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HomeMy WebLinkAboutVector Resources Inc; 2019-04-30;CITY OF CARLSBAD PUBLIC WORKS LETTER OF AGREEMENT Rack and UPS Install at Poinsettia Park ($5000 or less) This letter will serve as an agreement between Vector Resources, Inc., (Contractor) and the City of Carlsbad (City). The Contractor will provide all equipment, material and labor necessary to install rack and UPS at Poinsettia Park per the Contractor's proposal dated March 18, 2019 and City specifications, for a sum not to exceed three thousand one hundred ninety-six dollars and thirteen cents ($3,196.13). This work is to be completed within 30 working days after issuance of a Purchase Order. ADDITIONAL REQUIREMENTS 1. City of Carlsbad Business License 2 The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its agents, officers, officials, employees and volunteers, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of this Contract or work; or from any failure or alleged failure of the contractor to comply with any applicable law, rules or regulations including those relating to safety and health; except for loss or damage which was caused solely by the active negligence of the City; and from any and all claims, loss, damage, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by this Contract, unless the loss or damage was caused solely by the active negligence of the City. The expenses of defense include all costs and expenses, including attorney's fees for litigation, arbitration, or other dispute resolution method. 3. Contractor shall furnish policies of general liability insurance, automobile liability insurance and a combined policy of workers compensation and Employers' Liability in an insurable amount of not less than one million dollars ($1,000,000) each, unless a lower amount is approved by the Risk Manager or the City Manager. Said policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. Insurance is to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Proof of all such insurance shall be given by filing certificates of insurance with contracting department prior to the signing of the contract by the City. 4. The Contractor shall be aware of and comply with all Federal, State, County and City Statues, Ordinances and Regulations, including Workers Compensation laws (Division 4, California Labor Code) and the "Immigration Reform and Control Act of 1986" (8USC, Sections 1101 through 1525), to include but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants that are included in this Contract. 5 The Contractor may be subject to civil penalties for the filing of false claims as set forth in the California False Claims Act, Government Code se s 12650, et seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. ___jl.N\_ init _....,.. _ ___..,_init 6. The Contractor hereby acknowledges t t debarment by another jurisdiction is grounds fWioCity of Carlsbad to disqualify the Contractor from participating in contract bidding. 4 init init 7. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for solution of any disputes between the parties arising out of this agreement is San Diego County, California. Rack and UPS Install at Poinsettia Park --1 --City Attorney Approved 2/29/2016 8. The general prevailing rate of wages, for each craft or type of worker needed to execute the contract, shall be those as determined by the Director of Industrial Relations pursuant to the Section 1770, 1773 and 1773.1 of the California Labor Code. Pursuant to Section 1773.2 of the California Labor code, a current copy of applicable wage rates is on file in the office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in the execution of the work covered by this Letter of Agreement. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. 9. City Contact: Gary Hornby 760-602-2479 Contractor Contact: Christie Lange 858-444-6566 CONTRACTOR Vector Resources, Inc. dba VectorUSA 9808 Waples Street San Diego, CA 92121 (858) 546-1014 clange@vectorusa.com By: ~ere) Robert Messinger - Executive Vice President (print name/title) By: ~eJ Jeffrey Zukerman -Executive Vice President & Secretary (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Assistant City Manager, eputy City Man or Department Director as authorized by the City Manager Dated: .J/-/30 f ,cr (Proper notarial acknowledgment of execution by Contractor must be attached. Chairman, president or vice-president and secretary, assistant secretary, CFO or assistant treasurer must sign for corporations. Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.) APPROVED AS TO FORM: CELIA A. BR:WER,f /) Attorney BY: /ll{)J(~ ~ ~puty,-City Attorney Rack and UPS Install at Poinsettia Park --2 --City Attorney Approved 2/29/2016 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of l. oS:: An. 9e.. l~ ,:; On Arv: l '.:1:7 2--0 l 9' Date beforeme, Lhv\S H tJ_,. Do.-..<..(.(_ (VtJfc"Lj;L Pw~l,'c.. Here Insert Name and Title of the Officer personally appeared ~ 0 be. v+ h~/', ; -:3 e..v,, Je..ff v7,V -Z u k.,e..J.,""""'-~':J Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Place Notary Sea/ Above I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature ~ lJ ~~ Signature of Notary Public ----------------OPTIONAL---------------- Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: _____________ Document Date: _______ _ Number of Pages: ___ Signer(s) Other Than Named Above: ____________ _ Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ □ Corporate Officer -Title(s): ______ _ 17 Partner -□ Limited □ General lJ Individual □ Attorney in Fact lJ Trustee [J Guardian or Conservator [_]Other: _____________ _ Signer Is Representing: _________ _ Signer's Name: ____________ _ [J Corporate Officer -Title(s): ______ _ I I Partner -n Limited D General l Individual _J Trustee [] Attorney in Fact □ Guardian or Conservator D Other: _____________ _ Signer Is Representing: _________ _ • ©2014 National Notary Association· www.NationalNotary.org • 1-800-US NOTARY (1-800-876-6827) Item #5907 fECTOR Vech>r Resources, Inc. VRN 092868-001 dba VectorUSA USAc1~1u11s 9808 Waples Street ffC9lf ffi San Diego, CA 92121 !Ht!l!C fl\ P: (858}-546-1014 Date: 3/18/2019 flJ ;!~ A~l Company Site City of Carlsbad Poinsettia Park 1200 Carlsbad Village Dr 6600 Hidden Valley Rd. Carlsbad, CA 92008 Carlsbad, CA USA 92011 • SCoDe of Work Project Name: Rack and UPS Install (2) Sites Change Name: QQl Vector1JSA will install (1) 24"W x 36.L x 30"0 CPI cabinet with plexiglass door and (1) customer- provided UPS at Aviara and Poinsettia Parks for-the City of Carlsbad. The cabinets will be secured to a plywood backboard attachi!d to the wall. Qty Descrintion Unit Price &tEnded Price 2 361N x 241N x 30IN Wall Mount Cube It Cabinet Black 798.53 1,597.06 2 4x4ft 3/4 Plywood Fire Rated A-C Painted 75.00 150.00 2 Install Customer Provided UPS 0.00 0.00 1 Mobilization & Misc. Consumables 31.25 31.25 For r, By Sub-Total $1,778.31 City of Carlsbad I Christie Lange Labor-$1,280.00 Sales Tax 5137.82 Terms and Conditions Job Total $3,196.13 Signature and Purchase Order due upcin acceptance, balance due upcin completion; Net 30. Any materials not listed in the quote necessary to complete this project will be biDed additionally. This auote is valid for 30 davs onlv. ~ector Resources, Inc. Authorized Signature ~-l~t,; Date 3-18-2019 ~Nia OF ORDER: 1he prices, :!ip!id',catious .and concitioris ...-e :disfacb:lly and ..-e hereby accepted. VedorlJSA is aulhorized tD do the work as specified. VedDrUS'A shall be entiled tD iefuse or delay ~ for failure by cuslDmer-to pay within terms or any payments due to V~ In the event that it becomes necessary for VedorUSA to in:ur cnllectian msts or mtitulE a sut tu mlled any amouit: due and payable. the customer ilQJl!e5 tu pay such adcltional aillection msts. late <harges (1.5% monthly, 18"' anwaly), and expeuses, induding attorneys fees. Customer Authorized Signature Date Customer Printed Name Rack and UPS Install at Poinsettia Park --3 --City Attorney Approved 2/29/2016 VECTRES-01 PERKOVICHC ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 11/1/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # OE67768 ~2~tcT James Barth ----FAX-IOA Insurance Services PHONE 130 Vantis (A/C, No, Ext): (AIC,_No):(310) 792-7416 --- Suite 250 i~o"'~hss: Jamie.Barth@ioausa.com -Aliso Viejo, CA 92656 INSURER(S) AFFORDING COVERAGE NAIC# ------~- -------INSU_R_E:R A: Travelers Property Casualty f<>mpany of_ America __2_567 4 INSURED ; INSURERS: I --------- Vector Resources, Inc. INSURERC: ---------- 3530 Voyager Street INSU_RE:R D: ------Torrance, CA 90503 INSU~RE: ---------•-I ' 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 TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF P01=!~YEXP LIMITS LTR ,.,c:n WVD IMMIDDIYYYYl A X COMMERCIAL GENERAL LIABILITY , EACH OCCURRENCE '$ 1,000,000 ; x' / 1/20 I / / I DAMAGETORENTED --I --- CLAIMS-MADE OCCUR X X 6306H947178 11 0 18, 11 01 2019, PREMISES_{Eaoccurrence) $ 300,000 ---- MED EX_f'_ffi_ny one person) $ 10,000 ------- PERSO_t,JAfc §. ADV INJURY $ 1,000,000 -- GEN'L AGGREGATE LIMIT APPLIES PER: ! l GENER_A~ AGGREGATE ____ $ 2,000,000 POLICY X PRO-LOC I 2,00(),()()0 JECT PRODUCTS -COMP/OP AGG $ V OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 , (Ea accld@t) $ i - - X ANY AUTO X X BAOL893865 11/01/2018 i 11/01/2019 I BODILYlt-i_J_URY(Perpers_9n) $ OWNED SCHEDULED AUTOS ONLY --AUTOS BODIL 'l'__l_tiJ_lJ_RY (Per accident)_ $ ---- HIRED _ ~8{:Jo~'1i~Jr.~ PROPERTY DAMAGE AUTOS ONLY (Per accident) $ -- X !f'/r8bColl Ded ' I I '$ A X UMBRELLA LIAS X OCCUR I 10,000,000 --EACH_OCCURRENCE $ -- EXCESS LIAS CLAIMS-MADE CUP9J207638 11/01/2018 11/01/2019 AGGREGATE $ 10,000,000 ✓ ---------- OED RETENTION$ $ A I WORKERS COMPENSATION ! I l X ';~~IJTE I I OTH- AND EMPLOYERS' LIABILITY YlN EB -- 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE X UBOL239923 11/01/2018 11/01/2019 OFFICER/MEMBER EXCLUDED? y N/A . E.L. EACl:!1-_CCIDENT -$ --- (Mandatory in NH) - -E.L. DISEASE -EA EMF'~QYEE_ $ 1,000,000 , ~~1';_:~ftrf~ ~/'gPERATIONS below I E.L. DISEASE -POLICY LIMIT $ 1,000:0-00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES tCORD 101. Additional Remarks Schedule, may be attached If more space Is required) Professional Liability Aggregate Limit: $10,000, 00, Deductible: $25,000. Policy #ZPL21N80907, Travelers Property Casualty Company of America, 11/01/2018 - 11/01/2019. City of Carlsbad, its officials, employees and volunteers are included as Additional Insureds with respect to General Liability (per form #CGD417) and Auto Liability (per form #CAT353). Policy is Primary and Non-Contributory as respects General Liability (per form #CGD425) and Auto Liability (per form #CAT474). Waiver of Subrogation applies as respects General Liability (per form #CGD417), Auto Liability (per form #CAT353), and Workers Compensation (per form #WC990376) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Carlsbad / ,--✓-) t 1635 Faraday Avenue ,,,,:<t'rP~-r. !~,,4. 1"--'-'---' f'A O?nnA / ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 1. The following is added to Paragraph A.1.c., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: 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". 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 the first named insured when the 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, requires this insurance to be primary and non-contributory. CAT4740216 u 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered . A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS F. HIRED AUTO -LIMITED WORLDWIDE COVERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LIABILITY COV- ERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II -LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION H -LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. CAT3 53 0310 02010 The Travelers Indemnity Company. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV -BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing 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". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II -LIABILITY COV- ERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II -LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II -LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Polley Period, Coverage Territory, of SECTION IV -BUSINESS AUTO CONDI- TIONS: (5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership). members (if you are a limited liability company) or members of their house- holds. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (i) You must arrange to defend the "in- sured• against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (Ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies. that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limit Of Insurance, of SEC- TION II -LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described In Para- graph C., limit Of Insurance, of SECTION II -LIABILITY COVER- AGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the ap- plicable limit of insurance in pay- ments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available Page 2 of 4 C2010 The Travelers Indemnity Company. CAT3 53 0310 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. to the "Insured" whether primary, excess contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory Insurance in any country outside the United States, Its ter- ritories and possessions, Puerto Rico and Canada. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE -GLASS The following is added to Paragraph D., Deducti- ble, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses, of SEC- TION Ill -PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION Ill -PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. COMMERCIAL AUTO J. PERSONAL EFFECTS The following is added to Paragraph A.4-., Cover- age Extensions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Personal Effects We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Effects coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV -BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss• ap- plies only when the "accident" or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee• authorized by you to give no- tice of the •accident" or "loss". CA T3 53 0310 ©2010 The Travelers Indemnity Company. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident" or "loss•, provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies Otily to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B .2., Con- cealment, Misrepresentation, Or Fraud, of SECTION IV -BUSINESS AUTO CONDITIONS: The unintentional omission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this provision does not affect our right to col- lect additional premium or exercise our right of cancellation or non-renewal. Page4 of 4 e 2010 The Travelers Indemnity Company. CATJ 53 0310 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TECHNOLOGY XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be exduded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is exduded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exdusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Reasonable Force Property Damage -Ex- ception To Expected Or Intended Injury Ex- dusion 8. Non-OWned Watercraft Less Than 75 Feet C. Aircraft Chartered With Pilot D. Damage To Premises Rented To You E. Increased Supplementary Payments F. Who Is An Insured-Employees And Volun- teer Workers -First Aid G. Who Is An Insured -Employees -Supervi- sory Positions H. Who Is An Insured -Newly Acquired Or Formed Organizations I. Blanket Additional Insured -Owners, Manag- ers Or Lessors Of Premises J. Blanket Additional Insured -Lessors Of Leased Equipment PROVISIONS A. REASONABLE FORCE PROPERTY DAMAGE - EXCEPTION TO EXPECTED OR INTENDED IN- JURY EXCLUSION The following replaces Exclusion a., Expected Or Intended Injury, in Paragraph 2., of SECTION I - COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: a. Expected Or Intended Injury Or Damage ·Bodily injury• or ·property damage• expected or intended from the standpoint of the insured. This exclusion does not apply to •bodily injury• or •property damage• resulting from the use of rea- sonable force to protect any person or property. K. Blanket Additional Insured -Persons Or Or- ganizations For Your Ongoing Operations As Required By Written Contract Or Agreement L. Blanket Additional Insured -Broad Form Vendors M. Who Is An Insured -Unnamed Subsidiaries N. Who Is An Insured -Liability For Conduct Of Unnamed Partnerships Or Joint Ventures 0. Medical Payments -Increased Limits P. Contractual Liability-Railroads Q. Knowledge And Notice Of Occurrence Or Of- fense R. Unintentional Omission S. Blanket Waiver Of Subrogation B. NON-OWNED WATERCRAFT LESS THAN 75 FEET The following replaces Paragraph (2) of Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I -COVERAGES -COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (2) A watercraft you do not own that is: (a) Less than 75 feet long; and (b) Not being used to carry any person or property for a charge. C. AIRCRAFT CHARTERED WITH PILOT The following is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION CG 0417 0112 C 2012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its pennission. COMMERCIAL GENERAL LIABILITY I -COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY: This exdusion does not apply to an aircraft that is: (a) Chartered with a pilot to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or prop- erty for a dlarge. D. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- dusion J., Damage To Property, in Para- graph 2. of SECTION I -COVERAGES - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY is deleted. 2. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I - COVERAGES -COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABIL- ITY: Exdusions c., g. and h., and Paragraphs (1), (3) and (4) of Exdusion J., do not apply to "premises damage". Exdusion f.(1)(a) does not apply to "premises damage" caused by fire unless Exclusion f. of Section I -Cover- age A -Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Part that has Exclusion -All Pollution Injury Or Damage or Total Pollution Exclusion in its title. A separate limit of insur- ance applies to "premises damage" as de- scribed in Paragraph 6. of Section Ill -Limits Of Insurance. 3. The following replaces Paragraph 6. of SEC· TION Ill -LIMITS OF INSURANCE: 6. Subject to 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of •premises damage" to any one premises. The Damage To Premises Rented To You Limit will be: a. The amount shown for the Damage To Premises Rented To You Limit on the Dedarations of this Coverage Part; or b. $300,000 if no amount is shown for the Damage To Premises Rented To You Limit on the Dedarations of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI• TIONS Section: a. A contract for a lease of premises. How- ever, that portion of the contract for a lease of premises that indemnifies any person or organization for "premises damage" is not an "insured contract"; 5. The following Is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to: a. Any premises while rented to you or tem- porarily occupied by you with permission of the owner; or b. The contents of any premises while sudl premises is rented to you, if you rent sudl premises for a period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for "premises damage": or 7. Paragraph 4.b.(1)(c) of SECTION IV - COMMERCIAL GENERAL LIABILITY CON- DITIONS is deleted. E. INCREASED SUPPLEMENTARY PAYMENTS 1. The following replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS -COVER- AGES A AND B of SECTION I -COVER• AGES: b. Up to $2,500 for cost of bail bonds re- quired because of accidents or traffic law violations arising out of the use of any vehicle to whidl the Bodily Injury Liability Coverage applies. We do not have to fur- nish these bonds. 2. The following replaces Paragraph 1.d. of SUPPLEMENTARY PAYMENTS -COVER· AGES A AND B of SECTION I -COVER- AGES: d. All reasonable expenses Incurred by the insured at our request to assist us in the investigation or defense of the dalm or "suit", induding actual loss of earnings up to $500 a day because of time off from work. Page2of6 Cl 2012 The Travelers Indemnity Company. All rights reserved. CG D417 0112 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY F. WHO IS AN INSURED -EMPLOYEES AND your "employees" who hold a supervisory posi- VOLUNTEER WORKERS -FIRST AID tion. 1. The following is added to the definition of "oc-H. WHO IS AN INSURED -NEWLY ACQUIRED currence" in the DEFINITIONS Section: OR FORMED ORGANIZATIONS Unless you are in the business or occupation The following replaces Paragraph 4. of SECTION of providing professional health care services, II -WHO IS AN INSURED of the Commercial "occurrence" also means an act or omission General Liability Coverage Form, and Paragraph committed by any of your "employees" or 3. of SECTION II -WHO IS AN INSURED of the "volunteer workers", other than an employed Global Companion Commercial General Liability or volunteer doctor, in providing or failing to Coverage Form, to the extent such coverage provide first aid or "Good Samaritan services" forms are part of your policy: to a person. Any organization you newly acquire or form, other 2. The following is added to Paragraph 2.a.(1) of than a partnership or joint venture, of which you SECTION II -WHO IS AN INSURED: are the sole owner or in which you maintain the Unless you are in the business or occupation majority ownership interest, will qualify as a Named Insured if there is no other insurance of providing professional health care services, which provides similar coverage to that organize- Paragraphs (1 )(a), (b), (c) and (d) above do tion. However: not apply to "bodily injury• arising out of pro-a. Coverage under this provision is afforded viding or failing to provide first aid or "Good only: Samaritan services" by any of your "employ- ees" or "volunteer workers", other than an (1) Until the 180th day after you acquire or employed or volunteer doctor. Any of your form the organization or the end of the "employees" or "volunteer workers• providing policy period, whichever is earlier, if you or failing to provide first aid or "Good Samari-do not report such organization in writing tan services" during their work hours for you to us within 180 days after you acquire or will be deemed to be acting within the scope form it; or of their employment by you or performing du-(2) Until the end of the policy period, when ties related to the conduct of your business. that date is later than 180 days after you 3. The following is added to Paragraph 5. of acquire or form such organization, if you report such organization in writing to us SECTION Ill -LIMITS OF INSURANCE: within 180 days after you acquire or form For the purposes of determining the applies-it, and we agree in writing that it will con- ble Each Occurrence Limit, all related acts or tinue to be a Named Insured until the end omissions committed by any of your "employ-of the policy period; ees" or "volunteer workers• in providing or b. Coverage A does not apply to "bodily injury" failing to provide first aid or "Good Samaritan or "property damage• that occurred before services" to any one person will be deemed to you acquired or formed the organization; and be one ·occurrence·. c. Coverage B does not apply to "personal in- 4. The following is added to the DEFINITIONS jury" or "advertising injury" arising out of an Section: offense committed before you acquired or "Good Samaritan services" means any erner-formed the organization. gency medical services for which no compen-I. BLANKET ADDITIONAL INSURED -OWNERS, sation is demanded or received. MANAGERS OR LESSORS OF PREMISES G. WHO IS AN INSURED -EMPLOYEES -SU-The following is added to SECTION II -WHO IS PERVISORY POSITIONS AN INSURED: The following is added to Paragraph 2.a.(1) of Any person or organization that is a premises SECTION II -WHO IS AN INSURED: owner, manager or lessor is an insured, but only with respect to liability arising out of the owner- Paragraphs (1)(a), (b) and (c) above do not apply ship, maintenance or use of that part of any prem- to "bodily injury" or "personal injury• to a co-ises leased to you. "employee" in the course of the co-"employee's" The insurance provided to such premises owner, employment by you arising out of work by any of manager or lessor does not apply to: CG D417 0112 C>2012 The Travelers Indemnity Company. All rights reserved. Page 3of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY a. Any "bodily injury" or •property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed. after you cease to be a tenant in that premises: or b. Structural alterations. new construction or demolition operations performed by or on be- half of such premises owner. manager or les- sor. J. BLANKET ADDITIONAL INSURED -LESSORS OF LEASED EQUIPMENT The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is an equipment lessor is an insured, but only with respect to liabil- ity for "bodily injury", "property damage", "per- sonal injury" or "advertising Injury" caused, in whole or in part, by your acts or omissions in the maintenance, operation or use by you of equip- ment leased to you by such equipment lessor. The insurance provided to such equipment lessor does not apply to any "bodily injury" or "property damage" caused by an "occurrence" that takes place, or "personal injury" or "advertising injury" caused by an offense that is committed, after the equipment lease expires. K. BLANKET ADDITIONAL INSURED -PERSONS OR ORGANIZATIONS FOR YOUR ONGOING OPERATIONS AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is not otherwise an insured under this Coverage Part and that you have agreed in a written contract or agreement to indude as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement: and b. Is caused, in whole or in part, by your acts or omissions in the performance of your ongoing operations to which that contract or agree- ment applies or the acts or omissions of any person or organization performing such op- erations on your behalf. The limits of insurance provided to such insured will be the limits which you agreed to provide in the written contract or agreement. or the limits shown in the Dedarations, whichever are less. L. BLANKET ADDITIONAL INSURED -BROAD FORM VENDORS The following is added to SECTION II -WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to indude as an additional insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury" or "property damage" that: a. Is caused by an "occurrence" that takes place after you have signed and executed that con- tract or agreement: and b. Arises out of "your products" which are dis- tributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such ven- dor will be the limits which you agreed to pro- vide in the written contract or agreement, or the limits shown in the Dedarations, which- ever are less. b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you; (2) Any change in "your products" made by such vendor; (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container: (4) Any failure to make such inspections. ad- justments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business. in connection with the distribution or sale of "your products"; (5) Demonstration. installation. servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your prod- ucts"; or (6) "Your products" which, after distribution or sale by you, have been labeled or re- labeled or used as a container, part or in- gredient of any other thing or substance by or on behalf of such vendor. Page4 of6 C> 2012 The Travelers Indemnity Company. All rights reserved. CG D417 0112 Includes copyrighted material of Insurance Services Office. Inc. with its permission. Coverage under this provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingre- dient, part or container entering into, accom- panying or containing such products; or b. Any vendor for which coverage as an addi- tional insured specifically is scheduled by en- dorsement. M. WHO IS AN INSURED -UNNAMED SUBSIDI• ARIES The following is added to SECTION II -WHO IS AN INSURED: Any of your subsidiaries, other than a partnership or joint venture, that is not shown as a Named In- sured in the Declarations is a Named Insured if: a. You maintain an ownership interest of more than 50% in such subsidiary on the first day of the policy period; and b. Such subsidiary is not an insured under simi- lar other insurance. No such subsidiary is an insured for "bodily injury" or "property damage• that occurred, or "personal injury" or "advertising injury" caused by an of- fense committed: a. Before you maintained an ownership interest of more than 50% in such subsidiary; or b. After the date, if any, during the policy period that you no longer maintain an ownership in- terest of more than 50% in such subsidiary. N. WHO IS AN INSURED -LIABILITY FOR CON- DUCT OF UNNAMED PARTNERSHIPS OR JOINT VENTURES The following replaces the last paragraph of SECTION II -WHO IS AN INSURED: No person or organization is an insured with re- spect to the conduct of any current or past part- nership or joint venture that is not shown as a Named Insured in the Declarations. This para- graph does not apply to any such partnership or joint venture that otherwise qualifies as an in- sured under Section II -Who Is An Insured. 0. MEDICAL PAYMENTS -INCREASED LIMITS The following replaces Paragraph 7. of SECTION Ill -LIMITS OF INSURANCE: 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury• sustained by any one person, and will be the higher of: (a) $10,000; or COMMERCIAL GENERAL LIABILITY (b) The amount shown on the Declarations of this Coverage Part for Medical Expense Limit. P. CONTRACTUAL LIABILITY -RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINI- TIONS Section: c. Any easement or license agreement: 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is de- leted. Q. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Clalm or Suit, of SECTION IV -COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above. but only for the purposes of the in- surance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II -Who Is An Insured: (1) Notice to us of such "occurrence" or of- fense must be given as soon as practica- ble only after the "occurrence" or offense is known to you (if you are an individual). any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your trustees who is an individual (if you are a trust), any of your "executive officers" or directors (if you are an organization other than a partnership, joint venture, limited liability company or trust) or any "employee" authorized by you to give notice of an "occurrence• or offense. (2) If you are a partnership, joint venture, lim- ited liability company or trust, and none of your partners, joint venture members, managers or trustees are individuals, no- tice to us of such •occurrence• or offense must be given as soon as practicable only after the •occurrence" or offense is known by: (a) Any individual who is: (I) A partner or member of any part- nership or joint venture; {II) A manager of any limited liability company; CG D417 0112 C> 2012 The Travelers Indemnity Company. All rights reserved. Page 5of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY (Ill) A trustee of any trust; or (Iv) An executive officer or director of any other organization; that is your partner, joint venture member, manager or trustee; or (b) Any ·employee" authorized by such partnership, joint venture, limited li- ability company, trust or other organi- zation to give notice of an "occur- rence· or offense. (3) Notice to us of such "occurrence• or of- fense will be deemed to be given as soon as practicable if it is given in good faith as soon as practicable to your workers' compensation insurer. This applies only if you subsequently give notice to us of the "occurrence" or offense as soon as prac- ticable after any of the persons described in Paragraphs e. (1) or (2) above discov- ers that the "occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply. However, if this policy includes an endorse- ment that provides limited coverage for •bod- ily injury" or ·property damage" or pollution costs arising out of a discharge, release or escape of "pollutants" which contains a re- quirement that the discharge, release or es- cape of "pollutants• must be reported to us within a specific number of days after its abrupt commencement. this Paragraph e. does not affect that requirement. R. UNINTENTIONAL OMISSION The following is added to Paragraph 6., Repre- sentations, of SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS: The unintentional omission of, or unintentional er- ror in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect addi- tional premium or to exercise our rights of cancel- lation or nonrenewal in accordance with applica- ble insurance laws or regulations. S. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -COMMERCIAL GENERAL LI- ABILITY CONDITIONS: If the insured has agreed in a contract or agree- ment to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organiza- tion. but only for payments we make because of: a. "Bodily injury" or "property damage• caused by an "occurrence· that takes place; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. Page 6 of 6 C> 2012 The Travelers Indemnity Company. All rights reserved. CG D417 0112 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -ADDITIONAL INSUREDS - PRIMARY AND NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4. a., Primary Insurance, of SECTION IV -COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: However, if you specifically agree in a written contract or agreement that the insurance afforded to an addi- tional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought is caused by an "occurrence" that takes place; and (2) The "personal injury" or "advertising injury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that con- tract or agreement by you. CG D4250708 e 2008 The Travelers Companies, Inc. Page 1 of 1 TRAVELERs'f' ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A)· 001 POLICY NUMBER: UB-OL239923-18-I3-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2. o o % of the California workers' compensation pre- mium. Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company DATE OF ISSUE: 10-26-18 Policy No. Endorsement No. Premium Countersigned by ____________ _ ST ASSIGN: Page 1 of 1