicurrdbyofr a tyiiaoxesneroapr Pa a r prgah (1)a o ebv.o h r th n a i sure wi l be de m d to beteanndlee Thi e cl si n a pl e whe he th in ure m ysxuopistresdadaaeo"bo i y i j ry omgsfdlnu"r be l a l s a e p o e r n ny o heibeanmlyroiatr"pro e ty d m g ", ro i e th tpraaepvdda:a d t a y o l ga i n to sha e da a e wi h ononbitormgstr(a)Li b l t to such pa ty fo ,o fo theaiiyrrrr re a so e ne e se who m st pa da a epymoluymgscot o ,th t de e se ha a sosfafnsl be n a sum d in the sa e "i sureesemnd Thi e cl si n do s no a p y to l a i i ysxuoetplibltcotrct"; ndnaa a sum d by the i sure un e a "i suresenddrnnd(b)a t r e s'fe s a d l t g t otonyeniiain co tr ct .n a "e pe se a e fo de e se o th t pa txnsrrfnfary f.P l u i noltoaanst a ci i o a t rn t v di putgivlrleaiese (1)"Bo i y in u y o "pro e ty da a e a i i gdljr"r p r m g "r s nreoutoinwhihslinc o t o the ,a l g d o th e te eufleerranddaaetoths in ura cemgsisn di cha ge di pe sa ,se p g , m gr t o ,s r ,s r l e a e i a i napleaealge.p i s r l e d re e se o o "po l t n s":l a r f l u a tc.L q o i b l tiurLaiiy (a)At o fro a y pre i e , sit ormnmsser"Bo i y i j ry o "pr p rt da a e fodlnu"r o e y m g "r l ca i n whi h i o wa a a y ti eotocsrstnmayisureaehlibebesoo:n n d m y b e d l a l y r a n f o ne o by o re t d owdr,r n e r(1)Ca si g o to the i t x ca i nunrnoito l a e to a y i sure .Ho e e ,th sond,n n d w v r i o n e so ;f a y p r n subp ra ra h o s n t pp y t :a g p d e o a l o (2)The furn shi g o a co o i be e a e to ainflhlcvrgs (i)"Bo i y in u y i susta n d wit i adljr"f i e h n pe so und r the l g l dri k ng a e orneeanigr bu l i g a d ca se by sm k ,i d n n u d o e u de he o onrtfr fu e , o so t pro uce bymsrodd o o i i a i g fro e u pm n th trrgntnmqieta Pa e 2 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. because license activity which contract" occurs contract", necessary because party's Such proceeding consequence capacity actualwhich which contributing influence escape occupied vapor alcoholic beverages. "Bo i y i j ry o "pro e ty d m ge e pe te odlnu"r p r a a "x c d r re so a l f rce t p o e t pe so s o p o e t .a n b e o o r t c r n r r p r y of the contract or agreement; or furnishing alcoholic beverages. subse u n to t e e e ut o o t e co t a tqethxcinfhnrc conduct of the insured's business; or because of the injury. alcohol; COMM RCI L G NERA L IAB LI YEAELIT i use to he t co l o to pe f rm th no m lsda,o r r o e r a , th bu l i g o by o hy ra l c oeidn,r r d u i r o i i a i g fro e u pm n tha isrgntnmqiett fo th o e a i n oreprtof use to he t wa e fo pe so adatrrrnl "m bi e e ui m n "o it pa t , ifolqpetrsrs use by th bui di g s o cup n s oeln'c a t r such fue s, o o h rlrte th i u sts;e r g e o e a i g fl i s e ca e fro aprtnudspm (i )i "Bo i y i j ry o "pro e tydlnu"r p r o the .Thi e ce ti nrmsxpodaaefoyumybemg"r o a do s no a pl if the "bo i y i j ryetpydlnu"he d li b e if y u a e a co tr ct rlal,o r n a o o "pro e ty da a e a i e o t orprmg"r s s u fad the o ne o le se o suchnwrrsef th in e ti n l di cha ge di pe saetnoasr,s r lpreie, sit o l ca i n ha be nmsserotose o r l a e o the fue s, r e e s f ladetoyur a addosn o o h r o e a i g fl i s, o i suchrteprtnudrfadditionalinsuredwith respect to y ur o g i g o e a i ns pe fo m d fu l , o o he oononprtorreesrtrp r t neaig fo th t a d t o a i sure a tha fl i s a e bro gh o oradiinlndttudrutnr to the pre i e , sit o l ca i n a d suchmsseroton pre i e , sit o l ca i n wit themsserotoh pre i e , sit o l ca i n is nomsserotot i t nt th t th y be di cha g d,n e a e s r e a d ne e wa o n d o o cupi dnvrswerce di pe se o re e se a pa t osrdrladsrf by o re te o l a e to a y,r n d r o n d ,n th o e a i n be ng pe fo m d byeprtosirre i sure ,o he tha tha a d t o andtrntdiinl such in ure ,orsd i sure ;ondr (i ii)"Bo i y i j ry o "pro e tydlnu"r p r (i )i "Bo i y inj ry o "pro e tydlu"r p rdaaeaiigot o he t,m g "r s n u f a da a e susta n d wit i amg"i e h nsmkofuefroa"ho ti eoermsmsl bu l i g a d ca se by th re e seidnnudelafie;r "o ga e , fum s o v po s frofsserarm(b)At o fro a y pre i e , sit ormnmsser m te i l bro g t in o th t bu l i garasuhtaidn l ca i n whi h i o wa a a y ti eotocsrstnm use by o fo a y i sure o o h rs f rdrrnndrteo pe f r e by y u o o y u e a fromdornorbhlthhadlngstoaedispoa,e n i ,r g ,s l by a co tr ct r r subco t a ;onaoonrrrproesinr re tm n o w stecsgotaetfa;(i ii)"Bo i y inj ry o "pro e tydlu"r p r(c)If such "po l t n s"a e o we e a a yluatrrrtn da a e a i i g o t o he tmg"r s n u f a ,ti e tra spo t d,ha d e ,sto e ,m n r e n l d r d sm k o fu e fro a "ho ti eoermsmsltrae,di po e o ,o aetdssdfrs fi e ; rr"owatebyoo:s r f r (e)At o fro a y pre i e , sit ormnmsser(i)An nsure ;oyidr l ca i n o whi h a y in ure o a yotoncnsdrn(i )i An pe so o o g n z t o foyrnrraiainr o wo k ngrriwhoyu m y be le a lmoagly o o a y i sure 'r n n n d sreposil;s n b e be a f a e o we e a a y ti ehlrrrtnm(d)At o fro a y pre i e , sit ormnmsser pe fo m ng o e a i n to te t fo ,r r i p r t o s s r l ca i n o whi h a y in ure o a yotoncnsdrn m ni o ,cl a up,re o e co t i ,o t r e n m v ,n a n co tr ct rs o subco t a r wo k ngnaornrosri tr a ,de o i y o ne tr l z , o in a yettxfruaiernooayisure'srnnnd wa re po d to o a se s thysn,r s s ebeafaepefomngoeainifthehlrrriprtoso,"po l t n s".f l u a t"po l t n s"a e bro gh o o to theluatrutnr (2)An l ss, co t o e p n e a i in o t oyosrxesrsgufpreie, si e o l ca i n i co n ct omsstrotonnein a yn:wi h such o e a i n by such in ure ,t p r t o s s d co tr ct r o sub o tr ct r.Ho e e ,n a o r c n a o w v r (a)Re ue t, de a d o de o sta ut ry oqsmn,r r r t o rths subp ra ra h o s n t pp y t :i a g p d e o a l o re u a o y re ui e e t t a a y in uregltrqrmnhtnsd (i)"Bo i y inj ry o "pro e tydlu"r p r o o he s te t fo ,m ni o ,cle n up,r t r s r o t r a da a e a i i g o t o the e ca emg"r s n u f s p r m v , co t i , tre t de o i y oeoenana,t x f r o fue s, o ot eflrhr ne t a i e o in a y wa re po d to ourlz,r n y s n ,r o e a i g fl i s a e ne d dprtnudree a se s t e o ,"po l t n s"; rsshfluato CG 1 0 02 1T09 Pa e 3 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. dehumidify produced electrical mechanical functions necessary which policy lubricants receive lubricants lubricants contractor cto processed ct directly indirectly lubricants which contractors subcontractors directly indirectly effects effects i o n cti n wi h pe a i ns be nncneotortoig v hi l pa t de i n d to ho d,sto eecersgelr subcontractor; COMM RCIAL E ERAL IAB LITYEGNLI (b)Cl i o sui by o o be a f o a yamrtrnhlfn (b)The o e a i n o a y o the m chi e yprtofnfanr go e nm n a a t o i y o a y o he o e ui m n l ste in Pa avretluhrtrntrrqpetidrgra hp f.2)( pe so o o ga i a i n b ca se o ornrrnztoeufr f.3)(o the de i i i n o "m bi effntofol te ti g fo ,m n t r ng cl a i g up,e ui m n "; rsnroioi,e n n q p e t o re o i g,con a ni g,tre t ngmvntinai,(6)d to i y ng o ne t a i i g,o i a yexfirurlznrnn (a)Cha t re i h a pi o o a y i sure ;r e d w t l t t n n dwarepodig to o a se sin theysnn,r s s g e fe t o ,"po l t n s".f c s f l u a t (b)No w e y a y i sure ;a dtondbnndn g Ai craft u o O at rcra t (c).r ,A t r W e f No be n use to ca r a y pe so otigdrynrnr pro e ty f r p r o a"Bo i y in u y o "pro e t da a e a i i g o tdljr"r p r y m g "r s n u o th o n r hi , m i t na ce use orfewespanen,h Mob l q ip e t.i e E u m n e tr stm nt to o he s o a y "a t "onuetrfnuor "Bo i y in u y o "pro e ty da a e a i i g o tdljr"r p r m g "r s n uwtecrat o n d o o e a e by o re t d oarfwerprtdrner o :flaetoayinure. Use o e a i nondnsdprto (1)The tra spo t t o o "m bi e e u pm n "n r a i n f o l q i e tad"l a i g r n o d n ".n o d n o u l a i g by a "a t "o ne o o e a e by onuowdrprtdrThieclsinapiseeiftheclamsxuoplevnisretd r l a e o a y i sure ;oneoondtnndraanst a y i sure a l g ne l g nce o o h rginndleegierte (2)The use o "m bi e e ui m nt i ,o whi efolqpe"n r lwrogonithsupevsio,hir ngndignerini,i fo , o whi e be ngnrrlieplyettriig o m ni o i g o o he s bymomn,a n n r o t r n f t r a y spe d,de o i i n,n e m l t otht in ure ,if th whi h ca seasde"c u d o stun i grtn .th "bo i y i j ry o "pro e ty d m ge i v l eedlnu"r p r a a "n o v d th o ne shi ,m i t na ce use oewrpanen,r i.War e t ust e t to o he s o a y "a t "onrmntrfn,u o r "Bo i y in u y o "pro e ty da a e a i i g o tdljr"r p r m g "r s n uwaecratthais o ne o o e a e by otrftwdrprtdr o :fretd r o n d o a y i sure .n e o l a e t n n d (1)Wa ,i cl di g u d cl r d o ci i a ;r n u n n e a e r v l w rThieclsioos no a pl t :s x u n d e t p y o (2)Wa l k by a m l ta y fo cerieiirr,(1)A wa e cra t whi e a ho e o pre i e y utrflsrnmsso i hi d ri g o de e d ng a a n t annenrfnigisnon r e tworn;o e pe t d a t ck by a yrxceta,n (2)A a e cra t y u o n t o n ha s:go e n e t so e e gn owtrfodowttivrmn,v r i r o he a t o itruhrty usin i i a y pe so n l o t e ge t ; ogmltrrnerohransr(a)50 fe t o g o l ss; ndelnrea (3)In urr ct o ,re e l o ,re o ut o , usurp dseinblinvline(b)No be n use to ca r a y pe so otigdrynrnr po e ,o ta e by go e n e t lwrrknvrmnaproetyfr ha g ;p r o a c r e a t o i y in hi d ri g o de e d ng a a nstuhrtnenrfnigi(3)Pa k n a "a t "o ,o o the wa s ne trignuonrnyx a y o he enfts.to pre i e y u o n o re t,pro i e the,m s s o w r n v d d j.D m g o P o ertyaaeTrp"a t "i no o n d by o re t d o l a euostwernerond to y u r he i sure ;"Pro e ty d m ge toootndpraa": (4)Li b l t a sum d unde a y "i sureaiiysernnd (1)Pro e ty y u o n,re t,o o cup ,p r o w n r c y co tr ct fo he o ne shi ,m i t na ce o i cl di g a y co ts o ena"r t w r p a n e n r n u n n s r x e se i cu repnsnrd by y u,o a y o he pe so ,o g ni a iorntrrnrazto onr e t t ,fo re a r,re l ce e tniyrpipamn,(5)"Bo i y in u y o "pro e ty da a e a i i gdljr"r p r m g "r s n e ha ce e t,re to a i n o m i t na cennmnsrtoranenoto:u f o such pro e t fo a y re so , f p r y r n a n(a)The op ra i n o m chi e y oretofanr pre e ti n o i j ry to a pe so o da a evnofnurnrmgeuimnthtiatchdtoopatqpetastae,r r to a o he 's p o e t ;n t r r p r yo,a la d v hi l th t wo l qua i y afneceaudlfs (2)Pre i e y u sel ,gi e a a o a a d n ifmssolvwyrbno,"m bi e e u pm n "un e th d fi i i nolqietdreento th "pro e ty da a e a i e o t o a yeprmg"r s s u f no"m bi e e ui m nt i such la dfolqpe"f n pa t o h se pr m se ;r f t o e i sweenosubjct to arte co p l o y o fi a ci l re po si i i ymusrrnnasnblt (3)Pro e ty l a e o y u;p r o n d t o l w,o o he m t r v h cl in ura ceartrooeiesn (4)Pe so a pro e t i th ca e custo y ornlpryner,d rlw,whe e i is o pri ci a lartrnply co tr l o t e i sure ;n o f h n dgaae; rrgdo Pa e 4 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. includes "occurrence practice prearranged racing, prepared for, activity aircraft vehicle includingaction action actual action including licensed An aircraft that is: aircraft, use of aircraft or watercraft; charge. COMM RCI L G NERA L IAB LI YEAELIT (5)Tha pa t cul r pa t o re l pro e t o phy ica in u ytriarfaprynsljr to "y ur o or whi h y u o a y co tr ct rs o "y ur wo k a t r it ha be n putcornnaoror"f e s e to it in e destnd use. o y u be a f a e pe f rm n o e a i ns, ifnorhlrroigprto n Rec l O ro u ts W rk r mp i ed.a l f P d c ,o O I a rth"pro e ty da a e a i e o t o tho eeprmg"r s s u f s P o ertyrpoeain; rprtoso Da a e cl i e fo a y l ss, co t o e pe semgsamdrnosrxn (6)Tha pa t o a y pro e t thatrfnpryt i cu re by y u o o h r fo th l ss o usenrdortesreof, m st be re to e , re a re o re l ceusrdpidrpad wi hd a a ,,re a rtrwl,p i , b ca se "y ur wo k waeuor"s re l ce e t a j stm nt re o a o di po apamn,d u e ,m v l r s s l o :f (1)"Y u ro uct";o r p dPaarpsrgah(1),(3)a dn (4)o th s e cl si n dofixuo no a p y to "pre i e da a e . A se a a etplmssmg"p r t (2)"Y u o k ; rorwr"olmt o i sura ce a p i s to "pre i e da a eiifnnplemssmg"(3)"Im a re p o e t ";p i d r p r yadecribd in Pa a r pssergah 6.of III – i such wo k o pro e t is f r ,r p r yLiisOnsuracemtfIn. Pa a ra hrgp (2)o h s e cl sio o s no a pl iftixundetpyf pe so o o g n z t o o a k o n ornrraiainfnwrthpreieae"y ur wo k a d we e ne eemssror"n r v r o,,r,re t d r e d fo e t l by y uneohlrrnao.da g ro s co di i n i tneuntoni.Pa a r p srgah (3),(4),(5)a dn (6)o th sfi o P rso a n d erti i g I ju y.e n l A d A v s n n reclsiodonoapltolibltasumdxuntpyaiiyse "Bo i y in u y a i i g o t o "pe so a a ddljr"r s n u f r n l nunesidtrckaremntdraeagee. a v rt si g i j ry .d e i n n u "Pa a ra hrgp (6)o th s e cl sio do s no a plfixunetpy p a a.D tto"pro e ty da a e i cl de in th "pro uct -p r m g "n u d e d s co p e e p ra i n h z r ".m l t d o e t o s a a d Da a e a i i g o t o th lo s o ,lo s o usemgsrsnufesfsf o ,da a e to co ru t o o ,i a i i y to a ce s,f m g ,r p i n f n b l t c sk.D m g o Yo r P o u taaeTurdc "Pro e ty da a e to "y ur pr d ct a i i g o tprmg"o o u "r s n u o t o ny p rt o i .f i r a a f t Ho e e , thi e cl si n do s no a p y towvrsxuoetpl l a i i y fo a a e b ca se o "bo i y i j r ".i b l t r d m g s e u f d l n u yl.D m g o Yo r Wo kaaeTur "Pro e ty d "p r q U so i i e o m n ca i n.n l c t d C m u i t oaaetoyur wo k a i i g o t omg"o r "r s n u f i o a y pa t o it a d i cl d d i he "pro uct -t r n r f n n u e n t d s "Bo i y in u y o "pro e ty da a e a i i g o tdljr"r p r m g "r s n ucopeeprainhzr".m l t d o e t o s a a d o a y o a l g d v o a i n o a y l w thafnrleeiltofnat Thi e cl si n do s no a pl if th da a esxuoetpyemgd o pro i i s the se d ng tr n m t i grhbtni,a s i t n wo k o th wo k o t o whi h th da a errerufcemg o d stri ut n fribigo a i e wa pe fo m d o y ur be a f by arsssrrenohl r.Acc s O Di c o u e O Con id n i l Oesrslsrffetarsubcotrcto.n a r P rso a n o m ti nenlIfraom.D m g o I p i ed P o erty O P o ertyaaeTmarrprrp "Bo i y in u y o "pro e ty da a e a i i g o tdljr"r p r m g "r s n uNt h sic l y In u edoPyaljr o a y a ce s to o di cl sure o a y pe so 'f n c s r s o f n r n s"Pro e ty da a e to "i p i e pro e t "oprmg"m a r d p r y r o o g ni a i n'co f de ti l or pe so arraztosninarnlproetyththanobenlinue,p r a s t e l y j r d i f rm t o .n o a i naiigoto:r s n u f s.Asb st seo(1)A in d qu cy or,a e a (1)"Bo i y in u y o "pro e ty da a e a i i gdljr"r p r m g "r s ndagrosin"y ur pro uct oneuod"r o t o th a t a o a l g d pre e ce oufeculrleesnr"y ur o k ; rowr"o a t a ,a l ge o th e t ne di pe sa oculledrraedsrlf(2)A de a o fa l r by y u o a y nlyriueornoe a be to , a be to fi e s o pro u tsssssssbrrdcoyurbeaftopefomaonohlrrrcotannabeto, pro i e th t theniigsssvddaaremnticcodncewtttrm.g e e n a r a i h i s e s "bo i y i j ry o "pro e ty da a e idlnu"r p r m g "sThieclsin do s no a pl to the l ss o sesxuoetpyofu ca se o co t i ut d to by the ha a d usudrnrbezrooohr pro e t a i in o t o sudd n a dftepryrsgufen pro e ti s o sbe to .p r e f a s s CG 1 0 02 1T09 Pa e 5 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. particular incorrectly accidental product" recall inspection Section occupied product,withdrawn because suspected defect deficiency inadequacy Electronic actual restricts "unsolicited communication". physica deficiency condition acting contract subco t a t r wo k n di e t y o i d re tlnrcosrigrclrnicy performed on it. o re a l d fro th m rk t o fro use by a yrclemeaermn or inability to manipulate "electronic data". defect, COMM RCIAL E ERAL IAB LITYEGNLI (2)"Bo i y in u y o "pro e ty da a e a i i g e pl y e t-e a edljr"r p r m g "r s n m o m n r l t d de cri esbd in o t o th o a l g d pre e ce o Pa a r puferleesnrrgah (a),(b), ro (c)a o e ibvs a l ge o th e t ne di pe sa oledrraedsrlf Thi e cl si n a pl e whe he th in ure m ysxuopistresda a y so i ,li ui ,ga e us o th r anldqdsoreml be l a l s a e p o e r n ny o heibeanmlyroiatr o i cl di g sm k , v po s,r n u n o e a r a d t a y o l ga i n to sha e da a e wit ononbitormgshr so t fu e , , a k l s, a do,m s l a i n re a so e ne e se who m st pa da a epymoluymgs wa te a d th t a e pa t o a y os,n a r r f n r be a se o he "bo i y i j r ".c u f t d l n u y "sui "whi h a so a l ge a y "bo i y i j rytcllesndlnu"Ex l si nscuo c.th o gruh n.do no a p y to "pre i etplmsso"pro e ty da a e de cri e inrprmg"s b d da a e . A se a a e li i o i sura ce a p i s tomg"p r t m t f n n p l ePaarprgah(1)a o ebv."pre i e da a e a de cri e in Pa a r pmssmg"s s b d r g a h 6.of III –Li i s O nsur n emtfIac.(3)An l ss, co t o e p nse a i in o t oyosrxersguf a yn:CO ERA E B –P RSO A A D AD ERT SI GVGENLNVIN IN U Y L AB L TJRIIIY()a Re ue t, de a d o de o sta ut ry oqsmn,r r r t o r 1.In u in g e m nsrgAreetreuaoyreuieetthaayisuregltrqrmntnnd o o he s te t fo ,m ni o ,cle n up,r t r s r o t r a a.We wi l pa th se sum tha th i surelyostend re o e co t i , tre t de o i y omv,n a n a ,t x f r le a l o l ga e to pa a da a eglybitdysmgs ne t a i e o i a y wa re po d to ourlz,r n n y s n ,r o "pe so a a d a v rt si g in ur "tofrnlndeinjy a se s the e f ct o ,a be to ,s s f e s f s s s th s i sura ce a pl e . We wi l ha e theinnpislv a be to fi e s o pro uct co t i i gsssbrrdsnann ri ht a d du y to de e d t e i sure a a nst a ygntfnhndgin a be to ; rssso "sui "se k n th se da a e . Ho e e ,we wi lteigomgswvrl ha e no dut to de e d the in ure a a n t a yvyfnsdgisn()b Cl i o sui by o o be a f o a yamrtrnhlfn "sui "se k n da a e fo "pe so a a dteigmgsrrnlngoenetlatoiyoayohrvrmnauhrtrnteavrtsiginur"to thi i sura ce do sdeinjysnnepesooogaiainornrrnztofnoapyWe m y at o r t p l .a ,u ,te ti g fo ,m n t r ng cl a i g up,s n r o i o i ,e n n i v sti a e a y o fe se a d se t e a y cla m onegtnfnntlnirreoig,con a ni g,tre t ngmvntinai,"sui "th t a e ul .Bu :t a m y r s t tdeoiyngonetaiigoinaytxfirurlzn,r n wa re po di g to o a se sin theysnn,r s s g (1)The a o n we wil pa fo da a e ismutlyrmgs e fe t o ,a be to , a be to fi e s o l m te a de cri e ifcsfssssssbrriidssbdn III –Li i smt pro uct co t i i g a be to .Of I sura ce a ddsnannsssnn;n t.Em l ymen -Rel te ra ti espotadPcc (2)Ou rig t a d dut to de e d e d whe werhnyfnnn ha e use up th li i ovdemtf"Bo i y i j r "todlnuy: i sur n e i the pa m nt o j d m n s onacnyefugetr(1)A e so ri in ut o nyprnasgofa:se tl m n s und r Co e a eteetevrgs A or B or(a)Re usa o e p o h t e so ;f l t m l y t a p r n x e se un e o e a eepnsdrCvrg C .(b)Te m na i n o tha pe so 'sritoftrn No o he o l g t o o l a i i y to pa sum otrbiainribltysreplyetrmomn;o pe f r o se v ce i unl ssromrrisse(c)Em l y e t re a epomn-l t d ,,e pl ci l pro i e fo un e Su p e e t ryxityvddrdrplmnaooisin,such a co rci n,r m s o s e o Pa m nt .y e sdeoin,e a u ti n re ssi nm n ,m t o v l a o ,a g e t b.Thi i sura ce a pl e to "pe so a a dsnnpisrnlndicipiefalretoprooeosln,i u m t r a v rti i g in ur "ca se by a o fe se a i i gdesnjyudnfnrsnavncehaasmn, hum l a i nda,r s e t i i t o , o t o y u bu i e s but o l i th o f nse wauforsnsnyfefesdicrimnain,li e ,sl nd r v o a i nsitoblae,i l t o co m t e in th "co e a e te r t r "du i g thmitdevrgrioyrneothpeso's rig t ofernhf po i y p ri d.l c e oofasearet,r l r s de e t o o i p i o m n a p i d t otninrmrsnetpleor 2 Ex l si n.c u o sathapeso,re a dl ss ottrngref Thi i sura ce d e no p l osnnostapyt:whe he such otr,,r a.Kn w n i l t o f i h s f n th roigVoainORgtOAoeoisiniapid o ismsospler co m t e be o e duri g o a t r themitdfr,n r f e "Pe so a a d a v rt sin in ur "ca se by ornlndeigjyudrtieotaeso's e p o m nt rmfhtprnmlye;o a th o the i sure wi h thetefndt (2)The spo se chi d pa e t bro h r o sisteu,l ,r n ,t e r r k o l d e th t the wo l v o a e the rig tnwegaudilths o tha pe so a a co se u nce o "bo i yftrnsnqefdl o a o h r a d wo l "pe so a a dfntenudrnln i j ry to tha pe so a who a y o thenu"t r n t m n f a v rt si g i j r ".d e i n n u y Pa e 6 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. actual actual, irritant practices capacity contaminant, acids chemicals claim because Section becomes because which which discretion Section applicable practice policy act malicious prosecution directed practice policy act occurs, medical acts covered direction act inflict privacy, directed. COMM RCI L G NERA L IAB LI YEAELIT Thi e cl si n do s no a pl to "pe so a a a nst a ci i o asxuoetpyrnlgivlrl e n t v di puttraiese re o u i n pro e di g isltocenn da a e to th s in ura cemgsisnbMateiaulsedWihKnwedeO.r l P b i h t o l g f a pl e a e a l ge .p i s r l e dFliyast f.B ea h O o tracrcfCnt"Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u f o a o wri te pu l ca i n i cl di g "Adv rt sinrlrtnbito,n u n e i g i j ry a i i g o t onu"r s n u f a bre ch oaf co tr ctna. th o th i sure wi h kno l d e oefendtwegf g Q a it O erfo m n e f o d –F i u e.u l y r P r a c O G o s a l risfliytast.To Co fo m To S at m n snrteet c.Mate ia u l s ed O s d P i r T o i yrlPbihrUerooPlc "Adv rt sin in ur "a i i g o t o th fa l re oeigjyrsnufeiufPrioedgods, pro uct o se v ce to co fo m wi hodsrrisnrt (1)"Pe so a a d a v rt sin n u y a i i g o t a y sta e e t o quarnlndeigijr"r s n u n t m n f l t o pe foiyrrrm n e m deaca o o a o wri t n pu l ca i n i o r "a v rt se efrlrtebito,n y u d e i m nt ." pu l ca i n by e e t o i m a s,o m t ri lbitolcrncenfaea h Wro g D s ri ti n O ric s.n e c p o f P ewhoefist pu l ca i n to k pl ce be o esrbitooafr "Adv rt sin in u y a i i g o t o the wro geigjr"r s n u f nthbginigoteplcypeidreennfhoiro;o de cri t o o the pri e o go ds, pro uct ospinfcfodsr(2)"Ad e t si g i j ry a i i g ou ofvrinnu"r s n t se v ce sta e n y ur "a v rt se e t .r i s t d i o d e i m n "i f i ge e t o co y i ht "ti l "o "sl g n"n r n m n f p r g ,t e r o a i.In el ec u l P op rtytltareiyur"a v rt se e t who e fi stnodeimn"s r i f i ge e t i y ur "a v rt se e t wa "Pe so a a d a v rt sinnrnmnnodeimn"s r n l n d e i g in u y a i i g o tjr"r s n u of co m t e be o e the be i n n o the a y o a l g d i fmitdfrgnigfnrleenri ge e t o v o anmnrilt o oinf po i y p r o .a y o th fo l wi g ri h s o la s, o a ylceidnfelongtrwrn o h rte "pe so a a d a v rt si g in ur "a l ge i a yrnlndeinjylednndCrimnlAct.i a s cl i o "sui "th t a so a l ge a y suchamrtallesn"Pe so a nd a v rt si g i j ry a i i g o t o arnladeinnu"r s n u f i f i ge e t r i l t o :n r n m n o v o a i ncriiacomtebyoatheomnlmitdrtf(1)Co y i h ;p r g tthisure.e n d (2)Pa e ttn;e.Co trac u l L ab l tntaiiiy (3)Tra e d e s;d r s"Pe so a a d a v rt sin in ur "fo thernlndeigjyr i sure ha a sum d l a i i y in a ondsseibltr (4)Tra e n m ;d a e a re m nt T hi e cl sio do s no a pl togee.s x u n e t p y (5)Tra e a kdmr;l a i i y f r a a e :i b l t o d m g s (6)(1)Tha the i sure o l a e i h a se cetndwudhvntebn (7)Ot e n e l ctu l p o e t i h s o a s.h r i t l e a r p r y r g t r l w T hi e cl sio d e no p l osxunostapyt:(2)Be a se o "pe so a in u y a sum d bycufrnljr"s e y u in a o a re m nt th t i aorgeeasn (1)"Ad e t si g i j ry a i i g o t o a yvrinnu"r s n u f n "i sure co tr ct , pro i e th t thendna"v d d a o a l g d i fri g m n o v o a i n orleenneetriltof "pe so a in u y i ca se by a o f n ernljr"s u d n f e s a o h r's co y i h ,"ti l "o "sl g n"inteprgtteroan y ur "a v rt se e t ; rodeimn"o th o a re m n . So e y fo theergeetllr (2)An o h r "pe so a a d a v rt sin in u yyternlndeigjr"pu po e o li b l ty a sum d by y u i arssfaiiseonn a l ge in a y cla m o "sui "th t a solednirtal"i sure co t a t , re so a l a t r e s'n d n r c "a n b e t o n y a l ge a y such i f i ge e t o v o a i nlesnnrnmnriltofesad ne e sa y l t ga i n e pe seencsriitoxns o a o h r'co y i ht "ti l "o "sl g n"ifntesprg,t e r o a nicurebyofoapatyohethn anrdrrrtran y ur "a v rt se e t .o d e i m n "i sure wi l be de m d to be da a endleemgs be a se o "pe so a i j ry , ro i e h t:c u f r n l n u "p v d d t a j.In u ed I ed a n n e ne ypesrsnMiAdItrtT B si e s sunse(a)Li b l t to such pa t fo ,o fo thaiiyryrrre co t o ,th t pa t 'de e se ha a sosfarysfnsl "Pe so a a d a v rt si g in ur "ca se by arnlndeinjyudnben a sum d by y u in th sa eeseoem o fe se co m t e by a i sure who efnmitdnnds"i sure o t a t ; ndndcnrc"a bu i e s i :s n s s (b)Su h a t r e s'fe s a d l t g t octonyeniiain (1)Ad e t si g o pu l shi g;v r i n ,r b i nepeseaefodeeseotht pa txnsrrfnfary CG 1 0 02 1T09 Pa e 7 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. publication direction including which which actual act direction which contract contract contract actual "broadcasting" injury" caused by malicious prosecution. by e e tro i m a s,o a e i l f do e by o tlcncenfmtra,i n r a of the contract or agreement; or co m t e sub e ue t to th e e ut o omitdsqnexcinf Trade secret; or COMM RCIAL E ERAL IAB LITYEGNLI (2)De ig i g o de e m n n con e t o ne tr l z n ,o i a y wa esnnrtriigtnfuaiigrnnyrspo di g onnt, ro we sit s f r o he s; rbeotro (3)An In e n t se rch,a ce s, co t nt otreacsner o War. se v ce p o i e .r i r v d r "Pe so a nd a v rt si g i j ry a i i g o t o :r n l a d e i n n u "r s n u f Ho e e , thi e cl si n do s no a p y towvrsxuoetpl (1)Pa a ra hrgps a.1)(,(2)a dn (3)o th d fi i i n ffeentoo (2)Wa l k by a m l ta y fo ce in l d ngrieiirr,c u i"pe so a i j ry .r n l n u "a t o i hi d ri g o de e d ng a a n t acinnnenrfnigisnFrteprpseohs e cl sio :o h u o s f t i x u n a t a o e pe t d a t ck by a yculrxceta,n (1)Cre t n a d pro uci g co re po de ce go e nm nt so e e gn o oaigndnrsnnvre,v r i r t e a t o i yhruhrt wri t n in the co d ct o y u busin ss,usin i i a y pe so n ltenuforegmltrrne o t e ge t ; orohransr bu l t ns, fi a ci l o a n a re o t , oleinnarnulprsr (3)In urre t o ,re e l o ,re o ut o , usurp dscinblinvlinenesletes a o t y u go ds, pro u ts owtrbuorodcr po e ,o ta e by go e n e t lwrrknvrmnasevcewilnobecosieetherisltndrdathriyihidrngodeedigaanstuotnneirfnngibuiesoulshig;a dsnsfpbinn a y o he enfts. (2)The pl ci g o fra e , bo d rs o l n s, oanfmsrerikr p U so i i e o m n ca i n.n l c t d C m u i t oavrtsin,fo y u o o he s a y he e odeigrortrnwrn "Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u fthIntrntwilno,by i se f,be co si e eeeelttlndrd a y o a l ge v o a i n o a y l w th tnrlediltofnaathbuiesoavrtsig"bro dca ti gesnsfdein,a s n "o pro i i s the se d ng tr n m t i grhbtni,a s i t nopulshig.r b i n o d stri ut n f "un o i i e co m ni a i n".r i b i g o s l c t d m u c t ok.El c ro i h t oo s O u le i B ardetncCarmrBltnos q Acc s O Di c o u e O Con id n i l O.e s r s l s r f f e t a r "Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u f P rso a n o m ti nenlIfrao a e e tro i cha r o o bul e i bo rd thenlcnctomrltna "Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u fisurehotsoons, o o e whi h thendsrwrvrc a y a ce s to o di cl sure o a y pe so 'oncsrsofnrnsrisurexrciecoto.n d e e s s n r l o ga i a i n'co fi e t a o pe so arnztosndnilrrnl l.U au h rized U e f n th r's a e OntosOAoeNmr i f rm t o .n o a i n P o u trdc r.Asb st seo "Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u f (1)"Pe so a a d a v rt sin n u y a i i g o trnlndeigijr"r s n uthunatoieuseoaohe's na e oeuhrzdfntrmr o the o a l ge pre e ce ofrledsnrprouctinyur -a l a d e s, o a n n m odoemidrsdmiaer a l ge r hre t n d i pe sa o a be to ,l e d o t a e e d s r l f s s smtaa,o a y o he sim l r ta ti s to m sl aetgrntriaccied a be to fi e s o pro u ts co t i i gsssbrrdcnannaohrsptntaustoes.n t e 'o e i l c m r a be to , pro i e th t th "pe so a a dsssvddaernln m.P l u i nolto a v rt sin in ur "i ca se o co tr bu edeigjysudrnitd to by t e h z rd us pro e ti s o sbe to .h a a o p r e f a s s"Pe so a a d a v rt sin in u y a i i g o t ornlndeigjr"r s n u f (2)"Pe so a a d a v rt sin n u y a i i g o trnlndeigijr"r s n uthalgeotheteedichag,e l e d r r a n d s r e o the o a l ge pre e ce ofrledsnrdipesa,se pa e m gra i n,re e se osrleg,i t o l a r a l ge o th e t ne di pe sa o a y so i ,l e d r r a e d s r l f n l decaeo"po l t n s"a ny t m .s p f l u a t t a i e l q i ,ga e us o th rm l ir i a t oiudsoreartnrnPluinReltd.o l t o -a e co ta i a t i cl di g sm k ,v po s,n m n n ,n u n o e a r An o s, x e se a i in ut o nyylsepnrsgofa:so t fu e , a k l s, a do,m s l a i n wa te a d th t a e pa t o a y os,n a r r f n r(1)Re ue t, de a d o de o sta ut ry oqsmn,r r r t o r "sui "whi h a so a l ge a y "pe so a a dtcllesnrnlnreuaoyreureettht a y in ure ogltrqimnansdr a v rt sin in u y de cri e i Pa a r phdeigjr"s b d n r g aohrtet fo ,m n t r up re o etessroio,,m v ,(1)a o ebv.co ta n tre t de o i y o ne t a i e o inni,a ,t x f r u r l z ,r (3)An l ss, co t o e p n e a i in o t oyosrxesrsgufanywayrespondto,or assess the effects o ,"po l t n s"; r a yfluaton: (2)Cl i o sui by o o be a f o a yamrtrnhlfn (a)Re ue t, de a d o de o sta ut ry oqsmn,r r r t o r re u a o y re ui e e t tha a y i suregltrqrmntnndgovernmentalauthorityoranyother person o o g n z ti n o te ti g fo ,o o he s te t fo ,mrraiaofsnrrtrsro i o ,cle n up,n t r a m ni o i g,up, re o i g re o e co t i , tre t de ootrnmvn,m v ,n a n a ,t x fy oir co ta n n ,tre t ng de o i y ng or ne t a i e o i a y wa re poniigai,t x f i u r l z ,r n n y s nd to o,r Pa e 8 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. action action actual, actual restricts actual actual, actual actual, cost or clean because cleaning acids, chemicals claim assessing the effects of, "pollutants". War, including undeclared or civil war; COMM RCI L G NERA L IAB LI YEAELIT a se s the e f ct o ,a be to ,s s f e s f s s s (3)o y u pe a i ns;f o r o r t o a be to fi e s o pro uct co t i i gsssbrrdsnann pro i e ha :v d d t tabeto; rssso (a)The ta e pl ce in th "co e a eksaevrg()b Cl i o sui by o o be a f o a yamrtrnhlfn te r t r "a d uri g t e p l cy pe i drioyndnhoiro;go e n e t l a t o i y o a y o h rvrmnauhrtrnte (b)The e pe se a e i cu re a d re o t d toxnsrnrdnprepesooogaiainornrrnztofus wit i o e y a o the da e o thehnnerftftetigfo,m n t r ng cl a i g up,s n r o i o i ,e n n nadreoig,con a ni g tre t ngmvntin,a i , de o i y ng o ne t a i i g o in a ytxfirurlzn,r n (c)The in ur d pe so subm t to e a i a i njernisxmnto, wa re po di g to o a se sin theysnn,r s s g e fe t o ,a be to , a be to fi e s o a o t n s we re so a lfcsfssssssbrrsfeaanby re ui eqr. pro uct co t i i g a be to .d s n a n n s s s b.We wi l m k th se pa m nt olaeeyesf s.Em l ymen -Rel t d P act c spotaerie fa l .T he e pa m nt wi l no e ce d theutsyesltxe a pl ca l li i o i sura ce W e wi l papibemtfnn.l y"Pe so a n ur "tornlijy:re so a l x e se f r:a n b e e p n s o(1)A e so ri in ut o nyprnasgofa:(1)F rst a d a m ni te e a the ti e o aiidisrdtmfn(a)Re u a o e p o ha p rso ;f s l t m l y t t e n (b)Te m na i n o tha pe so 'sritoftrn (2),X-ra a dyneplyetrmomn;o de t l se v ce , n a r i s (c)Em l y e t re a epomn-l t d ,, a t o o i si n,such a co rci n,c r m s o s e o (3)ho pi a ,s t ldeoin,e a u ti n re ssi n e tmtovlao,a g m n ,pro e si n l nu si g a d un r l se v ce .f s o a r n n f e a r i sdicipiefalretoprooeorsln,i u m t 2.Ex l si ncuosavncehaasmn, hum l a i nda,r s e t i i t o , We wi l n t a e pe se fo "bo i y i j r ":l o p y x n s r d l n u ydicrimnain,li e ,sl nd r v o a i nsitoblae,i l t o o th pe so 's rig t ofernhf ,a.An I su edynr o fa se a re t,r l r s de e t o o i p i o m n a p i d t otninrmrsnetpleor b H red P rso.i e nathapeso,re a d e s ottrngrlsf whe he such otr,,r To a pe so hi e to do wo k fo o o be a f ornrdrrrnhl f o i si n i a p i d o ismsospler a y i sure r t na t f ny i sure .n n d o a e n o a n d co m t e be o e duri g o a t r themitdfr,n r f e c.In u y O N rma l O c p ed P em s sjrnolycuirietieotaeso's e p o m nt rmfhtprnmlye;o To a pe so in u e o th t pa t o pre i ernjrdnarfmss(2)The spo se chi d pa e t bro h r o sisteu,l ,r n ,t e r r y u o n o re t tha th pe so no m l yowrnternralotht pe so a a co se u nce ofarnsnqef "pe so a i j ry to th t pe so a whornlnu"a r n t m d Wo ke s'Co p n a i n An i il r L w.r r m e s t o d S m a a sayotheeplyetreaenfmomn-l t d To a pe so ,whe he o no a "e pl y e orntrrtnmoe"fdecrieinPaarahsbdrgp(a),(b), or (c) a y i sure ,i be e i s f r t e "bo i y i j r "a enndfnftohdlnuyraboveisdirected. pa a l o m st be pro i e und r a wo k r 'y b e r u v d d e r e sThieclsin a pl e w e he th in ure m ysxuopishtresda co p nsa i n o di a i i y be e i s la o ametorsbltnftwrbelalsaepoer n ny o heibeanmlyroiatr si i a a .m l r l wadtayolgain to sha e da a e wi h ononbitormgstr e.Ath et c c i iti slisAtverepaysomeoneelsewhomust pay damages o he "pe so a nj ry .f t r n l i u "To a pe so i j re whi ernnudl CO ERA E CVG o pa t ci a i g i a y phy ica e e ci e orriptnnnslxrssr–MED CAL P YMEN SIAT ga e , po t , o a h e i co te ts.m s s r s r t l t c n s1.In u in g e m nsrgAreet f.P o u ts-Co p e ed O era i n a ardrdcmltptosHza.We wi l pa m d ca e pe se alyeilxnss In l d d wi hi the "pro uct -co p e ecuetndsmltdbeoo"bo i y i j r "ca se b n cci e tlwfrdlnuyudyaadn: o e a i n h z r ".p r t o s a a d(1)On p e i e y u o n r e trmssoworn; g Co erag x l s o s.v e A E c u i n(2)On wa s ne t to pre i e y u o n o re tyxmssowrn; or u d r o e a eneCvrg A. CG 1 0 02 1T09 Pa e 9 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Because accident because practice policy privacy malicious prosecution directed practice policy act occurs, accident; regardless accident; Necessary medical,surgical including prosthetic devices; and Necessary ambulance, practices capacity because described occupies. practicing,instructing Excluded a o r e pe se by phy i i ntuxn,s c a s o o r ho cefuci To any insured, except "volunteer workers". COMM RCIAL E ERAL IAB LITYEGNLI SU P EMEN ARY P YMEN SPLTAT a sum d by th in ure in th sa e "i sureseesdemnd co tr ct ;n a "1.We wi l pa ,wi h to a y cl i welytnam d.The a l ga i ns i th "sui "a d t e i f r a i nletonetnhnomtoivstgaeosetl,o a y "sui "a a nst n i sureneitrterntgiand we k o a o t th "o cur e ce o o f n e a enwbuecrn"r f e s rwedfeden: such th t no co fl ct a p a s to e i t be we naniperxstea.A l e pe se we i curlxnsn.th i t re ts o the i sure a d the i t re ts oenesfndnnesf th i de n t eenmie;b.Up to $2 50 fo th co t o ba l bo ds re u re,0 r e s f i n q i d b ca se o a ci e ts o tra f c l w v o a i neufcdnrfiailtos e.The in e n t e a d the i sure a k us todmiennds a i i g o t o the use o a y torsnuffn a d co t o th de e se o thannrlefnft th Bo i y Inj ry Li b l t Co e a e a p i s. Weedluaiiyvrgple i d m i e a a n t such "sui "a d a re thanentegistnget do no h v t h se bo ds.t a e o t e n we ca a si n th sa e co n e to de e d thnsgemuslfne i sure nd th i d m i e ; ndndaenenteac.The co t o bo ds to a ta hm n s, butsfntcet f.The i d m i e :n e n t e o i sura ce W e do no ha e to furn sh th sefnn.t v i e (1)Ag e s i w i i g orenrtnt:bo d .n s (a)Co p r t wi h us in th in e ti a i n,o e a e t e v s g t o d.Al re so a l e pe se by thelanbexns se t e e t o d fe se o h "sui ";t l m n r e n f t e t i sure a o r re ue t to a sist us in thendtuqss (b)Im e i t l se d us co i s o a ymdaeynpefnivstgain o de e se o th cl i o "sui ",n e i t o r f n f e a m r t d m nd , no i e , sum o se o e aeastcsmnsrlglicldiglssoernns up to $5 0 anunofaig0 pa e s re e v d in wi h theprciet "sui ";t e.Al co rt co ts ta e a a nst th i sure in thelusxdgiend (c)No i y an o h r insure who etfyters "sui ".Ho e e , th se pa m nt do notwvreyest co e a e i a a l b e to th i de n t evrgsvialenmie; a t rne s'fe s o a t rn y 'e pe se ta etoyertoesxnsxd a dn a a nst h i sure .g i t e n d (d)Co p r t wi h us wi h tooeaett f.Pre u g e t i t re t a a d d a a nst the co rdi a i g o he a pl cajdmnneswregiontntrpib e i sura celnn i sure o tha pa t o th j d m n we pa .If a a l bl o tndntrfeugetyviaethe i de n t e nnmie;a d we m k a o f r to pa the a pl ca l li i oaenfeypibemtf (2)Pro i e u w t ri t n ut o i a i n tovdssihwteahrzto:i sura ce we wil no pa a y pre u g e tnn,l t y n j d m n (a)Ob a n a d o h r i f r a i ntintenomtoiteet ba e o tha pe i d o ti e a t r thenrssdntrofmfe re a e t h "sui "; ndltdotetaofe.f r (b)g.Al i t re t o the fu l a o n o a y ju g e tlnesnlmutfndmn i d m i e n uch "sui ".n e n t e i s ttht a t r e tr o th j d m n a dafenyfeugetn So lo g a th a o e co d t o s a e m t a t r e s'n s e b v n i i n r e ,t o n ybfoewehaepad,o f r d to pa ,oervifeeyr fe s by us in th de e se o thaeefnftdeoitd in co rt th pa t o th ju g e t thapseuerfedmnt i de n t e ne e sa y l t ga i n e pe senmie,c s r i i t o x n siwtihaplcallmtonuracesihntepibeiifisn. by us a d ne e sa y l t g ti n e p nse byncsriiaoxesTheepamns wi l no the l m ts osyetltiif th i d m i e a o r re u st wi l be pa d aenentetuqelis.Su p e e t ry Pa m n s. No wi h ta d n theplmnayetttsnig2.If we de e d a i sure a a nst a "sui "a d afnnndgitnn pro i i n o Pa a ra hvsosfrgp 2..2)b (of I –i d m i e o the in ure i a so na e a anentefsdslmds Co e a e –Co e a evrgsvrg A –Bo i y Inj ry Andludtothe"sui ", we wi l de e d tha i d m i e if a l otlfntnentelf Pro e ty Da a e Li bi i y o Pa a ra hprmgaltrrgp 2..e ofthfloig e o l w n I –Co e a e –Co e a evrgsvrg B –Pe so arnl An Adv rt sin Inj ry Li bi i y such pa m nt wi ldeigualt,y e s la.The "sui "a a nst the i d m i e se ktginentees no be de m d to be da a e fo "bo i y i j ry ,t e e m g s r d l n u "da a e fo the in ure ha a sum dmgsrsdsse "pro e ty da a e o "pe so a in u y ,a d wi l noprmg"r r n l j r "n l tthlaiiyothidmieinaoeibltfenenter re u e t e l m ts o n ura cedchiifisn.a re m ntgee b.Thi i sura ce a pl e t uch l a i i y a sum dsnnpisosibltse Ou o l g t o to de e d a in ure 'in e n t erbiainfnnsdsdmie by t e i sure ;h n d a d to pa fo a t rne s'fe s a dnyrtoyen l t g ti n e pe se a Sup l m n a y Pa m n siiaoxnsspeetryetc.The o l ga i n to de e d o the co t o thbitofn,r s f e e ds wh nne:de e se o ,tha i d m i e , ha a so be nfnftnentesle Pa e 10 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. respect vehicle which furnish release incurred actual conduct connection include accrues reduce insurance party which contract that is an "insured contract"; respect records incurred incurred incurred Section Section necessary itonlyfor bond amounts the applicable limwithin day because of time off from work. Co du t a d co t o th de e se o t encnnrlefnfh conditions are met: COMM RCI L G NERA L IAB LI YEAELIT a.We ha e use up the a pl ca l l m t o wo k rs"whi e pe fo m ng duvdpibeiifrelrriti se in th pa m nt o j d m n s,re a e to the co d ct oeyefugetltdnuf y uro se t e e t o m d ca x e se ; r bu i e s;t l m n s r e i l e p n s o s n s (b)To th spo se chi d pa e t,bro he oeu,l ,r n t r rb.The co d t o s se fo t a o e o the te m oniintrhbv,r r s f si te o tha co "e pl y e osrft-m o e "rthareeiaarahegemnnPrgpf.a o ebv, "v l n e r wo k r"a a co se u nceouteresnqeaenogee.r o l n r m t o a a r pfPrgah (1)a)(a o ebv;SE TI N I –WH S AN I SU EDCOIOINR (c)F r whi h th re i a y o l ga i n toocesnbito1.If y u re d si n t d n thoaegaeie sha e da a e wi h o re a so e nermgstrpymoa.An in i i ua ,y u a d y u spo se a edvdlonorur e se who m st pa da a e be a seluymgscuisures, but o l wit to thendnyh o the in ur de cri e in Pa a ra hfjysbdrgpousinssooretesoeonr.f a b e f y u a h l w e (1)a)(or (b)a o e rbv;ob.A pa tn rshi o jo n v n ure y u a e arepritet,o r n (d)Ari i g o t o hi o he pro i i g osnufsrrvdnrisure.Y ur m m e s, y u pa t e s, a dndoebrorrnrn fa l ng to pro i e pro e sio a he l hiivdfsnlatthisposeaeasoinures, bu o l wi herusrlsdtnyt ca e se v ce .r r i s Unl ss y u a e in th busin ss oeoreerc.A li i e l a i i y co pa y y u a e a i sure .m t d i b l t m n ,o r n n d o cup ti n o pro i i g pro e sio a he l hcaofvdnfsnlatYummesaeasoisures, bu o l wi horebrrlndtnyt ca e se v ce , Pa a ra hrrisrgps (1)a)(,(b),(c)to th o y ur busin ss. Y uefoeor a dn (d)a o e do no a pl to "bo i y i j r "b v t p y d l n u ymnaes a e i sure s, but o l wi h tagrrndnyto a i i g o t o pro i i g o fa l n to pro i ersnufvdnriigvdthiuisayur a a e s.e r d t e s o m n g r fi st a d o "Go d Sa a i a se v ce "byriromrtnrisd.An o ga i a i n o he th n a pa t e shi ,j i trnztotrarnrpon a y o y ur "e pl y e "o "v l n e rnfomoesroute v nt r o l m te l a i i y co p ny y u a e aeueriidibltma,o r n wo k rs", o h r tha a e p o e oretennmlydr v l n e r Any such "e pl y e "ooutemoesr a e in ure s, but o l wi h to th irsdnyter "v l n e r wo k rs"pro i i g o fa l ng toouterevdnrii d ti s a y ur o . Y uuesoror pro i e fi st a d o "Go d Sa a i avdriromrtn st ck o d r a e a so i sure s, but o l wi hohlesrlndnyt se v ce "du i g the r wo k ho rs fo y urisrniruro wi l be de m d to be wi hi theleetn sco e o the r e pl y e t by y u opfimomnore.A tr st, y u a e a in ure .Y u tru te s a euornsdorser pe f r i g dut e re a e to the co d ct oromnisltdnufasoinures, but o l wit to th ilsdnyher y ur usin ss.o b edtis a t u te s.u e s r s e (2)"Pro e ty d m ge to pr p rt :p r a a "o e y2.f he fo l wi g i a so a i sure :o t l o n s l n n d (a)Own d,r se yeoudb;a.Y ur "v l n e r wo k rs"o l whi e pe fo m ngoouterenylrri (b)Re t d to in the custo y one,,d rduis re a e to the o y ur busin ss,t e l t d f o e co tr l o ,o o e whi h phy icanofrvrcsloyu"e pl y e ", o h r th n e t e y urormoesteaihror co tr l i b i g e e ci e fo a ynosenxrsdrn pu po e b ;r s yohrthaapateshi,j i t v n u e o l m t dtenrnrponetrriie l a i i y co p ny o y u a a e s (i o re aibltma)r o r m n g r f y u a y u,a y o y u "e pl y e ","v l n e ronformoesoutelmtelaiiycopay,but o l foiidibltmn)n y r wo k rs", a y pa t e o m m e i o rerenrnrrebr(f y u awihitheother e p o m n by y u otnfimlyetor a pa t e shi o jo n v n u e ,o a yrnrpritetr)r nwhiepefrmnduis re a e to the co d ctlroigteltdnu m m e (i y u a e a li i e l a i i yebrformtdibltoyur busin ss. Ho e e ,no e o th sefoewvrnfe co pa y .m n )"e pl y e "o "v l n e r wo k rs"a emoesrouterer b.An pe so (o he tha y ur "e pl y e oyrntrnomoe"risurdfr:n e s o "v l n e r wo k r"),o a y o g n z t o ,whi eouterernraiainl(1)"Bo i y i j r "o "pe so a n ur ":d l n u y r r n l i j y a t n s y u e l e ta e m na e .c i g a o r r a s t a g r (a)To y u,to y u pa t e s o e be s (ioorrnrrmmrf c.An pe so o o g n z t o ha i g pro eyrnrraiainvnpryu a e a pa t e shi o j i t v n u e ,o r r n r p r o n e t r )te po a y custo y o y ur pro e ty if y u di ,m r r d f o p r o etoyummes(if y u a e a li i eorebrormtd bu nl :t o ylaiiycopn),to a co "e pl y eibltmay-m o e "(1)Wit to li b l t a i i g o t o thehaiiyrsnufwhieinthohiohelefsrrmitnaceoseotarprt;a danenrufhtpoeyneplyetopefomngdutemomnrrriis re a e to the o y ultdfor (2)Unt l y u l ga re r se t t v ha be niorelpenaiese bu i e s, o to y u o h r "v l n e r a po n e .s n s r o r t e o u t e p i t d CG 1 0 02 1T09 Pa e 11 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. insurance t described Declarations as: respect conduct which respect conduct respect respect officers directors respect Each conduct acts scope doctor. acting occupied care course conduct respect respect to the conduct of your business. i sure .Y u "e e u i e o fi e s"a d di e t rsndorxctvfcrnrco respect to their liability as stockholders. "e e u i e o f ce s"(i y u a e a o ga i a i nxctvfirfornrnzto COMM RCIAL E ERAL IAB LITYEGNLI d.Y u l g l re re e t t v if y u di , but o loreapsnaieoeny b.Ari e o t o th o n r hi , m i te a ce ossufewespannnr wi h to duti s as such. Tha use o t a a t o ny pre i etetfhtprfamss l a e o y u.e s d t o re re e ta i e wi l ha e a l y u rig t a dpsntvlvlorhsn The i sura ce pro i e to such pre i e o ne ,n n v d d m s s w rduis un e hi Co e a e Pa ttedrtsvrgr.m na e o l sso i to the fo l w ngagrrersloi e.An pe so o o ga i a i n tha , wi h y u pro i io s:y r n r r n z t o t t o r v s n e pre s o im l e co se t,e t e use o isxsrpidnnihrsr a.The l m ts o i sura ce pro i e to suchiifnnvddreposibefotheuseoawaecratthtyusnlrftrfaopreieone,m na e o le so wi l be themsswragrrsrldonoontht s:t w a i m n m m l m t th t y u gre d o p o i e i heiiuiisaoaetrvdnt (1)50 fe t o g r e s; a d wri t n o a r e e t,o the lelnolsntergemnri i smt sho n i he ra i ns, hi e a e l ss.w n t t o w v r r e(2)No be ng use to ca ry a y pe so otidrnrnr pro e ty f r .p r o a b.The in ura ce pro i e to such pre i esnvddmss o ne ,m na e r e so o s no a pl t :w r a g r o l s r d e t p y o3.An o g n z t o y u ne l o fo m o h ryraiainowyrr,t e th n a pa t e shi ,jo n v nt r o l m t d l a i i yarnrpiteueriieiblt (1)An "bo i y in u y o "pro e ty da a eydljr"r p r m g " co p ny a d o y u a e t e so e o n r o i th t o cur , o "pema,n f o r h l w e r n a c s r rso a a d a v rti inlndesng y u m i t i a o ne shi in e e t o m r i j ry ca se byoanannwrptrsfoenu"u d a o fe se tha infnts th n 50 , wi l qu l fy a a Na e nsure f t e e i co m t e , ft r oa%l a i s m d I d i h r s m i t d a e y u to be t na t naeni no o h r sim l r in ura ce a a l bl to tha th t re i e ; rteiasnviaetapmsso o ga i a i n o e e :r n z t o .H w v r (2)St u tu a a te a i ns, ne orcrllrtowr a.Co e a e und r thi pro i i n i a f rde o l de o i i n o e a ivrgesvsosfodnymltoprto s pe fo m dnrre by o orn un i th 180t da a t r y u o fo m th be a f o such p e i e otlehyfeorrehlfrmsswn r,m na e reagro o ga i a i n o the e d o the pe i d,l sso .r n z t o r n f r o e r 5.An pe so o o g n z t o th t is a e ui m ntyrnrraiainanqpe b.Co e a evrg A do s no a pl to "bo i y in u y o l sso nd t a o a eetpydljr"r e r a h t y u h v gr e i w i t n coaednartentr cta "pro e ty da a e th t be o e y u o a re m nt to in l dprmg"a f r o r g e e c u e a a a d t o asndiinl i sure ondn i e r f rm d he o ga i a i n nd th s Co e a e Pa t is aurdooetrnzto;a i v r g r n i sure ,bundt o l wi hnyt re pe t to l a i i y fo "bo i y i j ry ,"pro e tyscibltrdlnu"p rc.Co e a evrg B do s no a p y to "pe so a a detplrnln da a e , r "pe so a nd a v rt si g i j ry th t:m g "o r n l a d e i n n u "aavrtsinijryaiigot o a o f n edeignu"r s n u f n f e s co m t e be o e y u a q i e o fo m d themitdfrocurdrre a.Is "bo i y i j ry o "pro e ty da a e th tdlnu"r p r m g "a o ga i a i n o cur , o i "pe so a a d a v rt si g in u yrnzto.c s r s r n l n d e i n j r " ca se by a o fe se tha is co m t e ,u d n f n t m i t dFrthpupoeoPaarpoerssfrgah1.o Se t ofcin II –subse u nt to the si n ng o tha co tr ct oqegiftnarWhoIsAnInure, e ch such o ga i a i n wi l besdarnztol a re m nt a dgee;ndemd o b e ig a e n t eeetedsntdih b.Is ca se , in who e o i pa t,by y u a ts oudlrnrorcra.An o g n z t o ,o he tha a pa t e shi , jo nraiaintrnrnrpit o i si n in the m i t n nce o e a i n o usemsosanea,p r t o rvntrr i i e i bi i y co pa y reueolmtdlaltmn;o o e u pm n l a e to y u by such e u p e tfqietesdoqimn l sso .e rb.A rust;t The in ura ce pro i e t such qu p e t l sso ssnvddoeimneriaeinitnaeothedoumntthastdsmrcestsubjcttotefolwigpoiin:e h l o n r v s o sgoenis str ct revrtuu. a.The l m ts o i sura ce pro i e to suchiifnnvdd4.An pe so o o g n z t o th t i a pre i eyrnrraiainasmss e ui m n e so w l e t e m n m m l m t t aqpetlsrilbhiiuiishtone,m n g r o l sso a d th t y u ha e a re dwraaerernaovge y u a r e to pro i e i the wri te co tr ct oogedvdntnnariawritn co t a t o a re m nt to i cl d a antenrcrgeenuesn a re m nt o the li i s sho n i thgee,r m t w n eadiinlinureothsCoeaePatis adtoasdnivrgrn De l ra i ns, hi h v r a e l ss.c a t o w c e e r eisure,but o l wit re pe t to li b l t fo "bo i yndnyhscaiiyrdl b.The i sura ce pro i e to such e u p e tnnvddqimnijry,"pro e ty da a e o "pe so a a dnu"p r m g "r r n l n l sso do s no a pl to a y "bo i y i j ry oeretpyndlnu"ravrtsinnur"th t:d e i g i j y a "pro e ty da a e th t o curs, o "pe so aprmg"a c r r n l a.Is "bo i y i j ry o "pro e ty da a e th t a d a v rt sin in ur "cadlnu"r p r m g "a n d e i g j y u e by a o fe sesdnfn th t i co m t e ,a t r the e ui m nt l a easmitdfeqpeesoccurs, or is "personal and advertising injury" e pi e .x r scasebyaofesethais co m t e ,u d n f n t m i t d subse u nt to the si n ng o tha co tr ct oqegiftnar No pe so o o ga i a i n is a in urernrrnztonsdaremntadgee;n th co du t o a y curre t o pa t pa t e shi ,jo nencfnnrsrnrpit Pa e 12 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. respect charge acquire which which acquire policy whichever is earlier; occurred acq subject contract Decla che cease construction indica Declarations as: with respect to COMM RCI L G NERA L IAB LI YEAELIT a.The a o n sho n fo th Da a e Tomutwremg a Na e In ure in the ra i n .Thi pa a ra h Pre i e Re tmdsdatossrgpmssne To Y u Li i i thdomtne do s no a pl to a y such pa t e shi ,jo n v nt re o De raetpynrnrpiteurt o s o hi Co e a e Painftsvrgrt o;r l m te l a i i y co pa y tha o h rwi e qua i i s a aiidibltmntteslfesn b.$3 0 0 0 if no a o nt i sho n fo the0,0 m u s w r Da a e To Pre i e Re t d To Y u Li i imgmssneomtn SE TI N I I –L MIT F I S RAN ECOIISONUC 7.Su j ct to Pa a r pbergah 5.a o e the M d cabv,e i l1.The Li i s o Insura ce sho n i thmtfnwne Ex e se Li i i th m st we wil pa und rpnmtseolyead th rul s be o fi the m st we wi l paneelwxoly Co e a evrg C fo a l m di e p nse be a se orlexescufrgadesohenubef:e r l s f t m r o "bo i y i j r "su ta n d y a y o e p rso .d l n u y s i e b n n e na.In ure s;s d The Li i s o Insura ce o thi Co e a e Pa t a plmtfnfsvrgrpyb.Cl i s m de o "sui s"bro gh ;oamartutr se a a e y to e ch co se ut v a n a pe i d a d to a yprtlancienulronn re a ni g pe i d o l ss th n 12 m nt s, sta t n wi hminrofeaohrigtc.Pe so s o o ga i a i n m k ng ornrrnztosair th be i n n o the po i y pe i d sho n i theegnigflcrownbrigng"sui s".n i t De ra i ns, un e s the po i y pe i d is e t nd d a t rtolslcroxeefe2.The Ge e a Agg e a e L m t m st e wi l p ynrlrgtiiiowla i sua ce fo a a di i n l pe i d o le s th n 12snrndtoarofsafohesumo:r t f m nt s. In th t ca e th a d t o a pe i d wi l beohas,e d i i n l r o la.M di a x e se un e o e a eeclepnsdrCvrg C ;de m d pa t o h l st re i g e i d o urp se oeerfteapnprofrposf de e m n ng th L m ts o nsura cetriieiifIn.b.Da a e unde Co e a emgsrvrg A, e ce t da a expmgs o "bo i y i j ry o "pro e ty da a efdlnu"r p r m g "SE TI N I –CO MERCIAL G N RAL L AB L TYCOVMEEIII i cl d d in th "pro uct -co p e e o e a i nsnueedsmltdprto CO D TI NNIOShaad; ndzr"a 1.B n ru tcyakpc.Da a e u d r Co e a emgsnevrg B.Ba k up cy o i so v ncy o th i sure o o thnrtrnlefendrfe3.The Pro u ts-Co pl t d Ope a i ns Aggr g tedcmeertoea i sure 'e ta e wi l no re i v us o o r o l ga i nndsstltleefubitos Li i i th m st we wi l pa un e Co e a emtseolydrvrg A for un e hi Co e a e Pa tdrtsvrgr. da a e o "bo i y in u y a d "pro e tymgsfdljr"n p r 2.D ti s In T e vent O cc rren e O f n e,u e h E f O u c ,f e sdaaeicldeithe"pro uct -co p e emg"n u d n d s m l t d Cla m r S iiOutoeainhzrd.p r t o s a a "a.Y u m st se to i th t we a e no i i d a so nouetartfeso4.Su j ct to Pa a r pbergah 2.a o e th Pe so a Andbv,e r n l a pra a l o a o a o f n esbefn"r n f e sAdetsigInuyLiiis the m st we wi l pavrinjrmtoly whi h m y re ul i a cla m To the e t ncastni.x e tuneCoeaedrvrgBfothesumoaldaaerflmgsposil,sho lsbeudbeaseoal"pe so a i j ry a d "a v rt sincuflrnlnu"n d e i g (1)Ho , whe a d whe e the e ce ownnrrn"rijrysustand y a y o e pe so r r a i a i nnu"i e b n n r n o o g n z t o . o fe se t o l cefnokpa;5.Su j ct to Pa a r pbergah 2.or 3.a o ebv,(2)The na e a d a dr sse o a y in ur dmsndesfnjeaple, the Occurr n e Li i i th m st wepisecmtseo pe so s a d i n sse ; ndrnnwtesawilpyfohesumo:l a r t f (3)The na ur a d l ca i n o a y i j ry otenotofnnura.Da a e u d r Co e a emgsnevrg A; nda da a e a i i g o t o th e ce omgrsnufern"rb.M di a x e se un e o e a eeclepnsdrCvrg C ;o fe sefn. be a se o a l "bo i y i j ry a d "pro e ty da a ecufldlnu"n p r m g "b.If a cl i i m de o "sui "i bro g t a a nstamsartsuhgiaiigotoayoe"o cur e ce .r s n u f n n c r n "a y i sure ,y u u t:n n d o m sFrthepuroeodeemnigtheaplcalopssftrinpibe(1)Im e i t l re d th o themdaeyefEah Occurr n e Li i ,a l re a e ocecmtlltdr cl i r "sui "a d he da e r ce v d ndamotntteie;aoisincomteiproiigofalngtomsosmitdnvdnrii(2)No i y us a so n a pr ct ca l .t f s o s a i b eproiefist a d o "Go d Sa a i a se v ce "tovdriromrtnris a y o e pe so wi l be de m d to be o ennrnleen Y u m st se to i tha e r ce v ri t n o u e t t w e i e w t e "o cur e ce .c r n "o h cl i o "sui "a so n afteamrtsos 6.Su j ct to Pa a r pbergah 5.a o e th Da a e Tobv,e m g c.Y u a d ny o he n o v d n ure m st:o n a t r i v l e i s d u Pre i e Re t d To Y u Li i i the m st we wilmssneomtsol (1)Im e i t l se d us co i s o a ymdaeynpefnpaundr Co e a eyevrg A fo da a e ormgsf de a d , , sum o se o le amnsmnsrgl"pre i e da a e to a y o e pre i e .Themssmg"n n m s s pa e s re v d in co ne n wit thprenheDaaeToPreieRetdToYuLiiwlemgmssneomtilb:cl i r "sui ";a m o t CG 1 0 02 1T09 Pa e 13 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Decl Declarations claims s the because cla cal cla ced because whichever Each acts because ctic "occurrence notice include: "occur "occur cor specifics notice practicable. notices cei ctio v nt r o l m t d l a i i y co pa y tha is no sho n aeueriieibltmnttws the Declarations of this Coverage Part. insured under Section II – Who Is An Insured. COMM RCIAL E ERAL IAB LITYEGNLI (2)Au h ri e us to o ta n a d o h rtozbinte (i ii)An o f ce o ofirrf i f rm t o ;a y o h r r a i a i n rnoainnteognzto;o (3)Co p r t wi h us i th in e ti a i n ooeaetnevsgtor (v)i A ruste f ny t u t;t e o a r s se t e e t o the cl i o de e se a a nsttlmnfamrfngi th t is y u pa t e ,jo n v n u eaorrnritetrth"sui "; ndeta m m e ,m na e o ru te ; rebragrrtseo (4)Assi t us, upo o r re ue t,i thesnuqsn (b)An e p o e a t o i e by suchymlyeuhrzdefoceetoayrihaant a ynrmnfngtgisn pa t e shi ,j i t v n ure li i ernrponet,m t dpesooogaiainmybelalrnrrnztoaibelaiiycopnytrust or ot eibltma,h rtothisureoinuyodaaeendfjrrmgogaiaintogieoarnztovfntowhch hi i sura ce m y a so a p yitsnnalpl.o o fe se"r f n . d.No in ure wi l e ce t a th t in ure 's o nsdl,x p t a s d w (3)to us o such ofrcot, v l nt ri y m k a pa m n ,a sum a ysoualaeyetsen o fe se wi l be de m d to be gi e a so nfnleevnsoolgtinoayepeseohr tha fobiao,r n x n ,t e n r a pra ti a l i it is gi e i go d fa th asccbefvnnoisfist i ,wi h u o r r a d t o t u so n a pra ti a l to y u wo k r 'o s c c b e o r r e s co p nsa i n in ure .Thi a p i s o l ifmetosrsplenye.The fo l wi g pro i io s a p y to Pa a ra hlonvsnplrgp a. y u subse ue tl gi e no i e to us o theoqnyvtcfaoebuolfopuroeothinuracebv,t n y r p s s f e s n "o cur e ce o o fe se a so n acrn"r f n s o sproieunetiCoeaePat o y u o a yvdddrhsvrgrtorn pra t ca l a t r a y o th pe so scibefenfernisurelsteiPaarpndidnrgah1.or 2.o Se ti nfco II de cri e in Pa a ra hsbdrgp e.1()or (2)a o ebv–Who I A nsure :s n I d di co e s tha th "o cur e ce o o fe sesvrtecrn"r f n(1)No i e to us o such otcfr m y re ul in sum to whi h the in ura ceastscsnofesemst be gi e a so n afnuvnsos pro i e un e th s Co e a e Pa t m yvdddrivrgra pra l o l a t r th e ce obenyfeern"r a pl .p y o fe se is k o n to y u (i y u a e afnnwoforn Ho e e , i thi po i y i cl de a e do se e twvrfslcnusnnrmnidvdul,a y o y u pa tn rs orniia)n f o r r e th t pro i e li i e co e a e fo "bo i y i j ryavdsmtdvrgrdlnu"m m e s who i a in i i u l (if y u a e aebrsndvdaor o "pro e ty da a e o po l ti n co ts a i i grprmg"r l u o s r s npateshiojonvnure,a y o y urnrpritet)n f o r o t o a di cha ge re e se o e ca e oufsr,l a r s p fmnaes who is a in i i u l (i y u a e aagrndvdafor "po l t n s"whi h co t i s a re ui e e t thaluatcnanqrmntlmtelibltycopn),a y o y uiidaiimaynfor th di cha ge re e se o e ca e o "po l t n s"e s r ,l a r s p f l u a t"e e u i e o f ce s"o (i y u a exctvfirrfor m st be re o te to us wi h n a spe i i n m euprdticfcubraognztoohrthaapateshi,n r a i a i n t e n r n r p o da s a t r i s a ru t co m n e e t,th sfyfetbpmecmnijitvntreoliielaiiycopay,o n e u ,r m t d i b l t m n )Pa a r prgah e.do s n t a fe t t a e u re e t.e o f c h t r q i m nayoyur tr ste s who is a i d v du l (ifnfouenniia 3.L g l c i n Ag i s seaAtoantUyu a e a trust) o a y "e pl y eorrnmoe" No pe so o o g n z t o ha a ri h und r th srnrraiainsgteiatoiebyyu to gi e no i e o auhrzdovtcfn Co e a e P rtvrga:"o cur e ce o o fe secrn"r f n . a.To jo n us a a pa t o o h r i e bri g us i tisryrtewsnno(2)If y u a e a pa t e shi ,jo n v n ureorrnrpitet,a "sui "a ki g o d m ge f o n n ure ;otsnfraasrmaisdrlmtelibltycopayotrut,a d no eiidaiimnrsnn b.To sue us o th s Co e a e Pa t unl ss a l onivrgrelfoyurpates, jo n v nt r m m e s,f o r n r i t e u e e b r i s t rm ha e be n u l co p i d i htesveflymlewt.m na e s o t u te s a e i di i u l , o i eagrrrsernvdasntc to us o such "o cur e ce o o f nse m stfcrn"r f e u A pe so o o ga i a i n m y sue us to re o e ornrrnztoacvrn be gi e a so n a pra ti a l o l a t rvnsosccbenyfe a a r e se t e e t o o a fi a ju g e t a a nstngedtlmnrnnldmngi th "o cur e ce o o fe se i k o n yecrn"r f n s n w b :a in ure ;but we wil no be li b e fo da a ensdltalrmgs th t a e no pa a l und r th te m o th sartybeeersfi(a)An nd v du l w o i :y i i i a h s Co e a e Pa t o tha a e i e ce s o thevrgrrtrnxsf (i)A pa t e o m m e o a yrnrrebrfn a pl ca l l m t o in ura ce An a r e se tl m npibeiifsn.g e d t e e t pa t e shi r o n e t r ;r n r p o j i t v n u e m a s a se tl m n a d e e se o i b l t ig e yenteetnrlaflaiiysndb us, the i sure ,a d the cl i a t o th cla m n 'n d n a m n r e i a t s(i )i A m na e o a y l m te l a i i yagrfniidiblt l ga e r se ta i eelrpentv.co p nyma; Pa e 14 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. records which because executive director notice "occurrence Notice "occurrence" incur consent. ctica "occur directors "occurrence" COMM RCI L G NERA L IAB LI YEAELIT 4.O h r n u an e (iteIsrci)Tha i in ura ce fo "pre i etssnrmss da a e ;m g "If v l d a d co l cti l o h r i sura ce is a a l bl oainlebetennviaet (i )i i If th lo s a i e o t o theesrssufthisurefoaloswecoeundeCoeaeendrsvrrvrgsA m i t na ce o use o a rcra tanenrfif,or B o th s Co e a e Pa t o r o l g t o s a efivrgr,u b i a i n r "a t s"o wa e cra t to the e t ntuortrfxelmteadecrieiaarahiidssbdnPrgpsa.a dn b.be o .l w no subj ct to a y e cl sio i th stenxunniAs use a y he e in th s Co e a e Pa t o h rdnwrivrgr,t e Co e a e Pa t th t a pl e tovrgrapisisuracemasinuraceothfunigonnensn,r e d n f a rcra t "a t s"o w t rcra tif,u o r a e f ;l sse , ha s p o i e y hr u h o o b ha f o :o s t t i r v d d b ,t o g r n e l f (i )v Tha is in ura ce a a l bl to atsnviae(i)An t e i sura ce co pa yohrnnmn;pre i e ow e ,m na e ormssnragr(i )i Us o n f ur ff l a e n ura ce co pa i s,r a y o o a i i t d i s n m n e l sso th t qua i i s a a in ureeralfesnsd e ce t whe th No cum l t o oxpnenuainf un e Pa a ra hdrrgp 4.of II – Occurr n e Li i pro i io o Pa a ra hecmtvsnfrgp 5.of Who Is An Insure ,e ce t whedxpnIII–Li i s Of Insura ce o th Nomtnren Pa a r prgah d.be o pp i s; rlwaleo cum l ti n o Pe so a a d Adv rt sin In uruaofrnlneigjy (v)Tha is i sura ce a a l b e to atnnvialnLiiproiiooPaarahmtvsnfrgp4.of III –e ui m n l sso th t qua i i s aqpeteralfesLiisoInuraceapis thmtfsnplee a in ure unde Pa a r pnsdrrgah 5.ofAmnmn–No Cum l t o Of e d e t n u a i n II –Who Is An Insure ,dOccurrneLiiOf Li bi i y And Noecmtaltn e ce t whe Pa a ra hxpnrgp d.be olwCumltoOf Pe so a A d Ad e t si g Inj ryuainrnlnvrinu a pl e .p i sLiiedoseetiicldenthmtnrmnsnudii;(b)An o the o h r i sura ce whe heyftenn,t r(i ii)An i k e e ti n gro p;oyrsrtnour pri a y e ce s, co t n e t o o a ymr,x s n i g n r n n o h r ba is, tha i a a l bl to thtestsviaee(iv)Any self-insurance method or program,in i sure whe the i sure is andnndnwhich case the insured will be deemed to be th p o i e f o h r i sura ce a di i n l i sure , o is a y oervdrotenn.d t o a n d r n th re i sure tha do s no qu l fy a andtetaisOteinuracedosnoinldumrelhrsnetcueblanaeisure,un e such o h rmdnddrteisuraceoecesinuracethtwabogtnn,r x s s n ,a s u h i sura cenn.spe i i a l to a p y in e ce s o th Li i s ocfclyplxsfemtf (2)Whe th s i sura ce i e ce s, we wilninnsxslInuraceshon in the o th ssnwfi ha e no dut und r Co e a evyevrgs A or B toCoeaePrtvrga. de e d th i sure a a nst a y "sui "i a yfnendgintfnAs use a y he e in th s Pa t o h rdnwrir,t e o h r in ure ha a du y to de e d thetesrstfnisuremasaproieoohrinuraceAsnrenvdrftesn.i sure a a n t tha "sui ". If no o h rndgisttteuseinPaarahdrgpc.be o ,in ure m a s alwsren i sure de e d , we wi l un e t k t o sonrfnsldraeod,pro i e f n ura cevdroisn.bu we wi l b nt t e t h i sure 'ri h stleeildotendsgt a a nst l h se o h r nsur r .g i a l t o t e i e sa.P i ary I su an ermnrc (3)Whe thi in ura ce i e ce s o e o h rnssnsxsvrteThiinsuraceis pri a y whesnmrn i sura ce we wi l pa o l o r sha e o thenn,l y n y u r fPaarprgahb.be o a pl e . If th s i sura ce ilwpisinns a o nt o the lo s, i a y th t e ce d themufsfn,a x e spriayor o l g ti n a e no a f cte un e smr,u b i a o s r t f e d l s sum o :fayothohrisuraceis a so pri a ynfetennlmr. (a)The to a a o nt tha a l such o h rtlmutlteThe,we wi l sha e wi h a l t a o he n ura cenlrtlhttrisn i sur n e wo l pa fo th lo s i thnacudyresnebytemthd e cri e n Pa a r pheodsbdirgah c.be o ,l w a se ce o hi i sura ce nbnftsnn;a decet h n a a ra hxpwePrgp d.be o pp i s.l w a l e (b)The to a o a l a d se ftlflnl-b Ex e s I s ran e.c s n u c i sure a o nt unde a l th t o h rndmusrlate(1)Thi i sura ce i e ce s o e :s n n s x s v r i sur n enac. (4)We wi l sha e the re a n ng l ss, if a ylrmiion,()a An o the o he in ura ce whe heyftrsn,t r wi h a y o he in ura ce th t i notntrsnastpriayeces, co t n e t o o a ymr,x s n i g n r n n de cri e in thi Ex e s Insura cesbdscsnohrbsi:t e a s pro i i n a d wa no bo g t spe i i a l tvsonstuhcfclyo()i Tha is Fi e Ex e d d Co e a etr,t n e v r g ,a pl i e ce s o the Li i s o In ura cepynxsfmtfsnBule'Ri k In ta l t o Risk oidrss,s l a i n r sho n i th r t o s o thi Cov r gwneainfseae Pa tr. CG 1 0 02 1T09 Pa e 15 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Each Section Section because Each s policy Section Section except deductible Declasimilar coverage for "your work"; Declarations Coverage COMM RCIAL E ERAL IAB LITYEGNLI c.Meth d O h rin a.o f S a g The sta e e t in th a etmnser a cura e a d co p e ectnmlt;If a l o the o he i sura ce pe m t co t i ut olftrnnrisnrbin by e u l sha e , w i l fo l w t i m t o l oqarsewllohsehdas.b.Tho e sta e e ts a e ba e upostmnrsdn Und r th s e ch in ure co t i ut s re re e t ti n y ueiasrnrbepsnaoso a e to us; nmdad e ua a o n s unt l it ha pa d it a pl ca lqlmutisispibe c.We ha e i sue th s po i y i re i n e up nvsdilcnlacolmt o in ura ce o no e o th l ss re a ns,i i f s n r n f e o m i y ur e re e ta i ns.o r p s n t o The uni te ti n l o i sio o ,o uni t n i na e ronnoamsnfrnetolrrIfayothohrisuracedosnopemtnfetennetrii,a y i f rm ti n pro i e by y u whi h we re i dnnnoaovddoclecotrbuin by e u l sha e , we wi l co t i utnitoqarslnrbe up n i issui g th s po i y wi l no pre u i e y uonnilcltjdcorbylmt. Und r th s m t o ,e ch i sure 'siiseiehdanr ri ht unde th s in ura ce Ho e e ,thi pro i i ngsrisn.w v r s v s oshaeis ba e o the ra i o i s a p i a l i irsdntoftplcbelmt do s no a f ct o r ri h to co l ct a di i n letfeugtledtoaoinuracetothtoaaplcalliisofsnetlpibemtfpreimotoeecieor rig t o ca ce l t o omurxrsuhsfnlainrisuraceolnsures.n n f a l i r no re e a i cco d nce w t pp i a l n ura cennwlnaraihalcbeisn d P i a y And No -Co trib t ry In u an e If.r m r n n u o s r c l ws o e ul t o s.a r r g a i n Req i ed B Wri te o tracurytnCnt 7.Se arat o f n u edpinOIsrs If y u spe i i a l a re i a wri t n co t a t oocfclygentenrcr Ex e t wi h re pe t to the Li i s o In ura ce a dcptscmtfsn,naremntthatheisuraceafodd to ageetnnfren a y ri h s o du i s a sig e i th sngtrtesndniisureunehiCoeaePatmst p l nnddrtsvrgruapyo Co e a e Pa t to the fi st Na e Insure ,th svrgrrmddiapriaybai, o a pri a y a d no -m r s s r m r n n i sura ce a pl e :n n p i scotrbuoybais, th s i sura ce is pri a y tonitrsinnmr a.As i e ch Na e In ure we e the o lfamdsdrnyohrinuracetht i a a l bl otesnasviaet Na e n ure ; ndmdIsdawhih o e s such n ure a a n m d i sure ,c c v r i s d s a e n d b.Se a a e y to e ch in ure a a n t who cl iprtlasdgismamad we wil no sha e wi h th t o h r in ura cenltrtatesn,i m d o "sui "i b o g tsaertsruh.pro i e ha :v d d t t 8.Tra sfe O i h s O e o ery Ag i s t ersnrfRgtfRcvantOh(1)The "bo i y i j ry o "pro e ty da a e fodlnu"r p r m g "r To Uswhihcoeaeisoghocur; ndcvrgsutcsa If the i sure ha ri h s to re o e a l o pa t o a yndsgtcvrlrrfn(2)The "pe so a a d a v rt sin i j ry fornlndeignu"r pa m n we ha e m d unde thi Co e a e Pa tyetvaersvrgr,whi h co e a e is so gh i ca se by acvrgutsudn th se ri ht a e tra sfe re t us. he i sure ustogsrnrdoTndmofesetaicomte;f n h t s m i t d do no h ng a te l ss to i p i th m At o r re u st,t i f r o m a r e .u q esubseunttothesinngothacotrctoqegiftnarthisurewilbrig"sui "o tra sfe tho e ri h sendlntrnrsgtaremntbyyugeeo.to us a d h l s e f rce t e .n e p u n o h m5.P e i m Au irmudt 9.Wh n We D N t en weooRea.We wi l co p t a l p e i m f r h s Co e a elmuelrmusotivrg If we d ci e n t o r n w h s Co e a e P rt e wi ledoteetivrga,w lPaticcodncewtur u e a d a e .r n a r a i h o r l s n r t s m i o de i e to th fi st Na e In ure sho n inalrlvrermdsdwb.Pre i m sho n in th s Co e a e Pa t amuwivrgrs th De l ra i n wri te no i e o the no r n waecatostntcfneelavncepreimiadeoiprmumol.Adamuspsteinyt no l ss th n 0 da s be o e t e e pi a i n da etea3yfrhxrtot.th clo e o e ch a d t pe i d we wi l co p tesfauirolmue If no i e is m i e ,pro f o m i i g wi l be suffi i ntcaldofalnlcetthernd pre i m fo th t pe i d a d se deaemuraronn pro f f o i eoontc.no i e t th fi st Na e I sure .The du da etcoermdndet SE TI N V –D F N T O SCOEIIINfoadiadreropetiepeimitedtrutntscvrmusshae 1."shown as the due date on the bill.If the sum of Ad e t se e t"m a s a no i e th t s br a ca t ovrimnentcaiodsr pu l she to the ge e a pub i o spe i i m rbidnrllcrcfcatheadvanceandaudit premiums paid for the k te po i y pe i d is gre te tha the e rn dlcroarnae se m nt a o t y ur go ds, pro u ts o ser i egesbuoodcrvcs fo th purp se o a t a g custo e s oreoftrmrrpremium,we will return the excess to the fi rst Na e nsure .supp rt r . o h p r o e o hi de i i i nmdIdoesFrteupssftsfnto: c.The fi st Na e In ure m st k e re o d ormdsduepcrsf a.No i e th t a e publ she i cl de m t r atcsaridnuaeil th in o m t o we ne d fo pre i m pl ce o the Int rn t o oefrainermuadneern sim l r i a co p t ti n a d se d us co i s a such t m smuao,n n p e t i e m a s o co m ni a i n;a denfmucton a we m y re u st.s a q e b.Re a di g we sit s, o l tha pa t o a we si egrnbenytrfbt 6.Rep es n ati nretos th t is a o t y u go d , pro u ts o se v ceabuorosdcrris fo th pur o e o a t a custo e s orepssftrmrrBytigtiplcyogre:p n h s o i ,y u a e supp rt r i co si e e a a v rt se e toessndrdndeimn. Pa e 16 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. approach specifically ctin cting electronic acce whichever comes first. Declarations such insured COMM RCI L G NERA L IAB LI YEAELIT 2."Ad e t si g i j ry :v r i n n u "b.In by o wit a y o he e e o i m a s o,r h n t r l n c e n f co m n ca i n such a th In e n t,if thamuito,s e t r e ta.M a s in ur ca se by o e o m re o theenjyudnrof m te i l i p r f:a r a s a t ofolwigofese:l o n f n s (1)Ra i o te e i i n pro r m i g be ngdorlvsogamni(1)Ora o writ e a i n incl di glrtnto,u n tr n m t e ;a s i t dpulcain by e e o i m a s, o m t ri lbitolncenfaea i y ur "a v rt se e t th t sla d rs onodeimn"a n e r (2)Ot e en e ta n e t e uca i n lhrtrimn,d t o a ,l b l a pe son or or a i a i n oriesrgnzto i structi n l m si o ne s pro r m i gnoa,u c r w g a m ndipaaeapeso'o o ga i a i n ssrgsrnsrrnzto'be n ra sm t e ;oigtnitdrgods, pro u ts o se v ce , pro i e thaodcrrisvddt th cla m i m d o he "sui "i b o g t byeisaerttsruh (3)Ad e t si g tra sm t e wi h a y o suchvrinnitdtnf a pe so o o g ni a i n h t cl i s to ha ernrraztotaamv pro ra m n .g m i g be n sla d re o li e e ,o tha cla m toenedrbldrtis 6."Co e a e t rri o y m a s:v r g e t r "e nhaehaitgods, pro uct o se v cevdsodsrris di pa a e ;s r g d a.The Uni e Sta e o Am ri a (i cl di g i stdtsfecnunt te r t r e a d po se si ns), Pue t Ri o a drioisnssorocn(2)Ora o writ e pub i i n incl di glrtnlo,u n Ca a and;pu l ca i n by e e i m a s, o m t r abitolncenfaeil i o r "a v rt se e t th t:n y u d e i m n "a b.In e na i na wa e s o a rspa e but o l if thetrtoltrric,n y (a)Ap ro ri t s a pe so 'na e v i eppaernsm,o c ,i j ry o da a e o curs in th co rse o tra enurmgceufvl ph t gr p r i e e s; oooaholknsr o tra spo t t o be w e a y pl ce in l d drnraintennascue i Pa a r pnrgah a.a o e rbv;o(b)Unre so a l pl ce a pe so in aanbyasrn fa se l gh ; rlito c.Al o h r pa t o th wo l if th i j ry oltersferdenur da a e a i e o t o :m g r s s u f(3)In r ng m nt o co y i ht "ti l "o "sl g n"f i e e f p r g ,t e r o a i y u "a v rt se e t , pro i e tha thnordeimn"v d d t e (1)Go ds o pro uct m d o so d by y u inordsaerlo cl i i m d o th "sui "i bro gh by aamsaeretsut th te ri o y de cri e i Pa a r pertrsbdnrgah a.pe so o o ga i a i n tha cla mrnrrnztotis a o ebv;o ne shi o such co y i ht "ti l "owrpfprg,t e r (2)The a ti i i s o a pe so who e ho e i icvtefrnsmsn"sl g n .o a "th te ri o y de cri e i Pa a r pertrsbdnrgah a.b.In l d s "bo i y in ur "ca se by o e o m rcuedljyudnroe a o e but i a a fo a sho t ti e o y urbv,s w y r r m n ootheofnedecribd in Pa a ra hffesssergp a.bu i e s; rsnsoaoebv.(3)"Pe so a a d a v rt sin i j ry o fe sernlndeignu"f n s3."Au o m a s:t "e n th t ta e pl ce th o g th In e ne oakaruhetrtr a.A l nd m t r v h cl ,tra l r o se i r i eaooeieiermtalr si i a l ct o i m a s o o m n ca i nmlreerncenfcmuito; de i n d fo tra e o pub i ro ds, i cl di gsgervlnlcanun pro i e the insure 're po sib l ty to pavdddssniiyayatcheahieyoqupmn; rntadmcnrreieto da a e is de e m n d in a "sui "o th m r t imgstrietneeisnb.An o he la d v h cl th t is sub e t to aytrneieajc th te ri o y de cri e i Pa a r pertrsbdnrgah a.a o e o ibv,r n a co p l o y o fi a ci l re po si i i y la ,omusrrnnasnbltwr se t e e t we a re otlmnget. o h r m to v hi l i sura ce l w,whe e i iteorecennarts 7."El ct o i da a m a s in o m t o , fa t oernct"e n f r a i n c s rlceser ri ci a l a a e .i n d o p n p l y g r g d pro ra s sto e a o o ,cre te o use o , ogmrdsrnadrdnrHoee,"a t "do s no in l d "m bi ewvruoetcueol tr n m t e to o fro co pu e so tw r (i cl d ngasitdrmmtrfaenuieuimn".q p e t sy te s a d a p i a i ns so tw r )ha d o fl p ysmnplctofae,r r o p 4."Bo i y i j r "m a s:d l n u y e n di ks, CD-ROM , ta e , dri e , cel s, da asspsvslt pro e sin de i e o a y o h r m di a ecsgvcsrnteeara.Ph si a ha m i cl di g si kn ss o di e seyclr,n u n c e r s a , use i h e e o i a l co t o l d e ui m n .d w t l n c l y n r l e q p e tsustand y a pe so ;oiebrnr b.M nt l a g i h, i j ry o i l e s, o e o i n leanusnurlnsrmtoa 8."Em l y e i cl de a "l a e wo k r"."Em l y epoe"n u s e s d r e p o e " di tre s, re ul i g a a y ti e fro suchssstntnmm do s n t i cl d "te po a y wo k r .e o n u e a m r r r e " ph si a h rm i e s o di e seycla,s s r s a .9."Ex cut v o f ce "m a s a pe so ho di g a y oeiefirenrnlnnf5."Bro dca ti g m a s tra sm tt n a y a d o oasn"e n n i i g n u i r th o fi e po it o s cre te by y u cha t r,e f c r s i n a d o r r evsuaaeilfonyproeilmtraraups:co sti u i n by a s o a y o h r sim l r go e n ngntto,l w r n t e i a v r i do um n .c e ta.By ra i o e e i io ;odortlvsnr CG 1 0 02 1T09 Pa e 17 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. public ctr ctr cat ctro ckn which ctr COMM RCIAL E ERAL IAB LITYEGNLI 10."Go d Sa a i a se v ce "m a s a y e e g n y tr ck , ro db domrtnrisennmrecasaes, tu n l und r a sne,e p s or m di a se v ce fo whi h no co p n a i n is cro sin ;e c l r i s r c m e s t o s g de a d d r e e v dmneorcie.(2)Tha i d m i i s a a chi e g ne r otnenfenrtnier 11."Ho ti e fi e m a s a fi e whi h e surv y r o i j ry o a aslr"e n r c m s e o f r n u r d m g ri in ut o :e a s g o f tr l a l o bre k o t fro whe e i wanolberasumrts (a)Pre a i g a pr v ng o fa l n toprn,p o i ,r i i gitndd o b .n e e t e pr pa e or ap r v ,m p , shoerpoeasp 12."Im a re pro e t "m a s ta g bl pro e t ,o he dra i g , o ipidpryennieprytrwnspn o s, re o ts, survinpre s,y th n "y ur pro uct o "y ur wo k , tha ca n t be fi l o d rs, cha gaod"r o r "t n o e d r e n e o d rs o ra i gsrerdwn use r s l ss use u e a se a d pe i i a i ns; rdoieflbcu:n s c f c t o o a.It i co po a e "y ur pro uct o "y ur wo knrrtsod"r o r "(b)Gi i g di e t o s o i stru ti n , ovnrcinrncosr th t is kn wn o th ug t to be de e v ,fa l ng to gi e th m ifaorohfeiive,th t is thea de i n , n de u te o a g ro s; o pri a y ca se o the in u y oftiaqardneurmrufjrr da a emg; orb.Y u ha e fa l d to ful i l the te m o a co tr ctovieflrsfna (3)Und r whi h the i sure ,if a a chi e t,e c n d n r t coragreement; e gi e r o surv y r,a sum s l a i i y fonnereoseibltrisuch pro e t ca be re to e to use by t efprynsrdh a in u y o da a e a i in o t o thenjrrmgrsgufrear,re l ce e t,a j stm nt o re o a o "y urpipamnduermvlfo i sure 's re de i g o fa l r to re dendnrnriuenrproucto"y ur wo k o y u fu fi l n t e te m od"r o r "r o r l l i g h r s f pro e si n l se v ce , in l d n ho e l stefsoariscuigtsidthcotatogreet.e n r c r a e m n i Pa a r pnrgah (2)a o e a d sup r i o ybvnevsr,13."In ure co t a t m a s:s d n r c "e n i spe t o ,a chi e a o e g ne ri gncinrtrlrnien a t v ti s.c i i ea.A co t a t fo a l a e o pre i e . Ho e e ,n r c r e s f m s s w v r th t po t o o t e co t a t fo a l a e oarinfhnrcresf 14."Le se wo k r"m a s a pe so l a e o y u badreenrnesdtoy a pre i e tha in e n f e a y pe so omsstdmiisnrnr l bo l a in fi m unde a a r e e t be we n y uaresgrrngemnteo o ga i a i n fo "pre i e da a e i no arnztormssmg"s t n a d the la o le si g fi m to pe f rm dut e re a enbranr,r o i s l t d "i sure o tr ct ;n d c n a "to the co d ct o y ur bu i e s."Le se wo k r"n u f o s n s a d r e do s n t i cl d "te p ra y wo k r .e o n u e a m o r r e "b.A i e ra k a re m n ;s d t c g e e t 15."Lo di g o unl a i g"m a s th ha d i g oanrodnenenlnfc.An e se e t o li e se a re m nt e ce t inyamnrcngee,x p pro e typr:co ne ti n wi h co stru ti n o de o i i nncotncormlto o e a Af e i is m v d fro th pl ce whe e i isprtrtoemearttinooihn5etoarodosnrwti0fefaria;a.l t d fo m v m n i t o o t a a rcra tperoeetnornonif,d.An o l ga i n,a re u re by o d na ce tobitosqidrin,wa e cra t r "a t ";t r f o u oidmiyamnciaiyecet i co ne ti nnenfuiplt,x p n n c o wi h o k f r a m ni a i ytwroult;b.Whi e i is i o o a a rcra t wa e cra t oltnrnnif,t r f r "a t "; ruooe.An e e a o a nt na ce a re m ntlvtrmiengee; c.Whi e i is be n m v d fro a a rcra tltigoemnif,f.Tha pa t o a y o he co t a t o a re m nttrfntrnrcrgee wa e cra t o "a t "to th pl ce whe e i istrfruoeartpranntoyur busi e s (i cl di g aetiigonsnunn fi a l e i e e ;n l y d l v r didenfiain o a m ni i a i y i co nenmictofucpltnn n wi h wo k pe f r e fo a m n ci a i y und rtrromdruiplt)e bu "l a i g o unl a i g do s no i cl de thetodnrodn"e t n u whi h y u a sum th to t li b l t o a o h r m v m nt ocoseeraiiyfnteoeef pro e ty by m a s oprenf a m ch n caeail pa t to pa fo "bo i y in ur ","pro e ty de i e o h r tha a haryyrdljyprvc,t e n n tr ck tha i no a ta hedu,t s t t c d da a e o "pe so a i j ry t a thi d pe somg"r r n l n u "o r r n to t e a rcra t w t rcra t o "a t ".h i f ,a e f r u o o o ga i a i n T o t l a i i y m a s a li b l tyrrnzto.r i b l t e n a i i 16."M bi e e u pm n "m a s a y o the fo l wi golqietennflontht wo l be i po e by l w i t e a se ce oaudmsdanhbnf ty e o la d v hi l s, i cl di g a y a ta hepsfnecenunntcdaycotr g e m ntnnroaree.m chi e y o e ui m ntanrrqpe: Pa a r prgah f.do s no i cl de th t pa t o a yetnuarfn a.Bu l o e s, fa m m chi e y fo k i ts a d o h rldzrranr,r l f n t ecotrctoaremn:n a r g e e t v hi s de i n d fo use pri ci a l o f pub iesgernplyflc (1)Tha i d m i i s a ra l o d fo "bo i y ro d ;t n e n f e i r a r d l a s i j ry o "pro e ty da a e a i i g o t onu"r p r m g "r s n u f b.Ve i l s m i t i e fo use so e y o o ne t tohceanandrllnrxcostrunodeoiin o e a i ns,n r m l t o p r t o pre i e y u wn r e tmssooorn;wi hi 50 fe t o a y ra l o d pro e t a dtnefnirapryn c.Ve i l s t a t a e n l r t e ds;h c e h t r v l o w e r aafetngayralod bri g o tre tl ,f c i n i r a d e r s e Pa e 18 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. ect, beco unco cti cie ctu acce cip ctio act ctio cra cle COMM RCI L G NERA L IAB LI YEAELIT d.Ve i s, whe he sel -pro e l d o no ,h t r f p l e r t b.An a t o o i si n co m t e in pro i i g ocrmsomitdvdnr m i ta n d pri a i y to pro i e m b l ty to fa l ng to pro i e fi st a n i e m r l v d o i i i i v d r a d o "Go d Sairom ri aatn pe m ne t y m u t d:r a n l o n e se v ce "to a pe so ,un e s y u a e i therisrnlsorn bu i e s o occup ti n of pro i i gsnsraovdn(1)Po e cra e , sho e s, l a e s, di g rs owrnsvlodrger pro e sio a e l h ca e se v ce .f s n l h a t r r i sdril; olsr 18."Pe so a a d a v r i i g i j ry m a s "pe so arnlndetsnnu"e n r n l(2)Road construction or resurfacing e ui m n such a gra e s, scra e s o i j ry o "a v rt sin nqpetsdrprrnu"r d e i g i j r ".u y ro l rs;l e 19."Pe so a n ur ":r n l i j ye.Ve i l s no de crib d i Pa a r phcetsenrgah a.,b.,c.a.M a s i j ry o he tha "a v rt sin in u y ,e n n u ,t r n d e i g j r "or d.a o e th t a e no se f pro e l d a d a ebvartl-p l e n r ca se by o e o m r o th fo l w ngudnroefeloimitiepriaiytoproiemblttoanandmrlvdoiiyofese:f n spemnnlataheeupetoftheraetytcdqimn fo l wi g t p s:l o n y e (1)F l e a re t,de e t o r m ri o m n ;a s r s t n i n o i p s n e t (1)Ai co pr sso s, pum s a d ge e a o s,r m e r p n n r t r (2)M l ci us pr se o ;a i o o i nicldngspraig,we d ng bui d ngnuiynli,l i cl a i g ge ph si a e pl ra i n,l gh i genn,o y c l x o t o i t n (3)The wro gf l e i fro , wro gf l e trnuvnmnuny a d e l se v ci g e ui m nt rnwlrinqpe;o i t ,o in a i n o the ri h o pri a enorvsofgtfvt o cup ncy o a ro m dwe l n o pre i ecafo,l i g r m s s(2)Che ry pi k rs a d si i a de i e use torcenmlrvcsd th t a pe so o cup e , pro i e tha thearncisvddtraseooeokrs;i r l w r w r e wro g u v ct o ,wro g u nt y o n a i nnfleiinnflerrivsof.Ve i l s no de crib d i Pa a r phcetsenrgah a.,b.,c.o the ri h o pri a e o cupa cy isfgtfvtcnord.a o e m i ta n d pri a i y fo pu po ebvaniemrlrrss co m t e by o o be a f o the o ne ,m i t d r n h l f w rohrthathtraspottoopesosotenenrainfrnrlndod o le so o tha ro m dwe l ng oalrrsrfto,l i rcag.r o pre i e ;m s sHoee, se f pro e l d v h cl s wi h thwvrl-p l e e i e t e (4)Ora o writ e pub i a i n incl di glrtnlcto,u nfolwig ty e o pe m n nt y at a helonpsfraeltcd pu l ca i n by e e t o i m a s, o m t r abitolcrncenfaeileuimntaeno"m bi e e u pm n "bu wilqpertolqiettl th t sl nd r o l b l a pe so oaaesriesrnrbecosiee"a t s":n d r d u o o di pa a e a pe so 's orsrgsrnr(1)Eq i m nt de ig e ri a i y f r:u p e s n d p m r l o (a)Sn w r m v loeoa;pro i e t a the cl i i m d r he "sui "v d d h t a m s a e o t t i bro g t by a pe so o o g n z ti n thasuhrnrraiaot(b)Ro d m i t na ce but noaanen,t co stru n o r surfa i g;o cl i s to ha e be n sl nd r d o i enrecnramveaeerlbl d,oer th t cl i s to ha e ha i s go ds, pro u tsaamvdtodc(c)St e t i g;r e n n o se v ce di pa a e ;orrissrgdr(2)Che ry pi ke s an sim l r de i ercrdiavcs (5)Ora o wri te publ ca i n,in l d nlrtnitocuigmuneoatmbieotruckchasisotdnuoolrs pu l ca i n by e e tr n c m a s, o m t ri lbitolcoienfaeaad se t a se o o e o k rs; a dnudorirlwrwren th t:a(3)Ai co pr sso s, pum s a d ge e a o s,r m e r p n n r t r i cl di g spra i g we di g bui di gnunyn,l n ,l n (a)Ap ro ri t s a pe so 'na e v i eppaernsm,o c , cl a i g ge ph si a e pl ra i n,l gh i genn,o y c l x o t o i t n ph t gr p r i e e s; oooaholknsr a d e l se v ci g e ui m ntnwlrinqpe.(b)Unre so a l pl ce a pe so in aanbyasrnHoee,"m bi e e u p e t do s no i cl de a ywvrolqimn"e t n u n fa se l gh .l i tlndvhcltht is sub e t to a co pu so y oaeieajcmlrr b.In l d s "bo i y in ur "ca se by o e o m rcuedljyudnroefinancialresponsibilitylaw,or other motor vehicle i sura ce l w,whe e i is l ce se o pri ci a l o the o f n ennartindrnplyffess de crib d in Pa a ra hsergp a. ga a e . Such la d v h cl s a e co sid rergdneierned a o ebv. "a t s".u o 20."Po l t n s"m a a y so i ,l qu d ga e u oluatennldii,s o s r17."Occurr n e m a s:e c "e n th rm l irr t n o co t m n nt i cl di g sm k ,e a i a t r n a i a ,n u n o e v po ,so t,fu e , s, a k l s, che i a s a daromsdlaimclna.A a ci e t,i cl di g co ti uo s o re e t dncdnnunnnurpae wa te Wa te in l d s m te i l to be re y l d,s .s c u e a r a s c c eepouretosubstatalthsaegeeaxsnilyemnrl re o di i n d o r cl i e .c n t o e r e a m dhamulcodiin; rrfntoso CG 1 0 02 1T09 Pa e 19 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. cle cut ctio clea ctio aci organization organization's goods, products or services, COMM RCIAL E ERAL IAB LITYEGNLI 21."Pre i e da a e m a s:co tr ct ca l fo wo k a m re th nmssmg"e n n a l s r r t o a o e j b i enost.a.Wit re to th fi st pa a ra h o thehserrgpf e ce ti n in Ex l sioxposcun j.of I –(c)Whe tha pa t o the wo k do e a antrfrnt Co e a evrg A –Bo i y In ur And Pro e tdljypry j b si e ha be n put to it i t nd dotsesnee Da a e Li b l ty "pro e ty da a e to a ymgaii,p r m g "n use b ny p r o o rg n z t o th ryaesnroaiainoe pre i e whi e re t d to y u fo a pe i d omsslneorrof th n an th r co tr ct r oraoenao se e o fe e co se ut v da s, in l d ng thevnrwrncieycui subco t a t r wo k n o th sa enrcorignem co te ts o uch re i e ; rnnfspmsso pro e tjc. b.Wit re pe t to th e ce t o to Ex l si nshscexpincuo c.Wo k tha m y ne d se v ce m i t na certaeri,a n e n ,th o gruh n.i he l st a a ra h o a a r pntaprgpfPrgah 2.co r ct o ,re a r o re l ce e t,bu w i hreinpirpamnthcoSetinfcoI–Co e a evrg A –Bo i y Inj ry Anddlu i o h rwi e co pl t ,wi l be tre t d astesmeelaesProetyDaaeLaiiy"pro e ty d m ge toprmgiblt,p r a a "co p e e .m l t daypreiewhieretd t y u fo a pe i d onmsslneoorrof b.Do s no in l d "bo i y in u y o "pro e tyetcuedljr"r p rmrethn se e co se ut v da s, o whi eoavnncieyrl da a e a i i g o t o :m g "r s n u ftepraiyocupebyyuwih pe m ssio omorlcidotrinf th o n r,ca se yeweudb:(1)The tr n po t ti n o pro e t ,unl ss theasraofprye i j ry o da a e a i e o t o co d t o nnurmgrssufaniini(1)F rei;o on a v h cl no o n d o o e a e byreietwerprtd(2)Ex l si n;p o o y u,a d tha co di i n wa cre t d by theontntosae "o h t e i l b nyftavhceya(3)Lightning;l a i g o unl a i g"o d n r o d n i sure ;n d(4)Sm k re ul i g fro fi e e pl sio ooestnmr,x o n r l g t i g rihnn;o (2)The e i te ce o to l , uni sta l dxsnfosnle e ui m nt o ab nd n d o unuseqperaoerd(5)m te i l ; rarasoBu"pre i e da a e un e thi Pa a r ptmssmg"d r s r g a h (3)Pro uct o o e a i n fo whi h thdsrprtosrceb.do s no in l d "pro e ty da a e to a yetcueprmg"n cl ssi i a i n,li te i th De ra i ns oafctosdnetorpreiecaseb:m s s u d y i a po i y Sche u e sta e th t pro uct -n l c d l ,t s a d s(1)Rup u e bu sti g o o e a i n o pre suretr,r n ,r p r t o f s co p e e o e a i n a e subj ct to themltdprtosrereif e i e ;l e d v c s Ge e a g re a e Li i .n r l A g g t m t (2)Rup u e o bu sti g due to e p nsio otrrrnxanr 23."Pro e ty d m ge m a s:p r a a "e nswelnothcotnsoaybuidnoligfenetfnligra.Ph si a in u y to ta gi l pro e t ,in d ng a lycljrnbepryilstrutuecasebr e ul i g r m w t r;c r u d y o r s t n f o a e re ul i g l ss o use o th t pro e t .Al suchstnoffaprylorlssousewilbedemdtottetmfofleeahieo(3)Ex l si n o ste m bo l r , ste m pi e ,p o o f a i e s a p s th p y i a n u y t a ca se t rehsclijrhtudi;o ste m e gi e o te m t r i e .a n n s r s a u b n s b.Lo s o use o ta gi l pro e ty tha i nosffnbeprtst ph si a l in ur d Al such l ss o use wi l beyclyje.l o f l22."Products-completed operations hazard": de m d to o cur a the ti e o th ceeectmfen"a.In l d s a l "bo i y in ur "a d "pro e tycueldljynpr th t a se tacudi.da a e o cur i g a a fro pre i e y umg"c r n w y m m s s o F r the purp se o th s in ura ce "e e i da aoosfisn,l n c t "o n o re t a d a i in o t o "y ur pro uct owrnnrsgufod"r i n t a g bl ro e t .s o t n i e p p r y"y ur o k e ce t:o w r "x p 24."Sl g n :o a "(1)Pro uct th t a e sti l in y ur phy icadsarlosl a.M a s a phr se th t o h r u e fo he pu p seenaatessrtropossession;or o t ra ti g a t n i n n t e r d e t sin .f a t c n t e t o i h i a v r i g(2)Wo k tha ha no y t be n co p e e ortsteemltdr b.Do s no in l d a phra e use a , o in theetcuesdsr,a a d n d.Ho e e ,"y ur wo k wi l bebnoewvror"l na e o :m fdemd co pl t d a th e rl e t o theeemeeteaisf fo l wi g i e :l o n t m s (1)An pe so o o g n z t o ,o he th n y u;y r n r r a i a i n t r a o or(a)Whe a l o th wo k ca l d fo i y unlferlernor co tr ct ha b e o p e e .n a s e n c m l t d (2)An busin ss, o a y o th pre i e ,y e r n f e m s s go ds, pro uct , se v ce o wo k o a yodsrisrr,f n(b)Whe a l o th wo k to be do e a thenlfernt pe so r r a i a i n t e ha o .r n o o g n z t o ,o h r t n y ujb sit ha be n co pl t d i y uoesemeefor Pa e 20 o 21gf CG 1 0 02 1T09© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. pect Section cla clu occur "occurre ctro Water. COMM RCI L G NERA L IAB LI YEAELIT 25."Su t m a s a civ l pro e d n i whi h da a ei"e n i c e i g n c m g s (a)Y uo; be a se o "bo i y in u y ,"pro e ty da a e ocufdljr"p r m g "r (b)Ot e s t a i g nd r y u a e rhrrdnueornm;o"pe so a a d a v rt si g i j ry to whi h thirnlndeinnu"c s (c)A pe so o or a i a i n who ernrgnztosisuraceapleaealge."Su t i cl de :n n p i s r l e d i "n u s bu i e s o a se s y u ha e a qu re ;s n s r s t o v c i d a.An a b t a i n pro e di g i whi h suchrirtocennc a dn da a e a e cla m d a d to whi h th in uremgsriencesd (2)Co t i e s (o he tha v hi l s), m t ri l ,n a n r t r n e c e a e a smst subm t o do s sub i wi h o r co se tuiremttunn;pa t o e u pm n furn she i co ne ti nrsrqietidnncoorwih uch g o s o ro uct .t s o d r p d s b.An o he al e n ti e di put re o ut oytrtravseslin b.In l d s:c u eprcediginwhihsuch d m ge a e cl i eoencaasramd (1)Wa ra ti s o re re e ta i ns m de a a yrnerpsntoatnad to whi h th in ure subm ts wit o rncesdihu ti e wi h re pe t to the fi n ss, qua i ymtsctelt,co se t.n n du a i i y pe fo m n e o use o "y urrblt,r r a c r f o26."Te p ra y wo k r m a s a pe so who imorre"e n r n s pro uct ; ndd"afunihetoyu to substi ut fo a pe m ne trsdoterran (2)The pro i i g o o fa l re to pro i evdnfriuvd"e pl y e o l a e o to m e se so a o sho tmoe"n e v r e t a n l r r -wa ni g o n tr ct o s.r n s r i s u i ntemwrlaodiin.r o k o d c n t o s c.Do s no i cl de v nd ng m ch ne o o h retnueiaisrte27."Ti l "m a s a na e o l t r r r a t sti o kteenmfaieayoricwr.pro e ty re t d to o l ca e fo the use oprnerotdrf28."Unso i co m n ca i n m a s a yldmuito"e n n o h r b t no so dtesutl.co m n ca i n in a y fo m tha th re i nt omuito,n r ,t e e f 31."Y u o k :o r w r "such co m n ca i n di no spe i a l re ue t tomuitodtfclyqs a.M a s:e nreev.c i e (1)Wo k o o e a i n pe f rm d by y u o orrprtosroeorn29."Vo u t e wo k r m a s a pe so who i no y ulnerre"e n r n s t o r y ur e a f;a dobhln"e pl y e , a d who do a e hi o he wo k a dmoe"n n t s s r r r n a t a th di e ti n o a d wi hi the sco e ocstercofntnpf (2)M te i l , pa t o e u pm n furn she inarasrsrqietidduis de e m n d by y u a d is no pa d a fe ,t e t r i e o ,n t i e co ne ti n wi h uch w r o pe a i n .n c o t s o k r o r t o ssaayoohecopesain by y u o a y n e selrrtrmntoornoel b.In l d s:c u efoher o k p r o m d f r o .r t i w r e f r e o y u (1)Wa ra ti s o re re e ta i ns m de a a yrnerpsntoatn30."Y u ro uct :o r p d "ti e wi h re pe t to the fi n ss, qua i ymtsctelt,a.M a s:e n du a i i y pe fo m n e o use o "y urrblt,r r a c r f o (1)An go d o pro uct , o h r th n re l wo k ;a dyosrdsteaar"n pro e ty m n f ct r d so d ha d e ,p r ,a u a u e ,l ,n l d (2)The pro i i g o o fa l re to pro i evdnfriuvdditrbuerdspoef ysitdoisdob:o n tr ct o s.r i s u i n CG 1 0 02 1T09 Pa e 21 o 21gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. cite cip ci warnings COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 00 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 01 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 02 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 03 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 04 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 04 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 05 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 05 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 06 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 07 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 08 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:GENERAL PURPOSE ENDORSEMENT PageCG T8 09 COMMERCIAL GENERAL L IABIL ITY POLICY NUMBER ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTR ACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro vided under t he fol lowing: COMMERCIAL GENERAL L IABIL ITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Location of Covered Operations: (Information requ ired to comple te th is Schedule,if not shown above , will be show n in the Dec larat ions.) A.Section II –W ho Is An Insured is amended to in-This insurance d oe s not apply to "bodily injury " or clude as a n additional insured the per son(s) or "property damage" occurring, or “personal injury” organization(s) shown in the Schedule, but only or “advert ising injury” arising out of an offense with respect to liabi lity for "bodi ly in jury","property committed,after : damage", "personal injury” or “advertising injury"1.All work, materia ls, parts or equi p-caused, in whole or in par t,by:ment furnished in connection with such work, 1.Your acts or o missions; or on the project (other than service, maint e- nance or repairs) to be perfor med by or on2.The acts or omission s of those acting on your behalf of the addi tional insured(s) at the loc a-behalf ;tion of the covered operations has been com-in the perfor mance of your ongoing operations for pleted; orthe addit ional insured(s) at the location(s) desig-2.That of "your work" out of which thenated abo ve.injury or da mage arises ha s been p ut to its i n-B.W ith respect to the insurance afforded to these tended use by any per son or organizationadditional insureds, the following addit ional other than another contractor or subcontra c-sions apply:tor engaged in perfor ming operations for a principa l as a part of the same pro je ct. CG D3 61 03 05 Copyright 2005 The St. Pau l Travelers Co mpanies, Inc .All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Ser vices Office,Inc.with its per mission. including exclu- portion COMMERCIAL GENERAL L IABIL ITY POLICY NUMBER ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTR ACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro vided under t he fol lowing: COMMERCIAL GENERAL L IABIL ITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Location of Covered Operations: (Information requ ired to comple te th is Schedule,if not shown above , will be show n in the Dec larat ions.) A.Section II –W ho Is An Insured is amended to in-This insurance d oe s not apply to "bodily injury " or clude as a n additional insured the per son(s) or "property damage" occurring, or “personal injury” organization(s) shown in the Schedule, but only or “advert ising injury” arising out of an offense with respect to liabi lity for "bodi ly in jury","property committed,after : damage", "personal injury” or “advertising injury"1.All work, materia ls, parts or equi p-caused, in whole or in par t,by:ment furnished in connection with such work, 1.Your acts or o missions; or on the project (other than service, maint e- nance or repairs) to be perfor med by or on2.The acts or omission s of those acting on your behalf of the addi tional insured(s) at the loc a-behalf ;tion of the covered operations has been com-in the perfor mance of your ongoing operations for pleted; orthe addit ional insured(s) at the location(s) desig-2.That of "your work" out of which thenated abo ve.injury or da mage arises ha s been p ut to its i n-B.W ith respect to the insurance afforded to these tended use by any per son or organizationadditional insureds, the following addit ional other than another contractor or subcontra c-sions apply:tor engaged in perfor ming operations for a principa l as a part of the same pro je ct. CG D3 61 03 05 Copyright 2005 The St. Pau l Travelers Co mpanies, Inc .All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Ser vices Office,Inc.with its per mission. including exclu- portion COMMERCIAL GENERAL L IABIL ITY POLICY NUMBER ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTR ACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro vided under t he fol lowing: COMMERCIAL GENERAL L IABIL ITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Location of Covered Operations: (Information requ ired to comple te th is Schedule,if not shown above , will be show n in the Dec larat ions.) A.Section II –W ho Is An Insured is amended to in-This insurance d oe s not apply to "bodily injury " or clude as a n additional insured the per son(s) or "property damage" occurring, or “personal injury” organization(s) shown in the Schedule, but only or “advert ising injury” arising out of an offense with respect to liabi lity for "bodi ly in jury","property committed,after : damage", "personal injury” or “advertising injury"1.All work, materia ls, parts or equi p-caused, in whole or in par t,by:ment furnished in connection with such work, 1.Your acts or o missions; or on the project (other than service, maint e- nance or repairs) to be perfor med by or on2.The acts or omission s of those acting on your behalf of the addi tional insured(s) at the loc a-behalf ;tion of the covered operations has been com-in the perfor mance of your ongoing operations for pleted; orthe addit ional insured(s) at the location(s) desig-2.That of "your work" out of which thenated abo ve.injury or da mage arises ha s been p ut to its i n-B.W ith respect to the insurance afforded to these tended use by any per son or organizationadditional insureds, the following addit ional other than another contractor or subcontra c-sions apply:tor engaged in perfor ming operations for a principa l as a part of the same pro je ct. CG D3 61 03 05 Copyright 2005 The St. Pau l Travelers Co mpanies, Inc .All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Ser vices Office,Inc.with its per mission. including exclu- portion COMMERCIAL GENERAL L IABIL ITY POLICY NUMBER ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTR ACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro vided under t he fol lowing: COMMERCIAL GENERAL L IABIL ITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Location of Covered Operations: (Information requ ired to comple te th is Schedule,if not shown above , will be show n in the Dec larat ions.) A.Section II –W ho Is An Insured is amended to in-This insurance d oe s not apply to "bodily injury " or clude as a n additional insured the per son(s) or "property damage" occurring, or “personal injury” organization(s) shown in the Schedule, but only or “advert ising injury” arising out of an offense with respect to liabi lity for "bodi ly in jury","property committed,after : damage", "personal injury” or “advertising injury"1.All work, materia ls, parts or equi p-caused, in whole or in par t,by:ment furnished in connection with such work, 1.Your acts or o missions; or on the project (other than service, maint e- nance or repairs) to be perfor med by or on2.The acts or omission s of those acting on your behalf of the addi tional insured(s) at the loc a-behalf ;tion of the covered operations has been com-in the perfor mance of your ongoing operations for pleted; orthe addit ional insured(s) at the location(s) desig-2.That of "your work" out of which thenated abo ve.injury or da mage arises ha s been p ut to its i n-B.W ith respect to the insurance afforded to these tended use by any per son or organizationadditional insureds, the following addit ional other than another contractor or subcontra c-sions apply:tor engaged in perfor ming operations for a principa l as a part of the same pro je ct. CG D3 61 03 05 Copyright 2005 The St. Pau l Travelers Co mpanies, Inc .All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Ser vices Office,Inc.with its per mission. including exclu- portion COMMERCIAL GENERAL L IABIL ITY POLICY NUMBER ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED –OWNERS, LESSEES OR CONTR ACTORS –SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance pro vided under t he fol lowing: COMMERCIAL GENERAL L IABIL ITY COVERAGE PART SCHEDULE Names of Additional Insured Person(s) or Organization(s): Location of Covered Operations: (Information requ ired to comple te th is Schedule,if not shown above , will be show n in the Dec larat ions.) A.Section II –W ho Is An Insured is amended to in-This insurance d oe s not apply to "bodily injury " or clude as a n additional insured the per son(s) or "property damage" occurring, or “personal injury” organization(s) shown in the Schedule, but only or “advert ising injury” arising out of an offense with respect to liabi lity for "bodi ly in jury","property committed,after : damage", "personal injury” or “advertising injury"1.All work, materia ls, parts or equi p-caused, in whole or in par t,by:ment furnished in connection with such work, 1.Your acts or o missions; or on the project (other than service, maint e- nance or repairs) to be perfor med by or on2.The acts or omission s of those acting on your behalf of the addi tional insured(s) at the loc a-behalf ;tion of the covered operations has been com-in the perfor mance of your ongoing operations for pleted; orthe addit ional insured(s) at the location(s) desig-2.That of "your work" out of which thenated abo ve.injury or da mage arises ha s been p ut to its i n-B.W ith respect to the insurance afforded to these tended use by any per son or organizationadditional insureds, the following addit ional other than another contractor or subcontra c-sions apply:tor engaged in perfor ming operations for a principa l as a part of the same pro je ct. CG D3 61 03 05 Copyright 2005 The St. Pau l Travelers Co mpanies, Inc .All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Ser vices Office,Inc.with its per mission. including exclu- portion COMMERC LIABILI YIAL GENERAL T POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name of Perso or izati :n Organ on Locati And Descrip on Com O onsontiofpletedperati: Sectio –Wh Is An Insn o ured is a to as an insured the per son or organization shown in themended Schedule, but only with respect to liab li arising out of "your work"ion designated and describe d inity at the locat the schedule of this endorsement perfor for that insured a nd included leted onsmed in the "products-comp operati hazard". CG D3 73 11 05 Includes the copyrighted material of Insurance Services Office,Inc.with its permission.Page 1 o f 1 include II COMM RCI L G NERA L IAB LI YEAELIT PO I Y UMBE :IS UE DATE:L C N R S T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E OT HER INSURANCE –DESIGNATED ADDITIONAL INSUREDS –PRIMARY WITH RESPECT TO CERTA NI OT HER INSURANCE COMM RCI L G NERA L IAB LI Y COVERAG PA TEAELITER SCHEDU E O DES GNAT D ADDIT ONAL N UREDLFIEIISS P O ISIONRVS The is add ed to Pa ag raprh 4.a.,P imaryr In u ancesr , of SE TI N IV –CO MERCIALCOM GE ERAL L ABIL TY CO D T ONNIINIIS: The i sur ance a fo ded und e thi C ov rage Pa t t onfrrser any ad dit onal in ured i t he Sch edule Ofisn CG 4 26 02 9D1 Pa e 1 o 1gf© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. This endorsement modifies insurance provided under the following: shown following Designated Additional Insureds is primary to any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF INTELLECTUAL PROPERTY EXCLUSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following replaces Exclusion i., Intellectual Property, in Paragraph 2. of SECTION I – COVERAGES – COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY: i.Intellectual Property "Personal and advertising injury" arising out of any actual or alleged infringement or violation of any of the following rights or laws, or any other "personal and advertising injury" alleged in any claim or suit that also alleges any such infringement or violation: (1)Copyright; (2)Patent; (3)Trade dress; (4)Trade name; (5)Trademark; (6)Trade secret; or (7)Other intellectual property rights or laws. This exclusion applies regardless of whether the allegation of infringement or violation of any of these rights or laws is made by any person or organization making the claim or bringing the suit, by any insured or by any other party to the claim or suit. This exclusion does not apply to: (1)"Advertising injury" arising out of any actual or alleged infringement or violation of another's copyright, "title" or "slogan" in your "advertisement"; or (2)Any other "personal and advertising injury" alleged in any claim or "suit" that also alleges any such infringement or violation of another's copyright, "title" or "slogan" in your "advertisement". COMMERCIAL GENERAL LIABILITY CG D9 10 09 21 © 2021 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERC GENERAL L ITYIAL IABIL POLICY :ISSUE D :NUMBER ATE This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA P RTIAL IABIL CO GE A SCHEDULE Name of Perso or izati :n Organ on (I no entry appear s above required to comp th endor sement will be shown in the Declarationsf lete is as applicable is endorsement.)to th A.Sectio –Who Is An n is a to such work, on the projec (other than semended t r- include as an insured the person or v ce,ma or repairs) to be per-i intenance shown in the Sched ule, but only with re spect to by or on behal o the f f liab li f your ongoing operations per-insured(s) at the site o the co ered op-i ty arising out o f v for ed for i sured.erations has been completed;m that n or B.(2)respect to the insurance to these That o "your out o whichff additiona insureds, the fol wing is the injury or arises has bee n putl lo added:to its in use by any per son or tended ganization other than another contractor2.Exclusions or subcontractor engaged in This insurance does not apply to in-operations for a princ as a part of theipal same project. (1)Al work, includ parts orl ing equipment f in connect withurnished ion CG 20 10 10 01 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION © ISO Properties Inc., 2000 , information exclusion II Insured organization With "bodily jury" or "property damage" occurring after: materials, performing damage portion or- additionalformed afforded work" COMMERC GENERAL L ITYIALIABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name Of Add onal nsured n(s)Or izat n(s):iti I Perso Organ io Locati And Descrip on Com O ationtiOfpletedperons In mat red to co lete is Schedule, f shown above ll n in the Dec atforion requi mp th i not , wi be show lar ions. Sectio –Wh Is An Insn o ured is amended to in-locat designated and described in the schedule ofion clude as an insured the person(s) or or-this endorsement per in-for for that med ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to l l for injur or "property tions hazard".iabi ity y" age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 ©IS Propert , 2004 Page 1 o 1O ies, Inc.f dam- II "bodily additional additional COMMERC GENERAL L ITYIALIABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name Of Add onal nsured n(s)Or izat n(s):iti I Perso Organ io Locati And Descrip on Com O ationtiOfpletedperons In mat red to co lete is Schedule, f shown above ll n in the Dec atforion requi mp th i not , wi be show lar ions. Sectio –Wh Is An Insn o ured is amended to in-locat designated and described in the schedule ofion clude as an insured the person(s) or or-this endorsement per in-for for that med ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to l l for injur or "property tions hazard".iabi ity y" age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 ©IS Propert , 2004 Page 1 o 1O ies, Inc.f dam- II "bodily additional additional COMMERC GENERAL L ITYIALIABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name Of Add onal nsured n(s)Or izat n(s):iti I Perso Organ io Locati And Descrip on Com O ationtiOfpletedperons In mat red to co lete is Schedule, f shown above ll n in the Dec atforion requi mp th i not , wi be show lar ions. Sectio –Wh Is An Insn o ured is amended to in-locat designated and described in the schedule ofion clude as an insured the person(s) or or-this endorsement per in-for for that med ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to l l for injur or "property tions hazard".iabi ity y" age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 ©IS Propert , 2004 Page 1 o 1O ies, Inc.f dam- II "bodily additional additional COMMERC GENERAL L ITYIALIABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name Of Add onal nsured n(s)Or izat n(s):iti I Perso Organ io Locati And Descrip on Com O ationtiOfpletedperons In mat red to co lete is Schedule, f shown above ll n in the Dec atforion requi mp th i not , wi be show lar ions. Sectio –Wh Is An Insn o ured is amended to in-locat designated and described in the schedule ofion clude as an insured the person(s) or or-this endorsement per in-for for that med ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to l l for injur or "property tions hazard".iabi ity y" age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 ©IS Propert , 2004 Page 1 o 1O ies, Inc.f dam- II "bodily additional additional COMMERC GENERAL L ITYIALIABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTR ACTORS – COMPLETED OPERATIONS This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIAL IABIL CO GE P RT SCHEDULE Name Of Add onal nsured n(s)Or izat n(s):iti I Perso Organ io Locati And Descrip on Com O ationtiOfpletedperons In mat red to co lete is Schedule, f shown above ll n in the Dec atforion requi mp th i not , wi be show lar ions. Sectio –Wh Is An Insn o ured is amended to in-locat designated and described in the schedule ofion clude as an insured the person(s) or or-this endorsement per in-for for that med ganization(s) shown in the Schedule, but only with sured and included in the "products-completed opera- respect to l l for injur or "property tions hazard".iabi ity y" age" caused, in whole or in part, by "your work" at the CG 20 37 07 04 ©IS Propert , 2004 Page 1 o 1O ies, Inc.f dam- II "bodily additional additional CO MERCI GE LIAB TYMAL NERAL ILI T S ENDORSEMENT NG S T .SE READ T CAREF Y.HI CHA E HE POLICY PLEA I ULL AMENDMENT – NON CUMULATION OF EACH O C C UR R EN C E L IMIT O F L IAB IL IT Y a n d N ON C U MU L A T IO N O F P ER SO N A L a n d A D VERT ISING I NJ UR Y L IMIT T endorsem m i i ur ov ded under f l ihis ent odif es ns ance pr i the ol ow ng: CO ERCIA ENERA ABI Y ERAG PARTMML G L LI LIT COV E 1.2.Paragraph 5 of SECTION III – LIMITS OF INSUR-Paragraph 4 of SECTION III – LIMITS OF INSUR- ANCE,s am to ncl he f owi ANCE,s am to ncl he f owiiended i ude t oll ng:i ended i ude t oll ng: Non cum i of O urrence Lim t -If one Non cum ati of Personal and Adv ti i Li itulaton Each cc i -ul on er s ng m "oc e" causes "bodi y i ury"and/or "pr -–I "personal i y" and/or "ert i y" icurrenclnjopfnjuradvising njur s ert dam dur t pol cy peri and duri sust ned by any one person or organi ion dury age"ing he i od ng ai zat - the cy od of m pri or ut i the pol cy peri and duri t poli peripoliperione or ore or and/f ure ng i od ng he cy od pol ies that i ude a c m al general l abi t of one or m pri and/f ure pol ci thaticnclomerciiliyore or or ut i es cov age part f the insured i sued by us or any i ude a c m al general li l y coveror s ncl om erci abi it erage af i at i uranc com t am we wil part f the i ured i sued by us or any af i iatflied ns e pany,he ount l or ns s f l ed pay i li it hi poli ’s E currenc Li it i urance com t am we wi l pay ismed. T s cy ach Oc e m ns pany,he ount l s wi be reduced by t am of each paym l i T pol cy’s Personal Inj and A ert -ll he ount ent im ted.his i ury dv is m by us and any af il ated i urance com i Inj Li it wi be reduc by the am ofade f i ns pany ng ury m ll ed ount under the ot poli es because of such "-each pay ent m by us and any af il ated i -her ci occur m ade f i n rence"suranc com under t ot pol ci be-.e pany he her i es cause of such "personal i ury""adv ti injand/or er s ng i y".njur CG D2 9703 12 Copy ght,rav ers I ni Com 1997 P of 1riTelndemtypany, age 1 COMMERC GENERAL L ITYIAL IABIL POLICY :ISSUE D :NUMBER ATE THIS ENDORSEMENT CHA OLICY. PLEASE READ I EFULLYNGES THE P T CAR DESIGNATED PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement i ies insurance pro ided under t folmodfvhe lowing: COMMERC GENERAL L ITY VERA AIALIABILCOGE P RT SCHEDULE Designated jectPro Designated Pro General Aggregate(s):ject(s): A.3.COVERAGE A.For al sums which the insured becomes legal Any payments made unde rl ly obligated to pay as damages caused by "occur-for da or under formages COVERAGE C. rences"un der , and med e shall reduce the De siCOVERAGE A. (SECT IION )ical xpenses g- for al med e s caused by accidents un-nated Projec General Aggregate L m forl ical xpense t i it der , which can be that designated "project". Such paymentsCOVERAGEC (SEC I I)T ON attr only to operations at a single de sig-shall not reduce the General Aggregate Limibuted it nated "project shown in the Schedule abo e:"v shown in the Declarat nor shall they re-ions duce any other Designated Pro Generalject 1.A separate Designated Project General Ag-Aggregate Li it fo any other designatedmr gregate Li it app designated "pro-m lies to each "project"n in the dule abo e.show Sche vject"and that l m is equal to the amount of, i it the General Aggregate Li t shown in the The l m shown in the Declarations formiiits 4.Each Declarat unless separateions, Designated Occurrence, Damage T Premises Reonted Project General Ag T Yo and Me Expegregate(s)o u dical nseare sche continue tod- uled abo .ve apply.Howe instead o be subject tover,f ing the General Aggregate Li t shown in themi2.The Designated Project General Aggregate Declarat such li its will be subject to theions, mLiit is the most we will pay for the sum o almf l applicab Designated Project General Ag-le damages under , exceptCOVERAGE A.gregate Li itm.damages becau se of "bodil in "or "prop-y jury erty damage inc in the "products-For al sums which the insured becomes legal"luded l lyB. comp operations hazard , and for med obligated to pay as damages caused by "occur-leted "i- cal expenses un der , regar rences"un der , andCOVERAGE C COVERAGE A. (SECT Id-ION ) less of the onumberf:for al med e s cau sed by accidents un-l ical xpense der , which cannotCOVERAGEC. (SEC ON I)TIa.Insured s;be attribu only to operations at a sing desited le g-b.Clai made or "suits" brought; orms nated "project shown in the Schedule abo e:"v c.Person s or organizations m ing cla msaki or bringing "suits". CG D2 11 01 04 Copyright,Tra elers Inde ity mpany, 2004 Page 1 oThe v mn Co f 2 COMMERC GENERAL L ITYIAL IABIL 1.COVERAGE A.Any payments made under v ded, any pa ments for da beca use ofiymages for da or under for "bodily injury or "property damage"inmages "COVERAGE C. med e shall reduce the amount the "products-comp o erat hazard"willical xpenses leted p ions a ilab under the General Aggregate Lim reduce the Products Comp Operat Ag-va le it -leted ions or the Products Completed Operat Ag-gregate Li t, and not reduce the General Aggre--ions mi gregate Li it ver is applic bm, whiche a le; and gate Li it nor the Designated Pro Generalmject Aggregate Li itm.2.Such payments shall not reduce any De sig- nated Projec General Aggregate L m .t i it E.Defi i-For the purpose s of this endorsement the n tio Sections n is amended by the addit of theion C.2.SEC ION I –LI T OFPartofTIIMIS INSURANCE fo lowing def itlinion:is deleted and rep folaced by the llowing: "Projec "means an area away fro pre isestm m2.The General Aggregate Li i is the most wemt owned by or rented to you at which you are per-will for o :pay the sum f for ing oper t pursuant to a contract ormaions a.Coverage BDamages under ; and agreement. For the purpose s of deter ing themin b.Damages f m "occurrences"under applicab aggregate li t o insurance, eachrole mi f COVERAGE A (SECT I)ION and for al "project"that includes prem in l i thelises vo v ng med e caused by accidents same or connecting lots, or prem whose con-ical xpenses ises under which nection is interrupted only by a street, roadway,COVERAGE C (T I)SEC ION cannot be attr buted only to operat at water way or right of way of a railroad shall beiions -- considered a single "projec ".ta single designated "project" sho wn in the SCHEDULE abo e.v F.SEC ION I –LIM T OFThe pro ons ofvisi T II I S D.INSURANCEWcoerage for liab li arising out o the not otherwi se modi ied by this en-hen v i ty f f dorsement shall to applycontinue as stipulated."products-comple operations hazard is pro-ted " Page 2 o Copyright,Tra elers Inde ity mpany, 2004f 2 The v mn Co CG D2 11 01 04 included COMM RCI L G NERA L IAB L TYEAELII T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E BL ANKET ADDITIONAL INSURED (Incl des Products-Completed Op erations If Required By Conturact) Thi e dorseme t m d fie i suranc e prov ded und er he f l o ing :s n n o i s n i t o l w COMM RCI L G NERA L IAB LI Y COVERA E PARTEAELITG P O ISIONRVS (1)Any "bodily injury","property d am ge"oar "pe sonal injury arising out o the pr ov di g,r "f i nThefolowing i add ed t ols SE TI N II –WHO IS ANCO or f a l re t o prov de,any pro e sionaliuifsINSUEDR: arch te tur al engin eer ng o surv yingic,i r eAny person o o gan zat on that yo agree in arriiu se v ce , ncl ding:r i s i uwriten con ract or agreem nt to in lude a anttecs addi ional i sur ed o thi C ov rage Part i atnnsesn (a)The prep arin ,ap prov ng, or fa li g t ogiin i sured, ut onlynb :prepa e or approv , ma s, sh oprep drawi gs, opin on , reports, sur v y ,n i s e sa.Wi h re pe t to l abi ity f o "bodily injury otscilr"r fi l orders or chan ge orders , or th eed"prope ty dam ge that o curs, or f o "pers o alra"c r n prepa i g, appr ov ng, or f a l n torniiigijuycased b y an o fe se th at is comm ttednr"u f n i , prepa e or app ov ,dr awings andrresubsequent to th e signi ng of that contract or ag ee ent and while th a pa t o the contr a t ormtrfcr spe i i a io s;andcfctn ag ee ent s in e fe t;andrmifc (b)Su er v so y,in pe t on, archi ect ral opirsciturb.If a d only to the ex ent th at such injury o,n t ,r engineerin a t v t e .g c i i i sdamaeis ca sed by a ts o om ssio s o yo ogucrinfur (2)Any "bod i y inju y or "prope ty d am gelr"r a "y ur subco tra tor in th e perfo m nce o "y uoncrafor caused b y "y ur work an in luded in th eo"d cworkto which the wri ten c ont a t or agreemen"t r c t "produ ts-com leted o erat on hazardcppis"appl e . Such p ers on or organiz a ion doe n oistst un ess the wri ten c ont a t o ag ee entltrcrrmqualfyaan ad itional in ur ed with re pect t oisdss the ind ependent a t o om ssions o such spe i i a ly requi escsrifcfclr y u to pr ov de suchoi pe son or organizationr .cov rage f o that addi ional in ured durinertsg the oli y pe iod.p c rTheisuranceprovded to such ad it onal insured isnidi subje t o he o lo ing p ov sions:c t t f l w r i c.The ad itional insur ed m st c om ly with th edup a.If the Lim t o In uran e o thi Cov rage Part fo lowi g dutieisfscfseln s: shown in the De laratio s ex eed t he m nim mcnciu (1)Giv us wri ten no i e as soon a pra tic a leettcscblmtrequied by th e written co tr a t oiisrncr o an "o cur en e o an o fe se whi h m yfcrc"r f n c aageeent,th e i surance pr ov ded t o th ermni re ult i a clai . To t e e x en possible suchsnmhtt,addi ional insured wil be t o suchtl no ice should in l de:t c umnimmrequired lim ts. Fo the purp o e oiuirssf de erm nin whether thi applie , th etigss (a)How,when an where the "o cur en edcrc"m nim m im t requi ed by the wr i ten co tr a t oiulisrtncr or o fe se too pla e;f n k cageeentwillbe co sidered to include th ermn (b)The n am s and addre s e o any inj redessfumnimm lim ts o any Umb el a o Ex essiuifrlrc pe sons an witne s e ;andrdsslabltycovrage requi ed f o the addi ionaliiierrt i sured by th at writ en cont a t o agreem nt.n t r c r e (c)The nature and lo ation o any inj ry ocfurThiprovsion will not incr ea e th e lim t osisisf dama e ari ing out o the "o cur en egsfcrc"i suran e de cribed in Se tioncscn III –Lim t Ofis or o fe se.f nInurance.s (2)If a cla m is ma e or "sui "i brought ag ai stidtsnb.The insur ance prov ded t o such addi ionalit the ad it onal nsureddii:i sured does not ap ly o:n p t CG 2 46 04 19D Pa e 1 o 2gf limited limitation © 2018 The Travelers Indemnity Company. All rights reserved. COMM RCI L G NERA L IAB LITYEAELI (a)Im e ia ely re ord t he spe i i s o themdtccfcf (4)Te der th e de ense and i dem i y o anynfnntf cla m or "suit an the date re eiv d; and cla m or "su i "to any prov der i "d c e i t i o othefr i suran e which woul cov r such addi ionalncdet(b)No i y us a soo a pr acti able an d seetfsnsc i sured f o a lo s we c ov r. Howev r,thisnrseetoitthatwe re eiv wri ten noti e o th ecetcf condi ion d oe not a f ct wheth e th etsferclamor"suit a soon a pra ti ablei"s s c c .i suran e pr ov ded to such addi io alncitn(3)Im e ia ely send us cop es o all legalmdtif i sured i prima y to ot er insuranc ensrhpapesreceivd in c onn e t on with t he claireci m av ila le t o s uch addi ional insur ed whi habtcor"sui ", cooper a e wit us in t hetth cov r that person or a aessivstigaton o se tlem nt o the claim oneirtefr name i sured a d e cribed i Par agraphdnssn 4.,de e se against the "sui ", and o h erwisefntt Ot e In ur an e o Se tionhrsc,f c IV –Com e cialmrcomlywitallpolcy o ditio s.p h i c n n Ge er al ondit on .n C i s Pa e 2 o 2gf CG 2 46 04 19D organization Liability © 2018 The Travelers Indemnity Company. All rights reserved. COMM RCI L G NERA L IAB LI YEAELIT T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E XTEND ENDORSEMENT FO R CONTRACTO RS Thi e dorseme t m d fie i suranc e prov ded und er he f l o ing :s n n o i s n i t o l w COMM RCI L G NERA L IAB LI Y COVERAG PA TEAELITER GE ERAL D SCRIP ION O CO ERAGE –N E T F V Thi endors em nt broadens cov rage. H ow ev r cov rage f o anyseee,e r i ju y,dama e o me i al ex ense descri ed in any o the pr ovnrgrdcpsbfi ion o th s e dorseme t may bssfinne ex luded orc l m ted b y anoth e en dors em n to this Cov rage Pa t, and th e e ciireters ov rag e broadening prov sions do no ap ly toeitp the ex en t ha cov rage is ex l ded or lim ted by s uch an entttecuidorsem n . T he f o lo ing li ti g i a getlwsnseneral cov rage de cript on only Read al the prov sions o thi end orsesi.l i f s em nt and t he re t o y ur pol cy ca e ullesfoirf y to de erm ne r gh s,dut es, and w ha i and s not cov red .t i i t i t s i e A.Wh I An Insur ed –Unnam d Subs id arieoseis C.In i ent al Med cal Mal racti ecdipc B.Bla ket Addit onal Insured –Gov rnme talnien D.Bla ket Wa v r f Sub ogationnieOr En it e –Pe m t Or Au ho iza ions Re ati g T otisristrtln E.Co tra tua Liab l ty –Rai roadncliilsOpeatiosrnF.Da a e T o Prem se Ren ed o YoumgistT P O ISION a.R V S An o ganizat on o he than a pa tn ership,jo ntritrri v ntur e or l m ted liab l ty company;oreiiiiA.WH IS AN INSU ED –UNNAMEDOR b.A rust;tSUBSDIARIESI The fol owing is ad ed told SE TION II –WHO ISC a ind i a ed in i s nam o th e d ocu m n s t hasctterett AN INSU EDR :gov rn it stru tur e.e s c Any o yo r sub idiar e , o her than a pa tners hi ,f u s i s t r p B B ANKET ADD TIONA INSURED –.L I Ljonvnture o lim ted liabil ty com any,th at iiteriips GO E N ENT L EN IT ES –P RMIT OVRMATIESRnoshown as a N am d I nsured in th ete AU H R ZA I N R L TI G T O E AT O STOITOSEANOPRINia am d In ur ed f:s N e s i The fol owing is ad ed told SE TION II –WHO ISCa.Yo are the s o e owner o ,o ma ntai anulfrin AN INSU EDR :ownership inter e t o mo e th an 50 % in, suchsfr Any gov r men al en ti y t ha ha issued a perm tentttsisubsidiay on the fi st day o the pol cy perio ;r r f i d or auth oriza ion wit re pe t t o ope ationsthscrand pe fo med by yo or on your behal and that yourrufb.Su h subsidiary i not an in ured und ecssr are requir ed by an y o dinanc e,law , buil ing c oderdsiilaoher n uranc e.m r t i s or written c ont act or agreeme t to incl de a anrnus No such subsidiary i a insur ed f o "bodily inju ysnrr"addi ional i sured on thi Cov rage P a t is atnsern or "property dama e"th a o curred, o "pers o al i sured, but only wi h r e pgtcrnnts e t to liabi i y fo "bodilycltr i ju y","prope ty dam ge"or "pers o al andnrranand a v rt sing i ju y"caused by an o fe sedeinrfn adv rti ing inj ry"ari ing ou o uch operatio s.e s u s t f s ncomited:m t The in uran e pro v ded t o such gov r men alscienta.Be o e you ma ntai ed an ownership intere tfrins en ity do e not apply o:t s tomoe than 50% i such ub idiary;orfrnss a.Any "bod i y inju y ,"property dama e olr"g "rb.Af e th e date, i any duri g t he poli y periotrf,n c d "pe sonal and ad v rti ing injury"a i ing o t oresrsufthatyonolonger ma ntain a ownershiuinp operatio s perfo m d f o th e gov r men alnrerentiteretoore han 50% n such subsi ia y.n s f m t i d r en ity ort;Fo purpos e o Pa agrap hrsfr 1.o Se tionfc II –Who b.Any "bodily inj ry or "property d am geu"a "Is An Insured, ea h such subsidiary wil becl i clu ed in th e "products -co ple edndmtdeemd to e d e ignated in th e Declarat on a :e b s i s s operatio s hazar d".n CG 3 16 02 9D1 © 2017 The T avelers Indemnit Company.All rightsry reserved.Pa e 1 o 3gf Includes copyrighted material of In surance Services Of ice,Inc., with its permission.f Declarations COMM RCI L G NERA L IAB LI YEAELIT C.IN IDEN AL ED CAL ALPRACTI ECTMIMC pharma eut cal c o m t ed by o wi h th ecismit,r t k owledg e o co sent o ,th e n ur ednrnfis.1.The f o lo i g repla e Pa agr aphlwncsr b.o thef de i i ion o "o cur en e in t hefntfcrc"5.The f ol owing i a ded t o t helsd D FIN TIONEIS D FIN TIONEIS Se tion:c Se tio :c n b.An a t o om ssio com i ted i prov dincrinmtnig "In i ent al m d cal se v ce "m a s:c d e i r i s e nor fa l ng t o pr ov de "incidental me icaiiidl a.Med cal sur gi al dent al labor ato y,x rayi,c ,,r -se v ce ", fi st a d o "Good Sam r tanrisrirai or nur ing se v ce or tr eatm n , ad v ce osrietirsevce"to a pers on,unle s yo are irissun i struction o th e related fur i hi g on,r n s n fthe busin e s or o cup at on o prov dinscifig fo d or b ev rages; oroeproesionalheath a e s e v ce .f s l c r r i s b.The furni hing o di pensing o dru s osrsfgr2.The f o lowi g rep a es the la t par agraph olnlcsf m d cal d ent al o surgi al supplie oei,,r c s rPaagaphrr2..(1)a of SECTI N II –WHO ISO appl a ce .i n sANINSUEDR: 6.The f ol o ing i added t o P ar ag aphlwsr 4.b.,Unle s yo a e in t he business or o cupatiosurc n Ex ess In urancecs , of SE TION IV –Coprovdig pr o e sional healt ca e s e v ce ,f i n f s h r r i s Pa ag aphsrr (1)a)(,(b),(c)and (d)abov doe CO MERCIAL GENE AL L IABI ITMRLY COND T ONIISnot apply to :"bodily injury"arising out of prov din o ai ing o rov de:i g r f l t p i Thi i suranc e i ex e s ov r any v li ansnscseadd (a)"In i ent al me ic a se v ce "by any ocddlrisf col e ti le oth e in uranc e whether prim ry,l c b r s ,a y ur "em loyee "who is a nu se,nurseopsr ex e s, c onti gent o on an y oth er ba is,thatcsnrs a sist ant,em rgen y me i al tech ni iasecdccn i av ilab e t o any o your "em loy es"fosalfper or arame ic;orpd "bo ily injury that ari e ou o prov ding od"s s t f i r fa l n to prov de "i cidental medi al ser v ce "i i g i n c i s(b)F rst ai or "Good Sama itan se v ce "byidrris a y o y u "em loyee "o "to an y p erso t o t he ex ent notnforpsrnt su bje t t ocvlunteero Pa ag aphrr 2.a.1)(o S e t onfci II –Who Is Anworkers", other than an employed or v lunteer do tor.An y such "em loyee "o c p s In ured.s or "v lu teer wo kers"prov ding o fa l ngonririi D B ANKET WAIVER O SUB O ATION.L F R Gtoprovdefist aid or "Good Sama i anirrt The fo lowing is a d ed t o Paragraphld 8.,Tra sfenrsevce"during thei work h ou s fo yourisrrr O Righ s O Reco ery Agai st O hers To Usftfvnt,wil be deem d t o be a t ng wi hin t helecit of SE TION IV –CO MERCIAL GENER ALCMscoe o thei em loym nt by yo opfrpeur pe fo m n dutie rela ed to the co du trrigstnc L ABI I Y CO D T ONILTNIIS : o yo r busine s.f u s If the insured has a ree in a c ont act ogdrr 3.The f o lo i g repla e the la t se tenc e olwncssnf ag ee ent t o waiv that i sured 'righ ormenstf Pa ag aphrr 5.of SE TION III –LIMITS OCF re ov ry agains t any p erson o o gan zat on, wecerrii INSU AN ERC:waiv our right o e ov ry ag ain t uch pe son oefrcessrr organi ation,but only fo pay ents we ma ezrmkFothe pu rpo e o dete m nin th erssfrig be aus e o :c fapplcableEah Occurr enc e Lim t, al relatedicil a t or om ssions com i ted i prov di g ocsimtninr a."Bo ily i ju y"o "property dam ge "thatdnrrafalnto prov de "inci ent al me icaiigiddl o curs; ocrsevce", fi st a d o "Good Sam r tanrisrirai b."Pe so al and adv rti ing inj ry"ca sed byrnesuusevce"to any one p erso wil be deeme torisnld an o fe se hat i com it edfntsmt;be one "o currence".c 4.The f o lowi g ex lu ion i added to subsequent t o the ex cution o thelncssef cont a t orcr Pa ag aphrr 2.,Exclus onis , of SE TION I –C ag ee ent.r m CO ERAGES –CO ERAGE A –BODI YVVL E.CON RACTUAL IABILIT –RAIL OADTLYRSINJUY AND P OP RT DAMAGERREY L ABI I YILT :1.The fol o ing repla e P a agrap hlwcsr c.o th ef de i i ion o "insur ed cont act"i th efntfrnSae O Ph rmaceu icalslfat D FIN TIONEIS Se tion:c"Bo ily inju y or "property dama e"ari ingdr"g s ou o the v ola ion o a penal st at t e otfitfur c.Any ea em nt or l cense agr eem nt;s e i e ordi ance rela i g t o t he sale ontnf Pa e 2 o 3gf © 2017 The T avelers Indemnit Company.All rightsry reserved.CG 3 16 02 9D1 Includes copyrighted material of nsurance Services Of iceIf,Inc.,with its permission. COMM RCI L G NERAL IAB LITYEAELI 2.Pa ag aphrr f.1)(o the de init o o "i suredffinfn a.Any pr em se whi e rent ed t o yo oislur cont a t i therc"n D FIN TIONEIS Se tion is tem or a i y o cupied by you wi h pe m ssioncprlctri de eted.o he own e ; orlftr F DAMAGE TO P EMISE EN ED TO YOU b.R S R T .The c o tent o any premi e whi e suchnsfssl prem se i rented to yo , i y u rent suchissufoThefolowing repla e th e de i ition o "prem selcsfnfis prem se f o a p eriod o s ev n or f eweisrferdamaein heg"t DEF NIT ONSII Se tionc :conse utiv day .c e s"Pre i e dama e m a s "property dama e "to:m s s g "e n g CG 3 16 02 9D1 © 2017 The T avelers Indemnit Company.All righ sryt reserved.Pa e 3 o 3gf Includes copyrighted material of nsurance Services Of iceIf,Inc.,with its permission. COMMERC GENERAL L ITYIAL IABIL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION This endorsement i ies insurance pro ided under the lmodfvfolowing: COMMERC GENERAL L ITY VERA ARTIAL IABIL CO GE P A.2.B.2.The fo is added to Paragraph ,The fo e lusion is added to Paragraph ,llowing llowing xc Ex Ex oclusionsclusions fof Sectio I – C A – Bo Secti n I – C B – Per-n overage dily o overage Inj And perty Damage sonal And Advertisin In Lia lityury Pro g jury bi:: 2.Exclusi 2.Exclusionsons This insurance does not apply to This insurance does not apply to:: Fu i Fu i ng or Bacteria ng or Bacteria a.a."Bodi injur or "property da "Personal in or "ad ert injuryly y" mage"jury" v ising " which would not ha e occurred,in whole which would not ha e taken place,invv or in par bu for the , a or whole or in part but for the actua alt, t lleged , l,- threatened inhalat o , ingestion o ,leged or threatened inhalat o , inge -ion f f ion f s contact with,e to, e istence o or tion o , contact wi e to, e i -xposure x f,f th, xposure x s presence of, any "or on or tence o or presence of any "i" orfungi"f,fung within a bu ing or inc its bacteria on or within a bui ing or stru -ild luding ld c contents, regardless of whether any other ture, inc its contents, regardless ofluding cause, e mater or product whether any other cause, e matervent,ial vent,ial uted concurrently or in any sequence to or product concurrent or inly such injury or mage.any sequence to such injury.da b.b.Any loss, cost or e s arising out o Any loss, cost or e s arising out oxpensefxpensef the abating,testing f moni ,the abating,testing f moni ,or,toring or,toring cleaning up,re v ng, con ing, trea -cleaning up,re v ng, con ing, trea -mo i tain t mo i tain t ing, deto i ying neutra ing,re ting ing, deto i ying neutra ing,re tingxf, liz media x f , liz media or disposing of,or in any way responding or disposing of,or in any way respo nding to, or assessing the ef ects o , "i" or to, or assessing the ef ects o , "i" orfffungfffung bacteria,by any insured or by any other bacteria,by any insured or by any other person or entity.person or entity. This does not apply to any "i"The fo is added to thefungllowing C.Defi i-n tionsor bacteria that are, are on,or are contained in, a good or product intended for consump-"Fungi"means any type or f m o fungus, i -or f ntion.cluding m or m ldew and any my xoldicotoins, spores, scents or byproducts produced or r -e leased by fungi. CG D2 43 01 02 Copyright,Tra elers Inde ity mpany, 2002 Page 1 oThe v mn Co f 1 Includes copyrighted ter o Insurance Ser ices O f cemaialf v f i contrib- contributed definition actual bacteria structure, exclusion Section: exclusion COMMERC GENERAL L ITYIAL IABIL THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – CONSTRUCTION MANAGEMENT ERRORS AND OMISSIONS This endorsement i ies insurance pro ided under the lmodfvfolowing: COMMERC GENERAL L ITY VERA ARTIAL IABIL CO GE P The fo e lusion is added to Paragraph ,and specif ions by any arch , eng orllowing xc icat itect ineer 2. Exclusi Sect n I – C A – Bodonsiooverage ilyo surveyor per m ser ices on a projec onfforing v t which you serve manager; oras construction Inj And Pro Damage L ilury perty iab ity and Para- graph ,o2.Excl ons Sect n I – C B –usi io overage f 2.Inspection, super ision, qual y contro arch c-v it l,itePersonal And rtisin In Lia ityAdveg jury bil :tural or engineering ac i i ies done by or for youtvt This insurance does not apply to "bodi in on a project on which you ser as constructionly jury",ve manager."property da "personal injur or "ad rtmage", y" ve ising injury ar f" ising out o :This e lusion does not apply to "bodi in orxcly jury" 1.The preparing, appro i or fa to prepare or "property da due to construction or de itvng, ilure mage" mol ion appro maps, shop drawings, opinions, reports,work done by you, your "e loyees" or your subco -ve, mp n tractors.surveys, f ld orders, change orders or drawingsie CG D2 93 11 03 Copyright,Tra elers Inde ity mpany, 2003 Page 1 oThe v mn Co f 1 Includes copyrighted ter o Insurance Ser ices O f ce, , with ts perm ssion.ma ial f v f i Inc.i i 1.The following exclusion is added to Paragraph 2., Exclusions, of SECTION I – COVERAGES – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Claims Or Suits By Named Insureds Against Other Named Insureds "Bodily injury" or "property damage" alleged in a claim or "suit" made or brought by or on behalf of any Named Insured against any other Named Insured. 2.The following exclusion is added to Paragraph 2., Exclusions, of SECTION I – COVERAGES – COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY: Claims Or Suits By Named Insureds Against Other Named Insureds "Personal and advertising injury" alleged in a claim or "suit" made or brought by or on behalf of any Named Insured against any other Named Insured. 3.The following replaces the introductory phrase of Paragraph 7., Separation Of Insureds, of SECTION IV – COMMERCIAL GENERAL LIABILITY CONDITIONS: Except with respect to the Limits of Insurance, the Claims Or Suits By Named Insureds Against Other Named Insureds exclusions and any rights or duties specifically assigned in this Coverage Part to the First Named Insured , this insurance applies: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EXCLUSION – CLAIMS OR SUITS BY NAMED INSUREDS AGAINST OTHER NAMED INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CG D3 22 10 20 © 2020 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – ARCHITECTURAL, ENGINEERING OR SURVEYING PROFESSIONAL SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART but only with respect to any of the following op-PROVISIONS erations:1.The following exclusion is added to Paragraph 2., a.Providing, or hiring independent profession-Exclusions , of SECTION I – COVERAGES – als to provide, architectural, engineering orCOVERAGE A BODILY INJURY AND PROP- surveying services to others in any insured’sERTY DAMAGE LIABILITY : capacity as an architect, engineer or sur-Architectural, Engineering Or Surveying Pro-veyor; orfessional Services b.Providing, or hiring independent profession-"Bodily injury" or "property damage" arising out of als to provide, architectural, engineering orthe rendering of or failure to render any "profes-surveying services in connection with con-sional services" by or on behalf of any insured,struction work any insured performs.but only with respect to any of the following op-3.The following is added to the DEFINITIONSerations: Section:a.Providing, or hiring independent profession-"Professional services":als to provide, architectural, engineering or surveying services to others in any insured’s a.Includes: capacity as an architect, engineer or sur-(1)Preparing, approving, or failing to pre-veyor; or pare or approve, maps, shop drawings,b.Providing, or hiring independent profession-opinions, reports, surveys, field orders orals to provide, architectural, engineering or change orders, or preparing, approving, surveying services in connection with con-or failing to prepare or approve, drawingsstruction work any insured performs.and specifications; and 2.The following exclusion is added to Paragraph 2.,(2)Supervisory or inspection activities per-Exclusions , of SECTION I – COVERAGES –formed as part of any related architec-COVERAGE B PERSONAL AND ADVERTIS-tural, or engineering or surveying activi- ING INJURY LIABILITY :ties. Architectural, Engineering Or Surveying b.Does not include services within construction Professional Services means, methods, techniques, sequences and procedures employed by you in connection"Personal injury" or "advertising injury" arising out with your operations in your capacity as aof the rendering of or failure to render any "pro-construction contractor.fessional services" by or on behalf of any insured, CG D5 46 10 11 © 2011 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART "Consumer financial identity information" meansPROVISIONS any of the following information for a person that1.The following exclusion is added to Paragraph is used or collected for the purpose of serving2.,Exclusions , of SECTION I – COVERAGES as a factor in establishing such person's eligibil-– COVERAGE A BODILY INJURY AND ity for personal credit, insurance or employment,PROPERTY DAMAGE LIABILITY :or for the purpose of conducting a businessViolation Of Consumer Financial Protection transaction:Laws a.Part or all of the account number, the expi-"Bodily injury" or "property damage" arising out ration date or the balance of any credit,of any actual or alleged violation of a "consumer debit, bank or other financial account.financial protection law", or any other "bodily in-b.Information bearing on a person's creditjury" or "property damage" alleged in any claim worthines s, credit standing or credit capac-or "suit" that also alleges any such violation.ity.2.The following exclusion is added to Paragraph c.Social security number.2.,Exclusions , of SECTION I – COVERAGES – COVERAGE B PERSONAL AND ADVER-d.Drivers license number. TISING INJURY LIABILITY :e.Birth date. Violation Of Consumer Financial Protection "Consumer financial protection law" means:Laws a.The Fair Credit Reporting Act (FCRA) and"Personal injury" or "advertising injury" arising any of its amendments, including the Fairout of any actual or alleged violation of a "con-and Accurate Credit Transactions Actsumer financial protection law", or any other (FACTA);"personal injury" or "advertising injury" alleged in b.California's Song-Beverly Credit Card Actany claim or "suit" that also alleges any such and any of its amendments; orviolation. c.Any other law or regulation that restricts or3.The following is adde d to the DEFINITIONS prohibits the collection, dissemination,Section:transmission, distribution or use of "con- sumer financial identity information". CG D6 18 10 11 Page 1 of 1© 2011 The Travelers Indemnity Company. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS 1.The following exclusion is added to Paragraph 2., Exclusions, of SECTION I – COVERAGES – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Violation Of Biometric Information Privacy Laws "Bodily injury" or "property damage" arising out of any actual or alleged violation of a "biometric information privacy law", or any other "bodily injury" or "property damage" alleged in any claim or "suit" that also alleges any such violation. 2.The following exclusion is added to Paragraph 2., Exclusions, of SECTION I – COVERAGES – COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY: Violation Of Biometric Information Privacy Laws "Personal and advertising injury" arising out of any actual or alleged violation of a "biometric information privacy law", or any other "personal and advertising injury" alleged in any claim or "suit" that also alleges any such violation. 3.The following is added to the DEFINITIONS Section: "Biometric information": a.Means information about a person's physical, biological or behavioral characteristics that can be used to identify such person. b.Includes a person's retina or iris scan, fingerprint, voiceprint, scan of hand or face or other body geometry, DNA, vein pattern, keystroke pattern or rhythm, gait pattern or rhythm, or sleep, health or exercise data that contain identifying information. "Biometric information privacy law" means the parts of any law, ordinance, regulation or governmental rule that govern or relate to the collection, storage, disclosure, retention, destruction, protection, use, sale, lease or trade of "biometric information". COMMERCIAL GENERAL LIABILITY CG D9 44 01 23 © 2022 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Description And Location(s) Of Operation(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – DESIGNATED OPERATIONS COVERED BY A CONTROLLED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A.The following exclusion is added to Paragraph 2. Exclusions of Section I – Coverage A – Bodily Injury And Property Damage Liability: This insurance does not apply to "bodily injury" or "property damage": 1.Arising out of your ongoing operations; or 2.Included in the "products-completed operations hazard"; at the location(s) described in the Schedule of this endorsement, but only if you are enrolled in a "controlled (wrap-up) insurance program" with respect to the "bodily injury" or "property damage" described in Paragraphs A.1. and A.2. above at such location(s). This exclusion applies whether or not the "controlled (wrap-up) insurance program": a.Provides coverage identical to that provided by this Coverage Part; b.Has limits adequate to cover all claims; or c.Remains in effect. B.The following definition is added to the Definitions section: "Controlled (wrap-up) insurance program" means a centralized insurance program under which one party has secured either insurance or self-insurance covering some or all of the contractors or subcontractors performing work on one or more specific project(s). CG 21 54 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:ISSUE DATE: COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – LEAD This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART CATASTROPHE UMBRELLA POLICY PROVISIONS 2. 3. 1. CG D0 76 06 93 Page 1 of 1 Any obligation to share damages, losses, costs, payments or expenses with or repay someone else who must make payment because of such injury or damage, loss, cost, payment or ex- pense; or Any request, order or requirement to abate, mitigate, remediate, contain, remove or dispose of lead, lead compounds or materials or sub- stances containing lead. This insurance does not apply to any injury, damage, loss, cost, payment or expense, including, but not limited to, defense and investigation, of any kind aris- ing out of, resulting from, caused by or contributed to by the actual or alleged presence or actual, al- leged or threatened dispersal, release, ingestion, in- halation or absorption of lead, lead compounds or lead which is or was contained or incorporated into any material or substance. This exclusion applies, but is not limited to: Any supervision, instructions, recommendations, warnings or advice given in connection with the above; THIS ENDORSEMENT CH ANGES TH E POLIC Y. PLE ASE READ IT C AREFU LL Y. EXCLUSION –DISCRIMINATION PROV ISIONS 2.The f ollow ing is add ed t o 2., Exclus ions , of SECTION I –C OVER AGES –1.The f ollow ing is 2.,COVER AGE B –PERSONAL ANDExclusions, of SECTION I –C OVER AGES –ADVERTISI NG INJ URY LIABILITY :COVER AGE A –BODILY INJURY AND PROPERTY DAMAGE LI ABILITY :Discr imina tion Discr imina tion CG D1 42 02 19 Pag e 1 of 1 This endorsement modifies insurance provided under the following: exclusion added to Paragraph exclusion Paragraph © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY COVERAGE PART "Bodily injury" arising out of discrimination based upon a person's sex, sexual orientation, marital status, pregnancy, race, color, creed, religion, national origin, citizenship, veteran status, age, genetic information or physical or mental disability, or any other characteristic, attribute, trait, condition or status that qualifies a person for protection against discrimination under federal, state or local law. "Personal injury" arising out of discrimination based upon a person's sex, sexual orientation, marital status, pregnancy, race, color, creed, religion, national origin, citizenship, veteran status, age, genetic information or physical or mental disability, or any other characteristic, attribute, trait, condition or status that qualifies a person for protection against discrimination under federal, state or local law. COMMERCI AL GENERAL LIAB I LI TY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT – POLLUTION EXCLUSION – INCLUDING LIMITED COVERAGE FOR POLLUTION CO STS – CONTR ACTORS Thi s endorsement modifie s insuranc e prov ided und er the f ollowing: PROVISIONS respect to your on going op erations performed f or th at additional insured1.1.a.(2)The f ollowing repla ces Par agraph of at th at premises, site or locatio n andSECTIONI – COVERAGES – COVERAGE A –such pr emises, site or locatio n is notBODILYINJURY AND PROPERTY DAMAGE and never was owned,occupie d orLIABILITY SECTION I – C OVERAGES –and of managed by,or rented or loan ed to,COVERAGE B – PERSONAL AND any insured,other th an that addi tionalADVERTISINGINJURY LIABILITY:insured; or(2)Our right and duty to def end end when we (iii)"Bodily injury "or "pr operty d amage"have used up the applicable li mit of insuranc e arising out of h eat, smoke or fumesinthe pa yment of judg ments or settlements from a "hostile fire";A BunderCoveragesor ,medical expenses C (b) und er Coverage or "limited covered At or fr om any premises, sit e or locatio n Dpollutioncosts"und er Coverage .which is or was at an y time used b y or for any insur ed or others for t he handli ng,2.(1) The fol lowing replace s Paragraph of storage ,disp osal,processing orf.Pollution 2.SECTION I –, , in Paragraph of treat ment o f waste;COVERAGES – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY (c) : If such "p ollutants " are or were at any time transp orted,h and led,st ored,(1)"Bodi ly injury "or "property damage"arising treated ,disp osed of, or pr ocessed asoutoftheactual,alleged or t hreatened waste by o r for:discharge, dispersal, seepage,migratio n, (i) release o r escape o f "pollutan ts": An y insured; o r (a)(ii)At or fro m any pr emises, sit e or location An y pers on or org anizat ion f or wh om which is or was at an y tim e owned,you may be le gally resp onsible; occupied or manag ed by,or rent ed or (d)At or from any premises, sit e or locationloanedto,any insured. However,this on which an y insured or any cont ractorssubparagraph d oes not apply to:or subcontractors working directly or (i)"Bodi ly injury "if sustained within a indirectly on any insured's b ehalf are or build ing and c aused by smoke,were at any tim e perfo rming operation s to fumes, vapor or soot produced by or test f or,monitor, clean up, remove, orig ina ting fr om equipme nt th at is contain,treat, detox ify or neutr alize,or in used to heat, cool or dehumidify th e any way resp ond to, or assess the effects build ing,or pr oduced b y or originatin g of,"p ollut ant s"; or fro m equipm ent th at is used to heat (e)If any of s uch discharge, disp ersal,water for personal use by th e seepage,migration,releas e or escape ofbuilding's occup ants or thei r guests;"pollutant s" resulted in "b odily injury" or (ii)"Bodi ly injury "or "pr operty damage""prope rty d amage"that occurred,in fo r which you may be held lia ble,if whole or in p art,prio r to the p oli cy period . you ar e a c ontractor an d th e owner or Any continuat ion, chang e or resumption lessee of such premises, site or of such "bodily injury"or "prop erty location has been add ed to your damage"during or af ter the policy p eriod policy as an additional insur ed with will b e deemed to h ave occurr ed prior to CG D1 73 02 19 P age 1 o f 5© 2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insur ance Services Office,Inc. with its permission. Exclusion COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL GENERAL LIAB ILITY n.Pollution Coststhe poli cy period.However,this subparagraph does not apply to "b odily "Pollution costs".injury"or "prop erty dama ge" incl uded in 5.SECTION I –The fol lowing is added tothe"products-c ompleted ope rations COVERAGES:haza rd". COVERAGE D – LIMITED C OVERAGE FOR(1)(a)(b) (c) Paragraphs ,and of thi s POLLUT ION COSTSdo not apply t o "bodily inju ry"or 1. "prope rty dama ge" arising on ly ou t of th e Insuring Agreem ent discharge, relea se or escap e of any a.We will p ay tho se sums that you become"pollu tant" if such discharge,release or legally ob ligated t o pay as "lim itedescape:covered p ollu tio n c osts" to which thi s (1)Is either:insurance appl ies. We will have t he right and duty to defend you against an y "suit "(a)At or fr om any premises, s ite or seeking th ose "limited c overed p ollut ionlocation (ot her th an at or from an costs". However, we will have no d uty t o"underground tank") which is owned,defend you against any "suit" seekingoccupiedor ma nag ed b y,or rented or "limited covered pollution costs" to whichloaned to, you during the policy this insurance does not apply.We may atperiod;or our discretio n in vestiga te any discharge,(b)From a pipe contain ing sewage;release or escape of "pollu tants" and (2)Comme nces abru pt ly during the policy settle any claim or "su it" t hat may result. period and af te r the effective date of the But : Amendme nt – Poll ution –(1)The amount we will pa y f or "lim itedLimited Coverage F or Pollut ion covered p ollution c osts" will b eCosts–Contr actors endors ement;included withi n,and n ot in addition to, (3)End s within s even consecutive days afte r the lim its of insurance that apply t o Aitsabruptcommencement;C overage ; and (4)(2) Become s known t o an insured listed Our right and d uty to d efend end 1. IIunderParagraph of Section –W ho Is when we ha ve used up th e appli cable An I nsured,or t o an "employee "limit of insu rance in t he p ayment of authorized by you to giv e or receive judgmen ts or s ettlem ents und er A Bnoticeofany"occurrenc e"or claim,and C overage s or ,medical expenses is repo rted to us,within 30 days after its un der Coverag e C or "lim ited c overed Dabrupt commencement; and pollution costs"un der Cov erag e . No other obli gation or l iability t o pay sums(5)Does not arise out of any intentio nal or perform acts or s ervices is coveredviolationofanygovernmentallaw,unless explicitly pr ovided f or und erregulationorrule b y you or an yone actin g Supplem entar y Pay ments.on your beh alf. b.This insuranc e applie s t o "lim ited c overedAll"bodi ly inj ury"or "prop erty damage"pollution costs" only if the "pollutant s" fordescribed in this except ion will be deemed t o which t he "limited covered pollution costs "occur at th e tim e such discharge,release or are incurred also caus e "bodily injury"orescape abr uptly commen ces."prope rty d amage"covered und er ACoverage t hat:3.(2) The fol lowing replace s Paragraph of f.Pollution 2.SECTION I –, , in Paragraph of (1)Arises out of a disp ersal,seepage,COVERAGES – COVERAGE A – BODILY migrat ion,release or esca pe ofINJURY AND PROPERTY DAMAGE LIABILITY:"pollutants" at or from an y pr emises, site or locatio n on which an y insured(2)"Pol lution costs".or any c ontra ctors or subcont ractors 4.n.Pollution-The fol lowing repla ces ,working directly or indi rectly on any Related 2. SECTION I –, in Paragraph of insured's b ehalf are p erfo rming COVERAGES – COVERAGE B – PERSONAL operatio ns if the "pollutant s" are AND ADVERTISING INJURY LIABILITY:brought on or to th e pr emises, site or CG D1 73 02 19Page2 of 5 © 2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insurance Services Office,Inc. with its permission. exclusion Exclusion Including Exclusion Exclusion COMMERCI AL GENERAL LIAB I LI TY 6.SECTION II – WHO ISlocation in connection with such The following is added to AN INSUREDoperations by such insur ed,: cont ractor or subcont ractor; or 3.Parag raph is the only part of this section th at (2)f.I D.Is within the exception t o applies to Section –Coverage For the A D,of C overage th at req uire s th e purpo ses of C overage similar coverage as 3. discharge, relea se or escap e of used in Paragraph of this sect ion inclu des any "poll utant s"t o:pollution liability coverage. (a)7.SECTION III – LIM ITSBeeither:The f ollowing is added t o OF INSURANCE:(i)At or from any premises, sit e or location (other than at or For t he purpos es of any aggregate lim it an d th e fro m an "und erground tank")Each Occurr ence Limit ,"lim ited c overed p ollut ion Dwhichis owned,occupied or costs"und er Coverag e will be deemed t o be managed by,or rented or damages because of "property d amage "und er A.loaned t o,you during th e Coverage policy period; o r 8.3.LegalThe fol lowing is add ed to Paragrap h , (ii)Action Against Us SECTION IV –From a pipe contain ing , of COMMERCIAL GE NERAL L IABILITYsewage; CONDITIONS:(b)Comme nce abruptly during th e Wi th respe ct to "limited covered poll ution costs",policy period and af ter th e no p erson or organ ization h as a right u nder thiseffectivedateofthe Amendment Coverage Part :–Pollution –Including Limited Coverag e For Pollut ion a.To join us as a p arty or oth erwise bring us Costs –Contractors into a "suit"asking f or "limited covered end orsement;pollution costs"from you; o r b.To sue us on this C overage P art u nless all of(c)End within s even consecutiv e its term s h ave been fu lly complied with.days afte r its abrupt commen ceme nt;Wi th respect to "limited c overed pol lution costs", a person or organi zation may sue us t o recover on(d)Become known t o an insured an agree d s ettlement or on a fi nal judgme nt1.listed und er Paragr aph of against you,but we wil l n ot b e lia ble f or "lim itedIISection–Who I s An Insured, o r covered poll ution costs"that are not payabletoan"employee"aut horize d b y und er th e t erms of this Coverage Part or t hat ar eyou to give or receive not ice of in excess of th e applicable lim it of insuranc e.Asany"occurr ence "or and b e used in this pr ovision, an agr eed set tlem e ntreportedto us, within 30 da ys means a s ettlement and relea se of lia bility signedafter its abrupt commencement ;by us, b y you and by t he claima nt or th eandclaimant's legal repres entativ e. 9.4.Other(e)The f ollowing is added t o Paragraph ,Not arise out of an y intentional Insurance SECTION IV –COMMERCIAL, ofviolationofany governmental GENERAL LIABILITY CONDITIONS:law,regulation or rule by you or anyo ne acting on y our b ehal f.If valid and collectible oth er insuranc e is available to you for a loss we cover und er C overage D of2.Exclusion this C overage P art, this insuranc e is excess over Thi s insuranc e does not apply to "limited any of the oth er insuranc e,wheth er primary, covered pollution costs"which you ar e excess, conti ngent or on an y other basis. oblig ated to pay by reason of the assumpt ion We will hav e no duty und er Coverage D t o defendofliability in a cont ract or agreement.Th is you against any "suit"if any oth er insurer has adoesnotapplyto liabil ity that you duty t o defend you against th at "suit".If no otherwouldhavetopay"limited c overed pollution insurer defends, we will und ertake t o do so,but costs"in t he absenc e of the cont ract or we will be enti tled to your rig hts against all th ose agreement.other i nsur ers. CG D1 73 02 19 Page 3 of 5© 2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insurance Services Office,Inc. with its permission. exclusion Exclusion claim, exclusion COMMERCIAL GENERAL LIAB ILITY We will pay only our sh are of the amount of the detoxify or neut ralize, o r assess the e ffects of, loss, i f any,th at exceed s the su m of:"pollut ant s". (1)b.The total amount that all such other ins urance Does n ot would pay for the loss in the absence of this (1)Any pun itive or exemplary damage s orinsurance; and the portion of any multiplied damage (2)The total of all deducti ble and self-insured award that exceeds th e amoun t amounts under all such other i nsurance.multiplied ; 10.8.Transfe r (2)The following is added to Paragraph ,Any statutor y or administrativ e fi ne or Of Rights Of Recovery Against Others To Us ,pen alty; SECTION IV –COMMERCIAL GENER ALof (3)Any s alary of,or ben efit f or,any of yourLIABILITY CONDITIONS:"employees", any of your partners or Wi th respect to "limited c overed poll ution costs ", i f members (if you are a partnership or jo int you have agr eed in a cont ract or agreeme nt t o ventur e), any of your managers (if you waive your right s of recovery ag ainst an y person are a limited lia bili ty company),any of or organ ization ,we waiv e our right of recovery your trus tee s (if you are a trust), or any of against such pers on or organizat ion ,but only f or your "executive off icers"or directo rs (if payments we make because of "limited c overed you are an organization oth er than a pollu tion costs"incurred f or a discharge, release partn ership,joi nt venture, lim ited lia bil ity or escape of "pollutan ts"that c ommences company o r trust); abruptly after th e executio n of t he contra ct or (4)Any cost or ex pense for:agreement.(a)The repair, repla cement,11.The f ollowing replaces the defini t ion of "suit"in enh ancement, restor atio n orDEFINITIONStheSection:maintenanc e of an y premises,site or "Sui t" mea ns a civil proc eeding in which damages locat ion which is or was at any time because of "bod ily injury ","property damage",owned, occupied or managed b y,or "per sonal injur y"or "advertising inj ury"to which rented or loaned to,you; o r th is insuranc e applie s, or in which "limited (b)The prev ention of injury to a personcovered poll ution costs"to which this insuranc e or damage to another's pr ope rty;appl ies, are al leged ."Suit"include s:(5)Any c ost or expense to test for,monitor,a.An arbitration proceeding in which such clean up, remove, contai n, tr eat,detox ifydamagesare claim ed and to which th e or neutral ize,or assess the effects of,insured must submit or does submit with our "pollutant s", if such wor k or ope rationsconsent;beg an while such "pollutants"are or b.Any other alternativ e dispute resolut ion were: pro ceedi n g in which such dama ges ar e (a)At any pr emises, site or locatio nthe insured s ubmi ts with which is or was at any time owned,our consent;occupied or ma nag ed b y,or rented or c.An arbitration proceeding in which such loaned to ,you; or "limited covered pollution c osts"are claime d (b)On or in p ersonal pr operty in yourand to which you must sub mit or do submit care, custody o r contr ol;orwithourconsent;and (c)At t hat p arti cular part of an y prop ertyd.Any other alternativ e dispute resolut ion that must be restor ed,repaired orproceeding in which such "limited c overed replaced because "your work"waspollution c osts" are and to which you incorrectly performed on i t; orsubmit with ou r consent.(6)Any c ost or expense to test for,monitor,12.DEFINITIONSThefollowing is added t o th e clean up, remove, contai n,treat ,detox ifySection:or neutral ize,or assess the effe cts of, "Limited cov ered pollu tion costs":"pollutant s"on or in an y of your "employees", after the actual ,alle ged ora.Means any cost or expense to t est for, threatened abs orption ,ingestion ormonitor,up,remove, contai n,tr eat,inhala tion of such "pollutan t s"by any of CG D1 73 02 19Page4 of 5 © 2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insurance Services Office,Inc. with its permission. include: claimed and to which claimed clean COMMERCI AL GENERAL LIAB I LI TY your "employee s" arising out of and in th e "Underg round tan k"means any one or course of:combination of tank s (an y conn ected pipe or pump),th e volume of which (including th e(a)Employme nt by y ou; or volume of all c onne cted underg roun d pipe s or(b)Perfo rmi ng dutie s related to th e pumps) is 10% o r more: conduct of your busin ess.a.Beneath the surfa ce of th e gr ound outside of "Pol lution costs" means any lo ss, cost or expense a building or structure; arising out o f any:b.Beneath the low est b asement floor of aa.Request, demand, order or sta tutory or building or str ucture; regula tory requi rement t hat any insured or c.Otherwise covered with ea rth en materials; orotherstest for,monitor,clean up, remove,d.Beneath the surfa ce o f the water.contain ,tr eat, detoxify or neut ralize,or in any way respond to or assess th e effe cts of,Underg roun d pipes or pumps means all "pollu tants"; or und ergrou nd pipin g or p umps,incl uding valves, elbows, joint s, flange s and flex ible c onn ectorsb.Claim or suit by or on behalf of any attached to any one or a combination of tanks.governmental authority or any othe r person or organi zation because of testing for,However,"und erground tank"does not include monito ring,cleaning up, removing,the part of any tan k (includ ing the part of any contain ing,treating,detox ifying or connected pipe or pump)containin g sewage. neut ralizing,or in any way responding to,or assessing the e ffects of,"poll utants". CG D1 73 02 19 Page 5 of 5© 2017 The Travelers Indemnity Company.All rights reserved. Includes copyrighted material of Insurance Services Office,Inc. with its permission. including COMM RCI L G NERA L LIAB LITYEAEI T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E EXCLUSION –EXTERIOR INSULA ION A DTN FINISH SYSTEM Thi e dorseme t m d fie i suranc e prov ded und er he f l o ing :s n n o i s n i t o l w COMM RCI L G NERA L IAB LI Y COVERAG PA TEAELITER P O ISIONRVS 2.The f o lo i g is ad ed tolwnd SE TI N V –C O1.The f ollo wing exclusion is added to Parag raph D FIN TIONEIS:2.,Exclu io ssn,of SECTI N I –CO ERAGES –O V CO ERAGE A BODIL INJURY ANDVY "Ex erio insulation and fi i h sy temtrnss"P OPE TY DA AGE LIAB LI YRRMIT:(com o ly re err ed to a s y theti stucco omnfsncr EI S)F :Ex erio In ulati n And in sh SystemtrsoFi a.Mea s an ex erio cla ding or fi i h sy t emntrdnss(1)"Pro erty dama e"a i i g o t o "y upgrsnufor use on any pa t o any structu e andrfrdprodutor"y ur work :c "o " consisting o :f(a)Tha i o that i i o pa t o anytsrsnrrf (1)A ri i o sem rigid insula ion boargdritd"ex erio insulat on and fi i h s y tem otrinss"r m de o ex and ed poly t yrene or o heafpstrany ubstant ally sim la y t em orsiirss; m te ial ;a r s(b)That im acts the fi ness, quali y,p t t (2)The adhes iv or me hani al f a t enerseccsduabiity or pe fo man e o any "ex eriorlrrcft r use t o at a h th e i sula ion bo ard t o th edtcntisulaionand fin sh sy t em or anyntis"substrate;substan ia ly sim lar sy temtlis.(3)A ei fo ced b a e c oa ;andrnrst(2)"Bo ily inju y a i i g ou o "y u product"odr"r s n t f o r r (4)A fi i h coa pro v di g surfa e tex urenstinct"y u wo k"de cribed in P aragrap horrs (a)or (b)and olo .c rabovand th at is alle ed in any clai oegmr b.In l de any condi io er, pr im r a ce s o ycustne,c s r ,"sui "which al o al e es such "prope tytslgr fl shing, c oatin , caulk ng o seala t used iagirnndamae.g "connect on with uch a s y temiss. CG 2 04 12 17D ©2017 T e Travelers Indemnity Company.All rights rehserved.Pa e 1 o 1gf COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – SILICA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS a.Any supervision, instructions, recommendations, warnings or advice given or which should haveThis insurance does not apply to "bodily injury",been given in connection with the above; and"property damage", "personal injury" or "advertising injury" arising out of or in any way related to the b.Any obligation to share damages with or repay actual, alleged or threatened discharge, dispersal,someone else who must pay damages because emission, release, escape, handling, contact with,of such injury or damage. exposure to or inhalation or respiration of silica or This exclusion applies to all such "bodily injury" orproducts or substances containing silica. This i -n "property damage" whether or not the "bodily injury"cludes, but is not limited to:or "property damage" is included in the "products- completed operations hazard". CG D2 40 06 01 Copyright, The Travelers Indemnity Company, 2001 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION–ALL HAZARDS IN CONNECTION WITH A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE DESCRIPTION 1.Any exposure shown in the above schedule; or CG T4 81 11 88 Page 1 of 1 DESIGNATED EXPOSURE 2. Any supervision, instructions, recommendations or advice given or which should have been given in connection therewith. This insurance does not apply to "bodily injury," "property damage," personal injury" or "advertising injury" arising out of: COMMERCIAL GENERAL LIABILITY POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION–ALL HAZARDS IN CONNECTION WITH A This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE DESCRIPTION 1.Any exposure shown in the above schedule; or CG T4 81 11 88 Page 1 of 1 DESIGNATED EXPOSURE 2. Any supervision, instructions, recommendations or advice given or which should have been given in connection therewith. This insurance does not apply to "bodily injury," "property damage," personal injury" or "advertising injury" arising out of: EMPLOYEE BENEFITS LIABILITY POLICY NO.: COVERAGE PART DECLARATIONS ISSUE DATE: INSURING COMPANY: DECLARATIONS PERIOD:From to 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Employee Benefits Liability Coverage Part consists of these Declarations and the Coverage Form shown below. 1.COVERAGE AND LIMITS OF INSURANCE Employee Benefits Liability Limits of InsuranceCoverage Form Aggregate Limit $ Each Employee Limit $ 2.AUDIT PERIOD: 3.FORM OF BUSINESS: 4.RETROACTIVE DATE: Date, if any shown below. Retroactive Date: 5.EMPLOYEE BENEFIT PROGRAMS OTHER THAN THOSE LISTED IN SECTION VII–DEFINITIONS: 6.DEDUCTIBLE: EACH EMPLOYEE$ 7.PREMIUM COMPUTATION: Rate Estimated No.Estimated MinimumPer of Employees Premium PremiumEmployee $$ 8.NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART ARE ATTACHED AS A SEPARATE LISTING. CG T0 09 09 93 Page 1 of 1 PRODUCER:OFFICE: This insurance does not apply to negligent acts, errors or omissions which occurred before the Retroactive TABLE OF CONTENTS EMPLOYEE BENEFITS LIABILITY COVERAGE FORM Beginning on Page SECTION I - EMPLOYEE BENEFITS LIABILITY COVERAGE Insuring Agreement 1 Exclusions 2 3Supplementary Payments SECTION II - WHO IS AN INSURED 3 SECTION III - LIMITS OF INSURANCE 4 SECTION IV - DEDUCTIBLE 4 SECTION V - EMPLOYEE BENEFITS LIABILITY CONDITIONS 5 Bankruptcy 5 5Duties in The Event of Act, Error or Omission, Claim Or Suit Legal Action Against Us 6 Other Insurance 6 Premium Audit 6 Representations 7 Separation of Insureds 7 Transfer of Rights of Recovery Against Others To Us 7 When We Do Not Renew 7 Cancellation, Non-renewal And Renewal Conditions Applicable to Commercial General Liability Coverage Part 7 SECTION VI - EXTENDED REPORTING PERIODS 7 SECTION VII - DEFINITIONS 8 CG T0 43 01 16 ©2016 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 .................................................................................................... .................................................................................................................. ............................................................................................. ............................................................................................ .................................................................................................................. .............................................................................................................. .................................................................................. .............................................................................. ............................................................................................... ........................................ ...................................... ........................................................................................................... ........................................................................................................... ................................................................................................. ................................................... .............................................................................................. ............................................................................................. .......................................................... ................................................................. COMM RCI L G NERA L IAB LI YEAELIT EMPLOYEE BENEFITS LIABILITY C VERAGE FORMO T IS INSURANCE PROVIDES CLAIMS-MADE COVERAGE.H PLEASE REA T E ENTIRE F RM CAREFUL Y.D H O L Va iou prov sion i this pol cy re tr i t cov rage. Read thrsisnisce e enti e pol cy ca e ully to deter m ne rightrirfi s, dutie ands wha i and is n ot ov red.t s c e Thro gh out th s poli y the words "you a d "yo r re e touic"n u "f r th e Nam d Insured sh own in the De laratec io s a d anynn ot er p erso o o gan zat on qu al fyi g a a Nam d I sur ed unde this polhnrriiinsenr i y he w ords "we,""us" and "our" re ec.T f r to th e om any prov d ng thi insuranc e.c p i i s The wo d "insured" m a s any erson or organization qu al fyi g a such und e Serenpinsrction II –W ho Is An I sur ed.n Ot e wo ds and phr a e t at app ea in qu ota ion m r s hav pe ialhrrsshrtakesc m an ng. e er o e tio VII –De ineiRftScnfit on .i s SE TI N I –EMP O EE BENE IT L ABI I Y (3)The n egli en a t, e rCOLYFSILTgtcror o omi sio warsns CO ERAGE com i ted on o a te th e Retroa tivVmtrfrce Da e,if an y shown i the De la ations ot,n c r f1.In u ing Ag eementsrr th s C ov rage P art and b e or e th e end oieffa.We wi l pay th o e sum that th e insuredlss the oli y pe iod;andpcrbeomelegalyobliated t o pay a dam gecslgsas (4)A cla m or "sui " for dama e be aus e ofitgscbeauseolosstowhih thi insuranc ecfcs the loss is fi st m de o brought agai strarnapple.We wi l hav the ri ht an d duty toisleg any insur ed, in acco dance withrdeend the insured agai st any "suit seek ngfn"i Pa a raph e.below, du i g the p ol cyrgrnithoedamae. Howev r we will hav nosgse,e pe iod or an y Ex end ed Reporting Periortdduy to de end th e insur ed agai st any "sui "t f n t we p rov de under Section VI –Ex endeditseekig dam ge f o loss t o whi h thisnasrc Re ort ng Perio s.p i disurance doe not apply.We ma , at ournsy c.Ea h n egligent a t, e ror o om ssio in accrrindicretioninvstigateany negligen a t, erros,e t c r se ie o related n egligent a ts, e rors orsfcrror om ssion an se tle any claim or "suit" thatidt om ssions will be deem d to h av beenieemyresul:Bu :a t t com i ted on the d ate t he fi st s uch negl gentmtri(1)The am unt we wi l pay f o dam ges isolra a t, error or omi sion in th a se ie iscstrslmted a de crib ed in S e tion III – Lim tiisscis co m tted.m iOfIsuranceandn;d If the R e roa tiv D a e i le t blank in th e.t c e t s f(2)Ou righ and dut y t o de en ends whenrtfd De la ations o this Cov rage P art,th ecrfe we hav used up t he appli a le l m t oecbiif Re roa tiv Date will b e deeme to be th etced i suran e in the paymen of judgme t onctnsr fi st ay o he poli y pe iod.r d f t c r se tle ents.t m e.A cla m o "sui "seek n d am ge wi l b eirtigasl No other obli ation or liabi i y t o pay sum o deem d to h avgltsree bee fi st m de o broug ht anrart the ea lie o he fo lo ing ime :r r f t l w t sperformacts or services is covered unless ex li i ly prov ded f o under Supplem nt arypctire (1)Wh n we or an y i sur ed fi st re e v senrciePaymnts.e writ en notic e o such cl im o "sui ",t f a r t whi hev r om s f rst; orceceibThiisuranceapplieto lo s only i :.s n s s f (2)Wh n we fi st re eiv wri ten n oti e froercetcm(1)The lo s i c a sed by a neg l gent a t,s s u i c any ins ur ed o a sp e i i n egligent a t,f c f c ceroor om ssion com i ted by th errimt e ro or om ssion t hat c a sed th e los srriuisured, o by any o her p erso f o who enrtnrs whi h re ulted in such laim or "suit .c s c "a t the insured is lega ly l able i th ecsli,n "adm ni tration o you "em lo ee b enef tis"f r p y i Al claim o "sui s"th a seek dama elsrttgs program ;"be aus e o lo s sust ai ed b y any onecfsn "em lo ee ,incl ding the "em lo ee s"p y "u p y '(2)The neg igent a t, e ro or o i sion islcrrms dep en en ts a d b ene i iarie , wil be d eemednfcsldcomited n the "cov rag e territo y ;m t i e r " CG 1 1 01 16 © 2016 The T avelers Indemnit Company.T 0 r y All rights reserved.Pa e 1 of 9g Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT to hav been fi st m de or broug ht a th e tim (1)Fa l re o any i v stmeerateiufnent to erfo mpr; the fi st o thos e claim o "suit " is made orrfsrs (2)Erro s in prov di g i fo ma io on pa trinnrtnsbroughtagainst any in ured.s pe fo man e o i v stm nt v hicle ; orrrcfneees f.A cla m o "sui "that seek dam ge wil beirtsasl (3)Adv ce giv n to an y p erson wi h re pe tietscdeemdto h av bee fi st m de o broug ht aeenrart to that pe son's d e i ion t o parti i ate orcscprthetimwe re eiv wri ten noti e fr om anyecetc no to pa ti ipate in any plan included intrcisuredoaspeiinegient a t,e ror onfcfclgcrr the "em loy e b ene i program .p e f t "om ssion o ly i tha notice co ta n a l o theinftnislf f.Wo kers' Compensat on And Simi ar Lawrilsfolowig in o m tionlnfra : Lo s a i ing out o your f a lu e to c om ly witsrsfirph(1)How,when an d whe e the neg l gent a t,r i c the ma d ato y prov sion o any worke s'n r i s f rerrooomssion was com i ted;r r i m t com ens a io , unem loym nt c om ensatioptnpep n(2)A e cription o wha happ ened;d s f t i suran e, s o ial s e urity o di ab i i y benef tncccrsltis (3)A de crip ion o what dam ges m y law or any im lar a .s t f a a s i l w re ult;s g ERI A.S (4)The identi y o the pe son o o ganizat otfrrrin Lo s f o whi h an y insured i liable be aus esrcscthatmamakea c lai o bring a "sui ";y m r t o lia il ty im osed on a fi u ia y by th efbipdcrandEmloyeeRetiemet I ncom Se urity Act ofprnec 1974, a ame ded, or by any s i i a f e er alsnmlrd,(5)The id ent ty o ea h i sured thatifcn sta e o lo al laws.t r ccomited t he negli ent act,error omtgr om ssion.i h Availabl B nefits.e e No i e t o us that any insured ma in th etcy Lo s o be e it to th e ex ent that suchsfnfst fu u e re eiv writ en noti e of a negl genttrcetci ben e i s a e av ilab e,with reas onable ef o tftralfr a t, error or omi sion,claim or "sui "i notcsts and c oopera ion o the ins ur ed from th etf, no ice o a spe if c ne l gent a t e ror otfcigic,r r appl cab le fun s accru ed or o her col e ti leidtlcb om ssion.i i surance.n 2.Ex lu io scsn i.Ta es,Fines O P nalti sxree Thi i surance doe not apply to:s n s (1)Any t ax s, fi es, o p enal ie , incl dingenrtsu tho e im o ed und er a y pr ov sion o th espsnifa.Crim na , Disho est, Fraud l nt Oilnuer In ernal Rev nu e C ode o 1986 atef,sMalcosActsiiu am nd ed,or any sim la sta e or lo aleirtcLosaiing out o any cri i al, di honest,s r s f m n s law; orfradulet, o ma i iou a t, erro o om ssionunrlcscrri (2)Any lo s, c o t o ex ens e ari ing out ossrpsfcomited by any insur ed, i clu ing the wil fumtndll the im o itio o such tax s, fi e opsnfensroreklesvolaion o any law or eg ulationrcsitfr .pen al ie .t sbInuy O Damage.j r r j.Em lo men -Related P acticespytr"Bo ily injury ,"property dam ge ,"pers o ald"a "n Lo s to:sijuyo"adv rti i g in ury.n r "r e s n j " (1)A erso a i i g out o anypnrsnf:c.F i ure T P rform A Con ractaloet (a)Re usa t o em loy th at pe son;f l p rLosaiing out o fai ure o perfo m n e osrsflfracf cont a t y any i sure .(b Te m nat on o that p e son 'srcbnr)r i i f r em lo men t;orpydInuficincy O F nds.s f e f u (c)Em loy e t-related pr a ti e opmnccrLosaising out o an in uf i ie cy o fu ds t osrfsfcnfn po i y,such a coercio , dem tionlcsno ,m e any obli at on und e any plan in ludedetgisrc rea si n me t di ci li e,f ai ure t osgn,s p n lihe"em loyee ben e it rog ram .n t p f p "promo e o ad v nce, h ar a s me ttrasn,e.In d qu cy O Performance O In estmenaeaffvt hum l at on, discrim na ion libeliiiit,,O Advice Given With Respec Tort sla de , v o a ion o the p erson s rightnriltf'Pa ticipat onri o pr iv c y,ma i iou pr o ecution ofalcssr Any laim o "sui " b a ed upon:c r t s fa se arrest, detention olr Pa e 2 of 9 © 2016 The T avelers Indemnit Company.g r y All rights reserved.CG 1 1 01 16T0 Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT dep o it ed in co rt t he p art o t he judgme tsufnimprisonmentapplied to or di rected at that i withi th e appli ab e i i o i suranc esncllmtfn.that pe son,reg ardle s of wheth ersr such pr a ti e or pol cy o curs, iccics The e p ay ents wil n o red uce the lim t osmltisfappleor i comm tted b e o e,duringidsifr i suran e.n c or a ter th e tim o that pe son 'sfefr SE TI N II – WHO IS AN NSUREDCOIemloyent;orpm 1.If y u a e de ignated in he De la at on a :o r s t c r i s s(2)The spouse,chil ,par ent,brot er odhr a.An indiv du al you an d yo r spou e ar ei,u ssiterofthaperson a a co sequ ence ostsnf i sureds, but only with re pect t o th e c o ductnsnlosto that perso a whom an y o th esntf o a business o which you ar e the soleffemloyent-related pr a ti e o p ol ciepmccsris owner.de cri ed in Par agraphs (a),(b , or (c)s b ) b A pa tners hip or joint v ntu e,y u ar e an.r e r oabovidrected.e s i i sured.Yo r m m e s, yo r p a tners, andnuebrurThiexlsion appl e :s c u i s thei spous e a e al o in ur ed , but on y witrsrssslh (1)Wh ther the i sured may be l ab e as an re pe t to he c onduenilsct ct o your bus ine s.f s e ployer or in any o her capaci y andmtt;c.A l m ted l abi i y c om any,yo a e aniiiltpur i sured. You me be s ar e al o ins ur eds, b utnrmrs(2)To any obliga ion to share dam ge wittash on y with re pe t to the con du t o youlsccfror repay som o e el e who m st payensu bu in e s. Your managers a e ins ur eds, butssrdamaebeaue o he lo s.g s c s f t s on y wi h re pe t to thei dutie a yourltscrssk.Access O Di clos re O Confi en ial Orsufdtr m na ers.a gPesoalInomaiornfrtndAnoganizat on o he than a pa tn ership,jo nt.r i t r r i Lo s a ising out o any acc e s o di clo ur esrfsrss v ntur e or li i ed liab l ty com any,you ar eemtiip o any perso 's o organiza ion's co f dent alfnrtnii an in ured. You "ex cutiv o f ce s"ansreefird or ersonal info ma ionprt.di e to s ar e al o in ureds, but on y witrcrsslh re pe t to th ei liabil ty a your o f ce s oscrisfirr3.Su pl menta y Paymentsper di e to s. You st o kho ders are al orcrrclsWewil pay, with respe t to any claim welc i sureds, but on ly with re p e t to their liabi itynscl i v stigate or sett e,o any "sui "a ain t anelrtgsn a stockh ol ers.s d i sured w e de end:n f e.A tru t,you ar e an in ured.Yo r trustees aressu al o i sureds, but on y wi h re p e t t o theisnltsc ra.All expenses we in cur. du ie a t ust ee .t s s r sbThecot o bonds to re ea e at achmen s, but.s f l s t t 2.Ea h o the fo lo ing s al o an n ured :c f l w i s i sonyfobond am unt wi hin the appli a lelrostcb l m t o i surance W e do not ha v to furni hiifn.e s a.Ea h o you "em loyees", oth e than ei h ecfrprtr the e bonds .s y ur "ex cutiv o f ce s"(i yo a e anoeefirfur organiza ion other th an a partners hip,jo nttic.Al rea onable ex ens e i curred by th elspsn v ntur e or lim ted liabi ity com any) or youeilprisured a our requ e t to a si t us in th entsss m nagers (if you ar e a lim ted lia il tyaibiivstigatioodeense o the c laim o "sui ,n e n r f f r t "com any , wh o i or wa au horized t op)s s ticludig act al lo s o earnings up to $500 annusf adm ni t er y ur "e ployee bene it program.i s o m f "day be ause o t m o f rom work.c f i e f f b Any pe son or o g anizat o hav ng prope.r r i n i rdAlcots taxe agai st t he insured in th e.l s d n tem or a y authoriza ion t o adm ni te yourprtisr"sui .t ""em lo ee b enefi pr ogram i yo d ie,butpyt"f u e.o ly until yo r legal repre ent a iv isnustePrejudgmeninerest awarded ag ainst th e-t t app oi ted.nisured on hat pa t o the ju gme t we pay. fntrfdnI we m de an o fe to pay t e ap pli able i i oafrhclmtf c.Yo r leg al repres entat v i y u die,but onlyuiefo i suran e, we wil not pay any prej dgme tnclun wit re pe t t o dutie as such. Th ahscst i tere t ba ed on that perio o tim a ter th enssdfef re res entativ will h av all your right andpees o fe .f r du ie und e thi Cov rag e Part.t s r s e f.Al inter e t on the ful am u t o any judgme tlslonfn 3.Any or gan zat on you n ewly a qui e o fo m oth eiicrrr,r that a crues a te ent y o t he j dgment ancfrrfud than a partne shi , joi t v n ur e or li ited l abi ityrpnetmil be o e we hav paid,o fe ed to pay,ofrefrr com any,a d ov r whi h yo m in ain owne shipnecuatrp CG 1 1 01 16 © 2016 The T avelers Indemnit Company.T 0 r y All rights reserved.Pa e 3 of 9g Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT or ma o i y inter e t, wil qu al fy as a N am d ca e,t he additjrtslies ional pe iod wil b e d eem d p a t orlerf In ured i th e e is no oth e sim la insuranc esfrrir the la t pre eding p eriod fo purp o e oscrssf a aila le to hat o gani at on. owev r:v b t r z i H e de er m nin t e Lim t o In uranc etighisfs. a.Cov rage und e thi prov sion i a fo ded onlyersisfr SE TI N IV – DEDUCTI LCOBE un il the 180th day a ter you a qui e, o fo mtfcrrr 1.The Ded uct ble sh own in the De larat on an th eicisdtheorganizaion o the en o th e pol cytrdfi rule b elow fix th e am unt o dam ges incurredsofapeiodwhihevriearier:r ,c e s l by or on behal o ,you or any ins ur ed that yo,f f ubCovrage under t hi prov sion doe not ap ly.e s i s p wil be re pons i le fo p ay ng, re ar dle s o thelsbrigsftoany negli ent a t, erro o omi sio thatgcrrsn num er o :b fwacomited be ore yo acquired or fo medsmtfur a.l sured ;n sthe o gan za ion.r i t b Cla m made o "suit " brought;.i s r sNoperson o organi ation is an insur ed wi hrzt re pe t to the c onduct o any curren o pa tscftrs c.Pe sons o organ i at on ma ing clai s orrziskmrpatnership,joint v ntur e or lim ted liabi ityreil brin ing "suit ";g scomanythat is not shown a a Name I nsuredpsd d Act , e rors o om ssions; or.s r r iithe De laration .Th i parag ap does noncssrht apply to any such partne ship joi t v ntur e or,n e r e.Be e it included in your "em loy e b ene infspeft l m ted liabi i y com any t ha ot er wi e qual f eiiltpthsiis program ." a an in ur ed und er Se tio II –Who Is Ansscn If no am unt i shown f o the Ded uct ble in th eosriInured.s De la ation , the Ded uct ble d oes n ot apply t ocrsiSETINII– LI IT F INSU AN ECOIMSORC th s Cov rage Partie . 1.The Lim t o In uranc e shown in the De la ationsisfscr 2.The Deductible appl es t o all dam ges sustainediaand t he rule below fix the mo t we will payss by any one "em loyee , including d am gep"a sreardlesohe num er o :g s f t b f susta ned by such "em loy e's" d epend ent andipes ben e i iar e ,because o al negl gent acts, errorsfcisflia.l sured ;n s or om ssions c o m t ed in the "a mi istr a ion oimitdnt"fbClammade o "suit " brought;.i s r s y ur "emp oyee enefi program .o l b t "c.Pe sons o organ i at on ma ing clai s orrziskmr 3.The Lim ts o Insur an e will not be r edu ed by th eifccbrining"suit ";g s am unt o dam ges wit in t e d edu tible am un t.o f a h h c odAct, e rors o om ssions; or.s r r i 4.The t erm o thi p ol cy in lu din th o e wi hsfsi,c g s te.Be e it included in your "em loy e bene infspeft re pe t to:s cprogram."a.Ou ri ht and d uty with re pect t o the de ens ergsf2.The Ag gregate Lim t i th e mo t we wil pay fo alisslrl o "sui s"; andftdamaebeaue o al neg i ent a ts, errors ogscsfllgcr b Yo r dutie i the ev nt o an a t, err o o.u s n e f c r romssionscomted i the "adm n strat on oimitniii"f om ssion,cla m or uitiis;y ur "emp oyee enefi program.o l b t " apply i re pectiv o the appli a ion o th ersefctf3.Su je t t o th e Aggreg ate Lim t,t he Ea hbcic deducti le am unt.b oEmloee Limi is th e mo t we wil pay for alpytsll dama e sustai ed by any one "em lo ee ,g s n p y "5.If we sett e a claim or "suit fo dam ge , or pay al"r a s i clu ing dam ge sustai ed by suchndasn j dgmen fo dama es award ed in a "sui ", th autrgtt "em lo ee s"dep end en s and benefi ia ie ,p y 't c r s are subje t to a d eductible we may pay any partc, be ause o a l negli ent a ts, e ro s or om ssionscflgcrri or al o t he ded cti le am unt. You wi l pr om tlylfubolp com i ted in the "adm nistr a ion o youmtit"f r re m urs e us f o such part o the d edu tibleibrfc "em lo ee bene it pro ram .p y f g "am unt as we a v pai .o h e d The Lim t o Insuran e o thi Cov rag e Partisfcfse SE TI N V –EMP O EE BENEF T LI AB LITCOLYISI Y a ply separately to each conse utiv an nualpce COND T ONIIS pe iod an to any rem inin pe iod o le s thanrdagrfs 1.Bankru tcyp12moths,st a ti g wi h th e beginning o th enrntf Ba krupt y or i solv ncy o th e insur ed o o th encnefrfpoiypeiod shown i t he Declar at on , unlesslcrnis i sured's e t a e wi l not re iev us o o rnstllefuthepolcyperiodis ex end ed af er i suanc e for anitts ob i ations und er hi Cov rage Part.l g t s eaddiionalperiod o le s than 12 mo ths. In t hatfsnt Pa e 4 of 9 © 2016 The T avelers Indemnit Company.g r y All rights reserved.CG 1 1 01 16T0 Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT 2.D ti s In Th Even O Act,Error O Omissio ,v ntur e , any o y uueetfrne)f o r ma ag ers who i anns Cla m O ui i div dual (i yo a e a l m ted lia il tyirStnifuriibi com any , any o yo r "ex cutivp)f u e ea.Yo m st see to i that we a e noti ie auutrfds o fi e s"o dir e tors (if yo a e anfcrrcursoon a pra ti able o an a t, e ro osccfcrrr organi a ion o he th an a p a tners hip,z t t r romssion whi h may re ul in a clai . To th eicstm jo n v ntur e, or li i ed l abi i y c om any),i t e m t i l t petent poss ible,noti e should incl de:x c u any o y ur tru tees who i an i div dualfossni(1)Wh t the a t,e ror o om ssion wa anacrrisd (i y u a e a trust) o any "em lo eeforrpy"when t wa com i ted anismt;d au horized by you to giv not ce o an a t,t e i f c erro o om ssion.r r i(2)The nam s and ad resse o anyedsf "e ploye s" who may suff r lo s c ausedmees (2)If y u are a partn e ship,joi t v ntu e,o r n e rbythe a t, er o o om ssioncrrri.l m ted liabil ty c om any o tr ust, andiiipr non e o yo r p artn ers, joi t v ntur efunebIfaclamimaeor "sui " is brought by any.i s d t m m e s, m nage s o trustees a eebrarrrisured, y u m st:n o u i div dual , noti e to us of such a t erroniscc,r(1)Im e ia ely re ord th e spe i i s o th emdtccfcf or om ssion mu t b e giv n as soon aisesclamor"suit" an the date re eiv d; andidce pra tica le only a te th e a t,e ror ocbfrcrr om ssion s known by:i i(2)No i y us a soo a pra ti ab etfsnsccl. (a)Any n iv du al who i :i d i sYomut s ee t o it th a we re eiv wri tenustcet no ice o the clai or "sui "a s oo atfmtsns (i A lawfu ly ele ted or appoin ed)l c t pra ticablec .o fi ial ex cutiv o f ce ofc,e e f i r r di e to o any publ c enti y;r c r f i tc.Yo and any othe inv lv d i sured m st:u r o e n u (i )A p a tne or m m er o anyirrebf(1)Im e ia ely se d us c o ie o anymdtnpsf pa tn ership or oin v n ure;r j t e tdemad, noti e , sum on e o legalnscsmssr (i i A ma age o any lim ted liabi ityi)n r f i lpapesreeivd in connectio with th ercen com any;pclamora"sui ";i t (i ) An ex cutiv o f cer o dire tor oveefircf(2)Au ho ize us t o obtain re o ds a d o hetrcrntr any ot er organiza ion;orhtifomaionnrt; (v)A rustee o any rust;t f t(3)Coope ate wi h us in the in v stigat on orteir se tle ent o the claim o de ense agai sttmfrfn that i your pa tn er,joi t v ntur esrne the "sui "; andt m m e , ma age o tr stee; orebrnrru (4)Assi t us, upon our request, in th es (b Any "em loy e"au ho ize b y such)p e t r d e for em n of any right agai st an yncetn pa tn ership,join ve ture,lim tedrtni pe son or organi at on whi h may berzic l ab l ty c om any, trust o oth eiiiprr l ab e to the in ured be ause o lo s t oilscfs organiza ion t o giv n o ice o an a t,t e t f c whi h t is i surance ma al o applychnys .erro o om ssion.r r i d No i sur ed wi l ex ept at that insured's own.n l ,c 3.L gal Actio Again t Uenss co t, v lu tarily ma e a payme t, a sumesonkns No pe son or o g anizat o ha a right und errinsrany obl ga ion,or in ur any ex ens e wi houtitcpt th s Co erage Partiv :o r onsen .u c t a.To joi us a a p a t y o o her wi e ring usnsrrtsbe.The fo lowing prov sions apply t o Pa ag raplirh i to a "sui "a ki g for d am ge from antsnasna.abov ,bu t o ly f o purpos e o theenrsf i sured; ornisuranceprovded und e t hi Cov rage Partnirse b To sue us on this Cov rage P a t unless.e rtoyoor any i sured li ted in P a agr aph 1. orunsr al o it t e m hav b een fully com lielfsrsep d2.o ectio I –Who Is An Insured :f S n I wit .h(1)No i e to us o such a t error o om ssiontcfc,r i A person or organi ation ma s ue us t ozymstbe iv n a soon a pra ti able onlyugesscc re ov r on an agreed sett em nt or on a fi alcelenater th e a t, e ro o om ssion i knownfcrrris j dgmen ag ain t an in ur ed bu we wil notutss;t ltoyu (i you are an indiv dual ,any oofi)f be lia le for dam ges that are not payablebayur partners o mem ers who is aorbn und e th e t erm o thi Cov rage Pa t o thatrsfserridivdal(i yo a e a partnersh ip o jo ntniufurri CG 1 1 01 16 © 2016 The T avelers Indemnit Company.T 0 r y All rights reserved.Pa e 5 of 9g Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT are in ex ess o the ap li able lim t o 5.P emium Aud tcfpcifri i surance. An agreed set lem nt me n anteas a.We wi l com ute all prem um f o thislpisrsetleent a d relea e o liabi i y signed bytmnsflt Cov rage Part in a co dan e wi h our ruleecrctsus, th e i sured and th e clai a t or th enmn and ate .r sclamnt's le al repres entativ .i a g e b Prem um sh own i thi Cov rage Part a.i n s e s4.O her In urancets a v nc e pr em um i a d eposit pr em um onlydaisi. If v li an colle tib e oth e in uranc e isaddclrs At th e clos e o ea h audi p e iod we wilfctrl av ila le to th e insured fo a loss we cov rabre co pute th e earn ed prem um f o th at p eriomirdundethiCovrage Pa t,our obli atio s ar ersergn and s en not ce t o the fi st N am d I nsured.d i r elmtedasdescried in Pa agr aphs a.and b.i i b r The due da e f o audi and re rospe tivtrttcebeow.l prem u m is t he da e sh own a the due dateists As used an y her e i thi Cov rag e Part,on t he bil . If the s umwnsel o the adv nce anfad ot er insuranc e me n insuranc e,o th ehasr audi prem um pai for the poli y period istisdc fu d ng o lo se , that is pr ov ded by,thr oughnifssi greater than th e earn ed pr em um we wili,l or on behal o :f f re urn the ex e s to the f rst am d In ured .t c s i N e s (i Anot er in uranc e om any;)h s c p c.The i st Nam d Insur ed m st keep re ord ofreucsf the informa ion we n eed f o premiutr m(i )Us o any o ou a fi ia ed insuranc eirfrflt com u ation,and send us copies a suchpttcopanie;m s ti es a we ma reque t.m s y s(i i Any i k etentio group; ori)r s r n 6.Rep esen ationrts(i ) Any s el -nsurance method o program,invfir whi h c a e the insured will be deem d t ocse By a cepti g hi pol cy,yo agree:c n t s i ubethe pr o ide o other n uranc e.v r f i s a.The statem n s in the De lar a ion a eetctsrOteinurance does not include um rellahrsb a cur a e and comp ete;c t lisurance, or ex e s in urance t ha wancss,t s b Tho e stateme ts are ba ed upon.s n sbought spe if ca ly to ap ly in ex ess o thecilpcf re res entatio s you made o s;andpntuLimts o Insur ance shown in th eif De la a ions.c r t c.We hav i sued thi p ol cy in relia ce uponessin As used an y her e i thi Cov rag e Part,w n s e y ur repres entat o s.o i n ot er in ure mea s a prov der o oth ehsrnifr The uninten ional o i sion o ,or unintentio altmsfnisurance. As used in Paragraph b below,n .e ro in, any inf o m tion pro v ded by y u whi hrrraiocisurer m a s a prov der o nsuran e.n e n i f i c we relie upon in issu ing thi pol cy wil nodsilta.P imary I su ancernr prej di e yo r rights under th s i suranc eucuin. Thi i surance i prim ry.If any o th esnsaf Howev r, t hi prov sion doe n ot a fe t ou rightesisfcr ot er i suranc e is al o prim ry,we wilhnsal to c ol e t ad di ional pr em um or t o ex rcise ourlctie sha e wi h al th a o her insur ance by th ertltt ri ht o ca ce la ion or ren ewal in accordanc egsfnltmtod describ ed i Pa agr aph b below.e h n r .wit appl cab e nsuran e la s o reg l a ion .h i l i c w r u t s b Meth d O Sh ring.o f a 7.Se aratio O nsu edspnfIr If al o the other i surance pe m tslfnri Ex ep wi h re p e t t o the Lim t o In uranc ecttscisfs,co tribut on by equ al shar e , we wilnisl and a y righ s o dutie spe i i al y assi ned intrscfclgnfolowthimtod al o Under thislsehs.th s Cov rag e Pa t t o the fi st Nam d Insur edierre,approa h each insurer con ri ute equalctbs th s i surance ap pl e :i n i samunts unti it ha pa d its a pli a leolsipcb l m t o insuranc e or none of t he loss a.As i ea h Namiiffced I nsured were th e only re a ns, whi he v r om s fi st.m i c e c e r Na e Insured;andmd If any o the other insuranc e doe notfs b Se ar ately to each ins ur ed against whom.p pe m t co tributio by eq al share , werinnus cla m i m de or "suit i br oughtisa"s . wil con ri ute by lim t . U nder thisltbis 8.Tra sfe Of Righ s O Reco ery Againsnrtfvtmtod,ea h insurer's share is based onehc O hers To Utsthe atio o t appl cable lim t o n uranc erfisiifis If the i sured ha ri hts to re ov r all or p art onsgceftothetotalapplcablelimts o insuranc eiif any pa ym nt we hav ma e un der t hi Cov rageeedseoalnsurers.f l i Pa e 6 of 9 © 2016 The T avelers Indemnit Company.g r y All rights reserved.CG 1 1 01 16T0 Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT Pa t th o e right are transf e red to us. Th e 4.A Su pplem ntalr,s s r e Ex end ed Rep orti g Pe iod istnr i sured m st do n othing a te lo s to im air th em av ila le but o lynufrsp.a b ,n b y an endors em n and f o aetrn At o r requ e t, the i sured will bring "sui "o e t ra charge. Thi susntrxsuppleme tal pe iod s tar s wi hnrtt tra sf e th o e right to us a d h el us e fo ce the endnrssnpnr o the pol cy perio an la ts f ofiddsr three them y ars o an u nli i ed perio o time a s e fo t.e r m t d f ,s t r h i th e Sup ple ental Ex end ed Reporting Perionmtd9.Wh n e Do N t Ren weWoe En ors em n . Thi supplem nt al p eriod repla edetsecsIfwedeide not to ren ew this Cov rag e Pa t,wecer the a i Ex en ed R epo ting Pe iod.B s c t d r rwilmalodelvr to the fi st Na ed I nsuredlirierm Thi Supplem nt al Ex end ed R eport ng Periosetidshownin th e De la atio s writ en notic e o thecrntf wil not go into e fe t unle s we receiv al o th elfcselfnonrenewal not less than 30 day be o e th esfr fo lowi g wi hin 90 d ay a ter the end o th e pol cylntsffiexiraton date.p i pe iod and yo hav fulf l e all ot er dutie , anrueildhsdIfnoieis ma le , proo o ma l ng wil betcidffiil com l ed wi h all other c ondi ions andpittsuffcint p oo o noti eierffc.re ui em nts, und e t is policyqrerh : 10 Cance la io ,Non enewal An R enew l.l t n r d a a.A written reque t fro yo t o purc ha e th esmusCodtionAppiable T Comme cial Generalnislcor Su plem ntal Ex end ed ep orti g Perio ;p e t R n dLabiiy Covera ge Partilt b F ll p aym nt o t he earned pr em um f o this.u e f i rAlcodiions relat n to canc el a io , nonr enewallntigltn po i y;l cor renewal that a e included in any endors eme trn c.Paym nt o th e ad it onal premiu f o th eefdimrapplcable t o th e Com er ial Gener al Lia il tyimcbi Su plem ntal Ex ended Rep orti g PeriopetndCovrage Part attached to this poli y al o ap lyecsp En ors eme t;anddntothiCovrage art.s e P SE TI N VI –EXT NDED REPO T NG PERIOD d Re ay en o any deductib e yCOERIS.p m t f l ou owe us und e t is C ov rage Pa t.r h e r1.We will prov de on e or mo e Ex ended R e ort ngirtpi Pe iod , a de crib ed be ow, i :We wil d eterm ne the additio al pr emrssslflinium fo t hart end o sem nt i a co d anc e wi h o r rule anrencrtusda.Thi C ov rage Part i canc e le or notsesld ra e . T he addi ional prem um f o th etstirreewed for any ea on; onrs r Su plem ntal Ex ended Rep orti g PeriodpetnbWereew or repla e thi Cov rage Part wit.n c s e h En ors em n wil n ot ex eed 20 0% o the an nualdetlcfisurane th a ha a Ret oa tiv Date latenctsrce r prem um fo hi pol cy.i r t s ithanthe date hown i th e Declarat on .s n i s Thi endors em n will s e f o t the te m , nosettrhrst2.The Ex end ed R epo ting Period do not e tendtrsx i consi tent wi h thi Se t on VI –Ex endednstscitthe oli y erio o chan ge t e scope o cov ragepcpdrhfe Re ort ng Pe iods, ap pl cable t o th epiriprovded.Th ey only ap ply t o claim o "suit " foisrsr Su plem ntal E x end ed Reporting Periodpet ,lo s c a sed by a negl gent a t,err or o om ssionsuicri i clu ing a pr ov sion to the e fe t th at th endifccomited on or a te the R et oactiv D a e shownmtfrret i suran e a fo ded f o claim or "suit " fir t ma encfrrsssdithe De la ations and be ore th e end o th encrff or brought ag ai st any i sured d uring such p eriodnnpoiy e iod.l c p r i ex e s ov r an y v lid an c ol e ti le oth escseadlcbrOneiefet, Ex end ed R epo ting Perio s m ycnfctrda i suran e av ilable und er insuranc e in f o ce a tencarfrnobe canc e e .t l d the Sup ple ental E x end ed R epo ting Periodmtr sta t .r s3.A Basic Ex ended Rep o ti g Period istrn au om ti a ly pr ov ded wit out ad di ional char getacliht.The Suppleme tal Ex ended Reporting PeriontdThipeiostartwith th e end o the pol cy periodsrdsfi doe n o reins ta e or incr ease t he li i s osttmtfand asts fo 0 d ay .l r 9 s i surance.n The Basic Ex end ed Reportin Period doe notgst SE TI N VI – DEF NIT ONCOIIISapplyto claim o "su i s"fo lo s c ov red und esrtrser 1."Ad i istratio " me n :m n n a ssubsequent insuran e y u purch a e, o t hacosrt woul be c ov red und er such insuranc e but foder a.Prov di g in o mat on to "em lo ee ",i n f r i p y s the ex austion o i s appl cable l m t o n urance.h f t i i i f i s i clu ing th e r dep end ent and bene icia ies,n d i s f r wit re pe t t o eli ibi ity fo o sco e o th ehscglrrpfTheBasic Ex end ed Reportin Period d oe notgst "em lo ee bene it pro ram ;p y f g "re nsta e or ncreas e the im t o in ur ance.i t i l i s f s CG 1 1 01 16 © 2016 The T avelers Indemnit Company.T 0 r y All rights reserved.Pa e 7 of 9g Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT b b In l de "bod i y injury cause by one o..c u s l "d rHadlig re o ds i con e tion with th enncrnnc m re o the o fe se d e cribed in P a ag raphoffnssr"e ployee bene it program ; omf"r a.abov .ec.Ef e ti g, cont nui g or termi ating anyfcninn 4."Bo ily inju y :d r ""e ployee s"parti ip at on i any ben e im'c i n f t i clu ed i the "em lo ee bene it program "n d n p y f .a.Mea s any ha m,incl ding si kne s onrucsr di ea e,to t e h eal h o a pe so .s s h t f r nHowevr,"a mi istr a ion does not includeednt" handlin payroll deduction .g s b In l de men al angui h , inj ry o il ne s, o.c u s t s u r l s r em tional di tre s.o s s2."Adv rti em n " me n a noti e that is br oadcastesetasc 5."Ca ete ia pla "m ans plan auth orize byfrnesdor publi hed to th e gener al publi o specif cscri appl cab le law t o allow "e ployees"to ele t t oimcmrket s egmen s ab out your goods , pr oducts oatr pay o ertai ben e it with pre t ax dol a s.f r c n f s -l rsevcesfothe purp o e o att a tin custome srirsfrcgr or upporters . or the purp o e o thi de in tion:s F s s f s f i 6."Cov rage t errito y m a s t he Uni ed State oer"e n t s f Am ri a (including i s t e rito ies andectrra.No i e that a e publi hed include m teriatcsrsa l po se sions), Pu erto Ri o or C anada, pr ov dedssciplaed on th e Int e net o on sim la ele troniccrrirc that the ins ured's re ponsibi i y to pay dama e issltgsmas o com u ication andenfmn;de er m ned in a "suit on th e meri s in the Unitedti"tbReardig web site , only that pa t o a web.g n s r f Sta es o Am ric a (incl ding its te rito ie antfeurrsdsiethatis about y ur goo s,prod uct otodsr po se sions), P ue t o Rico or Can ada, or in assrsevces f o th e purp o es o att actingrirsfr se tle ent we agree to.t m custo er o supporters is co side ed anmsrnr 7."Em loyee m a s a p ers on a tiv ly e ployed,p "e n c e madvrtiemn.e s e t fo me ly em loyed, on leav of ab enc e orrpesr3."Adv rti i g in ury :e s n j "di abled or reti ed."Em loyee"i clud e as,r p n s "lea ed wo ker"."Em loyee does not incl de asrp"ua.Mea s injury,o her than "pers onal inj ry ,n t u ""te por a y worke ".m r rcaused by one o mo e o the fol owingrrfl 8."Em loyee bene i p ogr am :p f t r "offenses: a.Mea s a pr ogram pro v d ng s om or all o th eniief(1)Ora or writ en pu bl catio , includinltin g fo lowi g bene i s t o yo r "em lo ee ",l n f t u p y spublcation by ele tr oni m a s, oiccenf whe her prov ded throug h a "ca e eria plan ortift"m te ial in yo r "adv rti em nt"thataruese ot er wi e:h ssladesor li el a pers o or o ganizat onnrbsnri or di pa ages a pers o 's o organizat on'ssrnri (1)Gro p lif ins ur an e; gr oup a cident oueccr goods, prod uct o se v ce , pr ov ded t atsrrisih heal h i surance dental,v sion andtn;i the claim i ma e or the "suit" is broughtsd hearin plan ; and fle ible spen dinggsx by a pe son o organiza io t hat cl a m torrtnis a count , prov ded that no on e othe thancsir hav been slandered o l beled, o thaterir y ur "em loyee m y sub crib e to suchop"a s cla m to hav had its good , products oisesr ben e i s and such b enefi s are ma efttd se v ces di pa aged ;r i s r gen e ally av ila le t o al o th o erablfs "em loyee "who sati f y the plan'spss(2)Ora or writ en pu bl catio , includinltin g el g bili y equir em n s;i i t r e tpublcation by ele tr oni mea s, oficcn m te ial in y ur "adv rti eme t thataroesn":(2)Pro i sh aring plan , em loy e sav ngsftspei pla s, em lo ee st o k owne ship plan ,n p y c r s(a)Ap ropriate a pe son s name v i e,p s r ',o c pension plans a d sto k subscript oncinphotoraph or li eness; ogkr pla s, pr ov ded that no one o her thannit(b Unrea on ably pla es a pe son i a)s c r n y ur "em loyee m y sub crib e to suchop"a sfase i ht orllg;ben e i s a d such b ene it a e m deftnfsra gen e ally av ila le t o a l of thoserabl(3)In r ng em n o copyrig t,"tit e ofietfhl"r "e ployee "who ar e el g ble under th emsii"sl gan"in you "adv rti em n ",o r e s e t pla o uch ben e i s;n f r s f tprovded th at t he claim i made or th eis "sui "i brou ght by a person otsr (3)Unem loym nt insuranc e,so ial se uritypecc organi ation that claim owne ship o ben e i s, wo kers'co pens at onzsrfftrmi and di abil ty bene i s;s i f tsuch o yri ht,"ti le or "slo an".c p g t "g Pa e 8 of 9 © 2016 The T avelers Indemnit Company.g r y All rights reserved.CG 1 1 01 16T0 Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s COMM RCI L G NERA L IAB LI YEAELIT (4)Va a ion plans, in l ding buy an sel hav had its goods, prod uctctcudles o se v cerris program ; lea v o absen e program ,s e f c s di parag ed ors; i clu ing m l tary,mater ity fa i y anndiin,m l ,d (5)Ora or writ en pu bl catio , includinltin gcivlleav;tuitio a sistanc e plans;i e n s publ cation b y ele tr oni mea s, oficcntraspotaionand healt club subsidie ;n r t h s m te ial th a :a r tand(a)Ap ropriate a p e son s n ame v i e,p s r ',o c(5)Any oth e sim la ben e i s de ign ated irirftsn photo raph or li eness; ogkrthe D e la at on or add ed the eto bycrisr (b Unrea on ably pla es a pe son i a)s c r nedosemet.n r n fa se i htllg.b Doe no incl de any ben e it plan or program.s t u f b In l de "bod i y injury cause by one o.c u s l "d rdecriedin Par agraph a.abo v that i s e f-s b e s l m re o the o fe se d e cribed in P a ag rapoffnssrhisured.n a.abov .e9."Ex cutiv o f ce " mea s a pe son hol ing any oeefirnrdf 12 "Pro erty dam ge mean :.p a "sthe o f cer position created by yo r charter,f i s u co sti ution,bylaw or any oth e sim la go v rning a.Phy ica inju y tontsrireslr tangi le prop erty incl dingb,u do um n .al e ulti g lo s o se o hat property;orcetlrsnsfuft 10 "Lea ed worker m a s a p e son lea ed to you b Lo s o.s "e n r s .s f use o t a gible property that is notfn phy ica ly in ured.s l jbya labor leasing fi rm under an agreement betwe en you and the lab or lea ing firm t os,13 "Slo an":.gpefomdutierelatedto the con uct o yourrrsdf a.Mea s a p hr a e th at others use fo th ensrbuines."Lea ed worker"does not include asss pu po e o at ract ng attent o in theirsftiin r"te por a y worke ".m r r adv rti ing.e s11"Per o al in ury :.s n j "b Doe no incl d e a phras e used a , o in, th e.s t u s ra.Mea s inju y,oth e than "adv rti ing i jur y ,n r r e s n "name o :f caused by one o mo e o the fol owingrrfl (1)Any pe son o organi ation,other thanrrzofeses:f n y u; oro(1)Fa se a re t, detention or m r sonme tlrsipin;(2)Any busin e s, or a y o the pr em se ,s n f i s(2)Mal cious pro e utionisc ;goods,pr oducts, s erv ce or work, o anyisf pe son or organiz tion, othe than you.r a r(3)The wrongful ev ctio fro , wr ongfu entryinml i to,o in v sion o the right o priv tenraffa 14 "Su t'' me ns a civ l pro eeding in w hich dam ge.i a i c a s o cup a cy of a room dwell ng ocn,i r be aus e o lo s to whi h thi i suranc e appl ecfscsnis prem se th at a person occupie ,i s s are alleged "Su i "incl de :.t u s prov ded that th e wrongf l ev ctio ,i u i n a.An a bi ration pr o eeding i whi h suchrtcncwrongflentry o inv sion o the right ofuraf dam ge are claim d and to whi h th easecprivte occupanc y is c om i ted by or onamt i sured m st su bmi o submi s with o rnutrtubehalotheowner,lan dlo d o le s or offrrsf consent or;that roo , dw el i g or prem se ;m l n i s b Any othe alternativ di pute re olut on.r e s s i(4)Ora or writ en pu bl catio , includinltin g pro eedi g in whi h such dama es ar ecncgpublcation by ele tr oni mea s, oficcn cla m d and to wh i h he nsured submi s witiectithmteialthat sland ers o libel a persoarrsn ou ons en .r c tor organiza ion or di parag e a pe son 'stssr 15 "Tem ora y worker"m a s a pers on who i.p r e n sor o ganizat on s good , produ ts ori's c r fu ni hed t o you t o substitute f o a p er m nentrsrasevce, pr ov ded that the claim is m derisia "e ployee on eav or o me t seasonal or hort-m "l e t e sor t he "su i "i br ought by a pers o otsnr te m worklo d c o dit on .r a n i sorganiaion that claim t o hav beenztse 16 "Ti le me n a n am o a ite ary or a ti ti work..t "a s e f l r r s cslandered or libeled ,or th at claims t o CG 1 1 01 16 © 2016 The T avelers Indemnit Company.T 0 r y All rights reserved.Pa e 9 of 9g Includes copyrighted material of nsurance Services Of iceIf,Inc. with its permis ion.s THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION – VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS This endorsement modifies insurance provided under the following: EMPLOYEE BENEFITS LIABILITY COVERAGE PART PROVISIONS 1.The following exclusion is added to Paragraph 2., Exclusions, of SECTION I – EMPLOYEE BENEFITS LIABILITY COVERAGE: Violation Of Biometric Information Privacy Laws Loss arising out of any actual or alleged violation of a "biometric information privacy law", or any other loss alleged in any claim or "suit" that also alleges any such violation. 2.The following is added to the SECTION VII – DEFINITIONS: "Biometric information": a.Means information about a person's physical, biological or behavioral characteristics that can be used to identify such person. b.Includes a person's retina or iris scan, fingerprint, voiceprint, scan of hand or face or other body geometry, DNA, vein pattern, keystroke pattern or rhythm, gait pattern or rhythm, or sleep, health or exercise data that contain identifying information. "Biometric information privacy law" means the parts of any law, ordinance, regulation or governmental rule that govern or relate to the collection, storage, disclosure, retention, destruction, protection, use, sale, lease or trade of "biometric information". COMMERCIAL GENERAL LIABILITY CG D9 48 01 23 © 2022 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 INTERLINE ENDORSEMENTS INTERLINE ENDORSEMENTS IL T3 68 01 21 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. PROVISIONS The federal Terrorism Risk Insurance Act of 2002 as amended ("TRIA") establishes a program under which the Federal Government may partially reimburse "Insured Losses" (as defined in TRIA) caused by "Acts Of Terrorism" (as defined in TRIA). Act Of Terrorism is defined in Section 102(1) of TRIA to mean any 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; 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. The Federal Government's share of compensation for such Insured Losses is 80% of the amount of such Insured Losses in excess of each Insurer's "Insurer Deductible" (as defined in TRIA), subject to the "Program Trigger" (as defined in TRIA). In no event, however, will the Federal Government be required to pay any portion of the amount of such Insured Losses occurring in a calendar year that in the aggregate exceeds $100 billion, nor will any Insurer be required to pay any portion of such amount provided that such Insurer has met its Insurer Deductible. Therefore, if such Insured Losses occurring in a calendar year exceed $100 billion in the aggregate, the amount of any payments by the Federal Government and any coverage provided by this policy for losses caused by Acts Of Terrorism may be reduced. For each coverage provided by this policy that applies to such Insured Losses, the charge for such Insured Losses is included in the premium for such coverage. The charge for such Insured Losses that has been included for each such coverage is the percentage of the premium for such coverage indicated below, and does not include any charge for the portion of such Insured Losses covered by the Federal Government under TRIA: 1%. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE This endorsement applies to the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CYBERFIRST ESSENTIALS GENERAL PROVISIONS FORM CYBERFIRST GENERAL PROVISIONS FORM EMPLOYEE BENEFITS LIABILITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EMPLOYMENT PRACTICES LIABILITY + WITH IDENTITY FRAUD EXPENSE REIMBURSEMENT COVERAGE PART ENVIRONMENTAL HAZARD POLICY EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EXCESS (FOLLOWING FORM) LIABILITY INSURANCE LAW ENFORCEMENT LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MANUFACTURERS ERRORS AND OMISSIONS LIABILITY COVERAGE PART MEDFIRST PRODUCTS/COMPLETED OPERATIONS, ERRORS AND OMISSIONS, AND INFORMATION SECURITY LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PUBLIC ENTITY MANAGEMENT LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY – NEW YORK DEPARTMENT OF TRANSPORTATION TRIBAL BUSINESS MANAGEMENT LIABILITY COVERAGE PART Any other Commercial Liability coverage included in this policy that is subject to the federal Terrorism Risk Insurance Act of 2002 as amended T IS ENDORSEMENT CHANGES T E POLICY. PL ASE READ IT CAREFULLY.H H E A ENDMENT OF COMM N POLICY CONDITIONS –M O PROHIBITED COVERA E – UNLICENSED INSURANCEG AND TRADE OR ECONOMIC SA CT IONSN Thi e dorseme t m d fie i suranc e prov ded und er he f l o ing :s n n o i s n i t o l w AL COV RA ES NCLUDED IN HI PO IC YLEGITSL The f o lowin g is add ed to the C om o Pol cy Condi-b The furlmni.ni hing o cert f ca es o ot er ev -s f i i t r h i tio s:n denc e of in uranc e in a y countr y or juri dic-s n s tio i whi h we ar e not li ens ed t o prov denncciPohbiedCoverage – Un icen ed I suranceritlsn i suran e.n c1.Wi h re pe t t o loss susta ned by any insured , otscir P oh bi ed Cover age – Trade O Econ mic Sancritro-lo s to any pr operty,lo ated i a country or jur i -s c n s ti nsoditoniwhih we a e not li ense to prov decincrcdi th s insuran e, thi i surance doe not apply t oicsns We wi l pr ov de c ov rage f o an y lo s,o o her wi eliersrtsthe ex ent that insurin such lo s wou l v ola etgsdit wil prov de any bene i ,only to the ex ent t hat prov d-l i f t t ithe laws or r egulation o such c ountry o j ri di -s f r u s c i g such c ov rage or bene i doe not ex ose us oneftsprtio.n any o ou a f l a ed or parent com an ie to:f r f i i t p s 2.We do not a s um espon ibil ty fo :s e r s i r 1.Any trade or e onom c s an tio under an y law ocicnra.The pay ent o an y fi e, fee,penal y o oth emfntrr re ula io o he United Sta es o me i a ogtnfttfArc;r cha ge that may be im o ed on any persorpsn 2.Any other appli a le trade or e onomi sanctio ,c b c c nor organiza ion in an y c ountry o juri di tiotrscn prohi i ion or e tri tio .b t r s c nbeause we a e not li ense to prov de ins ur-c r c d i an e in such ountry or ju i di tion; orccrsc IL T 12 03 15 ©2014 The Travelers Indemnity Compa4ny.All rights reserved.Pa e 1 of 1g The following is added to this policy. This provision can limit coverage for any loss arising out of a "certified act of terrorism" if such loss is otherwise covered by this policy. This provision does not apply if and to the extent that coverage for the loss is excluded or limited by an exclusion or other coverage limitation for losses arising out of "certified acts of terrorism" in another endorsement to this policy. If aggregate insured losses attributable to "certified acts of terrorism" exceed $100 billion in a calendar year and we have met our insurer deductible under "TRIA", we will not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case, insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of "TRIA", to be an act of terrorism pursuant to "TRIA". The criteria contained in "TRIA" 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 "TRIA"; 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. "TRIA" means the federal Terrorism Risk Insurance Act of 2002 as amended. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CYBERFIRST ESSENTIALS GENERAL PROVISIONS FORM CYBERFIRST GENERAL PROVISIONS FORM DELUXE PROPERTY COVERAGE PART EMPLOYEE BENEFITS LIABILITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EMPLOYMENT PRACTICES LIABILITY + WITH IDENTITY FRAUD EXPENSE REIMBURSEMENT COVERAGE PART ENVIRONMENTAL HAZARD POLICY EQUIPMENT BREAKDOWN COVERAGE PART EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EXCESS (FOLLOWING FORM) LIABILITY INSURANCE LAW ENFORCEMENT LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MANUFACTURERS ERRORS AND OMISSIONS LIABILITY COVERAGE PART MEDFIRST PRODUCTS/COMPLETED OPERATIONS, ERRORS AND OMISSIONS, AND INFORMATION SECURITY LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PUBLIC ENTITY MANAGEMENT LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY - NEW YORK DEPARTMENT OF TRANSPORTATION TRAVELERS PROPERTY COVERAGE PART TRIBAL BUSINESS MANAGEMENT LIABILITY COVERAGE PART Any other Coverage Part or Coverage Form included in this policy that is subject to the federal Terrorism Risk Insurance Act of 2002 as amended IL T4 14 01 21 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY IL 00 21 09 08 © ISO Properties, Inc., 2007 Page 1 of 2 1.The insurance does not apply: A. Under any Liability Coverage, to "bodily in- jury" or "property damage": (1) With respect to which an "insured" under the policy is also an insured under a nu- clear energy liability policy issued by Nu- clear Energy Liability Insurance Associa- tion, Mutual Atomic Energy Liability Un- derwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an insured under any such pol- icy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indem- nity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B. Under any Medical Payments coverage, to expenses incurred with respect to "bodily in- jury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to "bodily in- jury" or "property damage" resulting from "hazardous properties" of "nuclear material", if: (1) The "nuclear material" (a) is at any "nu- clear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time pos- sessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an "insured"; or (3) The "bodily injury" or "property damage" arises out of the furnishing by an "in- sured" of services, materials, parts or equipment in connection with the plan- ning, construction, maintenance, opera- tion or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or pos- sessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "spe- cial nuclear material" or "by-product material". "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel com- ponent, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". Page 2 of 2 © ISO Properties, Inc., 2007 IL 00 21 09 08 "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentra- tion of uranium or thorium from any ore proc- essed primarily for its "source material" content, and (b) resulting from the operation by any per- son or organization of any "nuclear facility" in- cluded under the first two paragraphs of the defi- nition of "nuclear facility". "Nuclear facility" means: (a)Any "nuclear reactor"; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; (c) Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is lo- cated consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (d) Any structure, basin, excavation, prem- ises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the forego- ing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self- supporting chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioac- tive contamination of property. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES – CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 1 of 4 Page 2 of 4 © Insurance Services Office, Inc., 2020 IL 02 70 07 20 (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part – Farm Property – Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part – Causes Of Loss – Special Form; or (2)Farm Coverage Part – Causes Of Loss Form – Farm Property, Paragraph D. Covered Causes Of Loss – Special. d.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not cancel this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may cancel: (1)When you have not paid the premium, at any time by letting you know at least 10 days before the date cancellation takes effect; (2)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part – Farm Property – Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If this policy provides coverage as described in the preceding paragraph, and we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer record at the mailing address shown in the policy, at least 75 days, but not more than 120 days, before the expiration or anniversary date. If we fail to give the first Named Insured shown in the Declarations notice of nonrenewal at least 75 days prior to the policy expiration, as required in the paragraph above, this policy, with no change in its terms and conditions, shall remain in effect for 75 days from the date that the notice of nonrenewal is delivered or mailed to the Named Insured. A notice to this effect shall be provided by us to the first Named Insured with the notice of nonrenewal. b.We may elect not to renew such coverage for any reason, except as provided in Paragraphs c., d. and e. below. c.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 3 of 4 Page 4 of 4 © Insurance Services Office, Inc., 2020 IL 02 70 07 20 (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. d.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. e.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (e.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part – Causes Of Loss – Special Form; or (2)Farm Coverage Part – Causes Of Loss Form – Farm Property, Paragraph D. Covered Causes Of Loss – Special. f.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not nonrenew this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may nonrenew: (1)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; (2)If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. POLICYHOLDER NOTICES POLICYHOLDER NOTICES IMPORTANT NOTICE – INDEPENDENT AGENT AND BROKER COMPENSATION NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANYPROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICYCAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TODETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACTYOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE ORITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THISNOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please visit www.travelers.com, call our toll-free telephone number 1-866-904-8348, or request a written copy from Marketing at One Tower Square, 2GSA, Hartford, CT 06183. PN T4 54 01 08 Page 1 of 1 COMMERCIAL INSURANCE A Custom Insurance Policy Prepared for: Presented by: Report Claims Immediately by Calling* Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting THERMAL MECHANICAL, INC. 425 ALDO AVE RSC INS BROKERAGE INC SANTA CLARA CA 95054 1-877-828-4132 TRAVELERS CORP. TEL: 1-800-328-2189 COMMON POLICY DECLARATIONS POLICY NUMBER: ISSUE DATE: 1. NAMED INSURED AND MAILING ADDRESS: 2. POLICY PERIOD:From 3. LOCATIONS: Premises Bldg. AddressOccupancyLoc. No.No. 4. COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: 5. NUMBERS OF FORMS AND ENDORSEMENTS Each of the following is a separate policy Policy Policy No.Insuring Company 7. PREMIUM SUMMARY: Provisional Premium $ Due at Inception $ $ NAME AND ADDRESS OF AGENT OR BROKER:COUNTERSIGNED BY: Authorized Representative DATE: IL T0 02 11 89 (Rev. 09-07) INSURING COMPANY: 6. SUPPLEMENTAL POLICIES: to 12:01 A.M. Standard Time at your mailing address. FORMING A PART OF THIS POLICY: SEE IL T8 01 01 01 OFFICE: containing its complete provisions: PAGE OF Due at Each SEE CALCULATION OF PREMIUM COMPOSITE RATES ENDORSEMENT 810-8M554728-24-26-G 04/01/24 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA THERMAL MECHANICAL, INC. 425 ALDO AVE SANTA CLARA CA 95054 04/01/24 04/01/25 TIL RSC INS BROKERAGE INC(HE839) 1350 BAYSHORE HWY STE 125 BURLINGAME CA 94010-1829 WALNUT CREEK CA PLUMBING, HEATING, AND AIR CONDITIONING 13,141.00 13,141.00 131,410.00 COMMERCIAL AUTOMOBILE COV PART DECLARATIONS CA T0 01 02 15 1 1 1 MONTH EFFECTIVE DATE: POLICY NUMBER: ISSUE DATE: 810-8M554728-24-26-G 04/01/2024 04/01/2024 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS COMMON POLICY DECLARATIONSIL T0 02 11 89 FORMS ENDORSEMENTS AND SCHEDULE NUMBERSIL T8 01 01 01 COMMON POLICY CONDITIONSIL T0 01 01 07 CALCULATION OF PREMIUM - COMPOSITE RATESIL T3 02 07 86 CALCULATION OF PREMIUM - COMPOSITE RATESIL T8 25 COMMERCIAL AUTO BA- COVERAGE PART DECS (ITEMS 1 & 2)CA T0 01 02 15 BUS AUTO COV PART DECLARATIONS-4&5CA T0 03 02 15 DEDUCTIBLE COVERAGECA T3 95 02 15 BUSINESS AUTO/MC COV PART-UM SUPPL SCHDCA T0 30 02 16 TABLE OF CONTENTS-BUSINESS AUTO COV FORMCA T0 31 02 15 BUSINESS AUTO COVERAGE FORMCA 00 01 10 13 CALIFORNIA CHANGESCA 01 43 05 17 CALIFORNIA CHANGES - WAIVER OF COLLISION DEDUCTIBLECA 03 05 10 13 California Auto Medical Payments CoverageCA 04 24 10 13 CALIFORNIA DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS CA 04 26 10 13 LESSOR - ADDITIONAL INSURED AND LOSS PAYEECA 20 01 10 13 CA UM MOTORISTS COVERAGE - BODILY INJURYCA 21 54 11 16 POLL LIAB-BUS AUTO/MOTOR CARRIER COV FRMCA 99 48 10 13 SHORT TERM HIRED AUTO - ADDITIONAL INSURED AND LOSS PAYEE CA T4 52 02 16 AMENDMENT OF EMPLOYEE DEFINITIONCA T4 59 02 15 BLNKT ADDL INSD-PNC W/OTHR INS-CNTRCTRCA T4 99 02 16 BUSINESS AUTO EXTENSION ENDORSEMENTCA T3 53 02 15 LOSS PAYABLE CLAUSECA T4 45 04 09 INTERLINE ENDORSEMENTS CALIFORNIA CHANGES - CANCELLATION AND NONRENEWALIL 02 70 07 20 AMNDT COMMON POLICY COND-PROHIBITED COVGIL T4 12 03 15 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 00 21 09 08 LENDER'S CERTIFICATE OF INSURANCE - FORM AIL T0 10 12 86 IL T8 01 01 01 PAGE:OF 11 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: IL T0 01 01 07 (Rev. 06-09) Includes the copyrighted material of Insurance Services Office, Inc. with its permission.Page 1 of 2 A.Cancellation 1.The first Named Insured shown in the Decla- rations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2.We may cancel this policy or any Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a.10 days before the effective date of can- cellation if we cancel for nonpayment of premium; or b.30 days before the effective date of can- cellation if we cancel for any other rea- son. 3.We will mail or deliver our notice to the first Named Insured’s last mailing address known to us. 4.Notice of cancellation will state the effective date of cancellation. If the policy is cancelled, that date will become the end of the policy period. If a Coverage Part is canceIIed, that date will become the end of the policy period as respects that Coverage Part only. 5.lf this policy or any Coverage Part is can- celled, we will send the first Named Insured any premium refund due. If we cancel, the re- fund will be pro rata. If the first Named In- sured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a re- fund. 6.If notice is mailed, proof of mailing will be sufficient proof of notice. B.Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us as part of this policy. C.Examination Of Your Books And Records We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. D.Inspections And Surveys 1.We have the right to: a.Make inspections and surveys at any time; b.Give you reports on the conditions we find; and c.Recommend changes. 2.We are not obligated to make any inspec- tions, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a.Are safe or healthful; or b.Comply with laws, regulations, codes or standards. 3.Paragraphs 1. and 2. of this condition apply not only to us, but also to any rating, advi- sory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4.Paragraph 2. of this condition does not apply to any inspections, surveys, reports or rec- ommendations we may make relative to certi- fication, under state or municipal statutes, or- dinances or regulations, of boilers, pressure vessels or elevators. E.Premiums 1.The first Named Insured shown in the Decla- rations: a.Is responsible for the payment of all pre- miums; and b.Will be the payee for any return premi- ums we pay. 2.We compute all premiums for this policy in accordance with our rules, rates, rating plans, premiums and minimum premiums. The pre- mium shown in the Declarations was com- puted based on rates and rules in effect at Secretary President IL T0 01 01 07Page 2 of 2 Includes the copyrighted material of Insurance Services Office, Inc. with its permission.(Rev. 06-09) the time the policy was issued. On each re- newal continuation or anniversary of the ef- fective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. F.Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named in- sured. If you die, your rights and duties will be trans- ferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary cus- tody of your property will have your rights and duties but only with respect to that property. G.Equipment Breakdown Equivalent to Boiler and Machinery On the Common Policy Declarations, the term Equipment Breakdown is understood to mean and include Boiler and Machinery and the term Boiler and Machinery is understood to mean and include Equipment Breakdown. This policy consists of the Common Policy Declarations and the Coverage Parts and endorsements listed in that declarations form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. That insurance will be provided by the company indicated as insuring company in the Common Policy Declarations by the abbreviation of its name opposite that Coverage Part. One of the companies listed below (each a stock company) has executed this policy, and this policy is counter- signed by the officers listed below: The Travelers Indemnity Company (IND) The Phoenix Insurance Company (PHX) The Charter Oak Fire Insurance Company (COF) Travelers Property Casualty Company of America (TIL) The Travelers Indemnity Company of Connecticut (TCT) The Travelers Indemnity Company of America (TIA) Travelers Casualty Insurance Company of America (ACJ) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM - COMPOSITE RATES A.SCHEDULE 1. 2.to 12:01 A.M. 3. 4. 5. PREMIUM BASECOVERAGE ESTIMATED ADVANCE EXPOSURE RATE PREMIUM $ IL T3 02 07 86 (Rev. 12-08)Page 1 of 1 POLICY NUMBER: This endorsement modifies insurance provided under the following Coverage Part(s): This endorsement applies to the Declarations from Standard Time at your mailing address shown in the Common Policy Declarations. Definition of Premium Base (Bases): Exceptions (if any) to compositing of premium calculation: Premium Schedule ISSUE DATE: B.PROVISIONS 1.Referring to the Schedule above, the premium for the Coverage Parts shown in item 1, except with respect to any exceptions shown in item 4, shall be computed in accordance with the premium base (bases) and rate (rates) desig- nated in item 5. 2.The premium for the excepted hazards shall be computed in accordance with the rates and rules filed by us or on our behalf. 3.The advance premium stated above is an es- timated premium for the Declarations Period. Upon termination of this period, the earned premium shall be computed in accordance with the policy and this endorsement. If the earned premium thus computed exceeds the estimated advance premium paid, you shall pay the ex- cess to us; if less, we shall return to you the unearned paid portion. Rates and premiums for any subsequent Declarations Periods shall be determined at the inception date of those respective periods and shall be specified in en- dorsements to be added to the policy. After termination of each period, the earned premium shall be computed in accordance with the policy and this endorsement. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 810-8M554728-24-26-G 04-01-24 COMMERCIAL AUTOMOBILE COVERAGE 04-01-24 04-01-25 PER UNIT SEE IL T8 25 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ISSUE DATE: CALCULATION OF PREMIUM - COMPOSITE RATE(S) THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE PART A. SCHEDULE, 5. PREMIUM SCHEDULE TO READ: 810-8M554728-24-26-G 04/01/2024 ILT825 applies to any covered auto not shown on ITEM THREE – SCHEDULE OF COVERED AUTOS YOU OWN. MOD RATE COMPOSITECOVERAGE #VEHS PREMIUM DED PHYSICAL POL LEVEL DAMAGE VEHICLE TYPE: PRIVATE PASSENGER LIABILITY 1,834 2 3,668 COMPREHENSIVE 1,000 95 2 190 COLLISION 1,000 268 2 536 VEHICLE TYPE: LIGHT TRUCK LIABILITY 1,976 45 88,920 COMPREHENSIVE 1,000 91 45 4,095 COLLISION 1,000 302 45 13,590 VEHICLE TYPE: MEDIUM TRUCK LIABILITY 2,047 4 8,188 COMPREHENSIVE 1,000 47 4 188 COLLISION 1,000 151 4 604 VEHICLE TYPE: HEAVY TRUCK LIABILITY 2,275 1 2,275 COMPREHENSIVE 1,000 57 1 57 COLLISION 1,000 215 1 215 VEHICLE TYPE: TRAILER LIABILITY 201 1 201 COMPREHENSIVE 1,000 18 1 18 COLLISION 1,000 28 1 28 PREMIUM 8,637MISCELLANEOUS COVERAGES 131,410TOTAL PREMIUM PRODUCER OFFICE PAGE OFSYMBOL NO IL T8 25 04 24 1 418RSC INS BROKERAGE INC 1 COMMERCIAL AUTOMOBILE COMMERCIAL AUTOMOBILE Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO CD 810-8M554728-24-26-G 04-01-24 ITEM ONE ITEM TWO FORM OF BUSINESS: INSURING COMPANY: A.COVERAGE AND LIMITS OF INSURANCE Coverage applies only to those “autos” shown as Covered “Autos”. "Autos" are shown as covered "autos" for the applicable coverages by the entry of one or more of the symbols from Section I – Covered Autos of the Business Auto Coverage Form next to the name of the coverage. Declarations Period: From 04-01-24 to 04-01-25 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Commercial Auto Coverage Part consists of these Declarations and the Business Auto Coverage Form shown below. Corporation TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA COVERAGES COVERED AUTO SYMBOL LIMITS OF INSURANCE The most we will pay for any one accident or loss COVERED AUTOS LIABILITY 1 $1,000,000 AUTO MEDICAL PAYMENTS 7 $5,000 Each Insured UNINSURED and UNDERINSURED 2 See CA T0 30 MOTORISTS COVERAGE PHYSICAL DAMAGE Comprehensive Coverage 2 8 Actual Cash Value or Cost of Repair, whichever is less, minus deductible shown in IL T8 25 for each covered Auto. See Item Four for Hired or Borrowed Autos. PHYSICAL DAMAGE Collision Coverage 2 8 Actual Cash Value or Cost of Repair, whichever is less, minus deductible shown in IL T8 25 for each covered Auto. See Item Four for Hired or Borrowed Autos. B.AUDIT PERIOD:ANNUALLY PRODUCER of OFFICE Page Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved.CA T0 01 02 15 WALNUT CREEK CA 418 41 RSC INS BROKERAGE INC HE839 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO CD 810-8M554728-24-26-G 04-01-24 C.DESCRIPTION OF COVERED AUTO DESIGNATION SYMBOLS: Symbols 1-9, 19: SEE BUSINESS AUTO COVERAGE FORM Section 1 Covered Autos PRODUCER of OFFICE Page Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved.CA T0 01 02 15 WALNUT CREEK CA 418 42 RSC INS BROKERAGE INC HE839 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO CD 810-8M554728-24-26-G 04-01-24 D.LOSS PAYEE: Any loss under Physical Damage Coverages is payable as interest may appear to you and the Loss Payee named in the Declarations. (See Loss Payable Clause on reverse side) E.NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART: SEE IL T8 01 01 01 PRODUCER of OFFICE Page Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved.CA T0 01 02 15 WALNUT CREEK CA 418 43 RSC INS BROKERAGE INC HE839 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO CD 810-8M554728-24-26-G 04-01-24 LOSS PAYABLE CLAUSE A.We will pay you and the loss payee named in the policy for "loss" to a covered "auto", as interest may appear. B.The insurance covers the interest of the loss payee unless the "loss" results from conversion, secretion or embezzlement on your part. C.We may cancel the policy as allowed by the CANCELLATION Common Policy Condition. Cancellation ends this agreement as to the loss payee’s interest. If we cancel the policy we will mail you and the loss payee the same advance notice. D.If we make any payment to the loss payee, we will obtain their rights against any other party. VEHICLE NUMBER SCHEDULE OF LOSS PAYEES LOSS PAYEE (Name and Address) AS PER LIST ON FILE WITH COMPANY ANY LESSOR UNDER A LEASING CONTRACT OR AGREEMENT OF SIX MONTHS OR MORE THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR. PRODUCER of OFFICE Page Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved.CA T0 01 02 15 WALNUT CREEK CA 418 44 RSC INS BROKERAGE INC HE839 BUSINESS AUTO POLICY NUMBER: COVERAGE PART DECLARATIONS ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS. COVERED AUTOS LIABILITY PREMIUM COVERAGE HIRE FOR ALL STATES PRIMARY $$ COVERAGE $$EXCESS COVERAGE TOTAL HIRED AUTO PREMIUM $ COVERED AUTOS STATE PREMIUM LIABILITY COVERAGE FOR EACH STATE $$ $$ TOTAL HIRED AUTO PREMIUM $ CA T0 03 02 15 ISSUE DATE: ESTIMATED ANNUAL COST OF Page 1 of 2© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. ESTIMATED ANNUAL COST OF HIRE PRIMARY COVERAGE EXCESS COVERAGE COVERED AUTOS LIABILITY COVERAGE – COST OF HIRE RATING BASIS FOR AUTOS USED IN YOUR MOTOR CARRIER OPERATIONS (OTHER THAN MOBILE OR FARM EQUIPMENT) COVERED AUTOS LIABILITY COVERAGE – COST OF HIRE RATING BASIS FOR AUTOS NOT USED IN YOUR MOTOR CARRIER OPERATIONS (OTHER THAN MOBILE OR FARM EQUIPMENT) For "autos" NOT used in your motor carrier operations, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their fam- ily members). Cost of hire does not include charges for services performed by motor carriers of property or pas- sengers. For "autos" used in your motor carrier operations, cost of hire means: 1.The total dollar amount of costs you incurred for the hire of automobiles (includes "trailers" and semitrail- ers) and if not included therein, 2.The total remunerations of all operators and drivers' helpers, of hired automobiles whether hired with a driver by the lessor or an "employee" of the lessee, or any other third party, and 3.The total dollar amount of any other costs (e.g., repair, maintenance, fuel, etc.) directly associated with operating the hired automobiles whether such costs are absorbed by the "insured", paid to the lessor or owner, or paid to others. 810-8M554728-24-26-G 04-01-24 CA 4,800 1,714 1,714 COVERAGE STATE LIMIT OF INSURANCE ESTIMATED ANNUAL PREMIUM COST OF HIRE FOR EACH STATE (Excluding Autos Hired With a Driver) COMPREHENSIVE ACTUAL CASH VALUE OR COST $ OF REPAIR,WHICHEVER IS LESS, MINUS $DEDUCTIBLE. FOR EACH COVERED AUTO. ACTUAL CASH VALUE OR COST $SPECIFIED CAUSES OF OF REPAIR, WHICHEVER IS LESS, LOSS MINUS $DEDUCTIBLE. FOR EACH COVERED AUTO FOR LOSS CAUSED BY MISCHIEF OR VANDALISM. COLLISION ACTUAL CASH VALUE OR COST $ OF REPAIR, WHICHEVER IS LESS, MINUS $DEDUCTIBLE. FOR EACH COVERED AUTO. TOTAL HIRED AUTO PREMIUM $ ITEM FIVE SCHEDULE FOR NON-OWNERSHIP COVERED AUTOS LIABILITY NAMED INSURED'S BUSINESS RATING BASIS NUMBER PREMIUM NUMBER OF EMPLOYEES $OTHER THAN GARAGE SERVICE OPERATIONS AND OTHER THAN NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) NUMBER OF EMPLOYEES $ WHOSE PRINCIPAL DUTY INVOLVES THE OPERATION OF AUTOS NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) NUMBER OF EMPLOYEES $ NUMBER OF $ REGULARLY USE AUTOS TO TRANSPORT CLIENTS NUMBER OF PARTNERS $ (ACTIVE AND INACTIVE) $ CA T0 03 02 15Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. TOTAL NON-OWNERSHIP COVERED AUTOS LIABILITY PREMIUM SOCIAL SERVICE AGENCIES GARAGE SERVICE OPERATIONS SOCIAL SERVICE AGENCIES VOLUNTEERS WHO PHYSICAL DAMAGE COVERAGES – COST OF HIRE RATING BASIS FOR ALL AUTOS (OTHER THAN MOBILE OR FARM EQUIPMENT) For Physical Damage Coverages, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for any "auto" that is leased, hired, rented, or borrowed with a driver. $4,800 38CA 1000 $4,800 96CA 1000 134 95 294 294 EXPLANATION OF CERTAIN ENTRIES OR THE ABSENCE THEREOF ON CA T0 02/CA T0 45 THE ABSENCE OF AN ENTRY IN PREMIUM SPACES FOR A COVERAGE SHALL MEAN THAT INSURANCE IS NOT AFFORDED FOR THE DESIGNATED AUTO. THE ABBREVIATION ’ACV’ IN THE ’LIMIT OF LIABILITY’ SPACE SHALL MEAN ’ACTUALCASH VALUE’. THE ABBREVIATION ’BI’ SHALL MEAN ’BODILY INJURY’. THE ABBREVIATION ’GVW’ SHALL MEAN ’GROSS VEHICLE WEIGHT’. THE ABBREVIATION ’GCW’ SHALL MEAN ’GROSS COMBINED WEIGHT’. THE ABBREVIATION ’ADDED PIP’ SHALL MEAN ’ADDED PERSONAL INJURY PROTECTION’OR ’EQUIVALENT NO-FAULT COVERAGE’. THE ABBREVIATION ’BASIC PIP’ SHALL MEAN ’BASIC PERSONAL INJURY PROTECTION’OR ’EQUIVALENT NO-FAULT COVERAGE’. THE ABBREVIATION ’NDA’ SHALL MEAN ’NO DEDUCTIBLE APPLIES’. THE ABBREVIATION ’I’ SHALL MEAN ’DEDUCTIBLE APPLIES TO THE NAMED INSUREDONLY’. THE ABBREVIATION ’I/R’ SHALL MEAN ’DEDUCTIBLE APPLIES TO THE NAMED INSUREDAND RELATIVES’. THE ABBREVIATION ’PD’ SHALL MEAN ’PROPERTY DAMAGE’. THE ABBREVIATION ’SPEC CAUSES’ SHALL MEAN ’SPECIFIED CAUSES OF LOSSCOVERAGE’ AS DEFINED IN THE POLICY. OTHER ABBREVIATIONS DESIGNATED BELOW ARE DEFINED AS FOLLOWSTHE ABBREVIATION ’SP’ SHALL MEAN ’SPECIFIED CAUSES OF LOSS COVERAGE’. THE ABBREVIATION ’F’ SHALL MEAN ’FIRE COVERAGE’ ONLY. THE ABBREVIATION ’FT’ SHALL MEAN ’FIRE & THEFT COVERAGE’. THE ABBREVIATION ’FTW’ SHALL MEAN ’FIRE, THEFT & WINDSTORM COVERAGE’. THE ABBREVIATION ’LSP’ SHALL MEAN ’LIMITED SPECIFIED CAUSES OF LOSSCOVERAGE’. THE ABBREVIATION ’MED PAY’ SHALL MEAN ’MEDICAL PAYMENTS’. THE ABBREVIATION ’UM’ SHALL MEAN ’UNINSURED MOTORIST’. THE ABBREVIATION ’PRIM’ SHALL MEAN ’PRIMARY’. THE ABBREVIATION ’XS’ SHALL MEAN ’EXCESS’. INCLUDES COPYRIGHTED MATERIAL OF INSURANCE SERVICES OFFICE, WITH ITS PERMISSION. COPYRIGHT, INSURANCE SERVICES OFFICE, 1985 THE ABBREVIATION ’UIM’ SHALL MEAN ’UNDERINSURED MOTORIST’. THE ABBREVIATION ’LTD COLLISION’ SHALL MEAN ’LIMITED COLLISION’. THE ABBREVIATION ’CAC’ SHALL MEAN ’COMBINED ADDITIONAL COVERAGE’. THE ABBREVIATION ’FC’ SHALL MEAN ’FIRE & COMBINED ADDITIONAL COVERAGES’. THE ABBREVIATION ’SPV’ SHALL MEAN ’SELF PROPELLED VEHICLES’. THE ABBREVIATION ’PIP’ SHALL MEAN ’PERSONAL INJURY PROTECTION’ OR ’EQUIVALENT NO-FAULT COVERAGE’. COMMERCIAL AUTO POLICY NUMBER:ISSUE DATE: This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM DEDUCTIBLE SCHEDULE Bodily Injury and Property Damage Deductible (and $Per Accident $Property Damage Deductible (and associated Allocated Per Accident CA T3 95 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DEDUCTIBLE COVERAGE associated Allocated Loss Adjustment Expense) Loss Adjustment Expense) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2© 2015 The Travelers Indemnity Company. All rights reserved . PROVISIONS 1.The following is added to Paragraph C., Limit Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE of the BUSINESS AUTO COVERAGE FORM and the MOTOR CARRIER COVERAGE FORM, and to Paragraph 5., Limit Of Insurance – Covered Autos Liability Cover- age, in Paragraph D., Covered Autos Liability Coverage, of SECTION I – COVERED AUTOS COVERAGES in the AUTO DEALERS COVER- AGE FORM : If the Bodily Injury and Property Damage De- ductible is identified with an X in the Deductible Schedule: Our obligation under this policy to pay damages for covered "bodily injury" and "property damage", "covered pollution cost or expense", and associ- ated "Allocated Loss Adjustment Expense" ap- plies only to the amount of damages, "covered pollution cost or expense", and "Allocated Loss Adjustment Expense" in excess of the amount stated in the Deductible Schedule, and the appli- cable limits of insurance will be reduced by the amount of damages and "covered pollution cost or expense" within the deductible amount. The applicable limits of insurance will not be reduced by the amount of any "Allocated Loss Adjustment Expense" within the deductible amount. If the Property Damage Deductible is identified with an X in the Deductible Schedule: Our obligation under this policy to pay damages for "property damage", "covered pollution cost or expense" and associated "Allocated Loss Adjust- ment Expense" applies only to the amount of damages for "property damage", "covered pollu- tion costs or expense" and associated "Allocated Loss Adjustment Expense" in excess of the amount stated in the Deductible Schedule, and the applicable limit of insurance will be reduced by the amount of damages and "covered pollution cost or expense" within the deductible amount. The applicable limit of insurance will not be re- duced by the amount of any "Allocated Loss Ad- justment Expense" within the deductible amount. 2.The following is added to Paragraph B., General Conditions, of the CONDITIONS Section: Effect Of Deductible The terms of this insurance, including those with respect to: a.Our right and duty to defend the insured against any "suit" seeking damages; and b.Your duties in the event of an "accident", claim, or "suit"; apply irrespective of the application of the de- ductible amount. 3.The following is added to Paragraph A.5., Trans- fer Of Rights Of Recovery Against Others To Us, of the CONDITIONS Section: Any such recoveries made shall be applied in the following order: a.Any party in interest (including the insured) that may have paid any amount with respect to liability in excess of the limit of our liability under this Coverage Form. b.Us for the amount paid under this Coverage Form. c.All other parties in interest (including the in- sured), with respect to the remaining amount of the recovery, if any. 810-8M554728-24-26-G 04-01-24 1,000X COMMERCIAL AUTO CA T3 95 02 15Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved . When we have elected to participate in the exer- cise of the insured's right of recovery, reasonable expenses resulting from that participation will be apportioned among all the parties in interest in the ratio of their respective recoveries. 4.The following is added to the CONDITIONS Sec- tion: Payment Of Deductible We will pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you must promptly reimburse us for such part of the deductible amount as has been paid by us. If you fail to reimburse us for any such amounts, we may cancel this policy by mailing or delivering to the first Named Insured written notice of can- cellation as permitted by law. 5.The following is added to the DEFINITIONS Sec- tion: "Allocated Loss Adjustment Expense" (or "ALAE"): 1.Means our costs which can be directly allo- cated to a particular claim or "suit" as follows: a.Fees of attorneys, or other authorized representatives where permitted, for legal services, whether by outside or staff rep- resentatives. b.Court, Alternative Dispute Resolution, and other specific items of expense whether incurred by an outside vendor or by one of our employees, including: (1)Medical examinations of a claimant to determine the extent of injury, degree of permanency, or length of disability; (2)Expert medical or other testimony; (3)Autopsy; (4)Witnesses and summonses; (5)Copies of documents such as birth and death certificates and medical treatment records; (6)Arbitration fees; (7)Fees or costs for surveillance or other professional investigations which are conducted as part of handling of a claim or "suit"; (8)Fees or costs for loss prevention and engineering personnel and fees or costs for rehabilitation nurses or other nurses for services which are con- ducted as part of handling of a claim or "suit"; and (9)Appeal bond costs and appeal filing fees. c.All Supplementary Payments as de- scribed and included in the applicable Coverage Form. 2.Does not include: a.Salaries, overhead and traveling ex- penses of our employees, except for em- ployees while doing activities previously listed as allocated expenses. b.Fees paid to independent claims profes- sionals or attorneys (hired to perform the function of claim investigation normally performed by claim adjusters), for devel- oping and investigating a claim so that a determination can be made of the cause, extent or responsibility for the injury, dis- ease or damage, including evaluation and settlement of covered claims. BUSINESS AUTO/AUTO DEALERS/ MOTOR CARRIER COVERAGE PART SUPPLEMENTARY SCHEDULE POLICY NUMBER: ISSUE DATE: ITEM TWO COVERAGE AND LIMITS OF INSURANCE UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE Coverage The LIMIT OF INSURANCE for the coverages shown below is the LIMIT OF INSURANCE shown for the State where a covered "auto" is principally garaged. Refer to the specific coverage endorsement for description of the coverage provided for each State listed below. 810-8M554728-24-26-G 04-01-24 UNINSURED MOTORISTS LIMIT OF INSURANCE "Bodily Injury" and "Property Damage" Each "Accident"State "Bodily Injury" Each "Accident" "Bodily Injury" Each Person Each "Accident" "Property Damage" Each "Accident" CA $1,000,000 UNDERINSURED MOTORISTS (When not included in Uninsured Motorists Coverage) LIMIT OF INSURANCE State "Bodily Injury" and "Property Damage" Each "Accident" "Bodily Injury" Each "Accident" "Bodily Injury" Each Person Each "Accident" "Property Damage" Each "Accident" CA T0 30 02 16 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page of1 1 TABLE OF CONTENTS Beginning on Page Description Of Covered Auto Designation Symbols ......................................................................1 Owned Autos You Acquire After The Policy Begins ......................................................................2 Certain Trailers And Temporary Substitute Autos .........................................................................2 Coverage 2 Who Is An Insured 2 Coverage Extensions Supplementary Payments 3 Out of State 3 Exclusions 3 Limit of Insurance 5 Coverage 6 Exclusions 7 Limits of Insurance 7 Deductible 8 Appraisal For Physical Damage Loss ....................................................................................8 .............................................................8 Legal Action Against Us 8 ........................................................................9 ..........................................................9 General Conditions Bankruptcy 9 Concealment, Misrepresentation Or Fraud ............................................................................9 Liberalization 9 ............................................................9 Other Insurance 9 Premium Audit 9 Policy Period, Coverage Territory 10 Two Or More Coverage Forms Or Policies Issued By Us ....................................................10 10 CA T0 31 02 15 BUSINESS AUTO COVERAGE FORM SECTION I – COVERED AUTOS SECTION II – COVERED AUTOS LIABILITY COVERAGE SECTION III – PHYSICAL DAMAGE COVERAGE SECTION IV – BUSINESS AUTO CONDITIONS Loss Conditions Duties in the Event Of Accident, Claim, Suit or Loss Loss Payment – Physical Damage Coverage Transfer Of Rights Of Recovery Against Others To Us No Benefit To Bailee – Physical Damage Coverages SECTION V – DEFINITIONS Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 ..................................................................................................................................... ........................................................................................................................ ...................................................................................................... ........................................................................................................................... ..................................................................................................................................... .......................................................................................................................... ...................................................................................................................................... ..................................................................................................................................... ........................................................................................................................ ..................................................................................................................................... ........................................................................................................ ........................................................................................................................... ........................................................................................................................ .................................................................................................................... ...................................................................................................................... ....................................................................................... ............................................................................................................ © 2015 The Travelers Indemnity Compa ny. All rights reserved. COMMERCIAL AUTO Symbol Description Of Covered Auto Designation Symbols 1 2 Only Owned Private3 "Autos" Only Owned4 "Autos" Other Than Private "Autos" Only 5 Subject To No-fault 6 Subject To A Compulsory Uninsured Motorists Law Specifically7 Described "Autos" 8 Only 9 "Autos" Only CA 00 01 10 13 © Insurance Services Office, Inc., 2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE FORM Page 1 of 12 Any "Auto" Owned "Autos" Passenger Passenger Owned "Autos" Owned "Autos" Hired "Autos" Non-owned Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" re- fer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the company providing this insurance. Other words and phrases that appear in quotation marks have special meaning. Refer to Section V – Definitions. SECTION I – COVERED AUTOS Item Two of the Declarations shows the "autos" that are covered "autos" for each of your coverages. The following numerical symbols describe the "autos" that may be covered "autos". The symbols entered next to a coverage on the Declarations designate the only "autos" that are covered "autos". A.Description Of Covered Auto Designation Symbols Only those "autos" you own (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" you acquire ownership of after the policy begins. Only the private passenger "autos" you own. This includes those private passenger "autos" you acquire ownership of after the policy begins. Only those "autos" you own that are not of the private passenger type (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to power units you own). This includes those "autos" not of the private passenger type you acquire ownership of after the policy begins. Only those "autos" you own that are required to have no-fault benefits in the state where they are licensed or principally garaged. This includes those "autos" you acquire ownership of after the policy begins provided they are required to have no- fault benefits in the state where they are licensed or principally garaged. Only those "autos" you own that because of the law in the state where they are licensed or principally garaged are required to have and cannot reject Uninsured Motorists Coverage. This includes those "autos" you acquire ownership of after the policy begins provided they are subject to the same state uninsured motorists requirement. Only those "autos" described in Item Three of the Declarations for which a premium charge is shown (and for Covered Autos Liability Coverage any "trailers" you don't own while attached to any power unit described in Item Three). Only those "autos" you lease, hire, rent or borrow. This does not include any "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. Only those "autos" you do not own, lease, hire, rent or borrow that are used in connection with your business. This includes "autos" owned by your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households but only while used in your business or your personal affairs. COMMERCIAL AUTO 19 Mobile Equip- ment Subject To Compulsory Or Financial Or Other Motor Vehicle Insur- ance Law Only © Insurance Services Office, Inc., 2011 CA 00 01 10 13 Responsibility Page 2 of 12 Only those "autos" that are land vehicles and that would qualify under the definition of "mobile equipment" under this policy if they were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where they are licensed or principally garaged. B.Owned Autos You Acquire After The Policy Begins 1.If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered next to a coverage in Item Two of the Decla- rations, then you have coverage for "autos" that you acquire of the type described for the remainder of the policy period. 2.But, if Symbol 7 is entered next to a coverage in Item Two of the Declarations, an "auto" you acquire will be a covered "auto" for that cov- erage only if: a.We already cover all "autos" that you own for that coverage or it replaces an "auto" you previously owned that had that cov- erage; and b.You tell us within 30 days after you ac- quire it that you want us to cover it for that coverage. C.Certain Trailers, Mobile Equipment And Tem- porary Substitute Autos If Covered Autos Liability Coverage is provided by this Coverage Form, the following types of vehi- cles are also covered "autos" for Covered Autos Liability Coverage: 1."Trailers" with a load capacity of 2,000 pounds or less designed primarily for travel on public roads. 2."Mobile equipment" while being carried or towed by a covered "auto". 3.Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a.Breakdown; b.Repair; c.Servicing; d."Loss"; or e.Destruction. SECTION II – COVERED AUTOS LIABILITY COV- ERAGE A.Coverage We will pay all sums an "insured" legally must pay as damages because of "bodily injury" or "prop- erty damage" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". We will also pay all sums an "insured" legally must pay as a "covered pollution cost or expense" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of covered "autos". However, we will only pay for the "covered pollution cost or expense" if there is either "bodily injury" or "prop- erty damage" to which this insurance applies that is caused by the same "accident". We have the right and duty to defend any "in- sured" against a "suit" asking for such damages or a "covered pollution cost or expense". How- ever, we have no duty to defend any "insured" against a "suit" seeking damages for "bodily in- jury" or "property damage" or a "covered pollution cost or expense" to which this insurance does not apply. We may investigate and settle any claim or "suit" as we consider appropriate. Our duty to de- fend or settle ends when the Covered Autos Li- ability Coverage Limit of Insurance has been ex- hausted by payment of judgments or settlements. 1.Who Is An Insured The following are "insureds": a.You for any covered "auto". b.Anyone else while using with your per- mission a covered "auto" you own, hire or borrow except: (1)The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto" you own. COMMERCIAL AUTO CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 3 of 12 (2)Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3)Someone using a covered "auto" while he or she is working in a busi- ness of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4)Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company) or a lessee or borrower or any of their "employees", while mov- ing property to or from a covered "auto". (5)A partner (if you are a partnership) or a member (if you are a limited liability company) for a covered "auto" owned by him or her or a member of his or her household. c.Anyone liable for the conduct of an "in- sured" described above but only to the extent of that liability. 2.Coverage Extensions a.Supplementary Payments We will pay for the "insured": (1)All expenses we incur. (2)Up to $2,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (3)The cost of bonds to release attach- ments in any "suit" against the "in- sured" we defend, but only for bond amounts within our Limit of Insur- ance. (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $250 a day because of time off from work. (5)All court costs taxed against the "in- sured" in any "suit" against the "in- sured" we defend. However, these payments do not include at- torneys' fees or attorneys' expenses taxed against the "insured". (6)All interest on the full amount of any judgment that accrues after entry of the judgment in any "suit" against the "insured" we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. These payments will not reduce the Limit of Insurance. b.Out-of-state Coverage Extensions While a covered "auto" is away from the state where it is licensed, we will: (1)Increase the Limit of Insurance for Covered Autos Liability Coverage to meet the limits specified by a com- pulsory or financial responsibility law of the jurisdiction where the covered "auto" is being used. This extension does not apply to the limit or limits specified by any law governing motor carriers of passengers or property. (2)Provide the minimum amounts and types of other coverages, such as no- fault, required of out-of-state vehicles by the jurisdiction where the covered "auto" is being used. We will not pay anyone more than once for the same elements of loss because of these extensions. B.Exclusions This insurance does not apply to any of the fol- lowing: 1.Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the "in- sured". 2.Contractual Liability assumed under any contract or agreement. But this exclusion does not apply to liability for damages: a.Assumed in a contract or agreement that is an "insured contract", provided the "bodily injury" or "property damage" oc- curs subsequent to the execution of the contract or agreement; or b.That the "insured" would have in the ab- sence of the contract or agreement. 3.Workers' Compensation Any obligation for which the "insured" or the "insured's" insurer may be held liable under any workers' compensation, disability benefits COMMERCIAL AUTO © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 4 of 12 or unemployment compensation law or any similar law. 4.Employee Indemnification And Employer's Liability "Bodily injury" to: a.An "employee" of the "insured" arising out of and in the course of: (1)Employment by the "insured"; or (2)Performing the duties related to the conduct of the "insured's" business; or b.The spouse, child, parent, brother or sis- ter of that "employee" as a consequence of Paragraph a. above. This exclusion applies: (1)Whether the "insured" may be liable as an employer or in any other ca- pacity; and (2)To any obligation to share damages with or repay someone else who must pay damages because of the in- jury. But this exclusion does not apply to "bodily in- jury" to domestic "employees" not entitled to workers' compensation benefits or to liability assumed by the "insured" under an "insured contract". For the purposes of the Coverage Form, a domestic "employee" is a person en- gaged in household or domestic work per- formed principally in connection with a resi- dence premises. 5.Fellow Employee "Bodily injury" to: a.Any fellow "employee" of the "insured" arising out of and in the course of the fel- low "employee's" employment or while performing duties related to the conduct of your business; or b.The spouse, child, parent, brother or sis- ter of that fellow "employee" as a conse- quence of Paragraph a. above. 6.Care, Custody Or Control "Property damage" to or "covered pollution cost or expense" involving property owned or transported by the "insured" or in the "in- sured's" care, custody or control. But this ex- clusion does not apply to liability assumed under a sidetrack agreement. 7.Handling Of Property "Bodily injury" or "property damage" resulting from the handling of property: a.Before it is moved from the place where it is accepted by the "insured" for move- ment into or onto the covered "auto"; or b.After it is moved from the covered "auto" to the place where it is finally delivered by the "insured". 8.Movement Of Property By Mechanical De- vice "Bodily injury" or "property damage" resulting from the movement of property by a me- chanical device (other than a hand truck) unless the device is attached to the covered "auto". 9.Operations "Bodily injury" or "property damage" arising out of the operation of: a.Any equipment listed in Paragraphs 6.b. and 6.c. of the definition of "mobile equipment"; or b.Machinery or equipment that is on, at- tached to or part of a land vehicle that would qualify under the definition of "mo- bile equipment" if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. 10.Completed Operations "Bodily injury" or "property damage" arising out of your work after that work has been completed or abandoned. In this exclusion, your work means: a.Work or operations performed by you or on your behalf; and b.Materials, parts or equipment furnished in connection with such work or operations. Your work includes warranties or representa- tions made at any time with respect to the fit- ness, quality, durability or performance of any of the items included in Paragraph a. or b. above. Your work will be deemed completed at the earliest of the following times: (1)When all of the work called for in your contract has been completed; (2)When all of the work to be done at the site has been completed if your COMMERCIAL AUTO CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 5 of 12 contract calls for work at more than one site; or (3)When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or sub- contractor working on the same pro- ject. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as com- pleted. 11.Pollution "Bodily injury" or "property damage" arising out of the actual, alleged or threatened dis- charge, dispersal, seepage, migration, re- lease or escape of "pollutants": a.That are, or that are contained in any property that is: (1)Being transported or towed by, han- dled or handled for movement into, onto or from the covered "auto"; (2)Otherwise in the course of transit by or on behalf of the "insured"; or (3)Being stored, disposed of, treated or processed in or upon the covered "auto"; b.Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are ac- cepted by the "insured" for movement into or onto the covered "auto"; or c.After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "in- sured". Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other simi- lar "pollutants" that are needed for or result from the normal electrical, hydraulic or me- chanical functioning of the covered "auto" or its parts if: (1)The "pollutants" escape, seep, mi- grate or are discharged, dispersed or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pol- lutants"; and (2)The "bodily injury", "property dam- age" or "covered pollution cost or ex- pense" does not arise out of the op- eration of any equipment listed in Paragraphs 6.b. and 6.c. of the defi- nition of "mobile equipment". Paragraphs b. and c. above of this exclusion do not apply to "accidents" that occur away from premises owned by or rented to an "in- sured" with respect to "pollutants" not in or upon a covered "auto" if: (a)The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the main- tenance or use of a covered "auto"; and (b)The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or damage. 12.War "Bodily injury" or "property damage" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, includ- ing action in hindering or defending against an actual or expected attack, by any government, sovereign or other au- thority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power or action taken by gov- ernmental authority in hindering or de- fending against any of these. 13.Racing Covered "autos" while used in any profes- sional or organized racing or demolition con- test or stunting activity, or while practicing for such contest or activity. This insurance also does not apply while that covered "auto" is being prepared for such a contest or activity. C.Limit Of Insurance Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehi- cles involved in the "accident", the most we will pay for the total of all damages and "covered pol- lution cost or expense" combined resulting from any one "accident" is the Limit Of Insurance for Covered Autos Liability Coverage shown in the Declarations. COMMERCIAL AUTO © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 6 of 12 All "bodily injury", "property damage" and "cov- ered pollution cost or expense" resulting from continuous or repeated exposure to substantially the same conditions will be considered as result- ing from one "accident". No one will be entitled to receive duplicate pay- ments for the same elements of "loss" under this Coverage Form and any Medical Payments Cov- erage endorsement, Uninsured Motorists Cover- age endorsement or Underinsured Motorists Coverage endorsement attached to this Coverage Part. SECTION III – PHYSICAL DAMAGE COVERAGE A.Coverage 1.We will pay for "loss" to a covered "auto" or its equipment under: a.Comprehensive Coverage From any cause except: (1)The covered "auto's" collision with another object; or (2)The covered "auto's" overturn. b.Specified Causes Of Loss Coverage Caused by: (1)Fire, lightning or explosion; (2)Theft; (3)Windstorm, hail or earthquake; (4)Flood; (5)Mischief or vandalism; or (6)The sinking, burning, collision or de- railment of any conveyance transport- ing the covered "auto". c.Collision Coverage Caused by: (1)The covered "auto's" collision with another object; or (2)The covered "auto's" overturn. 2. Towing We will pay up to the limit shown in the Decla- rations for towing and labor costs incurred each time a covered "auto" of the private passenger type is disabled. However, the la- bor must be performed at the place of dis- ablement. 3. Glass Breakage – Hitting A Bird Or Animal – Falling Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered "auto", we will pay for the following under Comprehensive Coverage: a.Glass breakage; b."Loss" caused by hitting a bird or animal; and c."Loss" caused by falling objects or mis- siles. However, you have the option of having glass breakage caused by a covered "auto's" colli- sion or overturn considered a "loss" under Collision Coverage. 4.Coverage Extensions a.Transportation Expenses We will pay up to $20 per day, to a maxi- mum of $600, for temporary transporta- tion expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses in- curred during the period beginning 48 hours after the theft and ending, regard- less of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". b.Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" be- comes legally responsible to pay for loss of use of a vehicle rented or hired without a driver under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1)Other than collision only if the Decla- rations indicates that Comprehensive Coverage is provided for any covered "auto"; (2)Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is pro- vided for any covered "auto"; or (3)Collision only if the Declarations indi- cates that Collision Coverage is pro- vided for any covered "auto". However, the most we will pay for any expenses for loss of use is $20 per day, to a maximum of $600. B.Exclusions 1.We will not pay for "loss" caused by or result- ing from any of the following. Such "loss" is excluded regardless of any other cause or COMMERCIAL AUTO CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 7 of 12 event that contributes concurrently or in any sequence to the "loss". a.Nuclear Hazard (1)The explosion of any weapon em- ploying atomic fission or fusion; or (2)Nuclear reaction or radiation, or ra- dioactive contamination, however caused. b.War Or Military Action (1)War, including undeclared or civil war; (2)Warlike action by a military force, in- cluding action in hindering or defend- ing against an actual or expected at- tack, by any government, sovereign or other authority using military per- sonnel or other agents; or (3)Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. 2.We will not pay for "loss" to any covered "auto" while used in any professional or or- ganized racing or demolition contest or stunt- ing activity, or while practicing for such con- test or activity. We will also not pay for "loss" to any covered "auto" while that covered "auto" is being prepared for such a contest or activity. 3.We will not pay for "loss" due and confined to: a.Wear and tear, freezing, mechanical or electrical breakdown. b.Blowouts, punctures or other road dam- age to tires. This exclusion does not apply to such "loss" resulting from the total theft of a covered "auto". 4.We will not pay for "loss" to any of the follow- ing: a.Tapes, records, discs or other similar au- dio, visual or data electronic devices de- signed for use with audio, visual or data electronic equipment. b.Any device designed or used to detect speed-measuring equipment, such as ra- dar or laser detectors, and any jamming apparatus intended to elude or disrupt speed-measuring equipment. c.Any electronic equipment, without regard to whether this equipment is permanently installed, that reproduces, receives or transmits audio, visual or data signals. d.Any accessories used with the electronic equipment described in Paragraph c. above. 5.Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power from the "auto's" electrical system that, at the time of "loss", is: a.Permanently installed in or upon the cov- ered "auto"; b.Removable from a housing unit which is permanently installed in or upon the cov- ered "auto"; c.An integral part of the same unit housing any electronic equipment described in Paragraphs a. and b. above; or d.Necessary for the normal operation of the covered "auto" or the monitoring of the covered "auto's" operating system. 6.We will not pay for "loss" to a covered "auto" due to "diminution in value". C.Limits Of Insurance 1.The most we will pay for: a."Loss" to any one covered "auto" is the lesser of: (1)The actual cash value of the dam- aged or stolen property as of the time of the "loss"; or (2)The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. b.All electronic equipment that reproduces, receives or transmits audio, visual or data signals in any one "loss" is $1,000, if, at the time of "loss", such electronic equip- ment is: (1)Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; (2)Removable from a permanently in- stalled housing unit as described in Paragraph b.(1) above; or (3)An integral part of such equipment as described in Paragraphs b.(1) and b.(2) above. COMMERCIAL AUTO © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 8 of 12 2.An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". 3.If a repair or replacement results in better than like kind or quality, we will not pay for the amount of the betterment. D.Deductible For each covered "auto", our obligation to pay for, repair, return or replace damaged or stolen prop- erty will be reduced by the applicable deductible shown in the Declarations. Any Comprehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or light- ning. SECTION IV – BUSINESS AUTO CONDITIONS The following conditions apply in addition to the Common Policy Conditions: A.Loss Conditions 1.Appraisal For Physical Damage Loss If you and we disagree on the amount of "loss", either may demand an appraisal of the "loss". In this event, each party will select a competent appraiser. The two appraisers will select a competent and impartial umpire. The appraisers will state separately the actual cash value and amount of "loss". If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will: a.Pay its chosen appraiser; and b.Bear the other expenses of the appraisal and umpire equally. If we submit to an appraisal, we will still retain our right to deny the claim. 2.Duties In The Event Of Accident, Claim, Suit Or Loss We have no duty to provide coverage under this policy unless there has been full compli- ance with the following duties: a.In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "acci- dent" or "loss". Include: (1)How, when and where the "accident" or "loss" occurred; (2)The "insured's" name and address; and (3)To the extent possible, the names and addresses of any injured persons and witnesses. b.Additionally, you and any other involved "insured" must: (1)Assume no obligation, make no pay- ment or incur no expense without our consent, except at the "insured's" own cost. (2)Immediately send us copies of any request, demand, order, notice, summons or legal paper received concerning the claim or "suit". (3)Cooperate with us in the investigation or settlement of the claim or defense against the "suit". (4)Authorize us to obtain medical re- cords or other pertinent information. (5)Submit to examination, at our ex- pense, by physicians of our choice, as often as we reasonably require. c.If there is "loss" to a covered "auto" or its equipment, you must also do the follow- ing: (1)Promptly notify the police if the cov- ered "auto" or any of its equipment is stolen. (2)Take all reasonable steps to protect the covered "auto" from further dam- age. Also keep a record of your ex- penses for consideration in the set- tlement of the claim. (3)Permit us to inspect the covered "auto" and records proving the "loss" before its repair or disposition. (4)Agree to examinations under oath at our request and give us a signed statement of your answers. 3.Legal Action Against Us No one may bring a legal action against us under this Coverage Form until: a.There has been full compliance with all the terms of this Coverage Form; and b.Under Covered Autos Liability Coverage, we agree in writing that the "insured" has an obligation to pay or until the amount of that obligation has finally been deter- mined by judgment after trial. No one has the right under this policy to bring us into an action to determine the "insured's" li- ability. COMMERCIAL AUTO CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 9 of 12 4.Loss Payment – Physical Damage Cover- ages At our option, we may: a.Pay for, repair or replace damaged or sto- len property; b.Return the stolen property, at our ex- pense. We will pay for any damage that results to the "auto" from the theft; or c.Take all or any part of the damaged or stolen property at an agreed or appraised value. If we pay for the "loss", our payment will in- clude the applicable sales tax for the dam- aged or stolen property. 5.Transfer Of Rights Of Recovery Against Others To Us If any person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after "accident" or "loss" to impair them. B.General Conditions 1.Bankruptcy Bankruptcy or insolvency of the "insured" or the "insured's" estate will not relieve us of any obligations under this Coverage Form. 2.Concealment, Misrepresentation Or Fraud This Coverage Form is void in any case of fraud by you at any time as it relates to this Coverage Form. It is also void if you or any other "insured", at any time, intentionally con- ceals or misrepresents a material fact con- cerning: a.This Coverage Form; b.The covered "auto"; c.Your interest in the covered "auto"; or d.A claim under this Coverage Form. 3.Liberalization If we revise this Coverage Form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the re- vision is effective in your state. 4.No Benefit To Bailee – Physical Damage Coverages We will not recognize any assignment or grant any coverage for the benefit of any per- son or organization holding, storing or trans- porting property for a fee regardless of any other provision of this Coverage Form. 5.Other Insurance a.For any covered "auto" you own, this Coverage Form provides primary insur- ance. For any covered "auto" you don't own, the insurance provided by this Cov- erage Form is excess over any other col- lectible insurance. However, while a cov- ered "auto" which is a "trailer" is con- nected to another vehicle, the Covered Autos Liability Coverage this Coverage Form provides for the "trailer" is: (1)Excess while it is connected to a mo- tor vehicle you do not own; or (2)Primary while it is connected to a covered "auto" you own. b.For Hired Auto Physical Damage Cover- age, any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". c.Regardless of the provisions of Para- graph a. above, this Coverage Form's Covered Autos Liability Coverage is pri- mary for any liability assumed under an "insured contract". d.When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. 6.Premium Audit a.The estimated premium for this Coverage Form is based on the exposures you told us you would have when this policy be- gan. We will compute the final premium due when we determine your actual ex- posures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the balance, if any. The due date for the final premium or retrospective pre- mium is the date shown as the due date on the bill. If the estimated total premium exceeds the final premium due, the first Named Insured will get a refund. COMMERCIAL AUTO © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 10 of 12 b.If this policy is issued for more than one year, the premium for this Coverage Form will be computed annually based on our rates or premiums in effect at the begin- ning of each year of the policy. 7.Policy Period, Coverage Territory Under this Coverage Form, we cover "acci- dents" and "losses" occurring: a.During the policy period shown in the Declarations; and b.Within the coverage territory. The coverage territory is: (1)The United States of America; (2)The territories and possessions of the United States of America; (3)Puerto Rico; (4)Canada; and (5)Anywhere in the world if a covered "auto" of the private passenger type is leased, hired, rented or borrowed without a driver for a period of 30 days or less, provided that the "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada, or in a settlement we agree to. We also cover "loss" to, or "accidents" involv- ing, a covered "auto" while being transported between any of these places. 8.Two Or More Coverage Forms Or Policies Issued By Us If this Coverage Form and any other Cover- age Form or policy issued to you by us or any company affiliated with us applies to the same "accident", the aggregate maximum Limit of Insurance under all the Coverage Forms or policies shall not exceed the highest applicable Limit of Insurance under any one Coverage Form or policy. This condition does not apply to any Coverage Form or policy is- sued by us or an affiliated company specifi- cally to apply as excess insurance over this Coverage Form. SECTION V – DEFINITIONS A."Accident" includes continuous or repeated expo- sure to the same conditions resulting in "bodily in- jury" or "property damage". B."Auto" means: 1.A land motor vehicle, "trailer" or semitrailer designed for travel on public roads; or 2.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equip- ment". C."Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these. D."Covered pollution cost or expense" means any cost or expense arising out of: 1.Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pol- lutants"; or 2.Any claim or "suit" by or on behalf of a gov- ernmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutraliz- ing, or in any way responding to, or assessing the effects of, "pollutants". "Covered pollution cost or expense" does not in- clude any cost or expense arising out of the ac- tual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollut- ants": a.That are, or that are contained in any property that is: (1)Being transported or towed by, han- dled or handled for movement into, onto or from the covered "auto"; (2)Otherwise in the course of transit by or on behalf of the "insured"; or (3)Being stored, disposed of, treated or processed in or upon the covered "auto"; b.Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are ac- cepted by the "insured" for movement into or onto the covered "auto"; or c.After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "in- sured". COMMERCIAL AUTO CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 11 of 12 Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other simi- lar "pollutants" that are needed for or result from the normal electrical, hydraulic or me- chanical functioning of the covered "auto" or its parts, if: (1)The "pollutants" escape, seep, mi- grate or are discharged, dispersed or released directly from an "auto" part designed by its manufacturer to hold, store, receive or dispose of such "pol- lutants"; and (2)The "bodily injury", "property dam- age" or "covered pollution cost or ex- pense" does not arise out of the op- eration of any equipment listed in Paragraph 6.b. or 6.c. of the defini- tion of "mobile equipment". Paragraphs b. and c. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with re- spect to "pollutants" not in or upon a covered "auto" if: (a)The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the main- tenance or use of a covered "auto"; and (b)The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or damage. E."Diminution in value" means the actual or per- ceived loss in market value or resale value which results from a direct and accidental "loss". F."Employee" includes a "leased worker". "Em- ployee" does not include a "temporary worker". G."Insured" means any person or organization quali- fying as an insured in the Who Is An Insured pro- vision of the applicable coverage. Except with re- spect to the Limit of Insurance, the coverage af- forded applies separately to each insured who is seeking coverage or against whom a claim or "suit" is brought. H."Insured contract" means: 1.A lease of premises; 2.A sidetrack agreement; 3.Any easement or license agreement, except in connection with construction or demolition operations on or within 50 feet of a railroad; 4.An obligation, as required by ordinance, to in- demnify a municipality, except in connection with work for a municipality; 5.That part of any other contract or agreement pertaining to your business (including an in- demnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury" or "property damage" to a third party or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agree- ment; or 6.That part of any contract or agreement en- tered into, as part of your business, pertaining to the rental or lease, by you or any of your "employees", of any "auto". However, such contract or agreement shall not be considered an "insured contract" to the extent that it obli- gates you or any of your "employees" to pay for "property damage" to any "auto" rented or leased by you or any of your "employees". An "insured contract" does not include that part of any contract or agreement: a.That indemnifies a railroad for "bodily in- jury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass or crossing; b.That pertains to the loan, lease or rental of an "auto" to you or any of your "em- ployees", if the "auto" is loaned, leased or rented with a driver; or c.That holds a person or organization en- gaged in the business of transporting property by "auto" for hire harmless for your use of a covered "auto" over a route or territory that person or organization is authorized to serve by public authority. I."Leased worker" means a person leased to you by a labor leasing firm under an agreement be- tween you and the labor leasing firm to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". J."Loss" means direct and accidental loss or dam- age. K."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: COMMERCIAL AUTO © Insurance Services Office, Inc., 2011 CA 00 01 10 13Page 12 of 12 1.Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; 2.Vehicles maintained for use solely on or next to premises you own or rent; 3.Vehicles that travel on crawler treads; 4.Vehicles, whether self-propelled or not, main- tained primarily to provide mobility to perma- nently mounted: a.Power cranes, shovels, loaders, diggers or drills; or b.Road construction or resurfacing equip- ment such as graders, scrapers or rollers; 5.Vehicles not described in Paragraph 1., 2., 3. or 4. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the fol- lowing types: a.Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well-servicing equipment; or b.Cherry pickers and similar devices used to raise or lower workers; or 6.Vehicles not described in Paragraph 1., 2., 3. or 4. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": a.Equipment designed primarily for: (1)Snow removal; (2)Road maintenance, but not construc- tion or resurfacing; or (3)Street cleaning; b.Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and c.Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting or well-servicing equipment. However, "mobile equipment" does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehi- cle insurance law are considered "autos". L."Pollutants" means any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. M."Property damage" means damage to or loss of use of tangible property. N."Suit" means a civil proceeding in which: 1.Damages because of "bodily injury" or "prop- erty damage"; or 2.A "covered pollution cost or expense"; to which this insurance applies, are alleged. "Suit" includes: a.An arbitration proceeding in which such damages or "covered pollution costs or expenses" are claimed and to which the "insured" must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding in which such damages or "covered pollution costs or expenses" are claimed and to which the insured submits with our consent. O."Temporary worker" means a person who is fur- nished to you to substitute for a permanent "em- ployee" on leave or to meet seasonal or short- term workload conditions. P."Trailer" includes semitrailer. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM CA 01 43 05 17 © Insurance Services Office, Inc., 2016 Page 1 of 2 For a covered “auto” licensed or principally garaged in, or “auto dealer operations” conducted in, California, this endorsement modifies insurance provided under the following: With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.The following are added to the Other Insurance Condition in the Auto Dealers and Business Auto Coverage Forms and the Other Insurance – Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form and supersede any provisions to the contrary: 1.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to an “auto” and: a.One provides coverage to a Named Insured engaged in the business of selling, repairing, servicing, delivering, testing or road-testing “autos”; and b.The other provides coverage to a person not engaged in that business; and c.At the time of an “accident”, a person described in Paragraph 1.b. is operating an “auto” owned by the business described in Paragraph 1.a., then that person’s liability coverage is primary and the Coverage Form issued to a business described in Paragraph 1.a. is excess over any coverage available to that person. 2.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to an “auto” and: a.One provides coverage to a Named Insured engaged in the business of selling, repairing, servicing, delivering, testing or road-testing “autos”; and b.The other provides coverage to a person not engaged in that business; and c.At the time of an “accident”, an “insured” under the Coverage Form described in Paragraph 2.a. is operating an “auto” owned by a person described in Paragraph 2.b., then the Coverage Form issued to the business described in Paragraph 2.a. is primary and the liability coverage issued to a person described in Paragraph 2.b. is excess over any coverage available to the business. 3.When this Coverage Form and any other Coverage Form or policy providing liability coverage apply to a “commercial vehicle” and: a.One provides coverage to a Named Insured, who in the course of business, rents or leases “commercial vehicles” without operators; and b.The other provides coverage to a person other than as described in Paragraph 3.a.; and c.At the time of an “accident”, a person who is not the Named Insured of the Policy described in Paragraph 3.a., and who is not the agent or “employee” of such Named Insured, is operating a “commercial vehicle” provided by the business covered by the Coverage Form or policy described in Paragraph 3.a., then the liability coverage provided by the Coverage Form or policy described in Paragraph 3.b. is primary, and the liability coverage provided by the Coverage Form or policy described in Paragraph 3.a. is excess over any coverage available to that person. 4.Notwithstanding Paragraph A.3., when this Coverage Form and any other Coverage Form or policy providing liability coverage apply to a power unit and any connected “trailer” or “trailers” and: a.One provides coverage to a Named Insured engaged in the business of COMMERCIAL AUTO Page 2 of 2 © Insurance Services Office, Inc., 2016 CA 01 43 05 17 transporting property by “auto” for hire; and b.The other provides coverage to a Named Insured not engaged in that business; and c.At the time of an “accident”, a power unit is being operated by a person insured under the Coverage Form or policy described in Paragraph 4.a., then that Coverage Form or policy is primary for both the power unit and any connected “trailer” or “trailers” and the Coverage Form or policy described in Paragraph 4.b. is excess over any other coverage available to such power unit and attached “trailer” or “trailers”. B.As used in this endorsement: “Commercial vehicle” means an “auto” subject to registration or identification under California law which is: 1.Used or maintained for the transportation of persons for hire, compensation or profit; 2.Designed, used or maintained primarily for the transportation of property; or 3.Leased for a period of six months or more. POLICY NUMBER:ISSUE DATE: COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES – WAIVER OF COLLISION DEDUCTIBLE AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM Waiver Of Collision Deductible Designation Or Description Of Covered "Auto"Premium Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 03 05 10 13 © Insurance Services Office, Inc., 2012 SCHEDULE Page of PREMIUM SHOWN IN SCHEDULE OF COVERED AUTOS YOU OWN For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, California, this endorsement modifies insurance provided under the following: With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. A.When Physical Damage Coverage provides cov- erage for a "loss" to a covered "auto" caused by its collision or upset, and: 1.The "loss" involves an "uninsured motor vehi- cle"; and 2.You are legally entitled to recover the full amount of your "loss" from the owner or op- erator of the "uninsured motor vehicle"; and 3.The Schedule indicates that the Waiver Of Collision Deductible provision applies to the covered "auto"; then we will pay the full deductible. Subject to the above, if you are legally entitled to recover only a percentage of your "loss", we will pay that per- centage of your deductible. However, if the amount of the "loss" is less than your deductible, we will pay the percentage of the "loss" that you are legally entitled to recover. In no event will we pay more than the amount of the "loss". B.Conditions 1.The following is added to the Conditions section: Arbitration a.If we and an "insured" disagree whether the "insured" is legally entitled to recover damages from the owner or operator of an "uninsured motor vehicle" or do not agree as to the amount of damages that are recoverable by that "insured", the dis- agreement will be settled by a single neu- tral arbitrator. However, disputes con- cerning coverage under this endorsement may not be arbitrated. The arbitration must be formally instituted by the "in- sured" within one year from the date of the "accident". Each party will bear the expenses of the arbitrator equally. As per list on file with the company 810-8M554728-24-26-G 04-01-24 1 2 COMMERCIAL AUTO © Insurance Services Office, Inc., 2012 CA 03 05 10 13Pageof b.Unless both parties agree otherwise, arbi- tration will take place in the county in which the "insured" lives. Local rules of law as to arbitration procedure and evi- dence will apply. The decision of the arbi- trator will be binding. 2.Paragraph 2.a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition in the Business Auto and Motor Carrier Cover- age Forms and Paragraph 2.a. of the Duties In The Event Of Accident, Claim, Offense, Suit, Loss Or Acts, Errors Or Omissions Condition in the Auto Dealers Coverage Form are replaced by the following: a.You must report the "accident" or "loss" to us or our agent within 10 business days. You must tell us how, when and where the "loss" happened. You must assist in obtaining names and addresses of any in- jured persons and witnesses. C.Additional Definitions As used in this endorsement: 1.For Physical Damage Coverage: a."Auto" means a self-propelled motor ve- hicle. However, it does not include: (1)A vehicle transporting persons for hire, compensation or profit, other than a van pool vehicle; (2)A vehicle designed, used or main- tained primarily for the transportation of property; or (3)"Mobile equipment". b."Uninsured motor vehicle" means a land motor vehicle or trailer which is involved in a collision with a covered "auto" and for which: (1)No liability bond or policy at the time of an "accident" provides at least the amount required for property damage liability by the California Financial Responsibility Law; or (2)The insuring or bonding company denies coverage or refuses to admit coverage except conditionally or with reservation or becomes insolvent. The collision must involve direct physical contact between a covered "auto" and the "uninsured motor vehicle" and: (1)The owner or operator of that vehicle must be identified; or (2)The "uninsured motor vehicle" must be identified by its license number. However, "uninsured motor vehicle" does not include any vehicle: (1)Owned or operated by a self-insurer under any applicable motor vehicle law except a self-insurer who is or becomes insolvent and cannot pro- vide the amounts required by that motor vehicle law; (2)Owned by a governmental unit or agency; or (3)Designed for use mainly off public roads while not on public roads. 2 2 COMMERCIAL AUTO CA 04 24 10 13 © Insurance Services Office, Inc., 2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA AUTO MEDICAL PAYMENTS COVERAGE Page 1 of 2 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. A.Coverage We will pay reasonable expenses incurred for necessary medical and funeral services to or for an "insured" who sustains "bodily injury" caused by "accident". We will pay only those expenses incurred, for services rendered within three years from the date of the "accident". B.Who Is An Insured 1.You while "occupying" or, while a pedestrian, when struck by any "auto". 2.If you are an individual, any "family member" while "occupying" or, while a pedestrian, when struck by any "auto". 3.Anyone else "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, loss or destruction. C.Exclusions This insurance does not apply to any of the fol- lowing: 1."Bodily injury" sustained by an "insured" while "occupying" a vehicle located for use as a premises. 2."Bodily injury" sustained by you or any "family member" while "occupying" or struck by any vehicle (other than a covered "auto") owned by you or furnished or available for your regu- lar use. 3."Bodily injury" sustained by any "family mem- ber" while "occupying" or struck by any vehi- cle (other than a covered "auto") owned by or furnished or available for the regular use of any "family member". 4."Bodily injury" to your "employee" arising out of and in the course of employment by you. However, we will cover "bodily injury" to your domestic "employees" if not entitled to work- ers' compensation benefits. For the purposes of this endorsement, a domestic "employee" is a person engaged in household or domes- tic work performed principally in connection with a residence premises. 5."Bodily injury" to an "insured" while working in a business of selling, servicing, repairing or parking "autos" unless that business is yours. 6."Bodily injury" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, includ- ing action in hindering or defending against an actual or expected attack, by any government, sovereign or other au- thority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power, or action taken by gov- ernmental authority in hindering or de- fending against any of these. 7."Bodily injury" to anyone using a vehicle with- out a reasonable belief that the person is enti- tled to do so. 8."Bodily injury" sustained by an "insured" while "occupying" any covered "auto" while used in any professional racing or demolition contest or stunting activity, or while practicing for such contest or activity. This insurance also does not apply to any "bodily injury" sustained by an "insured" while the "auto" is being pre- pared for such a contest or activity. D.Limit Of Insurance Regardless of the number of covered "autos", "in- sureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for "bodily injury" for each "insured" injured in any one "accident" is the Limit Of Insurance for Auto Medical Payments Coverage shown in the Decla- rations. COMMERCIAL AUTO Page 2 of 2 © Insurance Services Office, Inc., 2012 CA 04 24 10 13 No one will be entitled to receive duplicate pay- ments for the same elements of "loss" under this coverage and any Liability Coverage form, Unin- sured Motorists Coverage endorsement or Under- insured Motorists Coverage endorsement at- tached to this Coverage Part. E.Changes In Conditions The Conditions are changed for Auto Medical Payments Coverage as follows: 1.The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply. 2.The reference in Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance – Primary And Ex- cess Insurance Provisions in the Motor Carrier Coverage Form to "other collectible insurance" applies only to other collectible auto medical payments insurance. F.Additional Definitions As used in this endorsement: 1."Family member" means a person related to you by blood, adoption, marriage or regis- tered domestic partnership under California law, who is a resident of your household, in- cluding a ward or foster child. 2."Occupying" means in, upon, getting in, on, out or off. POLICY NUMBER:ISSUE DATE: SCHEDULE $ $ Uninsured Motorists $ Physical Damage Collision COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA DRIVE OTHER CAR COVERAGE – BROADENED COVERAGE FOR NAMED INDIVIDUALS This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM LIMITS Liability Limits of Insurance as stated in Item Two of Name of Individual Comprehensive Deductible Premium Deductible Premium CA 04 26 10 13 © Insurance Services Office, Inc., 2012 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Page of With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Auto Medical Payments the applicable Coverage Part Declarations Liability Premium Auto Medical Payments Premium Uninsured Motorists Premium Note: When Uninsured Motorists Coverage is provided at limits higher than the basic limits required by a financial responsibility law, Underinsured Motorists Coverage is included, unless otherwise noted. 810-8M554728-24-26-G 04-01-24 $1000 $11 $1000DAVID ROOD $191 $4 $28 $63 $1000 $11 $1000DARLENE ROOD $191 $4 $28 $63 $1000 $11 $1000RICHARD ROOD $191 $4 $28 $63 21 CA 04 26 10 13 COMMERCIAL AUTO © Insurance Services Office, Inc., 2012Pageof A.This endorsement changes only those coverages where a premium is shown in the Schedule. B.Changes In Covered Autos Liability Coverage 1.Any "auto" you don't own, hire or borrow is a covered "auto" for Covered Autos Liability Coverage while being used by any individual named in the Schedule or by his or her spouse while a resident of the same house- hold except: a.Any "auto" owned by that individual or by any member of his or her household. b.Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos". 2.The following is added to Who Is An In- sured: Any individual named in the Schedule and his or her spouse, while a resident of the same household, are "insureds" while using any covered "auto" described in Paragraph B.1. of this endorsement. C.Changes In Auto Medical Payments And Unin- sured Motorists Coverages The following is added to Who Is An Insured: Any individual named in the Schedule and his or her "family members" are "insureds" while "occu- pying" or while a pedestrian when being struck by any "auto" you don't own except: Any "auto" owned by that individual or by any "family member". D.Changes In Physical Damage Coverage Any private passenger type "auto" you don't own, hire or borrow is a covered "auto" while in the care, custody or control of any individual named in the Schedule or his or her spouse while a resi- dent of the same household except: 1. Any "auto" owned by that individual or by any member of his or her household. 2.Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing, repairing or parking "autos". E.Additional Definition As used in this endorsement: "Family member" means a person related to the individual named in the Schedule by blood, adop- tion, marriage or registered domestic partnership under California law, who is a resident of the indi- vidual's household, including a ward or foster child. 22 COMMERCIAL AUTO POLICY NUMBER:ISSUE DATE: This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Insurance Company: Policy Number:Effective Date: Expiration Date: Named Insured: Address: Additional Insured (Lessor): Address: Coverages Limit Of Insurance Covered Autos Liability $ Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Comprehensive $ Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Collision $ Actual Cash Value Or Cost Of Repair, Whichever Is Less, MinusSpecified$Causes Of Loss CA 20 01 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR – ADDITIONAL INSURED AND LOSS PAYEE © Insurance Services Office, Inc., 2011 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Deductible For Each Covered "Leased Auto" Deductible For Each Covered "Leased Auto" Deductible For Each Covered "Leased Auto" Each "Accident" Designation Or Description Of "Leased Autos": Page of ANY AUTO LEASED FOR A PERIOD OF SIX MONTHS OR MORE UNDER A LEASING CONTRACT OR AGREEMENT THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. 810-8M554728-24-26-G 04-01-24 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 810-8M554728-24-26-G 04-01-24 04-01-25 THERMAL MECHANICAL, INC. 425 ALDO AVE SANTA CLARA CA 95054 SEE SCHEDULE 1,000,000 1 3 COMMERCIAL AUTO CA 20 01 10 13© Insurance Services Office, Inc., 2011Pageof A.Coverage 1.Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2.For a "leased auto" designated or described in the Schedule, the Who Is An Insured pro- vision under Covered Autos Liability Cov- erage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily in- jury" or "property damage" resulting from the acts or omissions by: a.You; b.Any of your "employees" or agents; or c.Any person, except the lessor or any "employee" or agent of the lessor, operat- ing a "leased auto" with the permission of any of the above. 3.The coverages provided under this endorse- ment apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B.Loss Payable Clause 1.We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "leased auto". 2.The insurance covers the interest of the les- sor unless the "loss" results from fraudulent acts or omissions on your part. 3.If we make any payment to the lessor, we will obtain his or her rights against any other party. C.Cancellation 1.If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2.If you cancel the policy, we will mail notice to the lessor. 3.Cancellation ends this agreement. D.The lessor is not liable for payment of your pre- miums. E.Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. 2 3 CA 20 01 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: COMMERCIAL AUTO Schedule Extension LESSOR – ADDITIONAL INSURED AND LOSS PAYEE 810-8M554728-24-26-G Additional Insured (Lessor): ANY LESSOR UNDER A LEASING CONTRACT OR AGREEMENT OF SIX MONTHS OR MORE THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR. of© Insurance Services Office, Inc., 2011 PageCA 20 01 10 13 33 $ POLICY NUMBER: COMMERCIAL AUTO ISSUE DATE: CALIFORNIA UNINSURED MOTORISTS COVERAGE – BODILY INJURY AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Each "Accident"Limit Of Insurance: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA 21 54 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 4 For a covered "auto" licensed or principally garaged in, or "auto dealer operations" conducted in, California, this endorsement modifies insurance provided under the following: With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A.Coverage 1.We will pay all sums the "insured" is legally entitled to recover as compensatory damages from the owner or driver of an "uninsured motor vehicle". The damages must result from "bodily injury" sustained by the "insured" caused by an "accident". The owner's or driver's liability for these damages must result from the ownership, maintenance or use of the "uninsured motor vehicle". 2.We will pay only after the limits of liability under any liability bonds or policies have been exhausted by payment of judgments or settlements. 3.Any judgment for damages arising out of a "suit" brought without our written consent is not binding on us. B.Who Is An Insured If the Named Insured is designated in the Declarations as: 1.An individual, then the following are "insureds": a.The Named Insured and any "family members". b.Anyone else "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or destruction. c.Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". 2.A partnership, limited liability company, corporation or any other form of organization, then the following are "insureds": a.Anyone "occupying" a covered "auto" or a temporary substitute for a covered "auto". The covered "auto" must be out of service because of its breakdown, repair, servicing, "loss" or destruction. b.Anyone for damages he or she is entitled to recover because of "bodily injury" sustained by another "insured". C.Exclusions This insurance does not apply to any of the following: 1.Punitive or exemplary damages. 2.Any claim settled without our consent. However, this exclusion does not apply to a settlement made with the insurer of a vehicle described in Paragraph b. of the definition of "uninsured motor vehicle". 3.The direct or indirect benefit of any insurer or self-insurer under any workers' compensation, disability benefits or similar law or to the direct benefit of the United States, a state or its political subdivisions. 4."Bodily injury" sustained by: a.An individual Named Insured while "occupying" or when struck by any vehicle owned by that Named Insured that is not a covered "auto" for Uninsured Motorists Coverage under this Coverage Form; b.Any "family member" while "occupying" or when struck by any vehicle owned by that "family member" that is not a covered "auto" for Uninsured Motorists Coverage under this Coverage Form; or 810-8M554728-24-26-G 04-01-24 SEE CAT030 COMMERCIAL AUTO Page 2 of 4 © Insurance Services Office, Inc., 2016 CA 21 54 11 16 c.Any "family member" while "occupying" or when struck by any vehicle owned by the Named Insured that is insured for Uninsured Motorists Coverage on a primary basis under any other Coverage Form or policy. However, Exclusion 4. shall not apply to "bodily injury" sustained by an individual Named Insured or "family member" when struck by a vehicle owned by that "insured" and operated or caused to be operated by a person without that "insured's" consent in connection with criminal activity that has been documented in a police report and to which that "insured" is not a party to. 5."Bodily injury" sustained by an individual Named Insured or any "family member" while "occupying" any vehicle leased by that Named Insured or any "family member" under a written contract for a period of six months or more that is not a covered "auto". 6.Anyone using a vehicle without a reasonable belief that the person is entitled to do so. 7."Bodily injury" sustained by an "insured" while "occupying" any "auto" that is rented or leased to that "insured" for use as a public or livery conveyance. However, this exclusion does not apply if the "insured" is in the business of providing public or livery conveyance. As used in this exclusion, public or livery conveyance includes, but is not limited to, any period of time an "auto" is being used by an "insured" who is logged into a "transportation network platform" as a driver, whether or not a passenger is "occupying" the "auto". 8."Bodily injury" arising directly or indirectly out of: a.War, including undeclared or civil war; b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. D.Limit Of Insurance 1.Regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident", the most we will pay for all damages resulting from any one "accident" is the Limit Of Insurance for Uninsured Motorists Coverage shown in the Schedule or Declarations. 2.For a vehicle described in Paragraph b. of the definition of "uninsured motor vehicle", our Limit of Insurance shall be reduced by all sums paid because of "bodily injury" by or for anyone who is legally responsible, including all sums paid or payable under this policy's Covered Autos Liability Coverage. 3.No one will be entitled to receive duplicate payments for the same elements of "loss" under this coverage and any Liability Coverage form or Medical Payments Coverage endorsement attached to this Coverage Part. We will not make a duplicate payment under this coverage for any element of "loss" for which payment has been made by or for anyone who is legally responsible. We will not pay for any element of "loss" if a person is entitled to receive payment for the same element of "loss" under any workers' compensation, disability benefits or similar law. E.Changes In Conditions The Conditions are changed for California Uninsured Motorists Coverage – Bodily Injury as follows: 1.Duties In The Event Of Accident, Claim, Suit Or Loss in the Business Auto and Motor Carrier Coverage Forms and Duties In The Event Of Accident, Claim, Offense, Suit, Loss Or Acts, Errors Or Omissions in the Auto Dealers Coverage Form are changed by adding the following: a.Promptly notify the police if a hit-and-run driver is involved; and b.Send us copies of the legal papers if a "suit" is brought. In addition, a person seeking coverage under Paragraph b. of the definition of "uninsured motor vehicle" must: (1)Provide us with a copy of the complaint by personal service or certified mail if the "insured" brings an action against the owner or operator of such "uninsured motor vehicle"; (2)Within a reasonable time, make all pleadings and depositions available for copying by us or furnish us copies at our expense; and (3)Provide us with proof that the limits of insurance under any applicable liability bonds or policies have been exhausted by payment of judgments or settlements. CA 21 54 11 16 © Insurance Services Office, Inc., 2016 Page 3 of 4 COMMERCIAL AUTO 2.Legal Action Against Us is replaced by the following: Legal Action Against Us No legal action may be brought against us under this Coverage Form until there has been full compliance with all the terms of this Coverage Form and with respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle" unless within two years from the date of the "accident": a.Agreement as to the amount due under this insurance has been concluded; b.The "insured" has formally instituted arbitration proceedings against us. In the event that the "insured" decides to arbitrate, the "insured" must formally begin arbitration proceedings by notifying us in writing, sent by certified mail, return receipt requested; or c."Suit" for "bodily injury" has been filed against the uninsured motorist in a court of competent jurisdiction. Written notice of the "suit" must be given to us within a reasonable time after the "insured" knew, or should have known, that the other motorist is uninsured. In no event will such notice be required before two years from the date of the accident. Failure of the "insured" or his or her representative to give us such notice of the "suit" will relieve us of our obligations under this Coverage Form only if the failure to give notice prejudices our rights. 3.Transfer Of Rights Of Recovery Against Others To Us is replaced by the following: Transfer Of Rights Of Recovery Against Others To Us a.With respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle", if we make any payment, we are entitled to recover what we paid from other parties. Any person to or for whom we make payment must transfer to us his or her rights of recovery against any other party. This person must do everything necessary to secure these rights and must do nothing that would jeopardize them. b.With respect to Paragraph b. of the definition of "uninsured motor vehicle", if we make any payment and the "insured" recovers from another party, the "insured" shall hold the proceeds in trust for us and pay us back the amount we have paid. 4.Other Insurance in the Auto Dealers and Business Auto Coverage Forms and Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form are replaced by the following: If there is other applicable insurance available under one or more policies or provisions of coverage: a.The maximum recovery under all Coverage Forms or policies combined may equal but not exceed the highest applicable limit for any one vehicle under any Coverage Form or policy providing coverage on either a primary or excess basis. b.Any insurance we provide with respect to a vehicle the Named Insured does not own shall be excess over any other collectible uninsured motorists insurance providing coverage on a primary basis. c.If the coverage under this Coverage Form is provided: (1)On a primary basis, we will pay only our share of the "loss" that must be paid under insurance providing coverage on a primary basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on a primary basis. (2)On an excess basis, we will pay only our share of the "loss" that must be paid under insurance providing coverage on an excess basis. Our share is the proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on an excess basis. 5.The following condition is added: Arbitration a.If we and an "insured" disagree whether the "insured" is legally entitled to recover damages from the owner or driver of an "uninsured motor vehicle" or do not agree as to the amount of damages that are recoverable by that "insured", the disagreement will be settled by arbitration. Such arbitration may be initiated by a written demand for arbitration made by either party. The arbitration shall be conducted by a single neutral arbitrator. However, disputes concerning coverage under this endorsement may not be arbitrated. Each party will bear the expenses of the arbitrator equally. b.Unless both parties agree otherwise, arbitration will take place in the county in which the "insured" lives. Local rules of law Page 4 of 4 © Insurance Services Office, Inc., 2016 CA 21 54 11 16 COMMERCIAL AUTO as to arbitration procedures and evidence will apply. The decision of the arbitrator will be binding. F.Additional Definitions The following are added to the Definitions section: 1."Family member" means the individual Named Insured's spouse, whether or not a resident of the individual Named Insured's household, and any other person related to such Named Insured by blood, adoption, marriage or registered domestic partnership under California law, who is a resident of such Named Insured's household, including a ward or foster child. 2."Occupying" means in, upon, getting in, on, out or off. 3."Transportation network platform" means an online-enabled application or digital network used to connect passengers with drivers using vehicles for the purpose of providing prearranged transportation services for compensation. 4."Uninsured motor vehicle" means a land motor vehicle or "trailer": a.For which no liability bond or policy at the time of an "accident" provides at least the amounts required by the applicable law where a covered "auto" is principally garaged; b.That is an underinsured motor vehicle. An underinsured motor vehicle is a land motor vehicle or "trailer" for which the sum of all liability bonds or policies at the time of an "accident" provides at least the amounts required by the applicable law where a covered "auto" is principally garaged but that sum is less than the Limit of Insurance for this coverage; c.For which an insuring or bonding company denies coverage or refuses to admit coverage except conditionally or with reservation or becomes insolvent; d.That is a hit-and-run vehicle and neither the driver nor owner can be identified. The vehicle must make physical contact with an "insured", a covered "auto" or a vehicle an "insured" is "occupying"; or e.That is owned by an individual Named Insured or "family member" and operated or caused to be operated by a person without the owner's consent in connection with criminal activity that has been documented in a police report. However, "uninsured motor vehicle" does not include any vehicle: a.Owned or operated by a self-insurer under any applicable motor vehicle law except a self-insurer who is or becomes insolvent and cannot provide the amounts required by that motor vehicle law; b.Owned by the United States of America, Canada, a state or political subdivision of any of those governments or an agency of any of the foregoing; or c.Designed or modified for use primarily off public roads while not on public roads. COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM CA 99 48 10 13 © Insurance Services Office, Inc., 2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY – BROADENED COVERAGE FOR COVERED AUTOS – BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS Page 1 of 1 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. persal, seepage, migration, release or escape of "pollutants": a.Before the "pollutants" or any prop- erty in which the "pollutants" are con- tained are moved from the place where they are accepted by the "in- sured" for movement into or onto the covered "auto"; or b.After the "pollutants" or any property in which the "pollutants" are con- tained are moved from the covered "auto" to the place where they are fi- nally delivered, disposed of or aban- doned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from prem- ises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (1)The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the main- tenance or use of a covered "auto"; and (2)The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or damage. A.Covered Autos Liability Coverage is changed as follows: 1.Paragraph a. of the Pollution Exclusion ap- plies only to liability assumed under a con- tract or agreement. 2.With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B.Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D."Covered pollution cost or expense" means any cost or expense arising out of: 1.Any request, demand, order or statutory or regulatory requirement that any "in- sured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or 2.Any claim or "suit" by or on behalf of a governmental authority for damages be- cause of testing for, monitoring, cleaning up, removing, containing, treating, detoxi- fying or neutralizing, or in any way re- sponding to or assessing the effects of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dis- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SHORT TERM HIRED AUTO – ADDITIONAL INSURED AND LOSS PAYEE SCHEDULE Additional Insured (Lessor): Designation Or Description Of "Leased Autos": CA T4 52 02 16 Page 1 of 2© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO POLICY NUMBER:ISSUE DATE: This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM A.Coverage 1.Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow for Covered Autos Liability Coverage. 2.For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor of such "leased auto". However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a.You; b.Any of your "employees" or agents; or c.Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3.Coverage for any "leased auto" described in the Schedule applies until the end of the policy period shown in the Declarations or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B.Loss Payable Clause 1.We will pay, as interest may appear, you and the lessor, if your policy includes Hired Auto Physical Damage Coverage, for "loss" to a "leased auto". 2.The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. 3.If we make any payment to the lessor, we will obtain his or her rights against any other party. Any lessor of a "leased auto" under a leasing or rental agreement of less than 6 months. Any "leased auto" under a leasing or rental agreement of less than 6 months. 810-8M554728-24-26-G 04-01-24 Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA T4 52 02 16 C.The lessor is not liable for payment of your premiums. D.Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra "auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. COMMERCIAL AUTO AMENDMENT OF EMPLOYEE DEFINITION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA T4 59 02 15 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following replaces the definition of "employee" in the DEFINITIONS Section: "Employee" includes a "leased worker" and a "temporary worker". © 2015 The Travelers Indemnity Company. All rights reserved. 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 CA T4 99 02 16 © 2016 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 PROVISIONS 1.The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION Il – COVERED AUTOS LIABILITY COVERAGE: This includes any person or organization who you are required under a written contract or agreement, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to name as an additional insured for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent of that person's or organization's liability for the conduct of another "insured". 2.The following is added to Paragraph B.5., Other Insurance of SECTION IV – BUSINESS AUTO CONDITIONS: Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, this insurance is primary to and non-contributory with applicable other insurance under which an additional insured person or organization is a named insured when a written contract or agreement with you, that is signed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, requires this insurance to be primary and non- contributory. COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA T3 53 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT Page 1 of 4© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. 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 B.BLANKET ADDITIONAL INSURED C.EMPLOYEE HIRED AUTO D.EMPLOYEES AS INSURED E.SUPPLEMENTARY PAYMENTS – INCREASED LIMITS F.HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS G.WAIVER OF DEDUCTIBLE – GLASS PROVISIONS A.BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B.BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H.HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT I.PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT J.PERSONAL PROPERTY K.AIRBAGS L.NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M.BLANKET WAIVER OF SUBROGATION N.UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C.EMPLOYEE HIRED AUTO 1.The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2.The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV – BUSI- NESS AUTO CONDITIONS: b.For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1)Any covered "auto" you lease, hire, rent or borrow; and (2)Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your COMMERCIAL AUTO CA T3 53 02 15Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D.EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E.SUPPLEMENTARY PAYMENTS – INCREASED LIMITS 1.The following replaces Paragraph A.2.a.(2), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE: (2)Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2.The following replaces Paragraph A.2.a.(4), of SECTION II – COVERED AUTOS LIABIL- ITY COVERAGE: (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F.HIRED AUTO – LIMITED WORLDWIDE COV- ERAGE – INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION IV – BUSINESS AUTO CONDI- TIONS: (5)Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a)With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i)You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii)Neither you nor any other involved "insured" will make any settlement without our consent. (iii)We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv)We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE. (v)We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II – COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b)This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c)This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. COMMERCIAL AUTO CA T3 53 02 15 Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2015 The Travelers Indemnity Company. All rights reserved. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d)It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G.WAIVER OF DEDUCTIBLE – GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III – PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H.HIRED AUTO PHYSICAL DAMAGE – LOSS OF USE – INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION III – PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I.PHYSICAL DAMAGE – TRANSPORTATION EXPENSES – INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III – PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J.PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1)Owned by an "insured"; and (2)In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K.AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a.If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b.The airbags are not covered under any war- ranty; and c.The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L.NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV – BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: (a)You (if you are an individual); (b)A partner (if you are a partnership); (c)A member (if you are a limited liability com- pany); (d)An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e)Any "employee" authorized by you to give no- tice of the "accident" or "loss". M.BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV – BUSINESS AUTO CONDI- TIONS : 5.Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by COMMERCIAL AUTO CA T3 53 02 15Page 4 of 4 © 2015 The Travelers Indemnity Compa ny. All rights reserved . Includes copyrighted material of Insurance Services Office, Inc. with its permission. such contract. The waiver applies only to the person or organization designated in such contract. N.UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV – BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LOSS PAYABLE CLAUSE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA T4 45 04 09 © 2009 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 The following replaces the LOSS PAYABLE CLAUSE in the BUSINESS AUTO COVERAGE PART DECLARATIONS: LOSS PAYABLE CLAUSE A.We will pay you and the loss payee on file with us for "loss" to a covered "auto", as interest may ap- pear. B.The insurance covers the interest of the loss payee unless the "loss" results from conversion, secretion or embezzlement on your part. C.We may cancel the policy as allowed by the CANCELLATION Common Policy Condition. Cancellation ends this agreement as to the loss payee's interest. If we cancel the policy we will mail you and the loss payee the same advance notice. D.If we make any payment to the loss payee, we will obtain their rights against any other party. INTERLINE ENDORSEMENTS INTERLINE ENDORSEMENTS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF COMMON POLICY CONDITIONS – PROHIBITED COVERAGE – UNLICENSED INSURANCE AND TRADE OR ECONOMIC SANCTIONS This endorsement modifies insurance provided under the following: ALL COVERAGES INCLUDED IN THIS POLICY IL T4 12 03 15 © 2014 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 The following is added to the Common Policy Condi- tions: Prohibited Coverage – Unlicensed Insurance 1.With respect to loss sustained by any insured, or loss to any property, located in a country or juris- diction in which we are not licensed to provide this insurance, this insurance does not apply to the extent that insuring such loss would violate the laws or regulations of such country or jurisdic- tion. 2.We do not assume responsibility for: a.The payment of any fine, fee, penalty or other charge that may be imposed on any person or organization in any country or jurisdiction because we are not licensed to provide insur- ance in such country or jurisdiction; or b. The furnishing of certificates or other evi- dence of insurance in any country or jurisdic- tion in which we are not licensed to provide insurance. Prohibited Coverage – Trade Or Economic Sanc- tions We will provide coverage for any loss, or otherwise will provide any benefit, only to the extent that provid- ing such coverage or benefit does not expose us or any of our affiliated or parent companies to: 1.Any trade or economic sanction under any law or regulation of the United States of America; or 2.Any other applicable trade or economic sanction, prohibition or restriction. ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY IL 00 21 09 08 © ISO Properties, Inc., 2007 Page 1 of 2 1.The insurance does not apply: A. Under any Liability Coverage, to "bodily in- jury" or "property damage": (1) With respect to which an "insured" under the policy is also an insured under a nu- clear energy liability policy issued by Nu- clear Energy Liability Insurance Associa- tion, Mutual Atomic Energy Liability Un- derwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an insured under any such pol- icy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "insured" is, or had this policy not been issued would be, entitled to indem- nity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. B. Under any Medical Payments coverage, to expenses incurred with respect to "bodily in- jury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to "bodily in- jury" or "property damage" resulting from "hazardous properties" of "nuclear material", if: (1) The "nuclear material" (a) is at any "nu- clear facility" owned by, or operated by or on behalf of, an "insured" or (b) has been discharged or dispersed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time pos- sessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an "insured"; or (3) The "bodily injury" or "property damage" arises out of the furnishing by an "in- sured" of services, materials, parts or equipment in connection with the plan- ning, construction, maintenance, opera- tion or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or pos- sessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "spe- cial nuclear material" or "by-product material". "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel com- ponent, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". Page 2 of 2 © ISO Properties, Inc., 2007 IL 00 21 09 08 "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentra- tion of uranium or thorium from any ore proc- essed primarily for its "source material" content, and (b) resulting from the operation by any per- son or organization of any "nuclear facility" in- cluded under the first two paragraphs of the defi- nition of "nuclear facility". "Nuclear facility" means: (a)Any "nuclear reactor"; (b) Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; (c) Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the "insured" at the premises where such equipment or device is lo- cated consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; (d) Any structure, basin, excavation, prem- ises or place prepared or used for the storage or disposal of "waste"; and includes the site on which any of the forego- ing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self- supporting chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioac- tive contamination of property. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES – CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A.Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 1 of 4 Page 2 of 4 © Insurance Services Office, Inc., 2020 IL 02 70 07 20 (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b.We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. B.The following provision is added to the Cancellation Common Policy Condition: 7.Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part – Farm Property – Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b.We may not cancel this policy solely because the first Named Insured has: (1)Accepted an offer of earthquake coverage; or (2)Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c.We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part – Causes Of Loss – Special Form; or (2)Farm Coverage Part – Causes Of Loss Form – Farm Property, Paragraph D. Covered Causes Of Loss – Special. d.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not cancel this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may cancel: (1)When you have not paid the premium, at any time by letting you know at least 10 days before the date cancellation takes effect; (2)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. C.The following is added and supersedes any provisions to the contrary: Nonrenewal 1.Subject to the provisions of Paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part – Farm Property – Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a.If this policy provides coverage as described in the preceding paragraph, and we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer record at the mailing address shown in the policy, at least 75 days, but not more than 120 days, before the expiration or anniversary date. If we fail to give the first Named Insured shown in the Declarations notice of nonrenewal at least 75 days prior to the policy expiration, as required in the paragraph above, this policy, with no change in its terms and conditions, shall remain in effect for 75 days from the date that the notice of nonrenewal is delivered or mailed to the Named Insured. A notice to this effect shall be provided by us to the first Named Insured with the notice of nonrenewal. b.We may elect not to renew such coverage for any reason, except as provided in Paragraphs c., d. and e. below. c.We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1)The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law; (2)The Commissioner of Insurance finds that the exposure to potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of those claims; or IL 02 70 07 20 © Insurance Services Office, Inc., 2020 Page 3 of 4 Page 4 of 4 © Insurance Services Office, Inc., 2020 IL 02 70 07 20 (3)We have: (a)Lost or experienced a substantial reduction in the availability or scope of reinsurance coverage; or (b)Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. d.We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority, that included an earthquake policy premium surcharge. e.We will not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (e.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1)Commercial Property Coverage Part – Causes Of Loss – Special Form; or (2)Farm Coverage Part – Causes Of Loss Form – Farm Property, Paragraph D. Covered Causes Of Loss – Special. f.If a state of emergency under California Law is declared and the residential property is located in any ZIP Code within or adjacent to the fire perimeter, as determined by California Law, we may not nonrenew this policy for one year, beginning from the date the state of emergency is declared, solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However, we may nonrenew: (1)If willful or grossly negligent acts or omissions by the Named Insured, or his or her representatives, are discovered that materially increase any of the risks insured against; (2)If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal; or (3)If there are physical changes in the property insured against, beyond the catastrophe-damaged condition of the structures and surface landscape, which result in the property becoming uninsurable. 3.We are not required to send notice of nonrenewal in the following situations: a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. COVERAGES AND DEDUCTIBLEDESIGNATED VEHICLE(S) A = Comprehensive 6. INSURANCE Coverages: Vehicles - B = Specified Perils to 2. NAMED INSURED: Policy Number: C = Collision INSURANCE–FORM A LENDER'S CERTIFICATE OF 5. INSURING COMPANY: 4. POLICY PERIOD: 1. CERTIFICATE HOLDER: Issue Date: ANY LESSOR UNDER A LEASING CONTRACT OR AGREEMENT OF SIX MONTHS OR MORE THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR. The policy names the Certificate Holder as a Loss Payee according to its Loss Payable Clause (see item 7. Special Provisions), for the vehicles described below: 3. CERTIFICATION - We certify that we have issued the policy to the Named Insured for the policy period as identified in this Certificate. Notwithstanding any requirements, terms or conditions of any contract or other document with respect to which this Certificate may be issued, the insurance is that which we customarily provide for the coverage indicated in item 6. below. This Certificate is issued as a matter of information only and does not amend, extend or alter the coverage afforded by the policy. 04-01-24 04-01-25 810-8M554728-24-26-G TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 425 ALDO AVE SANTA CLARA CA 95054 THERMAL MECHANICAL, INC. 04-01-24 PO Box 64095 St. Paul, MN 55102-0095 ANY AUTO LEASED FOR A PERIOD OF SIX MONTHS OR MORE UNDER A LEASING CONTRACT OR AGREEMENT THAT REQUIRES YOU TO PROVIDE DIRECT PRIMARY INSURANCE FOR THE LESSOR. See IL T8 25 PageIL T0 10 12 86 of1 2 Authorized Representative IL T0 10 12 86 Page of Issue Date: INSURANCE–FORM A Policy Number: LENDER'S CERTIFICATE OF COUNTERSIGNED BY: 7.SPECIAL PROVISIONS: LOSS PAYABLE CLAUSE A.We will pay you and the loss payee named in the policy for "loss" to a covered "auto", as interest may appear. B.The insurance covers the interest of the loss payee unless the "loss" results from conversion, secretion or embezzlement on your part. C.We may cancel the policy as allowed by the CANCELLATION Common Policy Condition. Cancellation ends this agreement as to the loss payee's interest. If we cancel the policy we will mail you and the loss payee the same advance notice. D.If we make any payment to the loss payee, we will obtain their rights against any other party notice. 8.NOTICE OF CANCELLATION – If we elect to cancel the policy or the Coverage Part which applies to the property described in item 6. of this Certificate, we will mail to the Certificate Holder written notice at least 10 days before the date our cancellation takes effect. If more than 10 days notice to the Certificate Holder is provided in this Certificate or is required by law, we will mail written notice according to such provision or requirement. 9.DEFINITIONS – As defined in the policy, the words "we," "us" and "our" refer to the Company providing this insurance. The words "you" and "your" refer to the Named Insured shown in the Declarations of the policy. 2 2 04-01-24 810-8M554728-24-26-G POLICYHOLDER NOTICES POLICYHOLDER NOTICES IMPORTANT NOTICE – INDEPENDENT AGENT AND BROKER COMPENSATION NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please visit www.travelers.com, call our toll-free telephone number 1-866-904-8348, or request a written copy from Marketing at One Tower Square, 2GSA, Hartford, CT 06183. PN T4 54 01 08 Page 1 of 1 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 3 FO R D F 3 5 0 1F D W F 3 6 S 7 3 E A 1 3 9 1 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 19 9 7 FO R D F 3 5 0 3F E K F 3 7 G 8 V M A 5 2 8 7 2 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 19 8 4 SC I S S O R L I F T R A I L E R 1J 9 D E 2 G 1 9 E F 0 1 5 2 8 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 6 FO R D E C O N O L I N E 1F T N E 2 4 W 3 6 H B 2 2 8 7 8 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 6 FO R D F 2 5 0 1F T N F 2 0 5 7 6 E B 8 0 1 1 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 6 FO R D F 3 5 0 1F D W F 3 6 Y X 6 E B 8 0 1 1 7 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 6 FO R D F 1 5 0 1F T P F 1 2 5 7 6 N A 9 8 0 3 2 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 0 6 LI N C O L N M A R K L T 5L T P W 1 8 5 7 6 F J 2 3 5 1 2 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D E C O N O L I N E 1F T N E 1 E W 5 B D B 0 1 1 5 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D E C O N O L I N E 1F T N E 1 E W 6 B D A 4 7 9 2 7 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D E C O N O L I N E 1F T N E 1 E W 8 B D A 4 7 9 2 8 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 1 5 0 1F T M F 1 C M X B K E 1 9 8 4 2 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 1 5 0 1F T M F 1 C M 1 B K E 1 9 8 4 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 1 5 0 1F T M F 1 C M 5 B K E 1 9 8 4 5 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 1 5 0 1F T M F 1 C M 3 B K E 1 9 8 4 4 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 1 5 0 1F T M F 1 C M 7 B K E 1 9 8 4 6 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 1 FO R D F 6 5 0 3F R N F 6 F B 0 B V 6 5 3 0 1 9 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 2 FO R D E S C A P E 1F M C U 0 E G X C K C 0 9 4 1 8 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 4 FO R D F 4 5 0 1F D U F 4 G Y X E E A 3 4 5 3 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 4 FO R D F 1 5 0 1F T M F 1 C M 6 E K F 1 1 0 9 6 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 4 FO R D F 1 5 0 1F T M F 1 C M 4 E K E 9 8 5 4 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 4 FO R D F 1 5 0 1F T M F 1 C M 6 E K E 9 8 5 4 4 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 3 FO R D E C O N O L I N E 1F T N E 1 E W 7 D D A 9 5 3 9 1 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 3 FO R D E C O N O L I N E 1F T N E 1 E W 9 D D A 9 5 3 9 2 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 3 FO R D E C O N O L I N E 1F T N E 1 E W 0 D D A 9 5 3 9 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 3 FO R D E C O N O L I N E 1F T N E 1 E W 2 D D A 9 5 3 9 4 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 3 FO R D E C O N O L I N E 1F T N E 1 E W 3 D D A 9 7 4 0 0 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 5 FO R D M U S T A N G 1F A 6 P 8 C F X F 5 4 3 1 7 2 6 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 3 G K F 0 0 3 6 7 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 1 G K F 0 0 3 6 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 5 G K F 0 0 3 7 1 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 3 G K F 0 0 3 7 0 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 7 G K F 0 0 3 6 9 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 5 G K F 0 0 3 6 8 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 X G K F 0 0 3 6 5 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 8 G K F 0 0 3 6 4 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T M F 1 C 8 7 G K F 0 0 3 7 2 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 6 FO R D F 1 5 0 1F T E X 1 C 8 5 G K G 0 3 0 3 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 7 H K A 1 2 3 4 5 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 5 H K A 1 2 3 4 4 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 9 H K A 1 2 3 4 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 0 H K A 1 2 3 4 7 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 3 H K A 1 2 3 4 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 9 H K B 2 9 3 4 4 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 2 H K B 2 9 3 4 6 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 6 H K B 2 9 3 4 8 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 8 FO R D F 1 5 0 1F T M F 1 C B 1 J K E 7 2 7 0 3 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 8 FO R D F 1 5 0 1F T M F 1 C B 3 J K E 7 2 7 0 4 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 8 FO R D F 1 5 0 1F T N F 1 E G 4 J K E 2 3 8 5 0 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 8 FO R D F 1 5 0 1F T E W 1 C P 2 J K E 5 9 6 8 4 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 9 FO R D T R A N S I T 1F T Y R 1 Y M 4 K K A 0 9 5 6 9 CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 7 FO R D T R A N S I T 1F T Y R 1 Y M 4 H K B 2 9 3 4 7 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . CA L I F O R N I A I N S U R A N C E I D E N T I F I C A T I O N C A R D Th e v e h i c l e d e s c r i b e d b e l o w i s c o v e r e d b y a c o m m e r c i a l l i a b i l i t y p o l i c y t h a t m e e t s t h e re q u i r e m e n t s o f C V C § 1 6 0 5 6 o r 1 6 5 0 0 . 5 . NA I C # : Co m p a n y : ON E T O W E R S Q U A R E , H A R T F O R D , C T 0 6 1 8 3 Po l i c y N u m b e r Ef f e c t i v e D a t e Ex p i r a t i o n D a t e Ye a r Ma k e / M o d e l Ve h i c l e I d e n t i f i c a t i o n N u m b e r In s u r e d CA I D C A R e v . 1 2 - 0 6 Se e I m p o r t a n t N o t i c e o n R e v e r s e S i d e 25 6 7 4 TR A V E L E R S P R O P E R T Y C A S U A L T Y C O M P A N Y O F A M E R I C A 8M 5 5 4 7 2 8 - 8 1 0 04 - 0 1 - 2 4 04 - 0 1 - 2 5 TH E R M A L M E C H A N I C A L I N C 42 5 A L D O A V E SA N T A C L A R A C A 9 5 0 5 4 20 1 8 FO R D F 1 5 0 1F T M F 1 C B X J K E 7 2 7 0 2 IN C A S E O F A N A C C I D E N T * C a l l T r a v e l e r s i m m e d i a t e l y . 1- 8 0 0 - 2 3 8 - 6 2 2 5 24 H O U R C L A I M R E P O R T I N G S E R V I C E * B e s u r e t o g e t n a m e a n d a d d r e s s o f e a c h d r i v e r , p a s s e n g e r , a n d w i t n e s s ; an d i n s u r a n c e c o m p a n y a n d p o l i c y n u m b e r f o r e a c h v e h i c l e i n v o l v e d . * D o n o t a s s u m e r e s p o n s i b i l i t y f o r a c c i d e n t . * C a l l p o l i c e . * P r o t e c t a g a i n s t f u r t h e r d a m a g e . * R e q u e s t m e d i c a l a s s i s t a n c e , i f r e q u i r e d . * O n l y d i s c u s s t h e a c c i d e n t w i t h p o l i c e o f f i c e r s o r T r a v e l e r s r e p r e s e n t a t i v e s . IM P O R T A N T L E G A L I N F O R M A T I O N CA I D C A ( B a c k ) Ca l i f o r n i a l a w r e q u i r e s t h a t e v i d e n c e o f f i n a n c i a l r e s p o n s i b i l i t y b e c a r r i e d i n y o u r v e h i c l e a t a l l ti m e s . T h i s c a r d m e e t s t h a t r e q u i r e m e n t a n d p r o v i d e s n e c e s s a r y i n f o r m a t i o n i n c a s e y o u a r e re q u e s t e d t o s h o w p r o o f o f i n s u r a n c e t o a l a w e n f o r c e m e n t o f f i c e r o r a r e i n v o l v e d i n a n ac c i d e n t . Report Claims Immediately by Calling* Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE POLICY A Custom Insurance Policy Prepared for: 1-877-828-4132 THERMAL MECHANICAL, INC. 425 ALDO AVENUE SANTA CLARA CA 95054 President Secretary EU 00 06 08 18 This policy consists of this policy cover, the Policy Declarations and the Policy Forms, and endorsements listed in that declaration form. In return for payment of the premium, we agree with the Named Insured to provide the insurance afforded by this policy. That insurance will be provided by the company indicated as insuring company in the Declarations by the abbreviation of its name. The company listed below (a stock company) has executed this policy, but it is valid only if countersigned on the Declarations by our authorized representative. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA (TIL) EFFECTIVE DATE: POLICY NUMBER: ISSUE DATE: CUP-1S615672-24-26 04/03/2024 04/01/2024 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS FORMS ENDORSEMENTS AND SCHEDULE NUMBERSIL T8 01 01 01 UMBRELLA / EXCESS POLICY DECLARATIONS EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE POLICY EU 00 02 09 20 SCHEDULE OF UNDERLYING INSURANCEEU 00 03 08 18 EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCEEU 00 01 07 16 AMENDMENT OF COVERAGE - DEFINITIONSEU 02 34 07 16 WAIVER OF RIGHTS OF RECOVERY FROM OTHERSEU 02 89 07 16 AMEND WHO IS INSD - DESIG PERSON, ORGEU 02 97 07 16 AUTO POLLUTION EXCLUSION WITH LIMITED EXCEPTIONS - COVERAGE A EU 03 21 08 18 CONSTRUCTION IDENTIFIED HAZARDS EXCLUSIONS - COVERAGE B EU 03 22 08 18 FUNGI OR BACTERIA EXCLUSION - COVERAGE BEU 03 35 08 18 NON CUMULATION OF OCCURRENCE LIMITEU 03 46 08 18 COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS EU 01 44 07 16 CAP LOSSES - CERT ACTS TERRORSM AND EXCLEU 00 07 07 16 NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) - COVERAGES A AND B EU 02 09 08 18 POLLUTION NOT RELATED TO AUTOS EXCLUSION WITH LIMITED EXCEPTIONS - COVERAGE A EU 02 16 04 20 DESIGNATED EXPOSURE EXCLUSION - COVERAGE BEU 03 04 08 18 AIR LIAB EXCL-SERV FOR HIRE LTD EXCEPTEU 03 12 10 20 DISCRIMINATION EXCLUSION - COVERAGE BEU 03 31 08 18 LEAD EXCLUSION - COVERAGE BEU 03 44 08 18 SILICA OR SILICA-RELATED DUST EXCLUSION - COVERAGE BEU 03 63 08 18 INTELLECTUAL PROPERTY EXCLUSION - COVERAGE BEU 04 21 09 21 VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS EXCLUSION - COVERAGE B EU 04 44 01 23 CALIFORNIA CHANGESEU 00 33 11 16 INTERLINE ENDORSEMENTS FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSUREIL T3 68 01 21 IL T8 01 01 01 PAGE:OF 11 PREMIUM SPLIT FORM POLICY NUMBER: ISSUE DATE: EFFECTIVE DATE: EXPIRATION DATE: INSURED'S NAME: ACCT.EFF.PREMIUMS.B.DATEMO.TOTAL EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE CUP-1S615672-24-26 04/03/2024 04/01/2024 04/01/2025 THERMAL MECHANICAL, INC. 8,716.00 8,716.0004/24 04/01/2024 8,716.00 8,716.0005/24 05/01/2024 8,716.00 8,716.0006/24 06/01/2024 8,716.00 8,716.0007/24 07/01/2024 8,716.00 8,716.0008/24 08/01/2024 8,716.00 8,716.0009/24 09/01/2024 8,716.00 8,716.0010/24 10/01/2024 8,716.00 8,716.0011/24 11/01/2024 8,716.00 8,716.0012/24 12/01/2024 8,716.00 8,716.0001/25 01/01/2025 87,160.00 87,160.00 OFFICE: PRODUCER NAME: Page 1 of 1 CG D0 31 10 91 WALNUT CREEK CA 418 RSC INS BROKERAGE INC HE839 POLICY DECLARATIONS EXCESS FOLLOW-FORM AND UMBRELLA POLICY NO.: LIABILITY INSURANCE POLICY ISSUE DATE: INSURING COMPANY: 1.NAMED INSURED AND MAILING ADDRESS: 2.POLICY PERIOD: From to 12:01 A.M. Standard Time at your mailing address. 3.LIMITS OF INSURANCE: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY Occurrence Limit 4.SELF-INSURED RETENTION:any one occurrence or event 5.PREMIUM: $Flat Charge Adjustable (See Premium Schedule) 6.TAXES AND SURCHARGES: 7. 8. 9. NAME AND ADDRESS OF AGENT OR BROKER:COUNTERSIGNED BY: Page 1 of 1© 2019 The Travelers Indemnity Company. All rights reserved.EU 00 02 09 20 COVERAGES LIMITS OF LIABILITY AGGREGATE LIMITS OF LIABILITY General Aggregate Products-Completed Operations Aggregate CRISIS MANAGEMENT SERVICE EXPENSES all Crisis Management Events Authorized Representative DATE: OFFICE: One Tower Square, Hartford, Connecticut 06183 On the effective date shown in Item 2., the Excess Follow-Form And Umbrella Liability Insurance Policy numbered above includes this Declarations Page and any forms and endorsements shown on the Listing Of Forms, Endorsements And Schedule Numbers. If the Schedule Of Underlying Insurance includes any coverage provided on a claims-made basis, then the following disclaimer applies. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING CLAIMS-MADE UNDERLYING INSURANCE. If the Schedule Of Underlying Insurance includes any coverage which includes defense expenses within the limits of liability, then the following disclaimer applies: DEFENSE EXPENSES ARE PAYABLE WITHIN, AND ARE NOT IN ADDITION TO, THE LIMITS OF INSURANCE WITH RESPECT TO SOME OR ALL OF THE COVERAGES PROVIDED. CUP-1S615672-24-26 04/03/2024 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA THERMAL MECHANICAL, INC. 425 ALDO AVENUE SANTA CLARA CA 95054 04/01/2024 $5,000,000 $5,000,000 $5,000,000 $50,000 $10,000 87,160 X RSC INS BROKERAGE INC - HE839 1350 BAYSHORE HWY STE 125 BURLINGAME CA 94010-1829 WALNUT CREEK CA 04/01/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA POLICY NUMBER:ISSUE DATE:CUP-1S615672-24-26 04/03/2024 From: Carrier Policy Number to: Policy Period Employee Benefits Liability Limits Of Liability Each Employee Aggregate THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT CO-8G80535A-24 04/01/2024 04/01/2025 $1,000,000 $2,000,000 From: Carrier Policy Number to: Policy Period Commercial General Liability Limits Of Liability THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT CO-8G80535A-24 Personal and Advertising Injury Products-Completed Operations Aggregate General Aggregate Each Occurrence 04/01/2024 04/01/2025 $2,000,000 $2,000,000 $1,000,000 $1,000,000 Limits Of Liability From: Carrier to: Policy Number Policy Period Employers Liability TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA UB-003K219589-24 Bodily Injury By Accident Each Accident Bodily Injury By Disease Policy Limit Bodily Injury By Disease Each Employee *UNLIMITED IN THE STATE OF NEW YORK FOR SUBJECT EMPLOYEES 04/01/2024 04/01/2025 $1,000,000* $1,000,000* $1,000,000* OFFICE: © 2018 The Travelers Indemnity Company. All rights reserved.EU 00 03 08 18 ofPage PRODUCER: 1 RSC INS BROKERAGE INC 2 WALNUT CREEK CA 418 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA POLICY NUMBER:ISSUE DATE:CUP-1S615672-24-26 04/03/2024 Policy Number to: From: Policy Period Carrier Limits Of LiabilityAutomobile Liability TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 810-008M554728-24 Bodily Injury And Property Damage Combined Single Limit 04/01/2024 04/01/2025 $1,000,000 From: Carrier Policy Number to: Policy Period Limits Of Liability From: Carrier Policy Number to: Policy Period Limits Of Liability OFFICE: © 2018 The Travelers Indemnity Company. All rights reserved.EU 00 03 08 18 ofPage PRODUCER: 2 RSC INS BROKERAGE INC 2 WALNUT CREEK CA 418 UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 1 of 22 EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE THIS POLICY, IN PART, PROVIDES FOLLOW-FORM LIABILITY COVERAGE. COVERAGE WILL APPLY ON A CLAIMS-MADE BASIS WHEN FOLLOWING CLAIMS-MADE UNDERLYING INSURANCE. COVERAGE WILL APPLY ON A DEFENSE-WITHIN-LIMITS BASIS WHEN FOLLOWING UNDERLYING INSURANCE UNDER WHICH DEFENSE EXPENSES ARE PAYABLE WITHIN, AND NOT IN ADDITION TO, THE LIMITS OF INSURANCE. WHEN FOLLOWING SUCH UNDERLYING INSURANCE, PAYMENT OF DEFENSE EXPENSES UNDER THIS POLICY WILL REDUCE, AND MAY EXHAUST, THE LIMITS OF INSURANCE OF THIS POLICY. PLEASE READ THE ENTIRE POLICY CAREFULLY. Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations and any other person or organization qualifying as a Named Insured under this policy. The words "we", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under SECTION II – WHO IS AN INSURED. Other words and phrases that appear in quotation marks have special meaning. Refer to SECTION VI – DEFINITIONS. SECTION I – COVERAGES A.COVERAGE A – EXCESS FOLLOW-FORM LIABILITY 1.We will pay on behalf of the insured those sums, in excess of the "applicable underlying limit", that the insured becomes legally obligated to pay as damages to which Coverage A of this insurance applies, provided that the "underlying insurance" would apply to such damages but for the exhaustion of its applicable limits of insurance. If a sublimit is specified in any "underlying insurance", Coverage A of this insurance applies to damages that are in excess of that sublimit only if such sublimit is shown for that "underlying insurance" in the Schedule Of Underlying Insurance. 2.Coverage A of this insurance is subject to the same terms, conditions, agreements, exclusions and definitions as the "underlying insurance", except with respect to any provisions to the contrary contained in this insurance. 3.The amount we will pay for damages is limited as described in SECTION III – LIMITS OF INSURANCE. 4.For the purposes of Paragraph 1. above: a.The applicable limit of insurance stated for the policies of "underlying insurance" in the Schedule Of Underlying Insurance will be considered to be reduced or exhausted only by the following payments: (1)Payments of judgments or settlements for damages that are covered by that "underlying insurance". However, if such "underlying insurance" has a policy period which differs from the policy period of this Excess Follow-Form And Umbrella Liability Insurance, any such payments for damages that would not be covered by this Excess Follow-Form And Umbrella Liability UMBRELLA Page 2 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 Insurance because of its different policy period will not reduce or exhaust the applicable limit of insurance stated for such "underlying insurance"; (2)Payments of "medical expenses" that are covered by that "underlying insurance" and are incurred for "bodily injury" caused by an accident that takes place during the policy period of this Excess Follow-Form And Umbrella Liability Insurance; or (3)Payments of defense expenses that are covered by that "underlying insurance", only if such "underlying insurance" includes such payments within the limits of insurance. However, if such "underlying insurance" has a policy period which differs from the policy period of this Excess Follow- Form And Umbrella Liability Insurance, any such payments for defense expenses that would not be covered by this Excess Follow-Form And Umbrella Liability Insurance because of its different policy period will not reduce or exhaust the applicable limit of insurance stated for such "underlying insurance". If the applicable limit of insurance stated for the policies of "underlying insurance" in the Schedule Of Underlying Insurance is actually reduced or exhausted by other payments, Coverage A of this insurance is not invalidated. However, in the event of a loss, we will pay only to the extent that we would have paid had such limit not been actually reduced or exhausted by such other payments. b.If any "underlying insurance" has a limit of insurance greater than the amount shown for that insurance in the Schedule of Underlying Insurance, this insurance will apply in excess of that greater amount. If any "underlying insurance" has a limit of insurance, prior to any reduction or exhaustion by payment of damages, "medical expenses" or defense expenses described in Paragraph a. above, that is less than the amount shown for that insurance in the Schedule Of Underlying Insurance, this insurance will apply in excess of the amount shown for such insurance in the Schedule Of Underlying Insurance. 5.When the "underlying insurance" applies on a claims-made basis and includes a retroactive date provision, the retroactive date for Coverage A of this insurance is the same as the retroactive date of that "underlying insurance". B.COVERAGE B – UMBRELLA LIABILITY 1.We will pay on behalf of the insured those sums in excess of the "self-insured retention" that the insured becomes legally obligated to pay as damages because of "bodily injury", "property damage", "personal injury" or "advertising injury" to which Coverage B of this insurance applies. 2.Coverage B of this insurance applies to "bodily injury" or "property damage" only if: a.The "bodily injury" or "property damage" is caused by an "occurrence" that takes place anywhere in the world; b.The "bodily injury" or "property damage" occurs during the policy period; and c.Prior to the policy period, no insured listed under Paragraph 1. in Paragraph B., COVERAGE B – UMBRELLA LIABILITY, of SECTION II – WHO IS AN INSURED and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, in whole or in part, then any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. 3.Coverage B of this insurance applies to "personal injury" or "advertising injury" caused by an offense arising out of your business, but only if the offense was committed during the policy period anywhere in the world. 4.The amount we will pay for damages is limited as described in SECTION III – LIMITS OF INSURANCE. 5."Bodily injury" or "property damage": a.Which occurs during the policy period; and b.Which was not prior to, but was during, the policy period known to have occurred by any insured listed under Paragraph 1. in Paragraph B., COVERAGE B – UMBRELLA LIABILITY of SECTION II – WHO IS AN INSURED, or any "employee" authorized by you to give notice of an "occurrence" or claim; UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 3 of 22 includes any continuation, change or resumption of the "bodily injury" or "property damage" after the end of the policy period. 6."Bodily injury" or "property damage" will be deemed to have been known to have occurred at the earliest time when any insured listed under Paragraph 1. in Paragraph B., COVERAGE B – UMBRELLA LIABILITY, of SECTION II – WHO IS AN INSURED or any "employee" authorized by you to give or receive notice of an "occurrence" or claim: a.Reports all, or any part, of the "bodily injury" or "property damage" to us or any other insurer; b.Receives a written or verbal demand or claim for damages because of the "bodily injury" or "property damage"; or c.Becomes aware by any other means that the "bodily injury" or "property damage" has occurred or has begun to occur. 7.Damages because of "bodily injury" include damages claimed by any person or organization for care, loss of services or death resulting at any time from the "bodily injury". 8.Coverage B of this insurance does not apply to damages covered by any "underlying insurance" or that would have been covered by any "underlying insurance" but for the exhaustion of its applicable limit of insurance. C.COVERAGE C – CRISIS MANAGEMENT SERVICE EXPENSES 1.We will reimburse the insured, or pay on the insured's behalf, "crisis management service expenses" to which Coverage C applies. 2.Coverage C of this insurance applies to "crisis management service expenses" that: a.Arise out of a "crisis management event" that first commences during the policy period; b.Are incurred by the insured, after a "crisis management event" first commences and before such event ends; and c.Are submitted to us within 180 days after the "crisis management advisor" advises you that the "crisis management event" no longer exists. 3.A "crisis management event" will be deemed to: a.First commence at the time when any "executive officer" first becomes aware of an "event" or "occurrence" that leads to that "crisis management event"; and b.End when we decide that the crisis no longer exists or when the Crisis Management Service Expenses Limit has been exhausted, whichever occurs first. 4.The amount we will pay for "crisis management service expenses" is limited as described in SECTION III – LIMITS OF INSURANCE. 5.A "self-insured retention" does not apply to "crisis management service expenses". 6.Any payment of "crisis management service expenses" that we make will not be determinative of our obligations under this insurance with respect to any claim or "suit" or create any duty to defend or indemnify any insured for any claim or "suit". D.DEFENSE AND SUPPLEMENTARY PAYMENTS 1.We will have the right and duty to defend the insured: a.Under Coverage A, against a "suit" seeking damages to which such coverage applies, if: (1)The "applicable underlying limit" is the applicable limit of insurance stated for a policy of "underlying insurance" in the Schedule Of Underlying Insurance and such limit has been exhausted solely due to payments as permitted in Paragraphs 4.a.(1), (2) and (3) of COVERAGE A – EXCESS FOLLOW-FORM LIABILITY of SECTION I – COVERAGES; or (2)The "applicable underlying limit" is the applicable limit of any "other insurance" and such limit has been exhausted by payments of judgments, settlements or medical expenses, or related costs or expenses (if such costs or expenses reduce such limits). For any "suit" for which we have the right and duty to defend the insured under Coverage A, defense expenses will be within the limits of insurance of this policy when such expenses are within the limits of insurance of the applicable "underlying insurance"; or b.Under Coverage B, against a "suit" seeking damages to which such coverage applies. 2.We have no duty to defend any insured against any "suit": a.Seeking damages to which this insurance does not apply; or b.If any other insurer has a duty to defend. UMBRELLA Page 4 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 3.When we have the duty to defend, we may, at our discretion, investigate and settle any claim or "suit". In all other cases, we may, at our discretion, participate in the investigation, defense and settlement of any claim or "suit" for damages to which this insurance may apply. If we exercise such right to participate, all expenses we incur in doing so will not reduce the applicable limits of insurance. 4.Our duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements, or defense expenses if such expenses are within the limits of insurance of this policy. 5.We will pay, with respect to a claim we investigate or settle, or "suit" against an insured we defend: a.All expenses we incur. b.The cost of: (1)Bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which this insurance applies; or (2)Appeal bonds and bonds to release attachments; but only for bond amounts within the applicable limit of insurance. We do not have to furnish these bonds. c.All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of such claim or "suit", including actual loss of earnings up to $1,000 a day because of time off from work. d.All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. e.Prejudgment interest awarded against the insured on that part of the judgment we pay. If we make an offer to pay the applicable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. f.All interest that accrues on the full amount of any judgment after entry of the judgment and before we have paid, offered to pay or deposited in court the part of the judgment that is within the applicable limit of insurance. If we do not pay part of the judgment for any reason other than it is more than the applicable limit of insurance, we will not pay any interest that accrues on that portion of the judgment. With respect to a claim we investigate or settle, or "suit" against an insured we defend under COVERAGE A – EXCESS FOLLOW- FORM LIABILITY, these payments will not reduce the applicable limits of insurance, but only if the applicable "underlying insurance" provides for such payments in addition to its limits of insurance. With respect to a claim we investigate or settle, or "suit" against an insured we defend under COVERAGE B – UMBRELLA LIABILITY, these payments will not reduce the applicable limits of insurance. SECTION II – WHO IS AN INSURED A.COVERAGE A – EXCESS FOLLOW-FORM LIABILITY With respect to Coverage A, the following persons and organizations qualify as insureds: 1.The Named Insured shown in the Declarations; and 2.Any other person or organization qualifying as an insured in the "underlying insurance". If you have agreed to provide insurance for that person or organization in a written contract or agreement: a.The limits of insurance afforded to such person or organization will be: (1)The amount by which the minimum limits of insurance you agreed to provide such person or organization in that written contract or agreement exceed the total limits of insurance of all applicable "underlying insurance"; or (2)The limits of insurance of this policy; whichever is less; and b.Coverage under this policy does not apply to such person or organization if the minimum limits of insurance you agreed to provide such person or organization in that written contract or agreement are wholly within the total limits of insurance of all available applicable "underlying insurance". B.COVERAGE B – UMBRELLA LIABILITY With respect to Coverage B: 1.The Named Insured shown in the Declarations is an insured. 2.If you are: a.An individual, your spouse is also an insured, but only with respect to the conduct of a business of which you are the sole owner. UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 5 of 22 b.A partnership or joint venture, your members, your partners and their spouses are also insureds, but only with respect to the conduct of your business. c.A limited liability company, your members are also insureds, but only with respect to the conduct of your business. Your managers are also insureds, but only with respect to their duties as your managers. d.An organization other than a partnership, joint venture or limited liability company, your "officers" and directors are also insureds, but only with respect to their duties as your "officers" or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. e.A trust, your trustees are also insureds, but only with respect to their duties as trustees. 3.Each of the following is also an insured: a.Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1)"Bodily injury" or "personal injury": (a)To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b)To the spouse, child, parent, brother or sister of that co- "employee" or "volunteer worker" as a consequence of Paragraph (1)(a) above; (c)For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or (b) above; or (d)Arising out of his or her providing or failing to provide professional health care services. Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide first aid or "Good Samaritan services" by any of your "employees" or "volunteer workers" other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. (2)"Property damage" to property: (a)Owned, occupied or used by; or (b)Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by; you, any of your "employees" or "volunteer workers", any of your partners or members (if you are a partnership or joint venture), or any of your members (if you are a limited liability company). b.Any person (other than your "employee" or "volunteer worker"), or any organization, while acting as your real estate manager. c.Any person or organization having proper temporary custody of your property if you die, but only: (1)With respect to liability arising out of the maintenance or use of that property; and (2)Until your legal representative has been appointed. d.Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this insurance. 4.Any organization, other than a partnership, joint venture or limited liability company, of which you are the sole owner, or in which you UMBRELLA Page 6 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 maintain an ownership interest of more than 50%, on the first day of the policy period is an insured and will qualify as a Named Insured. No such organization is an insured or will qualify as a Named Insured for "bodily injury" or "property damage" that occurred, or "personal injury" or "advertising injury" caused by an offense committed after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such organization. 5.Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and of which you are the sole owner, or in which you maintain an ownership interest of more than 50%, is an insured and will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a.Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and b.Coverage for such organization does not apply to: (1)"Bodily injury" or "property damage" that occurred; or (2)"Personal injury" or "advertising injury" arising out of an offense committed; before you acquired or formed the organization. No person or organization is an insured or will qualify as a Named Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. This paragraph does not apply to any such partnership, joint venture or limited liability company that otherwise qualifies as an insured under Paragraph B. of SECTION II – WHO IS AN INSURED. C.COVERAGE C – CRISIS MANAGEMENT SERVICE EXPENSES With respect to Coverage C, the following persons and organizations are insureds and will qualify as Named Insureds: 1.The Named Insured shown in the Declarations. 2.Any organization, other than a partnership, joint venture or limited liability company, of which you are the sole owner, or in which you maintain an ownership interest of more than 50%, on the first day of the policy period. No such organization is an insured or will qualify as a Named Insured for "crisis management service expenses" arising out of a "crisis management event" that first commences after the date, if any, during the policy period, that you no longer maintain an ownership interest of more than 50% in such organization. 3.Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and of which you are the sole owner, or in which you maintain an ownership interest of more than 50%, if there is no other similar insurance available to that organization. However: a.Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and b.Coverage for such organization does not apply to "crisis management service expenses" arising out of a "crisis management event" that occurred before you acquired or formed the organization, even if an "executive officer" only first becomes aware of an "event" or "occurrence" that leads to such "crisis management event" after the date you acquired or formed the organization. No person or organization is an insured or will qualify as a Named Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION III – LIMITS OF INSURANCE A.The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay for the amounts described below to which this insurance applies regardless of the number of: 1.Insureds; 2.Claims made or "suits" brought; 3.Number of vehicles involved; 4.Persons or organizations making claims or bringing "suits"; or 5.Coverages provided under this insurance. As indicated in Paragraph D.1. of SECTION I – COVERAGES, for any "suit" for which we have the right and duty to defend the insured under Coverage A, defense expenses will be within the limits of insurance of this policy when such expenses are within the limits of insurance of the applicable "underlying insurance". B.The General Aggregate Limit is the most we will pay for the sum of all: 1.Damages; and 2.Defense expenses if such expenses are within the limits of insurance of this policy; except: UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 7 of 22 1.Damages and defense expenses because of "bodily injury" or "property damage" included in the "auto hazard"; 2.Damages and defense expenses because of "bodily injury" or "property damage" included in the "products-completed operations hazard"; or 3.Damages and defense expenses for which insurance is provided under any Aircraft Liability coverage included as "underlying insurance" to which no aggregate limit applies. C.The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of all: 1.Damages; and 2.Defense expenses if such expenses are within the limits of insurance of this policy; because of "bodily injury" or "property damage" included in the "products-completed operations hazard". D.Subject to Paragraph B. or C. above, whichever applies, the Occurrence Limit is the most we will pay for the sum of all: 1.Damages, and defense expenses if such expenses are within the limits of insurance of this policy, under Coverage A arising out of any one "event" to which the "underlying insurance" applies a limit of insurance that is separate from any aggregate limit of insurance; and 2.Damages under Coverage B because of all "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any one "occurrence". For the purposes of determining the applicable Occurrence Limit, all related acts or omissions committed in the providing or failing to provide first aid or "Good Samaritan services" to any one person will be considered one "occurrence". E.The Crisis Management Service Expenses Limit is the most we will pay for the sum of all "crisis management service expenses" arising out of all "crisis management events". Payment of such "crisis management service expenses" is in addition to, and will not reduce, any other limit of insurance of this policy. F.The limits of insurance of this policy apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations. If the policy period is extended after issuance for an additional period of less than 12 months, the additional period will be deemed part of the last preceding period for purposes of determining the limits of insurance. SECTION IV – EXCLUSIONS This insurance does not apply to: A.With respect to Coverage A and Coverage B: 1.Asbestos a.Damages arising out of the actual or alleged presence or actual, alleged or threatened dispersal of asbestos, asbestos fibers or products containing asbestos, provided that the damages are caused or contributed to by the hazardous properties of asbestos. b.Damages arising out of the actual or alleged presence or actual, alleged or threatened dispersal of any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapors, soot, fumes, acids, alkalis, chemicals and waste, and that are part of any claim or "suit" which also alleges any damages described in Paragraph a. above. c.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, asbestos, asbestos fibers or products containing asbestos; or (2)Claim or "suit" by or on behalf of any governmental authority or any other person or organization because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, asbestos, asbestos fibers or products containing asbestos. 2.Employment-Related Practices Damages because of injury to: a.A person arising out of any: (1)Refusal to employ that person; (2)Termination of that person's employment; or (3)Employment-related practice, policy, act or omission, such as coercion, demotion, evaluation, reassignment, discipline, failure to promote or advance, harassment, humiliation, discrimination, libel, slander, violation of the person's right of privacy, malicious prosecution or false arrest, detention or imprisonment, applied to or directed at that person, regardless of whether such practice, policy, act or omission occurs, is applied or is UMBRELLA Page 8 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 committed before, during or after the time of that person's employment; or b.The spouse, child, parent, brother or sister of that person as a consequence of injury to that person as described in Paragraphs a.(1), (2) or (3) above. This exclusion applies: a.Whether the insured may be liable as an employer or in any other capacity; and b.To any obligation to share damages with or repay someone else who must pay damages because of the injury. 3.ERISA, COBRA And Similar Laws Any obligation of the insured under: a.The Employees Retirement Income Security Act Of 1974 (ERISA) or any of its amendments; b.The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) or any of its amendments; or c.Any similar common or statutory law of any jurisdiction. 4.Medical Expenses Or Payments Any obligation of the insured under any "medical expenses" or medical payments coverage. 5.Nuclear Material Damages arising out of: a.The actual, alleged or threatened exposure of any person or property to; or b.The "hazardous properties" of; any "nuclear material". As used in this exclusion: a."Hazardous properties" includes radioactive, toxic or explosive properties; b."Nuclear material" means "source material", "special nuclear material" or "by- product material"; and c."Source material", "special nuclear material" and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or any of its amendments. 6.Uninsured or Underinsured Motorists, No- Fault And Similar Laws Any liability imposed on the insured, or the insured's insurer, under any of the following laws: a.Uninsured motorists; b.Underinsured motorists; c.Auto no-fault or other first-party personal injury protection (PIP); d.Supplementary uninsured/underinsured motorists (New York); or e.Medical expense benefits and income loss benefits (Virginia). 7.War Damages arising out of: a.War, including undeclared or civil war; or b.Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or c.Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. 8.Workers Compensation And Similar Laws Any obligation of the insured under a workers compensation, disability benefits or unemployment compensation law or any similar law. B.With respect to Coverage B: 1.Expected Or Intended Bodily Injury Or Property Damage "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2.Contractual Liability "Bodily injury", "property damage", "personal injury" or "advertising injury" for which the insured is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. 3.Liquor Liability "Bodily injury" or "property damage" for which any insured may be liable by reason of: a.Causing or contributing to the intoxication of any person, including causing or contributing to the intoxication of any person because alcoholic beverages were permitted to be brought on your premises for consumption on your premises; UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 9 of 22 b.The furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of alcohol; or c.Any statute, ordinance or regulation relating to the sale, gift, distribution or use of alcoholic beverages. 4.Employers Liability "Bodily injury" to: a.An "employee" of the insured arising out of and in the course of: (1)Employment by the insured; or (2)Performing duties related to the conduct of the insured's business; or b.The spouse, child, parent, brother or sister of that "employee" as a consequence of "bodily injury" described in Paragraph a. above. This exclusion applies: a.Whether the insured may be liable as an employer or in any other capacity; and b.To any obligation to share damages with or repay someone else who must pay damages because of the "bodily injury". 5.Pollution a."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants". b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or any other person or organization test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2)Claim or "suit" by or on behalf of any governmental authority or any other person or organization because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". 6.Aircraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any aircraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any aircraft that is owned or operated by or rented or loaned to any insured. 7.Auto "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any "auto". Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any "auto". This exclusion does not apply to "bodily injury" or "property damage" caused by an "occurrence" that takes place outside of the United States of America (including its territories and possessions), Puerto Rico and Canada. 8.Watercraft "Bodily injury" or "property damage" arising out of the ownership, maintenance, use or entrustment to others of any watercraft owned or operated by or rented or loaned to any insured. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the ownership, maintenance, use or entrustment to others of any watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to a watercraft: a.While ashore on premises owned by or rented to any insured; or b.That is 50-feet long or less and that: (1)You own; or UMBRELLA Page 10 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 (2)You do not own and is not being used to carry any person or property for a charge. 9.Electronic Data Damages claimed for the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". 10.Damage To Property, Products Or Work "Property damage" to: a.Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person or organization, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; b.Premises you sell, give away or abandon if the "property damage" arises out of any part of those premises; c.Property loaned to you; d.Personal property in the care, custody or control of the insured; e.That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations if the "property damage" arises out of those operations; f.That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it; g."Your product" arising out of "your product" or any part of it; or h."Your work" arising out of "your work" or any part of it and included in the "products- completed operations hazard". 11.Damage To Impaired Property Or Property Not Physically Injured "Property damage" to "impaired property", or property that has not been physically injured, arising out of: a.A defect, deficiency, inadequacy or dangerous condition in "your product" or "your work"; or b.A delay or failure by you, or anyone acting on your behalf, to fulfill the terms of a contract or agreement. This exclusion does not apply to the loss of use of other property arising out of sudden and accidental physical injury to "your product" or "your work" after it has been put to its intended use. 12.Recall Of Products, Work Or Impaired Property Damages claimed for any loss, cost or expense incurred by you or others for the loss of use, withdrawal, recall, inspection, repair, replacement, adjustment, removal or disposal of: a."Your product"; b."Your work"; or c."Impaired property"; if such product, work or property is withdrawn or recalled from the market or from use by any person or organization because of a known or suspected defect, deficiency, inadequacy or dangerous condition in it. 13.Violation Of Consumer Financial Protection Laws "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any actual or alleged violation of a "consumer financial protection law", or any other "bodily injury", "property damage", "personal injury" or "advertising injury" alleged in any claim or "suit" that also alleges any such violation. 14.Unsolicited Communication "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any actual or alleged violation of any law that restricts or prohibits the sending, transmitting or distributing of "unsolicited communication". 15.Access Or Disclosure Of Confidential Or Personal Information "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any access to or disclosure of any person's or organization's confidential or personal information. 16.Knowing Violation Of Rights Of Another "Personal injury" or "advertising injury" caused by or at the direction of the insured with the knowledge that the act would violate the rights of another and would inflict "personal injury" or "advertising injury". 17.Material Published With Knowledge Of Falsity "Personal injury" or "advertising injury" arising out of oral or written publication, including publication by electronic means, of material, if done by or at the direction of the insured with knowledge of its falsity. UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 11 of 22 18.Material Published Or Used Prior To Policy Period a."Personal injury" or "advertising injury" arising out of oral or written publication, including publication by electronic means, of material whose first publication took place before the beginning of the policy period; or b."Advertising injury" arising out of infringement of copyright, "title" or "slogan" in your "advertisement" whose first infringement in your "advertisement" was committed before the beginning of the policy period. 19.Criminal Acts "Personal injury" or "advertising injury" arising out of a criminal act committed by or at the direction of the insured. 20.Breach Of Contract "Personal injury" or "advertising injury" arising out of a breach of contract. 21.Quality Or Performance Of Goods – Failure To Conform To Statements "Advertising injury" arising out of the failure of goods, products or services to conform with any statement of quality or performance made in your "advertisement". 22.Wrong Description Of Prices "Advertising injury" arising out of the wrong description of the price of goods, products or services stated in your "advertisement". 23.Intellectual Property "Personal injury" or "advertising injury" arising out of any actual or alleged infringement or violation of any of the following rights or laws, or any other "personal injury" or "advertising injury" alleged in any claim or "suit" that also alleges any such infringement or violation: a.Copyright; b.Patent; c.Trade dress; d.Trade name; e.Trademark; f.Trade secret; or g.Other intellectual property rights or laws. This exclusion does not apply to: a."Advertising injury" arising out of any actual or alleged infringement or violation of another's copyright, "title" or "slogan" in your "advertisement"; or b.Any other "personal injury" or "advertising injury" alleged in any claim or "suit" that also alleges any such infringement or violation of another's copyright, "title" or "slogan" in your "advertisement". 24.Insureds In Media And Internet Type Business "Personal injury" or "advertising injury" arising out of an offense committed by an insured whose business is: a.Advertising, "broadcasting" or publishing; b.Designing or determining content of web- sites for others; or c.An Internet search, access, content or service provider. This exclusion does not apply to Paragraphs a.(1), (2) and (3) of the definition of "personal injury". For the purposes of this exclusion: a.Creating and producing correspondence written in the conduct of your business, bulletins, financial or annual reports, or newsletters about your goods, products or services will not be considered the business of publishing; and b.The placing of frames, borders or links, or advertising, for you or others anywhere on the Internet will not, by itself, be considered the business of advertising, "broadcasting" or publishing. 25.Electronic Chatrooms Or Bulletin Boards "Personal injury" or "advertising injury" arising out of an electronic chatroom or bulletin board the insured hosts, owns or over which the insured exercises control. 26.Unauthorized Use Of Another's Name Or Product "Personal injury" or "advertising injury" arising out of the unauthorized use of another's name or product in your e-mail address, domain name or metatag, or any other similar tactics to mislead another's potential customers. C.With respect to Coverage C: Newly Acquired, Controlled Or Formed Entities "Crisis management service expenses" arising out of a "crisis management event" that involves any organization you newly acquire or form and that occurred prior to the date you acquired or formed that organization, even if an "executive officer" only first becomes aware of an "event" or "occurrence" that leads to such "crisis UMBRELLA Page 12 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 management event" after the date you acquired or formed such organization. SECTION V – CONDITIONS A.APPEALS 1.If the insured or the insured's "underlying insurer" elects not to appeal a judgment which exceeds the "applicable underlying limit" or "self-insured retention", we may do so. 2.If we appeal such a judgment, we will pay all costs of the appeal. These payments will not reduce the applicable limits of insurance. In no event will our liability exceed the applicable limit of insurance. B.BANKRUPTCY 1.Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obligations under this insurance. 2.In the event of bankruptcy or insolvency of any "underlying insurer", this insurance will not replace such bankrupt or insolvent "underlying insurer's" policy, and this insurance will apply as if such "underlying insurer" had not become bankrupt or insolvent. C.CANCELLATION 1.The first Named Insured shown in the Declarations may cancel this insurance by mailing or delivering to us advance written notice of cancellation. 2.We may cancel this insurance by mailing or delivering to such first Named Insured written notice of cancellation at least: a.10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b.60 days before the effective date of cancellation if we cancel for any other reason. 3.We will mail or deliver our notice to such first Named Insured's last mailing address known to us. 4.Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5.If this insurance is cancelled, we will send such first Named Insured any premium refund due. If we cancel, the refund will be pro rata. If such first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6.If notice is mailed, proof of mailing will be sufficient proof of notice. D.CHANGES This policy contains all the agreements between you and us concerning the insurance afforded. No change can be made in the terms of this insurance except with our consent. The terms of this insurance can be amended or waived only by endorsement issued by us and made a part of this policy. E.CURRENCY Payments for damages or expenses described in Paragraph 5. of Paragraph D., DEFENSE AND SUPPLEMENTARY PAYMENTS, of SECTION I – COVERAGES will be in the currency of the United States of America. At our sole option, we may make these payments in a different currency. Any necessary currency conversion for such payments will be calculated based on the rate of exchange published in the Wall Street Journal immediately preceeding the date the payment is processed. F.DUTIES REGARDING AN EVENT, OCCURRENCE, CLAIM OR SUIT 1.You must see to it that we are notified as soon as practicable of an "event" or "occurrence" which may result in a claim under this insurance. To the extent possible, notice should include: a.How, when and where the "event" or "occurrence" took place; b.The names and addresses of any persons or organizations sustaining injury, damage or loss, and the names and addresses of any witnesses; and c.The nature and location of any injury or damage arising out of the "event" or "occurrence". 2.If a claim is made or "suit" is brought against any insured which may result in a claim under this insurance, you must see to it that we receive written notice of the claim or "suit" as soon as practicable. 3.With respect to Coverage A, the insured must: a.Cooperate with us in the investigation, settlement or defense of any claim or "suit"; b.Comply with the terms of the "underlying insurance"; and c.Pursue all rights of contribution or indemnity against any person or organization who may be liable to the insured because of the injury, damage or loss for which insurance is provided under UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 13 of 22 this policy or any policy of "underlying insurance". 4.With respect to Coverage B, the insured must: a.Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit"; b.Authorize us to obtain necessary records and other information; c.Cooperate with us in the investigation, settlement or defense of any claim or "suit"; and d.Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which Coverage B may apply. 5.No insured will, except at that insured's own expense, voluntarily make a payment, assume any obligation, make any admission or incur any expense, other than for first aid for "bodily injury" covered by this insurance, without our consent. 6.Knowledge of an "event", "occurrence", claim or "suit" by your agent, servant or "employee" will not constitute knowledge by you, unless your insurance or risk manager, or anyone working in the capacity as your insurance or risk manager, or anyone you designate with the responsibility of reporting an "event", "occurrence", claim or "suit": a.Has received notice of such "event", "occurrence", claim or "suit" from such agent, servant or "employee"; or b.Otherwise has knowledge of such "event", "occurrence", claim or "suit". G.DUTIES REGARDING A CRISIS MANAGEMENT EVENT You must: 1.Notify us within 30 days of a "crisis management event" that may result in "crisis management service expenses". 2.Provide written notice of the "crisis management event" as soon as practicable. To the extent possible, notice should include: a.How, when and where that "crisis management event" took place; b.The names and addresses of any persons or organizations sustaining injury, damage or loss, and the named and addresses of any witnesses; c.The nature and location of any injury or damage arising out of that "crisis management event"; and d.The reason that "crisis management event" is likely to involve damages covered by this insurance in excess of the "applicable underlying limit" or "self- insured retention" and involve regional or national media coverage. H.EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and records as they relate to this insurance: 1.At any time during the policy period; 2.Up to three years after the end of the policy period; and 3.Within one year after final settlement of all claims under this insurance. I.EXTENDED REPORTING PERIOD OPTION 1.When the "underlying insurance" applies on a claims-made basis, any automatic or basic "extended reporting period" in such "underlying insurance" will apply to this insurance. 2.When the "underlying insurance" applies on a claims-made basis and you elect to purchase an optional or supplemental "extended reporting period" in such "underlying insurance," that "extended reporting period" will apply to this insurance only if: a.A written request to purchase an Extended Reporting Period endorsement for this insurance is made by you and received by us within 90 days after the end of the policy period; b.You have paid all premiums due for this policy at the time you make such request; c.You promptly pay the additional premium we charge for the Extended Reporting Period endorsement for this insurance when due. We will determine that additional premium after we have received your request for the Extended Reporting Period endorsement for this insurance. That additional premium is not subject to any limitation stated in the "underlying insurance" on the amount or percentage of additional premium that may be charged for the "extended reporting period" in such "underlying insurance"; and UMBRELLA Page 14 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 d.That Extended Reporting Period endorsement is issued by us and made a part of this policy. 3.Any Extended Reporting Period endorsement for this insurance will not reinstate or increase the Limits of Insurance or extend the policy period. 4.Except with respect to any provisions to the contrary contained in Paragraphs 1., 2. or 3. above, all provisions of any option to purchase an "extended reporting period" granted to you in the "underlying insurance" apply to this insurance. J.INSPECTIONS AND SURVEYS 1.We have the right but are not obligated to: a.Make inspections and surveys at any time; b.Give you reports on the conditions we find; and c.Recommend changes. 2.Any inspections, surveys, reports or recommendations relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. We do not warrant that conditions: a.Are safe or healthful; or b.Comply with laws, regulations, codes or standards. K.LEGAL ACTION AGAINST US 1.No person or organization has a right under this insurance: a.To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b.To sue us on this insurance unless all of its terms have been fully complied with. 2.A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured. We will not be liable for damages that: a.Are not payable under the terms of this insurance; or b.Are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. L.MAINTENANCE OF UNDERLYING INSURANCE 1.The insurance afforded by each policy of "underlying insurance" will be maintained for the full policy period of this Excess Follow- Form And Umbrella Liability Insurance. This provision does not apply to the reduction or exhaustion of the aggregate limit or limits of such "underlying insurance" solely by payments as permitted in Paragraphs 4.a.(1), (2) and (3) of COVERAGE A – EXCESS FOLLOW-FORM LIABILITY of SECTION I – COVERAGES. As such policies expire, you will renew them at limits and with coverage at least equal to the expiring limits of insurance. If you fail to comply with the above requirements, Coverage A is not invalidated. However, in the event of a loss, we will pay only to the extent that we would have paid had you complied with the above requirements. 2.The first Named Insured shown in the Declarations must give us written notice of any change in the "underlying insurance" as respects: a.Coverage; b.Limits of insurance; c.Termination of any coverage; or d.Exhaustion of aggregate limits. 3.If you are unable to recover from any "underlying insurer" because you fail to comply with any term or condition of the "underlying insurance", Coverage A is not invalidated. However, we will pay for any loss only to the extent that we would have paid had you complied with that term or condition in that "underlying insurance". M.OTHER INSURANCE This insurance is excess over any valid and collectible "other insurance" whether such "other insurance" is stated to be primary, contributing, excess, contingent or otherwise. This provision does not apply to a policy bought specifically to apply as excess of this insurance. However, if you specifically agree in a written contract or agreement that the insurance provided to any person or organization that qualifies as an insured under this insurance must apply on a primary basis, or a primary and non-contributory basis, then insurance provided under Coverage A is subject to the following provisions: UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 15 of 22 1.This insurance will apply before any "other insurance" that is available to such additional insured which covers that person or organization as a named insured, and we will not share with that "other insurance", provided that the injury or damage for which coverage is sought is caused by an "event" that takes place or is committed subsequent to the signing of that contract or agreement by you. 2.This insurance is still excess over any valid and collectible "other insurance", whether primary, excess, contingent or otherwise, which covers that person or organization as an additional insured or as any other insured that does not qualify as a named insured. N.PREMIUM 1.The first Named Insured shown in the Declarations is responsible for the payment of all premiums and will be the payee for any return premiums. 2.If the premium is a flat charge, it is not subject to adjustment except as provided in Paragraph 4. below. 3.If the premium is other than a flat charge, it is an advance premium only. The earned premium will be computed at the end of the policy period, or at the end of each year of the policy period if the policy period is two years or longer, at the rate shown in the Declarations, subject to the Minimum Premium. 4.Additional premium may become payable when coverage is provided for additional insureds under the provisions of SECTION II – WHO IS AN INSURED. O.PREMIUM AUDIT The premium for this policy is the amount stated in Item 5. of the Declarations. The premium is a flat charge unless it is specified in the Declarations as adjustable. P.PROHIBITED COVERAGE – UNLICENSED INSURANCE 1.With respect to loss sustained by any insured in a country or jurisdiction in which we are not licensed to provide this insurance, this insurance does not apply to the extent that insuring such loss would violate the laws or regulations of such country or jurisdiction. 2.We do not assume responsibility for: a.The payment of any fine, fee, penalty or other charge that may be imposed on any person or organization in any country or jurisdiction because we are not licensed to provide insurance in such country or jurisdiction; or b.The furnishing of certificates or other evidence of insurance in any country or jurisdiction in which we are not licensed to provide insurance. Q.PROHIBITED COVERAGE – TRADE OR ECONOMIC SANCTIONS We will provide coverage for any loss, or otherwise will provide any benefit, only to the extent that providing such coverage or benefit does not expose us or any of our affiliated or parent companies to: 1.Any trade or economic sanction under any law or regulation of the United States of America; or 2.Any other applicable trade or economic sanction, prohibition or restriction. R.REPRESENTATIONS By accepting this insurance, you agree: 1.The statements in the Declarations and any subsequent notice relating to "underlying insurance" are accurate and complete; 2.Those statements are based upon representations you made to us; and 3.We have issued this insurance in reliance upon your representations. S.SEPARATION OF INSUREDS Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured shown in the Declarations, this insurance applies: 1.As if each Named Insured were the only Named Insured; and 2.Separately to each insured against whom claim is made or "suit" is brought. T.WAIVER OR TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 1.If the insured has rights to recover all or part of any payment we have made under this insurance, those rights are transferred to us and the insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us, and with respect to Coverage A, the "underlying insurer", enforce them. If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against that person or organization, but only for payments we make because of an "event" that takes place or is committed subsequent to the UMBRELLA Page 16 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 execution of that contract or agreement by such insured. 2.Reimbursement of any amount recovered will be made in the following order: a.First, to any person or organization (including us or the insured) who has paid any amount in excess of the applicable limit of insurance; b.Next, to us; and c.Then, to any person or organization (including the insured and with respect to Coverage A, the "underlying insurer") that is entitled to claim the remainder, if any. 3.Expenses incurred in the process of recovery will be divided among all persons or organizations receiving amounts recovered according to the ratio of their respective recoveries. U.TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS INSURANCE 1.Your rights and duties under this insurance may not be transferred without our written consent except in the case of death of an individual Named Insured. 2.If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. V.UNINTENTIONAL OMISSION OR ERROR The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. W.WHEN LOSS IS PAYABLE If we are liable under this insurance, we will pay for injury, damage or loss after: 1.The insured's liability is established by: a.A court decision; or b.A written agreement between the claimant, the insured, any "underlying insurer" and us; and 2.The amount of the "applicable underlying limit" or "self-insured retention" is paid by or on behalf of the insured. SECTION VI – DEFINITIONS A.With respect to all coverages of this insurance: 1."Applicable underlying limit" means the sum of: a.The applicable limit of insurance stated for the policies of "underlying insurance" in the Schedule Of Underlying Insurance subject to the provisions in Paragraphs 4.a.(1), (2) and (3) of COVERAGE A – EXCESS FOLLOW-FORM LIABILITY of SECTION I – COVERAGES; and b.The applicable limit of insurance of any "other insurance" that applies. The limits of insurance in any policy of "underlying insurance" will apply even if: a.The "underlying insurer" claims the insured failed to comply with any term or condition of the policy; or b.The "underlying insurer" becomes bankrupt or insolvent. 2."Auto hazard" means all "bodily injury" and "property damage" to which liability insurance afforded under an auto policy of "underlying insurance" would apply but for the exhaustion of its applicable limits of insurance. 3."Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 4."Event" means an "occurrence", offense, accident, act, error, omission, wrongful act or loss. 5."Extended reporting period" means any period of time, starting with the end of the policy period of your claims-made insurance, during which claims or "suits" may be first made, brought or reported for that insurance. 6."Medical expenses" means expenses to which any Medical Payments section of any policy of Commercial General Liability "underlying insurance" applies. 7."Other insurance" means insurance, or the funding of losses, that is provided by, through or on behalf of: a.Another insurance company; b.Us or any of our affiliated insurance companies; c.Any risk retention group; UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 17 of 22 d.Any self-insurance method or program, in which case the insured will be deemed to be the provider of such insurance; or e.Any similar risk transfer or risk management method. "Other insurance" does not include: a.Any "underlying insurance"; or b.Any policy of insurance specifically purchased to be excess of the limits of insurance of this policy shown in the Declarations. 8."Products-completed operations hazard": a.Includes all "bodily injury" and "property damage" occurring away from premises you own or rent and arising out of "your product" or "your work" except: (1)Products that are still in your physical possession; or (2)Work that has not yet been completed or abandoned. However, "your work" will be deemed completed at the earliest of the following times: (a)When all the work called for in your contract has been completed; (b)When all the work to be done at the job site has been completed if your contract calls for work at more than one job site; or (c)When that part of the work done at a job site has been put to its intended use by any person or organization other than another contractor or subcontractor working on the same project. Work that may need service, maintenance, correction, repair or replacement, but which is otherwise complete, will be treated as completed. b.Does not include "bodily injury" or "property damage" arising out of: (1)The transportation of property, unless the injury or damage arises out of a condition in or on a vehicle not owned or operated by you, and that condition was created by the "loading or unloading" of that vehicle by any insured; (2)The existence of tools, uninstalled equipment or abandoned or unused materials; or (3)Products or operations for which the classification listed in a policy of Commercial General Liability "underlying insurance" states that products-completed operations are subject to the General Aggregate Limit. 9."Suit" means a civil proceeding which alleges damages. "Suit" includes: a.An arbitration proceeding in which damages are claimed and to which the insured must submit or does submit with our consent; or b.Any other alternative dispute resolution proceeding to which the insured submits with our consent. 10."Underlying insurance": a.Means the policy or policies of insurance listed in the Schedule Of Underlying Insurance. b.Includes any renewal or replacement of such policies if such renewal or replacement is during the policy period of this Excess Follow-Form And Umbrella Liability Insurance. c.Does not include any part of the policy period of any of the policies described in Paragraphs a. or b. above that began before, or that continues after, the policy period of this Excess Follow-Form And Umbrella Liability Insurance. 11."Underlying insurer" means any insurer which provides a policy of insurance listed in the Schedule Of Underlying Insurance. B.With respect to Coverage B and, to the extent that the following terms are not defined in the "underlying insurance", to Coverage A: 1."Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a.Notices that are published include material placed on the Internet or on similar electronic means of communication; and b.Regarding web sites, only that part of a web site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. 2."Advertising injury": UMBRELLA Page 18 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 a.Means injury, other than "personal injury", caused by one or more of the following offenses: (1)Oral or written publication, including publication by electronic means, of material in your "advertisement" that slanders or libels a person or organization or disparages a person's or organization's goods, products or services, provided that the claim is made or the "suit" is brought by a person or organization that claims to have been slandered or libeled, or that claims to have had its goods, products or services disparaged; (2)Oral or written publication, including publication by electronic means, of material in your "advertisement" that: (a)Appropriates a person's name, voice, photograph or likeness; or (b)Unreasonably places a person in a false light; or (3)Infringement of copyright, "title" or "slogan" in your "advertisement", provided that the claim is made or the "suit" is brought by a person or organization that claims ownership of such copyright, "title" or "slogan". b.Includes "bodily injury" caused by one or more of the offenses described in Paragraph a. above. 3."Auto" means: a.A land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or b.Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 4."Bodily injury" means: a.Physical harm, including sickness or disease, sustained by a person; or b.Mental anguish, injury or illness, or emotional distress, resulting at any time from such physical harm, sickness or disease. 5."Broadcasting" means transmitting any audio or visual material for any purpose: a.By radio or television; or b.In, by or with any other electronic means of communication, such as the Internet, if that material is part of: (1)Radio or television programming being transmitted; (2)Other entertainment, educational, instructional, music or news programming being transmitted; or (3)Advertising transmitted with any such programming. 6."Consumer financial identity information" means any of the following information for a person that is used or collected for the purpose of serving as a factor in establishing such person's eligibility for personal credit, insurance or employment or for the purpose of conducting a business transaction: a.Part or all of the account number, the expiration date or the balance of any credit, debit, bank or other financial account; b.Information bearing on a person's credit worthiness, credit standing or credit capacity; c.Social security number; d.Driver's license number; or e.Birth date. 7."Consumer financial protection law" means: a.The Fair Credit Reporting Act (FCRA) and any of its amendments, including the Fair and Accurate Credit Transactions Act (FACTA); b.California's Song-Beverly Credit Card Act and any of its amendments; or c.Any other law or regulation that restricts or prohibits the collection, dissemination, transmission, distribution or use of "consumer financial identity information". 8."Employee" includes a "leased worker". "Employee" does not include a "temporary worker". 9."Good Samaritan services" means any emergency medical services for which no compensation is demanded or received. 10."Impaired property" means tangible property, other than "your product" or "your work", that cannot be used or is less useful because: a.It incorporates "your product" or "your work" that is known or thought to be defective, deficient, inadequate or dangerous; or UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 19 of 22 b.You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by the repair, replacement, adjustment or removal of "your product" or "your work" or your fulfilling the terms of the contract or agreement. 11."Leased worker" means a person leased to you by a labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related to the conduct of your business. "Leased worker" does not include a "temporary worker". 12."Loading or unloading" means the handling of property: a.After it is moved from the place where it is accepted for movement into or onto an aircraft, watercraft or "auto"; b.While it is in or on an aircraft, watercraft or "auto"; or c.While it is being moved from an aircraft, watercraft or "auto" to the place where it is finally delivered; but "loading or unloading" does not include the movement of property by means of a mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or "auto". 13."Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a.Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads. b.Vehicles maintained for use solely on or next to premises you own or rent. c.Vehicles that travel on crawler treads. d.Vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: (1)Power cranes, shovels, loaders, diggers or drills; or (2)Road construction or resurfacing equipment such as graders, scrapers or rollers. e.Vehicles not described in Paragraph a., b., c. or d. above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2)Cherry pickers and similar devices used to raise or lower workers. f.Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. However, self-propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos": (1)Equipment designed primarily for: (a)Snow removal; (b)Road maintenance, but not construction or resurfacing; or (c)Street cleaning; (2)Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3)Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include any land vehicle that is subject to a compulsory or financial responsibility law, or other motor vehicle insurance law, where it is licensed or principally garaged. Such land vehicles are considered "autos". 14."Occurrence" means: a.With respect to "bodily injury" or "property damage": (1) An accident, including continuous or repeated exposure to substantially the same general harmful conditions, which results in "bodily injury" or "property damage". All "bodily injury" or "property damage" caused by such exposure to substantially the same general harmful conditions will be deemed to be caused by one "occurrence"; or (2)An act or omission committed in providing or failing to provide first aid or "Good Samaritan services" to a person by any of your "employees" or "volunteer workers" other than an employed or volunteer doctor, unless you are in the business or occupation of providing professional health care services; UMBRELLA Page 20 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 b.With respect to "personal injury", an offense arising out of your business that results in "personal injury". All "personal injury" caused by the same or related injurious material, act or offense will be deemed to be caused by one "occurrence", regardless of the frequency or repetition thereof, the number and kind of media used or the number of persons or organizations making claims or bringing "suits"; and c.With respect to "advertising injury", an offense committed in the course of advertising your goods, products and services that results in "advertising injury". All "advertising injury" caused by the same or related injurious material, act or offense will be deemed to be caused by one "occurrence", regardless of the frequency or repetition thereof, the number and kind of media used or the number of persons or organizations making claims or bringing "suits". 15."Officer" means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document. 16."Personal injury": a.Means injury, other than "advertising injury", caused by one or more of the following offenses: (1)False arrest, detention or imprisonment; (2)Malicious prosecution; (3)The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, provided that the wrongful eviction, wrongful entry or invasion of the right of private occupancy is committed by or on behalf of the owner, landlord or lessor of that room, dwelling or premises; (4)Oral or written publication, including publication by electronic means, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services, provided that the claim is made or the "suit" is brought by a person or organization that claims to have been slandered or libeled, or that claims to have had its goods, products or services disparaged; or (5)Oral or written publication, including publication by electronic means, of material that: (a)Appropriates a person's name, voice, photograph or likeness; or (b)Unreasonably places a person in a false light. b.Includes "bodily injury" caused by one or more of the offenses described in Paragraph a. above. 17."Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 18."Property damage" means: a.Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use will be deemed to occur at the time of the physical injury that caused it; or b.Loss of use of tangible property that is not physically injured. All such loss of use will be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. 19."Self-insured retention" is the greater of: a.The amount shown in the Declarations which the insured must first pay under Coverage B for damages because of all "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any one "occurrence"; or b.The applicable limit of insurance of any "other insurance" that applies. 20."Slogan": a.Means a phrase that others use for the purpose of attracting attention in their advertising. b.Does not include a phrase used as, or in, the name of: (1)Any person or organization other than you; or (2)Any business, or any of the premises, goods, products, services or work, of any person or organization other than you. UMBRELLA EU 00 01 07 16 © 2016 The Travelers Indemnity Company. All rights reserved.Page 21 of 22 21."Temporary worker" means a person who is furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 22."Title" means the name of a literary or artistic work. 23."Unsolicited communication" means any communication, in any form, that the recipient of such communication did not specifically request to receive. 24."Volunteer worker" means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed by you. 25."Your product": a.Means: (1)Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed of by: (a)You; (b)Others trading under your name; or (c)A person or organization whose business or assets you have acquired; and (2)Containers (other than vehicles), materials, parts or equipment furnished in connection with such goods or products. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your product"; and (2)The providing of or failure to provide warnings or instructions. c.Does not include vending machines or other property rented to or located for the use of others but not sold. 26."Your work": a.Means: (1)Work or operations performed by you or on your behalf; and (2)Materials, parts or equipment furnished in connection with such work or operations. b.Includes: (1)Warranties or representations made at any time with respect to the fitness, quality, durability, performance or use of "your work"; and (2)The providing of or failure to provide warnings or instructions. C.With respect to Coverage C: 1."Crisis management advisor" means any public relations firm or crisis management firm approved by us that is hired by you to perform "crisis management services" in connection with a "crisis management event". 2."Crisis management event" means an "event" or "occurrence" that your "executive officer" reasonably determines has resulted, or may result, in: a.Damages covered by this Coverage A or Coverage B that are in excess of the total applicable limits of the "underlying insurance" or "self-insured retention"; and b.Significant adverse regional or national media coverage. 3."Crisis management service expenses" means amounts incurred by you, after a "crisis management event" first commences and before such event ends: a.For the reasonable and necessary: (1)Fees and expenses of a "crisis management advisor" in the performance for you of "crisis management services" solely for a "crisis management event"; and (2)Costs for printing, advertising, mailing of materials or travel by your directors, officers, employees or agents or a "crisis management advisor" solely for a "crisis management event"; and b.For the following expenses resulting from such "crisis management event", provided that such expenses have been approved by us: (1)Medical expenses; (2)Funeral expenses; (3)Psychological counseling; (4)Travel expenses; (5)Temporary living expenses; (6)Expenses to secure the scene of a "crisis management event"; or (7)Any other expenses pre-approved by us. UMBRELLA Page 22 of 22 © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 01 07 16 4."Crisis management services" means those services performed by a "crisis management advisor" in advising you or minimizing potential harm to you from a "crisis management event" by maintaining or restoring public confidence in you. 5."Executive officer" means your: a.Chief Executive Officer; b.Chief Operating Officer; c.Chief Financial Officer; d.President; e.General Counsel; f.General partner (if you are a partnership); or g.Sole proprietor (if you are a sole proprietorship); or any person acting in the same capacity as any individual listed above. Page 1 of 1EU 02 34 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF COVERAGE – DEFINITIONS This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA The following replaces the introduction to Paragraph B. of SECTION VI – DEFINITIONS: With respect to Coverages B and C and, to the extent that the following terms are not defined in the "underlying insurance", to Coverage A: UMBRELLA POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF RIGHTS OF RECOVERY FROM OTHERS This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Designated Person Or Organization: 04/03/2024CUP-1S615672-24-26 PACIFIC RIDGE BUILDERS, INC. AND THE PROJECT OWNERS PROVISIONS The following is added to Paragraph T., WAIVER OR TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US, of SECTION V – CONDITIONS: If the insured has rights to recover all or part of any payment we have made under this insurance, those rights are transferred to us unless the insured has waived its rights of recovery against a person or organization shown in the Schedule Of Designated Persons Or Organizations above in a contract or agreement that is executed before loss. In that case, we will waive the right of recovery we would otherwise have against such person or organization. © 2016 The Travelers Indemnity Company. All rights reserved.EU 02 89 07 16 Page of1 1 UMBRELLA POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF WHO IS AN INSURED – DESIGNATED PERSON OR ORGANIZATION AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT – COVERAGE A This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Page 1 of 1EU 02 97 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. PACIFIC RIDGE BUILDERS, INC. AND THE PROJECT OWNERS PROVISIONS The following is added to Paragraph A., COVERAGE A – EXCESS FOLLOW-FORM LIABILITY, of SECTION II – WHO IS AN INSURED: With respect to Coverage A, any person or organization qualifying as an insured in the "underlying insurance" and shown in the Schedule Of Designated Persons Or Organizations also qualifies as an insured. If you have agreed to provide insurance for that person or organization in a written contract or agreement: 1.The limits of insurance afforded to such person or organization will be: a.The amount by which the minimum limits of insurance you agreed to provide such person or organization in that written contract or agreement exceed the total limits of insurance of all applicable "underlying insurance"; or b.The limits of insurance of this policy; whichever is less; and 2. Coverage under this policy does not apply to such person or organization if the minimum limits of insurance you agreed to provide such person or organization in that written contract or agreement are wholly within the total limits of insurance of all available applicable "underlying insurance". CUP-1S615672-24-26 04/03/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO POLLUTION EXCLUSION WITH LIMITED EXCEPTIONS – COVERAGE A This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 03 21 08 18 © 2017 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. PROVISIONS 1.The following is added to Paragraph A., COVERAGE A – EXCESS FOLLOW-FORM LIABILITY, of SECTION I – COVERAGES: For the purposes of Coverages A and C of this insurance, "auto pollution cost or expense" will be deemed to be damages because of "property damage" included in the "auto hazard". However, if any "auto pollution cost or expense" is to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants" in or on any person, such cost or expense will instead be deemed to be damages because of "bodily injury" included in the "auto hazard". 2.With respect to COVERAGE A – EXCESS FOLLOW FORM LIABILITY, the following exclusion is added to SECTION IV – EXCLUSIONS: Auto Pollution "Bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a.That are, or that are contained in any property that is: (1)Being transported or towed by, handled or handled for movement into, onto or from a "covered auto"; (2)Otherwise in the course of transit by a "covered auto" by or on behalf of any "auto insured"; or (3)Being stored, disposed of, treated or processed in or upon a "covered auto"; b.Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by any "auto insured" for movement into or onto the "covered auto"; or c.After the "pollutants" or any property in which the "pollutants" are contained are moved from the "covered auto" to the place where they are finally delivered, disposed of or abandoned by any "auto insured". Paragraph a. above does not apply to fuels, lubricants, fluids, exhaust gases or other similar "pollutants" that are needed for or result from the normal electrical, hydraulic or mechanical functioning of the "covered auto" or its parts if the "bodily injury" or "property damage" is included in the "auto hazard". Paragraphs b. and c. above do not apply to accidents that occur away from premises owned by or rented to an "auto insured" with respect to "pollutants" not in or upon a "covered auto" if: a.The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a "covered auto"; and b.The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. 3.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Auto insured" means any person or organization that qualifies as an insured for the liability insurance afforded under an auto policy of "underlying insurance" that would apply to the "bodily injury" or "property damage" but for the exhaustion of its applicable limits of insurance. "Auto pollution cost or expense" means any cost or expense arising out of: a.Any request, demand, order or statutory or regulatory requirement that any "auto insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants; or UMBRELLA b.Any claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants"; and to which liability insurance afforded under an auto policy of "underlying insurance" would apply but for the exhaustion of its applicable limits of insurance. "Covered auto" means any "auto" to which liability insurance afforded under an auto policy of "underlying insurance" would apply but for the exhaustion of its applicable limits of insurance. Page 2 of 2 © 2017 The Travelers Indemnity Company. All rights reserved.EU 03 21 08 18 Includes copyrighted material of Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION IDENTIFIED HAZARDS EXCLUSIONS – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 03 22 08 18 © 2017 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc. with its permission. PROVISIONS 1.The following exclusions are added to Paragraph B. of SECTION IV – EXCLUSIONS: Architectural, Engineering Or Surveying Professional Services "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of providing or failing to provide any "professional services" by or on behalf of any insured, but only with respect to any of the following operations: a.Providing, or hiring any independent professional to provide, any architectural, engineering or surveying service to others in any insured's capacity as an architect, engineer or surveyor; or b.Providing, or hiring any independent professional to provide, any architectural, engineering or surveying service in connection with construction work any insured performs. Construction Management Errors And Omissions "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: a.The preparing, approving, or failure to prepare or approve, any map, shop drawing, opinion, report, survey, field order, change order or drawing and specification by any architect, engineer or surveyor performing services on a project on which you serve as construction manager; or b.Inspection, supervision, quality control or engineering services done by or for you on a project on which you serve as construction manager. This exclusion does not apply to "bodily injury" or "property damage" due to construction or demolition work done by you, your "employees" or your subcontractors. Exterior Insulation And Finish System "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: a.The design, manufacture, construction, fabrication, distribution, sale, preparation, installation, application, maintenance or repair, including remodeling, service, correction or replacement, of any "exterior insulation and finish system" (commonly referred to as synthetic stucco or EIFS) or any part thereof, or any substantially similar system or any part thereof, including the application or use of any conditioner, primer, accessory, flashing, coating, caulking or sealant in connection with such a system; or b."Your product" or "your work" with respect to any exterior component, fixture or feature of any structure if an "exterior insulation and finish system", or any substantially similar system, is used on any part of that structure. Residential Construction "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of "your work" on or for any project that in whole or in part, is or will become any: a.Single-family housing; b.Multi-family housing; c.Residential apartment; d.Residential condominium; or e.Assisted living facility. Claims Or Suits By One Named Insured Against Another Named Insured "Bodily injury", "property damage", "personal injury" or "advertising injury" for which a claim is made or "suit" is brought by any Named Insured against another Named Insured. UMBRELLA Page 2 of 2 © 2017 The Travelers Indemnity Company. All rights reserved.EU 03 22 08 18 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Wrap-Up Insurance Program "Bodily injury" or "property damage" arising out of any project that is or was subject to a "wrap-up insurance program". 2.The following is added to Paragraph B. of SECTION VI – DEFINITIONS: "Exterior insulation and finish system" means an exterior cladding or finish system used on any part of any structure and consisting of: a.A rigid or semi rigid insulation board made of expanded polystyrene or other materials; b.The adhesive or mechanical fasteners used to attach the insulation board to the substrate; c.A reinforced base coat; and d.A finish coat providing surface texture and color. "Professional services": a.Includes: (1)Preparing, approving, or failing to prepare or approve, any map, shop drawing, opinion, report, survey, field order or change order, or preparing, approving, or failing to prepare or approve, any drawing or specification; and (2)Any supervisory or inspection activity performed as part of any related architectural, or engineering or surveying activity. b.Does not include any service within construction means, methods, techniques, sequences and procedures employed by you in connection with your operations in your capacity as a construction contractor. "Wrap-up insurance program" means any agreement or arrangement, including any contractor-controlled, owner-controlled or similar insurance program, under which: a.Some or all of the contractors working on a specific project, or specific projects, are required to enroll in a program to obtain insurance that: (1)Includes liability insurance; and (2)Is issued specifically for injury or damage arising out of such project or projects; and b.You are or were enrolled or allowed to enroll. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS 1.The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Fungi Or Bacteria a."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual, alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of or presence of any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage; or b."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual or alleged or threatened inhalation of, ingestion of, contact with, exposure to, existence of or presence of any other solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapors, soot, fumes, acids, alkalis, chemicals and waste, and that is part of any claim or "suit" which also alleges any injury or damage described in Paragraph a. of this exclusion. c.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or any other person or organization test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "fungi" or bacteria; or (2)Claim or suit by or on behalf of any governmental authority or any other person or organization because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "fungi" or bacteria. This exclusion does not apply to any "fungi" or bacteria that are, are on, or are contained in, a good or product intended for consumption. 2.The following is added to Paragraph B. of SECTION VI – DEFINITIONS: "Fungi" means any type or form of fungus, including mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. UMBRELLA EU 03 35 08 18 © 2017 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA © 2017 The Travelers Indemnity Company. All rights reserved.EU 03 46 08 18 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON CUMULATION OF OCCURRENCE LIMIT This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS 1.The following is added to Paragraph D. of SECTION III – LIMITS OF INSURANCE: Non cumulation of Occurrence Limit – If the following arise out of any one "event": a.Damages, or defense expenses if such expenses are within the limits of insurance of this policy, to which this Excess Follow-Form And Umbrella Liability Insurance applies; and b.Damages to which Excess Follow-Form And Umbrella Liability Insurance, or any other umbrella or excess liability coverage, included in one or more prior or future policies issued to you by us, or any of our affiliated insurance companies, or defense expenses if such expenses are within the limits of insurance of such policy, applies; this policy's Occurrence Limit applicable to that "event" also will be reduced by the amount of each payment made for the damages and defense expenses described in Paragraph b. above by us or any of our affiliated insurance companies under, and within the applicable limit of insurance of, each such other policy. If a Non cumulation of Personal and Advertising Injury Limit or a Non cumulation of Each Occurrence Limit provision in any such prior policy refers to a COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE policy, this Excess Follow-Form And Umbrella Liability Insurance will be deemed to be a COMMERCIAL EXCESS LIABILITY (UMBRELLA) INSURANCE policy for the purposes of each such provision. 2.The following is added to the definition of "other insurance" in Paragraph A. of SECTION VI – DEFINITIONS: "Other insurance" also does not include insurance that is provided by, through or on behalf of us or any of our affiliated insurance companies when the Non cumulation of Occurrence Limit provision of Paragraph D. of SECTION III – LIMITS OF INSURANCE applies. 3.The following is added to Paragraph 4. in Paragraph A., COVERAGE A – EXCESS FOLLOW-FORM LIABILITY, of SECTION I – COVERAGES: For the purposes of Paragraph a.(1) above, payments of judgments or settlements for damages that would have been covered by "underlying insurance", but are not only because of an Amendment – Non Cumulation Of Each Occurrence Limit Of Liability and Non Cumulation Of Personal and Advertising Injury Limit endorsement in that "underlying insurance" will be deemed to be payments of judgments or settlements for damages that are covered by that "underlying insurance". For the purposes of Paragraph a.(3) above, payments of defense expenses that would have been covered by that "underlying insurance", but are not only because of an Amendment – Non Cumulation Of Each Occurrence Limit Of Liability and Non Cumulation Of Personal and Advertising Injury Limit endorsement in that "underlying insurance" will be deemed to be payments of defense expenses that are covered by that "underlying insurance". © 2016 The Travelers Indemnity Company. All rights reserved.EU 01 44 07 16 Page 1 of 2 UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE FOR FINANCIAL INTEREST IN FOREIGN INSURED ORGANIZATIONS This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS 1.The following is added to Paragraph A., COVERAGE A – EXCESS FOLLOW-FORM LIABILITY, and Paragraph B., COVERAGE B – UMBRELLA LIABILITY, of SECTION I – COVERAGES: If a "foreign loss" is incurred by a "foreign insured organization", or by any other insured for whom such "foreign insured organization" is liable, we will reimburse the first Named Insured, or any other Named Insured that is not a "foreign insured organization", for such "foreign loss" because of its "financial interest" in that "foreign insured organization". For purposes of this insurance, amounts we reimburse under: a.Paragraph a. of the definition of "foreign loss" will be deemed to be sums that such Named Insured becomes legally obligated to pay as damages under this policy; and b.Paragraph b. of the definition of "foreign loss" will be deemed to be payments we make under Paragraph 5. of Paragraph D., DEFENSE AND SUPPLEMENTARY PAYMENTS, in SECTION I – COVERAGES. 2.The following is added to SECTION V – CONDITIONS: DUTIES IN THE EVENT OF A CLAIM OR SUIT FOR FOREIGN LOSS If a claim or "suit" for "foreign loss" is made or brought against a "foreign insured organization", or any other insured for whom such "foreign insured organization" is liable, the first Named Insured must: 1.Arrange to investigate and defend such claim or "suit"; 2.Notify us in writing in advance of any proposed settlement of such claim or "suit"; and 3.Comply with all other conditions of this insurance as if such claim or "suit" were made or brought against any insured that is not a "foreign insured organization". 3.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Financial interest" means the insurable interest in a "foreign insured organization" because of: a.Sole ownership of, or majority ownership interest in, such "foreign insured organization", either directly or through one or more intervening subsidiaries; b.Indemnification of, or an obligation to indemnify: (1)Such "foreign insured organization"; or (2)Any other insured for whom such "foreign insured organization" is liable; for a "foreign loss"; or c.An obligation to obtain insurance for such "foreign insured organization". "Foreign insured organization" means any organization that: a.Is an insured under SECTION II – WHO IS AN INSURED; and b.Is located in a country or jurisdiction in which we are not licensed to provide this insurance and where providing this insurance would violate the laws or regulations of such country or jurisdiction. "Foreign loss" means: a.Sums, in excess of the "applicable underlying limit" or "self-insured retention", that an insured becomes legally obligated to pay as damages because of loss to which the insurance provided under this policy would have applied; or b.Payments described in Paragraph 5. of Paragraph D., DEFENSE AND SUPPLEMENTARY PAYMENTS in SECTION I – COVERAGES that we would have made with respect to any claim or "suit" against an insured: © 2016 The Travelers Indemnity Company. All rights reserved.Page 2 of 2 EU 01 44 07 16 UMBRELLA (1)That we would have defended, investigated or settled; or (2)For which we would have paid our part of a judgment; but for the fact that such insured is located in any country or jurisdiction in which we are not licensed to provide this insurance and where providing this insurance would violate the laws or regulations of such country or jurisdiction. UMBRELLA POLICY NUMBER:ISSUE DATE: Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2EU 00 07 07 16 © 2016 The Travelers Indemnity Company. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM AND EXCLUSION OF OTHER ACTS OF TERRORISM COMMITTED OUTSIDE THE UNITED STATES This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE CERTIFIED ACTS OF TERRORISM SELF-INSURED RETENTION SCHEDULE Self-Insured Retention For Certified Acts Of Terrorism:$Each Occurrence PROVISIONS 1.The following is added to SECTION I – COVERAGES: If aggregate insured losses attributable to "certified acts of terrorism" exceed $100 billion in a calendar year and we have met our insurer deductible under "TRIA", we will 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. 2.With respect to COVERAGE B – UMBRELLA LIABILITY for any "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of a "certified act of terrorism": a.The following replaces Paragraph 1. in Paragraph D., DEFENSE AND SUPPLEMENTARY PAYMENTS, of SECTION I – COVERAGES: 1.We will have the right, but not the duty, to defend the insured under COVERAGE B – UMBRELLA LIABILITY against a "suit" seeking damages to which such coverage applies. b.The following replaces the definition of "self- insured retention" in Paragraph B. of SECTION VI – DEFINITIONS: "Self-insured retention" means the Self- Insured Retention For Certified Acts Of Terrorism shown in the Certified Acts Of Terrorism Self-Insured Retention Schedule which the insured must first pay under Coverage B for damages because of all any "bodily injury", "property damage", "personal injury" or "advertising injury" included in any one "occurrence". If no entry appears in the Certified Acts Of Terrorism Self-Insured Retention Schedule, the Self-Insured Retention For Certified Acts Of Terrorism is deemed to be $1,000,000. 3.The following exclusion is added to Paragraph A. of SECTION IV – EXCLUSIONS: Acts Of Terrorism Committed Outside The United States Damages arising out of any "act of terrorism" that is committed outside the United States of America (including its territories and possessions) and Puerto Rico. This exclusion does not apply to damages arising out of any "act of terrorism" that results in loss occurring to: (1)An air carrier (as defined in Section 40102 of title 49, United States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States); or (2)The premises of any United States mission. 4.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Act of terrorism" means a violent act or an act that is dangerous to human life, property or infrastructure that is committed by an individual or individuals and that appears to be part of an effort to coerce a civilian population or to influence the policy or affect the conduct of any government by coercion. "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in CUP-1S615672-24-26 04/03/2024 10,000 UMBRELLA Includes copyrighted material of Insurance Services Office, Inc. with its permission EU 00 07 07 16Page 2 of 2 © 2016 The Travelers Indemnity Company. All rights reserved. accordance with the provisions of "TRIA", to be an act of terrorism pursuant to "TRIA". The criteria contained in "TRIA" for a "certified act of terrorism" include the following: a.The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to "TRIA"; and b.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. "TRIA" means the federal Terrorism Risk Insurance Act of 2002 as amended. EU 02 09 08 18 Page 1 of 2© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION (BROAD FORM) – COVERAGES A AND B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA PROVISIONS 1.The following replaces Exclusion 5., Nuclear Material, in Paragraph A. of SECTION IV – EXCLUSIONS: Nuclear Energy Liability (Broad Form) a.Under any Liability Coverage, to "bodily injury" or "property damage": (1)With respect to which an insured under the policy is also an insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Association of Canada or any of their successors, or would be an insured under any such policy but for its termination upon exhaustion of its limit of liability; or (2)Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the insured is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. b.Under any Medical Payments coverage, to expenses incurred with respect to "bodily injury" resulting from the "hazardous properties" of "nuclear material" and arising out of the operation of a "nuclear facility" by any person or organization. c.Under any Liability Coverage, to "bodily injury" or "property damage" resulting from "hazardous properties" of "nuclear material" if: (1)The "nuclear material" (a) is at any "nuclear facility" owned by, or operated by or on behalf of, an insured or (b) has been discharged or dispersed therefrom; (2)The "nuclear material" is contained in "spent fuel" or "waste" at any time possessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an insured; or (3)The "bodily injury" or "property damage" arises out of the furnishing by an insured of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nuclear facility", but if such facility is located within the United States of America, its territories or possessions or Canada, this exclusion (3) applies only to "property damage" to such "nuclear facility" and any property thereat. 2.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material", "special nuclear material" or "by-product material". "Source material", "special nuclear material", and "by-product material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof. "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a "nuclear reactor". "Waste" means any waste material (a) containing "by-product material" other than the tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its "source material" content, and (b) resulting from the operation by any person or organization of any "nuclear facility" included under the first two paragraphs of the definition of "nuclear facility". EU 02 09 08 18Page 2 of 2 © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA "Nuclear facility" means: a.Any "nuclear reactor"; b.Any equipment or device designed or used for (1) separating the isotopes of uranium or plutonium, (2) processing or utilizing "spent fuel", or (3) handling, processing or packaging "waste"; c.Any equipment or device used for the processing, fabricating or alloying of "special nuclear material" if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235; or d.Any structure, basin, excavation, premises or place prepared or used for the storage or disposal of "waste". and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations. "Nuclear reactor" means any apparatus designed or used to sustain nuclear fission in a self- supporting chain reaction or to contain a critical mass of fissionable material. "Property damage" includes all forms of radioactive contamination of property. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION NOT RELATED TO AUTOS EXCLUSION WITH LIMITED EXCEPTIONS – COVERAGE A This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 02 16 04 20 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. PROVISIONS 1.The following replaces Paragraph 4.a.(1) of Paragraph A., COVERAGE A – EXCESS FOLLOW-FORM LIABILITY, of SECTION I – COVERAGES: (1)Payments of: (a)Judgments or settlements for damages that are covered by that "underlying insurance". However, if such "underlying insurance" has a policy period which differs from the policy period of this Excess Follow-Form And Umbrella Liability Insurance, any such payments for damages that would not be covered by this Excess Follow-Form And Umbrella Liability Insurance because of its different policy period will not reduce or exhaust the applicable limit of insurance stated for such "underlying insurance"; or (b)Judgments or settlements for any cost or expense to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or assess the effects of, "pollutants" that is covered by that "underlying insurance" if it is Commercial General Liability "underlying insurance" issued by us, or any of our affiliated insurance companies, and an endorsement that provides coverage for such cost or expense is a part of that “underlying insurance”. A governmental ruling or order that has imposed liability for such cost or expense will be deemed to be a judgment. However, if such "underlying insurance" has a policy period which differs from the policy period of this Excess Follow-Form And Umbrella Liability Insurance, any such payments that would not be covered by this Excess Follow-Form And Umbrella Liability Insurance because of its different policy period will not reduce or exhaust the applicable limit of insurance stated for such "underlying insurance". 2.With respect to COVERAGE A – EXCESS FOLLOW FORM LIABILITY, the following exclusion is added to SECTION IV – EXCLUSIONS: Pollution Not Related To Autos a.Damages arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants". However, this Paragraph a. does not apply to: (1)Any of the following arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at or from any premises, site or location which is or was at any time owned or occupied by, or rented or loaned to, any insured: (a)"Bodily injury" sustained within a building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or produced by or originating from equipment that is used to heat water for personal use by the building's occupants or their guests; (b)"Bodily injury" or "property damage" for which you may be held liable, if: (i)That premises, site or location is owned by, or rented to, any "specified additional insured" and is not and never was owned or occupied by, or rented or loaned to, any other insured; and (ii)Such "pollutants" are not brought on or to such premises, site or location in connection with operations being performed on such premises, site or location by any insured or any contractor or subcontractor working directly or indirectly on any insured's behalf; or UMBRELLA (c)"Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (2)Any of the following arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at or from any premises, site or location that is not and was not at any time owned or occupied by, or rented or loaned to any insured, other than any "specified additional insured", and on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations: (a)"Bodily injury" or "property damage" arising out of "pollutants" that are not brought on or to such premises, site or location in connection with such operations by such insured, contractor or subcontractor; (b)"Bodily injury" or "property damage" arising out of the escape of fuels, lubricants or other operating fluids which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the operation of "mobile equipment" or its parts, if such fuels, lubricants or other operating fluids escape from a vehicle part designed to hold, store or receive them. This exception does not apply if the "bodily injury" or "property damage" arises out of the intentional discharge, dispersal or release of the fuels, lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on or to such premises, site or location with the intent that they be discharged, dispersed or released as part of the operations being performed by such insured, contractor or subcontractor; (c)"Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor; or (d)"Bodily injury" or "property damage" arising out of heat, smoke or fumes from a "hostile fire"; (3)"Bodily injury" or "property damage" included in the "products-completed operations hazard"; or (4)"Bodily injury" or "property damage" included in the "auto hazard". The exceptions in Paragraphs (1), (2) and (3) above do not apply to "bodily injury" or "property damage" arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": (1)At or from any premises, site or location which is or was at any time used by or for any insured or any other person or organization for the handling, storage, disposal, processing or treatment of waste; (2)If such "pollutants" are or were at any time transported, handled, stored, treated, disposed of or processed as waste by or for: (a)Any insured; or (b)Any person or organization for whom any insured may be legally responsible; or (3)At or from any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are or were at any time performing operations to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants". b.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or any other person or organization test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "pollutants"; or (2)Claim or suit by or for any governmental authority or any other person or organization arising out of the testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "pollutants". Page 2 of 3 © 2020 The Travelers Indemnity Company. All rights reserved.EU 02 16 04 20 Includes copyrighted material of Insurance Services Office, Inc. with its permission. UMBRELLA EU 02 16 04 20 © 2020 The Travelers Indemnity Company. All rights reserved.Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. However, this Paragraph b. does not apply to "bodily injury" or "property damage" included in the "auto hazard". 3.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Hostile fire" means a fire which becomes uncontrollable or breaks out from where it was intended to be. "Specified additional insured" means the owner or lessee of a premises, site or location that has been added to your Commercial General Liability "underlying insurance" as an additional insured with respect to your ongoing operations performed for that additional insured at that premises, site or location if you are a contractor and if such premises, site or location is not and never was owned or occupied by, or rented or loaned to, any insured, other than that additional insured. 4.The definition of "pollutants" (including the statement in it that waste includes materials to be recycled, reconditioned or reclaimed) in Paragraph B. of SECTION VI – DEFINITIONS is deleted from that Paragraph B. and is added to Paragraph A. of SECTION VI – DEFINITIONS. UMBRELLA POLICY NUMBER:ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED EXPOSURE EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE SCHEDULE OF DESIGNATED EXPOSURE – COVERAGE B Designated Exposure: Page 1 of 1EU 03 04 08 18 © 2018 The Travelers Indemnity Company. All rights reserved. "YOUR WORK" ON OR FOR ANY PROJECT LOCATED IN THE STATE OF NEVADA PROVISIONS The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Designated Exposure "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any exposure shown in the Schedule Of Designated Exposure – Coverage B, including "bodily injury", "property damage", "personal injury" or "advertising injury" arising out of: a.Ownership, maintenance or use of any premises in connection with any such exposure; or b.Any supervision, instructions, recommendations or advice given or which should have been given in connection with such exposure; c."Your products" manufactured or distributed in connection with any such exposure; or d."Your work" performed anywhere related to any such exposure. CUP-1S615672-24-26 04/03/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AIRCRAFT LIABILITY EXCLUSION INCLUDING SERVICE FOR HIRE WITH LIMITED EXCEPTION FOR UNMANNED AIRCRAFT – COVERAGES A AND B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 03 12 10 20 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 PROVISIONS 1.The following exclusion is added to Paragraph A. of SECTION IV – EXCLUSIONS: Aircraft Damages arising out of the ownership, maintenance, use or entrustment to others of any aircraft. Use includes operation and "loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "event" which caused the damages involved the ownership, maintenance, use or entrustment to others of any aircraft. This exclusion does not apply to liability assumed under any contract or agreement. With respect to Coverage A, this exclusion also does not apply to any "unmanned aircraft". 2.Exclusion 6., Aircraft, in Paragraph B. of SECTION IV – EXCLUSIONS is deleted. 3.The following is added to Paragraph A. of SECTION VI – DEFINITIONS: "Unmanned aircraft" means an aircraft that is not designed, manufactured or modified after it is manufactured, to be controlled directly by a person from within or on the aircraft. Page 1 of 1EU 03 31 08 18 © 2017 The Travelers Indemnity Company. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DISCRIMINATION EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Discrimination "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of discrimination based upon a person's sex, sexual orientation, marital status, pregnancy, race, color, creed, religion, national origin, citizenship, veteran status, age, genetic information or physical or mental disability, or any other characteristic, attribute, trait, condition or status that qualifies a person for protection against discrimination under federal, state or local law. UMBRELLA UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LEAD EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE © 2017 The Travelers Indemnity Company. All rights reserved.EU 03 44 08 18 Page 1 of 1 PROVISIONS The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Lead a."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual or alleged presence or actual, alleged or threatened dispersal, release, ingestion, inhalation or absorption of lead, lead compounds or lead which is or was contained or incorporated into any material or substance. b."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual or alleged presence or actual, alleged or threatened dispersal, release, ingestion, inhalation or absorption of any other solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapors, soot, fumes, acids, alkalis, chemicals and waste, and that is part of any claim or "suit" which also alleges any injury or damage described in Paragraph a. of this exclusion. c.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or any other person or organization test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, lead, lead compounds or lead which is or was contained or incorporated into any material or substance; or (2)Claim or suit by or for any governmental authority or any other person or organization arising out of the testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing or in any way responding to, or assessing the effects of, lead, lead compounds or lead which is or was contained or incorporated into any material or substance. EU 03 63 08 18 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. © 2017 The Travelers Indemnity Company. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SILICA OR SILICA-RELATED DUST EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE PROVISIONS 1.The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Silica or Silica-Related Dust a."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, emission, release, escape, handling, contact with, exposure to or inhalation or respiration of "silica" or "silica- related dust". b."Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of the actual, alleged or threatened discharge, dispersal, emission, release, escape, handling, contact with, exposure to or inhalation or respiration of any other solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapors, soot, fumes, acids, alkalis, chemicals and waste, and that is part of any claim or "suit" which also alleges any injury or damage described in Paragraph a. of this exclusion. c.Any loss, cost or expense arising out of any: (1)Request, demand, order or statutory or regulatory requirement that any insured or any other person or organization test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of, "silica" or "silica-related dust"; or (2)Claim or suit by or on behalf of any governmental authority or any other person or organization because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of, "silica" or "silica-related dust". 2.The following is added to Paragraph B. of SECTION VI – DEFINITIONS: "Silica" means silica dioxide (occurring in crystalline, amorphous and impure forms), silica particles, silica dust or silica compounds. "Silica-related dust" means a mixture or combination of "silica" and other dust or particles. UMBRELLA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INTELLECTUAL PROPERTY EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 04 21 09 21 © 2021 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 The following replaces Exclusion 23., Intellectual Property, in Paragraph B. of SECTION IV – EXCLUSIONS: 23.Intellectual Property "Personal injury" or "advertising injury" arising out of any actual or alleged infringement or violation of any of the following rights or laws, or any other "personal injury" or "advertising injury" alleged in any claim or “suit” that also alleges any such infringement or violation: a.Copyright; b.Patent; c.Trade dress; d.Trade name; e.Trademark; f.Trade secret; or g.Other intellectual property rights or laws. This exclusion applies regardless of whether the allegation of infringement or violation of any of these rights or laws is made by any person or organization making the claim or bringing the “suit”, by any insured or by any other party to the claim or “suit”. This exclusion does not apply to: a."Advertising injury" arising out of any actual or alleged infringement or violation of another's copyright, "title" or "slogan" in your "advertisement"; or b.Any other "personal injury" or "advertising injury" alleged in any claim or "suit" that also alleges any such infringement or violation of another's copyright, "title" or "slogan" in your "advertisement". THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS EXCLUSION – COVERAGE B This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA EU 04 44 01 23 © 2022 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 PROVISIONS 1.The following exclusion is added to Paragraph B. of SECTION IV – EXCLUSIONS: Violation Of Biometric Information Privacy Laws "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of any actual or alleged violation of a "biometric information privacy law", or any other "bodily injury", "property damage", "personal injury" or "advertising injury" alleged in any claim or "suit" that also alleges any such violation. 2.The following is added to Paragraph B. of SECTION VI – DEFINTIONS: "Biometric information": a.Means information about a person's physical, biological or behavioral characteristics that can be used to identify such person. b.Includes a person's retina or iris scan, fingerprint, voiceprint, scan of hand or face or other body geometry, DNA, vein pattern, keystroke pattern or rhythm, gait pattern or rhythm, or sleep, health or exercise data that contain identifying information. "Biometric information privacy law" means the parts of any law, ordinance, regulation or governmental rule that govern or relate to the collection, storage, disclosure, retention, destruction, protection, use, sale, lease or trade of "biometric information". UMBRELLA Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 2EU 00 33 11 16 © 2016 The Travelers Indemnity Company. All rights reserved. PROVISIONS 1.The following replaces Paragraphs 2. and 3. in Paragraph C., CANCELLATION, of SECTION V – CONDITIONS: 2.All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this insurance by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a.10 days before the effective date of cancellation if we cancel for: (1)Nonpayment of premium; or (2)Discovery of fraud by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy; or b.30 days before the effective date of cancellation if we cancel for any other reason. 3.All Policies In Effect For More Than 60 Days a.If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this insurance only upon the occurrence, after the effective date of the policy, of one or more of the following: (1)Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2)Discovery of fraud or material misrepresentation by: (a)Any insured or his or her representative in obtaining this insurance; or (b)You or your representative in pursuing a claim under this policy. (3)A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. (4)Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5)Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6)A determination by the Commissioner of Insurance that the: (a)Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b)Continuation of the policy coverage would: (i)Place us in violation of California law or the laws of the state where we are domiciled; or (ii)Threaten our solvency. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following: EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE UMBRELLA Includes copyrighted material of Insurance Services Office, Inc. with its permission © 2016 The Travelers Indemnity Company. All rights reserved.EU 00 33 11 16Page 2 of 2 a.If the transfer or renewal of a policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. b.If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph B.1. c.If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d.If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e.If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f.If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph B.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. (7)A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. (8)A material change in limits, type or scope of coverage, or exclusions in one or more of the underlying policies. (9)Cancellation or nonrenewal of one or more of the underlying policies where such policies are not replaced without lapse. (10)A reduction in financial rating or grade of one or more insurers, insuring one or more underlying policies based on an evaluation obtained from a recognized financial rating organization. b.We will mail or deliver advance notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1)10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2)30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph a above. 2.The following is added to SECTION V – CONDITIONS: WHEN WE DO NOT RENEW 1.If we elect not to renew this policy, we will mail or deliver written notice, stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. 2.We are not required to send notice of nonrenewal in the following situations: IL T3 68 01 21 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE This endorsement applies to the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CYBERFIRST ESSENTIALS GENERAL PROVISIONS FORM CYBERFIRST GENERAL PROVISIONS FORM EMPLOYEE BENEFITS LIABILITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EMPLOYMENT PRACTICES LIABILITY+ WITH IDENTITY FRAUD EXPENSE REIMBURSEMENT COVERAGE PART ENVIRONMENTAL HAZARD POLICY EXCESS FOLLOW-FORM AND UMBRELLA LIABILITY INSURANCE EXCESS (FOLLOWING FORM) LIABILITY INSURANCE LAW ENFORCEMENT LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MANUFACTURERS ERRORS AND OMISSIONS LIABILITY COVERAGE PART MEDFIRST PRODUCTS/COMPLETED OPERATIONS, ERRORS AND OMISSIONS, AND INFORMATION SECURITY LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PUBLIC ENTITY MANAGEMENT LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY – NEW YORK DEPARTMENT OF TRANSPORTATION TRIBAL BUSINESS MANAGEMENT LIABILITY COVERAGE PART Any other Commercial Liability coverage included in this policy that is subject to the federal Terrorism Risk Insurance Act of 2002 as amended PROVISIONS The federal Terrorism Risk Insurance Act of 2002 as amended ("TRIA") establishes a program under which the Federal Government may partially reimburse "Insured Losses" (as defined in TRIA) caused by "Acts Of Terrorism" (as defined in TRIA). Act Of Terrorism is defined in Section 102(1) of TRIA to mean any 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; 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. The Federal Government's share of compensation for such Insured Losses is 80% of the amount of such Insured Losses in excess of each Insurer's "Insurer Deductible" (as defined in TRIA), subject to the "Program Trigger" (as defined in TRIA). In no event, however, will the Federal Government be required to pay any portion of the amount of such Insured Losses occurring in a calendar year that in the aggregate exceeds $100 billion, nor will any Insurer be required to pay any portion of such amount provided that such Insurer has met its Insurer Deductible. Therefore, if such Insured Losses occurring in a calendar year exceed $100 billion in the aggregate, the amount of any payments by the Federal Government and any coverage provided by this policy for losses caused by Acts Of Terrorism may be reduced. For each coverage provided by this policy that applies to such Insured Losses, the charge for such Insured Losses is included in the premium for such coverage. The charge for such Insured Losses that has been included for each such coverage is the percentage of the premium for such coverage indicated below, and does not include any charge for the portion of such Insured Losses covered by the Federal Government under TRIA: 1%. IMPORTANT NOTICE – INDEPENDENT AGENT AND BROKER COMPENSATION NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please visit www.travelers.com, call our toll-free telephone number 1-866-904-8348, or request a written copy from Marketing at One Tower Square, 2GSA, Hartford, CT 06183. PN T4 54 01 08 Page 1 of 1 SAFETY SERVICES © 2023 The Travelers Indemnity Company. All rights reserved. SAFETY IS OUR CONCERN SAFETY IS YOUR CONCERN Contact Us WUNT3J23 Page 1 of 4 For more information, please visit travelers.com/riskcontrol or contact your local Travelers office. Thank you for purchasing your insurance from one of the writing companies owned or managed by The Travelers Companies, Inc. We appreciate your business and welcome the opportunity to be of service. An important part of that service concerns safety and accident prevention. Travelers Risk Control has an extensive staff of safety and loss prevention professionals assisting customers across the country and around the world. We have one of the largest Risk Control departments in the industry, and our scale allows us to apply the right resource at the right time to meet customer needs. We have a wide range of industry-specific experience, which includes manufacturing, construction, wholesale and retail businesses, service organizations, technology-related business, the oil and gas industry, the public sector and others. Following are some examples of available safety services: Accident Prevention – Our staff can help you address hazards within your operations, premises and equipment, and recommend solutions for reducing or eliminating these hazards. Analysis of Accident Causes – Our REACT accident investigation program can assist you in determining root causes of accidents and help you prevent recurrences. Safety Consultations – Our consultants can assist you with solutions in specialized areas such as ergonomics, industrial hygiene and fleet safety. Industrial Hygiene/Health Services – Travelers has an AIHA accredited lab to analyze air samples taken by our IH Specialists, or by you, through our Pump Loan program to help you identify potential exposures to occupational illnesses. Safety Literature and Digital Media – Our Risk Control customer website has hundreds of resources including checklists, sample programs, self-assessments, instructional videos and other safety and health related tools. Safety Training – We offer face-to-face classroom courses, as well as distance learning and online training programs on a variety of safety and risk management topics in order to provide flexibility for your safety training needs. Return-To-Work Coordination – We have consultants who specialize in post injury management that can assist you with developing or enhancing a return-to-work program, along with other aspects of our Corridor of Care® post injury process. Please note: For ALL loss control assistance requests, please contact your local office directly, which is listed on one of the following pages. Notice to policy recipient: If you are not the person directly responsible for the accident prevention activities for your company, please direct this Safety Services notice to the person that is directly responsible for them. These services are available upon request. See the remainder of this document for the Travelers Risk Control office nearest you. These phone numbers should not be used for questions regarding your policy or claims. At Travelers, we are committed to helping protect your business. Travelers Risk Control has the experience, resources and capabilities to provide a range of safety services Onsite, Online and On-Demand. As our customer, you have access to hundreds of safety resources that cover an array of safety and risk management topics to help you control hazards and reduce risks of injury or illness. You can access these resources by logging in at www.travelers.com. Not registered? Select "Log In" and then "Register Now" to register for MyTravelers for Business. Examples of what you will find include: •Safety checklists, sample programs and self-assessments. •Safety training offerings including classroom, and online. •Additional safety products and services These resources can help you improve your workplace safety practices. The loss of a key employee due to an injury can seriously impact your business. We can help you to understand the types of accidents that may occur in your business and the steps you can take to help prevent them. © 2023 The Travelers Indemnity Company. All rights reserved. For all other inquiries please contact your agent, underwriter or claim representative Please call these numbers FOR SAFETY SERVICES ONLY Page 2 of 4WUNT3J23 ALABAMA Birmingham 3000 Riverchase Galleria Ste. 600 Birmingham, AL 35244 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Sacramento 11070 White Rock Road, Suite 130 Rancho Cordova, CA 95670 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim GEORGIA Atlanta 1000 Windward Concourse Alpharetta, GA 30005 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim ALASKA Portland, OR 4000 SW Kruse Place, Suite 100 Lake Oswego, OR 97035 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA San Diego 9325 Sky Park Court, Suite 220 San Diego, CA 92123 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim HAWAII Irvine, CA 3333 Michelson Drive City Blvd. W Suite 1000 Irvine, CA 92612 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim ARIZONA Phoenix 2401 W Peoria Ave., Suite 130 Phoenix, AZ 85029 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Walnut Creek 401 Lennon Lane, Suite 100 Walnut Creek, CA 94598 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim IDAHO Sacramento, CA 11070 White Rock Rd, Suite 130 Rancho Cordova, CA 95670 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim ARKANSAS Kansas City, KS 7465 West 132nd, Suite 400 Overland Park, KS 66213 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim COLORADO Denver 6060 S. Willow Dr. #300 Greenwood Village, CO 80111 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim ILLINOIS Chicago 161 N Clark St. Suite 900 Chicago, IL 60601 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Diamond Bar 21688 Gateway Center Drive P.O. Box 6512 Diamond Bar, CA 91765-8512 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CONNECTICUT Hartford 300 Windsor Street Hartford, CT 06120 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim ILLINOIS Naperville 215 Shuman Boulevard P.O. Box 3208 Naperville, IL 60566 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Glendale 655 N. Central Avenue, Suite 1600 Glendale, CA 91203 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim DELAWARE Philadelphia, PA 10 Sentry Parkway, Suite 300 Blue Bell, PA 19422 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim INDIANA Indianapolis Suite 300 280 East 96th Street Indianapolis, IN 46240 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Irvine 3333 Michelson Dr. City Blvd. W Suite 1000 Irvine, CA 92612 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim DISTRICT OF COLUMBIA Washington, DC 14200 Park Meadow Dr. Chantilly, VA 20151 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim IOWA Des Moines 7101 Vista Dr. West Des Moines, IA 50266-9313 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim CALIFORNIA Los Angeles 888 South Figueroa St., Ste. 500 Los Angeles, CA 90017 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim FLORIDA Orlando 2420 Lakemont Dr Orlando, FL 32814 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim KANSAS CITY 7465 West 132nd, Suite 400 Overland Park, KS 66213 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim © 2023 The Travelers Indemnity Company. All rights reserved. Please call these numbers FOR SAFETY SERVICES ONLY For all other inquiries please contact your agent, underwriter or claim representative Page 3 of 4WUNT3J23 KENTUCKY Louisville Suite 150 303 N Hurstbourne Pkwy Louisville, KY 40222 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MICHIGAN Troy 1441 W. Long Lake Rd., Ste. 300 Troy, MI 48098 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW HAMPSHIRE Portland, ME 207 Larrabee Road, Suite 3 Westbrook, ME 04092 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim LOUISIANA New Orleans 3838 N. Causeway, Suite 2700 Metairie, LA 70002 P.O. Box 61479 New Orleans, LA 70161-1479 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MINNESOTA St. Paul 385 Washington St., MC 104P St. Paul, MN 55102 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW JERSEY Morristown 445 South Street Morristown, NJ 07960 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MAINE Portland, ME 207 Larrabee Road, Suite 3 Westbrook, ME 04092 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MISSISSIPPI Jackson 1080 River Oaks Dr Ste B-200 Flowood, MS 39232 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW JERSEY Marlton Lake Center Exec Park Building 30 Suite 110 Marlton, NJ 08053 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MARYLAND Blue Bell, PA 10 Sentry Parkway, Suite 300 Blue Bell, PA 19422 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MISSOURI St. Louis 940 West Port Plaza, Suite 270 St. Louis, MO 63146 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW MEXICO Phoenix 2401 W Peoria Ave., Suite 130 Phoenix, AZ 85029 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MASSACHUSETTS Boston 100 Summer Street, Suite 201A Boston, MA 02110 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MISSOURI WORKERS' COMPENSATION PLAN (MWCP) 4801 Main Street, Suite 350 Kansas City, MO 64112 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW YORK Albany 900 Watervliet-Shaker Road Albany, NY 12205 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MASSACHUSETTS Hudson 1 Cabot Road Suite 250 Hudson, MA 01749 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MONTANA Sacramento, CA 11070 White Rock Rd, Suite 130 Rancho Cordova, CA 95670 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW YORK Buffalo 60 Lakefront Blvd. P.O. Box 242 Buffalo, NY 14240-0242 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MASSACHUSETTS Braintree 350 Granite Street Suite 1201 Braintree, MA 02184 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEBRASKA Omaha 11516 Miracle Hills Dr., St. 400 Omaha, NE 68154 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW YORK Melville 3 Huntington Quadrangle Melville, NY 11747 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim MICHIGAN Grand Rapids 625 Kenmoor Ave Suite 213 Grand Rapids, MI 49546 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEVADA Las Vegas 7450 Arroyo Crossing Pkwy Suite 200 Las Vegas, NV 89113 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW YORK New York 485 Lexington Ave. New York, NY 10017-2630 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim © 2023 The Travelers Indemnity Company. All rights reserved. Please call these numbers FOR SAFETY SERVICES ONLY For all other inquiries please contact your agent, underwriter or claim representative WUNT3J23 Page 4 of 4 NEW YORK Rochester 75 Town Centre Drive P.O. Box 23235 Rochester, NY 14692-3235 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim PENNSYLVANIA Philadelphia 10 Sentry Parkway, Suite 300 Blue Bell, PA 19422 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim UTAH Denver, CO 6060 S. Willow Drive#300 Greenwood Village , CO 80111 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NEW YORK Syracuse 440 South Warren Street P.O. Box 4963 Syracuse, NY 13221-4963 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim PENNSYLVANIA Pittsburgh 112 Washington Place, Suite 910 Pittsburgh, PA 15219 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim VERMONT Hartford, CT 300 Windsor Street Hartford, CT 06120 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NORTH CAROLINA Charlotte 11440 Carmel Commons Blvd. Suite 400 Charlotte, NC 28226 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim PENNSYLVANIA Reading 1105 Berkshire Blvd. P.O. Box 13426 Wyomissing, PA 19610 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim VIRGINIA Richmond 9954 Mayland Drive, Suite 6100 Richmond, VA 23233 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NORTH CAROLINA Raleigh 4504 Emperor Blvd. Durham, NC 27703 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim RHODE ISLAND Braintree 350 Granite Street Suite 1201 Braintree, MA 02184 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim Washington, DC 14200 Park Meadow Dr. Chantilly, VA 20151 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim NORTH DAKOTA St. Paul, MN 385 Washington St., MC 104P St. Paul, MN 55102 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim SOUTH CAROLINA Charlotte 11440 Carmel Commons Blvd. P.O. Box 473500 Charlotte, NC 28247-3500 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim WASHINGTON Seattle 1501 4th Avenue, Suite 400 Seattle, WA 98101 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim OHIO Cincinnati Baldwin Center, Suite 500 625 Eden Park Drive Cincinnati, OH 45202 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim SOUTH DAKOTA St. Paul, MN 385 Washington St. St. Paul, MN 55102 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim WEST VIRGINIA Charleston, WV 119 Virginia St. W. Charleston, WV 25302 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim OHIO Cleveland 6150 Oak Tree Blvd., Suite 400 Independence, OH 44131 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim TENNESSEE Franklin 6640 Carothers Pkwy, Suite 300 Franklin, TN 37067 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim WISCONSIN Milwaukee 13935 Bishops Drive, Suite 200 Brookfield, WI 53005 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim OKLAHOMA Tulsa 9820 East 41st St., Suite 401 P.O Box 3510 Tulsa, OK 74101 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim TEXAS Dallas 1301 E Collins Blvd., Suite 300 Richardson, TX 75081 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim WYOMING Denver, CO 6060 S. Willow Drive #300 Greenwood Village, CO 80111 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim OREGON Portland 4000 SW Kruse Way Place, Building 1, Suite 255 Lake Oswego, OR 97035 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim TEXAS Houston 4650 Westway Park Blvd., Suite 350 Houston, TX 77041 Risk Control: 1-800-973-9215 Claims: 800-238-6225 or travelers.com/claim WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A Custom Insurance Policy Prepared for: THERMAL MECHANICAL, INC. 425 ALDO AVE SANTA CLARA CA 95054 Report Claims Immediately by Calling* 1-877-828-4132 Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Notice or ReportingWritten WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: INSURER: NCCI CO CODE:1. INSURED:PRODUCER: Insured is Other work places and identification numbers are shown in the schedule(s) attached. Bodily Injury by Accident:$Each Accident Bodily Injury by Disease:$Policy Limit Bodily Injury by Disease:$Each Employee DATE OF ISSUE: OFFICE: PRODUCER: 2.The policy period is from 04-01-24 to 04-01-25 12:01 A.M. at the insured's mailing address. 3.A.WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: B.EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: C.OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: D.This policy includes these endorsements and schedules: 4.The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY CA AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV ONE TOWER SQUAREHARTFORD CT 06183 V UB-3K219589-24-26-G RENEWAL OF (UB-3K219589-23-26-G) TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 13579 THERMAL MECHANICAL, INC. 425 ALDO AVE SANTA CLARA, CA 95054 RSC INS BROKERAGE INC 1350 BAYSHORE HWY STE 125 BURLINGAME, CA 94010-1829 A CORPORATION 1,000,000 1,000,000 1,000,000 SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 04-02-24 CD WALNUT CREEK CA 418 RSC INS BROKERAGE INC HE839 A Stock Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: CLASSIFICATION SCHEDULE: PREMIUM BASIS RATES ESTIMATEDESTIMATEDPER $100 OF ANNUALTOTAL ANNUAL REMUNERATIONCLASSIFICATIONSCODE NO PREMIUMREMUNERATION SEE EXTENSION OF INFORMATION PAGE - SCHEDULE(S) SIC-CODE: Minimum Premium:$ DATE OF ISSUE: OFFICE: PRODUCER: ONE TOWER SQUAREHARTFORD CT 06183 V UB-3K219589-24-26-G 1711 NAICS: 238210 STANDARD TOTAL ESTIMATED ANNUAL STANDARD PREMIUM $ 244612 PREMIUM DISCOUNT 12475 0900-04 EXPENSE CONSTANT 160 TERRORISM 2228 TOTAL ESTIMATED PREMIUM 235025 TAXES AND SURCHARGES 14220 DEPOSIT AMOUNT DUE 249245 937 CD04-02-24 WALNUT CREEK CA 418 RSC INS BROKERAGE INC HE839 COUNTERSIGNED-AGENT WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 100 001 THERMAL MECHANICAL, INC.13579-CA EXP. MOD. EFFECTIVE DATE: 04-01-24 RATE BUREAU ID: 001260248 INSURER: INSURED'S NAME: CLASSIFICATION CODE PREMIUM BASIS ESTIMATED TOTAL ANNUAL REMUNERATION RATES PER $100 OF REMUNERATION ESTIMATED ANNUAL PREMIUM LOCATION 001 FEIN 941682162 ENTITY CD 001 00 THERMAL MECHANICAL, INC. 425 ALDO AVE SANTA CLARA , CA 95054 NAICS: 238210 ELECTRICAL WIRING-WITHIN BUILDINGS-INCLUDING INSTALLATION OR REPAIR OF ELECTRICAL FIXTURES-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $34.00 PER HOUR. ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $34.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $34.00 PER HOUR SHALL BE CLASSIFIED AS 5190, ELECTRICALWIRING. 5140 172143.00 2.588 4455 HEATING OR AIR CONDITIONING EQUIPMENT-INSTALLATION, SERVICE OR REPAIR-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOES NOT EQUAL OR EXCEED $31.00 PER HOUR-N.O.C. 5183 192823.00 8.114 15646 DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 1 6 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 2 6 REFRIGERATION EQUIPMENT-NOT HOUSEHOLD UNITS-INSTALLATION, SERVICE OR REPAIR-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $31.00 PER HOUR-N.O.C.ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $31.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $31.00 PER HOUR SHALL BE CLASSIFIED AS 5183(2), REFRIGERATION EQUIPMENT. 5187 4189182.00 3.787 158644 ELECTRICAL WIRING-WITHIN BUILDINGS-INCLUDING INSTALLATION OR REPAIR OF ELECTRICAL FIXTURES-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOES NOT EQUAL OR EXCEED $34.00 PER HOUR. 5190 IF ANY 5.292 0 SHEET METAL WORK-ERECTION, INSTALLATION OR REPAIR- INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOESNOT EQUAL OR EXCEED $29.00 PERHOUR-N.O.C. 5538 7547.00 8.83 666 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 3 6 HEATING OR AIR CONDITIONING DUCTWORK-INSTALLATION OR REPAIR-INCLUDING SHOP, YARD ORSTORAGE OPERATIONS-INCLUDING INSTALLATION OF FURNACES OR AIR CONDITIONING EQUIPMENT- EMPLOYEES WHOSE REGULAR HOURLYWAGE EQUALS OR EXCEEDS $29.00 PER HOUR-N.O.C. ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECTTO VERIFICATION AT THE TIME OFFINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $29.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $29.00 PER HOUR SHALL BE CLASSIFIED AS 5538(2), HEATINGOR AIR CONDITIONING DUCTWORK. 5542 1935930.00 3.699 71610 CONTRACTORS-CONSTRUCTION OR ERECTION-EXECUTIVE LEVEL SUPERVISORS-NO DIRECT SUPERVISION-DIVISION OF A SINGLE EMPLOYEES PAYROLL WITH ANY OTHER CLASSIFICATION IS NOT PERMITTED 5606 436407.00 0.98 4277 SALESPERSONS-OUTSIDE 8742 491617.00 0.424 2084 CLERICAL OFFICE EMPLOYEES NOC 8810 675690.00 0.307 2074 CLASSIFICATION CODE WAIVER PREMIUM BASIS RATE ESTIMATED ANNUAL PREMIUM BLANKET WAIVER OF SUBROGATION SEE ENDT WC 99 03 76 A 0930 259456 0.020 5189 CLASSIFICATION CODE PREMIUM BASIS ESTIMATED TOTAL ANNUAL REMUNERATION RATES PER $100 OF REMUNERATION ESTIMATED ANNUAL PREMIUM LOCATION 002 FEIN 941682162 ENTITY CD 001 00 THERMAL MECHANICAL, INC. 437 ALDO AVE # B SANTA CLARA , CA 95054 NAICS: 238210 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 4 6 CLASSIFICATION CODE PREMIUM BASIS ESTIMATED TOTAL ANNUAL REMUNERATION RATES PER $100 OF REMUNERATION ESTIMATED ANNUAL PREMIUM LOCATION 002 (CONT'D) ELECTRICAL WIRING-WITHIN BUILDINGS-INCLUDING INSTALLATION OR REPAIR OF ELECTRICAL FIXTURES-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $34.00 PER HOUR. ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $34.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $34.00 PER HOUR SHALL BE CLASSIFIED AS 5190, ELECTRICALWIRING. 5140 IF ANY 2.588 0 HEATING OR AIR CONDITIONING EQUIPMENT-INSTALLATION, SERVICE OR REPAIR-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOES NOT EQUAL OR EXCEED $31.00 PER HOUR-N.O.C. 5183 IF ANY 8.114 0 REFRIGERATION EQUIPMENT-NOT HOUSEHOLD UNITS-INSTALLATION, SERVICE OR REPAIR-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE EQUALS OR EXCEEDS $31.00 PER HOUR-N.O.C.ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECT TO VERIFICATION AT THE TIME OF FINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $31.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $31.00 PER HOUR SHALL BE CLASSIFIED AS 5183(2), REFRIGERATION EQUIPMENT. 5187 IF ANY 3.787 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 5 6 ELECTRICAL WIRING-WITHIN BUILDINGS-INCLUDING INSTALLATION OR REPAIR OF ELECTRICAL FIXTURES-INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOES NOT EQUAL OR EXCEED $34.00 PER HOUR. 5190 IF ANY 5.292 0 SHEET METAL WORK-ERECTION, INSTALLATION OR REPAIR- INCLUDING SHOP, YARD OR STORAGE OPERATIONS-EMPLOYEES WHOSE REGULAR HOURLY WAGE DOESNOT EQUAL OR EXCEED $29.00 PERHOUR-N.O.C. 5538 IF ANY 8.83 0 HEATING OR AIR CONDITIONING DUCTWORK-INSTALLATION OR REPAIR-INCLUDING SHOP, YARD ORSTORAGE OPERATIONS-INCLUDING INSTALLATION OF FURNACES OR AIR CONDITIONING EQUIPMENT- EMPLOYEES WHOSE REGULAR HOURLYWAGE EQUALS OR EXCEEDS $29.00 PER HOUR-N.O.C. ASSIGNMENT OF THIS CLASSIFICATION IS SUBJECTTO VERIFICATION AT THE TIME OFFINAL AUDIT THAT THE EMPLOYEESREGULAR HOURLY WAGE EQUALS OR EXCEEDS $29.00 PER HOUR. THE PAYROLL OF AN EMPLOYEE WHOSE REGULAR HOURLY WAGE IS NOT SHOWN TO EQUAL OR EXCEED $29.00 PER HOUR SHALL BE CLASSIFIED AS 5538(2), HEATINGOR AIR CONDITIONING DUCTWORK. 5542 IF ANY 3.699 0 CONTRACTORS-CONSTRUCTION OR ERECTION-EXECUTIVE LEVEL SUPERVISORS-NO DIRECT SUPERVISION-DIVISION OF A SINGLE EMPLOYEES PAYROLL WITH ANY OTHER CLASSIFICATION IS NOT PERMITTED 5606 IF ANY 0.98 0 SALESPERSONS-OUTSIDE 8742 IF ANY 0.424 0 CLERICAL OFFICE EMPLOYEES NOC 8810 IF ANY 0.307 0 CLASSIFICATION CODE WAIVER PREMIUM BASIS RATE ESTIMATED ANNUAL PREMIUM BLANKET WAIVER OF SUBROGATION SEE ENDT WC 99 03 76 A 0930 0 0.020 0 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: ONE TOWER SQUAREHARTFORD CT 06183 EXTENSION OF INFO PAGE-SCHEDULE WC 00 00 01 ( A) UB-3K219589-24-26-G WAIVER OF SUBROGATION 5189 TOTAL PREMIUM SUBJECT TO EXPERIENCE MOD. 264645 EXPERIENCE MODIFICATION:0.79 MODIFIED PREMIUM 209070 17.00% SCHEDULE DEBIT(9889) 35542 TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 244612 -5.10% PREMIUM DISCOUNT(0064) -12475 EXPENSE CONSTANT(0900) 160 CA ADDITIONAL DEFENSE OBLIGATION(0986) 500 TERRORISM(9740) 2228 CA MANUAL PREMIUM $259456 $ --------------------------------------------------------------------------------------- TOTAL ESTIMATED PREMIUM 235025 2.4604% WC ADMIN REVOLVING FUND ASSESSMENT 5783 0.4122% STATE FRAUD SURCHARGE 969 0.1505% UNINSURED EMPLOYERS BENEFIT TRUST FUND ASST 354 1.5891% SUBSEQUENT INJURY BENEFIT TRUST FUND ASST 3735 0.7266% OCCUPATIONAL SAFETY & HEALTH FUND ASSESSMENT 1708 0.7109% LABOR ENFORCEMENT & COMPLIANCE FUND ASSESSMENT 1671 TOTAL PREMIUM 249245 DEPOSIT AMOUNT DUE 249245 DATE OF ISSUE:SCHEDULE NO:OF04-02-24 CD 6 6 EMPLOYERS LIABILITY POLICY POLICY NUMBER: LISTING OF ENDORSEMENTS ENDORSEMENT WC 00 00 01 (A ) We agree that the following listed endorsements form a part of this policy on its effective date. WORKERS COMPENSATION EXTENSION OF INFO PAGE AND UB-3K219589-24-26-G ONE TOWER SQUARE HARTFORD CT 06183 WC 00 00 01 A - 001 INFORMATION PAGE WC 00 00 01 A - 001 INFORMATION PAGE 2 WC 00 00 01 A - 001 EXTENSION OF INFORMATION PAGE - SCHEDULE WC 00 00 01 A - 001 ENDORSEMENT LISTING WC 00 04 22 C - 001 TERRORISM RISK INS PROG REAUTH ACT ENDT WC 04 03 01 B - 001 POLICY AMENDATORY ENDORSEMENT-CALIFORNIA WC 99 03 76 A - 001 WAIVER OF OUR RIGHTS TO RECOVER-CA WC 99 03 99 00 - 001 CA WORKERS' COMP NOTICE OF NON-RENEWAL WC 99 03 F3 00 - 001 CA LIMITS OF LIABILITY ENDT WC 99 06 H6 D - 001 CA DESIGNATED WORKPLACE EXCLUSION-CIP WC 00 04 21 F - 001 CATASTROPHE (O/T CERT ACTS OF TERR) ENDT WC 99 03 10 A - 001 CALIFORNIA ADDITIONAL DEFENSE OBLIGATION WC 99 04 08 00 - 001 PREMIUM DISCOUNT ENDORSEMENT WC 04 03 03 C - 001 OFFICERS & DIRECTORS COV/EXCLUSION - CA WC 04 03 17 B - 001 EMPLOYEE INSD BY GENERL EMPLYER EXCLUDED WC 04 03 45 A - 001 COMPREHENSIVE PERSONAL LIAB POL EXCL WC 04 03 60 B - 001 EMPLOYERS' LIAB COV AMENDATORY ENDT-CA WC 04 04 21 00 - 001 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA WC 04 04 22 00 - 001 CALIFORNIA SHORT-RATE CANCELATION ENDT WC 04 06 01 B - 001 CA CANCELATION ENDT WC 04 06 04 A - 001 COVID-19 REPORTING REQUIREMENT ENDT-CA WC 99 03 J3 K - 001 EXTEND CLASS SCHED ENDT CONST & ERECT-CA ST ASSIGN:Page ofDATE OF ISSUE:04-02-24 1 1 WC 00 00 00 ( C) (Rev 5-20) GENERAL SECTION Page 1 of 6© Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: A.The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B.Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an employer of the partnership's employees. C.Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D.State State means any state of the United States of America, and the District of Columbia. E.Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self- insured for such workplaces. PART ONE WORKERS COMPENSATION INSURANCE A.How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1.Bodily injury by accident must occur during the policy period. 2.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B.We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C.We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D.We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1.reasonable expenses incurred at our request, but not loss of earnings; 2.premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance. 3.litigation costs taxed against you; 4.interest on a judgment as required by law until we offer the amount due under this insurance; and 5.expenses we incur. WC 00 00 00 ( C) (Rev 5-20) © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.Page 2 of 6 Enforcement may be against us or against you and us. 4.Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5.This insurance conforms to the parts of the workers compensation law that apply to: a.benefits payable by this insurance; b.special taxes, payments into security or other special funds, and assessments payable by us under that law. 6.Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO EMPLOYERS LIABILITY INSURANCE A.How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1.The bodily injury must arise out of and in the course of the injured employee's employment by you. 2.The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A. of the Information Page. 3.Bodily injury by accident must occur during the policy period. 4.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5.If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. E.Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is paid. If any insurance or self- insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F.Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1.of your serious and willful misconduct; 2.you knowingly employ an employee in violation of law; 3.you fail to comply with a health or safety law or regulation; or 4.you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G.Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H.Statutory Provisions These statements apply where they are required by law. 1.As between an injured worker and us, we have notice of the injury when you have notice. 2.Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3.We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. WC 00 00 00 ( C) (Rev 5-20) © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.Page 3 of 6 B.We Will Pay We will pay all sums that you legally must pay as damages because of bodily injury to your employees, provided the bodily injury is covered by this Employers Liability Insurance. The damages we will pay, where recovery is permitted by law, include damages: 1.For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2.For care and loss of services; and 3.For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4.Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C.Exclusions This insurance does not cover: 1.Liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; 2.Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; 3.Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4.Any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 5.Bodily injury intentionally caused or aggravated by you; 6.Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7.Damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8.Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 U.S.C Sections 901 et seq.), the Nonappropriated Fund Instrumentalities Act (5 U.S.C Sections 8171 et seq.), the Outer Continental Shelf Lands Act (43 U.S.C Sections 1331 et seq.), the Defense Base Act (42 U.S.C Sections 1651– 1654), the Federal Mine Safety and Health Act (30 U.S.C Sections 801 et seq. and 901– 944), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 9.Bodily injury to any person in work subject to the Federal Employers' Liability Act (45 U.S.C Sections 51 et seq.), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10.Bodily injury to a master or member of the crew of any vessel, and does not cover punitive damages related to your duty or obligation to provide transportation, wages, maintenance, and cure under any applicable maritime law; 11.Fines or penalties imposed for violation of federal or state law; and 12.Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 U.S.C Sections 1801 et seq.) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D.We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages payable by this insurance. We WC 00 00 00 ( C) (Rev 5-20) © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.Page 4 of 6 have the right to investigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E.We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1.Reasonable expenses incurred at our request, but not loss of earnings; 2.Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3.Litigation costs taxed against you; 4.Interest on a judgment as required by law until we offer the amount due under this insurance; and 5.Expenses we incur. F.Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G.Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below: 1.Bodily Injury by Accident. The limit shown for "bodily injury by accident – each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2.Bodily Injury by Disease. The limit shown for "bodily injury by disease – policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily injury by disease. The limit shown for "bodily injury by disease – each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include disease that results directly from a bodily injury by accident. 3.We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H.Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them. I.Actions Against Us There will be no right of action against us under this insurance unless: 1.You have complied with all the terms of this policy; and 2.The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. PART THREE OTHER STATES INSURANCE A.How This Insurance Applies 1.This other states insurance applies only if one or more states are shown in Item 3.C. of the Information Page. 2.If you begin work in any one of those states after the effective date of this policy and are not insured or are not self-insured for such work, all provisions of the policy will apply as though that state were listed in Item 3.A. of the Information Page. 3.We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. WC 00 00 00 ( C) (Rev 5-20) © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.Page 5 of 6 4.If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Information Page, coverage will not be afforded for that state unless we are notified within thirty days. B.Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1.Provide for immediate medical and other services required by the workers compensation law. 2.Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. 3.Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit. 4.Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. 5.Do nothing after an injury occurs that would interfere with our right to recover from others. 6.Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE PREMIUM A.Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B.Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C.Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: 1.all your officers and employees engaged in work covered by this policy; and 2.all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. D.Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E.Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1.If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. WC 00 00 00 ( C) (Rev 5-20) Secretary President © Copyright 2013 National Council on Compensation Insurance, Inc. All Rights Reserved.Page 6 of 6 2.If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancelation table and procedure. Final premium will not be less than the minimum premium. F.Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G.Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. PART SIX CONDITIONS A.Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they IN WITNESS WHEREOF, the company has caused this policy to be signed by its President and Secretary at Hartford, Connecticut and countersigned on the Information page by a duly authorized agent of the company. comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision. B.Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C.Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. D.Cancelation 1.You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2.We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3.The policy period will end on the day and hour stated in the cancelation notice. 4.Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law. E.Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation. DATE OF ISSUE:ST ASSIGN: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 04 22 ( C) POLICY NUMBER: TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT Form WC 00 04 22 ( C) Page 1 of 2 © 2020 National Council on Compensation Insurance, Inc. All rights reserved. This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019 "Act of Terrorism" means any 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 as meeting all of the following requirements: a.The act is an act of terrorism. b.The act is violent or dangerous to human life, property, or infrastructure. c.The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d.The act has 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. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027 an amount equal to 20% of our direct earned premiums during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 Rate Countersigned by DATE OF ISSUE:ST ASSIGN: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 04 22 ( C) POLICY NUMBER: State Schedule Premium Endorsement Effective Policy No.Endorsement No. Premium $Insured Insurance Company Form WC 00 04 22 ( C) Page 2 of 2 © 2020 National Council on Compensation Insurance, Inc. All rights reserved. Policyholder Disclosure Notice 1.Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2.Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3.The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. For all other states please refer to the other Federal Terrorism Risk Insurance Act Disclosure Endorsements attached to your policy This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: DATE OF ISSUE:ST ASSIGN: POLICY AMENDATORY ENDORSEMENT – CALIFORNIA Page 1 of 2 © 2011 Workers’ Compensation Insurance Rating Bureau of California. All rights reserved. ENDORSEMENT WC 04 03 01 ( B) It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: 1.Minors Illegally Employed – Not Insured. This policy does not cover liability for additional compensation imposed on you under Section 4557, Division IV, Labor Code of the State of California, by reason of injury to an employee under sixteen years of age and illegally employed at the time of injury. 2.Punitive or Exemplary Damages – Uninsurable. This policy does not cover punitive or exemplary dam- ages where insurance of liability therefor is prohibited by law or contrary to public policy. 3.Increase in Indemnity Payment – Reimbursement. You are obligated to reimburse us for the amount of increase in indemnity payments made pursuant to Subdivision (d) of Section 4650 of the California Labor Code, if the late indemnity payment which gives rise to the increase in the amount of payment is due less than seven (7) days after we receive the completed claim form from you. You are obligated to reimburse us for any increase in indemnity payments not covered under this policy and will reimburse us for any increase in indemnity payment not covered under the policy when the aggregate total amount of the reimbursement payments paid in a policy year exceeds one hundred dollars ($100). If we notify you in writing, within 30 days of the payment, that you are obligated to reimburse us, we will bill you for the amount of increase in indemnity payment and collect it no later than the final audit. You will have 60 days, following notice of the obligation to reimburse, to appeal the decision of the insurer to the Depart- ment of Insurance. 4.Application of Policy. Part One, "Workers Compensation Insurance", A, "How This Insurance Applies", is amended to read as follows: This workers compensation insurance applies to bodily injury by accident or disease, including death result- ing therefrom. Bodily injury by accident must occur during the policy period. Bodily injury by disease must be caused or aggravated by the conditions of your employment. Your employee's exposure to those conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5.Rate Changes. The premium and rates with respect to the insurance provided by this policy by reason of the designation of California in Item 3 of the Information Page are subject to change if ordered by the Insurance Commissioner of the State of California pursuant to Section 11737 of the California Insurance Code. 6.Long Term Policy. If this policy is written for a period longer than one year, all the provisions of this policy shall apply separately to each consecutive twelve-month period or, if the first or last consecutive period is less than twelve months, to such period of less than twelve months, in the same manner as if a separate pol- icy had been written for each consecutive period. 7.Statutory Provision. Your employee has a first lien upon any amount which becomes owing to you by us on account of this policy, and in the case of your legal incapacity or inability to receive the money and pay it to the claimant, we will pay it directly to the claimant. 8.Part Five, "Premium", E, "Final Premium", is amended to read as follows: The premium shown on the Information Page, schedules, and endorsements is an estimate. The final pre- mium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: Endorsement No. Insured Insurance Company Countersigned by DATE OF ISSUE:ST ASSIGN: Endorsement Effective Policy No. Page 2 of 2 ENDORSEMENT WC 04 03 01 ( B) the balance to you. The final premium will not be less than the highest minimum premium for the classifica- tions covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: a.If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. b.If you cancel, final premium may be more than pro rata; it will be based on the time this policy was in force, and may be increased by our short-rate cancelation table and procedure. Final premium will not be less than the pro rata share of the minimum premium. It is further agreed that this policy, including all endorsements forming a part thereof, constitutes the entire contract of insurance. No condition, provision, agreement, or understanding not set forth in this policy or such endorsements shall affect such contract or any rights, duties, or privileges arising therefrom. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) © 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION (BLANKET WAIVER) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS POLICY NUMBER: AND EMPLOYERS LIABILITY POLICY ENDORSEMENT – CALIFORNIA ENDORSEMENT WC 99 03 76 ( A) - UB-3K219589-24-26-G HARTFORD CT 06183 ONE TOWER SQUARE 001 Schedule Job DescriptionPerson or Organization We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation pre- mium. 2.00 ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER, INCLUDING SKANSKA USA BUILDING, INC. AND THE CITY OF SANTA CLARA, ITS CITY COUNCIL, INCLUDING: SKANSKA USA BUILDING, INC. AND THE CITY OF SANTA CLARA, ITS CITY COUNCIL, COMMISSIONS, OFFICERS, EMPLOYEES, VOLUNTEERS, AND AGENTS. Countersigned byInsurance Company PremiumInsured Endorsement No.Policy No.Endorsement Effective This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ST ASSIGN: DATE OF ISSUE: Page of04-02-24 1 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 99 (00) POLICY NUMBER: CALIFORNIA WORKERS’ COMPENSATION NOTICE OF NON-RENEWAL Page 1 of 1DATE OF ISSUE:ST ASSIGN: Section 11664 of the California Insurance Code which becomes operative November 30, 1994 requires us in most instances to provide you with a notice of non-renewal. Except as specified in paragraphs 1 through 6 below, if we elect to non-renew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the non-renewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of non-renewal in any of the following situations: 1.Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2.The policy was extended for 90 days or less and the required notice was given prior to the extension. 3.You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4.The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5.You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6.We made a written offer to you at least 30 days, but not more than 120 days, prior to the end of the policy period to renew the policy at a changed premium rate. ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 AND EMPLOYERS LIABILITY INSURANCE POLICY ENDORSEMENT WC 99 03 F3 (00) $1,000,000 $1,000,000 $1,000,000 Pol Endorsement No.icy No. Insured Prem miu $ Insurance Company Countersigned by DATE OF ISSUE:ST ASSIGN: POLICY NUMBER: CALIFORNIA LIMITS OF LIABILITY ENDORSEMENT WORKERS COMPENSATION The limits of our liability under Part Two of the policy are: Bodily Injury by Accident Bodily Injury by Disease This change applies to the insurance this policy provides for California operations only. Bodily Injury by Disease Endorsement Effective Page 1 of 1 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) or the amount shown in Item 3.B. of the Information Page, whichever is greater, each accident This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. or the amount shown in Item 3.B. of the Information Page, whichever is greater, policy limit or the amount shown in Item 3.B. of the Information Page, whichever is greater, each employee ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 06 H6 ( D) POLICY NUMBER: CALIFORNIA ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Designated Workplaces Exclusion Endorsement – CIP Workplaces Exclusion Check box if liability is lawfully uninsured. Endorsement Effective Insured Insurance Company Policy No.Endorsement No. Premium $ Countersigned by Page 1 of 1DATE OF ISSUE:ST ASSIGN: © 2020 The Travelers Indemnity Company. All rights reserved. Designated Workplaces The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT COVER: Work conducted at or from any workplace that is part of a project covered by a Consolidated Insurance Program (CIP) (including an Owner Controlled Insurance Program (OCIP), Contractor Controlled Insurance Program (CCIP), Wrap-Up or similar program) in which any insured is an enrolled contractor of any tier and which includes the same or similar insurance as that provided by this policy. Check box if policyholder has affirmed in writing that other coverage is secured or the entity is lawfully uninsured. This policy may be deemed unlimited to the extent that any of the following requirements are not met: (1) the employer affirms in writing to the insurer that coverage for the excluded liability is secured and (2) the employer actually obtains coverage for the excluded liability. Nothing contained in this endorsement agreement 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 of this endorsement agreement. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include remuneration for any person excluded from coverage in accordance with the foregoing. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) X ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 PO ICY NUMBER:L State Rate Premium DATE OF ISSUE:ST ASSIGN: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 04 21 ( F) CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT Schedule Form WC 00 04 21 ( F) © 2021 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 1 of 1 This endorsement is notification that we are charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism). Coverage for such losses is subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement attached to this policy. For purposes of this endorsement, Catastrophe (Other Than Certified Acts of Terrorism) is defined as: A single event or peril resulting in a group of claims with aggregate workers compensation losses in excess of $50 million. This $50 million threshold applies per occurrence, across all states for which claims arise from a single event or peril. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 10 ( A) POLICY NUMBER: CALIFORNIA ADDITIONAL DEFENSE OBLIGATION DATE OF ISSUE:ST ASSIGN:Page 1 of 1 In consideration of additional premium paid, we will defend a claim or proceeding against you for increased workers’ compensation benefits because of an alleged violation of California Labor Code Sections 132a or 4553 and 4553.1, provided: A.You are represented by defense counsel who are acceptable to us; B.Defense counsel have substantial experience representing employers in workers’ compensation claims; and C.Our obligation is limited to reasonable fees and costs of defense counsel at billing rates actually paid by us to attorneys we usually retain to defend workers’ compensation claims in your community. The most which we will pay under this endorsement is $100,000, for defense costs regardless of the number of claims or proceedings against you. Any dispute concerning this endorsement shall be resolved by final and binding arbitration before a single impartial arbitrator selected by the parties to the dispute. We have no duty under this endorsement to pay any increased workers’ compensation benefits on your behalf. All other terms and conditions of this policy remain in effect. ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 AND WORKERS COMPENSATION EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 04 08 (00) POLICY NUMBER: PREMIUM DISCOUNT ENDORSEMENT OTHER POLICIES: DATE OF ISSUE:ST ASSIGN: The premium for the state and other states, if any, listed in item 3.A of the Information Page may be eligible for a discount. The final calculation of premium discount will be determined by our manuals and your premium as determined by audit. Premium subject to retrospective rating is not subject to premium discount. ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 POLICY NUMBER : ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE / EXCLUSION–CALIFORNIA WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 03 ( C) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G If the employer named in Item 1 of the Information Page is a quasi-public or private corporation, this policy applies to all officers and members of boards of directors while rendering actual service for the corporations for pay, as em ployees, except those excluded below who 1.individually own at least 10 percent of the corporation's issued and outstanding stock, or 2.individually own at least 1 percent of the corporation's issued and outstanding stock if that officer's or member's parent, grandparent, sibling, spouse, or child owns at least 10 percent of the corporation's issued and outstanding stock and that officer or member is covered by a health insurance policy or a health care service plan, or 3.are officers or members of the board of directors of a cooperative corporation organized pursuant to the Cooperative Corporation Law (Corporations Code Sections 12200 – 12704) who state that he or she is covered by both a health care service plan or health insurance policy, and a disability insurance policy that is comparable in scope and coverage, as determined by the Insurance Commissioner, to a workers' compensation policy. If the employer named in Item 1 of the Information Page is a private corporation, or a cooperative corporation organized pursuant to the Cooperative Corporation Law, this policy applies to an officer or director who is the sole shareholder of the corporation, as an employee, except if excluded below. The insurance under this policy is limited as follows: It is AGREED that, any thing in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Officers, Directors and Trustee Excluded Title RICHARD ROOD CHIEF EXECUTIVE OFFICER DAVID ROOD PRESIDENT DATE OF ISSUE:ST ASSIGN:ofPage04-02-24 21 POLICY NUMBER: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 03 ( C) Endorsement Effective Insured Insurance Company Policy No. Countersigned by Endorsement No. Premium ofPageST ASSIGN:DATE OF ISSUE: 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. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 22 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 17 ( B) POLICY NUMBER: ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Employee Insured by General Employer Excluded DATE OF ISSUE:ST ASSIGN:Page 1 of 2 The insurance under this policy is limited as follows: It is AGREED that, anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: NO LIABILITY FOR EMPLOYEE INSURED BY GENERAL EMPLOYER Any liability you may have as the special employer of an employee who is not on your payroll at the time of injury, based upon your representation that: (1) you have entered into a valid and enforceable agreement pursuant to Labor Code Section 3602(d) with the employee's general employer under which the general employer agrees to secure the payment of compensation for such employee and (2) the general employer has obtained workers' compensation coverage for the employee. This policy will be deemed unlimited to the extent that any of the following requirements are not met: (1) the employer actually obtains coverage for the excluded liability and (2) such coverage remains in effect for the term of this policy. 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. It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.). ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 POLICY NUMBER: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 17 ( B) DATE OF ISSUE:Page 2 of 2ST ASSIGN: Countersigned byInsurance Company Insured Endorsement Effective Policy No.Endorsement No. Premium $ This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 45 ( A) POLICY NUMBER: ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE Comprehensive Personal Liability Policy Exclusion DATE OF ISSUE:ST ASSIGN:Page 1 of 1 The insurance under this policy is limited as follows: It is AGREED that, any thing in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Any liability you may have for any injury to any employee(s) who is covered for workers' compensation benefits on a policy also affording comprehensive personal liability insurance which has been issued to this insured. THIS POLICY DOES NOT INSURE ANY EMPLOYEE(S) COVERED BY A COMPREHENSIVE PERSONAL LIABILITY POLICY 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 of this endorsement It is further agreed that "remuneration" when used as a premium basis for such insurance as is afforded by this policy shall not include the remuneration of any person excluded from coverage in accordance with the foregoing. FAILURE TO SECURE THE PAYMENT OF FULL COMPENSATION BENEFITS FOR ALL EMPLOYEES AS REQUIRED BY LABOR CODE SECTION 3700 IS A VIOLATION OF LAW AND MAY SUBJECT THE EMPLOYER TO THE IMPOSITION OF A WORK STOP ORDER, LARGE FINES, AND OTHER SUBSTANTIAL PENALTIES (Labor Code Section 3710.1, et seq.) This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 60 ( B) POLICY NUMBER: CALIFORNIA Page 1 of 1 EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT Endorsement No. Insured Insurance Company Countersigned by DATE OF ISSUE:ST ASSIGN: Endorsement Effective Policy No. Premium © 2014 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) The insurance afforded by Part Two (Employers' Liability Insurance) by reason of designation of California in item 3 of the information page is subject to the following provisions: A."How This Insurance Applies," is amended to read as follows: A.How This Insurance Applies This employers' liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury means a physical injury, including resulting death. 1.The bodily injury must arise out of and in the course of the injured employee's employment by you. 2.The employment must be necessary or incidental to your work in California. 3.Bodily injury by accident must occur during the policy period. 4.Bodily injury by disease must be caused or aggravated by the conditions of your employment. The em- ployee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5.If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. C.The "Exclusions" section is modified as follows (all other exclusions in the "Exclusions" section remain as is): 1.Exclusion 1 is amended to read as follows: 1.liability assumed under a contract. 2.Exclusion 2 is deleted. 3.Exclusion 7 is amended to read as follows: 7.damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, termination of employ- ment, or any personnel practices, policies, acts or omissions. 4.The following exclusions are added: 1.bodily injury to any member of the flying crew of any aircraft. 2.bodily injury to an employee when you are deprived of statutory or common law defenses or are subject to penalty because of your failure to secure your obligations under the workers' compensation law(s) appli- cable to you or otherwise fail to comply with that law. 3.liability arising from California Labor Code Section 2810.3 which relates to labor contracting. ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NUMBER: Endorsement Effective Policy No.Endorsement No. Insured Insurance Company Countersigned By DATE OF ISSUE:ST ASSIGN:DATE OF ISSUE:ST ASSIGN: ENDORSEMENT WC 04 04 21 (00) OPTIONAL PREMIUM INCREASE ENDORSEMENT – CALIFORNIA Page 1 of 1 You must provide us, or our authorized representative, access to records necessary to perform a payroll verifica- tion audit. If you fail to provide access within 90 days after expiration of the policy, you are liable to pay a total premium equal to 3 times our current estimate of the annual premium for your policy. In addition, if you fail to provide access after our third request within a 90 day or longer period, you are also liable for our costs in at- tempting to perform the audit unless you provide a compelling business reason for your failure. We will contact you to schedule appointments during normal business hours. We will notify you of your failure to provide access by mailing a certified, return-receipt document stating the increased premium and the total amount of our costs incurred in our attempt(s) to perform an audit. In addition to any other obligations under this contract, 30 days after you receive the notification, you will be obligated to pay the total premium and costs referenced above. If, thereafter, you provide access to your records within three years after the policy expires, or within another mutually agreed upon time, and we succeed in performing the audit to our satisfaction, we will revise your total premium and the costs due to reflect the results of the audit. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 AND ENDORSEMENT WC 04 04 22 (00) CALIFORNIA SHORT-RATE CANCELATION ENDORSEMENT Short Rate Cancelation Table Days in Factors to Apply to Days in Factors to Apply to Days in Factors to Apply to Policy Short Rate Earned Premium for Policy Short Rate Earned Premium for Policy Short Rate Period Percentages Period Policy in Effect Period Percentages Period Period Policy in Effect 1 5%18.2482 46 23%1.8250 91 35%1.4038 2 6 10.9489 47 23 1.7861 92 36 1.4283 3 7 8.5158 48 24 1.8250 93 36 1.4129 4 7 6.3869 49 24 1.7877 94 36 1.3979 5 8 5.8394 50 24 1.7520 95 37 1.4216 6 8 4.8662 51 24 1.7176 96 37 1.4068 7 9 4.6924 52 25 1.7548 97 37 1.3923 8 9 4.1058 53 25 1.7216 98 37 1.3781 9 10 4.0552 54 25 1.6899 99 38 1.4010 10 10 3.6496 55 26 1.7255 100 38 1.3870 11 11 3.6496 56 26 1.6947 101 38 1.3733 12 11 3.3455 57 26 1.6650 102 38 1.3598 13 12 3.3689 58 26 1.6362 103 39 1.3820 14 12 3.1283 59 27 1.6704 104 39 1.3688 15 13 3.1630 60 27 1.6425 105 39 1.3557 16 13 2.9653 61 27 1.6156 106 40 1.3774 17 14 3.0056 62 27 1.5895 107 40 1.3645 18 14 2.8386 63 28 1.6222 108 40 1.3519 19 15 2.8818 64 28 1.5969 109 40 1.3395 20 15 2.7377 65 28 1.5723 110 41 1.3605 21 16 2.7812 66 29 1.6038 111 41 1.3482 22 16 2.6547 67 29 1.5799 112 41 1.3362 23 17 2.6980 68 29 1.5566 113 41 1.3243 24 17 2.5856 69 29 1.5341 114 42 1.3447 25 17 2.4821 70 30 1.5643 115 42 1.3330 26 18 2.5270 71 30 1.5423 116 42 1.3215 27 18 2.4334 72 30 1.5208 117 43 1.3414 28 18 2.3465 73 30 1.5000 118 43 1.3301 29 18 2.2656 74 31 1.5291 119 43 1.3189 30 19 2.3117 75 31 1.5087 120 43 1.3079 31 19 2.2371 76 31 1.4888 121 44 1.3273 32 19 2.1672 77 32 1.5169 122 44 1.3164 33 20 2.2121 78 32 1.4974 123 44 1.3057 34 20 2.1471 79 32 1.4785 124 44 1.2951 35 20 2.0857 80 32 1.4600 125 45 1.3140 36 20 2.0278 81 33 1.4870 126 45 1.3036 37 21 2.0716 82 33 1.4689 127 45 1.2933 38 21 2.0171 83 33 1.4512 128 46 1.3117 39 21 1.9654 84 34 1.4774 129 46 1.3016 40 21 1.9162 85 34 1.4600 130 46 1.2916 41 22 1.9585 86 34 1.4430 131 46 1.2817 42 22 1.9119 87 34 1.4264 132 47 1.2996 43 22 1.8674 88 35 1.4517 133 47 1.2899 44 23 1.9079 89 35 1.4354 134 47 1.2802 45 23 1.8655 90 35 1.4194 135 47 1.2708 WORKERS COMPENSATION EMPLOYERS LIABILITY POLICY POLICY NUMBER: Page 1 of 3 © 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved DATE OF ISSUE:ST ASSIGN: Earned Premium for PercentagesPeriod Policy in Effect It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: If you cancel the policy and a disclosure was provided in accordance with Section 481(c) of the California Insurance Code, final premium will be based on the time this policy was in force and increased by the short-rate cancelation table below: ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 AND ENDORSEMENT WC 04 04 22 (00) Days in Factors to Apply to Days in Factors to Apply to Days in Factors to Apply to Policy Short Rate Earned Premium for Policy Short Rate Earned Premium for Policy Short Rate Period Percentages Period Policy in Effect Period Percentages Period Policy in Effect Period Percentages Period Policy in Effect 136 48%1.2882 181 60%1.2099 226 70%1.1305 137 48 1.2788 182 60 1.2033 227 70 1.1255 138 48 1.2696 183 61 1.2167 228 70 1.1206 139 49 1.2867 184 61 1.2101 229 71 1.1317 140 49 1.2775 185 61 1.2035 230 71 1.1267 141 49 1.2684 186 61 1.1970 231 71 1.1219 142 49 1.2595 187 61 1.1906 232 71 1.1170 143 50 1.2762 188 62 1.2037 233 72 1.1279 144 50 1.2674 189 62 1.1974 234 72 1.1231 145 50 1.2586 190 62 1.1910 235 72 1.1183 146 50 1.2500 191 62 1.1848 236 72 1.1136 147 51 1.2663 192 63 1.1977 237 72 1.1089 148 51 1.2578 193 63 1.1914 238 73 1.1195 149 51 1.2493 194 63 1.1853 239 73 1.1149 150 52 1.2653 195 63 1.1792 240 73 1.1102 151 52 1.2569 196 63 1.1732 241 73 1.1056 152 52 1.2487 197 64 1.1858 242 74 1.1161 153 52 1.2405 198 64 1.1798 243 74 1.1115 154 53 1.2562 199 64 1.1739 244 74 1.1070 155 53 1.2481 200 64 1.1680 245 74 1.1025 156 53 1.2401 201 65 1.1804 246 74 1.0980 157 54 1.2554 202 65 1.1745 247 75 1.1083 158 54 1.2475 203 65 1.1687 248 75 1.1038 159 54 1.2396 204 65 1.1630 249 75 1.0994 160 54 1.2319 205 65 1.1573 250 75 1.0950 161 55 1.2469 206 66 1.1694 251 76 1.1052 162 55 1.2392 207 66 1.1638 252 76 1.1008 163 55 1.2316 208 66 1.1582 253 76 1.0964 164 55 1.2241 209 66 1.1526 254 76 1.0921 165 56 1.2388 210 67 1.1645 255 76 1.0878 166 56 1.2313 211 67 1.1590 256 77 1.0979 167 56 1.2240 212 67 1.1535 257 77 1.0936 168 57 1.2384 213 67 1.1481 258 77 1.0893 169 57 1.2311 214 67 1.1428 259 77 1.0851 170 57 1.2238 215 68 1.1544 260 77 1.0810 171 57 1.2167 216 68 1.1491 261 78 1.0908 172 58 1.2308 217 68 1.1438 262 78 1.0866 173 58 1.2237 218 68 1.1385 263 78 1.0825 174 58 1.2167 219 69 1.1500 264 78 1.0784 175 58 1.2097 220 69 1.1448 265 79 1.0881 176 59 1.2236 221 69 1.1396 266 79 1.0840 177 59 1.2167 222 69 1.1345 267 79 1.0800 178 59 1.2098 223 69 1.1294 268 79 1.0759 179 60 1.2235 224 70 1.1406 269 79 1.0719 180 60 1.2167 225 70 1.1356 270 80 1.0815 © 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved WORKERS COMPENSATION EMPLOYERS LIABILITY POLICY POLICY NUMBER: DATE OF ISSUE:ST ASSIGN:Page 2 of 3 Earned Premium for ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 AND ENDORSEMENT WC 04 04 22 (00) Days in Factors to Apply to Days in Factors to Apply to Days in Factors to Apply to Policy Short Rate Earned Premium for Policy Short Rate Earned Premium for Policy Short Rate Period Percentages Period Policy in Effect Period Percentages Period Policy in Effect Period Percentages Period Policy in Effect 271 80%1.0775 316 90%1.0396 361 100%1.0111 272 80 1.0735 317 90 1.0363 362 100 1.0083 273 80 1.0696 318 90 1.0330 363 100 1.0055 274 81 1.0790 319 90 1.0298 364 100 1.0027 275 81 1.0751 320 91 1.0380 365 100 1.0000 276 81 1.0712 321 91 1.0347 277 81 1.0673 322 91 1.0315 278 81 1.0635 323 91 1.0283 279 82 1.0728 324 92 1.0364 280 82 1.0689 325 92 1.0332 281 82 1.0651 326 92 1.0301 282 82 1.0614 327 92 1.0269 283 83 1.0705 328 92 1.0238 284 83 1.0667 329 93 1.0318 285 83 1.0630 330 93 1.0286 286 83 1.0593 331 93 1.0255 287 83 1.0556 332 93 1.0224 288 84 1.0646 333 94 1.0303 289 84 1.0609 334 94 1.0272 290 84 1.0572 335 94 1.0242 291 84 1.0536 336 94 1.0211 292 85 1.0625 337 94 1.0181 293 85 1.0589 338 95 1.0259 294 85 1.0553 339 95 1.0229 295 85 1.0517 340 95 1.0198 296 85 1.0481 341 95 1.0169 297 86 1.0569 342 95 1.0139 298 86 1.0534 343 96 1.0216 299 86 1.0498 344 96 1.0186 300 86 1.0463 345 96 1.0156 301 86 1.0429 346 96 1.0127 302 87 1.0515 347 97 1.0203 303 87 1.0480 348 97 1.0174 304 87 1.0446 349 97 1.0145 305 87 1.0411 350 97 1.0116 306 88 1.0497 351 97 1.0087 307 88 1.0462 352 98 1.0162 308 88 1.0429 353 98 1.0133 309 88 1.0395 354 98 1.0105 310 88 1.0361 355 98 1.0076 311 89 1.0445 356 99 1.0150 312 89 1.0412 357 99 1.0122 313 89 1.0379 358 99 1.0094 314 89 1.0346 359 99 1.0065 315 90 1.0429 360 99 1.0038 Endorsement No. Insured Insurance Company Countersigned by © 2011 Workers' Compensation Insurance Rating Bureau of California. All rights reserved WORKERS COMPENSATION EMPLOYERS LIABILITY POLICY POLICY NUMBER: Endorsement Effective Policy No. Premium $ DATE OF ISSUE:ST ASSIGN:Page 3 of 3 Earned Premium for This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 06 01 ( B) POLICY NUMBER: Form WC 04 06 01 ( B) DATE OF ISSUE:ST ASSIGN:Page 1 of 2 CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation: 1.You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2.We may cancel this policy for one or more of the following reasons: a.Non-payment of premium; b.Failure to report payroll; c.Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d.Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e.Material misrepresentation made by you or your agent; f.Failure to cooperate with us in the investigation of a claim; g.Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives; h.The occurrence of a material change in the ownership of your business; i.The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; j.The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; k.The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3.If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 06 01 ( B) POLICY NUMBER: Form WC 04 06 01 ( B) DATE OF ISSUE:ST ASSIGN:Page 2 of 2 4.If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. 5.The policy period will end on the day and hour stated in the cancelation notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by ONE TOWER SQUAREHARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 06 04 ( A) POLICY NUMBER: COVID-19 REPORTING REQUIREMENT ENDORSEMENT – CALIFORNIA Form WC 04 06 04 ( A) (Ed. 01-23) DATE OF ISSUE:ST ASSIGN:Page 1 of 2 In addition to the requirements under Part 4, "Your Duties if Injury Occurs" of your policy, if you have five or more employees and an employee that is not described in California Labor Code section 3212.87 tests positive for COVID-19, you are required to report the following information as provided below. Pursuant to California Labor Code Section 3212.88(i), when you know, or reasonably should know, that an employee has tested positive for COVID-19 between September 17, 2020 and January 1,2024, you must report to your claims administrator in writing via electronic mail or facsimile within 3 business days all of the following: (1)An employee has tested positive. For purposes of this reporting, do not provide any personally identifiable information regarding the employee who tested positive for COVID-19 unless the employee asserts the infection is work related or has filed a claim form pursuant to California Labor Code Section 5401. (2)The date that the employee tests positive, which is the date the specimen was collected for testing. (3)The specific address or addresses of the employee's specific place of employment during the 14-day period preceding the date of the employee's positive test. (4)The highest number of employees who reported to work at the employee's specific place of employment in the 45-day period preceding the last day the employee worked at each specific place of employment. Labor Code Section 3212.88(j) states that the intentional submission of false or misleading information or the failure to report the above information as required may subject you to a civil penalty in the amount of up to $10,000 to be assessed by the Labor Commissioner. For the purposes of these reporting requirements, California Labor Code Section 3212.88(m) provides the following: (1)"COVID-19" means the 2019 novel coronavirus disease. (2)"Test" or "testing" means a PCR (Polymerase Chain Reaction) test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA. "Test" or "testing" does not include serologic testing, also known as antibody testing. "Test" or "testing" may include any other viral culture test approved for use or approved for emergency use by the United States Food and Drug Administration to detect the presence of viral RNA which has the same or higher sensitivity and specificity as the PCR Test. (3)"A specific place of employment" means the building, store, facility, or agricultural field where an employee performs work at the employer's direction. "A specific place of employment" does not include the employee's home or residence, unless the employee provides home health care services to another individual at the employee's home or residence. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 06 04 ( A) POLICY NUMBER: Form WC 04 06 04 ( A) (Ed. 01-23) DATE OF ISSUE:ST ASSIGN:Page 2 of 2 Endorsement Effective Policy No.Endorsement No. Insured Premium Insurance Company Countersigned by This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 EXTENDED CLASSIFICATION SCHEDULE ENDORSEMENT CONSTRUCTION AND ERECTION – CALIFORNIA Schedule of Construction and Erection Classification Codes WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 1 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: This endorsement is an extension of the Information Page (Classification Schedule). The Construction and Erection Classification Codes listed in the schedule below are also part of this policy as of the effective date of this endorsement. The Information Page contains estimated remuneration assigned to construction and erection classifications known to us at policy inception. Construction and Erection operations may require changes to the construction trade specialties used in your business. These changes in operations may be discovered by or reported to us during the policy period or at audit. When this occurs, we will apply remuneration to the applicable classifications representing the trade specialties listed in this schedule. 1322 Oil or Gas Well Servicing - N.O.C. - by contractors using well service or work-over rigs - no drilling or redrilling - including Outside Salespersons 1330 Blasting - N.O.C. - all employees 3365 Welding or Cutting - N.O.C. - shop or outside - including incidental machining operations 3719 Oil or Gas Refineries - erection or repair - all operations 3724(1) Millwright Work - N.O.C. - erection or repair of machinery or equipment at customers’ locations 3724(2) Electrical Machinery or Auxiliary Apparatus - installation, service or repair - including incidental wiring 3726 Boiler Installation, Service or Repair - steam or hot water 5020 Ceiling Installation - suspended panels 5027 Masonry - employees whose regular hourly wage does not equal or exceed $32.00 per hour - N.O.C. 5028 Masonry - employees whose regular hourly wage equals or exceeds $32.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $32.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $32.00 per hour shall be classified as 5027, Masonry. 5029 Concrete or Asphalt Sawing or Drilling - N.O.C. 5040 Iron or Steel Erection - structural 5102 Iron, Steel, Brass, Bronze or Aluminum Erection - non-structural 5107 Door, Door Frame or Pre-Glazed Window Installation - not overhead doors 5108 Door Installation - overhead doors 5140 Electrical Wiring - within buildings - including installation or repair of electrical fixtures - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $34.00 per hour. Assignment of UB-3K219589-24-26-G 04-02-24 ONE TOWER SQUARE HARTFORD CT 06183 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 2 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $34.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $34.00 per hour shall be classified as 5190, Electrical Wiring. 5146(1) Cabinet, Fixture or Trim Installation - N.O.C. At a particular job or location, Classification 5146(1) shall not be used for division of payroll in connection with Classifications 5403/5432, Carpentry, or 5632/5633, Steel Framing. 5146(2) Sign Installation or Repair - interior or affixed to building surfaces 5160 Elevator Erection or Repair 5183(1) Plumbing - including shop, yard or storage operations - gas, steam, hot water or other pipe fittings installation, including house connections installation - employees whose regular hourly wage does not equal or exceed $31.00 per hour - N.O.C. 5183(2) Refrigeration Equipment - not household units - installation, service or repair - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $31.00 per hour - N.O.C. 5183(3) Heating or Air Conditioning Equipment - installation, service or repair - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $31.00 per hour - N.O.C. 5184 Steam Pipe or Boiler Insulation - applying non-conducting materials - including shop, yard or storage operations 5185 Automatic Sprinkler Installation - within buildings - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $32.00 per hour 5186 Automatic Sprinkler Installation - within buildings - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $32.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $32.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $32.00 per hour shall be classified as 5185, Automatic Sprinkler Installation. 5187(1) Plumbing - including shop, yard or storage operations - gas, steam, hot water or other pipe fittings installation, including house connections installation - employees whose regular hourly wage equals or exceeds $31.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5183(1), Plumbing. 5187(2) Refrigeration Equipment - not household units - installation, service or repair - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $31.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5183(2), Refrigeration Equipment. 5187(3) Heating or Air Conditioning Equipment - installation, service or repair - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $31.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5183(3), Heating or Air Conditioning Equipment. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 3 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: 5190 Electrical Wiring - within buildings - including installation or repair of electrical fixtures - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $34.00 per hour 5195 Communications Cabling - within buildings - including shop, yard or storage operations 5201(1) Concrete or Cement Work - pouring or finishing of concrete sidewalks, driveways, patios, curbs or gutters - including the making or stripping of forms - employees whose regular hourly wage does not equal or exceed $32.00 per hour 5201(2) Concrete or Cement Work - pouring or finishing of concrete floor slabs, poured in place and on the ground, and concrete slab-type foundations, for other than concrete buildings or structural steel buildings of multi- story construction - including the making or stripping of forms - employees whose regular hourly wage does not equal or exceed $32.00 per hour 5205(1) Concrete or Cement Work - pouring or finishing of concrete sidewalks, driveways, patios, curbs or gutters - including the making or stripping of forms - employees whose regular hourly wage equals or exceeds $32.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $32.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $32.00 per hour shall be classified as 5201(1), Concrete or Cement Work. 5205(2) Concrete or Cement Work - pouring or finishing of concrete floor slabs, poured in place and on the ground, and slab-type foundations, for other than concrete buildings or structural steel buildings of multi-story construction - including the making or stripping of forms - employees whose regular hourly wage equals or exceeds $32.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $32.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $32.00 per hour shall be classified as 5201(2), Concrete or Cement Work. 5212 Concrete Pumping - all operations 5213 Concrete Construction - N.O.C. 5214 Concrete or Cement Work - pouring or finishing of precast concrete wall panels, precast floor slabs or precast roof slabs at ground level and at job site - including the making or stripping of forms 5222(1) Concrete Construction - in connection with bridges or culverts where clearance exceeds 10 feet at any point or entire distance between terminal abutments exceeds 20 feet 5222(2) Chimney Construction - industrial- stone, brick or concrete 5225 Reinforcing Steel Installation - placing for concrete construction 5348 Tile, Stone, Mosaic, or Terrazzo Work - not fireproof tile construction 5403 Carpentry - including the installation of interior trim, doors and cabinet work in connection therewith - employees whose regular hourly wage does not equal or exceed $39.00 per hour - N.O.C. 5432 Carpentry - including the installation of interior trim, doors and cabinet work in connection therewith - employees whose regular hourly wage equals or exceeds $39.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $39.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $39.00 per hour shall be classified as 5403, Carpentry. UB-3K219589-24-26-G 04-02-24 ONE TOWER SQUARE HARTFORD CT 06183 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 4 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: 5436 Hardwood Floor Laying - including finishing 5443 Lathing 5446 Wallboard Installation - within buildings - including finishing and preparation prior to painting - employees whose regular hourly wage does not equal or exceed $38.00 per hour - N.O.C. 5447 Wallboard Installation - within buildings - including finishing and preparation prior to painting - employees whose regular hourly wage equals or exceeds $38.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 5446, Wallboard Installation. 5467 Glaziers - away from shop - employees whose regular hourly wage does not equal or exceed $36.00 per hour 5470 Glaziers - away from shop - employees whose regular hourly wage equals or exceeds $36.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $36.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $36.00 per hour shall be classified as 5467, Glaziers. 5473 Asbestos Abatement - all operations - including shop, yard or storage operations 5474(1) Painting or Wallpaper Installation - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $31.00 per hour - N.O.C. 5474(2) Waterproofing - other than roofing or subaqueous work - performed as a separate operation not a part of or incidental to any other operation - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $31.00 per hour 5474(3) Painting - water, oil or gasoline storage tanks - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $31.00 per hour 5479 Insulation Work - installation or application of acoustical or thermal insulating materials in buildings or within building walls - N.O.C. 5482(1) Painting or Wallpaper Installation - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $31.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5474(1), Painting or Wallpaper Installation. 5482(2) Waterproofing - other than roofing or subaqueous work - performed as a separate operation not a part of or incidental to any other operation - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $31.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5474(2), Waterproofing. 5482(3) Painting-water, oil or gasoline storage tanks - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $31.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $31.00 per hour. UB-3K219589-24-26-G 04-02-24 ONE TOWER SQUARE HARTFORD CT 06183 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 5 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: The payroll of an employee whose regular hourly wage is not shown to equal or exceed $31.00 per hour shall be classified as 5474(3), Painting. 5484 Plastering or Stucco Work - employees whose regular hourly wage does not equal or exceed $36.00 per hour 5485 Plastering or Stucco Work - employees whose regular hourly wage equals or exceeds $36.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $36.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $36.00 per hour shall be classified as 5484, Plastering or Stucco Work. 5506 Street or Road Construction - paving or repaving, surfacing or resurfacing or scraping - all kinds - including airport runways, warming aprons, incidental field plants, fence or guardrail construction 5507 Street or Road Construction - grading - all operations of bringing roadbed to grade, including clearing and grubbing right-of-way and temporary surfacing 5538(1) Sheet Metal Work - erection, installation or repair - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $29.00 per hour - N.O.C. 5538(2) Heating or Air Conditioning Ductwork - installation or repair - including shop, yard or storage operations - including installation of furnaces or air conditioning equipment - employees whose regular hourly wage does not equal or exceed $29.00 per hour - N.O.C. 5542(1) Sheet Metal Work - erection, installation or repair - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $29.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $29.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $29.00 per hour shall be classified as 5538(1), Sheet Metal Work. 5542(2) Heating or Air Conditioning Ductwork - installation or repair - including shop, yard or storage operations - including installation of furnaces or air conditioning equipment - employees whose regular hourly wage equals or exceeds $29.00 per hour - N.O.C. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $29.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $29.00 per hour shall be classified as 5538(2), Heating or Air Conditioning Ductwork. 5552 Roofing - all kinds - including shop, yard or storage operations - employees whose regular hourly wage does not equal or exceed $29.00 per hour 5553 Roofing - all kinds - including shop, yard or storage operations - employees whose regular hourly wage equals or exceeds $29.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $29.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $29.00 per hour shall be classified as 5552, Roofing. 5606 Contractors-construction or erection - executive level supervisors - no direct supervision - division of a single employee’s payroll with any other classification is not permitted 5610 Contractors - Construction or erection - all construction subcontracted - all other employees 5632 Steel Framing - light gauge - including the incidental installation of interior trim, doors and cabinet work - employees whose regular hourly wage does not equal or exceed $39.00 per hour. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 6 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: 5633 Steel Framing - light gauge - including the incidental installation of interior trim, doors and cabinet work - employees whose regular hourly wage equals or exceeds $39.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $39.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $39.00 per hour shall be classified as 5632, Steel Framing. 5650 Termite Control Work - all operations - including shop, yard or storage operations, Outside Salespersons and estimators 6003(1) Pile Driving 6003(2) Wharf Building - timber - including pile driving 6003(3) Bridge or Trestle Construction - wood - all operations 6011 Dam Construction - all operations - including dam repair, alteration, seismic retrofitting and demolition 6204 Drilling - N.O.C. - not geothermal, oil or gas producing, mining or quarrying 6206(1) Oil or Gas Wells - cementing 6206(2) Oil or Gas Wells - acidizing or hydraulic fracturing - all operations 6206(3) Oil or Gas Wells - vacuum truck service companies - all operations 6206(4) Oil or Gas Wells - gravel packing 6213 Oil or Gas Wells - specialty tool companies - N.O.C. - all employees - including shop, yard or storage operations and outside supervisors 6216 Oil or Gas Lease Work - N.O.C. - not lease operators 6218(1) Excavation - N.O.C. - including borrowing, filling or backfilling - employees whose regular hourly wage does not equal or exceed $38.00 per hour 6218(2) Grading Land - N.O.C. - including borrowing, filling or backfilling - employees whose regular hourly wage does not equal or exceed $38.00 per hour 6218(3) Land Leveling - grading farm lands - employees whose regular hourly wage does not equal or exceed $38.00 per hour 6220(1) Excavation - N.O.C - including borrowing, filling or backfilling - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6218(1), Excavation - N.O.C. 6220(2) Grading Land - N.O.C. - including borrowing, filling or backfilling - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6218(2), Grading Land. ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 7 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: 6220(3) Land Leveling - grading farm lands - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6218(3), Land Leveling. 6233 Oil or Gas Pipeline Construction - all operations 6235(1) Oil or Gas Wells - drilling or redrilling - including installation of casing 6235(2) Oil or Gas Wells - installation or recovery of casing 6235(3) Drilling - geothermal wells - including installation of casing 6237(1) Oil or Gas Wells - wireline service companies - including instrument logging or survey work in wells 6237(2) Oil or Gas Wells - perforating of casing - all operations 6251 Tunneling or Underground Mining - all employees 6258 Foundation Preparation Work - including foundation drilling - all operations to completion of substructure 6307 Sewer Construction - all operations - including construction of laterals and tunneling at street crossings - employees whose regular hourly wage does not equal or exceed $38.00 per hour 6308 Sewer Construction - all operations - including construction of laterals and tunneling at street crossings - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6307, Sewer Construction. 6315(1) Water Mains or Connections Construction - including tunneling at street crossings - employees whose regular hourly wage does not equal or exceed $38.00 per hour 6315(2) Gas Mains or Connections Construction - including tunneling at street crossings - employees whose regular hourly wage does not equal or exceed $38.00 hour 6316(1) Water Mains or Connections Construction - including tunneling at street crossings - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6315(1), Water Mains or Connections Construction. 6316(2) Gas Mains or Connections Construction - including tunneling at street crossings - employees whose regular hourly wage equals or exceeds $38.00 per hour. Assignment of this classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds $38.00 per hour. The payroll of an employee whose regular hourly wage is not shown to equal or exceed $38.00 per hour shall be classified as 6315(2), Gas Mains or Connections Construction. 6325 Conduit Construction or Underground Wiring - including tunneling at street crossings 6361(1) Canal Construction - all operations 6361(2) Cross-Country Water Pipeline Construction - all operations ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by WC 99 03 J3 ( K) DATE OF ISSUE: ST ASSIGN: Page 8 of 8 © 2023 The Travelers Indemnity Company. All rights reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 J3 ( K) POLICY NUMBER: 6361(3) Jetty or Breakwater Construction - all operations to completion 6364 Irrigation Pipe Installation - agricultural - all operations 6400 Fence Construction - metal or wood 7538 Electric Power Line Construction - by contractor 7601 Aerial Line Construction - by contractor - not power lines 7605 Security Alarm, Fire Alarm or Life Safety Systems Installation, Service or Repair - including shop, yard or storage operations 7855 Railroad Construction - all operations 8227 Construction or Erection Permanent Yards or Shops - for maintenance of equipment or storage of material 9529(1) Scaffolds, Shoring, Concrete or Cement Distributing Towers, Hod Hoists or Construction Elevators - installation or removal 9529(2) Decorating - interior or exterior - hanging flags or bunting for conventions or celebrations 9529(3) Tent - erection, removal or repair - away from shop 9549 Advertising Companies - outdoor - selling space for advertising purposes - including shop, yard or storage operations; the erection, painting, repair and maintenance, or removal of signs; bill posting; and sign painting or lettering in or upon buildings or structures This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) ONE TOWER SQUARE HARTFORD CT 06183 UB-3K219589-24-26-G 04-02-24 Travelers Medical Provider Network (MPN) Plan – CALIFORNIA Necessary Action for MPN Participation W04NIB15 Page 1 of 1 www.travelers.com/CAMPN Dear Policyholder: As your workers compensation insurer, Travelers is pleased to include your Company in our California Medical Provider Network (MPN) plan. Travelers has an extensive MPN with physicians who understand workers compensa- tion and are experienced in providing expert care for injured workers. Our program ensures that every covered employee that suffers a work-related injury or illness has access to prompt medical care and an improved likelihood of a safe return to work as soon as medically appropriate. MPN utilization can reduce overall workers compensation claim payouts by providing greater control over medical fees and obtaining more favorable medical treatment outcomes. Your role is crucial to the success of the MPN program. Together, we can better manage your Workers Compensation claims within the MPN. The MPN is a standard product in all Travelers workers compensation policies, and all policyholders are expected to participate. This information is being provided to you to help you understand the requirements for proper MPN participation. The State Division of Workers' Compensation (DWC) regulates how an employee is notified of an employer's MPN participation. Section § 9767.12 of Title 8, California Code of Regulations specifies what notices are to be provided to employees, as well as when and how they are to be provided. Information about the Travelers MPN and notice requirements is available to policyholders on www.travelers.com. Please type this web address into your browser to access the information: A "Frequently Asked Questions" page is also available through the above web address. Look for the link called FAQ – MPN. If you have additional, general questions regarding the MPN and do not have a contact in the Claim Department, you can contact the Travelers MPN Team by calling (800) 287-9682 or sending an email to CAMPN@travelers.com. Please listen for the prompts for Employers or Employer Representatives. In addition to reviewing the information on our web page, we also recommend that you: •Make sure your management staff has instructions on how to access the MPN Medical Provider directory via www.travelers.com/CAMPN. •Select an occupational medicine clinic, urgent care clinic, or, an acute care hospital from the MPN to serve as your designated initial injury treatment facility for each plant/location. Contact this facility and inform them that you are participating in the Travelers Medical Provider Network Plan. Update the State Posting Notices to in- clude the name, address, and phone number of the facility. •Review your procedures for handling work-related injuries, your modified duty policy, and your safety commit- tee operation with your management staff. We believe the MPN program will provide better overall workers compensation outcomes for you as an employer. Sincerely, Travelers IMPORTANT NOTICE – COPYRIGHT For all policy forms other than the workers compensation bureau forms of the states identified below: © 1983-National Council on Compensation Insurance, Inc. All Rights Reserved For the workers compensation bureau policy forms of the following states: DELAWARE: © Delaware Compensation Rating Bureau MICHIGAN: MINNESOTA: © 1992-Minnesota Workers' Compensation Insurers Association, Inc. All Rights Reserved. NEW JERSEY: © Compensation Rating and Inspection Bureau NEW YORK: © 1987- New York Compensation Insurance Rating Board NORTH CAROLINA: PENNSYLVANIA: ©Pennsylvania Compensation Rating Bureau © 2008- WUNN1B23 Page 1 of 1©The Travelers Indemnity Company. All rights reserved. NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. The National Council on Compensation Insurance and certain state workers compensation bureaus require a copyright notice on policy forms that contain their copyrighted material. This Important Notice addresses this copyright notice requirement for any policy form included in this policy that does not separately contain a copyright notice. Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. Includes copyright material of the National Council on Compensation Insurance, Inc. and the Michigan Workers' Compensation Placement Facility, used with their permission. North Carolina Rate Bureau. Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. 2024 2024 2024 2024 2024 2024 2024 IMPORTANT NOTICE – NEW, UNCOLLECTED OR UNCONTEMPLATED SURCHARGES WUND1C17 © 2016 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. The insurer is responsible for the collection of any surcharge related to the policy premium in accordance with state laws or regulations. While surcharges are commonly known at the time of policy issuance, there are instances when a state amends existing, or institutes new, surcharge rates after policy issuance. The insured is responsible to reimburse the insurer when billed for the amount of any surcharge. W04N1C14 Page 1 of 1 STATE OF CALIFORNIA IMPORTANT LOSS CONTROL INFORMATION Notice To Policy Recipient: California Labor Code § 6354.5 (b)(3) requires workers' compensation insurance carriers to provide their California policyholders with occupational safety and health loss control consultation services at no additional charge. See the enclosed Safety Services notice for a list of services available and for the phone number and address of the Travelers Risk Control office nearest you. If you are not the person directly responsible for the loss control activities of your company in California, please direct these safety services notices to the person directly responsible for loss control activities. IMPORTANT NOTICE TO CALIFORNIA EMPLOYERS W04N1J15 © 2015 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. California Labor Code Section 3550 requires you to post and keep posted in each of your California workplaces, in a conspicuous location frequented by employees, a notice that states the name of your current workers compensation insurance carrier and who is responsible for claims adjustment. The notice must be posted in English and Spanish if you have Spanish-speaking employees. Failure to keep the notice posted as required constitutes a misdemeanor. For your convenience, we have enclosed copies of notice DWC 7, Notice to Employees – Injuries Caused by Work, for each of your California locations. POLICYHOLDER NOTICE PAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS W04N2A20 PN 04 99 06 D Page 1 of 1 Your policy includes one or more construction or erection classifications. Dual wage classifications are pairs of classifications that describe the same construction or erection operation yet are assigned based upon whether the employee's hourly wage is above or below a specified threshold. Each pair of dual wage classifications contains one "high wage" classification that is assignable to payrolls earned by employees whose regular hourly wage equals or exceeds a specified wage threshold and one "low wage" classification that is assignable to payrolls earned by employees whose regular hourly wage is less than the specified threshold. Payroll Record Requirements The assignment of a high wage classification is contingent on verifying that the employee's hourly wage equals or exceeds the specified wage threshold. The determination of the regular hourly wage for any non-salaried employee must be supported by one of the following sources: • Original time cards or time book entries for each employee. Original records must include the operations performed, the total hours worked each day and the times the employee started and ended each work period throughout the workday. At job locations where all of the employer's operations cease for a uniform unpaid meal period, recording the start and stop times of the uniform break period is not required. • A valid collective bargaining agreement that shows the regular hourly wage rate by job classification of a worker. If using a collective bargaining agreement, the records must include an employee roster by job classification that permits the reconciliation of individual employees to the job classifications set forth in the collective bargaining agreement. The non-salaried employee's regular hourly wage shall be determined by dividing that employee's total remuneration by the hours worked during the pay period, irrespective of whether the employee is paid on an hourly, piecework, production or commission basis. The payroll earned by any non-salaried employees for whom the records specified above are not maintained and/or made available will be assigned to the low wage classification that describes the operations performed. The regular hourly wage of salaried employees is determined by dividing the total annual remuneration by 2000 hours. If an employee is salaried for less than 12 months, the regular hourly wage for the salaried period is calculated on a prorated basis. Audit Requirements If your policy has an effective date on or after January 1, 2020 and produces a final premium of $10,500 or more, a physical audit is required at least once a year; if it produces a final premium of less than $10,500 and develops payroll in a high wage classification, a physical audit of the policy is required unless the policy is a renewal and a physical audit was completed for one of the two immediately preceding policy periods. A "physical audit" is defined as an audit of payroll, whether conducted at the policyholder's location or at a remote site, that is based upon an auditor's examination of the policyholder's books of accounts and original payroll records (in either electronic or hard copy form) as necessary to determine and verify the exposure amounts by classification. If you hold a C-39 Roofing Contractor license from the California Contractors State License Board, a physical audit is required on the complete policy period of each policy regardless of the amount of final premium. See California Insurance Code Section 11665(a) for additional requirements regarding the audit of C-39 license holders. W04N2H12 POLICYHOLDER NOTICE SHORT RATE CANCELATION CALIFORNIA INSURANCE CODE SECTION 481 Page 1 of 1 CA Insurance Code Section 481 requires that where an insurance policy includes a provision to refund premium on anything other than a pro rata basis, including the assessment of cancellation fees, the insurer must disclose that fact to the policyholder in writing prior to, or concurrent with, the proposal or quote prior to each renewal. The disclosure must include the actual or maximum fees or penalties to be applied. The WCIRB also created a Short Rate Cancelation Endorsement which complements the disclosure requirement. This requirement applies to in- surance policies issued or renewed on or after January 1, 2012. In order to respond to this insurance code requirement we have created this Policyholder Notice to disclose our use of short rate calculations as described in the California Short Rate Cancelation Endorsement included in the policy. PN 04 99 02 B © (Ed. 5-02) POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS CALIFORNIA WORKERS' COMPENSATION INSURANCE NOTICE OF NONRENEWAL 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Page 1 of 2W04NBA02 Pursuant to Section 11752.8 of the California Insurance Code, we are providing you with an explanation of the California workers' compensation rating laws. 1.We establish our own rates for workers' compensation. Our rates, rating plans, and related information are filed with the insurance commissioner and are open for public inspection. 2.The insurance commissioner can disapprove our rates, rating plans, or classifications only if he or she has determined after public hearing that our rates might jeopardize our ability to pay claims or might create a mo- nopoly in the market. A monopoly is defined by law as a market where one insurer writes 20% or more of that part of the California workers' compensation insurance that is not written by the State Compensation Insur- ance Fund. If the insurance commissioner disapproves our rates, rating plans, or classifications, he or she may order an increase in the rates applicable to outstanding policies. 3.Rating organizations may develop pure premium rates that are subject to the insurance commissioner's ap- proval. A pure premium rate reflects the anticipated cost and expenses of claims per $100 of payroll for a given classification. Pure premium rates are advisory only, as we are not required to use the pure premium rates developed by any rating organization in establishing our own rates. 4.We must adhere to a single, uniform experience rating plan. If you are eligible for experience rating under the plan, we will be required to adjust your premium to reflect your claim history. A better claim history generally results in a lower experience rating modification; more claims, or more expensive claims, generally result in a higher experience rating modification. The uniform experience rating plan, which is developed by the insur- ance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. 5.A standard classification system, developed by the insurance rating organization designated by the insurance commissioner, is subject to approval by the insurance commissioner. The standard classification system is a method of recognizing and separating policyholders into industry or occupational groups according to their similarities and/or differences. We can adopt and apply the standard classification system or develop and ap- ply our own classification system, provided we can report the payroll, expenses, and other costs of claims in a way that is consistent with the uniform statistical plan or the standard classification system. 6.Our rates and classifications may not violate the Unruh Civil Rights Act or be unfairly discriminatory. 7.We will provide an appeal process for you to appeal the way we rate your insurance policy. The process re- quires us to respond to your written appeal within 30 days. If you are not satisfied with the result of your ap- peal, you may appeal our decision to the insurance commissioner. Section 11664 of the California Insurance Code requires us, in most instances, to provide you with a notice of nonrenewal. Except as specified in paragraphs 1 through 6 below, if we elect to nonrenew your policy, we are required to deliver or mail to you a written notice stating the reason or reasons for the nonrenewal of the policy. The notice is required to be sent to you no earlier than 120 days before the end of the policy period and no later than 30 days before the end of the policy period. If we fail to provide you the required notice, we are required to continue the coverage under the policy with no change in the premium rate until 60 days after we provide you with the required notice. We are not required to provide you with a notice of nonrenewal in any of the following situations: 1.Your policy was transferred or renewed without a change in its terms or conditions or the rate on which the premium is based to another insurer or other insurers who are members of the same insurance group as us. 2.The policy was extended for 90 days or less and the required notice was given prior to the extension. PN 04 99 02 B © W04NBA02 (Ed. 5-02) This notice does not change the policy to which it is attached. 2002 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Page 2 of 2 3.You obtained replacement coverage or agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. 4.The policy is for a period of no more than 60 days and you were notified at the time of issuance that it may not be renewed. 5.You requested a change in the terms or conditions or risks covered by the policy within 60 days prior to the end of the policy period. 6.We made a written offer to you to renew the policy at a premium rate increase of less than 25 percent. (A)If the premium rate in your governing classification is to be increased 25 percent or greater and we intend to renew the policy, we shall provide a written notice of a renewal offer not less than 30 days prior to the policy renewal date. The governing classification shall be determined by the rules and regulations estab- lished in accordance with California Insurance Code Section 11750.3(c). (B)For purposes of this Notice, “premium rate” means the cost of insurance per unit of exposure prior to the application of individual risk variations based on loss or expense considerations such as scheduled rating and experience rating. PN 04 99 01 I Page 1 of 3 W04NBG22 PN 04 99 01 I POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I.Information Available to You A.Information Available from Us – Travelers Property Casualty Company of America (1)General questions regarding your policy should be directed to: TRAVELERS P.O. Box 6512 21688 Gateway Center Drive Diamond Bar, CA 91765 Telephone: 1-909-612-3609 Fax: 1-909-612-3629 Website: www.travelers.com (2)Dividend Calculation. If this is a participating policy (a policy on which a dividend may be paid), upon payment or non-payment of a dividend, we shall provide a written explanation to you that sets forth the basis of the dividend calculation. The explanation will be in clear, understandable language and will express the dividend as a dollar amount and as a percentage of the earned premium for the policy year on which the dividend is calculated. (3)Claims Information. Pursuant to Sections 3761 and 3762 of the California Labor Code, you are entitled to receive information in our claim files that affects your premium. Copies of documents will be supplied at your expense during reasonable business hours. For claims covered under this policy, we will estimate the ultimate cost of unsettled claims for statistical purposes eighteen months after the policy becomes effective and will report those estimates to the Workers' Compensation Insurance Rating Bureau of California (WCIRB) no later than twenty months after the policy becomes effective. The cost of any settled claims will also be reported at that time. At twelve-month intervals thereafter, we will update and report to the WCIRB the estimated cost of any unsettled claims and the actual final cost of any claims settled in the interim. The amounts we report will be used by the WCIRB to compute your experience modification if you are eligible for experience rating. B.Information Available from the Workers' Compensation Insurance Rating Bureau of California (1)The WCIRB is a licensed rating organization and the California Insurance Commissioner's designated statistical agent. As such, the WCIRB is responsible for administering the California Workers' Compensation Uniform Statistical Reporting Plan–1995 (USRP) and the California Workers' Compensation Experience Rating Plan–1995 (ERP). WCIRB contact information is: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service; 888.229.2472 (phone); 415.778.7272 (fax); and customerservice@wcirb.com (email). The regulations contained in the USRP and ERP are available for public viewing through the WCIRB's website at wcirb.com. (2)Policyholder Information. Pursuant to California Insurance Code (CIC) Section 11752.6, upon written request, you are entitled to information relating to loss experience, claims, classification assignments, and policy contracts as well as rating plans, rating systems, manual rules, or other information impacting your premium that is maintained in the records of the WCIRB. Complaints and Requests for Action requesting policyholder information should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Custodian of Records. The Custodian of Records can be reached at 415.777.0777 (phone) and 415.778.7272 (fax). PN 04 99 01 I PN 04 99 01 I Page 2 of 3 W04NBG22 (3)Experience Rating Form. Each experience rated risk may receive a single copy of its current Experience Rating Form/Worksheet free of charge by completing a Policyholder Experience Rating Worksheet Request Form on the WCIRB's website at wcirb.com/ratesheet. The Experience Rating Form/Worksheet will include a Loss-Free Rating, which is the experience modification that would have been calculated if $0 (zero) actual losses were incurred during the experience period. This hypothetical rating calculation is provided for informational purposes only. II.Dispute Process You may dispute our actions or the actions of the WCIRB pursuant to CIC Sections 11737 and 11753.1. A.Our Dispute Resolution Process. If you are aggrieved by our decision adopting a change in a classification assignment that results in increased premium, or by the application of our rating system to your workers' compensation insurance, you may dispute these matters with us. If you are dissatisfied with the outcome of the initial dispute with us, you may send us a written Complaint and Request for Action as outlined below. You may send us a written Complaint and Request for Action requesting that we reconsider a change in a classification assignment that results in an increased premium and/or requesting that we review the manner in which our rating system has been applied in connection with the insurance afforded or offered you. Written Complaints and Requests for Action should be forwarded to: TRAVELERS TRAVELERS 1109 White Rock Road P.O. Box 6512 Rancho Cordova, CA 95670-6001 21688 Gateway Center Drive Diamond Bar, CA 91765 Phone: 1-800-328-2189 Phone: 1-909-612-3609 Fax: 1-909-612-3629 Website: www.Travelers.com Website: www.Travelers.com After you send your Complaint and Request for Action, we have 30 days to send you a written notice indicating whether your written request will be reviewed. If we agree to review your request, we must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If we decline to review your request, if you are dissatisfied with the decision upon review, or if we fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. B.Disputing the Actions of the WCIRB. If you have been aggrieved by any decision, action, or omission to act of the WCIRB, you may request, in writing, that the WCIRB reconsider its decision, action, or omission to act. You may also request, in writing, that the WCIRB review the manner in which its rating system has been applied in connection with the insurance afforded or offered you. For requests related to classification disputes, the reporting of experience, or coverage issues, your initial request for review must be received by the WCIRB within 12 months after the expiration date of the policy to which the request for review pertains, except if the request involves the application of the Revision of Losses rule. For requests related to your experience modification, your initial request for review must be received by the WCIRB within 6 months after the issuance, or 12 months after the expiration date, of the experience modification to which the request for review pertains, whichever is later, except if the request for review involves the application of the Revision of Losses rule. If the request involves the Revision of Losses rule, the time to state your appeal may be longer. (See Section VI, Rule 7 of the ERP). You may commence the review process by sending the WCIRB a written Inquiry. Written Inquiries should be sent to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Customer Service. Customer Service can be reached at 888.229.2472 (phone), 415.778.7272 (fax) and customerservice@wcirb.com (email). If you are dissatisfied with the WCIRB's decision upon an Inquiry, or if the WCIRB fails to respond within 90 days after receipt of the Inquiry, you may pursue the subject of the Inquiry by sending the WCIRB a written Complaint and Request for Action. After you send your Complaint and Request for Action, the WCIRB has 30 days to send you written notice indicating whether your written request will be reviewed. If PN 04 99 01 I Page 3 of 3 W04NBG22 PN 04 99 01 I the WCIRB agrees to review your request, it must conduct the review and issue a decision granting or rejecting your request within 60 days after sending you the written notice granting review. If the WCIRB declines to review your request, if you are dissatisfied with the decision upon review, or if the WCIRB fails to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner as described in paragraph II.C., below. Written Complaints and Requests for Action should be forwarded to: WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Complaints and Reconsideration. The WCIRB's contact information is 888.229.2472 (phone), 415.371.5204 (fax) and customerservice@wcirb.com (email). C.California Department of Insurance – Appeals to the Insurance Commissioner. After you follow the appropriate dispute resolution process described above, if (1) we or the WCIRB decline to review your request, (2) you are dissatisfied with the decision upon review, or (3) we or the WCIRB fail to grant or reject your request or issue a decision upon review, you may appeal to the Insurance Commissioner pursuant to CIC Sections 11737, 11752.6, 11753.1 and Title 10, California Code of Regulations, Section 2509.40 et seq. You must file your appeal within 30 days after we or the WCIRB send you the notice rejecting review of your Complaint and Request for Action or the decision upon your Complaint and Request for Action. If no written decision regarding your Complaint and Request for Action is sent, your appeal must be filed within 120 days after you sent your Complaint and Request for Action to us or to the WCIRB. The filing address for all appeals to the Insurance Commissioner is: Administrative Hearing Bureau California Department of Insurance 1901 Harrison Street, 3rd Floor Mailroom Oakland, CA 94612 415.538.4243 You have the right to a hearing before the Insurance Commissioner, and our action, or the action of the WCIRB, may be affirmed, modified or reversed. III.Resources Available to You in Obtaining Information and Pursuing Disputes A.Policyholder Ombudsman. Pursuant to California Insurance Code Section 11752.6, a policyholder ombudsman is available at the WCIRB to assist you in obtaining and evaluating the rating, policy, and claims information referenced in I.A. and I.B., above. The ombudsman may advise you on any dispute with us, the WCIRB, or on an appeal to the Insurance Commissioner pursuant to Section 11737 of the Insurance Code. The address of the policyholder ombudsman is WCIRB, 1901 Harrison Street, 17th Floor, Oakland, CA 94612, Attn: Policyholder Ombudsman. The policyholder ombudsman can be reached at 415.778.7159 (phone), 415.371.5288 (fax) and ombudsman@wcirb.com (email). B.California Department of Insurance – Information and Assistance. Information and assistance on policy questions can be obtained from the Department of Insurance Consumer HOTLINE, 800.927.HELP (4357) or insurance.ca.gov. For questions and correspondence regarding appeals to the Administrative Hearing Bureau, see the contact information in paragraph II.C. This notice does not change the policy to which it is attached. PN 04 99 04 (00)W04NDC02 POLICYHOLDER NOTICE CALIFORNIA INSURANCE GUARANTEE ASSOCIATION (CIGA) SURCHARGE Companies writing property and casualty insurance business in California are required to participate in the California Insurance Guarantee Association. If a company becomes insolvent, the California Insurance Guarantee Association settles unpaid claims and assesses each insurance company for its fair share. California law requires all companies to surcharge policies to recover these assessments. If your policy is surcharged, “CA Surcharge” or “CA Surcharge (CIGA) Surcharge)” with an amount will be displayed on your premium notice. This notice does not change the policy to which it is attached. Your Workers' Compensation Benefits CALIFORNIA Workers' compensation benefits include: W04NEI16 travelers.com Page 1 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 This form should be given to all newly hired employees in the State of California. Its content applies to industrial injuries on or after January 1, 2013. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony. You may be entitled to workers' compensation benefits if you are injured or become ill because of your job, or are a victim of a workplace crime. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures to a harmful condition (such as hurting your wrist from doing the same motion over and over). Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat your injury. You should never see a bill. Physical therapy, occupational therapy and chiropractic visits may be limited to 24 each. Temporary Disability Benefits: Payments if you lose wages while recovering. For most injuries, temporary disability benefits are limited to 104 weeks within 5 years from your date of injury. Filing a timely Employment Development Department claim may result in additional state disability benefits when TTD benefits are terminated, delayed or denied. Permanent Disability Benefits: Payments if your injury causes a permanent disability. Once your injury stabilizes, your treating physician may find permanent disability, depending upon your level of recovery. The amount of permanent disability found by your doctor will be rated by your claims administrator according to your age and occupation in order to determine the percentage and corresponding dollar amount of permanent disability due. These amounts are set by state law. You have the right to obtain a state disability rating or appeal a rating. Supplemental Job Displacement Vouchers: If your injury causes you to miss time from work and results in permanent disability, you may receive a supplemental job displacement voucher if your employer has not offered modified, alternative or regular employment within 60 days of receipt of the doctor's medical report indicating you have made a maximum medical recovery. The voucher is for reimbursement of education-related costs and is capped at $6,000.00, If you receive a voucher as a result of your injury, you have two years from the date you are furnished the voucher or five years from your date of injury (whichever occurs later), to request reimbursement for qualifying expenditures. Death Benefits: Paid to dependents of a worker who dies from a work-related injury or illness. Burial expenses are also provided, with the maximum amount allowed dependent upon the date of injury. Return to Work Program: If you experience a permanent earnings loss as a result of your injury and your permanent disability benefits are determined to be disproportionately low, you may qualify for additional monies from the Department of Industrial Relation's Return to Work Fund. Contact the Department of Industrial Relations at: www.dir.ca.gov/ to learn more about this additional benefit. Temporary disability, permanent disability, and death benefits are all payable at a rate based on 2/3 of your average weekly wage, and subject to state minimum and maximum amounts in effect on your date of injury. These benefits are paid every two weeks while you are eligible. Voluntary, off duty, recreational, social or athletic activities may not be covered under workers' compensation. © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 W04NEI16 travelers.com Page 2 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 If you get hurt: Get Medical Care. If you need first aid, contact your employer. If you need emergency care, call for help immediately. Report Your Injury. Report the injury immediately to your supervisor. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you a claim form within one working day after learning about your injury, and must also authorize treatment within one working day after you have returned a signed and completed copy of the form. The statute of limitations for filing a workers' compensation claim is one year from the date of injury or, if resulting from repeated exposures, one year from when you realized or should have realized that your job caused the injury. See Your Treating Physician. Your primary treating physician is the doctor with overall responsibility for treating your injury or illness. He or she is charged with maintaining the continuity of your care, as well as initiating referrals to specialists. If your employer has an approved Medical Provider Network (MPN), they may be able to limit your choices of treating physicians retain medical control, and require you to treat with an MPN physician from the onset. (An MPN is a selected network of healthcare providers who provide treatment to workers injured on the job. See your employer for more information on your MPN.) Otherwise, your employer has the right to select the physician who will treat you for the first 30 days. If your employer does not have an approved MPN and you wish to change doctors in the first 30 days after reporting your claim, your claims administrator must select a new physician within five days of your request. If you have provided your employer with the name of your personal physician before your injury and have group health insurance at the time of injury, you may see your personal physician for treatment even if your employer has an approved MPN. Your personal physician must be a general practitioner or a board-certified or board-eligible internist, pediatrician, obstetrician- gynecologist, family practitioner, or multi-specialty medical group of doctors of medicine or osteopathy, and must have treated you and maintained your medical history and records before your work injury and must also agree to treat you for a work-related injury or illness. If your employer does not have an approved MPN and you gave your employer the name of your personal chiropractor or acupuncturist in writing before you were injured, you may switch to the chiropractor or acupuncturist upon request. If you still need medical care after 30 days, you may be able to switch to a doctor of your own choice. For your convenience, optional forms to predesignate your personal physician or multi-specialty medical group of doctors of medicine or osteopathy are attached to this document. Also attached, are forms to predesignate your personal acupuncturist or chiropractor if your employer does not have a medical provider network in place. By law, chiropractors are not allowed to be the treating physician after 24 visits. Discrimination: It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. If your employer has been found to discriminate, you may be entitled to job reinstatement with back pay, increased compensation, and costs and expenses. You may also have additional rights under the Americans with Disabilities Act (ADA) or the Fair Employment and Housing Act (FEHA). For additional information, contact FEHA at (800) 884-1684 or the Equal Employment Opportunity Commission (EEOC) at (800) 669-3362. You can get free information from a state Division of Workers' Compensation Information & Assistance Officer. Hear recorded information and a list of local offices by calling toll-free (800) 736-7401 or learn more online at: http://www.dir.ca.gov. If medical care is not being provided by your employer you have several options. First, contact your claims administrator to find out the status of your claim. If you have given your employer a completed and signed claim form but your claim has been delayed for investigation, your employer is still required to authorize treatment, up to $10,000.00, during the delay. If the claim has not been accepted yet and your medical costs have exceeded the statutory $10,000.00 cap, you can go to your group health plan for care, find a doctor, clinic or hospital that will bill the claims administrator directly, or use public health services. You have the right to disagree with decisions affecting your claim. If you have a disagreement, contact your claims administrator first to see if you can resolve it. © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 W04NEI16 travelers.com Page 3 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 Your Workers' Compensation Insurance Company is Travelers Property Casualty Company of America. You can also look up your insurance carrier at the WCIRB online lookup: https://www.caworkcompcoverage.com/ You can obtain free information from an Information and Assistance Officer of the state Division of Workers' Compensation, or you can hear recorded information and a list of local offices by calling (800) 736-7401. A list of Information and Assistance offices can be found at the end of this pamphlet to help you locate the I&A office nearest you. You may also go to the DWC web site at: http://www.dir.ca.gov for further information. You can consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee may be taken out of some of your benefits. For names of workers' compensation attorneys, call the State Bar of California at (415) 538-2120 or go to their web site at: http://www.californiaspecialist.org. You may get a list of attorneys from your local information and assistance officer or look in your yellow pages. NOTICE OF PREDESIGNATION OF PERSONAL PHYSICIAN Employee: Complete this section. To:(name of employer) If I have a work-related injury or illness, I choose to be treated by: (Name of Doctor, M.D., D.O., or medical group) (Street address, city, state, zip code) (Telephone number) Employee Name (please print): Employee's Address: Employee's Signature Date: Physician: I agree to this Predesignation. Signature:Date: (Physician or designated employee of the physician or medical group) Title 8, California Code of Regulations, section 9783 (Optional DWC Form 9783 Effective date July 1, 2014) Predesignation of Personal Physician; Reporting Duties of the Primary Treating Physician Regulations 8 C.C.R. section 9780, et seq. (Approved 02/12/2014) W04NEI16 travelers.com Page 4 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 PREDESIGNATION OF PERSONAL PHYSICIAN In the event you sustain an injury or illness related to your employment, you may be treated for such injury or illness by your personal medical doctor (M.D.) or doctor of osteopathic medicine (D.O.) or medical group if: •on the date of your work injury, you have health care coverage for injuries or illnesses that are not work related; •the doctor is your regular physician, who shall be either a physician who has limited his or her practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, family practitioner, and has previously directed your medical treatment, and retains your medical records; •your "personal physician" may be a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group providing comprehensive medical services predominantly for nonoccupational illnesses and injuries; •prior to the injury your doctor agrees to treat you for work injuries or illnesses; •prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor's name and business address. You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteopathic medicine treat you for a work- related injury or illness and the above requirements are met. Name of Insurance Company, Plan, or Fund providing health coverage for nonoccupational injuries or illnesses: The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, other documentation of the physician's agreement to be predesignated will be required pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3). © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 Your Chiropractor or Acupuncturist's Information: (name of chiropractor or acupuncturist) (street address, city, state, zip code) (Telephone number) Employee Name (please print): Employee's Address: Employee's Signature Date: Title 8, California Code of Regulations, section 9783.1 (Optional DWC Form 9783.1 Effective date July 1, 2014) Predesignation of Personal Physician; Reporting Duties of the Primary Treating Physician Regulations 8 C.C.R. section 9780, et seq. (Approved 02/12/2014) W04NEI16 travelers.com Page 5 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If your employer or your employer's insurer does not have a Medical Provider Network, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your claims administrator generally has the right to select your treating physician within the first 30 days after your employer knows of your injury or illness. After your claims administrator has initiated your treatment with another doctor during this period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist. NOTE: If your date of injury is January 1, 2004, or later, a chiropractor cannot be your treating physician after you have received 24 chiropractic visits unless your employer has authorized additional visits in writing. The term "chiropractic visit" means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management. Once you have received 24 chiropractic visits, if you still require medical treatment, you will have to select a new physician who is not a chiropractor. This prohibition shall not apply to visits for postsurgical physical medicine visits prescribed by the surgeon, or physician designated by the surgeon, under the postsurgical component of the Division of Workers' Compensation's Medical Treatment Utilization Schedule. You may use this form to notify your employer of your personal chiropractor or acupuncturist. © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 W04NEI16 travelers.com Page 6 of 6 The Travelers Indemnity Company and its property casualty affiliates. One Tower Square, Hartford, CT 06183 Anaheim 1065 N. PacifiCenter Drive Anaheim, CA 92806 (714) 414-1801 Oxnard 1901 N. Rice Ave., Ste. 200 Oxnard, CA 93030 (805) 485-3528 San Francisco 455 Golden Gate Avenue, 2nd floor San Francisco, CA 94102-7014 (415) 703-5020 Bakersfield 1800 30th Street, Suite 100 Bakersfield, CA 93301-1929 (661) 395-2514 Pomona 732 Corporate Center Drive Pomona, CA 91768-2653 (909) 623-8568 San Jose 100 Paseo de San Antonio Room 241 San Jose, CA 95113-1402 (408) 277-1292 Eureka 100 "H" Street, Room 202 Eureka, CA 95501-0481 (707) 441-5723 Redding 2115 Civic Center Drive, Room 15 Redding, CA 96001-2796 (530) 225-2047 San Luis Obispo 4740 Allene Way, Suite 100 San Luis Obispo, CA 93401 (805) 596-4159 Fresno 2550 Mariposa Mall, Room 2035 Fresno, CA 93721-2219 (559) 445-5355 Riverside 3737 Main Street, Room 300 Riverside, CA 92501-3337 (951) 782-4347 Santa Ana 605 W Santa Ana Blvd Bldg 28, Room 451 Santa Ana, CA 92701 (714) 558-4597 Long Beach 300 Oceangate Street, Suite 200 Long Beach, CA 90802-4304 (562) 590-5240 Sacramento 160 Promenade Circle, Suite 300 Sacramento, CA 95834 (916) 928-3158 Santa Barbara *Satellite office 130 East Ortega Street Santa Barbara, CA 93101-1631 (805) 884 1032 Los Angeles 320 W. 4th Street, 9th floor Los Angeles, CA 90013-2329 (213) 576-7389 Salinas 1880 North Main Street, Suite 100 Salinas, CA 93906-2037 (831) 443-3058 Santa Rosa 50 "D" Street, Room 420 Santa Rosa, CA 95404-4771 (707) 576-2452 Marina del Rey 4720 Lincoln Blvd, 2nd floor Marina del Rey, CA 90292-6902 (310) 482-3820 San Bernardino 464 W. Fourth Street, Suite 239 San Bernardino, CA 92401-1411 (909) 383-4522 Stockton 31 East Channel Street, Room 344 Stockton, CA 95202-2314 (209) 948-7980 Oakland 1515 Clay Street, 6th floor Oakland, CA 94612 (510) 622-2861 San Diego 7575 Metropolitan Drive, Suite 202 San Diego, CA 92102-4424 (619) 767-2082 Van Nuys 6150 Van Nuys Blvd., Room 105 Van Nuys, CA 91401-3370 (818) 901-5367 © 2016 The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries. CE-10277 Rev. 10-2015 Contact the information & assistance unit •By phone at 1-800-736-7401: For recorded information that helps injured workers, employers and others understand •California's workers' compensation system, and their rights and responsibilities under the law. •By attending a workshop for injured workers •By calling or going in person to a local Information & Assistance Unit office: Sus beneficios de compensación laboral CALIFORNIA W04NFI16 travelers.com Pagina 1 of 6 Este formulario debe entregarse a todos los empleados recién contratados en el estado de California. Su contenido se aplica a los accidentes de trabajo ocurridos a partir del 1 de enero de 2013. Cualquier persona que haga o propicie que se haga cualquier declaración sustancial a sabiendas falsa o fraudulenta con el propósito de obtener o denegar beneficios o pagos de compensación laboral es culpable de un delito. Usted puede tener derecho a beneficios de compensación laboral si resulta lesionado o se enferma a causa de su trabajo, o si es víctima de un delito en el lugar de trabajo. La compensación laboral cubre la mayoría de las lesiones y enfermedades físicas o mentales relacionadas con el trabajo. Una lesión o enfermedad puede ser causada por un acontecimiento (como lastimarse la espalda en una caída) o por exposiciones repetidas a una circunstancia perjudicial (como lastimarse la muñeca por hacer el mismo movimiento una y otra vez). Los beneficios de compensación laboral incluyen: Atención médica: consultas médicas, servicios hospitalarios, fisioterapia, análisis de laboratorio, radiografías y medicamentos que sean razonablemente necesarios para tratar su lesión. No debe recibir nunca una factura. Es posible que las visitas para fisioterapia, terapia ocupacional y al quiropráctico tengan un límite de 24 visitas para cada tipo. Beneficios por incapacidad temporal: Pagos si usted deja de recibir su salario mientras se recupera. Para la mayoría de las lesiones ocurridas después del 18 de abril de 2004, los beneficios por incapacidad temporal se limitan a 104 semanas dentro del lapso de 5 años a partir de la fecha de la lesión. Presentar de forma oportuna una reclamación en el Departamento de Desarrollo Laboral (Employment Development Department) puede conducir a la obtención de beneficios estatales adicionales por incapacidad cuando se terminan los beneficios por incapacidad total temporal (TTD, por sus siglas en inglés), o cuando estos se demoran o los deniegan. Beneficios por incapacidad permanente: Pagos si su lesión causa una incapacidad permanente. Una vez que su lesión se estabilice, es posible que el médico que lo trata determine que usted tiene una incapacidad permanente, dependiendo de su grado de recuperación. La cantidad de incapacidad permanente que su médico determine será clasificada por su administrador de reclamaciones según su edad y ocupación con el fin de determinar el porcentaje y la cantidad correspondiente en dólares que se le debe a usted a causa de la incapacidad permanente. La ley estatal establece dichas cantidades. Usted tiene derecho a obtener una clasificación estatal de incapacidad o a apelar la clasificación. Vales suplementarios por destitución laboral: Si su lesión conlleva a que usted falte a su trabajo y le causa una incapacidad permanente, usted puede recibir un vale suplementario por destitución laboral si su empleador no le ofrece un empleo modificado, alternativo o regular dentro de 60 días de haber recibido el informe médico que indique que usted logró una recuperación médica máxima. El vale es para reembolsar los costos educativos y tiene un límite de $6,000.00. Si usted recibe un vale como consecuencia de su lesión, tiene dos años desde la fecha en que le proporcionen el vale o cinco años desde la fecha de su lesión (lo que ocurra último), para solicitar el reembolso de los gastos que califiquen. Beneficios por muerte: Se pagan a los dependientes de un trabajador que muere a causa de una lesión o enfermedad laboral. También se cubren los gastos del entierro; la cantidad máxima permitida depende de la fecha de la lesión. Los beneficios por incapacidad temporal, incapacidad permanente y muerte se pagan a una tasa basada en 2/3 de su salario semanal promedio, y están sujetos a las cantidades mínimas y máximas vigentes en el estado en la fecha de su lesión. Estos beneficios se pagan cada dos semanas mientras usted sea elegible. Programa para reintegrarse al trabajo: Si usted sufre la pérdida permanente de sus ingresos como resultado de su lesión y se determina que sus beneficios por incapacidad permanente son desproporcionadamente bajos, es posible que usted califique para recibir dinero adicional del Fondo para la reintegración al trabajo del Departamento de The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 W04 F 16NI Pa i a 2 of 6gn travel rs.oec m Relaciones Laborales (Department of Industrial Relations). Comuníquese con el Departamento de Relaciones Laborales en: www.dir.ca.gov/ para conocer más acerca de este beneficio adicional. Es posible que las actividades como voluntario, en sus horas libres, recreacionales, sociales o atlética s no estén cubiertas bajo la compensación laboral. Si se lastima: Obtenga atención médica. Si necesita primeros auxilios, comuníquese con su empleador. Si necesita atención urgente, pida ayuda de inmediato. Informe sobre su lesión. Informe de inmediato a su supervisor sobre su lesión. No demore en hacerlo; existen límites de tiempo. Si espera demasiado, puede perder los derechos que tiene a recibir beneficios. Su empleador tiene que proporcionarle un formulario de reclamación a más tardar un día laborable después de que esté enterado de su lesión, y también debe autorizar el tratamiento a más tardar un día laborable después de que usted le entregue una copia del formulario lleno y firmado. El plazo de prescripción para presentar una reclamación de compensación laboral es de un año a partir de la fecha de la lesión o, si esta se debe a exposiciones repetidas, un año a partir del momento en que usted se dio cuenta o debió darse cuenta de que su trabajo causó la lesión. Vea a su médico tratante. Su médico tratante primario es el médico con la responsabilidad global de tratar su lesión o enfermedad. Él o ella están a cargo de mantener la continuidad de su atención, así como de remitirlo a los especialistas. Si su empleador tiene una Red de Proveedores Médicos (MPN, por sus siglas en inglés) aprobada, es posible que ellos puedan limitar sus opciones de médicos tratantes, que retengan el control médico, y que le exijan que se atienda con un médico de la MPN desde el principio. (Una MPN es una red escogida de proveedores de atención médica que proveen tratamiento a los empleados que se lesionan en el trabajo. Consulte con su empleador para obtener más información sobre su MPN). De lo contrario, su empleador tiene el derecho de escoger el médico que lo tratará a usted por los primeros 30 días. Si su empleador no tiene una MPN aprobada y usted desea cambiar de médico en los primeros 30 días después de presentar su reclamación, su administrador de reclamaciones debe escoger un médico nuevo en un lapso de cinco días después de que usted lo solicite. Si usted le proporcionó a su empleador el nombre de su médico personal antes de sufrir la lesión y tiene seguro médico de grupo al momento de la lesión, usted puede tratarse con su médico personal incluso si su empleador tiene una MPN aprobada. Su médico personal debe ser un médico general o un médico internista, pediatra, ginecobstetra o médico de familia con certificado de especialidad o que haya completado su especialidad, o un grupo médico con múltiples especialidades con doctores o licenciados en medicina, y debe haberlo tratado y tener sus antecedentes médicos y su historia clínica antes de su lesión laboral y también debe estar de acuerdo en tratarlo por una lesión o enfermedad laboral. Si su empleador no tiene una MPN aprobada y usted le dio a su empleador por escrito el nombre de su quiropráctico o acupunturista personal antes de sufrir la lesión, usted puede cambiarse al quiropráctico o acupunturista cuando lo solicite. Si todavía necesita recibir atención médica luego de 30 días, quizás pueda cambiarse a un médico de su propia elección. Para mayor comodidad, se adjuntan a este documento formularios opcionales para predesignar a su médico personal o a un grupo médico con múltiples especialidades con doctores o licenciados en medicina. También se adjuntan formularios para predesignar a su acupunturista o quiropráctico personal si su empleador no cuenta con una red de proveedores médicos. Por ley, no se permite que los quiroprácticos sean el médico tratante luego de 24 visitas. Discriminación: Es ilegal que su empleador lo castigue o lo despida por sufrir una lesión o enfermedad laboral, por presentar una reclamación, o por testificar en el caso de compensación laboral de otra persona. Si se determina que su empleador ha cometido discriminación, usted puede tener derecho a que se le reincorpore a su puesto de trabajo con pagos retroactivos, una mayor compensación, y costos y gastos. Es posible que usted tenga otros derechos bajo la Ley de Protección para Personas Discapacitadas (ADA, por sus siglas en inglés) o la Ley de Igualdad en el Empleo y la Vivienda (FEHA, por sus siglas en inglés). Para obtener más información, comuníquese con FEHA al (800) 884-1684 o con la Comisión de Igualdad de Oportunidades Laborales (EEOC, por sus siglas en inglés) al (800) 669-3362. Puede obtener información gratuita de un funcionario de información y ayuda de la División de Compensación Laboral de su estado. Puede escuchar información grabada y una lista de las oficinas locales llamando sin costo al (800) 736-7401 o averiguar más en línea en: http://www.dir.ca.gov. The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 W04NFI16 travelers.com Pagina 3 of 6 Si su empleador no le proporciona atención médica, usted tiene varias opciones. Primero, comuníquese con su administrador de reclamaciones para averiguar el estado de su reclamación. Si le entregó a su empleador un formulario de reclamación lleno y firmado pero su reclamación está retrasada por la investigación, su empleador tiene que autorizar el tratamiento, hasta un máximo de $10,000.00, durante el retraso. Si todavía no se ha aceptado la reclamación y sus costos médicos sobrepasan el límite reglamentario de $10,000.00, usted puede acudir a su plan médico de grupo para recibir atención, buscar un médico, una clínica o un hospital que le facture directamente al administrador de reclamaciones, o utilizar los servicios públicos de atención médica. Usted tiene derecho a estar en desacuerdo con las decisiones que afectan su reclamación. Si está en desacuerdo, comuníquese primero con su administrador de reclamaciones para ver si lo pueden resolver. Su compañía de seguros de compensación laboral es Travelers Property Casualty Company of America. También puede buscar su compañía de seguros en el directorio en línea de WCIRB: https://www.caworkcompcoverage.com/ Puede obtener información gratuita de un funcionario de Información y Ayuda de la División de Compensación Laboral de su estado, o puede escuchar información grabada y una lista de las oficinas locales llamando al (800) 736-7401. Al final de este folleto, encontrará una lista de las oficinas de Información y Ayuda. Esto lo ayudará a localizar la oficina más cerca de usted. Para más información, también puede visitar el sitio web del DWC en: http://www.dir.ca.gov. Puede consultar con un abogado. La mayoría de los abogados ofrecen una consulta gratuita. Si decide contratar un abogado, es posible que los honorarios se saquen de algunos de sus beneficios. Para obtener los nombres de los abogados especializados en compensación laboral, llame al Colegio de Abogados del estado de California al (415) 538-2120 o visite su sitio web en: http://www.californiaspecialist.org. El funcionario local de información y ayuda puede proporcionarle una lista de los abogados o usted puede buscarlos en las páginas amarillas. The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 A: NOTICIA DE DESIGNACIÓN PREVIA DE MÉDICO PARTICULAR Empleado: Llene esta sección. (nombre del empleador) Si tengo una lesión o enfermedad de trabajo, yo elijo ser atendido por: (nombre del médico) (M.D., D.O., o grupo médico) (dirección, ciudad, estado, código postal) (número de teléfono) Nombre del Empleado (en letras de molde, por favor): Domicilio del Empleado: Nombre de la Compañía de Seguros, Plan o Fondo de proporcionar cobertura de salud para lesiones o enfermedades no ocupacionales: Firma del Empleado:Fecha: Médico: Estoy de acuerdo con esta Designación Previa: Fecha:Firma: (Médico o Empleado designado por el Médico o Grupo Médico) W04NFI16 travelers.com Pagina 4 of 6 Designación Previa De Médico Particular En caso de que usted sufra una lesión o enfermedad relacionada con su empleo, usted puede recibir tratamiento médico por esa lesión o enfermedad de su médico particular (M.D.), médico osteópata (D.O.) o grupo médico si: • en la fecha de su lesión de trabajo, usted tiene cobertura de salud por lesiones o enfermedades que no están relacionado con el trabajo • el médico es su médico familiar o de cabecera, que será un médico que ha limitado su práctica médica a medicina general o que es un internista certificado o elegible para certificación, pediatra, gineco-obstreta, o médico de medicina familiar y que previamente ha estado a cargo de su tratamiento médico y tiene su expediente médico • su "médico particular" puede ser un grupo médico si es una corporación o sociedad o asociación compuesta de doctores certificados en medicina u osteopatía, que opera un integrado grupo médico multidisciplinario que predominantemente proporciona amplios servicios médicos para lesiones y enfermedades no relacionadas con el trabajo. • antes de la lesión su médico está de acuerdo a proporcionarle tratamiento médico para su lesión o enfermedad de trabajo • antes de la lesión usted le proporcionó a su empleador por escrito lo siguiente: (1) notificación de que quiere que su médico particular le brinde tratamiento para una lesión o enfermedad de trabajo y (2) el nombre y dirección comercial de su médico particular. Puede utilizar este formulario para notificarle a su empleador que desea que su médico particular o médico osteópata lo atienda para una lesión o enfermedad de trabajo y que los requisitos mencionados arriba han sido cumplidos. El médico no está o bligado a firmar este formul ario, sin embargo, si el médico o empl eado designado por el médico o grupo médico no firma, será n ecesario presentar documentación sobre el consentimiento del médico de ser designado previamente de acuerdo al Código de Reglamentos de California, Tí tulo 8, sección 9780.1 (a) (3). Tí tulo 8, Código de Regulaciones de California, sección 9783 Opcional Formulario DW C 9783, Fecha de vigencia 1 de Julio 2014 Designación Previa del Médico Personal;Obligaciones de Información de la prima ria El tratamiento médico Reglamentos 8 CCR Sección 9780, et seq. (Aprobado 12/02/2014) The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 Información sobre su Quiropráctico o Acupunturista: (nombre del quiropráctico o acupunturista) (dirección, ciudad, estado, código postal) (número de teléfono) Nombre del Empleado (en letras de molde, por favor): Domicilio del Empleado: Firma del Empleado:Fecha: W04NFI16 travelers.com Pagina 5 of 6 AVISO DE QUIROPRÁCTICO PERSONAL O ACUPUNTURISTA PERSONAL Si su empleador o la compañía de seguros de su empleador no tiene una Red de Proveedores Médicos establecida, posiblemente puede cambiar su médico que lo está atendiendo a su quiropráctico o acupunturista personal después de una lesión o enfermedad de trabajo. Para hacer este cambio, usted debe darle por escrito a su empleador el nombre y la dirección comercial de un quiropráctico o acupunturista personal antes de la lesión o enfermedad. Generalmente, su administrador de reclamos tiene el derecho de elegir al médico que le proporcionará el tratamiento dentro de los primeros 30 días después de que su empleador sepa de su lesión o enfermedad. Después de que su administrador de reclamos ha iniciado su tratamiento con otro médico durante este tiempo, puede entonces usted, bajo petición, transferir su tratamiento a su quiropráctico o acupunturista personal. NOTA: Si la fecha de la lesión es el 1 de enero de 2004 o posterior, un quiropráctico no puede ser su médico tratante después de haber recibido 24 visitas al quiropráctico a menos que su empleador ha autorizado visitas adicionales por escrito. El término "visita quiropráctica", cualquier visita a la oficina de la quiropráctica, independientemente de si los servicios prestados implican la manipulación quiropráctica o se limitan a la evaluación y gestión. Una vez que haya recibido 24 visitas al quiropráctico, si aún necesita tratamiento médico, usted tendrá que elegir un nuevo médico que no es un quiropráctico. Esta prohibición no se aplicará a las visitas para las visitas de medicina física posquirúrgicos prescritos por el cirujano o un médico designado por el cirujano, en el marco del componente posquirúrgica de la División de Tratamiento Médico programa de utilización de Compensación para Trabajadores. Puede utilizar este formulario para notificarle a su empleador de su quiropráctico o acupunturista personal. Tí tulo 8, Código de Regulaciones de California, sección 9783.1 (Opcional Formulario DW C 9783.1, Fecha de vigencia 1 de Julio 2014) Designación Previa del Médico Personal;Obligaciones de Información del Médico Primario Regulaciones 8 C.C.R. Sección 9780,et seq. (Aprobado 12/02/2014) The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 • • • W04 F 16NI Pa i a 6 o 6gnf travel rs.oec m Comuniquese con la unidad de información y ayuda Asistiendo a un taller para trabajadores lesionados Llamando o yendo en persona a una oficina local de la Unidad de información y ayuda: Por teléfono al 1-800-736-7401: Para obtener información grabada que ayuda a los trabajadores lesionados, los empleadores y otras personas a entender el sistema de compensación laboral de California, y sus derechos y responsabilidades conforme a la ley. The Travelers Indemnity Company y sus filiales de seguros generales/patrimoniales. One Tower Square, Hartford, CT 06183 © 2016 The Travelers Indemnity Company. Todos los derechos reservados. Travelers y el logotipo con la sombrilla de Travelers son marcas registradas de The Travelers Indemnity Company en los EE. UU. y otros pa ses. CE- 10277 Rev. 10-2015 Anaheim 1065 N. PacifiCenter Drive Anaheim, CA 92806 (714) 414-1801 Bakersfield 1800 30th Street, Suite 100 Bakersfield, CA 93301-1929 (661) 395-2514 Eureka 100 "H" Street, Room 202 Eureka, CA 95501-0481 (707) 441-5723 Fresno 2550 Mariposa Mall, Suite 4078 Fresno, CA 93721-2219 (559) 445-5355 Long Beach 300 Oceangate Street, Suite 200 Long Beach, CA 90802-4304 (562) 590-5240 Los Angeles 320 W. 4th Street, 9th floor Los Angeles, CA 90013-2329 (213) 576-7389 Marina del Rey 4720 Lincoln Blvd, 2nd &3rd floors Marina del Rey, CA 90292-6902 (310) 482-3858 Oakland 1515 Clay Street, 6th floor Oakland, CA 94612 (510) 622-2861 San Diego 7575 Metropolitan Drive, Suite 202 San Diego, CA 92108 (619) 767-2082 San Bernardino 464 W. Fourth Street, Suite 239 San Bernardino, CA 92401-1411 (909) 383-4522 Salinas 1880 North Main Street, Suite 100 Salinas, CA 93906-2037 (831) 443-3058 Sacramento 160 Promenade Circle, Suite 300 Sacramento, CA 95834 (916) 928-3158 Riverside 3737 Main Street, Room 300 Riverside, CA 92501-3337 (951) 782-4347 Redding 25o Hemsted-Drive, 2nd Floor, Ste. B Redding, CA 96002 (530) 225-2047 Pomona 732 Corporate Center Drive Pomona, CA 91768-2653 (909) 623-8568 Oxnard 1901 N. Rice Ave., Ste. 200 Oxnard, CA 93036 (805) 485-3528 San Francisco 455 Golden Gate Avenue, 2nd floor San Francisco, CA 94102-7014 (415) 703-5020 San Jose 100 Paseo de San Antonio Room 241 San Jose, CA 95113-1402 (408) 277-1292 San Luis Obispo 4740 Allene Way, Suite 100 San Luis Obispo, CA 93401 (805) 596-4159 Santa Ana 605 W Santa Ana Blvd Bldg 28, Room 451 Santa Ana, CA 92701 (714) 558-4597 Santa Barbara Satellite Office 130 E. Ortega Street Santa Barbara, CA 93101-1631 (805) 884-1032 Santa Rosa 50 "D" Street, Room 420 Santa Rosa, CA 95404-4771 (707) 576-2452 Stockton 31 East Channel Street, Room 344 Stockton, CA 95202-2314 (209) 948-7980 Van Nuys 6150 Van Nuys Blvd., Room 105 Van Nuys, CA 91401-3370 (818) 901-5367 IMPORTANT WUNN7F00 Policy Audit Information Dear Policyholder: This policy is issued with an estimated premium based upon information provided through your Producer. This premium is subject to adjustment at the end of the policy period. At that time, you may receive a request for information in the mail or a premium auditor may contact you to review the necessary records. The information developed is needed to determine the final earned premium for this policy. Record Maintenance In order to facilitate audit service, it is necessary to maintain proper records and have them available at the proper time. Based on the nature of your business, some of the following data will be necessary to complete the audit: 1.General Ledger, Financial Statements 2.Payroll Records, Time Books, State Unemployment Returns, FICA Returns, Individual Earnings Records-Monthly totals separated by type of work and overtime. 3.Cash Receipts, Sales Journal 4.Cash Disbursements Journal - Including subcontractors. casual labor and material costs. 5.Certificates of Insurance IMPORTANT COVERAGE NOTE: If you utilize subcontractors whose legal status is that of sole proprietor/partner, we may charge premium for these persons as provided under Part 5 of the policy contract even though certificates of insurance may exist. Please contact your producer if you have any questions regarding your Workers' Compensation coverage needs. Work in Other States Please advise your Producer if employees are hired for work in states other than those listed in Item 3. of your policy. This will enable your producer to consider your need for coverage in accordance with state laws. We appreciate the opportunity to serve you. If you have any questions about the enclosed policy or any insurance matters please contact your producer or your Company representative. WUNN9C01 ALASKA NOTICE TO INSURED Dear Policyholder: This is to notify you that your Workers’ Compensation and Employers Liability policy does not provide Other States Coverage for the State of Alaska. If you have operations or start up an operation in Alaska, and it is not listed in Item 3A of the Information Page, you or your agent must notify us and request that this state be covered under your policy. With receipt of your request for coverage, we will extend the policy to include this state. Your Agent can provide you with necessary information and will assist you in obtaining coverage for this state. PRIVACY NOTICE PRIVACY POLICY WUNNAB09 Page 1 of 2 Thank you for selecting THE TRAVELERS INSURANCE COMPANIES as your workers compensation insurer. At THE TRAVELERS INSURANCE COMPANIES a subsidiary of Travelers, we recognize that privacy is important to you. That is why we are committed to protecting your privacy through the adoption of the following privacy principles: Collection Of Information We collect, retain, and use information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, only where we believe that it will help or is necessary to provide you products and services or otherwise conduct our business. We collect nonpublic personal financial information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, from the following sources: •information we receive from you or through your agent or broker on applications or other forms; •information we receive from or about you in the process of adjusting claims; •information about your other transactions, including risk control and other consulting services, with us, our affiliates or other third parties; •information about your coverages and loss activity with other carriers; and •information we receive from a consumer reporting agency. Such information includes identifying information such as policyholder, participant, beneficiary or claimant name, address, and social security number; financial information such as income, payment history, or credit history; and, under certain circumstances, health information such as information about an illness, disability, or injury. It could also include information on claims with other insurance companies and us and the condition and mainte- nance of your property. Disclosure Of Information We usually do not disclose nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, without your consent. However, in some circumstances we may disclose information to others without your prior authorization. The most common disclosures are to the following persons: •our affiliated property and casualty insurance companies; •state insurance departments, for their regulation of our business; •other government authorities; •our agents and brokers as necessary to conduct our business; •organizations that perform underwriting and claims investigations; •another insurance company to which you have applied for a policy or submitted a claim; •insurance support agencies, law enforcement agencies and our reinsurers; and •any other third party, as permitted or required by law. Most importantly, THE TRAVELERS INSURANCE COMPANIES does not and will not disclose or sell nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to anyone for marketing purposes. WUNNAB09 Page 2 of 2 Confidentiality And Security We restrict access to nonpublic personal information about you, or about participants, beneficiaries or claimants under your workers compensation coverage, to those who need it to serve your insurance needs and to maintain and improve customer service. We maintain physical, electronic, and procedural safeguards that comply with federal and state laws and regulations to guard your nonpublic personal information. Disclosure and Protection of Former Customers' Information We may disclose all the personal information we have collected, as described above. However, even if you no longer have a customer relationship with us, we will continue to follow our privacy policies and practices to protect your information. Changes In Privacy Policy We may choose to modify our policy regarding the treatment of personal information at any time. Before we do so, we will notify you and provide an updated privacy notice. COMPENSATION WUNNDD08 PN T4 54 01 08 IMPORTANT NOTICE – INDEPENDENT AGENT AND BROKER Page 1 of 1 NO COVERAGE IS PROVIDED BY THIS NOTICE. THIS NOTICE DOES NOT AMEND ANY PROVISION OF YOUR POLICY. YOU SHOULD REVIEW YOUR ENTIRE POLICY CAREFULLY FOR COMPLETE INFORMATION ON THE COVERAGES PROVIDED AND TO DETERMINE YOUR RIGHTS AND DUTIES UNDER YOUR POLICY. PLEASE CONTACT YOUR AGENT OR BROKER IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ITS CONTENTS. IF THERE IS ANY CONFLICT BETWEEN YOUR POLICY AND THIS NOTICE, THE PROVISIONS OF YOUR POLICY PREVAIL. For information about how Travelers compensates independent agents and brokers, please visit www.travelers.com, call our toll-free telephone number 1-866-904-8348, or request a written copy from Marketing at One Tower Square, 2GSA, Hartford, CT 06183. ATTENTION WUNNNJ23 Page 1 of 1 The enclosed Posting Notices must be displayed in a prominent location in the workplace. It is your responsibility to distribute the applicable Posting Notice(s) to each of your locations and to notify each location that it must post these notices, and keep them posted, in a conspicuous location frequented by your employees. Posting Notices for the states of Missouri, New Mexico and Texas (Spanish Version) are provided on two separate forms, which must be connected to create one large notice to be posted. Please contact us at wcppn@travelers.com for assistance in completing the healthcare provider information on Posting Notices for Georgia, Pennsylvania, Tennessee and Virginia. While carriers are required to provide Posting Notices in AZ, AR, CA, CO, DC, FL, ID, KS, KY, MO, MT, NH and NY, Travelers is providing Posting Notices to you for all states* covered under your policy as a courtesy. All such Posting Notices remain subject to state regulation and are subject to change at any time. For states in which Travelers is providing you with Posting Notices as a courtesy, Travelers assumes no obligation to provide you with revised notice(s) if a state changes its Posting Notice during the current policy term. If you need additional copies of any Posting Notice, please contact your agent. * Excluding: DE, GU, IA, NE, ND, OH, PR, SD, VI, WA, WI and WY. The following states do not require posting notices: DE, GU, IA, NE, SD, and WI. The state of OR will provide the posting notice directly. The following are monopolistic states – there are no posting notices for employers' liability: ND, OH, PR, VI, WA and WY. W04P2D24 STATE OF CALIFORNIA – DEPARTMENT OF INDUSTRIAL RELATIONS Division of Workers' Compensation Notice to Employees – Injuries Caused By Work MPN website: MPN Effective Date:MPN Identification number Claims Administrator Phone W orkers' compensation insurer (Enter "self-insured" if appropriate) Information & Assistance Officer can be found at location: DWC 7 (1/1/2016) ISSUE TO: or If you need help locating an MPN physician, call your MPN access assistant at: WWW.TRAVELERS.COM/CAMPN (800) 287-9682 (800) 287-9682 You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over). Naming Your Own Physician Before Injury or Illness (Predesignation). You may be able to choose the doctor who will treat you for a job injury or illness. If eligible, you must tell your employer, in writing, the name and address of your personal physician or medical group before you are injured. You must obtain their agreement to treat you for your work injury. For instructions, see the written information about workers' compensation that your employer is required to give to new employees. Discrimination. It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state. Questions? Learn more about workers' compensation by reading the information that your employer is required to give you at time of hire. If you have questions, see your employer or the claims administrator (who handles workers' compensation claims for your employer): False claims and false denials. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be fined and imprisoned. Your employer may not be liable for the payment of workers' compensation benefits for any injury that arises from your voluntary participation in any off-duty, recreational, social , or athletic activity that is not part of your work-related duties. If you have questions about the MPN or want to file a complaint against the MPN, call the MPN Contact Person at by calling toll-free (800) 736-7401. Learn more information about workers' compensation online: www.dwc.ca.gov and access a useful booklet "Workers' Compensation in California: A Guidebook for Injured Workers." You can also get free information from a State Division of Workers' Compensation Information (DWC) & Assistance Officer. The nearest 4.Medical Provider Networks. Your employer may be using an MPN, which is a group of health care providers designated to provide treatment to workers injured on the job. If you have predesignated a personal physician or medical group prior to your work injury, then you may go there to receive treatment from your predesignated doctor. If you are treating with a non-MPN doctor for an existing injury, you may be required to change to a doctor within the MPN. For more information, see the MPN contact information below: Benefits. Workers' compensation benefits include: •Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, medicines, medical equipment and travel costs that are reasonably necessary to treat your injury. You should never see a bill. There are limits on chiropractic, physical therapy and occupational therapy visits. •Temporary Disability (TD) Benefits: Payments if you lose wages while recovering. For most injuries, TD benefits may not be paid for more than 104 weeks within five years from the date of injury. •Permanent Disability (PD) Benefits: Payments if you do not recover completely and your injury causes a permanent loss of physical or mental function that a doctor can measure. •Supplemental Job Displacement Benefit: A nontransferable voucher, if you are injured on or after 1/1/2004, your injury causes permanent disability, and your employer does not offer you regular, modified, or alternative work. •Death Benefits: Paid to your dependents if you die from a work-related injury or illness. If You Get Hurt: 1.Get Medical Care. If you need emergency care, call 911 for help immediately from the hospital, ambulance, fire department or police department. If you need first aid, contact your employer. 2.Report Your Injury. Report the injury immediately to your supervisor or to an employer representative. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you with a claim form within one working day after learning about your injury. Within one working day after you file a claim form, your employer or claims administrator must authorize the provision of all treatment, up to ten thousand dollars, consistent with the applicable treatment guidelines, for your alleged injury until the claim is accepted or rejected. 3.See Your Primary Treating Physician (PTP). This is the doctor with overall responsibility for treating your injury or illness. •If you predesignated your personal physician or a medical group, you may see your personal physician or the medical group after you are injured. •If your employer is using a medical provider network (MPN) or a health care organization (HCO), in most cases you will be treated within the MPN or HCO unless you predesignated a personal physician or medical group. An MPN is a group of physicians and health care providers who provide treatment to workers injured on the job. You should receive information from your employer if you are covered by an HCO or a MPN. Contact your employer for more information. •If your employer is not using an MPN or HCO, in most cases the claims administrator can choose the doctor who first treats you when you are injured, unless you predesignated a personal physician or medical group. THERMAL MECHANICAL, INC. 04-01-24 3195 THE TRAVELERS INSURANCE COMPANIES (877) 828-4132 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA W04P2D24 STATE OF CALIFORNIA – DEPARTMENT OF INDUSTRIAL RELATIONS Division of Workers' Compensation Notice to Employees – Injuries Caused By Work MPN website: MPN Effective Date:MPN Identification number Claims Administrator Phone W orkers' compensation insurer (Enter "self-insured" if appropriate) Information & Assistance Officer can be found at location: DWC 7 (1/1/2016) ISSUE TO: or If you need help locating an MPN physician, call your MPN access assistant at: WWW.TRAVELERS.COM/CAMPN (800) 287-9682 (800) 287-9682 You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over). Naming Your Own Physician Before Injury or Illness (Predesignation). You may be able to choose the doctor who will treat you for a job injury or illness. If eligible, you must tell your employer, in writing, the name and address of your personal physician or medical group before you are injured. You must obtain their agreement to treat you for your work injury. For instructions, see the written information about workers' compensation that your employer is required to give to new employees. Discrimination. It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state. Questions? Learn more about workers' compensation by reading the information that your employer is required to give you at time of hire. If you have questions, see your employer or the claims administrator (who handles workers' compensation claims for your employer): False claims and false denials. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be fined and imprisoned. Your employer may not be liable for the payment of workers' compensation benefits for any injury that arises from your voluntary participation in any off-duty, recreational, social , or athletic activity that is not part of your work-related duties. If you have questions about the MPN or want to file a complaint against the MPN, call the MPN Contact Person at by calling toll-free (800) 736-7401. Learn more information about workers' compensation online: www.dwc.ca.gov and access a useful booklet "Workers' Compensation in California: A Guidebook for Injured Workers." You can also get free information from a State Division of Workers' Compensation Information (DWC) & Assistance Officer. The nearest 4.Medical Provider Networks. Your employer may be using an MPN, which is a group of health care providers designated to provide treatment to workers injured on the job. If you have predesignated a personal physician or medical group prior to your work injury, then you may go there to receive treatment from your predesignated doctor. If you are treating with a non-MPN doctor for an existing injury, you may be required to change to a doctor within the MPN. For more information, see the MPN contact information below: Benefits. Workers' compensation benefits include: •Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, medicines, medical equipment and travel costs that are reasonably necessary to treat your injury. You should never see a bill. There are limits on chiropractic, physical therapy and occupational therapy visits. •Temporary Disability (TD) Benefits: Payments if you lose wages while recovering. For most injuries, TD benefits may not be paid for more than 104 weeks within five years from the date of injury. •Permanent Disability (PD) Benefits: Payments if you do not recover completely and your injury causes a permanent loss of physical or mental function that a doctor can measure. •Supplemental Job Displacement Benefit: A nontransferable voucher, if you are injured on or after 1/1/2004, your injury causes permanent disability, and your employer does not offer you regular, modified, or alternative work. •Death Benefits: Paid to your dependents if you die from a work-related injury or illness. If You Get Hurt: 1.Get Medical Care. If you need emergency care, call 911 for help immediately from the hospital, ambulance, fire department or police department. If you need first aid, contact your employer. 2.Report Your Injury. Report the injury immediately to your supervisor or to an employer representative. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you with a claim form within one working day after learning about your injury. Within one working day after you file a claim form, your employer or claims administrator must authorize the provision of all treatment, up to ten thousand dollars, consistent with the applicable treatment guidelines, for your alleged injury until the claim is accepted or rejected. 3.See Your Primary Treating Physician (PTP). This is the doctor with overall responsibility for treating your injury or illness. •If you predesignated your personal physician or a medical group, you may see your personal physician or the medical group after you are injured. •If your employer is using a medical provider network (MPN) or a health care organization (HCO), in most cases you will be treated within the MPN or HCO unless you predesignated a personal physician or medical group. An MPN is a group of physicians and health care providers who provide treatment to workers injured on the job. You should receive information from your employer if you are covered by an HCO or a MPN. Contact your employer for more information. •If your employer is not using an MPN or HCO, in most cases the claims administrator can choose the doctor who first treats you when you are injured, unless you predesignated a personal physician or medical group. THERMAL MECHANICAL, INC. 04-01-24 3195 THE TRAVELERS INSURANCE COMPANIES (877) 828-4132 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA ISSUE TO: ESTADO DE CALIFORNIA – DEPARTAMENTO DE RELACIONES INDUSTRIALES División de Compensación de Trabajadores Aviso a los Empleados – Lesiones Causadas por el Trabajo Página web de la MPN: Fecha de vigencia de la MPN:Número de identificación de la MPN: Si usted necesita ayuda en localizar un médico de una MPN, llame a su asistente de acceso de la MPN al: Administrador de Reclamos Teléfono Asegurador del Seguro de Compensación de trabajador (Anote "autoasegurado" si es apropiado) DWC 7 (1/12016) W04P3D24 (800) 287-9682 (800) 287-9682 WWW.TRAVELERS.COM/CAMPN Es posible que usted tenga derecho a beneficios de compensación de trabajadores si usted se lesiona o se enferma a causa de su trabajo. La compensación de trabajadores cubre la mayoría de las lesiones y enfermedades físicas o mentales relacionadas con el trabajo. Una lesión o enfermedad puede ser causada por un evento (como por ejemplo lastimarse la espalda en una caída) o por acciones repetidas (como por ejemplo lastimarse la muñeca por hacer el mismo movimiento una y otra vez). Beneficios. Los beneficios de compensación de trabajadores incluyen: •Atención Médica: Consultas médicas, servicios de hospital, terapia física, análisis de laboratorio, radiografías, medicinas, equipo médico y costos de viajar que son razonablemente necesarias para tratar su lesión. Usted nunca deberá ver un cobro. Hay límites para visitas quiroprácticas, de terapia física y de terapia ocupacional.•Beneficios por Incapacidad Temporal (TD): Pagos si usted pierde sueldo mientras se recupera. Para la mayor a de las lesiones, beneficios de TD no se pagarán por más de 104 semanas dentro de cinco años después de la fecha de la lesión.•Beneficios por Incapacidad Permanente (PD): Pagos si usted no se recupera completamente y si su lesión le causa una pérdida permanente de su función física o mental que un médico puede medir.•Beneficio Suplementario por Desplazamiento de Trabajo: Un vale no-transferible si su lesión surge en o después del 1/1/04, y su lesión le ocasiona una incapacidad permanente, y su empleador no le ofrece a usted un trabajo regular, modificado, o alternativo.•Beneficios por Muerte: Pagados a sus dependientes si usted muere a causa de una lesión o enfermedad relacionada con el trabajo. Designación de su Propio Médico Antes de una Lesión o Enfermedad (Designación previa). Es posible que usted pueda elegir al médico que le atenderá en una lesión o enfermedad relacionada con el trabajo. Si elegible, usted debe informarle al empleador, por escrito, el nombre y la dirección de su médico personal o grupo médico, antes de que usted se lesione. Usted debe de ponerse de acuerdo con su médico para que atienda la lesión causada por el trabajo. Para instrucciones, vea la información escrita sobre la compensación de trabajadores que se le exige a su empleador darle a los empleados nuevos. Si Usted se Lastima: 1.Obtenga Atención Médica. Si usted necesita atención de emergencia, llame al 911 para ayuda inmediata de un hospital, una ambulancia, el departamento de bomberos o departamento de policía. Si usted necesita primeros auxilios, comuníquese con su empleador. 2.Reporte su Lesión. Reporte la lesión inmediatamente a su supervisor(a) o a un representante del empleador. No se demore. Hay límites de tiempo. Si usted espera demasiado, es posible que usted pierda su derecho a beneficios. Su empleador está obligado a proporcionarle un formulario de reclamo dentro de un día laboral después de saber de su lesión. Dentro de un día después de que usted presente un formulario de reclamo, el empleador o administrador de reclamos debe autorizar todo tratamiento médico, hasta diez mil dólares, de acuerdo con las pautas de tratamiento aplicables a su presunta lesi n, hasta que el reclamo sea aceptado o rechazado. 3.Consulte al Médico que le está Atendiendo (PTP). Este es el médico con la responsabilidad total de tratar su lesión o enfermedad. •Si usted designó previamente a su médico personal o grupo médico, usted puede consultar a su médico personal o grupo médico después de lesionarse.•Si su empleador está utilizando una Red de Proveedores Médicos (MPN) o una Organización de Cuidado Médico (HCO), en la mayoría de los casos usted será tratado dentro de la MPN o la HCO a menos que usted designó previamente un médico personal o grupo médico. Una MPN es un grupo de médicos y proveedores de atención médica que proporcionan tratamiento a trabajadores lesionados en el trabajo. Usted debe recibir informaci n de su empleador si est cubierto por una HCO o una MPN. Hable con su empleador para más información.•Si su empleador no está utilizando una MPN o HCO, en la mayoría de los casos el administrador de reclamos puede escoger el médico que lo atiende primero, cuando usted se lesiona, a menos que usted designó previamente a un médico personal o grupo médico. 4.Red de Proveedores Médicos (MPN): Es posible que su empleador use una MPN, lo cual es un grupo de proveedores de asistencia médica designados para dar tratamiento a los trabajadores lesionados en el trabajo. Si usted ha hecho una designación previa de un médico personal antes de lesionarse en el trabajo, entonces usted puede recibir tratamiento de su médico previamente designado. Si usted está recibiendo tratamiento de parte de un médico que no pertenece a la MPN para una lesión existente, puede querirse que usted se cambie a un médico dentro de la MPN. Para más información, vea la siguiente información de contacto de la MPN: Discriminación. Es ilegal que su empleador le castigue o despida por sufrir una lesión o enfermedad en el trabajo, por presentar un reclamo o por testificar en el caso de compensación de trabajadores de otra persona. De ser probado, usted puede recibir pagos por pérdida de sueldos, reposición del trabajo, aumento de beneficios y gastos hasta los límites establecidos por el estado. ¿Preguntas? Aprenda más sobre la compensación de trabajadores leyendo la información que se requiere que su empleador le dé cuando es contratado. Si usted tiene preguntas, vea a su empleador o al administrador de reclamos (que se encarga de los reclamos de compensación de trabajadores de su empleador): Es posible que su empleador no sea responsable por el pago de beneficios de compensación de trabajadores para ninguna lesión que proviene su participación voluntaria en cualquire actividad fuera del trabajo, recreativa, social, o atlética que no sea parte de sus deberes laborales. Los reclamos falsos y rechazos falsos del reclamo. Cualquier persona que haga o que ocasione que se haga una declaración o una representaci n material intencionalmente falsa o fraudulenta, con el fin de obtener o negar beneficios o pagos de compensación de trabajadores, es culpable de un delito grave y puede ser multado y encarcelado. o llamando al número gratuito (800) 736-7401 . Usted puede obtener más información sobre la compensación del trabajador en el Internet en: www.dwc.ca.gov y acceder a una guía útil "Compensación del Trabajador de California Una Guía para Trabajadores Lesionados." Si uste d tie ne pre gunta s sobre la MPN o quiere presentar una queja en contra de la MPN, llame a la Persona de Contacto de la MPN al : Usted también puede obtener información gratuita de un Oficial de Información y Asistencia de la División Estatal de Compensación de Trabajadores. El Oficial de Información y Asistencia más cercano se localiza en: THERMAL MECHANICAL, INC. 04-01-24 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA THE TRAVELERS INSURANCE COMPANIES (877) 828-4132 3195 ISSUE TO: ESTADO DE CALIFORNIA – DEPARTAMENTO DE RELACIONES INDUSTRIALES División de Compensación de Trabajadores Aviso a los Empleados – Lesiones Causadas por el Trabajo Página web de la MPN: Fecha de vigencia de la MPN:Número de identificación de la MPN: Si usted necesita ayuda en localizar un médico de una MPN, llame a su asistente de acceso de la MPN al: Administrador de Reclamos Teléfono Asegurador del Seguro de Compensación de trabajador (Anote "autoasegurado" si es apropiado) DWC 7 (1/12016) W04P3D24 (800) 287-9682 (800) 287-9682 WWW.TRAVELERS.COM/CAMPN Es posible que usted tenga derecho a beneficios de compensación de trabajadores si usted se lesiona o se enferma a causa de su trabajo. La compensación de trabajadores cubre la mayoría de las lesiones y enfermedades físicas o mentales relacionadas con el trabajo. Una lesión o enfermedad puede ser causada por un evento (como por ejemplo lastimarse la espalda en una caída) o por acciones repetidas (como por ejemplo lastimarse la muñeca por hacer el mismo movimiento una y otra vez). Beneficios. Los beneficios de compensación de trabajadores incluyen: •Atención Médica: Consultas médicas, servicios de hospital, terapia física, análisis de laboratorio, radiografías, medicinas, equipo médico y costos de viajar que son razonablemente necesarias para tratar su lesión. Usted nunca deberá ver un cobro. Hay límites para visitas quiroprácticas, de terapia física y de terapia ocupacional.•Beneficios por Incapacidad Temporal (TD): Pagos si usted pierde sueldo mientras se recupera. Para la mayor a de las lesiones, beneficios de TD no se pagarán por más de 104 semanas dentro de cinco años después de la fecha de la lesión.•Beneficios por Incapacidad Permanente (PD): Pagos si usted no se recupera completamente y si su lesión le causa una pérdida permanente de su función física o mental que un médico puede medir.•Beneficio Suplementario por Desplazamiento de Trabajo: Un vale no-transferible si su lesión surge en o después del 1/1/04, y su lesión le ocasiona una incapacidad permanente, y su empleador no le ofrece a usted un trabajo regular, modificado, o alternativo.•Beneficios por Muerte: Pagados a sus dependientes si usted muere a causa de una lesión o enfermedad relacionada con el trabajo. Designación de su Propio Médico Antes de una Lesión o Enfermedad (Designación previa). Es posible que usted pueda elegir al médico que le atenderá en una lesión o enfermedad relacionada con el trabajo. Si elegible, usted debe informarle al empleador, por escrito, el nombre y la dirección de su médico personal o grupo médico, antes de que usted se lesione. Usted debe de ponerse de acuerdo con su médico para que atienda la lesión causada por el trabajo. Para instrucciones, vea la información escrita sobre la compensación de trabajadores que se le exige a su empleador darle a los empleados nuevos. Si Usted se Lastima: 1.Obtenga Atención Médica. Si usted necesita atención de emergencia, llame al 911 para ayuda inmediata de un hospital, una ambulancia, el departamento de bomberos o departamento de policía. Si usted necesita primeros auxilios, comuníquese con su empleador. 2.Reporte su Lesión. Reporte la lesión inmediatamente a su supervisor(a) o a un representante del empleador. No se demore. Hay límites de tiempo. Si usted espera demasiado, es posible que usted pierda su derecho a beneficios. Su empleador está obligado a proporcionarle un formulario de reclamo dentro de un día laboral después de saber de su lesión. Dentro de un día después de que usted presente un formulario de reclamo, el empleador o administrador de reclamos debe autorizar todo tratamiento médico, hasta diez mil dólares, de acuerdo con las pautas de tratamiento aplicables a su presunta lesi n, hasta que el reclamo sea aceptado o rechazado. 3.Consulte al Médico que le está Atendiendo (PTP). Este es el médico con la responsabilidad total de tratar su lesión o enfermedad. •Si usted designó previamente a su médico personal o grupo médico, usted puede consultar a su médico personal o grupo médico después de lesionarse.•Si su empleador está utilizando una Red de Proveedores Médicos (MPN) o una Organización de Cuidado Médico (HCO), en la mayoría de los casos usted será tratado dentro de la MPN o la HCO a menos que usted designó previamente un médico personal o grupo médico. Una MPN es un grupo de médicos y proveedores de atención médica que proporcionan tratamiento a trabajadores lesionados en el trabajo. Usted debe recibir informaci n de su empleador si est cubierto por una HCO o una MPN. Hable con su empleador para más información.•Si su empleador no está utilizando una MPN o HCO, en la mayoría de los casos el administrador de reclamos puede escoger el médico que lo atiende primero, cuando usted se lesiona, a menos que usted designó previamente a un médico personal o grupo médico. 4.Red de Proveedores Médicos (MPN): Es posible que su empleador use una MPN, lo cual es un grupo de proveedores de asistencia médica designados para dar tratamiento a los trabajadores lesionados en el trabajo. Si usted ha hecho una designación previa de un médico personal antes de lesionarse en el trabajo, entonces usted puede recibir tratamiento de su médico previamente designado. Si usted está recibiendo tratamiento de parte de un médico que no pertenece a la MPN para una lesión existente, puede querirse que usted se cambie a un médico dentro de la MPN. Para más información, vea la siguiente información de contacto de la MPN: Discriminación. Es ilegal que su empleador le castigue o despida por sufrir una lesión o enfermedad en el trabajo, por presentar un reclamo o por testificar en el caso de compensación de trabajadores de otra persona. De ser probado, usted puede recibir pagos por pérdida de sueldos, reposición del trabajo, aumento de beneficios y gastos hasta los límites establecidos por el estado. ¿Preguntas? Aprenda más sobre la compensación de trabajadores leyendo la información que se requiere que su empleador le dé cuando es contratado. Si usted tiene preguntas, vea a su empleador o al administrador de reclamos (que se encarga de los reclamos de compensación de trabajadores de su empleador): Es posible que su empleador no sea responsable por el pago de beneficios de compensación de trabajadores para ninguna lesión que proviene su participación voluntaria en cualquire actividad fuera del trabajo, recreativa, social, o atlética que no sea parte de sus deberes laborales. Los reclamos falsos y rechazos falsos del reclamo. Cualquier persona que haga o que ocasione que se haga una declaración o una representaci n material intencionalmente falsa o fraudulenta, con el fin de obtener o negar beneficios o pagos de compensación de trabajadores, es culpable de un delito grave y puede ser multado y encarcelado. o llamando al número gratuito (800) 736-7401 . Usted puede obtener más información sobre la compensación del trabajador en el Internet en: www.dwc.ca.gov y acceder a una guía útil "Compensación del Trabajador de California Una Guía para Trabajadores Lesionados." Si uste d tie ne pre gunta s sobre la MPN o quiere presentar una queja en contra de la MPN, llame a la Persona de Contacto de la MPN al : Usted también puede obtener información gratuita de un Oficial de Información y Asistencia de la División Estatal de Compensación de Trabajadores. El Oficial de Información y Asistencia más cercano se localiza en: THERMAL MECHANICAL, INC. 04-01-24 TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA THE TRAVELERS INSURANCE COMPANIES (877) 828-4132 3195 <Project Title> 2021 Form PAYMENT BOND <Project Number> Page 30 Payment Bond <________________________________> (“City”) and ________________________ (“Contractor”) have entered into a contract for work on the <_________________________________________________> Project (“Project”). The Contract is incorporated by reference into this Payment Bond (“Bond”). 1. General. Under this Bond, Contractor as principal and ____________________________, its surety (“Surety”), are bound to City as obligee in an amount not less than $_________________, under California Civil Code § 9550 et seq., to ensure payment to authorized claimants. This Bond is binding on the respective successors, assigns, owners, heirs, or executors of Surety and Contractor. 2. Surety’s Obligation. If Contractor or any of its Subcontractors fails to pay a person authorized in California Civil Code § 9100 to assert a claim against a payment bond, any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract, or any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of Contractor and its Subcontractors under California Unemployment Insurance Code § 13020 with respect to the work and labor, then Surety will pay the obligation. 3. Beneficiaries. This Bond inures to the benefit of any of the persons named in California Civil Code § 9100, so as to give a right of action to those persons or their assigns in any suit brought upon this Bond. Contractor must promptly provide a copy of this Bond upon request by any person with legal rights under this Bond. 4. Duration. If Contractor promptly makes payment of all sums for all labor, materials, and equipment furnished for use in the performance of the Work required by the Contract, in conformance with the time requirements set forth in the Contract and as required by California law, Surety’s obligations under this Bond will be null and void. Otherwise, Surety’s obligations will remain in full force and effect. 5. Waivers. Surety waives any requirement to be notified of alterations to the Contract or extensions of time for performance of the Work under the Contract. Surety waives the provisions of Civil Code §§ 2819 and 2845. City waives the requirement of a new bond for any supplemental contract under Civil Code § 9550. Any notice to Surety may be given in the manner specified in the Contract and delivered or transmitted to Surety as follows: Attn: _____________________________________________________ Address: __________________________________________________ City/State/Zip: ______________________________________________ Phone: ___________________________________________________ Email: ____________________________________________________ 6. Law and Venue. This Bond will be governed by California law, and venue for any dispute pursuant to this Bond will be in the <__________________> County Superior Court, and no other place. Surety will be responsible for City’s attorneys’ fees and costs in any action to enforce the provisions of this Bond. [Signatures are on the following page.] <Project Title> 2021 Form PAYMENT BOND <Project Number> Page 31 7. Effective Date; Execution. This Bond is entered into and is effective on __________, 20__. SURETY: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title END OF PAYMENT BOND <Project Title> 2021 Form PERFORMANCE BOND <Project Number> Page 32 Performance Bond <______________________________> (“City”) and __________________________ (“Contractor”) have entered into a contract for work on the <_______________________________________________> Project (“Project”). The Contract is incorporated by reference into this Performance Bond (“Bond”). 1. General. Under this Bond, Contractor as Principal and ___________________________, its surety (“Surety”), are bound to City as obligee for an amount not less than $__________________ to ensure Contractor’s faithful performance of its obligations under the Contract. This Bond is binding on the respective successors, assigns, owners, heirs, or executors of Surety and Contractor. 2. Surety’s Obligations. Surety’s obligations are co-extensive with Contractor’s obligations under the Contract. If Contractor fully performs its obligations under the Contract, including its warranty obligations under the Contract, Surety’s obligations under this Bond will become null and void. Otherwise, Surety’s obligations will remain in full force and effect. 3. Waiver. Surety waives any requirement to be notified of and further consents to any alterations to the Contract made under the applicable provisions of the Contract Documents, including changes to the scope of Work or extensions of time for performance of Work under the Contract. Surety waives the provisions of Civil Code §§ 2819 and 2845. 4. Application of Contract Balance. Upon making a demand on this Bond for completion of the Work prior to acceptance of the Project, City will make the Contract Balance available to Surety for completion of the Work under the Contract. For purposes of this provision, the Contract Balance is defined as the total amount payable by City to Contractor as the Contract Price minus amounts already paid to Contractor, and minus any liquidated damages, credits, or backcharges to which City is entitled under the terms of the Contract. 5. Contractor Default. Upon written notification from City of Contractor’s termination for default under Article 13 of the Contract General Conditions, time being of the essence, Surety must act within the time specified in Article 13 to remedy the default through one of the following courses of action: 5.1 Arrange for completion of the Work under the Contract by Contractor, with City’s consent, but only if Contractor is in default solely due to its financial inability to complete the Work; 5.2 Arrange for completion of the Work under the Contract by a qualified contractor acceptable to City, and secured by performance and payment bonds issued by an admitted surety as required by the Contract Documents, at Surety’s expense; or 5.3 Waive its right to complete the Work under the Contract and reimburse City the amount of City’s costs to have the remaining Work completed. 6. Surety Default. If Surety defaults on its obligations under the Bond, City will be entitled to recover all costs it incurs due to Surety’s default, including legal, design professional, or delay costs. 7. Notice. Any notice to Surety may be given in the manner specified in the Contract and sent to Surety as follows: Attn: _____________________________________________________ <Project Title> 2021 Form PERFORMANCE BOND <Project Number> Page 33 Address: __________________________________________________ City/State/Zip: ______________________________________________ Phone: ___________________________________________________ Fax: ______________________________________________________ Email: ____________________________________________________ 8. Law and Venue. This Bond will be governed by California law, and venue for any dispute pursuant to this Bond will be in the <___________> County Superior Court, and no other place. Surety will be responsible for City’s attorneys’ fees and costs in any action to enforce the provisions of this Bond. 9. Effective Date; Execution. This Bond is entered into and effective on ____________________, 20___. SURETY: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title (Attach Acknowledgment with Notary Seal and Power of Attorney) CONTRACTOR: ___________________________________ Business Name s/__________________________________ ______________________________ Date ___________________________________ Name, Title END OF PERFORMANCE BOND On-call heating, air conditioning and ventilation services at various City facilities - Thermal Mechanical Inc. Final Audit Report 2025-01-06 Created:2024-12-11 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAAkgUH5I6sm8ZMi4oYCeL-w-l6865axGS "On-call heating, air conditioning and ventilation services at vario us City facilities - Thermal Mechanical Inc." History Document created by Webmaster Admin (webmaster@cupertino.org) 2024-12-11 - 0:39:18 AM GMT- IP address: 35.229.54.2 Document emailed to Sundari Pilaka (Sundarip@cupertino.org) for approval 2024-12-11 - 2:05:23 AM GMT Email viewed by Sundari Pilaka (Sundarip@cupertino.org) 2024-12-11 - 2:05:45 AM GMT- IP address: 52.202.236.132 Document approved by Sundari Pilaka (Sundarip@cupertino.org) Approval Date: 2024-12-11 - 2:35:17 AM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval 2024-12-11 - 2:35:30 AM GMT Email viewed by Araceli Alejandre (aracelia@cupertino.org) 2024-12-11 - 2:35:37 AM GMT- IP address: 52.202.236.132 Document approved by Araceli Alejandre (aracelia@cupertino.org) Approval Date: 2024-12-11 - 4:25:38 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to wshipley@thermalmech.com for signature 2024-12-11 - 4:25:51 PM GMT Webmaster Admin (webmaster@cupertino.org) replaced signer wshipley@thermalmech.com with drood@thermalmech.com 2024-12-19 - 11:44:48 PM GMT- IP address: 64.165.34.3 Document emailed to drood@thermalmech.com for signature 2024-12-19 - 11:44:49 PM GMT Email viewed by drood@thermalmech.com 2024-12-20 - 4:32:02 AM GMT- IP address: 146.75.154.0 New document URL requested by drood@thermalmech.com 2025-01-02 - 10:59:17 PM GMT- IP address: 50.193.40.85 Email viewed by drood@thermalmech.com 2025-01-02 - 11:00:38 PM GMT- IP address: 50.193.40.85 Signer drood@thermalmech.com entered name at signing as David Rood 2025-01-02 - 11:02:18 PM GMT- IP address: 50.193.40.85 Document e-signed by David Rood (drood@thermalmech.com) Signature Date: 2025-01-02 - 11:02:24 PM GMT - Time Source: server- IP address: 50.193.40.85 Document emailed to Christopher Jensen (christopherj@cupertino.org) for signature 2025-01-02 - 11:02:32 PM GMT Email viewed by Christopher Jensen (christopherj@cupertino.org) 2025-01-02 - 11:02:52 PM GMT- IP address: 3.232.50.116 Signer Christopher Jensen (christopherj@cupertino.org) entered name at signing as Christopher D. Jensen 2025-01-02 - 11:09:22 PM GMT- IP address: 174.194.186.98 Document e-signed by Christopher D. Jensen (christopherj@cupertino.org) Signature Date: 2025-01-02 - 11:09:24 PM GMT - Time Source: server- IP address: 174.194.186.98 Document emailed to Chad Mosley (chadm@cupertino.org) for signature 2025-01-02 - 11:09:36 PM GMT Email viewed by Chad Mosley (chadm@cupertino.org) 2025-01-02 - 11:09:45 PM GMT- IP address: 3.232.50.116 Document e-signed by Chad Mosley (chadm@cupertino.org) Signature Date: 2025-01-06 - 5:10:59 PM GMT - Time Source: server- IP address: 64.165.34.3 Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature 2025-01-06 - 5:11:11 PM GMT Email viewed by Kirsten Squarcia (kirstens@cupertino.org) 2025-01-06 - 5:11:21 PM GMT- IP address: 3.232.50.116 Document e-signed by Kirsten Squarcia (kirstens@cupertino.org) Signature Date: 2025-01-06 - 5:27:14 PM GMT - Time Source: server- IP address: 176.108.138.169 Agreement completed. 2025-01-06 - 5:27:14 PM GMT