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Insurance - Charles King Company - 2017-01-04 ----"'"" CHARKIN-01 DLOPEZ ACORLYDATE(MWDD/YYYY) kb./ 01/04/2017 OF LIABILITY INSURANCE o1/oa/2o17 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#0D79613 CONTACT Denise Lopez Bowermaster&Associates Insurance Agency,Inc. P(AH/C"N,Ext):(714)733-6219 (A/C,No): 10805 Holder Street,Suite 350 Cypress,CA 90630 neo ass:dlopez@bowermaster.com INSURERS)AFFORDING COVERAGE NAIC# ' INSURER A:National Fire Insurance of Hartford '20478 INSURED INSURER B:COntmental Casualty Co. ' 20443. Charles King Company,Inc. INSURER C_Stanstone National Insurance Company I 25496 2841 Gardena Avenue INSURER D:AIG Specialty Insurance Company' 26883 Signal Hill,CA 90755 INSURER E:Scottsdale Insurance Company' 41297 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 'ADDL SUER POLICY EFF , D/ POLICY EXP A X TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYYI IMMIDYYYYI LIMITS COMMERCIAL GENERAL LIABILITY ,EACH OCCURRENCE1,000,000 CLAIMS-MADE X OCCUR X 4034952911 03/30/2016 03/30/2017 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence/ $ X Deductible:$5,000MED EXP(Any one person) $ 15,000 X PD/SubsidencePERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1 GENERAL AGGREGATE_. . $ 2,000,000 - - POLICY XPECT LOC PRODUCTS-COM P/OP AGG $ 2,000,000 . __-OTHER: , $ COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY �', (_Ea accident) $ X ANY AUTO X 15091114974 03/30/2016 03/30/2017 BODILY INJURY(Per person) $ OWNED 'SCHEDULED AUTOSRE� ONLY AUUTNOSSWNEp BODILY INJURY(Per accident) $ X AUTOS ONLY X VIM (Per Paccid nt)DAMAGE $ A 1 X UMBRELLA LIAB X I OCCUR , 11,000,000 OCCURRENCE $ 11,000,000 EXCESS LIAB CLAIMS-MADE 5091114988 03/30/2016103/30/2017 AGGREGATE $ 11,000,000 DED X RETENTION$ 10,000 $ C WORKERS COMPENSATION X STATUTE _ OTH- ER AND EMPLOYERS'LIABILITY Y/N 710160030 06/02/2016 06/02/2017 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE _-'I X E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? Y I N/A 1,000,000 (Mandatory in NH) - E.L.DISEASE-EA_ EMPLOYEE $ _ _ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ D Pollution Liability ICPL3850939 03/30/2016 03/30/2017 'Ded:$10,000 5,000,000 E Excess Liability XLS0099253 03/30/2016 03/30/2017 8,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Job#314,Grade 5 Non-phase Work#2 Costa Mesa Sanitary District, its directors,officials,officers,employees,agents,and volunteers shall be covered as Additional Insured as respects General Liability per forms CNA74705XX&CNA75079XX;Primary and Non Contributory wording included.With respects to Auto Liability per form CNA63359XX; Primary and Non Contributory wording included.Waiver of Subrogation applies to Work Comp per form WC040306. 30 day notice of cancellation applies as per policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Costa Mesa Sanitary District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ry ACCORDANCE WITH THE POLICY PROVISIONS. 290 Paularino Avenue It�L( Costa Mesa,CA 92626 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Named Insured; Charles King Company,Inc. Policy Number: 4034952911 CNA Blanket Additional Insured -Owners, Lessees or Contractors -with Products-Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional insured on this coverage part,including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization is an insured only with respect to such person or organization's liability for: A. unless paragraph B.below applies, 1. bodily injury,property damage,or personal and advertising injury caused in whole or in part by the acts or omissions by or on behalf of the Named Insured and in the performance of such Named Insured's ongoing operations as specified in such written contract;or 2. bodily injury or property damage caused in whole or in part by your work and included in the products-completed operations hazard,and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury,property damage,or personal and advertising injury arising out of your work described in such written contract,but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard;and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11-85 or 10-01 edition of CG2010 or the 10-01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract;or B. a higher limit of insurance than required by the written contract. III. The insurance granted by this endorsement 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 coverage part. IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary,excess,contingent or any other basis. However,if this insurance CNA75079XX(1-15) Policy No:4034952911 Page 1 of 2 Endorsement No:1 Effective Date:3/30/2016 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc,with IIs permission JP, CNA Blanket Additional Insured - Owners, Lessees or Contractors - with Products-Completed Operations Coverage Endorsement is required by written contract to be primary and non-contributory, this insurance will be primary and non- contributory relative solely to insurance on which the additional insured is a named insured. V. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result in a claim; 2. except as provided in Paragraph IV. of this endorsement, agree to make available any other insurance the additional insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation,defense,or settlement of the claim;and 4. tender the defense and indemnity of any claim to any other insurer or self insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this insurance to be primary and non-contributory,this paragraph (4)does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VI. Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part,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. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. s 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. CNA75079XX(1-15) Policy No:4034952911 Page 2 of 2 Endorsement No: 1 Effective Dale:3/30/2016 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with Its permission. 11 Named Insured:Charles King Company, Inc. Policy Number: 4034952911 CNA Contractors' General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in • paragraphs A.through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement,provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part;and (2) was executed prior to: (a) the bodily injury or property damage;or (b) the offense that caused the personal and advertising injury, fur which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement;or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A.through H.below. Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of a Named Insured;or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability for bodily injury,property damage or personal and advertising Injury as co-owner of such premises. C. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused,in whole or in part,by the Named Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. D. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. CNA74705XX(1-15) Policy No: 4034952911 Page 2 of 17 Endorsement No: 1 Effective Date: 3/30/2016 Copyright CNA All Rights Reserved_ Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA Contractors' General Liability Extension Endorsement E. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that the occurrence giving rise to such bodily Injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of,or for such additional insured. F. Mortgagee,Assignee or.Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership,maintenance,or use of a premises by a Named Insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. G. State or Governmental Agency or Subdivision or Political Subdivisions—Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury,property damage or personal and advertising injury arising out of; 1, the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection,or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults,street banners,or decorations and similar exposures;or b. the construction,erection,or removal of elevators;or c. the ownership,maintenance or use of any elevators covered by this insurance;or 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to; a. Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision;or b. Bodily injury or property damage included within the products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. H. Trade Show Event Lessor 1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury caused by: a. the Named Insured's acts or omissions;or b. the acts or omissions of those acting on the Named Insured's behalf, CNA74705XX(1-15) Policy No:4034952911 Page 3 of 17 Endorsement No: 1 Effective Date:3/30/2016 Copyright CNA All Rights Reserved. Includes copyrightea material of Insurance Services Office,Inc.,with its permission. CNA Contractors' General Liability Extension Endorsement in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2. ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance,then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own insurance means insurance on which the additional insured is a named insured.Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization. 3. BODILY INJURY—EXPANDED DEFINITION Under DEFINITIONS,the definition of bodily Injury is deleted and replaced by the following: Bodily injury means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury,sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE/NOTICE OF OCCURRENCE Under CONDITIONS, the condition entitled Duties In The Event of Occurrence, Offense, Claim or Sult is amended to add the following provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the Insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a partner,executive officer, manager or member of a Named Insured, or an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily Injury or property damage is not covered under this CoYrerage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence,offense or claim. 5. BROAD NAMED INSURED WHO IS AN INSURED is amended to delete its Paragraph 3.in its entirety and replace it with the following: 3. Pursuant to the limitations described in Paragraph 4.below,any organization in which a Named Insured has management control: a. on the effective date of this Coverage Part;or b. by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary, contributory, excess,contingent or otherwise,which provides coverage to such organization,or which would have provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or narrower than that provided by this insurance. CNA74705XX(1-15) Policy No:4034952911 Page 4 of 17 Endorsement No:1 Effective Date:3/30/2016 Copyright CNA All Rights Reserved Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • Contractors' General Liability Extension Endorsement (d) explosion. B. The following paragraph is added to LIMITS OF INSURANCE: Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for the sum of damages arising out of any one occurrence because of property damage to your product and your work that is caused by fire, smoke, collapse or explosion and is included within the product-completed operations hazard, This sublimit does not apply to property damage to your work if the damaged work, or the work out of which the damage arises,was performed on the Named Insured's behalf by a subcontractor. C. This Broadened Liability Coverage For Damage To Your Product And Your Work Provision does not apply if an endorsement of the same name is attached to this policy. 7. CONTRACTUAL LIABILITY—RAILROADS With respect to operations performed within 50 feet of railroad property, the definition of insured contract is replaced by the following: 'Insured Contraal means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to a Named Insured or temporarily occupied by a Named Insured with permission of the owner is not an insured contract; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; f. That part of any other contract or agreement pertaining to the Named Insured's business (including an indemnification of a municipality in connection with work performed for a municipality) under which the Named Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person or organization.Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f.does not include that part of any contract or agreement: (1) That indemnifies an architect,engineer or surveyor for injury or damage arising out of: (a) Preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications;or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; (2) Under which the Insured,if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1)above and supervisory,inspection,architectural or engineering activities. 8. ELECTRONIC DATA LIABILITY A. Under COVERAGES, Coverage A—Bodily Injury and Property Damage Liability,the paragraph entitled Exclusions is amended to delete exclusion p.Electronic Data and replace it with the following: This insurance does rot apply to: - p. Access Or Disclosure Of Confidential Or Personal Information And Data-related Liability Damages arising out of: CNA74705XX(1-15) Policy No:4034952911 Page 6 of 17 Endorsement No:1 Effective Date:3/30/2016 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA Contractors' General Liability Extension Endorsement 10. EXPECTED OR INTENDED INJURY—EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following: This insurance does not apply to: Expected or Intended Injury Bodily Injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily Injury or property damage resulting from the use of reasonable force to protect persons or property. 11. GENERAL AGGREGATE LIMITS OF INSURANCE-PER PROJECT A. For each construction project away from premises the Named Insured owns or rents, a separate Construction Project General Aggregate Limit,equal to the amount of the General Aggregate Limit shown in the Declarations, is the most the Insurer will pay for the sum of: 1. All damages under Coverage A, except damages because of bodily injury or property damage included in the products-completed operations hazard;and 2. All medical expenses under Coverage C, that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations,nor the Construction Project General Aggregate Limit of any other construction project. B. All: 1. Damages under Coverage B,regardless of the number of locations or construction projects involved; 2. Damages under Coverage A, caused by occurrences which cannot be attributed solely to ongoing operations at a single construction project, except damages because of bodily injury or property damage included in the products-completed operations hazard;and 3. Medical expenses under Coverage C caused by accidents which cannot be attributed solely to ongoing operations at a single construction project, will reduce the General Aggregate Limit shown in the Declarations. C. The limits shown in the Declarations for Each Occurrence,for Damage To Premises Rented To You and for Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit or the General Aggregate Limit shown In the Declarations,depending on whether the occurrence can be attributed solely to ongoing operations at a particular construction project. D. 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 shown in the Declarations,regardless of the number of projects involved. E. If a single construction project away from premises owned by or rented to the Insured has been 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 construction project. F. The provisions of LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated. CNA74705XX(1-15) Policy No:4034952911 Page 8 of 17 Endorsement No: 1 Effective Date: 3/30/2016 Copyright CNA All Rights Reserved, Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA Contractors' General Liability Extension Endorsement A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000,limit;and B. Paragraph 1.d. is amended to delete the limit of$250 shown for daily loss of earnings and replace it with a $1,000,limit. 24. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of tt+e Named Insured's Coverage Part,the Insurer will not deny coverage under this Coverage Part because of such failure. 25. WAIVER OF SUBROGATION-BLANKET Under CONDITIONS,the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations;or 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement,and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part;arid 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 26. WRAP-UP EXTENSION:OCIP,CCIP,OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap- up)insurance program by applicable state statute or regulation. If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I_P.)is attached,then the following changes apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily Injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4.Other Insurance is amend to add the following subparagraph 4.b.(1)(c): This insurance is excess over: (c) Any of the other insurance whether primary, excess, contingent or any other basis that is insurance available to the Named Insured as a result of the Named Insured being a participant in a consolidated (wrap-up) insurance program, but only as respects the Named Insured's involvement in that consolidated(wrap-up)Insurance program. CNA74705XX(1-15) Policy No:4034952911 Page 16 of 17 Endorsement No: 1 Effective Date:3/3012016 Copyright CNA All Rights Resorved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA Contractors' General Liability Extension Endorsement C. DEFINITIONS is amended to add the following definitions: Consolidated(wrap-up)insurance program means a construction,erection or demolition project for which the prime contractor/project manager or owner of the construction project has secured general liability insurance covering some or all of the contractors or subcontractors involved in the project,such as an Owner Controlled Insurance Program(O.C.I.P.)or Contractor Controlled Insurance Program(C.C.I.P.). Residential structure means any structure where 30% or more of the square foot area is used or is intended to be used for human residency,including but not limited to: 1. single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments;and 2. the common areas and structures appurtenant to the structures in paragraph 1. (including pools, hot tubs,detached garages,guest houses or any similar structures). However, when there is no individual ownership of units, residential structure does not include military housing, college/university housing or dormitories, long term care facilities, hotels or motels. Residential structure also does not include hospitals or prisons. This WRAP-UP EXTENSION: OCIP, CCIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Provision does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part. 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. CNA74705XX(1-15) Policy No:4034952911 Page 17 of 17 Endorsement No: 1 Effective Date: 3/30/2016 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CNA63359XX CNANAMED INSURED: CharlesKing COMPany,Inc. POLICY NUMBER: 6091114974 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE 4. An "employee".of yours is an"insured"while AWhAn operating an "auto" hired or rented under a O Is Insured. contract or agreement in that "employee's". The following is added to Section II,Paragraph name, with your permission, while A.1.,Who Is An Insured: performing duties related to the conduct of your business. 1. a.. Any incorporated entity. of 'which the Named Insured owns a majority of the "Policy,"as used in this provision A. Who Is An voting stock.on the date of inception of Insured, includes those policies that were in this Coverage Form;provided that, force on the inception date of this Coverage b. The insurance.afforded by this provision Form but: A.1. does not apply to anysuch entity 1. Which are no longer in force;or that is liability an "insured" -under 'any other 2. .Whose.limits have been exhausted. 'policy" providing "auto" coverage. B. Bail Bonds and Loss of Earnings 2. Any organization you newly acquire or form, Section II, Paragraphs A.2. (2) and ,A.2. (4) Other. .than :a limited liability company, are revised as follows: partnership or jOint VentUre, and Over which . 1. In a(2) the limit for the cost of ball bonds is you maintain majority ownership interest. changed from $2,000 to'$5,000;and The: insurance afforded by this provision A2.: 2: In a.(4); the limit for the loss of earnings is Changed from$250 to$500 a day. a. Is effective on the acquisition or formation date, and is afforded only until C. Fellow Employee the end of the policy period of this Section II,Paragraph B.5 does not apply. Coverage Form, or the next anniversary .of its inception date, whichever is Such coverage as is afforded by this provision earlier. C. is excess over any other collectible insurance. b. Does not apply to: II. PHYSICAL DAMAGE COVERAGE (1) "Bodily injury"or"property damage" Glass Breakage—.Hitting A Bird OrAnimal caused by an "accident". that . . occurred before you acquired Or Falling Objects Or Missiles formed the organization;or The following is added to Section ill, (2) Any such :organization that Paragraph A.3.' ' 'insured" under any other liability With respect to any covered "auto" any "policy"providing"auto"coverage.. deductible -Shown in. the Declarations Will not to glass, breakage if such glass Y 1. Any person or organization that you are Anni• is reOaired, in a manner acceptable to us, rather required by a:written:contract to name as an " :additional insured is an insured but only than replaced with,respect to their legal liability for acts Or B. TrantpOrtation Expentes Omissions of a person, who qualifies as an • Insured" under 'Section II = Who Is An Section III, Paragraph A.4.a. is revised, with Insured and for whom Liability Coverage is respect to transportation expense incurred by afforded under this policy. If required .by You,to provide: written contract, this insurance will be a. $60 per day,in lieu of$20, subject to primary and non-contributory to insurance on which the additional insured is'a Named b. $1,800 maximum, in lieu Of$600. insured. CNA631590.. Copyright,CNA Corporation,2000. Page 1 of 3 (Ed. 04/1 Includes copyrighted material of:the Insurance Services OritiCe used 41h its permission. CNA63359XX CNA (Ed. 04/12) C. Loss of Use Expenses Section III, Paragraphs B4 c and B.4.d. are Section IA, Paragraph A.4.b. is revised, with deleted and replaced by he following: respect.to loss of use expenses incurred by you, c. Physical Damage Coverage on a covered to provide: "auto" also applies to "loss" to any permanently installed electronic equipment a. $1,000 maximum, in Ileo of$600, including its antennas and other D. Hired"Autos" accessories. The following is added to Section HI. d. A$100 per occurrence deductible applies to Paragraph-A. the coverage provided by this provision. 5. Hired "Autos" G. Diminution In Value If Physical Damage coverage is provided under . The following is added `to Section III, thispolicy, and such coverage does not extend Paragraph B6:_ to Hired Autos, then Physical damage coverage Subject to the following, the "diminution in is extended to value"exclusion does not apply to:. a. Any covered"auto you lease, hire, rent a. Any covered "auto" of the private or borrow without a driver;:and passenger type you lease, hire; rent or b.: Any covered 'auto"' hired or rented by borrow, without::a driver for a period of your "employee"without a'driver,under 30 days or less,while performing duties a contract in that individual related to the conduct of your business; "eiiiployee's name, with your and permission, while performing duties related to the conduct of your business, �• Any covered 'auto" of the private passenger type hired or rented by your c. The most we Will pay for any one "emploYee"without a driver for a period "accident" or "loss" is the actual cash of-30 days or less, under a contract in value, cost of repair, cost of that individual °employee's"'netiie, with replacement or $75;000, whichever-is your permission, while . performing less, minus;a $500.deductible for each duties :related to the conduct of your covered auto. No deductible:applies to business. loss"caused by fire or lightning., c. Suchcoverage as is provided by this rvisio is "diminution The physical damage coverage as 'is p o Ison (invited:to a in provided by this provision is equalto the value" loss arising directly out of physical damage coverage(s) provided accidental damage and not as a result on your owned"autos." of the failure"to make: repairs; faulty or incomplete maintenance .or repairs; or e, Such physical damage coverage for the installation of substandard parts. hired"autos"will: d. The most we will pay for "loss" to a (1) Include loss of use, provided it is covered "auto" in any one accident is the Consequence of an "accident" the'lesser of: for which the Named Insured :is legally liable, and as a result of (1) $5,000; or which a monetary loss is sustained (2) :20% of the: auto's" actual cash oythe leasing or rental coricerri. value(ACV). (2) Such coverage as is: :provided by this provision will be :subject to a. III. :Drive ether Car"Coverage—Executive Officers limit of$750 per"accident". The,following is added to:SSections II and III: E. Airbag Coverage 1• My"auto" you don't own, hire or borrow is a The covered"auto"for Liability while being following is added #o Section 111, Paragraph B 3.: used by, and; for Physical Damage Coverage while in the care, custody or control of,any of The accidental discharge of an airbag shall not your"executive officers,"except: be considered mechanical breakdown. a. An "auto" ©caned by,hat "executive officer" F. Electronic E ui�pinent or a member of that;person's household;or q "CNA63359XX Copyright„CNA Corporation,2000: Page 2 of 3 (Ed:04/12.) includes:copyrighted.material oi:.ihe Insurance Services Office:used with its permissions: CNA63359XX CNA {Ed. 04/12) b. An "auto" used by that "executive officer" The following is added. to Section IV, while working in a business of selling, Paragraph A.5. Transfer Of Rights Of servicing, repairing or parking"autos." Recovery Against Others To Us: Such Liability and/or .`Physical Damage We waive any right of recovery we may have, Coverage as is afforded by this provision. because of payments we make for injury or . damage, against any person or organization for {1) Equalto the greatest of those ,, whom or which you are required by written coverages afforded any covered auto', contract or agreement to obtain this waiver from and us, {2) Excess over any other collectible This injury or damage must arise out of your insurance. activities under a contract with that person or 2. For purposes of this provision, "executive organization. officer" means a person holding any of the You,must agree to that requirement prior to an officer positions created by your charter, "accident"or"loss," constitution, by-laws or any other similar governing document, and, while a resident of C. Concealment, Misrepresentation or Fraud the same household, includes that person's The following is added to. Section IV, spouse: Paragraph B.2:: Such "executive officers" are "insureds while Your failure to disclose all hazards existing on the usinga covered 'auto" 'described in this date of inception of this Coverage Form shall not provision_ prejudice you respect to the coverage afforded p 1 Y Ae IV. BUSINESS AUTO-CONDITIONS provided such failure:or omission is not intentional. A. Duties In The Event Of Accident, Claim,Suit D. Other Insurance Or Loss The following is added to Section IV, The following is added to Section IV, Paragraph B.5.: Paragraph A.2.a. Regardless of the provisions of Paragraphs 5.a. (4) Your "employees" may know of an and 5.d. above, the coverage provided by this "accident" or "loss. This will not mean policy shall be on" a primary non-contributory that you have such knowledge, unless basis. This provision is applicable only when such ''accident or "loss" is known to required by a written contract. That written you or if you are not an individual, to contract must have been entered into prior to any of your executive :officers or "Accident"or partners or your insurance manager. E. Policy Period,Coverage Territory The following is added to Section IV, Section IV, Paragraph B.7.(5).(a).is revised to Paragraph R.2.b.: provide: (6) Your "employees" may know of documents received concerning a claim a. 45 days of coverage in lieu of 30 days. or ''suit."" This will not: mean that you V. DEFINITIONS have such knowledge, unless receipt of such documents is known to you or if Section V. Paragraph C. is deleted and replaced ,you are not an individual, to:any,of your by the following. executive officers or partners or your "Bodily injury" means bodily, injury, sickness, or insurance manager,: disease, sustained by a person, including mental B. Transfer Of. Rights Of Recovery Against 'anguish, mental injury or death resulting from any of Others To Us these. CNA6335$XX Copyright,CNA Corporation,2000. Page 3 of 3 {Ed.04/12) Includes-copyrighted material otthe.insurance Services Office used with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. *The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 06/02/15 Policy No. T10150030 Endorsement No. 10 Insured Charles King Company, Inc. Policy Effective Date 06/02/15 Insurance Company Torus National Insurance Company 1,1 Countersigned By ati, t' Let WC 04 03 06 (Ed. 4-84) dIF ®1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.