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25-065 4 Point Power Inc. for Electrical On-Call Services4 Point Power, Inc., for Electrical On-Call Services On-Call Public Works Contract/ April 2024 Page 1 of 12 ON-CALL PUBLIC WORKS CONTRACT WITH 4 POINT POWER, INC. 1. PARTIES This On-Call Public Works Contract (“Contract”) is made by and between the City of Cupertino, a municipal corporation (“City”), and 4 Point Power, Inc. (“Contractor”) a Corporation for Electrical On-Call Services, 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 Pro ject 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. 4 Point Power, Inc., for Electrical On-Call Services 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): C10, 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. 4 Point Power, Inc., for Electrical On-Call Services 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 4 Point Power, Inc., for Electrical On-Call Services 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 Contract by 4 Point Power, Inc., for Electrical On-Call Services 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: 4 Point Power, Inc., for Electrical On-Call Services 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 4 Point Power, Inc., for Electrical On-Call Services 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. 4 Point Power, Inc., for Electrical On-Call Services 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; 4 Point Power, Inc., for Electrical On-Call Services 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 Paula Herrera 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 4 Point Power, Inc., for Electrical On-Call Services 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. 26. SEVERABILITY/PARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal, invalid, or unenforceable, the 4 Point Power, Inc., for Electrical On-Call Services On-Call Public Works Contract/ April 2024 Page 11 of 12 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: 4 Point Power, Inc. 1313 N Milpitas Blvd, Suite 161 Milpitas, CA 95035 Attention: Paula Herrera Email: paula@4pointpowerinc.com 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. 4 Point Power, Inc., for Electrical On-Call Services On-Call Public Works Contract/ April 2024 Page 12 of 12 IN WITNESS WHEREOF, the parties have caused the Contract to be executed. CITY OF CUPERTINO A Municipal Corporation By Name Title Date 4 POINT POWER, INC. By Name Title Date APPROVED AS TO FORM: FLOY ANDREWS Interim City Attorney ATTEST: KIRSTEN SQUARCIA City Clerk Date Louis Herrera Louis Herrera CFO Apr 22, 2025 Chad Mosley Director of Public Works Apr 24, 2025 Apr 24, 2025 EXHIBIT A SCOPE OF WORK A. GENERAL REQUIREMENT A. The Contractor shall furnish all labor, tools, transportation, supplies, equipment, materials, and supervision necessary to perform the work as described in this section. B. All work shall be done in a first class, complete and workmanlike manner, confirming to best industry practices and applicable original manufacturer specifications. C. Contractor shall be responsible for initiating, maintaining, and supervising all safety precautions in connection with the work and shall comply with all applicable safety laws, best industry standards, and take all reasonable precautions for safety of the public, City employees and other persons on or about the property. D. Contractor shall possess a valid/current Contractor’s license, if applicable. E. The City’s normal (standard) working hours for this contract shall be from 6:00am to 3:30pm Monday through Thursday and 6:00am to 2:30pm on Friday. F. Contractor is to comply with all codes and regulations having jurisdiction for work to be performed under this contract. Project conditions will be identified individually. When contacted, Contractor may be required to meet with the project manager on site and receive a scope of work for the project. Contractor is required to have the capability to perform all work requested at multiple locations throughout the City in a timely manner. G. The services are to be provided on an “as-needed” basis pursuant to the issuance of Service Order for specific sites during the term of the contract or to be provided during an emergency. H. All scheduled work with the City will require a written quote and schedule to be submitted prior to start of work. I. Each worker performing Work under this Contract shall be paid at a rate not less than the prevailing wage as defined in Sections 1771 and 1774 of the Labor Code for Service Order greater than $1,000, if applicable. The prevailing wage rates are available online at http://www.dir.ca.gov/dlsr. Contractor shall post a copy of the applicable prevailing rates at the Worksite. Responsibilities of the Contractor include, but are not limited to, the following: Troubleshooting and repairing the electrical system and components by performing a variety of tasks including, but not limited to, laying out, installing, replacing, wiring and testing electrical service and electrical wire systems and components used to provide heat, light, power, air conditioning, and refrigeration in municipal buildings and facilities. Services may also include installing and repairing conduit and other materials; connecting electrical machinery, equipment and controls and transmission systems and servicing other electrical related issues as they arise and services necessary to ensure safe, well maintained electrical systems for City employees and the public. The scope and number of projects and tasks are unknown at the time of contract execution. Please Attach Time and Materials Rate Sheets EFFECTIVE July 1, 2024 to June 30, 2025 Hourly Rate  Reg: 6:00 A.M. to 3:30 P.M. $ 186.38  Overtime $ 229.96  Double Time $ 273.12  Saturday to Sunday $ 273.12  Holiday $ 273.12  Shift work starts at 3:30 P.M. to 12:00 A.M. $ 186.38 + 10%  Shift work starts at 12:00 A.M. to 8:00 A.M. $ 186.38 + 15%  Emergency on-call $ 273.12 CITY OF CUPERTINO MASTER AGREEMENT CONSULTANT SERVICES SERVICE ORDER NO. MA Date:Master Agreement Contract #: Maximum Compensation: 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 #:PO #: Project #:Date: Approvals Signatures: 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: Encumbrance this Service Order: MA End Date: Consultant/ Contractor Manager/ Supervisor: Management Analyst Master Agreement Maximum Compensation: Master Agreement Unencumbered Balance: Total Previously Encumbered to Date: City of Cupertino Master Agreement Service Order 191002 Exhibit B n Choose 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. <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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 10/14/2024 Acrisure Partners West Coast Insurance Services,LLC 1950 W Corporate Way #1 Anaheim CA 92801 408-350-5700 License#:6009644 Valley Forge Insurance Company 20508 4POINTP-01 Travelers Casualty Insurance Company of America 190464PointPower,Inc. 1313 N.Milpitas Blvd,Suite 161 Milpitas CA 95035 Continental Casualty Company 20443 879508509 A X 1,000,000 X 300,000 10,000 1,000,000 2,000,000 X X Y Y 7038572189 10/17/2024 10/17/2025 2,000,000 B 1,000,000 X X X Y Y BA2X945887 9/20/2024 9/20/2025 C X X 2,000,000703857219210/17/2024 10/17/2025 2,000,000 X 10,000 City of Cupertino and all parties as required by written contract are named as additional insured. City of Cupertino 10300 Torre Avenue Cupertino CA 95014 USA 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. Policy Number: 810-002X945887 COMMERCIAL AUTO This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM CA T3 40 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION Page 1 of 1© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. The following replaces Paragraph A.5., Transfer of Rights Of Recovery Against Others To Us, of the CONDITIONS Section: 5. Transfer Of Rights Of Recovery Against Oth- ers To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver ap- plies only to the person or organization desig- nated in such contract. Policy Number: 810-002X945887 BLANKET ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS COMPLETED OPERATIONS COVERAGE AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE PART BUSINESSOWNERS COMMON POLICY CONDITIONS TABLE OF CONTENTS I.Blanket Additional Insured – including Primary-Noncontributory provision II.Liability Extension Coverages A.Bodily Injury – Expanded Definition B.Broad Knowledge of Occurrence C.Estates, Legal Representatives and Spouses D.Fellow Employee First Aid E.Personal and Advertising Injury – Discrimination or Humiliation F.Personal and Advertising Injury – Broadened Eviction G.Waiver of Subrogation – Blanket H.Additional Insured – Extended Coverage I.BLANKET ADDITIONAL INSURED PROVISIONS A.Who Is An Insured is amended to include as an additional insured any person or organization whom you are required by “written contract" to add as an additional insured on the Businessowners Liability Coverage Form. B.The insurance provided to the additional insured is limited as follows: 1.The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf in the performance of your ongoing operations specified in the “written contract”; or c.“Your work" that is specified in the written contract but only for "bodily injury" or "property damage" included in the products completed operations hazard, and only if : (1)The “written contract” requires you to provide the additional insured such coverage; and (2)This Coverage Part provides such coverage. 2.Subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide such additional insured with: a.Coverage broader than required by the “written contract”; Policy No: Endorsement No: Effective Date: SB146935E (10-19) Page 1 Insured Name: 4 Point Power, Inc. Copyright CNA All Rights Reserved. 7038572189 10/17/2024 b.A higher limit of insurance than required by the “written contract.” C.The insurance provided to the additional insured does not apply to "bodily Injury," "property damage," or "personal and advertising injury" arising out of: a.The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1)The preparing approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and (2)Supervisory, inspection, architectural or engineering activities; or b.Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Policy. D.Notwithstanding anything to the contrary in the Other Insurance condition of the Businessowners Common Policy Conditions, this insurance is excess of all other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis. But if required by the “written contract,” this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. E.Under Businessowners Liability Conditions, the Duties in the Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured is amended as follows: An additional insured under this endorsement will as soon as practicable: a.Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or "suit" that does result; b.Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to all loss we cover under this Policy; c.Except as provided in Paragraph B.3. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Policy; and d.Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or "suit." We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or "suit." F.Under Liability and Medical Expense Definitions, the following definition is added: “Written contract” means a written contract or agreement that requires you to make a person or organization an additional insured on this policy, provided the contract or agreement: a.Is currently in effect or becomes effective during the term of this policy; and b.Was executed prior to: (1)The “bodily injury” or “property damage”; or (2)The offense that caused the “personal and advertising injury”; for which the additional insured seeks coverage. SB146935E (10-19) Policy No: Page 2 Endorsement No: Effective Date: Insured Name: Copyright CNA All Rights Reserved. 4 Point Power, Inc. 7038572189 10/17/2024 II.LIABILITY EXTENSION COVERAGES It is understood and agreed that this endorsement amends the Businessowners Liability Coverage Form. If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply. A.Bodily Injury – Expanded Definition Under Liability and Medical Expenses Definitions, the definition of "Bodily Injury" is deleted and replaced with the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the physical injury, sickness or disease. B.Broad Knowledge of Occurrence Under Businessowners Liability Conditions, the condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following: Paragraphs a. and b. apply to you or to any additional insured only when such "occurrence," offense, claim or "suit" is known to: (1)You or any additional insured that is an individual; (2)Any partner, if you or an additional insured is a partnership; (3)Any manager, if you or an additional insured is a limited liability company; (4)Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5)Any trustee, if you or an additional insured is a trust; or (6)Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e. applies separately to you and any additional insured. C.Estates, Legal Representative and Spouses The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives and spouses only for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative or spouse outside the scope of such person’s capacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses’ acts, errors or omissions in the conduct of the Named Insured’s business. D.Fellow Employee First Aid Coverage In the section entitled Who Is An Insured, paragraph 2.a.1. is amended to add the following: Policy No: Endorsement No: Effective Date: SB146935E (10-19) Page 3 Insured Name: 4 Point Power, Inc. Copyright CNA All Rights Reserved. 7038572189 10/17/2024 The limitations described in subparagraphs 2.a.1.(a), (b) and (c) do not apply to your “employees” for “bodily injury” that results from providing cardiopulmonary resuscitation or other first aid services to a co- “employee” or “volunteer worker” that becomes necessary while your “employee” is performing duties in the conduct of your business. Your “employees” are hereby insureds for such services. But the insured status conferred by this provision does not apply to “employees” whose duties in your business are to provide professional health care services or health examinations. E.Personal and Advertising Injury – Discrimination or Humiliation 1.Under Liability and Medical Expenses Definitions, the definition of “Personal and advertising injury” is amended to add the following: h.Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: (1)Not done intentionally by or at the direction of: (a)The insured; or (b)Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and (2)Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. 2.Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising injury is amended to add the following additional exclusions: (15)Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub- lease or prospective sale, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured. (16)Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person by any insured. (17)Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. 3.This provision (Personal and Advertising Injury – Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. F.Personal and Advertising Injury - Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of “Personal and advertising injury” is amended to delete Paragraph c. and replace it with the following: c.The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of its owner, landlord or lessor. Policy No: Endorsement No: Effective Date: SB146935E (10-19) Page 4 Insured Name: 4 Point Power, Inc. Copyright CNA All Rights Reserved. 7038572189 10/17/2024 G.Waiver of Subrogation – Blanket We waive any right of recovery we may have against: 1.Any person or organization with whom you have a written contract that requires such a waiver. H.Additional Insured – Extended Coverage When an additional insured is added by this or any other endorsement attached to this Coverage Part, the section entitled Who Is An Insured is amended to make the following natural persons insureds: If the additional insured is: 1.An individual, then his or her spouse is an insured; 2.A partnership or joint venture, then its partners, members and their spouses are insureds; 3.A limited liability company, then its members and managers are insureds; 4.An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are insureds; or 5.Any type of entity, then its employees are insureds; but only with respect to locations and operations covered by the additional insured endorsement’s provisions, and only with respect to their respective roles within their organizations. Furthermore, employees of additional insureds are not insureds with respect to liability arising out of: (1)“Bodily injury” or “personal and advertising injury” to any fellow employee or to any natural person listed in paragraphs 1. through 4. above; (2)“Property damage” to property owned, occupied or used by their employer or by any fellow employee; or (3)Providing or failing to provide professional health care services. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Policy No: Endorsement No: Effective Date: SB146935E (10-19) Page 5 Insured Name: 4 Point Power, Inc. Copyright CNA All Rights Reserved. 7038572189 10/17/2024 SB-300001-C Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 1 (Ed. 06/11) Copyright, Insurance Services Office, Inc., 2002 SB-300001-C (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT – AGGREGATE LIMITS OF INSURANCE (PER PROJECT) This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM A.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under COVERAGE A.1., and for all medical expenses caused by accidents under COVERAGE A.2., which can be attributed only to ongoing operations at a single "project": 1.A separate "Project" General Aggregate limit applies to each "project." The "Project" General Aggregate limit is equal to the amount of the General Aggregate limit shown in the Declarations. 2.The "Project" General Aggregate limit is the most we will pay for the sum of all damages payable under COVERAGE A.1., except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard," and for medical expenses payable under COVERAGE A.2. regardless of the number of: a.Insureds; b.Claims made or "suits" brought; or c.Persons or organizations making claims or bringing "suits." 3.Any payments made under COVERAGE A.1. for damages or under COVERAGE A.2. for medical expenses shall reduce the "Project" General Aggregate limit for the applicable "project." Such payments shall not reduce the General Aggregate limit shown in the Declarations nor shall they reduce any "Project" General Aggregate limit applicable to other "projects." 4.The limits shown in the Declarations for Liability and Medical Expenses, Damage to Premises Rented to You, and Medical Expenses continue to apply. However, instead of being subject to the General Aggregate limit shown in the Declarations, such limits will be subject to the applicable "Project" General Aggregate limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences," and for all medical expenses caused by accidents, which cannot be attributed only to ongoing operations at a single "project": 1.Any payments made under COVERAGE A.1. for damages or under COVERAGE A.2. for medical expenses shall reduce the amount available under the General Aggregate limit or the Products/Completed Operations Aggregate limit, whichever is applicable; and 2.Such payments shall not reduce any "Project" General Aggregate limit. C.When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products/Completed Operations Aggregate limit, and not reduce the General Aggregate limit nor any "Project" General Aggregate limit. D.If a "project" has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the "project" will still be deemed to be the same "project." E.The provisions of the Limits Of Insurance section not otherwise modified by this endorsement shall continue to apply as stipulated. F.The following definition is added to Section F. Liability and Medical Expenses Definitions: "Project" means "your work" at location(s) away from premises owned or rented to you. Policy Number: 7038572189 Policy No: 7038572189 Endorsement No: Effective Date:10/17/2024 CNA80103XX (09-14) Page 1 Insured Name: 4 Point Power, Inc. Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY- OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COMMON POLICY CONDITIONS The following is added to Paragraph H. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1.The additional insured is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. Policy No: Insured Name: SB147052C46 (4-16) Page 1 © CNA All Rights Reserved. CHANGES - NOTICE TO CERTIFICATEHOLDERS OF CANCELLATION OR MATERIAL COVERAGE CHANGE This endorsement modifies insurance provided under the following: BUSINESSOWNERS COMMON POLICY CONDITIONS In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part (other than the reduction of aggregate limits through payment of claims), we agree to mail written notice of cancellation or material change at a minimum of thirty (30) days prior to such cancellation or material change, to: SCHEDULE Name of Designated Entity:______________ Address/Contact Information of Designated Entity: ___________ *Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following conditions are added: 1.If the policy is cancelled or not renewed, we will give written notice of such cancellation or nonrenewal to the Designated Entity shown in the Schedule above, or in the Declarations, at a minimum of thirty (30) days prior to such cancellation or nonrenewal. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity will state the effective date of cancellation or nonrenewal. However, such notice of cancellation or nonrenewal is solely for the purpose of informing the Designated Entity of the effective date of cancellation or nonrenewal and does not grant, alter, or extend any rights or obligations under this policy. 2.If we cancel or elect not to renew the policy for any reason other than nonpayment of premium, we will give written notice to the Designated Entity shown in the Schedule above, or in the Declarations, at a minimum of thirty (30) days prior to such cancellation or nonrenewal, at the same time notice is given to the first Named Insured. 3.If we cancel or elect not to renew this policy for nonpayment of premium, we will give written notice to the Designated Entity shown in the Schedule above, or in the Declarations. Such notice may be provided before or after the effective date of cancellation or nonrenewal. 4.Failure to give notice in accordance with the terms of this endorsement does not: a. Alter the effective date of policy cancellation, nonrenewal or expiration; b.Render such cancellation or nonrenewal ineffective; c. Grant, alter, or extend any rights or obligations under this policy; or d. Extend the insurance beyond the effective date of cancellation or policy expiration, whichever comes first. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. 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 4 POINT POWER INC 1313 N MILPITAS BLVD MILPITAS CA 95035-3193 ASERO INS SERVICES STE 161 1-800-238-6225 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: 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 BA-2X945887-24-42-G 08/06/24 TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035-3193 09/20/24 09/20/25 ACJ ASERO INS SERVICES(HE871) 200 N ALMADEN BLVD # 3RD SAN JOSE CA 95110-2441 WALNUT CREEK CA ELECTRICIAN ELECTRICAL WIRING CONTRACT 9,810.00 DIRECT BILL COMMERCIAL AUTOMOBILE COV PART DECLARATIONS CA T0 01 02 15 1 1IL T0 02 11 89 (REV. 09-07) EFFECTIVE DATE: POLICY NUMBER: ISSUE DATE: BA-2X945887-24-42-G 08/06/2024 09/20/2024 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 COMMERCIAL AUTO BA- COVERAGE PART DECS (ITEMS 1 & 2)CA T0 01 02 15 BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEM 3)CA T0 02 02 15 BUS AUTO COV PART DECLARATIONS-4&5CA T0 03 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 EMPLOYEE HIRED AUTOSCA 20 54 10 13 CA UM MOTORISTS COVERAGE - BODILY INJURYCA 21 54 11 16 RENTAL REIMBURSEMENT COVERAGECA 99 23 10 13 CALIFORNIA AUTO ENDORSEMENTCA F1 26 02 15 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 ROADSIDE ASSISTANCE COVERAGECA T6 25 07 18 BLANKET WAIVER OF SUBROGATIONCA T3 40 02 15 BLANKET ADDITIONAL INSUREDCA T4 37 02 16 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 POLICY HOLDER NOTICES USE OF CREDIT INFORMATION DISCLOSUREPN CB 45 04 20 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) COMMERCIAL AUTOMOBILE COMMERCIAL AUTOMOBILE Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO SD BA-2X945887-24-42-G 08-06-24 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 09-20-24 to 09-20-25 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 CASUALTY INSURANCE 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 2 $5,000 Each Insured UNINSURED and UNDERINSURED 2 See CA T0 30 MOTORISTS COVERAGE PHYSICAL DAMAGE Comprehensive Coverage 7 Actual Cash Value or Cost of Repair, whichever is less, minus deductible shown in ITEM THREE--SCHEDULE OF COVERED AUTOS YOU OWN for each covered Auto. PHYSICAL DAMAGE Collision Coverage 7 Actual Cash Value or Cost of Repair, whichever is less, minus deductible shown in ITEM THREE--SCHEDULE OF COVERED AUTOS YOU OWN for each covered Auto. 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 ASERO INS SERVICES HE871 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO SD BA-2X945887-24-42-G 08-06-24 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 ASERO INS SERVICES HE871 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO SD BA-2X945887-24-42-G 08-06-24 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 ASERO INS SERVICES HE871 Policy Number: ISSUE DATE: COVERAGE PART DECLARATIONS BUSINESS AUTO SD BA-2X945887-24-42-G 08-06-24 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) 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 ASERO INS SERVICES HE871 ITEM THREE.AUTOS YOU OWN(SEE SEPARATE PAGE EXPLAINING CERTAIN ENTRIES OR ABSENCE THEREOF) POLICY NUMBER: INSURED’S NAME:CA T0 02 02 15 SCHEDULE OF COVERED COVEREDAUTONO GARAGING CITY & STATE ZIP CODE COUNTYTOWN CODE TERRZONE CODE ISO/STAT CODE USE CLASS GVW/GCW COVERED AUTO NO YEAR MAKE/MODEL (VIN) VEHICLE ID NO COST NEW LIMIT OF INSURANCE AGE GROUP COVERED AUTO COVERED AUTO COVERED AUTO COVERED AUTO COVERED AUTO * APPLICABLE TO COMPREHENSIVE AND SPECIFIED CAUSES OF LOSS COVERAGE **APPLICABLE TO COMPREHENSIVE, SPECIFIED CAUSES OF LOSS AND COLLISION COVERAGES SPV PAGE OR SEAT CAPACITY BA-2X945887-24-42-G 4 POINT POWER INC 1 MILPITAS CA 95035 053 10,00001283 1 2003 FORD F250 1FDNF20L43EC58373 X 1 2 3 4 2 3 4 MILPITAS MILPITAS MILPITAS CA 95035 053 10,00001283 CA 95035 053 10,00001283 CA 95035 053 68183 2 2014 FORD F150 1FTMF1CM3EKD46737 F 3 2014 FORD F150 1FTMF1CM3EKD26892 F 4 2017 BIX TEX TR TRAILER 4RAL1210HK059226 C COMPREHENSIVE 3 1 DEDUCTIBLES: COLLISION PREMIUMS: COVERED AUTOS LIABILITY AUTO MED PAY 1000 1000 1000 1000 1000 1000 2212 2423 2423 173 95 95 95 10 COMPREHENSIVE COLLISION 27 58 58 59 202 202 2622 3007 3007 183TOTAL 21640 29520 29520 5000 ACV ACV ACV Total Uninsured and Underinsured Motorists Premium $426 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. BA-2X945887-24-42-G 08-06-24 CA 1,600 445 445 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 96 96 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’. 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. BA-2X945887-24-42-G 08-06-24 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. 1 2 3 BA-2X945887-24-42-G 08-06-24 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. COMMERCIAL AUTO EMPLOYEE HIRED AUTOS CA 20 54 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Page 1 of 1 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.Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while op- erating 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 business. B.Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the Business Auto and Auto Dealers Coverage Forms and Paragraph 5.f. of the Other Insur- ance – Primary And Excess Insurance Provi- sions Condition in the Motor Carrier Coverage Form are replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "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 "em- ployee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". © Insurance Services Office, Inc., 2011 $ 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 BA-2X945887-24-42-G 08-06-24 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 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 Maximum Payment Designation Or Description Any One Any One Coverage Period PremiumThis Insurance Applies Day Days $$$Comprehensive Collision $$$ Specified $$$ Total Premium $ CA 99 23 10 13 © Insurance Services Office, Inc., 2011 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RENTAL REIMBURSEMENT COVERAGE Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Of Covered "Autos" To Which Each Covered "Auto" No. Of Causes Of Loss Page of A.This endorsement provides only those coverages where a premium is shown in the Schedule. It ap- plies only to a covered "auto" described or desig- nated in the Schedule. B.We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" be- cause of "loss" to a covered "auto". Payment ap- plies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. C.We will pay only for those expenses incurred dur- ing the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expi- ration, with the lesser of the following number of days: 1.The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. 2.The number of days shown in the Schedule. D.Our payment is limited to the lesser of the follow- ing amounts: 1.Necessary and actual expenses incurred. 2.The maximum payment stated in the Sched- ule applicable to "any one day" or "any one period". E.This coverage does not apply while there are spare or reserve "autos" available to you for your operations. F.If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not al- ready provided for under the Physical Damage Coverage Extension. With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. BA-2X945887-24-42-G 08-06-24 SEE SCHEDULE 1 2 COMMERCIAL AUTO POLICY NUMBER:CA 99 23 10 13 SCHEDULE Premium THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RENTAL REIMBURSEMENT COVERAGE Designation Or Description This Insurance Applies Of Covered "Autos" To Which Coverage Maximum Payment Any One Any One PeriodDayDays Each Covered "Auto" No. Of $$ BA-2X945887-24-42-G 75 30 2,250 $ 231COMPREHENSIVE $ 391COLLISION $ 232COMPREHENSIVE $ 392COLLISION $ 233COMPREHENSIVE $ 393COLLISION CA 99 23 10 13 © Insurance Services Office, Inc., 2011 Page of 2 2 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA AUTO ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM CA F1 26 02 15 Page 1 of 1© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. PROVISIONS A.SUPPLEMENTARY PAYMENTS – INCREASED LIMITS The following replaces Paragraph A.2.a.(4) of SECTION II – COVERED AUTOS LIABILITY COVERAGE: (4)All reasonable expenses incurred by the "in- sured" at our request, including actual loss of earnings up to $600 a day because of time off from work. B.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 $60 per day to a maximum of $1,800 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. C.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 $50 per day, to a maximum of $1,000 for any one "accident". D.LOST ELECTRONIC KEY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Lost Electronic Key We will pay up to $250 for "loss" or damage to an electronic key for your covered "auto". No deductible applies to this coverage. E.SEATBELT REPLACEMENT 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 any seatbelt in a covered "auto" you own. We will pay up to $250 for replacement of the seatbelt in your covered "auto" due to wear and tear. No deductible applies to this coverage. F.PROPERTY OF OTHERS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III – PHYSICAL DAMAGE COVERAGE: Property of Others We will pay up to $250 for "loss" of property of others which is in or on your covered "auto" for which Physical Damage Coverage is provided. No deductible applies to this coverage. 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. BA-2X945887-24-42-G 08-06-24 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 POLICY NUMBER: ISSUE DATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ROADSIDE ASSISTANCE COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM ROADSIDE ASSISTANCE SCHEDULE Description of Auto Premium 08-06-24BA-2X945887-24-42-G 2003 FORD F250 1FDNF20L43EC58373 $25 2014 FORD F150 1FTMF1CM3EKD46737 $25 2014 FORD F150 1FTMF1CM3EKD26892 $25 PROVISIONS 1.The following is added to Paragraph A., Coverage, of SECTION III – PHYSICAL DAMAGE COVERAGE: Roadside Assistance Coverage a.We will pay for any roadside assistance service specified below provided by our "authorized service provider" when a covered "auto" that is an "eligible auto" is disabled and located within 100 feet of a paved public road, on a driveway, on a private road or in a parking facility, if the "eligible auto" is accessible as determined by our "authorized service provider": (1)Towing or flatbed transport; (2)Winching; (3)Jump starting a dead battery; (4)Changing a flat tire: (5)Key lock-out service; or (6)Delivery of fuel, oil, water or other vehicle fluids. b.We will pay for towing or flatbed transport for an "eligible auto": (1) Up to 100 miles; or (2)To the nearest qualified repair facility selected by our "authorized service provider" when there is no repair facility available within 100 miles. We will not pay for the cost of supplies, replacement parts, fuel, other fluids or any labor performed at the service or repair facility. c.In the event that you decide not to use our "authorized service provider", or our "authorized service provider" is unable to provide the roadside assistance service, we will reimburse you for the cost of any roadside assistance service listed in Paragraph a. that you receive from another provider, but only for reasonable charges as determined by us. Receipt for any of these services must be provided to us for consideration of payment. d.No deductible applies to this Roadside Assistance Coverage. 2.The following is added to Paragraph A.2., Towing, of SECTION III – PHYSICAL DAMAGE COVERAGE: This Towing Coverage does not apply to any covered "auto" that is an "eligible auto" for Roadside Assistance Coverage under this policy. CA T6 25 07 18 © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page of1 2 COMMERCIAL AUTO © 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page of CA T6 25 07 18 3.The following is added to Paragraph B.7., Policy Period, Coverage Territory, of SECTION IV – BUSINESS AUTO CONDITIONS: However, for any Roadside Assistance Coverage under this policy, the coverage territory is only the United States of America and Canada. 4.The following is added to the DEFINITIONS Section: "Authorized service provider" means a service provider contracted by us, at no charge to you, to provide or procure roadside assistance services on our behalf. "Eligible auto" means any "auto" you own that is shown in the Roadside Assistance Schedule, and for which a premium is shown, that is a covered "auto" for Comprehensive Coverage or Specified Causes of Loss under this policy. 2 2 COMMERCIAL AUTO This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM CA T3 40 02 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION Page 1 of 1© 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. The following replaces Paragraph A.5., Transfer of Rights Of Recovery Against Others To Us, of the CONDITIONS Section: 5.Transfer Of Rights Of Recovery Against Oth- ers To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver ap- plies only to the person or organization desig- nated in such contract. COMMERCIAL AUTO This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM CA T4 37 02 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE in the BUSINESS AUTO COVERAGE FORM and Paragraph e. in A.1., Who Is An Insured, of SECTION II – COVERED AUTOS LIABILITY COVERAGE in the MOTOR CARRIER COVERAGE FORM, whichever Coverage Form is part of your policy: This includes any person or organization who you are required under a written contract or agreement between you and that person or organization, 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". © 2016 The Travelers Indemnity Company. All rights reserved . 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%. 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 Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number Roadside Assistance Call 1-800-238-6225 24 hours a day Named Insured Policy Number 4 POINT POWER INC 4 POINT POWER INC 4 POINT POWER INC 4 POINT POWER INC 4 POINT POWER INC 4 POINT POWER INC COMMERCIAL AUTO ROADSIDE ASSISTANCE COVERAGE CARDS Thank you for choosing Travelers. Roadside Assistance Coverage provides a variety of roadside services conveniently accessed through our authorized service provider. Below are your Roadside Assistance Cards to keep in each of your vehicles for which you have purchased Roadside Assistance Coverage. Roadside Assistance Coverage will apply to your Private Passenger Type vehicles, Light Trucks (gross vehicle weight of 10,000 lbs or less) and Service/Utility Trailers listed on the enclosed Roadside Assistance Coverage endorsement CA T6 25. PN CB 36 09 18 © 2018 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 2X945887-BA 2X945887-BA 2X945887-BA 2X945887-BA 2X945887-BA 2X945887-BA Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor. Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor. Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor. Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor. Roadside Assistance Call 1-800-238-6225 24 hours a day Services include: • •Winching; •Jump start a dead battery; •Changing a flat tire; •Key lock-out service; •Delivery of fuel, oil, water or other vehicle fluids MYTRAVELERS.COM This card is not evidence of insurance coverage. Roadside is provided by an independent service contractor. PN CB 36 09 18 © 2018 The Travelers Indemnity Company. All rights reserved.Page 2 of 2 Towing or flatbed transport up to 100 miles; Towing or flatbed transport up to 100 miles; Towing or flatbed transport up to 100 miles; Towing or flatbed transport up to 100 miles; Towing or flatbed transport up to 100 miles; Towing or flatbed transport up to 100 miles; PN CB 42 04 20 © 2020 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 SIGNATURE OF BUSINESS PRINCIPAL DATE Name: Address: Date of Birth: Name: Address: IMPORTANT NOTICE REGARDING YOUR RENEWAL AND CONSUMER REPORTING OPT-IN FORM Please return this completed notice to your agent, broker or Travelers representative (if your policy is being serviced by us) and we will apply your consumer report to your next policy term. If you want to have your consumer report applied sooner, contact your agent, broker or Travelers representative. In connection with the commercial insurance for the above named business insured, Travelers would like to review my credit report and credit score, as an individual business principal of and representing the entity seeking this insurance. In addition, Travelers would like to review my credit report and credit score in connection with any future renewal of the business's policy. Travelers may obtain or use a FICO insurance score in connection with underwriting the submission for, or renewal of, commercial insurance. I hereby authorize Travelers to obtain a credit report about me in connection with underwriting the business's submission for, or renewal of, commercial insurance. Name, Home Address, and Date of Birth of Business Principal* * If Named Insured is an individual, list information for that individual. If not list the President/CEO or the Business Principal if he/she is managing the day to day operations of the business Name and Address of Business Insured Thank you for trusting us with insuring your business. We are committed to providing excellent service at a competitive price. As part of our underwriting process various information may be used to determine the price of insurance, including financial history and information about your business such as claim and insurance history. We would like to offer you the opportunity to have a FICO insurance score of a representative business principal used as an additional tool for pricing the insurance. This insurance score is only one factor we review in order to determine the price of insurance. It may enable us to lower the price of your insurance or conversely, it could result in an increase in your premium or have no impact at all on the price you pay for insurance. To opt-in, complete and sign below. USE OF CREDIT INFORMATION DISCLOSURE Payment history Bankruptcy, foreclosures and collection activity Length of credit history Amount of outstanding debt in relation to credit limits Types of credit in use (i.e. mortgages, installment loans) Number of new applications for credit The information used to develop the FICO insurance score comes from TransUnion Corporation. TransUnion Corporation - Consumer Relations P.O. Box 1000 2 Baldwin Place Chester, PA 19022 1-800-888-4213 Website: www.transunion.com/direct If you need to contact us about this notice, you can do so at: Travelers Insurance Score Resource Center SVC PO BOX 1515 Spokane, WA 99210 1-844-269-0336 If you have general questions about your policy or billing, please call. • • • • • • PN CB 45 04 20 © 2020 The Travelers Indemnity Company. All rights reserved Page 1 of 1 If the business principal who consented to use of their credit in connection with underwriting this insurance has questions concerning their credit information, they may contact the following consumer reporting agency: Credit information is any credit-related information derived from a credit report itself or provided in an application for Commercial Automobile insurance. Insurance score is a number or rating derived from a mathematical formula, computer application, model, or other process based on credit information and used to assist in predicting future insurance loss exposure. The types of factors that go into developing the insurance score are: This notice is to inform you that in connection with your Commercial Automobile insurance, Travelers will seek to obtain and use FICO credit information related to your business principal as a routine part of an insurance scoring process. your agent. DRIVER LISTING POLICY NUMBER: COMMERCIAL AUTO ISSUE DATE: NEW/ADDED DRIVERS LAST FIRST DATE OF BIRTH LICENSE NUMBER LICENSED STATE CA A1 05 02 15 Page of The subsequent page(s) of this form includes those drivers whom you have indicated will be using your automobiles insured through us. Please be sure this listing is complete and includes both full-time and occasional drivers. If this information needs modification or when drivers are added or deleted, please complete both sides of this form, as applicable, and send it to your agent in a secure manner, being mindful of the sensitive information it could contain. BA-2X945887-24-42-G 08-06-24 1 2 DRIVER LISTING POLICY NUMBER: COMMERCIAL AUTO ISSUE DATE: CURRENT DRIVERS LAST FIRST DELETE This list includes those drivers whom you have indicated will be using your automobiles insured through us. Please be sure this listing is complete and includes both full-time and occasional drivers. If this information needs modification or when drivers are added or deleted, please complete both sides of this form, as applicable, and send it to your agent in a secure manner, being mindful of the sensitive information it could contain. BA-2X945887-24-42-G 08-06-24 ALVAREZ DARRIN JAKUBS JOSHUA HERRERA LOUIS CA A1 05 02 15 Page of2 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 19 0 4 6 TR A V E L E R S C A S U A L T Y I N S U R A N C E C O M P A N Y O F A M E R I C A 2X 9 4 5 8 8 7 - B A 09 - 2 0 - 2 4 09 - 2 0 - 2 5 4 P O I N T P O W E R I N C 13 1 3 N M I L P I T A S B L V D ST E 1 5 9 MI L P I T A S C A 9 5 0 3 5 - 3 1 8 6 20 0 3 FO R D F 2 5 0 1F D N F 2 0 L 4 3 E C 5 8 3 7 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 19 0 4 6 TR A V E L E R S C A S U A L T Y I N S U R A N C E C O M P A N Y O F A M E R I C A 2X 9 4 5 8 8 7 - B A 09 - 2 0 - 2 4 09 - 2 0 - 2 5 4 P O I N T P O W E R I N C 13 1 3 N M I L P I T A S B L V D ST E 1 5 9 MI L P I T A S C A 9 5 0 3 5 - 3 1 8 6 20 1 4 FO R D F 1 5 0 1F T M F 1 C M 3 E K D 4 6 7 3 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 19 0 4 6 TR A V E L E R S C A S U A L T Y I N S U R A N C E C O M P A N Y O F A M E R I C A 2X 9 4 5 8 8 7 - B A 09 - 2 0 - 2 4 09 - 2 0 - 2 5 4 P O I N T P O W E R I N C 13 1 3 N M I L P I T A S B L V D ST E 1 5 9 MI L P I T A S C A 9 5 0 3 5 - 3 1 8 6 20 1 4 FO R D F 1 5 0 1F T M F 1 C M 3 E K D 2 6 8 9 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 19 0 4 6 TR A V E L E R S C A S U A L T Y I N S U R A N C E C O M P A N Y O F A M E R I C A 2X 9 4 5 8 8 7 - B A 09 - 2 0 - 2 4 09 - 2 0 - 2 5 4 P O I N T P O W E R I N C 13 1 3 N M I L P I T A S B L V D ST E 1 5 9 MI L P I T A S C A 9 5 0 3 5 - 3 1 8 6 20 1 7 BI X T E X T R T R A I L E R 4R A L 1 2 1 0 H K 0 5 9 2 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 . (To be completed and signed by Named Insured) ADDRESS: $50,000 each accident (CSL) $60,000 each accident (CSL) $100,000 each accident (CSL) $250,000 each accident (CSL) $300,000 each accident (CSL) $350,000 each accident (CSL) $500,000 each accident (CSL) $750,000 each accident (CSL) $ SUPPLEMENTARY COMMERCIAL AUTOMOBILE APPLICATION CALIFORNIA UNINSURED MOTORISTS COVERAGE OFFER FORM $1,000,000 each accident (CSL) UI CA 10 04 09 Page 1 of 3 NAME: California law permits you to make certain decisions regarding Uninsured Motorists Coverage. This document provides general descriptions of coverage and the options available. Refer to your policy for the prevailing cover- age provisions. I.BODILY INJURY – UNINSURED MOTORISTS COVERAGE Your automobile bodily injury liability insurance policy will automatically include Uninsured Motorists Coverage for bodily injury in limits equal to your bodily injury liability limit(s), unless you (1) delete this coverage com- pletely, (2) delete the coverage as to a motor vehicle operated by a natural person(s) designated by name or (3) select a lower limit(s) of coverage, but not less than the Minimum Financial Responsibility limits. If you wish to delete or reduce the bodily injury uninsured motorists coverage limits, please make your choice(s) be- low. A.Selection of Lower Limit(s) of Bodily Injury Uninsured Motorists Coverage The California Insurance Code requires an insurer to provide Uninsured Motorists Coverage in each bod- ily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to provide the coverage in an amount less than that required by subdivision (m) of Section 11580.2 of the Insurance Code but not less than the financial responsibility requirements. Uninsured Motorists Coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, which the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, dis- ease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or op- erated by the insured or a resident of the same household. An uninsured motor vehicle includes an un- derinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. I hereby select Uninsured Motorists Coverage for bodily injury in limits equal to the Minimum Finan- cial Responsibility limits of $15,000 each person/$30,000 each accident; OR $30,000 each accident. The Uninsured Motorists Coverage limits will be either split (each person/each accident) or a com- bined single limit (each accident, CSL), consistent with the bodily injury liability limits on the policy. I hereby select Uninsured Motorists Coverage for bodily injury at limits greater than the Minimum Fi- nancial Responsibility limits, but lower than the policy bodily injury liability limit. (Specify limit) 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035-3193 0920242X945887092025BA UI CA 10 04 09 Page 2 of 3 I hereby delete bodily injury Uninsured Motorists Coverage entirely. I hereby delete Waiver of Collision Deductible coverage. B.Property Damage – Uninsured Motorists Coverage If your motor vehicle liability insurance policy does not include collision coverage AND you have not agreed to delete bodily injury Uninsured Motorists Coverage, your motor vehicle liability insurance policy will automatically include coverage for property damage to an applicable covered auto (excluding per- sonal property contained therein) caused by the owner or operator of an uninsured motor vehicle, unless you indicate otherwise below. Property Damage Uninsured Motorist Coverage covers payment for loss or damage to the covered auto resulting from collision, not to exceed its actual cash value or $3,500, which- ever is less, for which loss or damage the insured is legally entitled to recover from the owner or operator of an uninsured motor vehicle. PLEASE CONSIDER YOUR WAIVER OF COLLISION DEDUCTIBLE COVERAGE OPTIONS CARE- FULLY, PARTICULARLY IF YOU HAVE ELECTED TO PURCHASE A LARGE DEDUCTIBLE RATING PLAN IN CONNECTION WITH A PHYSICAL DAMAGE DEDUCTIBLE, AS THIS COVERAGE MAY LIMIT APPLICATION OF THE PHYSICAL DAMAGE DEDUCTIBLE YOU HAVE CHOSEN. IF YOU HAVE ANY QUESTIONS ABOUT THIS COVERAGE OR HOW IT MAY IMPACT YOUR PHYSICAL DAMAGE DEDUCTIBLE, PLEASE CONTACT YOUR AGENT OR BROKER. B.Deletion of Bodily Injury Uninsured Motorists Coverage The California Insurance Code requires an insurer to provide Uninsured Motorists Coverage in each bod- ily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured Motorists Coverage insures the insured, his or her heirs, or legal repre- sentatives for all sums within the limits established by law, which the person or persons are legally enti- tled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the in- sured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code. I hereby delete bodily injury Uninsured Motorists Coverage only with respect to the following named persons(s): II.OFFER OF WAIVER OF COLLISION DEDUCTIBLE AND PROPERTY DAMAGE – UNINSURED MOTOR- ISTS COVERAGE (Complete this section if you have not deleted bodily injury uninsured motorists coverage.) If bodily injury uninsured motorists coverage is not deleted, the California Insurance Code (Section 11580.26) requires insurers to offer the following additional coverage options. However, Waiver of Collision Deductible and Property Damage – Uninsured Motorists Coverage options do not apply to commercial vehicles used or maintained for the transportation of persons for hire, compensation or profit (excluding van pool vehicles), or designated, used or maintained primarily for the transportation of property. A.Waiver of Collision Deductible If your motor vehicle liability insurance policy includes collision coverage AND you have not agreed to de- lete bodily injury uninsured motorists coverage, your motor vehicle liability insurance policy will automati- cally include coverage for the amount of the deductible applicable to such collision coverage in the event of collision involving an applicable vehicle owned by the named insured and insured under the policy, and an uninsured motor vehicle, unless you indicate otherwise below. I hereby delete Waiver of Collision Deductible coverage only with respect to a covered auto used or operated by the following named persons(s): DATE UI CA 10 04 09 SIGNATURE OF NAMED INSURED I hereby delete property damage Uninsured Motorists Coverage. Page 3 of 3 I understand that the coverage acceptance, selection or deletion indicated herein shall apply on the policy(ies) in effect at the time this form is executed and all future renewal policies until I notify the Company IN WRITING of any changes. My signature below, and/or payment of any premium, evidences my actual knowledge and understanding of the availability of these benefits and limits as well as the benefits and limits I have selected, deleted or accepted by default. I hereby delete property damage Uninsured Motorists Coverage only with respect to a covered auto used or operated by the following named person(s): WLTR005 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 October 3, 2024 City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 Account Information: Policy Holder Details :4 Point Power Inc DBA 4 Point Electric Contact Us Need Help? Chat online or call us at (866) 467-8730. We're here Monday - Friday. Enclosed please find a Certificate Of Insurance for the above referenced Policyholder.Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/03/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AUTOMATIC DATA PROCESSING INS AGCY 76250937 1 ADP BLVD M/S 625 ROSELAND NJ 07068 CONTACT NAME: PHONE (A/C, No, Ext): (800) 524-7024 FAX (A/C, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Hartford Casualty Insurance Company 29424 INSURED 4 POINT POWER INC DBA 4 POINT ELECTRIC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035-3193 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/Y YYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS- MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A X 76 WEG AH5THK 09/07/2024 09/07/2025 X PER STATUTE OTH- ER Y/N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 SCPHS018 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 July 29, 2024 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Policy Information: Policy Number:76 WEG AH5THK Renewal Date:09/07/24 Contact Us Visit https://business.thehartford.com 24/7 access to pay bills, view policy documents, get your certificate of insurance and more. Need Help?Start a live chat online or call us at (866) 225-7966.We’re here weekdays from 8:00 AM to 8:00 PM ET Dear Policyholder, Thanks for being a loyal customer of The Hartford!Your workers'compensation policy is scheduled to renew on 09/07/24. This packet has your renewal documents and other important info about your upcoming policy term. What you should do right now Check the back of your packet.There may be posting notices to put up in the workplace,or forms that you'll need to sign and return if you haven't already. After that,you can look through the rest of the packet to make sure everything looks right.Here's what you'll find,in this order: ·Any documents required by your state ·Your Declarations page ·Billing information ·Any endorsements on your policy ·Information about your premium audit ·Privacy notices and miscellaneous legal documents ·Forms/documents that you should sign and return, if you haven't already SCPHS018 ·Posting notices Need to make updates? If anything at your business has changed,or if something in your renewal doesn’t look right,let us know.We’ll work together to review your policy and your needs. Log in to https://business.thehartford.com, start a live chat online or call us at (866) 225-7966 to get started. At the end of your policy term,we may also contact you about a premium audit.The state requires us to audit certain types of policies to make sure you didn’t over- or underpay for your last policy term. Report a loss immediately online 24/7 or call us at 800-327-3636. On behalf of AUTOMATIC DATA PROCESSING INS AGCY,thanks for choosing us for your business insurance needs. We look forward to another year with you! Sincerely, The Hartford Please keep a copy of this letter with your insurance policy for future reference. Form WC 66 04 56 Printed in U.S.A. CALIFORNIA FRAUD STATEMENT For your protection, California law requires that you be advised of the following: Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Form 97485 18th Rev.Printed in U.S.A.Page 1 of 4 Process Date:07/29/24 Policy Expiration Date:09/07/25 Policy Number 76 WEG AH5THK Policy Effective Date 09/07/24 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Dear Hartford Insured, Re: An Important Message to Workers Compensation Policyholders The control of workplace accidents and injuries should be among the highest priorities of your firm.Each accident wastes precious human and financial resources,and introduces inefficiencies into your operations.From a practical standpoint, the control of accidents, and their inevitable costs, simply makes good business sense. An effective risk engineering program can save you money and aggravation,can positively impact your loss experience (and thus your premium), and most importantly, can help you maintain solid control of your operations. As a service to you,our valued customer,the Risk Engineering Department of The Hartford in cooperation with your independent agent,can assist you in establishing risk engineering strategies.If you would like assistance, please complete and return to us the reply portion of this brochure, or contact your independent agent. Services Available The following is a description of some of the services that we provide.The types of services that may be appropriate for your business depend upon the nature and size of your operations and the specific risk engineering services you have requested.The cost of risk engineering services may or may not be a part of your insurance premium.This depends on the extent of the requested services,agreements stated in your insurance policy and program,and statutory regulations that may require us to provide risk engineering services. 1)Reference Materials –Information about risk engineering topics that can be provided or made available to you to help you to enhance your risk engineering program. 2)Telephone Consultation –We can hold a teleconference with you to help you to evaluate your risk engineering program,identify areas for improvement,and recommend ways to implement such improvements. 3)Onsite Consultation –This consists of visiting your premises and helping you to assess and remedy your risk engineering needs onsite.This level of service is usually only appropriate for larger,higher hazard operations.The following are examples of some of the services that could be provided onsite: o A review of your safety program to determine its adequacy and recommend modifications to that plan where needed. o Specific hazard evaluations, including ergonomics, industrial hygiene or material handling. o An initial survey and evaluation to address potential safety and health hazards. o Consultation to help management establish a comprehensive loss prevention Program. o Periodic summaries of accidents and analysis of causes. o Follow-up visits to check on progress and to provide continuing assistance when required. Form 97485 18th Rev.Printed in U.S.A.Page 2 of 4 A Word About OSHA The Occupational Safety and Health Act of 1970 and similarly approved State Plans require employers to provide their employees with safe and healthful places to work.The Occupational Safety and Health Administration (OSHA)of the U.S.Department of Labor and similar State agencies enforce the regulations and apply penalties (civil and criminal) for non-compliance. New standards have been developed,and through application and interpretation,standards change.You should make yourself aware of the standards that are applicable to your operations,and assure yourself that reasonable efforts are made to be in compliance.Copies of the standards are available through most libraries,or can be obtained through OSHA or the U.S. Government Printing Office. You should know that neither The Hartford,nor any other party,can fulfill your obligations under the Law. Questions related to your legal obligations should be referred to your legal counsel. Some Safety Reminders from The Hartford: Have you considered: o The need to formalize your safety efforts to assure compliance and document your efforts? o The need to acquire Material Safety Data Sheets on all hazardous materials and the need for training on appropriate safety measures for your employees? o Requirements for record keeping of injuries, illnesses, and exposure to hazardous substances? o Assessing each job task to determine hazards and needed controls? o Measuring each exposure to hazardous substances to determine the need for control or personal protective equipment? o What mechanisms are in place to periodically verify that exposure controls (guards,ventilation systems, etc.) are still in place and working? o What specific training your employees and your supervisors need to avoid hazards in the workplace? o What specific OSHA standards apply to your business? o What mechanism exists to promptly investigate all accidents and ‘near-misses’to limit the chance of another occurrence? o The financial impact an injury or illness has on your business? o What resources are available to you to help prevent accidents and illnesses? Thank you for your business. Sincerely, The Hartford's Risk Engineering Department Form 97485 18th Rev.Printed in U.S.A.Page 3 of 4 THIS BROCHURE IS PROVIDED FOR INFORMATIONAL PURPOSES ONLY.IT IS NOT INTENDED TO BE A SUBSTITUTE FOR A COMPLETE ON-SITE SAFETY INSPECTION CONDUCTED BY A QUALIFIED RISK ENGINEERING SPECIALIST.READERS ARE ENCOURAGED TO HAVE SUCH AN INSPECTION CONDUCTED BOTH TO PROMOTE WORKPLACE SAFETY AND TO COMPLY WITH APPLICABLE LAW. FOR ADDITIONAL INFORMATION OR ASSISTANCE,EITHER TELEPHONE OR MAIL THIS FORM TO YOUR HARTFORD AGENT OR NEAREST OFFICE OF THE HARTFORD NOTICE TO ARKANSAS POLICYHOLDERS The Hartford is required by law to provide its policyholders with certain accident prevention services at no additional cost as required by ARK.Code Ann.§11-9-409(D)and Rule 32.If you would like more information,call The Hartford’s Risk Engineering Department,One Hartford Plaza,COG1,Hartford,CT 06155 at 1-866-586-0467. If you have any questions about this requirement,call the Health and Safety Division,Arkansas Workers’ Compensation Commission at 1-800-622-4472. NOTICE TO CALIFORNIA POLICYHOLDERS The Hartford is required by law to provide its policyholders with certain occupational safety and health risk engineering consultation services as required by the California Labor Code,§6354.5,at no additional charge.If you would like more information call The Hartford’s Risk Engineering Department at 1-866-586-0467 for occupational safety and health risk engineering consultation services. California Workers Compensation insurance policyholders may register comments about the insurer’s risk engineering consultation service by writing to: State of California Department of Industrial Relations Division of Occupational Safety and Health P.O. Box 420603 San Francisco, California 94142 NOTICE TO PENNSYLVANIA POLICYHOLDERS The Hartford maintains and provides accident and illness prevention services as required by the nature of the policyholder's business or its operation,in accordance with the Pennsylvania Workers'Compensation Act.For more information about these services contact your Hartford Agent or nearest office of The Hartford. NOTICE TO TEXAS POLICYHOLDERS Pursuant to Texas Labor Code §411.066,The Hartford is required to notify its policyholders that accident prevention services are available from The Hartford at no additional charge.These services may include surveys, recommendations,training programs,consultations,analyses of accident causes,industrial hygiene and industrial health services. The Hartford is also required to provide return-to-work coordination services as required by Texas Labor Code §413.021 and to notify you of the availability of the return-to-work reimbursement program for employers under Texas Labor Code §413.022. If you would like more information,contact The Hartford at 1-866-586-0467 and email contactriskengineering@thehartford.com for accident prevention services or 1-877-952-9222 and email CentralClaimCenter.WCEDM@thehartford.com for return-to-work coordination services. For information about these requirements call the Texas Department of Insurance,Division of Workers’ Compensation (TDI-DWC)at 1-800-687-7080 or for information about the return-to-work reimbursement program for employers call the TDI-DWC at 1-512-804-5000. If The Hartford fails to respond to your request for accident prevention services or return-to-work coordination services,you may file a complaint with the TDI-DWC in writing at http://www.tdi.texas.gov or by mail to Texas Department of Insurance, Division of Workers’ Compensation, P.O. Box 12050, Austin, Texas 78711. Form 97485 18th Rev.Printed in U.S.A.Page 4 of 4 Request for Technical Resources To The Hartford's Risk Engineering Department: Yes - I am interested in obtaining information concerning: General Topics Business Continuity Construction Accident Analysis Business Travel Safety Construction Site Consultation Accident Investigations Contingency Planning Overview Construction Equipment Hazards Establishing a Risk Engineering Program Emergency/Disaster Response Hazard Communication Hazard Recognition Emergency Evacuation Drills Ladders & Scaffolds Safety Committees Emergency Preparedness Planning Trenching & Evacuation Fall Protection Ergonomics Industrial Hygiene Property Back Injury Prevention Hazard Communication Automatic Sprinkler System Computer Workstation Industrial Hygiene (general)Flammable Liquids Cumulative Trauma Disorders Indoor Air Quality Fire Prevention and Protection Ergo Train-the-Trainer Noise Exposures Fire Drill and Evacuation Telecommuting Respiratory Protection Hot Work Permit Program Transportation Workers' Compensation Other Topics 3-D Driver Training Bloodborne Pathogens Business Risk Management Driving Defensively Drug Screening General Liability Investigations Fleet Newsletter Machine Safeguarding Product Liability Programs Guide to Successful Driver Mgmt Return to Work Programs Safety Training School Bus Driving Tips Slip and Falls Security/Terrorism Name Company Policy # Address City & State Zip Code Email Address:Telephone For more information on the above, you can visit our website at https://www.thehartford.com/riskengineering Or you may forward your request to: Fax line: 1-860-723-4459 Or mail to: The Hartford Financial Services Group Risk Engineering Department One Hartford Plaza, COG1 Hartford, CT 06155 Form WC 99 00 02 (03/14)Page 1 of 1 Workers’ Compensation and Employers’ Liability Business Insurance Policy (Policy Provisions:WC000000C) INFORMATION PAGE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY Form WC 00 00 01 A (1)Printed in U.S.A.Page 1 (Continued on next page) Process Date:07/29/24 Policy Expiration Date:09/07/25 INSURER:Hartford Casualty Insurance Company ONE HARTFORD PLAZA HARTFORD CT 06155 NCCI Company Number:14397 Company Code:3 Suffix LARS RENEWAL POLICY NUMBER:76 WEG AH5THK 5 Previous Policy Number:76 WEG AH5THK 1.Named Insured and Mailing Address: (No., Street, Town, State, Zip Code) 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 FEIN Number:81-2549147 State Identification Number(s): The Named Insured is:Corporation Business of Named Insured:Electrical Contractors Other workplaces not shown above:1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 2.Policy Period:From 09/07/24 To 09/07/25 ANNUAL 12:01 a.m., Standard time at the insured's mailing address. Producer’s Name:AUTOMATIC DATA PROCESSING INS AGCY 1 ADP BLVD M/S 625 ROSELAND NJ 07068 Producer’s Code:76250937 Issuing Office:THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO TX 78251 (866) 225-7966 Total Estimated Annual Premium:$8,573 Deposit Premium: Policy Minimum Premium:$661 CA Audit Period:ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized representative. Countersigned by 07/29/24 Authorized Representative Date INFORMATION PAGE (Continued)Policy Number:76 WEG AH5THK Form WC 00 00 01 A (1)Printed in U.S.A.Page 2 Process Date:07/29/24 Policy Expiration Date:09/07/25 3.A. Workers Compensation Insurance:Part one of the policy applies to the Workers Compensation Law of the states listed here:CA 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: Bodily injury by Accident $1,000,000 each accident Bodily injury by Disease $1,000,000 policy limit Bodily injury by Disease $1,000,000 each employee C. Other States Insurance:Part Three of the policy applies to the states, if any , listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING, U.S.TERRITORIES AND STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: SEE ENDORSEMENT-WC 99 03 68 4.The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.All information required below is subject to verification and change by audit. Classifications Code Number and Description Premium Basis Total Estimated Annual Remuneration Rates Per $100 of Remuneration Estimated Annual Premium Total Standard Premium $7,904 Premium Discount -$103 Expense Constant $200 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement $84 Estimated Annual Premium (before Surcharges)$8,085 Total Estimated Surcharges $488 *See the attached Schedule(s) of Operations for Location and State Level Premium Information Total Estimated Annual Premium:$8,573 Deposit Premium: Policy Minimum Premium:$661 CA Interstate/Intrastate Identification Number:Refer to Schedule of Operations NAICS: 238210 Labor Contractors Policy Number:SIC:1731 Form WC 99 03 68 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 EXTENSION OF THE INFORMATION PAGE - ITEM 3.D - ENDORSEMENTS Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Item 3.D. of the Information Page is completed to include the following endorsements: G-4119-0 POLICYHOLDER NOTICE-PAYROLL BILLING PN049901I POLICYHOLDER NOTICE - YOUR RIGHT TO RATING AND DIVIDEND INFORMATION WC000000C WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC000001A.1 INFORMATION PAGE WC000001A.2 INFORMATION PAGE WC000406 Premium Discount Endorsement WC000422C TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT WC040301BB POLICY AMENDATORY ENDORSEMENT - CALIFORNIA WC040303C OFFICERS AND DIRECTORS COVERAGE/EXCLUSION ENDORSEMENT - CALIFORNIA WC040306 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA WC040360B EMPLOYERS LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA WC040421 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA WC040422 CALIFORNIA SHORT-RATE CANCELLATION ENDORSEMENT WC040601B CALIFORNIA CANCELATION ENDORSEMENT WC550011D Employees Claim for Workers compensation Benefits WC880400I Notice to Employees - Injuries Caused By Work (TITLE IN SPANISH) WC880401I Notice to Employees - Injuries Caused By Work Form WC 99 03 68 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 EXTENSION OF THE INFORMATION PAGE - ITEM 3.D - ENDORSEMENTS Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Item 3.D. of the Information Page is completed to include the following endorsements: WC990001K Signature/Copyright WC990002 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY BUSINESS INSURANCE POLICY WC990005 SCHEDULE OF OPERATIONS WC990302B WORKERS COMPENSATION BROAD FORM ENDORSEMENT WC990358B AMENDMENT TO WORKERS COMPENSATION BROAD FORM ENDORSEMENT - EMPLOYERS LIABILITY STOP GAP COVERAGE WC990368 EXTENSION OF THE INFORMATION PAGE - ITEM 3.D. - ENDORSEMENTS WC990375 CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT WC990394 NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) WC990628 MINIMUM RETAINED PREMIUM ENDORSEMENT WC990689 GOODS AND SERVICES ENDORSEMENT SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER:HARTFORD CASUALTY INSURANCE COMPANY Company Code:3 Policy Number:76 WEG AH5THK Schedule Number:01-04-01 Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 NAICS: 238210 FEIN:81-2549147 SIC: 1731 NO. OF EMPL: 2 4.The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans.All information required below is subject to verification and change by audit. Classifications Code Number and Description Premium Basis Total Estimated Annual Remuneration Rates Per $100 of Remuneration Estimated Annual Premium Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 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 419,000.00 4.610000 19,316 SCHEDULE OF OPERATIONS This Schedule of Operations forms a part of the policy effective on the inception date of the policy unless another date is indicated below: INSURER:HARTFORD CASUALTY INSURANCE COMPANY Company Code:3 Policy Number:76 WEG AH5THK Schedule Number:01-04-01 Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Location Address of operations covered by this schedule: 4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 NAICS: 238210 FEIN:81-2549147 SIC: 1731 NO. OF EMPL: 2 4.The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans.All information required below is subject to verification and change by audit. Classifications Code Number and Description Premium Basis Total Estimated Annual Remuneration Rates Per $100 of Remuneration Estimated Annual Premium Countersigned by Authorized Representative Form WC 99 00 05 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 Total State Summary Total Class Premium 19,316 CA Territorial Differential 0.910000 -1,738 Waiver of Subrogation 0.020000 386 Experience modifier 8574430 0.880000 -2,156 Schedule Rating Factor 0.500000 -7,904 Total Estimated Annual Standard Premium 7,904 Premium discount 0.013000 -103 Expense constant 200 Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement 419,000.00 0.020000 84 CA User Fund 2.460400 199 CA Fraud 0.412200 33 CA Uninsured Employers Benefit Trust Fund 0.150500 12 CA Subsequent Injuries Benefit Trust Fund Assessments 1.589100 128 CA Occupational Safety & Health Fund 0.726600 59 CA Labor Enforcement & Compliance Fund 0.710900 57 Total Estimated Annual Premium 8,573 Form WC 66 01 56 B Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE Beginning Beginning on Page on Page INFORMATION PAGE PART TWO - Continued 1 G.Limits of Liability ..............................................4 General Section..............................................................1 H.Recovery From Others.....................................4 A.The Policy...............................................................1 I.Actions Against Us...........................................4 B.Who Is Insured.......................................................1 C.Workers Compensation Law..................................1 PART THREE - OTHER STATES INSURANCE 4 D.State.......................................................................1 A.How This Insurance Applies.............................4 E.Locations................................................................1 B.Notice...............................................................5 PART ONE - WORKERS COMPENSATION INSURANCE...1 PART FOUR - YOUR DUTIES IF INJURY OCCURS.....5 A.How This Insurance Applies...................................1 B.We Will Pay............................................................1 PART FIVE - PREMIUM...............................................5 C.We Will Defend.......................................................1 A.Our Manuals.....................................................5 D.We Will Also Pay....................................................1 B.Classifications..................................................5 E.Other Insurance......................................................2 C.Remuneration...................................................5 F.Payments You Must Make......................................2 D.Premium Payments..........................................5 G.Recovery From Others...........................................2 E.Final Premium..................................................5 H.Statutory Provisions................................................2 F.Records............................................................6 G.Audit.................................................................6 PART TWO - EMPLOYERS LIABILITY INSURANCE......2 A.How This Insurance Applies...................................2 PART SIX - CONDITIONS.......................................6 B.We will Pay.............................................................3 A.Inspection.........................................................6 C.Exclusions..............................................................3 B.Long Term Policy.............................................6 D.We Will Defend.......................................................3 C.Transfer of Your Rights and Duties..................6 E.We Will Also Pay....................................................4 D.Cancellation.....................................................6 F.Other Insurance......................................................4 E.Sole Representative.........................................6 IMPORTANT:This Quick Reference is not part of the Workers Compensation and Employers Liability Policy and does not provide coverage.Refer to the Workers Compensation and Employers Liability Policy itself for actual contractual provisions. PLEASE READ THE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CAREFULLY. Form WC 00 00 00 C Printed in U.S.A.Page 1 of 6 Process Date: 07/29/24 Policy Expiration Date: 09/07/25 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: GENERAL SECTION 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; Form WC 00 00 00 C Printed in U.S.A.Page 2 of 6 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. 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.Enforcement may be 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 Form WC 00 00 00 C Printed in U.S.A.Page 3 of 6 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. 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 com- pensation,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,dis- crimination 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 Noappropriated 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 have the right to investigate and settle these claims,proceedings and suits. Form WC 00 00 00 C Printed in U.S.A.Page 4 of 6 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. 4.If you have work on the effective date of this policy in any state not listed in Item 3.A. of the Form WC 00 00 00 C Printed in U.S.A.Page 5 of 6 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. Form WC 00 00 00 C Printed in U.S.A.Page 6 of 6 If this policy is cancelled,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. 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 cancellation 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 obligated 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 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.Cancellation 1.You may cancel this policy.You must mail or deliver advance written notice to us stating when the cancellation 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 cancellation 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 cancellation notice. 4.Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with that 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 cancellation. Form PN 04 99 02 B (Ed. 5-02)Printed in U.S.A.Page 1 of 2 POLICYHOLDER NOTICE CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS 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 create a monopoly 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 Insurance 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 approval.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 insurance 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 apply 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 requires us to respond to your written appeal within 30 days.If you are not satisfied with the result of your appeal,you may appeal our decision to the insurance commissioner. Form PN 04 99 02 B (Ed. 5-02)Printed in U.S.A.Page 2 of 2 CALIFORNIA WORKERS’ COMPENSATION INSURANCE NOTICE OF NONRENEWAL 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. 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 established in accordance with California Insurance Code 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. This notice does not change the policy to which it is attached. Form G-4119-0 Printed in U.S.A. © 2017, The Hartford POLICY HOLDER NOTICE - PAYROLL BILLING Thank you for choosing The Hartford.Your policy is on our payroll billing method.The payroll billing method uses actual payrolls received throughout the policy period and a blended rate(s)to determine premiums due during the policy period. To learn more about how your premium is calculated on the payroll billing method please visit: https://www.thehartford.com/blended Below are the blended rate(s) being used for each state and classification code on your policy: State Class Code Blended Rate Effective 1: 1313 N MILPITAS BLVD STE 161, MILPITAS, CA 5140 2 09/07/2024 Form PN 04 99 01 I (02/22)Printed in U.S.A.Page 1 of 3 Process Date: 07/29/24 Policy Expiration Date:09/07/25 POLICYHOLDER NOTICE YOUR RIGHT TO RATING AND DIVIDEND INFORMATION I.Information Available to You A.Information Available from Us -Hartford Casualty Insurance Company (1)General questions regarding your policy should be directed to your Hartford Agent or Hartford Casualty Insurance Company 3600 Wiseman Blvd San Antonio, TX 78251 Telephone:(866) 225-7966 agency.services@thehartford.com www.thehartford.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). Form PN 04 99 01 I (02/22)Printed in U.S.A.Page 2 of 3 (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. 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: Hartford Casualty Insurance Company One Pointe Drive, Suite 200, Brea, CA 92821; Telephone (800) 451-6944; Fax (860) 723-4289. 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 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). Form PN 04 99 01 I (02/22)Printed in U.S.A.Page 3 of 3 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. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 00 04 06 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 PREMIUM DISCOUNT ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 The premium for this policy and the policies,if any,listed in Item 3 of the Schedule may be eligible for a discount.This endorsement shows your estimated discount in Item 1 or 2 of the Schedule.The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit.Premium subject to retrospective rating is not subject to premium discount. SCHEDULE 1.Table of States California or any other State that has approved the premium discount plan applicable to the total policy premium on an interstate basis at the effective date of the policy. 2.Average percentage discount: 1.30 % 3.Other policies: 4.If there are no entries in Items 1,2 and 3 of the Schedule,see the Premium Discount Endorsement attached to your policy number: THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 04 03 01 BB Printed in U.S.A.Page 1 of 2 Process Date:07/29/24 Policy Expiration Date:09/07/25 POLICY AMENDATORY ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 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 damages 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 Department 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 resulting 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 Form WC 04 03 01 BB Printed in U.S.A.Page 2 of 2 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 policy 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 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: 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.PLEASE READ IT CAREFULLY. Form WC 04 03 03 C (07/18)Printed in U.S.A.Page 1 of 2 Process Date:07/29/24 Policy Expiration Date:09/07/25 ENDORSEMENT AGREEMENT LIMITING AND RESTRICTING THIS INSURANCE OFFICERS AND DIRECTORS COVERAGE / EXCLUSION - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Name of California Insurer:Hartford Casualty Insurance Company 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 corporation for pay,as employees, 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 private 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,anything in this policy to the contrary notwithstanding, this policy DOES NOT INSURE: Officers, Directors and Trustees Excluded Title Louis Herrera Officer Paula Herrera Officer Form WC 04 03 03 C (07/18)Printed in U.S.A.Page 2 of 2 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.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description R.C. Bensos & Sons, Inc. General Contractors, 1959 Leghorn St. , Suite Suite A, Mountain View, CA, 95035 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Chandler Signs LLC 14201 SOVEREIGN RD, FORT WORTH, TX 76155 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description City of Cupertino 10300 TORRE AVE CUPERTINO CA 95014-3202 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description San Jose Evergreen Community College District, its trustees, officers, agents, employees, and volunteers, individually and collectively, 40 S MARKET ST SAN JOSE, CA 95113 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Mcquire and Hester 2810 Harbor Bay Parkway Alameda CA 94502 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Calstate Construction, Inc. 4165 Business Center Dr, Freemont, CA 94538 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be %of the California workers'compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Kent Construction 8505 Church St Ste 12, Gilroy, CA 95020 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 60 B Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 EMPLOYERS' LIABILITY COVERAGE AMENDATORY ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 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 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. 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 employment,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) applicable 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. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 04 04 21 Printed in U.S.A.Page 1 of 1 Process Date:07/29/24 Policy Expiration Date:09/07/25 OPTIONAL PREMIUM INCREASE ENDORSEMENT - CALIFORNIA Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 You must provide us,or our authorized representative, access to records necessary to perform a payroll verification 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 attempting 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.PLEASE READ IT CAREFULLY. Form WC 04 04 22 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 CALIFORNIA SHORT-RATE CANCELATION ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 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: Extended Number of Days Percent of Full Policy Premium Extended Number of Days Percent of Full Policy Premium Extended Number of Days Percent of Full Policy Premium 1 ..........5%95-98 ..........37%219-223 ..........69% 2 ..........6%99-102 ..........38%224-228 ..........70% 3-4 ..........7%103-105 ..........39%229-232 ..........71% 5-6 ..........8%106-109 ..........40%233-237 ..........72% 7-8 ..........9%110-113 ..........41%238-241 ..........73% 9-10 ..........10%114-116 ..........42%242-246 (8 mos.)74% 11-12 ..........11%117-120 ..........43%247-250 ..........75% 13-14 ..........12%121-124 (4 mos.)44%251-255 ..........76% 15-16 ..........13%125-127 ..........45%256-260 ..........77% 17-18 ..........14%128-131 ..........46%261-264 ..........78% 19-20 ..........15%132-135 ..........47%265-269 ..........79% 21-22 ..........16%136-138 ..........48%270-273 (9 mos.)80% 23-25 ..........17%139-142 ..........49%274-278 ..........81% 26-29 ..........18%143-146 ..........50%279-282 ..........82% 30-32 (1 mo.)19%147-149 ..........51%283-287 ..........83% 33-36 ..........20%150-153 (5 mos.)52%288-291 ..........84% 37-40 ..........21%154-156 ..........53%292-296 ..........85% 41-43 ..........22%157-160 ..........54%297-301 ..........86% 44-47 ..........23%161-164 ..........55%302-305 (10 mos.)87% 48-51 ..........24%165-167 ..........56%306-310 ..........88% 52-54 ..........25%168-171 ..........57%311-314 ..........89% 55-58 ..........26%172-175 ..........58%315-319 ..........90% 59-62 (2 mos.)27%176-178 ..........59%320-323 ..........91% 63-65 ..........28%179-182 (6 mos.)60%324-328 ..........92% 66-69 ..........29%183-187 ..........61%329-332 ..........93% 70-73 ..........30%188-191 ..........62%333-337 (11 mos.)94% 74-76 ..........31%192-196 ..........63%338-342 ..........95% 77-80 ..........32%197-200 ..........64%343-346 ..........96% 81-83 ..........33%201-205 ..........65%347-351 ..........97% 84-87 ..........34%206-209 ..........66%352-355 ..........98% 88-91 (3 mos.)35%210-214 (7 mos.)67%356-360 ..........99% 92-94 ..........36%215-218 ..........68%361-365 (12 mos.)100% THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 04 06 01 B (01/22)Printed in U.S.A. Process Date: 07/29/24 Policy Expiration Date:09/07/25 CALIFORNIA CANCELATION ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Name of California Insurer:Hartford Casualty Insurance Company 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. 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.PLEASE READ IT CAREFULLY. Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00)Page 1 of 4 Process Date:07/29/24 Policy Expiration Date:09/07/25 © 2000, The Hartford WORKERS’ COMPENSATION BROAD FORM ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT PAGE SECTION I 2 PARTS ONE and TWO 2 01 We Will Also Pay 2 PART - THREE 2 02 How This Insurance Works 2 PART - SIX 2 03 Transfer of Your Rights and Duties 2 04 Liberalization 2 SECTION II 2 VOLUNTARY COMPENSATION INSURANCE 2 05 Voluntary Compensation Insurance 2 A.How This Insurance Applies 2 B.We will Pay 3 C.Exclusions 3 D.Before We Pay 3 E.Recovery From Others 3 F.Employers’ Liability Insurance 3 EMPLOYERS’ LIABILITY STOP GAP COVERAGE 3 06 Employers’ Liability Stop Gap Coverage 3 A.Stop Gap Coverage Limited Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming 3 B.Part One does not Apply 3 C.Application of Coverage 3 D.Additional Exclusions 3 E.West Virginia 3 SECTION III 4 07 Schedule of Covered States 4 Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00)Page 2 of 4 SECTION I PARTS ONE and TWO 1.WE WILL ALSO PAY D.We Will Also Pay of Part One (WORKERS’ COMPENSATION INSURANCE); and E.We Will Also Pay of Part Two (EMPLOYERS’LIABILITY INSURANCE)is replaced by the following: 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,INCLUDING 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 law; and 5.expenses we incur. PART THREE 2.How This Insurance Applies Paragraph 4. of A.How This Insurance Applies of Part 3 (Other States Insurance)is replaced by the following: 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 sixty days. PART SIX 3.Transfer Of Your Rights and Duties C.Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the following: Your rights or duties under this policy may not be transferred without our written consent. If you die and we receive notice within sixty days after your death,we will cover your legal representative as insured. 4.Liberalization If we adopt a change in this form that would broaden the coverage of this form without extra charge,the broader coverage will apply to this policy.It will apply when the change becomes effective in your state. SECTION II VOLUNTARY COMPENSATION AND EMPLOYERS’ LIABILITY COVERAGE 5.Voluntary Compensation Insurance A.How This Insurance Applies This insurance applies to bodily injury by accident or bodily injury by disease.Bodily injury includes resulting death. 1.The bodily injury must be sustained by any officer or employee not subject to the workers’compensation law of any state shown in Item 3.A.of the Information Page. 2.The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A.of the Information Page. 3.The bodily injury must occur in the United States of America,its territories or possessions,or Canada,and may occur elsewhere if the employee is a United States or Canadian citizen,or otherwise legal resident,and legally employed,in the United States or Canada and temporarily away from those places. 4.Bodily injury by accident must occur during the policy period. 5.Bodily injury by disease must be caused or aggravated by the conditions of the officer’s or employee’s employment. Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00)Page 3 of 4 The officer’s or 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 an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers’ compensation law of any state shown in Item 3.A.of the Information Page.We will pay those amounts to the persons who would be entitled to them under the law. C.Exclusion This insurance does not cover: 1.any obligation imposed by workers’ compensation or occupational disease law or any similar law. 2.bodily injury intentionally caused or aggravated by you. 3.officers or employees who have elected not to be subject to the state workers’ compensation law. 4.partners or sole proprietors not covered under the Standard Sole Proprietors, Partners,Officers and Others Coverage Endorsement. D.Before We Pay Before we pay benefits to the persons entitled to them, they must: 1.Release you and us,in writing,of all responsibility for the injury or death. 2.Transfer to us their right to recover from others who may be responsible for the injury or death. 3.Cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits of this insurance fail to do those things,our duty to pay ends at once.If they claim damages from you or from us for the injury or death, our duty to pay ends at once. E.Recovery From Others If we make a recovery from others,we will keep an amount equal to our expenses of recovery and the benefits we paid.We will pay the balance to the persons entitled to it. If the persons entitled to the benefits of this insurance make a recovery from others,they must reimburse us for the benefits we paid them. F.Employers’ Liability Insurance Part Two (Employers’Liability Insurance)applies to bodily injury covered by this endorsement as though the State of Employment was shown in Item 3.A. of the Information Page. This provision 5.does not apply in New Jersey or Wisconsin. EMPLOYERS’ LIABILITY STOP GAP COVERAGE 6.Employers’ Liability Stop Gap Coverage A.This coverage only applies in Montana,North Dakota,Ohio,Washington,West Virginia and Wyoming. B.Part One (Workers’Compensation Insurance) does not apply to work in states shown in Paragraph A above. C.Part Two (Employers’Liability Insurance)applies in the states,shown in Paragraph A.,as though they were shown in Item 3.A.of the Information Page. D.Part Two,Section C.Exclusions is changed by adding these exclusions. This insurance does not cover; 5.bodily injury intentionally caused or aggravated by you or in Ohio bodily injury resulting from an act which is determined by an Ohio court of law to have been committed by you with the belief than an injury is substantially certain to occur.However,the cost of defending such claims or suits in Ohio is covered. 13.bodily injury sustained by any member of the flying crew of any aircraft. 14.any claim for bodily injury with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default in premium under the provisions of the workers’compensation law or laws of a state shown in Paragraph A. E.This insurance applies to damages for which you are liable under West Virginia Code Annot.S 23- 4-2. Countersigned by Authorized Representative Form WC 99 03 02 B Printed in U.S.A. (Ed. 8/00)Page 4 of 4 SECTION III 7.SCHEDULE OF COVERED STATES A.This endorsement only applies in the states listed in this Schedule of Covered States. B.If a state,shown in Item 3.A.of the Information Page,approves this endorsement after the effective date of this policy,this endorsement will apply to this policy.The coverage will apply in the new state on the effective date of the state approval. C.Schedule of Covered States: CA THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 99 03 58 B Printed in U.S.A (Ed. 7/08) Process Date:07/29/24 Policy Expiration Date:09/07/25 AMENDMENT TO WORKERS’ COMPENSATION BROAD FORM ENDORSEMENT- EMPLOYERS’ LIABILITY STOP GAP COVERAGE Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 This endorsement changes the Workers’ Compensation Broad Form Endorsement – Employers’Liability Stop Gap Coverage 6.Employers’Liability Stop Gap Coverage A.This coverage only applies in North Dakota, Ohio, Washington, and Wyoming E.This paragraph is removed. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 99 03 75 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 CALIFORNIA INSTALLMENT FEE DISCLOSURE ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 This endorsement applies only to the insurance provided because California is shown in Item 3.A.of the Information Page. A service fee of $7.00 is charged for each installment when your premium is paid in installments.The service fee is $5.00 per withdrawal when you select an electronic fund transfer payment plan.The service fee will be added to the premium amount shown on your premium billing statement. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 99 03 94 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 © 2011, The Hartford NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 This policy is subject to the following additional Conditions: A.If this policy is cancelled by the Company,other than for non-payment of premium,notice of such cancellation will be provided at least thirty (30)days in advance of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record or the Company. B.If this policy is cancelled by the Company for non-payment of premium,or by the insured,notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s)with mailing addresses on file with the agent of record or the Company. If notice is mailed,proof of mailing to the last known mailing address of the certificate holder(s)on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s)who were issued a certificate of insurance applicable to this policy’s term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective,nor will it negate cancellation of the policy.Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 99 06 28 Printed in U.S.A. Process Date:07/29/24 Policy Expiration Date:09/07/25 MINIMUM RETAINED PREMIUM ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 It is agreed that: Section E. Final Premium of Part Five – Premium of the policy is changed as follows: Sub-paragraphs 1. and 2. are deleted and replaced by the following: 1.a.If we cancel,for any reason other than nonpayment of premium,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 we cancel for nonpayment of premium final premium will not be less than the minimum premium. 2.a.If you cancel for any reason,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 cancellation table and procedure. b.If you cancel due to retiring from business or when all work covered by this policy has been completed,final premium will not be less than the minimum premium. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 99 06 89 (02/21)Printed in U.S.A.Page 1 of 1 Process Date:07/29/24 Policy Expiration Date:09/07/25 GOODS AND SERVICES ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Name of Insurer:Hartford Casualty Insurance Company This endorsement modifies insurance provided under all Coverage Parts of this Policy. We may offer or make “goods or services”available to you through this underwriting company,a non-insurer subsidiary,or unaffiliated third parties as a part of this policy.The “goods or services”may be provided for a charge, at a discount,on a subsidized basis,or free of charge.In some cases,we may receive a fee from the unaffiliated third parties that provide “goods or services”.We do not warrant or guarantee the “goods or services”provided by third parties,and such third parties shall be solely liable and responsible for the “goods or services”they provide.The “goods or services” offered or made available by us may be modified or discontinued at any time. “Goods or services”means goods,products or services,including but not limited to risk mitigation,safety,and/or loss prevention services or equipment. Form 98456 5th Rev. 12-13 Printed in U.S.A.Page 1 of 2 MAINTAINING YOUR RECORDS FOR AUDIT PURPOSES WHAT IS A PREMIUM ADJUSTMENT? When your Workers'Compensation policy was issued you paid a deposit premium based on the nature of your business and estimates of your payroll.At the end of the policy period,we conduct an audit to compare the estimates against the actual figures and operations. Based on this comparison an adjustment is made.If the actual premium is less than what you already have paid,a refund will be made.If it's more,you will be billed for the difference.These adjustments are subject to any minimum premiums that apply. HOW WILL THE PREMIUM ADJUSTMENT BE MADE? On smaller,less complex operations we may e-mail you, call you,or mail you a request to ask you to provide the information via our online web-based portal,mail or telephone.If we require this information,we will provide an electronic link to,or a paper copy of,the necessary forms for you to complete. On larger,more complex operations one of our Premium Auditors will contact you for an appointment.You will be contacted either by e-mail,telephone or mail.If directed, the auditor will contact your accountant to obtain as much information as possible and contact you at a later time for additional information that may be needed. BASIS OF PREMIUM Remuneration (Payroll) in most states, includes: Payment of:Wages,bonuses,commissions, overtime,*sick pay,vacation pay,*tool allowances,contributions to individual retirement accounts,employee contributions to employee benefit plans. Payments on basis of:Piece work, incentive plans, profit sharing. The value of:Housing furnished to employees,*meals furnished to employees,*store certificates, merchandise and other dollar substitutes. Remuneration does not include: a.Employer contributions to a group insurance or pension plan other than statutory plans of insurance. b.Special awards for individual inventions or discoveries. c.Overtime.* Subcontractors.In the absence of other insurance,most state laws hold a contractor responsible for injuries to employees of subcontractors.At the time of audit Certificates of Insurance must be available for subcontractors with employees,in order to avoid payment of premium. Independent Contractors,without employees,whose duties closely resemble those of an employee,will be considered your employee with the appropriate premium charged. The actual working relationship between you and the Independent Contractor is examined.Items such as,but not limited to:whether the work performed is an integral part of your operations,whether you have the right to control the details of the work,the method of payment, who supplied the materials used,does the person regularly work for others,whose regulatory authority did person operate under,whether the person is involved in a separate and distinct business offering the same services to the public. RECORDS As part of the policy conditions,we are allowed to examine your financial books and records to determine actual exposures and operations.We would appreciate your cooperation in making the needed records available for the auditor's inspection. What Records Will Be Needed? The records needed will vary.In most cases,the Premium Auditor will be able to obtain the necessary audit data from two or more of the following records:Journals, Ledgers,State and Federal Tax Reports,Individual Earning Cards, Checkbooks and Contracts. Form 98456 5th Rev. 12-13 Printed in U.S.A.Page 2 of 2 How You Should Keep Your Records By maintaining your payroll records in accordance with the following guidelines,you might reduce your insurance costs. Overtime.In most states,the amount paid in excess of straight time pay can be deducted if it can be verified in your records.You must maintain your records to show pay separately by employee and in summary by classification of work. *Division of an employee's payroll to more than one classification is not allowed in most states. Exception:For construction,erection or stevedoring operations the payroll of an employee may be allocated to each type of work performed if proper records are kept. Your records must show the number of hours and amount of payroll for each type of work.If you do not keep such a breakdown,the full salary must be charged to the highest rated classification to which the employee is exposed. Executive Officers in most states are considered employees of their corporation and included in the computation of premium.Their remuneration is assigned without division to the actual operation in which they are engaged.If their duties are the same as those of a worker,foreman or superintendent,their payroll is assigned to the classification that develops the highest payroll.Minimum and maximum payrolls apply to executive officers. Automated Records.If your records are automated or you plan to automate in the near future you can obtain maximum benefits by setting up your records to include insurance requirements.Our Premium Auditor will be pleased to assist you in setting up your records.Contact your Hartford Representative if you would like this assistance. NOTE:The contents of this publication are not intended to supersede any definitions or conditions of your policy, the Workers' Compensation Law or any legal rulings. *Your state may have specific rules or exceptions. Please contact your Hartford Representative for details that may apply and answer questions you may have. Form WC 66 03 30 Q Printed in U.S.A.Page 1 of 2 Customer Privacy Notice The Hartford Financial Services Group, Inc. and Affiliates (herein called “we, our, and us”) This Privacy Policy applies to our United States Operations We value your trust.We are committed to the responsible: a)management; b)use; and c)protection; of Personal Information. This notice describes how we collect,disclose,and protect Personal Information. We collect Personal Information to: a)service your Transactions with us; and b)support our business functions. We may obtain Personal Information from: a)You; b)your Transactions with us; and c)third parties such as a consumer-reporting agency. Based on the type of product or service You apply for or get from us,Personal Information such as: a)your name; b)your address; c)your income; d)your payment; or e)your credit history; may be gathered from sources such as applications, Transactions, and consumer reports. To serve You and service our business,we may share certain Personal Information.We will share Personal Information,only as allowed by law,with affiliates such as: a)our insurance companies; b)our employee agents; c)our brokerage firms; and d)our administrators. As allowed by law,we may share Personal Financial Information with our affiliates to: a)market our products; or b)market our services; to You without providing You with an option to prevent these disclosures. We may also share Personal Information,only as allowed by law, with unaffiliated third parties including: a)independent agents; b)brokerage firms; c)insurance companies; d)administrators; and e)service providers; who help us serve You and service our business. When allowed by law,we may share certain Personal Financial Information with other unaffiliated third parties who assist us by performing services or functions such as: a)taking surveys; b)marketing our products or services; or c)offering financial products or services under a joint agreement between us and one or more financial institutions. We,and third parties we partner with,may track some of the pages You visit through the use of: a)cookies; b)pixel tagging; or c)other technologies; and currently do not process or comply with any web browser’s “do not track”signal or other similar mechanism that indicates a request to disable online tracking of individual users who visit our websites or use our services. For more information,our Online Privacy Policy,which governs information we collect on our website and our affiliate websites,is available at https://www.thehartford.com/online-privacy-policy. We will not sell or share your Personal Financial Information with anyone for purposes unrelated to our business functions without offering You the opportunity to: a)“opt-out;” or b)“opt-in;” as required by law. We only disclose Personal Health Information with: a)your authorization; or b)as otherwise allowed or required by law. Our employees have access to Personal Information in the course of doing their jobs, such as: a)underwriting policies; b)paying claims; c)developing new products; or d)advising customers of our products and services. Form WC 66 03 30 Q Printed in U.S.A.Page 2 of 2 We use manual and electronic security procedures to maintain: a)the confidentiality; and b)the integrity of; Personal Information that we have.We use these procedures to guard against unauthorized access. Some techniques we use to protect Personal Information include: a)secured files; b)user authentication; c)encryption; d)firewall technology; and e)the use of detection software. We are responsible for and must: a)identify information to be protected; b)provide an adequate level of protection for that data; and c)grant access to protected data only to those people who must use it in the performance of their job- related duties. Employees who violate our privacy policies and procedures may be subject to discipline,which may include termination of their employment with us. We will continue to follow our Privacy Policy regarding Personal Information even when a business relationship no longer exists between us. As used in this Privacy Notice: Application means your request for our product or service. Personal Financial Information means financial information such as: a)credit history; b)income; c)financial benefits; or d)policy or claim information. Personal Financial Information may include Social Security Numbers,Driver’s license numbers,or other government-issued identification numbers,or credit,debit card, or bank account numbers. Personal Health Information means health information such as: a)your medical records; or b)information about your illness, disability or injury. Personal Information means information that identifies You personally and is not otherwise available to the public. It includes: a)Personal Financial Information; and b)Personal Health Information. Transaction means your business dealings with us,such as: a)your Application; b)your request for us to pay a claim; and c)your request for us to take an action on your account. You means an individual who has given us Personal Information in conjunction with: a)asking about; b)applying for; or c)obtaining; a financial product or service from us if the product or service is used mainly for personal,family,or household purposes. If you have any questions or comments about this privacy notice,please feel free to contact us at The Hartford -Consumer Rights and Privacy Compliance Unit, One Hartford Plaza, Mail Drop: HO1-09, Hartford, CT 06155, or at ConsumerPrivacyInquiriesMailbox@thehartford.com. This Customer Privacy Notice is being provided on behalf of The Hartford Financial Services Group,Inc.and its affiliates (including the following as of February 2024), to the extent required by the Gramm-Leach-Bliley Act and implementing regulations: 1stAGChoice,Inc.;Access CoverageCorp,Inc.;Access CoverageCorp Technologies,Inc.;Business Management Group,Inc.;Cervus Claim Solutions, LLC;First State Insurance Company;FTC Resolution Company LLC;Hart Re Group L.L.C.;Hartford Accident and Indemnity Company;Hartford Administrative Services Company;Hartford (Asia)Limited;Hartford Casualty General Agency,Inc.;Hartford Casualty Insurance Company;Hartford Corporate Underwriters Limited;Hartford Fire General Agency,Inc.;Hartford Fire Insurance Company;Hartford Funds Distributors,LLC;Hartford Funds Management Company,LLC;Hartford Funds Management Group,Inc.;Hartford Holdings,Inc.;Hartford Insurance Company of Illinois;Hartford Insurance Company of the Midwest;Hartford Insurance Company of the Southeast;Hartford Insurance,Ltd.;Hartford Integrated Technologies,Inc.; Hartford Investment Management Company;Hartford Life and Accident Insurance Company;Hartford Lloyd’s Corporation;Hartford Lloyd’s Insurance Company;Hartford Management,Ltd.;Hartford Management (UK)Limited;Hartford Productivity Services LLC;Hartford of the Southeast General Agency,Inc.;Hartford of Texas General Agency,Inc.;Hartford Residual Market,L.C.C.;Hartford Specialty Insurance Services of Texas,LLC;Hartford STAG Ventures LLC;Hartford Strategic Investments,LLC;Hartford Underwriters General Agency,Inc.;Hartford Underwriters Insurance Company; Hartford Underwriting Agency Limited;Heritage Holdings,Inc.;Heritage Reinsurance Company,Ltd.;HLA LLC;Horizon Management Group,LLC;HRA Brokerage Services,Inc.;Lattice Strategies LLC;Maxum Casualty Insurance Company;Maxum Indemnity Company;Maxum Specialty Services Corporation;Millennium Underwriting Limited;MPC Resolution Company LLC;Navigators Holdings (UK)Limited;Navigators Insurance Company; Navigators Management Company,Inc.;Navigators Specialty Insurance Company;Navigators Underwriting Limited;New England Insurance Company; New England Reinsurance Corporation;New Ocean Insurance Co.,Ltd.;NIC Investments (Chile)SpA;Nutmeg Insurance Agency,Inc.;Nutmeg Insurance Company;Pacific Insurance Company,Limited;Property and Casualty Insurance Company of Hartford;Sentinel Insurance Company,Ltd.; The Navigators Group, Inc.; Trumbull Flood Management, L.L.C.; Trumbull Insurance Company; Twin City Fire Insurance Company; Y-Risk, LLC. Form PN 04 99 06 D Printed in U.S.A. POLICYHOLDER NOTICE PAYROLL RECORD AND AUDIT REQUIREMENTS FOR DUAL WAGE CONSTRUCTION OR ERECTION CLASSIFICATIONS 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: o 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. o 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. Form G-3418-0 PRODUCER COMPENSATION NOTICE You can review and obtain information on The Hartford’s producer compensation practices at www.TheHartford.com or at 1-800-592-5717. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. Form WC 00 04 22 C (01/21)Printed in U.S.A.Page 1 of 2 Process Date:07/29/24 Policy Expiration Date:09/07/25 TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT Policy Number:76 WEG AH5THK Endorsement Number: Effective Date:09/07/24 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:4 POINT POWER INC 1313 N MILPITAS BLVD STE 161 MILPITAS CA 95035 Name of California Insurer: 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. Form WC 00 04 22 C (01/21)Printed in U.S.A.Page 2 of 2 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. 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. Schedule State Rate Premium See Attached Schedule Form WC 66 00 15 A Printed in U.S.A. CALIFORNIA NOTICE CALIFORNIA LABOR CODE 3551 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS CODE,EXCEPT EMPLOYERS OF EMPLOYEES DEFINED IN SUBDIVISION (d)OF SECTION 3351,SHALL GIVE EVERY NEW EMPLOYEE,EITHER AT THE TIME OF HIRE,OR BY THE END OF THE FIRST PAY PERIOD, WRITTEN NOTICE OF THE INFORMATION CONTAINED IN SECTION 3550. CALIFORNIA LABOR CODE 3550 PROVIDES THAT EVERY EMPLOYER SUBJECT TO THE COMPENSATION PROVISIONS OF THIS DIVISION SHALL POST AND KEEP POSTED IN A CONSPICUOUS LOCATION FREQUENTED BY EMPLOYEES,AND WHERE THE NOTICE MAY BE EASILY READ BY EMPLOYEES DURING THE HOURS OF THE WORKDAY,A NOTICE WHICH SHALL STATE THE NAME OF THE CURRENT COMPENSATION INSURANCE CARRIER OF THE EMPLOYER,OR WHEN SUCH IS THE FACT,THAT THE EMPLOYER IS SELF-INSURED,AND WHO IS RESPONSIBLE FOR CLAIMS ADJUSTMENT. Form WC 66 02 05 A Printed in U.S.A. NOTICE TO POLICYHOLDER CALIFORNIA WORKERS' COMPENSATION INSURANCE RATING LAWS Pursuant to Section 11752.8 of the California Insurance Code,we are providing you with an explanation of the California workers'compensation rating laws applicable to new and renewal policies with policy effective dates on and after January 1, 1995. 1.The laws requiring all insurers to charge the same minimum rate uniformly to all employers within a given classification has been repealed.Beginning January 1,1995,we will establish our own rates for workers' compensation.Our rates will not be applicable prior to the first normal policy effective date of a policy incepting on or after January 1,1995.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 has determined after public hearing that our rates might jeopardize our ability to pay claims or create a monopoly 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 Insurance Fund.If the insurance Commissioner disapproves our rates,rating plans or classification,he may order an increase in the rates applicable to outstanding policies. 3.Rating organizations may develop pure premium rates which are subject to the Insurance Commissioner's approval. 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 sue 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 developed by the insurance rating organization designated by the Insurance commissioner is subject to the approval of the Insurance Commissioner. 5.A standard classification system developed by the insurance rating organization designated by the Insurance Commissioner is subject to approval of 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 apply our own classification system,provided that we can report the payroll,expenses and other costs of claims in a way which is consistent with 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 will require us to respond to your written appeal within 30 days.If you are not satisfied with the result of your appeal,you may appeal our decision to the Insurance Commissioner. Form WC 66 04 52 Printed in U.S.A. POLICYHOLDER NOTICE CALIFORNIA CONSTRUCTION DUAL WAGE CLASSIFICATION THRESHOLD In California,a number of construction and erection operations are divided into two separate classifications based on the hourly wage of the employees and each of these classifications has a different advisory pure premium rate.For each of these classification pairs,a specific hourly wage threshold is used to determine whether the payroll and claims for an employee are assigned to the “high wage”or “low wage”classification.There are currently 16 pairs of “dual wage” classifications. Assignment of each high wage classification is subject to verification at the time of final audit that the employee’s regular hourly wage equals or exceeds the specified wage threshold.Payroll recordkeeping requirements for dual wage classifications are listed in the California Workers’Compensation Uniform Statistical Reporting Plan –1995 at Part 3, Standard Classification System, Section IV,Special Industry Classification Procedures, Rule 2a. To see the most recent Dual Wage Classification Thresholds by Classification and Year,type the following into an internet Search Engine: WCIRB Dual Wage Thresholds by Year -Select the Understanding Construction Dual Wage Thresholds – WCIRB -In the WCIRB California Learning Center section,select the Dual Wage Classification Thresholds by Year Table Or, contact your Hartford agent or broker if you have any questions about Dual Wage Classifications. POLICY NUMBER:76 WEG AH5THK NAME OF INSURER:Hartford Casualty Insurance Company Form WC 99 00 01 K Printed in U.S.A.Page 1 of 1 Process Date:07/29/24 Policy Expiration Date:09/07/25 Our President and Secretary have signed this policy.Where required by law,the Information Page has been countersigned by our duly authorized representative. Kevin Barnett, Secretary M. Ross Fisher, President Includes copyright material of the National Council on Compensation Insurance, Inc. used with its permission. ©2000 National Council on Compensation Insurance, Inc. All Rights Reserved. DELAWARE: Delaware forms have been copyrighted by the Delaware Compensation Rating Bureau Inc. NEW YORK: Includes copyrighted material of the New York Compensation Insurance Rating Board, used with its permission. © 2021 New York Compensation Insurance Rating Board, all rights reserved. NORTH CAROLINA: Includes copyrighted material of the North Carolina Rate Bureau, used with its permission. PENNSYLVANIA: Pennsylvania forms have been copyrighted by the Pennsylvania Compensation Rating Bureau. Form WC 55 00 11 D Printed in U.S.A. INSTRUCTIONS EMPLOYEE’S CLAIM FOR WORKERS’ COMPENSATION BENEFITS As of January 1,1990,California employers are required by law to furnish a claim form to an injured worker within one working day of knowledge of a work-related injury or illness (other than First Aid).While it is mandatory for the employer to furnish the claim form to the employee,it is not mandatory for the employee to complete it. The employer should complete sections 9-17,with the exception of section 13 (which reads,"Date employer received claim form").This is to be completed after the claimant has completed his or her portion of the claim form and returned it to you, at which time section 13 should be immediately filled out or date stamped. Penalties can be invoked if employers fail to provide an injured employee an EMPLOYEE’S CLAIM FOR COMPENSATION BENEFITS form or if employers fail to report the claim to the workers’compensation insurance carrier. DO NOT DELAY REPORTING A CLAIM TO THE HARTFORD: Whether or not the employee completes the EMPLOYEE’S CLAIM FOR WORKER’S COMPENSATION BENEFITS,please contact The Hartford’s LossConnect (1-800-327-3636)to report every occupational injury or illness which results in lost time beyond the date of the incident or requires medical treatment beyond First Aid. Form WC 66 03 84 Printed in U.S.A. Reporting a Work-Related Injury is Time Sensitive! Call The Hartford’s LossConnect immediately to report a claim. 1-800-327-3636 Available 24 hours a day, 365 days a year. The Benefits of Timely Loss Reporting: Research has shown that faster loss reporting significantly affects loss costs. The sooner we are notified, the sooner we can investigate the accident and coordinate with you, the injured employee, and the medical team to ensure the fastest possible return to health and work. The Effect of Timely Reporting on Controlling the Cost of Your Loss: Average Loss for Closed Claims (Accident Years 2002-2005) Report Lag in Days Percent Change in Loss Costs Compared to First Week Report Incident Day -6% Week 1 0% Week 2 13% Week 3 or 4 16% 1 Month or Later 24% Statutory requirements also necessitate the prompt initial reporting of the accident causing injury or death.Failure to comply may result in a fineable offense by the State. Information You’ll Need Company Information o Account Number o Location Code (if applicable) o Parent Company (or program name) o Policy Number Worker Information o Name, DOB, Address, Phone o Social Security Number o Age, Gender o Marital Status, Number of Dependants o Hire Date, Years in Current Position o Wage Information Incident Information o Type of injury (burn, cut, etc.)? o Exact body part injured? o What caused the accident? o Any reason to question the injury? o Any witnesses? o Address where injury occurred? o Where was the injured employee treated? (Provide name, address, phone of medical provider.) o When was the accident reported to you and by whom (date, time)? Network Providers A listing of more than 400,000 network providers qualified to treat work-related injuries is available online at www.talispoint.com/hartext or by calling our Network Referral Unit at 1-800-327-3636 (select 4 at the prompt). Since network referrals are often impacted by state specific rules, please call to learn how to maximize our network capabilities on behalf of your employees. 4 Point Power, Inc. Electrical On-Call Services Final Audit Report 2025-04-24 Created:2025-04-17 By:Webmaster Admin (webmaster@cupertino.org) Status:Signed Transaction ID:CBJCHBCAABAAu1TRCmcfo5yJ06J8GzvLW8Qarj_oLCh5 "4 Point Power, Inc. 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