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Insurance - Gentry General Engineering - 2020-12-21r,PUT R no In- KIM CERTIFICATE OF LIABILITY INSURANCE DATE 11202YYj 12/2112020 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 INSURERESt, AUT►iORIZEO 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 endorsements . PRODUCER 909-980-4211 Sliverstone Insurance Services Jetton 8. Associates, Inc MIACT Brent Jetton, AAI, CIC PHONE 909-980-4211 FAx 9a9-960.4785 tAIC, No, Extt: MAIC, Not : PO BOX 1200 RANCHO CUCAMONGA, CA 91729 House Account INSURERLB} AFFORDING COVERAGE NAIC INSURERA;James River Insurance Company 12203 INSURED Gentry General Engineering Inc INSURER 8 ; Regent Insurance Co. 24449 9277 Archibald Avenue Ran Rancho Cucamonga, CA 91730 INSURER C: Insurance Company of the West 27847 INSURER D ; INSURER E : INSURER F : COVERAGES r^_FRTII:IrATF NIIMRI:R- nrvlclnu kl"Unco. 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 ADDL SUB POLICY NUMBER POLICY EFF POUCYEXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR Ltd Contractual Y Y 000865582 NOT EXCLUDED 10/1912020 10/19/2021 EACH OCCURRENCE 1,000,000 - X DAMAGE TO RENTED _FBEM I SF_(Ea_QS=Qac.p.)� 50,000 _ MED EXP (Lny ono orson 5,000 X X, C, U PERSONAL � ADV INJURY 1,000 000 r GEN'L AGGREGATE LIMIT APPLIES PER POLICY I " I Pg2Q_T FILOC OTHER. t GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEUULELD At ONl Y AUUTCSW E AUIR' ONLY X ACUU C:N I y y BCA0005149-00 05106/2020 0510612021 COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY Per er>on $ BODILY INJURY Per accident PPeI acClea AGE A _ UMBRELLALIAB EXCESS LIAS X OCCUR CLAIMS -MADE 000965371 10/1912020 10/19/2021 EACH 5,00a flan $ r AC7GREGATE $ 5,000,000 DED I X I RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIE?ORIT>AP'TNER1FXECUT'IVE �Y i N �FFI+✓ERRlM Mgt EXCLUDED? l 1 Mandatoryn NH} If yes, describe under DESCRIPTION OF OI>ERA71ONS brxiow N / A Y W.SA 5048153 01 05/06/2020 05/06/2021 x PER X OTH STATUTE ER E.L EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 $ E.L. DISEASE - POLICY LIMIT 11000,000 p POLLUTION LIAR G71564630002 10/19/2020 10/19/2021 GEM AGG 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonst Remarks Schedule, may be attached If more space is required) Costa Mesa Sanitary District is named as additional insureds with respects o general liability andauto liability. Waiver of subrogation applies to general liability, auto liability and workers comp. Coverage is primary/non-contributory. *30 Days NOC. COSMESA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Costa Mesa Sanitary District ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue oa l Costa Mesa, CA 92626 AUTHORIZED REPRESENTATIVE / I 1, r In ' ACORD 25 (2016103) Q 1989-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy No. 000865582 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Th-i's en0otsemenk modifies in. urance provided under the fbilowing: C'ONINIIEROAL GENERAt. I.IA-31LITY C'OVERAGE P.,"-,RT SCHEDULE Name Of Aldffi*nal Insured Person4) Or Orcianization(s), Location(s) Of Coverod Operations Were requiredby writien cantra;� 11c;v Writter" ?greemen" A�operations of tn!e Niameo Insureds --------------------------------- - ----- - ------ - ------------- — -- ------ - ------------------------ - -- - -- - ------ ---------------------- - - ------ - ----- - - --- - ------------------- Inforniation to nonnplete It -is 5c hedille. j abr5kI-e, will P,)e ch,ow:r, in the A, Section 11 — Who Is An Insured is aroended fo al insi-ired' the personi'' cws nicKicle as an ad di"... I � - orc 4 1 ' gani-alionts) ^:-,hown in, Me 5chaduie, bUt onlyl - wifh respee,,.t tc,, -a tiij-, j for lh-A -qur p, "pro e damage" or 'personal and ilrllyertisijlg 1MMY" ,Caused,, in whole, nlrin part., aY: th-o"'o. ai.1ing (;I-., behalt of youl ongeux ;-ner-atirjos for 101 the addit;cnal at une location(s) des;!Q,- fnated B. With respeo to fte inliurance- afl-xided to Vle�el addi-jonal sions apply: T'iisins ,urarice does appfy to "bodily injixv"or A. yd -ricaft propert, I All q?,ksdirto incatel"als. Paris or equip- nx1vt 011 the, projt.,cl itAix.-I, set ice, or repairs s to be perfQrrned by or onblef'--aff c)f the ada;-tional insured(s) att the lorat14-m- of the covered qpelrafions has been completed; or 2. Thz�t poflion Of "YOUT' wn-rk" out 4,f *,M-:i0h the irsiury or damage arises has been put zo, its in- tended use by ally person or organization oth- er another conllractor or subox-MI'aclor erigaged in erforinin- g operations for a prnr" pal as a par" of the sarne project. Policy No. 000865582 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, ADDITIONAL INSURED .. OWNERS, LESSEES € R CONTRACTORS - COMPLETED OPERATIONS T . s endorsement mcifi €es ►nsuianc;e prow€fed under the fiAlowing: r;')Mk41 RC.1AL (3ENEIRIAL LIABILITY CX.)LfkPvAGE PART SCHEDULE Name Of Additional Insured Person(s) € j .canon And Description Of Completed Opera- I ter Grganization€s1: j liang V,jhere ri'quired by written conlm:d or oitten Ail hoerat-o s of t-se Named Insureds --- - --- ---- - -- ------------_- ..___..... ..........—_-..........�.i........ .,.... - - - --- —Y-. --- .y-........_..........__ _r.....�..-------------- ln;or. ation re ;, fired i() s C niniele this Schedule, if not q",*vm above, wilt Ine .�s�,wr- in the. Declarations. Section 11 —Who Is An Insurod iS amemled t:0 i-inc-1 sde as an aCd€tiona: ins:lt d the: but or orgar:iza- as�3!'s". •sl'�l�`wn in the~J�i�iL-`i�i1€�, butyCo.! ;y 5-viuh, reSpsu. o €ia5i€ ty for "bodiiv injury!, or "pte rty da!,naye" cause,, . in �,'ir *o!i; or in part. by "your;liork" at the iocat.=or, , desig- nated and descrilbed' in the schedule of' this erlcl rse- ment performed €U ttsat additional lt'sured and in%clUded in the operafions hazard". about:blank 5/8/201.9 Policy No. 000865582 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT GAREf ULLY, r A` AND O CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Blanket as required by written contract or written agreement If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis_ ALL OTHER TERMS AND CONDITIONS OF THE POUCY REMAIN UNCHANGED. AP5031 US 04-10 Page 1 of 1 COMMERCIAL GENERAL LIAWLITY CG 24 04 06 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US TN:s endorsement rnodffies -nsuracfice ptovided unde.- the fdjoA--..qc.j: COMMERCAL GENERAL IJABILiTY UCOVERAGE PART PRt'.)DL#CT�!CrM!>',-ETECj'OPER,rki-IONS LIABILITY GO)VERAGE PART SCHEDULE Name Of Person Or Organization, Where required by written contract nT written agfearrient 'n cornmiefe Ihis %!Qche-"ju1e'- i! r01% sh("'mi above'. V.A. be S?Ionkmiin trie" The. fN:evving isl �,Rdded I* P;-.iravaph 8. Transfer Of Rights or Recovery Against Others To Us of Sectiov. IV - Conditiolls; We W.'alve �arfv ricy"it ofrewvery W-1,1- filay tj-'.El rKlITISO(I abcve of poyfleflts "'ve 'I'llaEct for injiury or dan,a .9e aysl Out 01' VoUr Of-lagSingoperialiwis or g 1-<: or erganizalion and included in the u)a)pleted operations, hazard'. Thl's waivei applie,,ii, only to the person ;>r !s�hovm in the above. POLICY NO. BCA0006149-00 QQMMLRQIAL AUTIQ AH CA 85 90 09 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES IN COMMERCIAL AUTO COVERAGE FORM This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. BROADENED WHO IS AN INSURED Paragraph A.I. Who Is an Insured of SECTION 11 — LIABILITY COVERAGE is amended to include the following* d. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. e. Any "employee" of yours is an "insured" while using an "auto" hired or rented under a contract or agreement in that "employ- ee's" name, with your permission, while performing duties related to the conduct of your business. C Each person or Organization to whom you are required by a written contract or agreement to provide additional insured status is an "insured" under Liability Cov- erage, but only to the extent that person or organization qualifies as an "insured" un- der the Who is an Insured Provision con- tained in Section It of the coverage form. The written contract or agreement must be in effect during the policy period shown in the Declarations and must have been exe- cuted prior to the "bodily injury" or "proper- ty damage." B. LIABILITY COVERAGE EXTENSIONS SLIPPLE- IMENTARY PAYMENTS Paragraphs A.2.a. (2) and A.2.a. (4) Coverage Extensions — Supplementary Payments of SECTION 11 — LIABILITY COVERAGE are deleted and replaced with the following: (2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "ac- cident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. C. FELLOW EMPLOYEE COVERAGE Paragraph B.5. Fellow Employee Exclusion con- tained in SECTION 11 — LIABILITY COVERAGE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire that is not a bus, motorcycle or van used to transport em- ployees. This Fellow Employee Coverage is excess over any other collectible insurance. D. POLLUTION LIABILITY — BROADENED COV- ERAGE FOR COVERED AUTOS 1. Liability Coverage is changed as follows: a. Paragraph B.11.a. of the Pollution Exclu- sion in SECTION 11 — LIABILITY COV- ERAGE applies only to liability assumed under a contract or agreement. b. With respect to the coverage afforded by Paragraph I.a. Above, Exclusion B.6. Care, Custody or Control of SECTION 11 LIABILITY does not apply. 2. Changes in Definitions For the purposes of this endorsement, Para- graph D. of SECTION V — DEFINITIONS is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statuto- ry or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, de- toxify or neutralize, or in any way re- spond to, or assess the effects of "pol- lutants"; or Includes copyrighted material of Insurance Services Office, Inc., AH CA 85 90 0917 with its permission. Page 1of6 2. Any claim or "suit" by or on behalf of a 2. govemmental authority for damages be- cause of testing for, monitoring, cleaning up, removing, containing, treating, detoxify- ing or neutralizing, or in any way respond- ing to or assessing the effects of "pollu- tants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dis- persal, seepage, migration, release or escape of "pollutants". - a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. 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 deliv- ered, disposed of or abandoned by the "i nsured". Paragraphs a. and b. above do not apply to "accidents" that occur away from prem- ises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" it (1) The "pollutants" or any property in which the "pollutants" are con- tained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (2) The discharge, dispersal, seep- age, migration, release or escape of the "pollutants" is caused di- rectly by such upset, overturn or darn age. This Pollution Liability Coverage is subject to an Annual Aggregate Limit of Liability of $100,000. E. NEWLY ACQUIRED OR FORMED ORGANIZATIONS Throughout this policy, the words you and your al- so refer to any organization you newly acquire or form, other than a partnership, joint venture or lim- ited liability company, and over which you maintain ownership or majority interest, but only if there is no similar insurance available to that organization. However: 1. The coverage does not apply to an "accident" which occurred before you acquired or formed the organization. Unless you no% us to add cmml; t m policy, the coverage under this provision is af- forded only until a. The 120th day after you acquire or form the organization, or b. The end of the policy period, whichever is earl ier. F. EXTENDED TOWING Paragraph A.2. Towing of SECTION III — PHYS- ICAL DAMAGE COVERAGE is deleted and re- placed with the following: We will pay for towing and labor costs each time a covered "auto" is disabled. All labor must be per- formed at the place of disablement. If the "auto" is of the private passenger type, there will be no de- ductible. If the "auto" is other than a private pas- senger type, a $100 deductible will apply. The most we will pay under this EXTENDED TOW- ING coverage is $750 per occurrence. G. PHYSICAL DAMAGE COVERAGE EXTENSIONS Paragraph A.4. — Coverage Extensions of SEC- TION III — PHYSICAL DAMAGE COVERAGE is amended as follows: a. Transportation Expenses The amount we will pay for temporary transportation expense is increased to $50 per day to a maximum of $3,000. b. Loss of Use Expenses The amount we will pay for loss of use is increased to $75 per day and to a maxi- mum limit of $1,000. H. RENTAL REIMBURSEMENT 1. This coverage applies only to a covered "auto," described or designated in the Schedule or in the Declarations as carrying physical damage coverage. 2. 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 applies in addition to the otherwise applicable amount of coverage you have on each covered "auto". 3. We will pay only for those expenses incurred during the policy period beginning 24 hours af- ter the "loss" and ending, regardless of the pol- icy's expiration, with the lesser of the following number of days: Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 6 with its permission. AH CA 85 90 0917 m. The number ofdays to repair or replace the ocxeed "auto". If ^(ooa' is caused by theft. this number of days is added to the number of days it takes to locate the covered "muto" and re- turn b. 3Odmys. 4. Our payment islimited bmthe lesser of the fo|- |mwngamomntm: a. Necessary and actual expenses incurred-, or b. $50per day 5. This coverage does not apply while there are spare or reserve "autos' available to you for your operations. 6. If^|oaa" results from the total theft ofacovered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already proWded for under the paragraph A.4. Coverage Extensions in SECTION II| -- PHYS|CALDAMAGE COVERAGE No Deductible applies tothis oownngm. |. AIRBAG COVERAGE Exclusion B.3. in SECTION III -- PHYSICAL DAMAGE COVERAGE is amended to add: This amo|ueinn does not apply to the accidental discharge of an airbag, J. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT 1. Coverage a. We will pay with respect to mcovered "mu' to" described }nthe Schedule fbr"|oma' to any electronic equipment that receives or transmits audio, \�muaU or data signals and that is not designed solely fbxthe repro- duction of soundThis oowamgo applies only if the equipment is permanently in- stalled in the oqwmmmd ''auto" at the time of the ''|oso^ or the equipment is nxnmowab|e from ahousing unit which is permanently installed in the covered "auto" at the time of the ''|oso~, and such equipment is de- signed to be solely operated by use ofthe power from the "auto's" e|motr|om| system, in or upon the covered "auto". b. We will pay with respect to acovored "au- to" desohbed in the Schedule for "loss" to any accessories used with the electronic equipment described in Paragraph 1.a' above. However, this does not include tapes. records ordiscs. 2. Exclusions The eXCIUSIOnS that apply to SECTION III — PHYSICAL DAMAGE, except for the exclusion relating to Audio, Visual and Data Electronic Equipment, also apply to coverage provided by this endorsement, In addition, the following ex- clusions apply: We will not pay' under this endorsement, for either any electronic equipment or accessories used with such electronic equipment that is: a. Necessary for the normal operation ofthe covered "auto" or the monitoring of the covered "outo's"operating system; or (1).Anintegral part oYthe same unit hous- ing designed solely for the reproduction of sound if the sound nspno1ucingequip- ment is permanently installed in the covered "auto" . and (2). Permanently installed in the opening of the dash or console nomnm|/y used by the manufacturer for the installation of m radio. 3. Limit Of Insurance With respect bocoverage under this endorse- ment. the Limit Of Insurance pnmAsion of SECTION U|U --PHYSICAL DAMAGE COV- ERA*GEis replaced hythe following: m' The most wewill pay for all "loss" to audio, \�eusU or data electronic equipment and any occemauMma used with this equipment as a result of any one "ecuident" is the lesser of: (1). The actual cash wslueofthe damaged orstolen property maoythe time ofthe "lmss"; (2) The cost of repairing or replacing the damaged or stolen property with other property oflike kind and qua|ity�cr (3). $1.500 b. An adjustment for depreciation and physi- cal condition will be made in determining actual cash value at the time of the "loss". c. If a repair orreplacement results in better than like kind orquality, we will not pay for the amount of betterment. 4. Deductible Nodeductible applies tothis coverage. The insurance provided bythis extension is excess over any other collectible insurance. Includes copyrighted material o[Insurance SeNcaeOffice, Inc. K. TAPES, RECORDS AND DISCS COVERAGE Exclusion 8.4.a. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: 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 except when the tapes, records, discs or other similar au- dio, visual or data electronic devices: (1) Are your property or that of a family member, and (2) Are in a covered "auto" at the time of "loss (a). The most we will pay for "loss" is $200. No Physical Damage Cov- erage deductible applies to this coverage. This extension provides coverage only to a covered "auto". L. PHYSICAL DAMAGE DEDUCTIBLE — SINGLE DEDUCTIBLE AND GLASS REPAIR Paragraph D. Deductible in SECTION III PHYSICAL DAMAGE COVERAGE is deleted and replaced by the following: D. Deductible For each covered "auto," our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable de- ductible shown in the Declarations, Any Com- prehensive Coverage deductible shown in the Declarations does not apply to "loss" caused by fire or lightning. When two or more covered "autos" sustain "loss" in the same occurrence, the total of all the "loss" for all the involved covered "autos" will be reduced by a single deductible, which will be the largest of all the deductibles apply- ing to all such covered "autos." No deductible applies to glass damage if the glass is repaired rather than replaced. M. PERSONAL EFFECTS COVERAGE 1. If you purchase Comprehensive Coverage on this policy for a stolen owned "auto", we will pay up to $600 for "personal effects" stolen with the "auto". 2. "Persoft mect, n U%m 1n IM gilftm means tangible property that is worn or oarriecl by the "insure'. "Personal effects" does not include tools, jewelry, money, securities, radar or laser detectors, or tapes, records, discs or similar audio, visual or data electronic equip- ment. No Deductible applies to this extension. The insurance provided by this extension is excess over any other collectible insurance. N. LOAN/LEASE PAYOFF COVERAGE The SECTION III — PHYSICAL DAMAGE COV- ERAGE is amended by the addition of the follow- ing: In the event of a total "loss" to a covered "auto" shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered "au- to", less: 1. The amount paid under the Physical Damage Coverage Section of the policy; and 2. Any: a. Overdue lease/loan payments at the time of the "loss", b. Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. c. Security deposits not returned by the les- sor, d. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and e. Carry-over balances from previous loans or leases, O. CUSTOM SIGNS AND DECORATIONS In the event of a total loss to a vehicle insured for auto physical damage coverage on this policy, in addition to the ACV of the vehicle, we will pay the actual cost to repair or replace signage or custom paint details up to $5,000. P. HIRED AUTO PHYSICAL DAMAGE If hired "autos" are covered "autos" for Liability Coverage and if Physical Damage Coverage of Comprehensive, Specified Causes of Loss, or Col- lision are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverage's provided are extended to "autos" you hire of like kind and use subject to the following limit: The most we will pay for any one loss is the lesser of the following: 1. $50,000 per accident, Includes copyrighted material of Insurance Services Office, Inc., Page 4 of 6 with its permission. AN CA 85 90 0917 2. Actual Cash Value, or 3. The cost of repair. The deductible will be equal to the largest deducti- ble applicable to any owned "auto" for that cover- age. No deductible applies to "loss" caused by fire or lightning. This Hired Auto Physical Damage cov- erage is excess over any other collectible insur- ance. Subject to the above limit, deductible and T. excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. Q. DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS Subparagraphs A.2.a. of SECTION IV — BUSI- NESS AUTO CONDITIONS is deleted and re- placed by: a. In the event of "accident", claim, "suit" or "loss", you, your insurance manager or any other person you designate must give us or our authorized representative prompt notice of such "accident" or "loss". Include: (1) How, when and where the "accident' or "loss" occurred: (2) The "insureds" name and address: and (3) To the extent possible, the names and ad- dresses of any injured persons and wit- nesses. Knowledge of an "accident" or "loss" by your agent, servant or "employee" shall not be consid- ered knowledge by you unless you, your insurance manager or any other person you designate has received notice of the "accident" or "loss" from your agent, servant, or "employee." R. WAIVER OF SUBROGATION SECTION IV — BUSINESS AUTO CONDI- TIONS— A. 5. Transfer of Rights of Recovery Against Others to Us is amended as follows: This condition does not apply to any person or or- ganization to which you waived this condition by written contract or agreement, but only to the ex- tent that subrogation is waived prior to the "acci- dent" or "loss" under a contract with that person or organization. S. UNINTENTIONAL FAILURE TO DISCLOSE HAZ- ARDS Paragraph B.2. Concealment, Misrepresentation Or Fraud in SECTION IV — BUSINESS AUTO CONDITIONS is amended by adding the following'. Any unintentional tail"M to 6S6M all 2iDmTg or hazards existing as of the effective gate of tne Business Auto Coverage Form or at any time dur- ing the policy period will not invalidate or adversely affect the coverage for such exposure or hazard. However, you must report the undisclosed expo- sure or hazard to us as soon as reasonably possi- ble after its discovery. EXTENDED EMPLOYEE HIRED AUTO PHYSICAL DAMAGE Paragraph B.5.b. Other Insurance of SECTION IV — BUSINESS AUTO CONDITIONS is deleted and replaced by the following: 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 performing du- ties 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". POLICY PERIOD, COVERAGE TERRITORY Paragraph B.7. Policy Period, Coverage Territo- ry of SECTION IV — BUSINESS AUTO CONDI- TIONS is deleted and replaced by: 7. Policy Period, Coverage Territory Under this Coverage Form, we cover "acci- dents!'and "losses" occurring'. a. During the policy period shown in the Dec- larations; and b. Within the coverage territory. The coverage territory is: a. The United States of America; b. The territories and possessions of the United States of America, c. Puerto Rico: d. Canada; and e. Anywhere in the world if: (1) A covered "auto" is leased, hired, rented or borrowed for a period of 30 days or less; and Includes copyrighted material of Insurance Services Office, Inc., AH CA 85 90 0917 with its permission. Page 5 of 6 (2) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and posses- sions of the United States of America, Puerto Rico, or Canada or in a settle- ment we agree to. We also cover "loss" to, or "accidents" inualving, a covered "auto" while being transported between any of these places. V. DEFINITION OF BODILY I%JURY AMMID Paragraph C. of SECTION V — DEFINITIONS is amended to include: "Bodily Injury" includes mental anguish or other mental injury resulting from "bodily injury." Howev- er, no coverage is provided for mental anguish or mental injury absent physical injury. None of the extensions provided under this cover- age endorsement apply if coverage is more specifi- cally identified elsewhere in the policy or endorse- ments, for which a premium charge is made or a higher limit is identified. Under no circumstances is any limit provided under this extension to be com- bined with a limit provided elsewhere in the policy or endorsements. Includes copyrighted material of Insurance Services Office, Inc., Page 6 of 6 with its permission. AH CA 85 90 09 17 WORKERS COMPENSATION AND 'LOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be otherwise due. Person or Organization ANY PERSON/ORGANIZATION WHEN REQUIRED BY WRITTEN CONTRACT 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA OPERATIONS 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 05/06/20 20 Policy No. WSA 5048153 01! Endorsement No. Insured GENTRY GENERAL ENGINEERING INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By VVC 99 06 34 (Ed. 8.00) INSURED Rating Search: Search Pant w C� Ot e;p Advanced Search Insurance Company of the West AMB #: 004667 NAIC #: 27847 FEIN #: 952769232 Mailing Address P.O. Box 509039 San Diego, California 92150-9039 United States Web: www_icwgroup.com Phone: 858-350-2400 Fax: 858-350-2792 View Additional Andress Informa=ion AM Best Rating Unit: AMB #: 002967 - IrU`J Pool Assigned to insurance companies that have, in our opinion, an excellent ability to meet their ongoing insurance obligations. AJ�1 �Ex e l I t Based on AM Best's analysis, 051656 - Ernest Rady Trust is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of operating insurance entities in this structure. Financial Strength Rating View Definition Rating: A (Excellent) Affiliation Code: p (Pooled) Financial Size XII ($1 Billion to $1.25 Category: Billion) Outlook: Stable Action: Affirmed Effective Date: November 04, 2020 Initial Rating Date: June 30, 1978 Best's Credit Rating Analyst Rating Office: A.M. Best Rating Services, Inc. Financial Analyst: Christine DePalma Director: Robert Raber Note_ See the Disclosure information Form or Press Release below for the office and analyst at the time of the rating event. Disclosure Information Powered by AM Best's Global Insurance Database Page 1 of 4 Long -Term Issuer Credit Rating View Definition Long -Term: a (Excellent) Outlook: Stable Action: Affirmed Effective Date: November 04, 2020 Initial Rating Date: July 30, 2007 i u Denotes Ra4:�Q Disclosure Information Form i View AM Best's 1= ann a Di. cdosi ire Far;, The following links provide access to related data records that AM Best utilizes to provide financial and analytical data on a consolidated or branch basis. Company AMB # Company Description Name 019407 ICW Pool Represents the "as filed" Company Consolidated financials for the Property/Casualty (C) business of this legal entity. 002007 ICW Pool Represents the AM Best Consolidated financials for the Property/Casualty business of (G) this legal entity. Best's Cied;t Report - financial data included in Best's Credit Report reflects the data used in � determining the current credit rating(s) for AM Best Rating Unit: AMB #: 002967 - lC'VV Pool. Powered b}• .4M Best's Global Insurance Database Page 2 of 4 Company Profile https:Hinteractive.web.insurance.ca.gov/companyprofile/companypro. Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIC Group List Lines of Business Workers' Compensation Complaint and Request for Action/Appeals Contact Information Financial Statements PDF's Annual Statements Quarterly Statements Company Complaint Company Performance & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information Old Company Names Agent For Service Michael Warnick 15025 Innovation Drive San Diego CA 92128-3409 Reference Information INSURANCE COMPANY OF THE WEST PO BOX 509039 SAN DIEGO, CA 92150-9039 Effective Date NAIC #: 27847 California Company ID #: 12071-9 Date Authorized in California: 05/17/1972 License Status: UNLIMITED -NORMAL Company Type: Property & Casualty State of Domicile: CALIFORNIA back to top NAIC Group List NAIC Group #: 0922 ICW Grp Assets Inc Grp Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AIRCRAFT AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY CREDIT DISABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY 1 of 2 1/5/2021, 1:21 Pb Rating Search: Search ,~Punt tDF OHelp Advanced Search Regent Insurance Company AMB #: 002418 NAIC #: 24449 FEIN #: 396062860 Domiciliary Address One QBE Way Sun Prairie, Wisconsin 53596 United States Web: wwpi,gbena com Phone: 800-362-5448 Fax: 608-837-2051 AM Best Rating Unit: AMB # 085434 - OBE Insurance Group Lir,Eited Assigned to insurance companies that have, in our opinion, an excellent ability to meet their ongoing insurance obligations. Based on AM Best's analysis, 085434 - OBE Insurance Group Limited is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of operating insurance entities in this structure. Financial Strength Rating View Definition Rating: A (Excellent) Affiliation Code: p (Pooled) Financial Size XV ($2 Billion or Category: greater) Outlook: Stable Action: Affirmed Effective Date: August 14, 2020 Initial Rating Date: June 30, 1964 Long -Term Issuer Credit Rating View Best's Credit Rating Analyst Rating Office: A.M. Best Rating Services, Inc. Senior Financial Analyst: Edward Zonenberg Senior Director: Daniel J. Ryan `dotes Seethe Disclosure information Form or Press Release below for the office and analyst at the time of the rating event. Disclosure information Powered by AM Best's Global Insurance Database Page 1 of 4 , _ _ _ -- _ _ ____ 1— __ Defijmtion Long -Term: a+ (Excellent) Outlook: Stable Action: Affirmed Effective Date: August 14, 2020 Initial Rating Date: June 21, 2005 u Denotes F1_, E_�i Financial Strength Rating I Disclosure Information Form View AM Best's R atinQ Dis +osure i=alrn Press Release AM Afflnn -,is Ins it 3c;e Grow,,, t ,? 111s K j August 14, 2020 Long -Term Issuer Credit Rating Red t - .ir�ni�;� - reports which were released prior to the current Best's Credit Report. Fig?a,?%:ial 'Reoc+ - financial data included in Best's Financial Report reflects the most current data available to AM Best, including updated financial exhibits and additional company information, and is available to subscribers of Best's Insurance Reports. View additional neeo s. re po is a_?t p >ri�7;cis for this company. Powered by AM Best's Global Insurance Database Page 2 of 4 Company Profile https:Hinteractive.web.insurance.ca.gov/companyprofile/companypro. Company Profile Company Search Company Search Results Company Information Old Company Names Agent for Service Reference Information NAIC Group List Lines of Business Workers' Compensation Complaint and Request for Action/Appeals Contact Information Financial Statements PDF's Annual Statements Quarterly Statements Company Complaint Company Performance & Comparison Data Company Enforcement Action Composite Complaints Studies Additional Info Find A Company Representative In Your Area View Financial Disclaimer COMPANY PROFILE Company Information Old Company Names Agent For Service Vivian Imperial 818 WEST SEVENTH STREET SUITE 930 LOS ANGELES CA 90017 Reference Information REGENT INSURANCE COMPANY ONE QBE WAY SUN PRAIRIE, WI 53596 800-362-5448 Effective Date NAIC #: 24449 California Company ID #: 4301-8 Date Authorized in California: 11/30/1995 License Status: UNLIMITED -NORMAL Company Type: Property & Casualty [State of Domicile: WISCONSIN back to top NAIC Group List NAIC Group #: 0796 QBE INS GRP Lines Of Business The company is authorized to transact business within these lines of insurance. For an explanation of any of these terms, please refer to the glossary. AUTOMOBILE BOILER AND MACHINERY BURGLARY COMMON CARRIER LIABILITY FIRE LIABILITY MARINE MISCELLANEOUS PLATE GLASS SPRINKLER SURETY TEAM AND VEHICLE 1 of 2 1/5/20215 1:20 Pr Rating Search: Advanced Search Search I i�IPnnt tDF ()Help James River Insurance Company AMB #: 012604 NAIC #: 12203 FEIN #: 222824607 Mailing Address P.O. Box 27648 Richmond, Virginia 23261 United States Web: wwwjamesriverins.corn Phone: 804-289-2700 Vie�oj Additional Address Information AM Best Rating Unit: AMB #; 055488 - James River Group Holdings.. Ltd Assigned to insurance companies that have, in our opinion, an excellent ability to meet their ongoing insurance obligations. Based on AM Best's analysis, 055488 - James River Group Holdings, Ltd is the AMB Ultimate Parent and identifies the topmost entity of the corporate structure. View a list of operating insurance entities in this structure. Financial Strength Rating View Definition Rating: Affiliation Code: Financial Size Category: Outlook: Action: Effective Date: Initial Rating Date A (Excellent) g (Group) XI ($750 Million to $1 Billion) Stable Affirmed August 20, 2020 July 03, 2003 Best's Credit Rating Analyst Rating Office: A.M. Best Rating Services, Inc. Director: Robert Raber Senior Director: Gregory T. Williams NafeSee the Disclosure information Form or Press Release below for the office and analyst at the time of the rating event. Disclosure Information Powered by AM Best's Global Insurance Database Page I of 4 Long -Term Issuer Credit Rating Vie�nt Definition Long -Term: a (Excellent) Outlook: Stable Action: Affirmed Effective Date: August 20, 2020 Initial Rating Date: November 18, 2005 Disclosure Information Form View AM Best's Ruing Dtsciosure Form Press Release Gro-un F'iolding�; I,t,.i- r:i ii August 20, 2020 u Denotes i.f, F,ev e * F,e, L Rfit; r,a i Best's Credit Relnort - financial data included in Best's Credit Report reflects the data used in Idetermining the current credit rating(s) for AM Best Rating Unit: AMB #: 055'" - �� nes Ri er r Flo�,dlm s, Ltd -- v -st`s Credit R loc,- ; - Archive - reports which were released prior to the current Best's Credit Report _ Bests Rnan ial Report - financial data included in Best's Financial Report reflects the most current . data available to AM Best, including updated financial exhibits and additional company information, and is available to subscribers of Best's Insurance Reports. View additional e orts and procc :_;cis for this company. Powered bi- AM Best's Global Insurance Database Page 2 of 4