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Home My WebLink AboutAGMT - Meek Company John S (Pier Deck, Phase 1, #50217) (2) 0 This Documentjts electronically recorded by Cert Mail B Recorded in Official Records,Orange County RECORDING REQUESTED BY Tom Daly, Clerk-Recorder AND WHEN RECORDED MAIL TO IINININNINNIIINIIINIIIIIIIININNIIIIININIIINNNNI NO FEE CITY OF SEAL BEACH 2007000473437 10:19am 07/30/07 Attn: City Clerk 213 33 N12 1 211 8th Street 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Seal Beach, CA 90740 • Space of above this line for Recorder's use. ***No Recording Fee Pursuant to Government Code Section 6103,27383 **** NOTICE OF COMPLETION Notice pursuant to Civil Code Section 3093,must be filed within 10 days after completion. Notice is hereby given that: 1. The undersigned is owner or corporate officer of the owner of the interest or estate stated below in the property hereinafter described: 2. The full name of the owner is: City of Seal Beach 3. The address of the owner is: City of Seal Beach,211 8th Street,Seal Beach,CA 90740 4. The nature of the interest or estate of the owner is;In fee.The City of Seal Beach. 5. A work of improvement on the property hereinafter is described as substantially completed on July 23, 2007.The work was: Pier Decking Rehabilitation Phase I, Project 50217. 6. The name of the contractor,for such improvement was: John S. Meek Company,Inc. The date of the Contract Award was:November 13,2006. 7. The property on which said work of improvement was completed in the City of Seal Beach,County of Orange,State of California,and is described as follows: Ocean Avenue. Date: —7/21/47f // Signature of owner or co • :to officer of owner named in paragraph 2 or . agent. VERIFICATION I,the undersigned,say: the Director of Public Works declarant of the foregoing notice of completion;have read said notice of completion and know the contents thereof;the same is true of my own knowledge. I declare under penalty of perjury the foregoing is true and correct. Executed on 7- 2 ,2007,at Seal Beach,California. (Date of ignature) Director of Public Works • • ' TABLE OF CONTEN;TS• CONTRACT DOCUMENTS 1 DOCUMENTS TO SUBMIT UPON AWARD: 1 PUBLIC WORKS CONTRACT 3 PERFORMANCE BOND 5 PAYMENT BOND 7 INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF SUBROGATION AND CONTRIBUTION 9 AGREEMENT TO COMPLY WITHCALIFORNIA LABOR LAW REQUIREMENTS 10 STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS' LICENSING LAWS 12 INSURANCE REQUIREMENTS 15 WORKER'S COMPENSATION CERTIFICATE OF INSURANCE 17 ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY 18 ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY 21 ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY 23 2 I !. ` , . PUBLIC WORKS CONTRACT 41- 502 i For the following project named Pier Deck Rehabilitation Phase I,in the�City�oof Seal Beach. THIS AGREEMENT, made and entered into this /3 4"h Y`-f'� "day of ' . 20 04s by and between the City of Seal Beach, California, hereinafter referred to as the "CITY," Party of the First Part, and John s. M.e.ek Co-wipakl f, lip. hereinafter designated as the"CONTRACTOR,"Party of the Second Part. WITNESSETH: That the Parties do hereto mutually agree as follows: ARTICLE L For and in consideration of the payments and agreements hereinafter mentioned to be made and performed by said CITY,the CONTRACTOR agrees with said CITY to perform and complete in a good and workmanlike manner all the work pertaining thereto shown on the drawings and described in the Specifications and Contract Documents, therefore, to furnish at his own proper cost and expense all tools, equipment, labor and materials necessary therefore (except those materials expressly noted as to be furnished by the CITY), and to do everything required by this Agreement and the said Specifications, Drawings,and Contract Documents. ARTICLE II. For furnishing all said materials and labor, furnishing and removing all plant, temporary works or structures, tools and equipment and doing all the work contemplated and embraced in this Agreement, also for all loss and damage arising out of the nature of the work aforesaid, or from the action of the elements, or from any unforeseen difficulties which may arise or be encountered in the prosecution of the work until its acceptance by said CITY, and for all risks of every description connected with the work; also for all expenses incurred by or in consequence of the suspension or discontinuance of work; except such as in the said Specifications are expressly stipulated to be borne by the said CITY and faithfully completing the work and the whole thereof, in the manner shown and described in the said Drawings, Specifications, and Contract Documents and in accordance with the requirements of the Engineer, said CITY will pay and the CONTRACTOR shall receive in full compensation, therefore, the unit prices and the lump sum prices named in the Schedule of Work Items of the Proposal. ARTICLE III. The CITY hereby promises and agrees with said CONTRACTOR to employ and does hereby employ said CONTRACTOR to provide the materials and to do the work according to the terms and conditions herein contained and referred to for the price aforesaid,and hereby contracts to pay the same,at the time, in the manner and upon the conditions set forth in the Specifications and Contract Documents,and the said parties for themselves, their heirs, executors, administrators, successors and assigns, do hereby agree to the full performance of the covenants herein contained. ARTICLE IV. The advertisement for Bids, the Proposal, the Specifications, and the Drawings mentioned therein, and all addenda issued by the CITY with respect to the foregoing prior to the opening of bids, are hereby incorporated in and made a part of this Agreement. ARTICLE V. By my signature hereunder, as CONTRACTOR, I certify that I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workmen's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract. 3• • • 0 IN WITNESS WHEREOF: The Parties hereto have caused this contract to be executed the day and year first above written. CITY OF S ' • , CALIF', • Party of t 1 I� BY City Maria:: AT EST: • AO ,/ _ - L -- a Clerk r. CONT CTO -Party of the Second Part J 'n S. Meek Company, Inc. o S. Meek, President Tit 14732 So. Maple Avenue Gardena, CA 90248 Address 4 • • Bond No. Bond Premium PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded (Name and address of Contractor) ("Principal"), a contract(the"Contract") for the work described as follows: Sand Retention Groin Repair, including removal of existing temporary steel repair, removal of a portion of the existing concrete cap, furnishing and installing new precast concrete sheetpiles, construction of new concrete cap, and, as directed,repair of remaining concrete cap. WHEREAS, Principal is required under the terms of the Contract to furnish a bond for the faithful performance of the Contract. NOW,THEREFORE,we,the undersigned Principal,and (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Dollars (S ), this amount being not less than the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT,if the hereby bounded Principal,his,her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed,all within the time and in the manner therein specified,and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided,then this obligation shall become null and void;otherwise,it shall be and remain in full force and effect. In case suit is brought upon this bond,Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received,hereby stipulates and agrees that no change, extension of time, alteration,addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. The City is the principal beneficiary of this bond and has all • 5 a • rights of a party hereto. IN WITNESS WHEREOF,two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" By: By: Its Its By: By: Its Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. • 6 • Bond No. Bond Premium PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to (Name and address of Contractor) ("Principal"), a contract(the "Contract") for the work described as follows: Sand Retention Groin Repair, including removal of existing temporary steel repair, removal of a portion of the existing concrete cap, furnishing and installing new precast concrete sheetpiles, construction of new concrete cap, and, as directed,repair of remaining concrete cap. WHEREAS,Principal is required under the terms of the Contract and the California Civil Code to secure the payment of claims of laborers,mechanics,materialmen,and other persons as provided by law. NOW,THEREFORE,we,the undersigned Principal,and (Name and address of Surety) • ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Dollars($ this amount being not less than fifty percent (50%)of the total contract price,in lawful money of the United States of America,for the payment of which sum well and truly to be made,we bind ourselves,our heirs,executors,administrators,successors, and assigns,jointly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT, if the hereby bounded Principal,his,her or its heirs, executors, administrators, successors or assigns, or subcontractors shall fail to pay any of the persons named in Section 3181 of the California Civil Code, or any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract,or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surety will pay for the same in an amount not exceeding the penal sum specified in this bond;otherwise,this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received,hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change,extension of time, alteration, addition, or modification to the terms of the • • • Contract or to the work or to the specifications thereunder. Surety hereby waives the provisions of California Civil Code §§2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" By: By: Its Its By: By: Its Its (Seal) (Seal) - Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. 8 • INDEMNIFICATION AND HOLD HARMLESS AGREEMENTAND WAIVER OF SUBROGATION AND CONTRIBUTION TITLE OF PROJECT OR WORK: Pier Deck Rehabilitation Phase I Indemnitor(s)(list all names): To the fullest extent permitted by law, Indemnitor hereby agrees, at its sole cost and expense, to defend, protect, indemnify, and hold harmless the City of Seal Beach and its elected officials, officers, attorneys, agents, employees, volunteers, successors, and assigns (collectively "Indemnitees") from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses, judgments, penalties, liens, and losses of any nature whatsoever, including fees of accountants, attorneys, or other professionals and all costs associated therewith (collectively "Liabilities"), arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to any act, failure to act, error, or omission of Indemnitor or any of its officers, agents, servants, employees, subcontractors, materialmen, suppliers or their officers, agents, servants or employees, arising or claimed to arise, directly or indirectly, out of, in connection with, resulting from, or related to the above-referenced contract, agreement, license, or permit (the "Agreement") or the performance or failure to perform any term, provision, covenant, or condition of the Agreement, including this indemnity provision. This indemnity provision is effective regardless of any prior, concurrent, or subsequent active or passive negligence by Indemnitees and shall operate to fully indemnify Indemnitees against any such negligence. This indemnity provision shall survive the termination of the Agreement and is in addition to any other rights or remedies which Indemnitees may have under the law. Payment is not required as a condition precedent to an Indemnitee's right to recover under this indemnity provision, and an entry of judgment against an Indemnitee shall be conclusive in favor of the Indemnitee's right to recover under this indemnity provision. Indemnitor shall pay Indemnitees for any attorneys fees and costs incurred in enforcing this indemnification provision. Notwithstanding the foregoing, nothing in this instrument shall be construed to encompass(a) Indemnitees' sole negligence or willful misconduct to the limited extent that the underlying Agreement is subject to Civil Code §2782(a)or(b)the contracting public agency's active negligence to the limited extent that the underlying Agreement is subject to Civil Code § 2782(b). This indemnity is effective without reference to the existence or applicability of any insurance coverage which may have been required under the Agreement or any additional insured endorsements which may extend to Indemnitees. Indemnitor,on behalf of itself and all parties claiming under or through it, hereby waives all rights of subrogation and contribution against the Indemnitees,while acting within the scope of their duties, from all claims,losses and liabilities arising out of or incident to activities or operations performed by or on behalf of the Indemnitor regardless of any prior, concurrent, or subsequent active or passive negligence by the Indemnitees. In the event there is more than one person or entity named in the Agreement as an Indemnitor, then all obligations, liabilities, covenants and conditions under this instrument shall be joint and several. "Indemnitor" Name John S. Meek Company, In . Name: John S. Meek Ccnpany, c. s\By: "` " �' By: !, Its ,b ohn S. Meek, President s John S. Meek, Secretary (1)/ 9 • Page Intentionally Left Blank 10 • • AGREEMENT TO COMPLY WITH CALIFORNIA LABOR LAW REQUIREMENTS [Labor Code§§ 1720,1773.8,1775, 1776,1777.5, 1813,1860, 1861,3700] The undersigned Contractor certifies that it is aware of and hereby agrees to fully comply with the Following provisions of California law: 1. Contractor acknowledges that this contract is subject to the provisions of Division 2, Part 7, Chapter 1 (commencing with Section 1720) of the California Labor Code relating to public works and the awarding public agency("Agency")and agrees to be bound by all the provisions thereof as though set forth in full herein. 2. Contractor agrees to comply with the provisions of California Labor Code Section 1773.8 which requires the payment of travel and subsistence payments to each worker needed to execute the work to the extent required by law. 3. Contractor agrees to comply with the provisions of California Labor Code Sections 1774 and 1775 concerning the payment of prevailing rates of wages to workers and the penalties for failure to pay prevailing wages. The Contractor shall, as a penalty to the Agency, forfeit not more than fifty dollars($50) for each calendar day, or portion thereof, for each worker paid less than the prevailing rates as determined by the Director of Industrial Relations for the work or craft in which the worker is employed for any public work done under the contract by Contractor or by any subcontractor. 4. Contractor agrees to comply with the provisions of California Labor Code Section 1776 which require Contractor and each subcontractor to (1) keep accurate payroll records, (2) certify and make such payroll records available for inspection as provided by Section 1776, and (3) inform the Agency of the location of the records. The Contractor is responsible for compliance with Section 1776 by itself and all of its subcontractors. 5. Contractor agrees to comply with the provisions of California Labor Code Section 1777.5 concerning the employment of apprentices on public works projects, and further agrees that Contractor is responsible for compliance with Section 1777.5 by itself and all of its subcontractors. 6. Contractor agrees to comply with the provisions of California Labor Code Section 1813 concerning penalties for workers who work excess hours. The Contractor shall, as a penalty to the Agency, forfeit twenty-five dollars ($25) for each worker employed in the execution of the contract by the Contractor or by any subcontractor for each calendar day during which such worker is required or permitted to work more than 8 hours in any one calendar day and 40 hours in any one calendar week in violation of the provisions of Division 2,Part 7,Chapter 1,Article 3 of the California Labor Code. 7. California Labor Code Sections 1860 and 3700 provide that every contractor will be required to secure the payment of compensation to its employees. In accordance with the provisions of California Labor Code Section 1861,Contractor hereby certifies as follows: "I am aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract." Date ( 2_-0 -0 b Signature ,1 A i 11 Page Intentionally Left Blank • 12 • • STATEMENT ACKNOWLEDGING PENAL AND CIVIL PENALTIES CONCERNING THE CONTRACTORS° LICENSING LAWS [Business&Professions Code § 7028.15] [Public Contract Code§20103.5] I, the undersigned, certify that I am aware of the following provisions of California law and that I, or the entity on whose behalf this certification is given,hold a currently valid California contractor's license as set forth below(required at time of award) : Business&Professions Code§ 7028.15: (a) It is a misdemeanor for any person to submit a bid to a public agency in order to engage in the business or act in the capacity of a contractor within this state without having a license therefor, except in any of the following cases: •(1) The person is particularly exempted from this chapter. (2) The bid is submitted on a state project governed by Section 10164 of the Public Contract Code or on any local agency project governed by Section 20104 [now § 20103.5] of the Public Contract Code. (b) If a person has been previously convicted of the offense described in this section, the court shall impose a fine of 20 percent of the price of the contract under which the unlicensed person performed contracting work, or four thousand five hundred dollars ($4,500), whichever is greater, or imprisonment in the county jail for not less than 10 days nor more than six months,or both. In the event the person performing the contracting work has agreed to furnish materials and labor on an hourly basis, "the price of the contract" for the purposes of this subdivision means the aggregate sum of the cost of materials and labor furnished and the cost of completing the work to be performed. (c) This section shall not apply to a joint venture license, as required by Section 7029.1. However, at the time of making a bid as a joint venture, each person submitting the bid shall be subject to this section with respect to his or her individual licensure. (d) This section shall not affect the right or ability of a licensed architect, land surveyor, or registered professional engineer to form joint ventures with licensed contractors to render services within the scope of their respective practices. (e) Unless one of the foregoing exceptions applies, a bid submitted to a public agency by a contractor who is not licensed in accordance with this chapter shall be considered non-responsive and shall be rejected by the public agency. Unless one of the foregoing exceptions applies, a local public agency shall, before awarding a contract or issuing a purchase order, verify that the contractor was properly licensed when the contractor submitted the bid. Notwithstanding any other provision of law,unless one of the foregoing exceptions applies, the registrar may issue a citation to any public officer or employee of a public entity who knowingly awards a contract or issues a purchase order to a contractor who is not licensed pursuant to this chapter. The amount of civil penalties, appeal, and finality of such citations shall be subject to Sections 7028.7 to 7028.13, inclusive. Any contract awarded to,or any purchase order issued to,a contractor who is not licensed pursuant to this chapter is void. (f) Any compliance or noncompliance with subdivision (e) of this section, as added by Chapter 863 of the Statutes of 1989, shall not invalidate any contract or bid awarded by a public agency during which time that subdivision was in effect. (g) A public employee or officer shall not be subject to a citation pursuant to this section if the public employee, officer, or employing agency made an inquiry to the board for the purposes of 13 • verifying the license status of any person or contractor and the board failed to respond to the inquiry within three business days. For purposes of this section, a telephone response by the board shall be deemed sufficient. Public Contract Code §20103.5: In all contracts subject to this part where federal funds are involved, no bid submitted shall be invalidated by the failure of the bidder to be licensed in accordance with the laws of this state. However,at the time the contract is awarded, the contractor shall be properly licensed in accordance with the laws of this state. The first payment for work or material under any contract shall not be made unless and until the Registrar of Contractors verifies to the agency that the records of the Contractors' State License Board indicate that the contractor was properly licensed at the time the contract was awarded. Any bidder or contractor not so licensed shall be subject to all legal penalties imposed by law, including, but not limited to, any appropriate disciplinary action by the Contractors' State License Board. The agency shall include a statement to that effect in the standard form of pre-qualification questionnaire and financial statement. Failure of the bidder to obtain proper and adequate licensing for an award of a contract shall constitute a failure to execute the contract and shall result in the forfeiture of the security of the bidder. License no.: 709151 Class: A B HAZ. Expiration date: ,I • Date 12-8-06 Signature v " - • 14 i • INSURANCE REQUIREMENTS The Contractor shall at all times during the terms of the Contract carry,maintain,and keep in full force and • effect a policy or policies of comprehensive general liability insurance in which the City, along with its City Council and each member thereof, and every officer, official, agent, attorney, employee or volunteer of the City, is the named insured or is named as an additional insured with the Contractor in accordance with the General Provisions. The insurance company issuing such policy(ies) must be acceptable to, and approved by, the City Engineer and City Attorney. Contractor shall maintain limits of no less than One Million Dollars($1,000,000)combined single limit coverage per occurrence for personal injury or death or property loss or damage which may arise from or relate directly or indirectly to the acts, operations or omissions of the performance of the Contractor and/or its subcontractors and/or the employees, agents, officers,officials or volunteers of either, in the performance of this Public Works Contract. Such insurance shall include coverage for all automobiles utilized by Contractor's or any subcontractor's employees or agents in the performance of the Contract. Contractor shall also provide an endorsement in the forms included in Book II. • 15 S • Page Intentionally Left Blank 16 • • WORKER'S COMPENSATION CERTIFICATE OF INSURANCE WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by NOW THEREFORE,the undersigned insurance company does hereby certify that it has issued the policy or policies described below to the following named insureds and that the same are in force at this time. 1. This certificate is issued to: CITY OF SEAL BEACH, City Hall, 211 EIGHTH STREET, SEAL BEACH, CA 90740-6379. 2. The insureds under such policy or policies are: 3. Worker's Compensation Policy or Policies in a form approved by the Insurance Commissioner of California covering all operations of the named insureds,as follows: POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the CITY OF SEAL BEACH. By: Its Authorized Representative • 17 • • Page Intentionally Left Blank 18 • • ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFICIAL TITLE OF PROJECT:Pier Deck Rehabilitation Phase I Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows: 1. The City of Seal Beach, its elected officials, officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. • 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s) or permit(s) designated above, between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or'non-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereof. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent,or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction,interpretation,and enforcement of this contract of insurance. 19 • 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: Director of Public Works City of Seal Beach 211 8th Street,2nd Floor Seal Beach CA 90740 10. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: ❑ Contractual Liability ❑ Explosion Hazard ❑ Owners/Landlords/Tenants ❑ Collapse Hazard ❑ Manufacturers/Contractors ❑ Underground Property Damage ❑ Products/Completed Operations ❑ Pollution Liability ❑ Broad Form Property Damage ❑ Liquor Liability ❑ Extended Bodily Injury ❑ ❑ Broad Form Comprehensive - ❑ ❑ General Liability Endorsement 12. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s)except: (if none, so state). The deductible is applicable ❑ per claim or ❑ per occurrence(check one). 13. This is an ❑ occurrence or ❑ claims made policy(check one). 14. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed ,20 • • Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: ( ) 20 • • ADDITIONAL INSURED ENDORSEMENT AUTOMOBILE LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFFICAL TITLE OF PROJECT:Pier Deck Rehabilitation Phase I Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy")or in any endorsement now or hereafter attached thereto, it is agreed as follows: The City of Seal Beach,its elected officials,officers,attorneys, agents,employees,and volunteers are additional insureds(the above named additional insureds are hereafter referred to as the"Additional Insureds")under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 1. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 2. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 3. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 4. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained or executed in conjunction with the written agreement(s)or permit(s)designated above,between the Named Insured and the Additional Insureds. 5. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits(except as the result of the payment of claims),or non-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 6. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent, or subsequent active or passive negligence by the Additional Insureds. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction, interpretation,and enforcement of this contract of insurance. This endorsement and all notices given hereunder shall be sent to Public Agency at: Director of Public Works City of Seal Beach 211 8th Street,2nd Floor Seal Beach CA 90740 7. Except as stated above and not in conflict with this endorsement, nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. • 21 • • TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: ❑ Any Automobiles ❑ Truckers Coverage ❑ All Owned Automobiles ❑ Motor Carrier Act ❑ Non-owned Automobiles ❑ Bus Regulatory Reform Act ❑ Hired Automobiles ❑ Public Livery Coverage ❑ Scheduled Automobiles ❑ ❑ Garage Coverage ❑ 11. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s)except: (if none,so state). The deductible is applicable ❑ per claim or ❑ per occurrence(check one). 12. This is an ❑ occurrence or ❑ claims made policy(check one). 13. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed ,20 Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: ( ) 22 • • . ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY Name and address of named insured("Named Insured"): Name and address of Insurance Company("Company"): OFFICIAL TITLE OF PROJECT:Pier Deck Rehabilitation Phase I Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy")or in any endorsement now or hereafter attached thereto, it is agreed as follows: 1. The City of Seal Beach, its elected officials,officers, attorneys, agents, employees, and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s)or pennit(s)designated above,between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or non-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prior to the effective date thereto. In the event of Company's failure to comply with this notice provision,the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior,concurrent, or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity, construction,interpretation,and enforcement of this contract of insurance. • 23 • 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: Director of Public Works City of Seal Beach 211 8th Street,2nd Floor Seal Beach CA 90740 10. Except as stated above and not in conflict with this endorsement,nothing contained herein shall be held to waive, alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO LIABILITY ❑ Following Form ❑ Umbrella Liability 0 10. Applicable underlying coverages: INSURANCE COMPANY POLICY NO. AMOUNT 11. The following inclusions, exclusions, extensions or specific provisions relate to the above coverages: 12. A ❑ deductible or ❑ self-insured retention (check one) of $ applies to all coverage(s)except: (if none, so state). The deductible is applicable ❑per claim or❑ per occurrence(check one). 13. This is an ❑ occurrence or ❑ claims made policy(check one). 14. This endorsement is effective on at 12:01 A.M. and forms a part of Policy Number I, (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,I do so bind the Company. Executed ,20 Signature of Authorized Representative (Original signature only; no facsimile signature or initialed signature accepted) Phone No.: ( ) 24 • • Dond No. 176-74-16 Bond Premium $2,971.00 PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach, has awarded, John S. Meek Company, Inc. 14732 So. Maple Avenue. Gard- , . , C: 90737 (Name and address of Contractor) ("Principal"), a contract(the "Contract")fbr the work described as follows: Sand Retention Groin Repair, including removal of existing temporary steel repair, removal of a portion of the existing concrete cap, furnishing and installing new precast concrete sheetpiles, construction of new concrete cap, and, as directed,repair of remaining concrete cap. W1{EREAS. Principal is required under the termc of the f;nntrac:t to #irnich H hnnd for the faithful performance of the Contract. NOW,THEREFORE, we,the undersigned Principal, and Great American Insurance Company 750 The City Boulevard South, Suite 300. Orange. CA 92668-4940 (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Two hundred sixty two thousand nine hundred twenty f ve and no/100 Dollars (S 262,925.00 ), this amount being not less than the total contract price, in lawful money of the United States of America, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and absigub,juiutly and severally,firmly by these presents. THE CONDITION OF THIS OBLIGA"1ION IS SUCH THAT, if the hereby bounded Principal,his,her or its heirs, executors, administrators, successors or assigns, shall in all things stand to and abide by, and well and truly keep and perform all the undertakings, terms, covenants, conditions and agreements in the Contract and any alteration thereof made as therein provided, on the Principal's part to be kept and performed,all within the time and in the manner therein specified,and in all respects according to their true intent and meaning, and shall indemnify and hold harmless the Public Agency, its officers, agents, and others as therein provided,then this obligation shall become null and void; otherwise,it shall be and remain in full force and effect. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to he perfnrrned thereunder, or the specifications for the same,shall in any way affect its obligations under this bond,and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the Contract or to the work or to the specifrcatiuua thereunder, Surety hereby waives the provisions of California Civil Code §§ 2845 and 2849. The City is the principal beneficiary of this bond and has all • 5 • . rights of a party hereto. IN WITNESS WHEREOF,two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof, have been duly executed by Principal and Surety, on the date set tbrth below, the name of each corporate pary being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" JOHN S. MEEK COMPANY, INC. GREAT AMERICAN INSURANCE COMPANY• ralL p By, j By: Rhonda C. Abel John S. Meek, Pi nt Its Attorney—in—Fact By: , Presi By: 1 o . 'ee , -cretary Its (Seal) (Seal) Note: This bond must be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. 6 • • CLIL DIFOIACIOA ,k1,11,-PUIRP©SCE ACGIM®N%LIEDGIVCNT Y F.F. State of California g 0 County of Los Angeles ss. On . gr a00 6 before me, Emily J. White, Notary Public �y Date Name and Title of Officer(e.g.."Jane Doe,Notary Public") Ai personally appeared John S. Meek Name(s)of Signer(s) , 1 E personally known to me ❑ proved to me on the basis of satisfactory Pevidence �3 to be the person() whose name(s)glare EMILY 1.WHITE f subscribed to the within instrument and co mmiuion# 1513023 acknowledged to me that h�/she/they executed $: .% � Notary public-Cal(fornlu the same in EM/her/their authorized (• t ,��;,;`:I M9eles County ( capacity(ies), and that by (s er/their 'i MY Comm.Expires Sep 12,20081 1 signature(§)on the instrument the person(s), or y ` the entity upon behalf of which the person(s) yi acted, executed the instrument. WITNESS my hand and official seal. '$1 Sigo3ture of Notary Public $ V :I OPTIONAL �' Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent $1 fraudulent removal and reattachment of this form to another document. ri 1 Description of Attached Document ; ' s �� Title or Type of Document:G?14�C¢/agif (3�c.v ) Aa a $1 Document Date: /1/Z.S/D Number of Pages: 2— ' Signer(s)Other Than Named Above: gLnitw a $' E. $ Capacity(ies) Claimed by Signer )$1 A. John S. Meek Signer's Name: RIGHT THUMBP..R.IN.T�11 OF SIGNEf3ti i f ❑ Individual Top of thumb here ft, [ Corporate Officer—Title(s): President 's i« ❑ Partner—❑Limited ❑General ? ` ❑ Attorney-in-Fact '91` ❑ Trustee '•i ❑ Guardian or Conservator 'l % ❑ Other: s Signer Is Representing: John S. Meek Company, Inc. $1 s. L•..-7-• - ..-- . •!7-Ate'•-- •d.,:e7 t7-.A7•es-. - •417 P7 AS'.S1,d'•d" AY er-t7•ey.aY. �. - -ay,d>•a, . •v.E/Z— •�'• - -- •G V, 0 1999 National Notary Association•9350 De Solo Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnolary.org Prod.No.5907 Reorder:Call Toll-Free 1-800.876-6827 , , • • C1A14.MIP®I iI& LILL-PURPOSE ACKNOWLEDGMENT 14 •vi4�-]•�,S c.<., :Ts-=1 9i,:]oi..,-f.:5?... . .1r,...71, of iC-',..751 s�75..,t]•c\2.7.�.,. •�cNCs�_-=i4 ,,.�,.,._ c�!T.s�,:�',ca. s i 4 .J '1 ia State of California ? County of Los Angeles ss. s) On c?. V 7-00 S before me, Emily J. White, Notary Public 9 Date Name and Title of Officer(e.g.,"Jane Doe,Notary Public') • 9 l personally appeared -SoLv\ $•Mee ,4 > Name(s)of Signer(s) On 1 personally known to me ?1 �� ❑ proved to me on the basis of satisfactory l evidence ? i', ,y, EMILYJ.WHITE to be the person(k) whose nameIs)(mare .1 11 4, Commission# 1513023 subscribed to the within instrument and ?' -■ Notary Public-California t acknowledged to meh.atj�she/they executed '9 ` ' �1::,;:,,,3';;q Los Angeles County the same in f er/their Authorized ''$ '� �My Comm.Expires Sep 12,2008 capacity(ics), and that by (his'/her/their i signature(s)on the instrument the person(p), or yl the entity upon behalf of which the person(s) s acted, executed the instrument. y WITNESS my hand and official seal. 9- ig atuy6 t Notary Public ?1 OPTIONAL ., (`4 Though the information below is not required by law,it may prove valuable to persons relying-on the document and could prevent :i fraudulent removal and reattachment of this form to another document. ') Description of Attached Document '$ �/L C t�0 Title or Type of Document: ®� U" 4 13and 3�(�v„3 1 xve_a a- ADocument Date: if/t;rf/O c Number of Pages: -2 Signer(s)Other Than Named Above: Re-t-sk o-- a _' s• r4 (4<4 Capacity(ies) Claimed by Signer • Signer's Name: John S. Meek '$ RIGHTITHUMBPRINT ';.i OFISIGNER <<: ❑ Individual Top of thumb here • ?C7 Corporate Officer—Title(s): Secretary >$1 ❑ Partner—❑Limited ❑General ❑ Attorney-in-Fact ?: ❑ Trustee :'$ ❑ Guardian or Conservator 'l (e; ❑ Other: ) Signer Is Representing: John S. Meek Company, Inc. (c� 9 p 9 1 ry e.,a% e74-'e7;�3i r%c<A,-,•�er v•ar;J:("ti'A."4• e7ry: 4✓C3;`e7.riti ri,ri ✓t en--e%-4✓< ,,G<:_?,G ri ei% .,✓6"_- .] 0 1999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnotary.org Prod.No.5907 Reorder:Call Toll-Free 1-800-876.6827 • ACKNOWLEDGEMENT State of California County of Orange On I I —.2 — V 6 before me, J. Barragan,Notary Public (here insert name and title of the officer) personally appeared Rhonda C.Abel personally known to me (or 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 acknowledge 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. J. BARRAGAN WITNESS my hand and official se-I. -•ti._ Commission# 1635125 $ ' Notary Public-California Zi Orange County Signature .i 7 My Comm.Expires Jan 5,2010 / (Seal) OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ® ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR NUMBER OF PAGES ❑ OTHER: SIGNER IS REPRESENTING: DATE OF DOCUMENT NAME OF PERSON(S)OR ENTITY(IES) SIGNER(S) OTHER THAN NAMED ABOVE S-4067/GE 1/06 FRP • • Bond No. 176-74-16 Bond Premium included in charge for Performance Bond PAYMENT BOND (LABOR AND MATERIALS) KNOW ALL PERSONS BY THESE PRESENTS that: WHEREAS the City of Seal Beach,has awarded to John S. Meek Company t Inc. 14732 So. Maple Avenue, Gardena, CA 90732 (Name and address of Contractor) ("Principal"), a contract(the "Contract") for the work described as follows: Sand Retention Groin Repair, including /en/oval of existing tempora,y steel of a purtiuu of the existing concrete cap, furnishing and installing new precast concrete sheetpiles, construction of new concrete cap, and, as directed,repair of remaining concrete cap. WHEREAS, Principal is required under the terms of the Contract and the California Civil Code to secure the payment of claims of laborers.mechanics.rnaterialmen, and other persons as provided by law. NOW,THEREFORE,we,the undersigned Principal,and Great American Insurance Company 750 The City Boulevard South, Suite 300. 0jange,, CA 92668-4940 (Name and address of Surety) ("Surety") a duly admitted surety insurer under the laws of the State of California, as Surety, are held and firmly bound unto the Public Agency in the penal sum of Two hundred sixty two thousand nine hundred twenty five and no/100 Dollars($ 262.925.00 this amount being not less than fifty rerr•nr (50%)of the total contract price, in lawful money of the United States of America,for the payment of which sum well and truly to be made,we bind ourselves,our heirs,executors,administrators,successors, and assigns,jointly and severally, firmly by theee presents. THE CONDITION OF THIS OBLIGATION IS SUCH THAT,if the hereby bounded Principal,his,her ur its heirs, executors, administrators, successors or assigns, or subcontractors shall fall to pay any of the persons named in Section 3181 of the California Civil Code, or any amounts due under the Unemployment Insurance Code with respect to work or labor performed under the Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of the Principal and subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to work or labor performed under the Contract, the Surely will ray fnr the same in an amount not exceeding the penal sum specified in this bond;otherwise,this obligation shall become null and void. This bond shall insure to the benefit of any of the persons named in Section 3181 of the California Civil Code so as to give a right of action to such persons or their assigns in any suit brought upon the bond. In case suit is brought upon this bond, Surety further agrees to pay all court costs and reasonable attorneys' fees in an amount fixed by the court. FURTHER,the Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration, addition or modification to the terms of the Contract, or of the work to be performed thereunder, or the specifications for the same, shall in any way affect its obligations wide' this bond, and it does hereby waive notice of any such change, extension of time, alteration, addition, or modification to the terms of the 7 I • Contract or to the work or to the.specifications thereunder. Surety hereby waives the provisions of California Civil Code §§2845 and 2849. IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original hereof,have been duly executed by Principal and Surety, on the date set forth below, the name of each corporate party being hereto affixed and these presents duly signed by its undersigned representative(s)pursuant to authority of its governing body. Dated: "Principal" "Surety" JOHN S. MEEK COMPANY, INC. GREAT AMERICAN INSURANCE mow Dy: / By: Rhonda C. Abel By: I4 S. Pre i. -nt By. Its Attorney—in—Fact y: is John S. Meek, Secretary its (Seal) (Seal) Note: This bond must.be dated, all signatures must be notarized, and evidence of the authority of any person signing as attorney-in-fact must be attached. 8 • • ©&ILDlF©RMILe1 &11.11,-PMIAIPOo SIE Lc1CCZ1N1ON7D.l,12(01191ER4 ..A...-z— ,:;...,, ,..7 =1,?a_v.a�.,.s ,.z•oa.v.<=�L.T.,. ,.- .- .-_ ,.:,..c-•..\_.,-5,:. .o3.•_c1......_-a. :. -N.. * <,%c .;9i-;o, •_ , ; bi r C lcc, State of California $1 �% Los An Angeles SS. '..1 (� County of g '9 W,.,,• On t o - ) 2 O o G before me, Emily J. White, Notary Public Date Name and Title of Officer(e g.,°Jane Doe,Notary Public') 9 �` personally appeared John S. /V1 e E '�1 Names)of Signer(s) ' �C ,�I personally known to me k ❑ proved to me on the basis of satisfactory �� (e evidence '$1 $ ( � � EMILY J.WHITE to be the person( whose name(�)�is7are f( „1 Commission# 1513023 subscribed to the within instrument and ?i ` ..4-,..-,1-c,-6- ' acknowledged to me t at s/she/they executed °� Notary Public-CaUfomlu ` � ,'r Los Angeles County the same in t i) er/their authorized '9( ��IT.1 My Comm.ExplresSM 12,2006 capacity(ies), and that by (a/her/their .>$I K signature(4)on the instrument the person( ), or y( r,G the entity upon behalf of which the person(s) ',y e acted, executed the instrument. (S WITNESS my hand and official seal. '�1 SLiji turNotary Public 9 . VVVVVV '$ r. � $ OPTIONAL yl Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent g fraudulent removal and reattachment of this form to another document. '; (4. Description of Attached Document '$) �G '$) Title or Type of Document:9Cc�(�v� e4kt iigte c3'•L' ) /ma_e '$ J ,I • Document Date: rr/ s(/0 Co Number of Pages: Signer(s)Other Than Named Above: (} dc� lip-6-ee $. 14 X91 �< $I v Capacity(ies) Claimed by Signer : Signer's Name: John S. Meek ?( RIGHTtaomBPRWT ;'$1 A OFASIGNER i L Top of thumb here i- y ;0 ?❑ Corporate Officer—Title(s): Secretary ❑ Partner—❑ Limited ❑General 1 ❑ Attorney-in-Fact ?( ❑ Trustee '$ ❑ Guardian or Conservator ; ❑ Other: y (4„ Signer Is Representing: John S. Meek Company, Inc. ;� 'i-r,, r,:d-cW< c. ;��;L;r3i L, .—e.re7rer,'v ai r--v;`<en Us ."r trrU<�z".:rs�i e..,;Cvi":;•: 4 '•r✓", z', 0 1999 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.naaonalnotary.org Prod.No.5907 Reorder:Call Toll-Free 1-800-876-6827 I . C&ILOIFORRIOA Add.FIDE F®SE ACGINi®NdEIDOf>ifilENIT cx^� .e. :co.ec r.ec:-xlc. �.�c�S g:P. ,. 5 ' S'.e'c`�C' ..�5` 5 -CetcC �,0, v 1 �•' State of California rS `{ Los Angeles SS. County of ` i //ll ,•g�• On 1-C- S, Lao before me, Emily J. White, Notary Public ([�� Date Name and Title of Officer(e.g.,'Jane Doe,Notary Public") } �' personally appeared Job S S. Meek �1 Name(s)of Signer(s) ,,rrSS; llpersonally known to me rr�,y1 ❑ proved to me on the basis of satisfactory • 'Z�� evidence �1� AN to be the person(s) whose name($) are ' EMILY J.WHITE subscribed to the within instrument and g t, Commission# 1513023 1 <, •° r; acknowledged to me that/she/they executed Notary Public-California i T `; - the same in her/their authorized Los Angeles County l0 r capacity(ies), and that by t1i her/their '1 MyCornm.Expires Sep 12 2008 signature(s) on the instrument the person(s), or $ I the entity upon behalf of which the person(e) $1 acted, executed the instrument. y; i' 9 1' WITNESS my hand and official seal. 'S1 Sign f NpC#ry Public $I 0 $ I� OPTIONAL yi i Though the information below is not required by law,it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. 1 i� Description of Attached Document Title or Type of Document: 1 r ( 'oii (3 rl e7) icea- _, Document Date: ft/L.-K/0 , Number of Pages: Z 1 Signer(s)Other Than Named Above: gt„,,a��– a�..e yl S, Capacity(ies) Claimed by Signer ' John S. Meek .. Signer's Name: RIGHT.ttT,HUMBPRINT yOF�SIGNEfa� ❑ Individual Top of thumb here tg E Corporate Officer—Title(s): President $ I'' ❑ Partner—❑ Limited ❑General s ❑ Attorney-in-Fact ❑ Trustee 1 ❑ Guardian or Conservator y ❑ Other: ;;1 i John S. Meek Company, Inc. 11 2 Signer Is Representing: +y• s -- a7 AY d AY aY a7 a7 a7 A 7- V. - •ale A7 d' - •A' d' A- d'.ar•er-A7" d'•a7 e7•A.Y. . •AY A 7 eY.d',A;"-d-.a''• - . ,a:� 0 1999 National Notary Association•9350 De Solo Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.nationalnolary.org Prod.No.5907 Reorder.Call Toll-Free 1-800.876-6827 • ACKNOWLEDGEMENT State of California County of Orange On I I —28 — oC before me, J.Barragan,Notary Public (here insert name and title of the officer) personally appeared Rhonda C.Abel personally known to me (or 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 acknowledge 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 instrum J. BARRAGAN _ 4 ! Commission# 1635125 i ,61.:b Notary Public-California WITNESS my hand and official seal. � �� 9. ry '`:' :+ Orange Coun My Comm.Expires Jan ty 5,2010 Signature 0009- ii (Seal) OPTIONAL Though the data below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent reattachment of this form. CAPACITY CLAIMED BY SIGNER DESCRIPTION OF ATTACHED DOCUMENT ❑ INDIVIDUAL ❑ CORPORATE OFFICER TITLE OR TYPE OF DOCUMENT TITLE(S) ❑ PARTNER(S) ❑ LIMITED ❑ GENERAL ATTORNEY-IN-FACT ❑ TRUSTEE(S) ❑ GUARDIAN/CONSERVATOR NUMBER OF PAGES ❑ OTHER: SIGNER IS REPRESENTING: DATE OF DOCUMENT NAME OF PERSON(S)OR ENTITY(IES) SIGNER(S)OTHER THAN NAMED ABOVE S-4067/GE 1/06 FRP • I • • • GREAT AMERICAN INSURANCE COMPANY® Administrative Office:580 WALNUT STREET° CINCINNATI,OHIO 45202° 513-369-5000° FAX 513-723-2740 The number of persons authorized by this power of attorney is not more than SIX No.0 14079 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the GREAT AMERICAN INSURANCE COMPANY,a corporation organized and existing under and by virtue of the laws of the State of Ohio,does hereby nominate,constitute and appoint the person or persons named below its true and lawful attomeyin-fact,for it and in its name,place and stead to execute in behalf of the said Company,as surety,any and all bonds,undertakings and contracts of suretyship,or other written obligations in the nature thereof;provided that the liability of the said Company on any such bond,undertaking or contract of suretyship executed under this authority shall not exceed the lint stated below. Name Address Limit of Power STANLEY C.LYNN ALL OF ALL JAMES A.SCHALLER IRVINE, $75,000,000.00 JANE KEPNER CALIFORNIA NANETTE MARIELLA-MYERS RHONDA C.ABEL SUZANNE EDWARDS This Power of Attorney revokes all previous powers issued in behalf of the attomey(s)-in-fact named above. IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officers and its corporate seal hereunto affixed this 28`" day of, JUNE , 2006. Attest GREAT AMERICAN INSURANCE COMPANY STATE OF OHIO,COUNTY OF HAMILTON-ss: DAVID C.KITCHIN (513-369-3811) On this 28th day of JUNE , 2006, before me personally appeared DAVID C.KITCHIN,to me known,being duly sworn, deposes and says that he resides in Cincinnati,Ohio,that he is the Divisional Senior Vice President of the Bond Division of Great American Insurance Company,the Company described in and which executed the above instrument;that he knows the seal of the said Company;that the seal affixed to the said instrument is such corporate seal;that it was so affixed by authority of his office under the By-Laws of said Company,and that he signed his name thereto by like authority. This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated March 1,1993. RESOLVED:That the Division President,the several Division Vice Presidents and Assistant Vice Presidents,or any one of them,be and hereby is authorized,from time to time,to appoint one or more Attorneys-in-Fact to execute on behalf of the Company,as surety,any and all bonds,undertakings and contracts of suretyship,or other written obligations in the nature thereof, to prescribe their respective duties and the respective limits of their authority;and to revoke any such appointment at any time. RESOLVED FURTHER:That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond,undertaking,contract or suretyship, or other written obligation in the nature thereof such signature and seal when so used being hereby adopted by the Company as the original signature of such officer and the original seal of the Company,to be valid and binding upon the Company with the same force and effect as though manually affixed. CERTIFICATION I,RONALD C.HAYES,Assistant Secretary of Great American Insurance Company,do hereby certify that the foregoing Power of Attorney and the Resolutions of the Board of Directors of March 1,1993 have not been revoked and are now in full force and effect. Signed and sealed this a -1117ay of,gLe-vK....)e-L... ,a00‘ S 1029T(11/01) • • WORKER'S COMPENSATION CERTIFICATE OF LN'SURANCE WHEREAS,the CITY OF SEAL BEACH has required certain insurance to be provided by Commerce& Industry Ins. Co. NOW THEREFORE,the undersigned insurance company does hereby certify that it has issued the policy or policies les''l i'4 l.' luw lo the following named insureds and that the same are in force at this time. 1. This certificate is issued to: CITY OF SEAL BEACH, City Hall,211 EIGHTH STREET, SEAL BEACH,CA 90740-6379. 2. The insureds under such policy nr poi iriRs Are:John S. Meek Company Inc. 3. Workcr'a Compensation Policy or Policies in a form approved by the Ius•wan a Cuuunissioner of California covering all operations of the named insureds,as follows: POLICY NUMBER EFFECTIVE DA J.'I~ EXPIRATION DATE WC2955458 1/1/06-1/1/07 WC2955459 1/1/06-1/1/07 4. Said policy or policies shall not be canceled, voided or reduced in coverage or limits of liability, unless and until thirty days' advance written notice thereof has been served upon the City Clerk of the Lil'Y OF L BEACH. Its Auth • epresentative • 17 I ADDITIONAL INSURED ENDORSEMENT COMPREHENSIVE GENERAL LIABILITY JOHN S. MEEK COMPANY, INC. 14732 S. MAPLE AVE., GARDENA, CA 90248 Name and address of named insured("Named Insured"): AMERICAN HOME ASSURANCE CO ,, 777 S. FIGUEROA ST., LOS ANGELES, CA 90017 Name and address of Insurance Company("Company"): OFFICIAL TITLE OP PROJECT:Pier Deck Rehabilitation Phase I Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the"Policy")or in any endorsement now or hereafter attached thereto,it is agreed as follows: 1. Thu City of Seal Beach,its elected officials,officers,attorneys,agents,employees,and volunteers are additional insureds (the above named additional insureds are hereafter referred to as the "Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured The Additional Insureds have no liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance, and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. - 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one insured under the policy against another insured under the policy. All such claims shall covered as third-party claims, i.e., in the same manner as if separate policies had been issued to each insured Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. • 5. The insurance afforded by the Policy for contractual liability insurance (subject to the terms, conditions and exclusions applicable to such insurance) includes liability assumed by the Named Insured under the indemnification and/or hold harmless provision(s) contained in or executed in conjunction with the written agreement(s)or permit(s)designated above,between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage,reduction of limits (except as the result of the payment of claims), or'non-renewal except after writtcu nutius to Public Agency, by certified mail,return receipt requested,not less than thirty (30) days prior to the effective date thereof. In the event of Company's failure to comply with this notice provision, the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. • 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims, losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior, concurrent,or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California shall apply to and govern the validity. construction,interpretation,and enforcement of this contract of insurance. 19 80/E0 39Vd 00 >93'4 S NHOP E9tZSE88TE 8b:ZT 9092/LZ/TT • S 9. This endorsement and all notices given hereunder shall be sent to Public Agency at: Director of Public Works City of Seal Beach 211 Nth Street,2"Floor Seal Beach CA 90740 10. Except as stated above and not in conflict with this endorsement,nothing contained herein shall be held to waive,alter or extend any of the limits, agreements, or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACKS FROM/TO r_ret:ILITy 1-1-06/07 $1,000,000/$2,000,000 11. Scheduled items or locations are to be identified on an attached sheet. The following inclusions relate to the above coverages. Includes: XI Contractual Liability 30 Explosion Hazard ❑ Owners/Landlords/Tenants ff Collapse Hazard ❑ Manufacturers/Contractors 2) Underground Property Damage R. Products/Completed Operations 0 Pollution Liability II Broad Form Property Damage 0 Liquor Liability ❑ Extended Bodily Injury ❑ IX Broad Form Comprehencive - ❑ at General Liability Endorsement 12. A'XX deductible or ❑ self-insured retention (check ono) of S 5,000 applies to all coverage(s)except: — (if none,so state). The deductible is applicable ❑per claim or 0 per occurrence(check one). 13. This is an X occurrence or 0 claims made policy(check one). 14. This endorsement is effective on 11-27-06 • at 12:01 A.M.and forms a part of Policy Number_ 00419 DIANE HALL (print name), hereby declare under penalty of perjury under the laws of the State of California,that 1 have the authority to bind the Company to this endorsement and that by my execution hereon I do so bind the Company. Executed, NOVEMBER 27 _ ,200+ • of Authorized Nepres • •- 've (Original signature only; no facsimile signature or initialed signature accepted) Phone Na.: (213 ) 630-3200 • 20 B0/170 39Vd OD >133'l S NHOI' E9'29E80TE 8t':ZT 9002/LZ/TT S ADDITIONAL INSURED ENDORSEMENT EXCESS LIABILITY . JOHN S. MEEK COMPANY, INC. 14732 S. MAPLE AVE., GARDENA, CA 90248 Nu ne and address of named Insured C Named Insured.): AMERICAN HOMES ASSURANCE CO., 777 S. FIGUEROA ST. , LOS ANGELES, CA 90017 Name and address of Insurance Company("Company"): OFFICIAL TTTT.(i.OR PROJECTS Pier beck Rehabilitation Phase Notwithstanding any inconsistent statement in the policy to which this endorsement is attached (the "Policy")ur in any endorsement now or hereafter attached thereto,it is agreed as follows: I. The City of Seal Beach,its elected officials,officers,attorneys,agents,employees.and volunteers are additional insureds(the above named additional insureds are hereafter referred to as the"Additional Insureds") under the Policy in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured. The Additional Insureds have nn liability for the payment of any premiums or assessments under the Policy. 2. The insurance coverages afforded the Additional Insureds under the Policy shall be primary insurance,and no other insurance maintained by the Additional Insureds shall be called upon to contribute with the insurance coverages provided by the Policy. _ 3. Each insurance coverage under the Policy shall apply separately to each Additional Insured against whom claim is made or suit is brought except with respect to the limits of the Company's liability. 4. Nothing in this contract of insurance shall be construed to preclude coverage of a claim by one . insured under the policy against another insured under the policy. All such claims shall covered as thhd pasty claims,i.e.,in the same manner as if separate policies had been issued to each insured. Nothing contained in this provision shall operate to increase or replicate the Company's limits of liability as provided under the policy. 5. The insurance afforded by the Policy for contractual liability insurance (subject to the touts, conditions and exclusions applicable to such insurance)includes liability assumed by the Named Insured under the indernni$catiou iwd/ur hold harmless provision(s) contained in or executed in conjunction with the written agreements)or permit(s)designated above,between the Named Insured and the Additional Insureds. 6. The policy to which this endorsement is attached shall not be subject to cancellation, change in coverage, reduction of limits (except as the result of the payment of claims), or eon-renewal except after written notice to Public Agency, by certified mail, return receipt requested, not less than thirty (30) days prim to the effective date thereto. In the event of Company's failure to comply with this notice provision,the policy as initially drafted will continue in full force and effect until compliance with this notice requirement. 7. Company hereby waives all rights of subrogation and contribution against the Additional Insureds, while acting within the scope of their duties, from all claims,losses and liabilities arising out of or incident to the perils insured against in relation to those activities described generally above with regard to operations performed by or on behalf of the Named Insured regardless of any prior,concurrent,or subsequent active or passive negligence by the Additional Insureds. 8. It is hereby agreed that the laws of the State of California.shall apply to and govern the validity, Consfrnrtion,interpretation,and enforcement of this contract of insurance. 23 80/L0 3JVd 00 >133W S NHOL' ESIZ5E80IE 817:ZI 9002/LZ/TT • • • 9. This endorsement and all notices given hereunder shall be sent to Public Agency at Director of Public Works City of Seal Beach 211 8th Street,2"4 Floor Seal Beach CA 90740 10. Except as stated above and nut in conflict with this endorsement,nothing contained herein shall be held to waive, alter or extend any of the limits, agreements,or exclusions of the policy to which this endorsement is attached. TYPE OF COVERAGES TO WHICH POLICY PERIOD LIMITS OF THIS ENDORSEMENT ATTACHES FROM/TO 1-1-06/07 LIABILITY ❑ Following Form N Umbrella Liability ❑ 10. Applicable underlying coverages: INSURANCE COMPANY POLICY NO. AMOUNT $1,000,000/$2,000,000 - Q0419 AMERICAN HONE ASSURANCE $1,000,000 CSL 72UENIL4406 HARTFORD FIRE INS. CO,.. 11. The following inclusions, exclusions, extensions or specific provisions relate to the above coverages_ 12. A u deductible or IN sell-insured retention (check one) of $ 25,000 applies to all coverage(s)except: (if none, so state). The deductible is applicable 0 per claim or N per occurrence(check one). 13. This is an occurrence or 0 claims made policy(check one). 14. This endorsement is effective on IlA4I7+-06 at 12:01 A.M.and forms a part of Policy Number Q0420 I, DIANE HALL (print name), hereby declare under penalty of perjury under the laws of the State of California, that I have the authority to bind the Company to this endorsement and that by my execution hereof,l do so bind the Company. Executed NOVEMBER 27 ,2006./ / e , ahire:of Authorized Re. -sentative (Original signature I nly; no facsimile signature or initialed signature accepted) • Phone No.: (213 ) 630-3200 24 80/80 39Vd 00 >133W S NHOL' E9TZ9EBBTE Bti:ZT 900Z/LZ/IT ` .1011:4,112110. CERTIF� DATE(MM/DD/YY) ATE OF LIABILITY INSUNCE 11/27/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Aon Risk Services,Inc.of Southern California CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 707 Wilshire Blvd.,Suite 6000 DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Los Angeles,CA 90017 POLICIES BELOW. Phone: (213)630-3200 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER k John S.Meek Company,Inc. INSURER B: Hartford Fire Insurance Co. 19682 - 14732 S.Maple Ave INSURER C: Gardena,CA 90248 INSURER D: INSURER E: • .R '.Uy=.tf N, '.�sp 4:46,,....1. . . ,- ._.. ye .-:.}�6" .. .. ','.'4_..-4.: * ._ ik -' t, --4,w. 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LIMITS LTR INSRD DATE(MMIDDNY) DATE(MMIDDIYY ❑ GENERAL LIABILITY EACH OCCURRENCE $ El COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1=1 CLAIMS MADE OCCURRENCE PREMISES(Ea occurence) ❑ MED EXP(My one person) $ ❑ PERSONAL&ADV INJURY $ • GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS—COMP/OP AGG $ ❑POLICY ❑PROJECT ❑LOC B ❑ AUTOMOBILE LIABILITY 72UENIL4406 1/1/2006 1/1/2007 COMBINED SINGLE LIMIT 1,000,000 n ANY AUTO (Ea accdent) $ • n ALL OWNED AUTOS BODILY INJURY 0 SCHEDULED AUTOS (Per person) $ n HIRED AUTOS BODILY INJURY n NON OWNED AUTOS (Per accident) $ Q $500 Ded.Comp/Coll Ea PROPERTY DAMAGE $ ❑ (Per accident) ❑ GARAGE LIABILITY AUTO ONLY—EA ACCIDENT $ ❑ ANY AUTO EA ❑ OTHER THAN ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ ❑ OCCUR ❑ CLAIMS MADE AGGREGATE $ El DEDUCTIBLE $ 1=I RETENTION $ WORKERS'COMPENSATION AND ❑ TORY LIMMITS ❑OThER -r EMPLOYERS'LIABILITY ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L.DISEASE—EA EMPLOYEE $ If Yes,describe under SPECIAL PROVISIONS below E.L DISEASE—POLICY LIMIT .$ OTHER DESCRIPTION OF OPERATIONS ILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS John S.Meek Company 2006/07 161588 Re:Pier Deck Rehabilitation Phase I • Certificate Holder is added as Additional Insured for vehicles used by or on behalf of the Named Insured. .adg^ cuwraa+.ssA ,. ... t-e. �Y �, 's:2:: ' -1Zi i. '`� •.i` -"'L y -.- 3� a .Q , fir yr .. :r,CER.i FICATE'HOL'•DER� rz�� . �.�. _ ; ,- C N ELLATION3i,�,�. ��,,� .-,� _,�-� _.i_s��.�._ y_,�'� �> k q SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of Seal Beach ,,1 THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL R0 DAYS WRITTEN NOTICE TO THE Director of Public Works •`,.- CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION - 211 8th St.,2nd FL ' OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Seal Beach,CA 90740 AUTHORIZED REPRESENTATIVE` -,;tir 4111111111P 'ACORD 25'(2QUJ1/08):17.,:.1-z. r SP 4�. 1'1 .. . r°.:.R 4 y:.> „-;' ' t_ i f r,3.- -'®ACORQ C-OTRP�Q�ATION+7988 1 • • Wood Gutmann&Bogart Insurance Brokers 15901 Red Hill Ave.,Suite 100 ? Tustin CA 92780 ry DUUUQU v Certificates of Insurance&Evidence of Property U.S. Mail Document City of Seal Beach Sender: Amanda Vanderlip City Hall Phone: 714 505.7000 211 Eighth St. Subject: john S. MeekfCompany,Inc. SEAL BEACH CA 90740-6379 Date: 12/26/2007 No.of Pages: 3 URL: www.wgbib.com This document was created by eCertsONLINE. - The attached or linked document(s)contain certification of insurance coverage for the insured named in the subject above. Your company is listed as the organization requesting receipt of these documents. Please review the coverages listed, as this document may reference only certain lines of coverage for renewal purposes only. If the certificate references specific lines of coverage that have recently renewed, you will receive updated certificates as appropriate, as the successive policies also renew. If this document is sent via e-mail, you must click on the link below. The linked document is in a pdf format, and you must have Adobe Acrobat Reader installed on your system. To download the Adobe Reader for free,visit www.Adobe.com. If you have any questions regarding the content of this message, you should contact the Producer/Agency listed on the attached/linked documents. To find out more about how you can create, send and receive all of your Certificates of Insurance or Evidences of Property documents via email, fax, US mail or next day mail, call Insurance Visions at (800)497-9996, or visit our web site at www.eCertsONLINE.com. Click on the following link to retrieve and print the documents. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITIY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE ININTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT,YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION,DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. W W W.eCerisOnline.com ®2003 Insurance Visions,inc.-www.insurancevisions.com • • Aco oT CERTIFICATE OF LIABILITY INSURANCE Date(mm/dd/yy) L 12/26/2007 Producer Amanda Vanderiip THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. Wood Gutmann &Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE 15901 Red Hill Ave., Suite 100 COVERAGE AFFORDED BY THE POLICIES BELOW. Tustin CA 92780 INSURERS AFFORDING COVERAGE 714 505.7000 INSURER National Union Fire Ins.Co.Pitts,PA www.wgbib.com A License No. 0679263 INSURER B Insured INSURER C INSURER John S. Meek Company, Inc. D 14732 So. Maple Ave. INSURER Gardena CA 90248 E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY INSR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER M DATE M DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIAR FIRE DAMAGE(An one fire) $ (CLAIMS MADE IDOCCUR MED EXP(An one.erson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGG LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY I�ROJECTI I—I LOC $ AUTOMOBILE LIABILITY _ ANY AUTO COMBINED SINGLE LIMIT ALL OWNED AUTOS BODILY INJURY _SCHEDULED AUTOS (Per person) $ _HIRED AUTOS BODILY INJURY _NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ _ R ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG$ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ RDEDUCTIBLE $ RETENTION$ $ WORKERS'COMPENSATION& EI D LIMIT I OTHER A EMPLOYERS'LIABILITY WC 295-33-10 1/1/2008 1/1/2009 EL EACH A CCIDENT 5 1.000.000 EL DISEASE-EA EMPLOYEE 5 1,000.000 EL DISEASE-POLICY LIMIT $ 1.000.000 A (USL&H/JONES) WC 295-33-11 1/1/2008 1/1/2009 Ea.Acc 1M Dis/Empl. 1M/1M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISISNS Re:City Project#50217 CERTIFICATE HOLDER CANCELLATION City Project#50217 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Seal Beach EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City Hail 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- 211 Eighth St. SENTATIVES. *10 Days for Non-Payment of Premium Seal Beach CA 90740-6379 AUTHORIZED REPRESENTATIVE James E.Gutmann ACORD 25-S(7/97) ©ACORD CORPORATION 1988 s • IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) created at www.e CertsON LIN E.com ! w Wood Gutmann&Bogart Insurance Brokers 15901 Red Hill Ave.,Suite 100 Tustin,CA 92780 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonline TM Sender: An Odebiyi City of Seal Beach r Phone:. 714 505.7000 City Hall 211 Eighth St. • -' . Certificate of Liability:John S.Meek Company, SEAL BEACH CA 90740-6379 'Subject_, Inc. Date:: 12/31/2008 'No.of Pages:, 3 URL:i www.wgbib.com This document was created by eCertsONLINE. The attached or linked document(s)contain certification of insurance coverage for the insured named in the subject above.Your company is listed as the organization requesting receipt of these documents. Please review the coverages listed, as this document may reference only certain lines of coverage for renewal purposes only. If the certificate references specific lines of coverage that have recently renewed, you will receive updated certificates as appropriate, as the successive policies also renew. If this document is sent via e-mail, you must click on the link below. The linked document is in a pdf format, and you must have Adobe Acrobat Reader installed on your system. To download the Adobe Reader for free,visit www.Adobe.com. If you have any questions regarding the content of this message,you should contact the Producer/Agency listed on the attached/linked documents. To find out more about how you can create, send and receive all of your Certificates of Insurance or Evidences of Property documents via email,fax, US mail or next day mail, call Insurance Visions at (800)497-9996,or visit our web site at www.eCertsONLINE.com. Click on the following link to retrieve and print the documents. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT.YOU ARE HEREBYNOTIFIED THAT ANY DISSEMINATION,DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMEDIATELY BY TELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. 0 2002 Certificate of Insurance Delivered by ecertsoolmeTM Insurance Visions,Inc.All rights reserved. r • • ACO,o" CERTIFICATE OF LIABILITY INSURANCE • Date(mm/dd/yy) 12/31/2008 Producer THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES Wood Gutmann & Bogart Insurance Brokers COVERAGE CERTIFICATE FORDED BY THETPOLICES BELOW.D OR ALTER THE 15901 Red Hill Ave., Suite 100 Tustin, CA 92780 INSURERS AFFORDING COVERAGE INSURER Seabright Insurance A 714 505.7000 License No.0679263 INSURER www.wgbib.com B Insured INSURER John S. Meek Company, Inc. C 14732 So. Maple Ave. INSURER Gardena CA 90248 D INSURER E COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY POLICY INSR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/DAE M DATE LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIAB FIRE DAMAGE(Any one fire) $ 'CLAIMS MADE LIOCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEN'L AGG LIMIT APPLIES PER PRODUCTS.COMP/OP AGG $ POLICY riPROJECTI—I LOC $ AUTOMOBILE LIABILITY _ANY AUTO COMBINED SINGLE LIMIT s —ALL OWNED AUTOS BODILY INJURY _SCHEDULED AUTOS (Per person) $ _HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S RANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S EXCESS LIABILITY EACH OCCURRENCE S OCCUR ['CLAIMS MADE AGGREGATE $ S RDEDUCTIBLE S RETENTION S $ A EMPLOYERS'OLABI LIABILITY & BB1091892 1/1/2009 1/1/2010 EL EACH ACCIDENT LIMIT OTHER EL EACH ACCIDENT S 1,000,000 EL DISEASE-EA EMPLOYEE 5 1.000.000 EL DISEASE-POLICY LIMIT S 1.000.000 A (USL&H/JONES) BB1091892 1/1/2009 1/1/20.10 Ea.Acc 1M Dis/Empl. 1M/1M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISI6NS Re:City Project#50217 CERTIFICATE HOLDER . , • • • - CANCELLATION . . City Project#50217 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Seal Beach EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL City Hall 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 211 Eighth St. LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION Seal Beach CA 90740-6379 OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE- SENTATIVES. •10 Days for Non-Payment of Premium. AUTHORIZED REPRESENTATIVE �� ^ .�.�• James E.Gutmann J V ACORD 25-S(7/97) • - . - O ACORD CORPORATION 1988 CERT NO.: 4268343 CLIENT CODE: JOHNS-2 An Odebiyi 12/31/2008 3:39:21 PM Page 1 • • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97) created at www.e CertsONLINE.com CERT NO.: 4268343 CLIENT CODE: .IOHNS-2 Ari Odebiyi 12/31/2008 3:39:21 PM Page 2 . IF • • .•3.4 '• • StpecE.Ra_ 0 - m FLez POLICY From The Hartford , , ,.- - , .. ' , - -:- • ., , .! .....e.,•:,,.. • - - •. -.... : , ,, ,,,,.., , . .p .., „..r....,, .... .r; .. -...;, -.244 , ,.... f h.•-•.;- . ..•6•-•-• ,-,•-!.--" it::-•,;',-- . ,!, .,..--.....,--- • --t--zz=- - .'''''...:--,,---.--..5,„-..„...-7•--- --N-Y.:•-',.7.'.,71'7:-..'1..41"•••,.-1:•--,----i'%::::- _44:•„...•--.`-''''''.....---__,-,--.. 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''' -- ' ,i ...:.!t.' f' - -!'" --..-- •,.1.1.17 r . . 1/ ' V Ir.:-.'.‘‘ .1.:1,-''' .7-' r ''' ,. ..". ‘••• '',/..f•.`4//';''' 'y —... . ....t- '. 'I .: ' it- - '. ' '. ' ' • . '''( IA : i''': 'P..: • • •I .• . . /,\. •', .., ,e,1• a . / i c 7'4 Ids SPECIAL MULTI-FLEX POL1CYSrovided by the insurance company(s)of Th rtford Insurance Group,shown below. I r._ COMMON POLICY DECLARATIONS THE A04'POLICY NUMBER: 72 USN 11,4406 x2 HARTFORD RENEWAL OF: 72 UEN IL4406 Named Insured and Mailing Address: MEN S• AMIE COMPANY, INC. (No.,Street,Town,State,Zip Code) 1931 N. GAIFEY STREET STE C SAN PEDRO , CA 90731 d, (LOS ANGELES COUNTY) c Policy Period: From 01/01/06 To 01/01/07 • T-1 12:01 A.M. , Standard time at your mailing address shown above. 0 `D in return for the payment of the premium, and subject to all of the terms of this policy,we agree with you to provide Insurance as stated In this policy. The Coverage Parts that are a part of this policy are listed below. The Advance H Premium shown may be subject to adjustment. N Total Advance Premium: $36,414.00 In Coverage Part and Insurance Company Summary Advance Premium G COMMERCIAL AUTO HARTFORD FIRE INSURANCE COMPANY III HARTFORD PLAZA $36,414.00 HARTFORD, CONNECTICUT 06115 sa ` sat Certified Copy Signed a IM Form Numbers of Coverage Parts,Forms and Endorsements that are a part of this policy and that are not listed In the Coverage Parts. Nam HM0001 IL00171198 1H09850203 IL00210702 IL02701104 HA00250302 Esmi AgentlBroker Name: ACE RISK SERVICES, INC of 8o C7►LIF This policy is not binding unless countersigned by our Authorized Representative. Countersigned by Date Authorized Representative ORIGINAL / ,t... '• / I ./„ COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. in N O O r°.4 A. Cancellation C. Examination Of Your Books And Records 0 1. The first Named Insured shown in the We may examine and audit your books and CCP Declarations may cancel this policy by mailing records as they relate to this policy at any time a or delivering to us advance written notice of during the policy period and up to three years H cancellation. afterward. N c4 2. We may cancel this policy by mailing or D. Inspections And Surveys °o delivering to the first Named Insured written 1. We have the right to: 1 notice of cancellation at least: a. Make inspections and surveys at any time; * a. 10 days before the effective date of b. Give you reports on the conditions we find; s cancellation if we cancel for nonpayment of and • premium; or c. Recommend changes. imb. 30 days before the effective date of 2. We are not obligated to make any inspections, cancellation if we cancel for any other surveys, reports or recommendations and any >= reason. such actions we do undertake relate only to 3. We will mail or deliver our notice to the first insurability and the premiums to be charged. is Named Insured's last mailing address known We do not make safety inspections. We do to us. not undertake to perform the duty of any •4. Notice of cancellation will state the effective person or organization to provide for the m date of cancellation. The policy period will health or safety of workers or the public. And end on that date. we do not warrant that conditions: Em 5. If this policy Is cancelled, we will send the first a. Are safe or healthful; or ® Named Insured any premium refund due. If b. Comply with laws, regulations, codes or ® we cancel, the refund will be pro rata. If the standards. first Named Insured cancels, the refund may 3. Paragraphs 1. and 2. of this condition apply be less than pro rata. The cancellation will be not only to us, but also to any rating, advisory, effective even if we have not made or offered rate service or similar organization which a refund. makes insurance inspections, surveys, reports 6. If notice is mailed, proof of mailing will be or recommendations. = sufficient proof of notice. 4. Paragraph 2. of this condition does not apply g_ B. Changes to any inspections, surveys, reports or This policy contains all the agreements between recommendations we may make relative to I• you and us concerning the insurance afforded. certification, under state or municipal statutes, The first Named Insured shown in the ordinances or regulations, of boilers, pressure Declarations is authorized to make changes in vessels or elevators. the terms of this policy with our consent. This policy's terms can be amended or waived only by IM endorsement issued by us and made a part of this policy. • IL 00 17 11 98 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2 • • a . - .. . E. Premiums If you die, your rights and duties will be The first Named Insured shown in the transferred to your legal representative but only Declarations: while acting within the scope of duties as your 1. Is responsible for the payment of all legal representative. Until your legal premiums; and representative is appointed, anyone having 2. Will be the payee for any return premiums we proper temporary custody of your property will pay. have your rights and duties but only with respect F. Transfer Of Your Rights And Duties Under to that property. This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual named insured. • Our President and Secretary have signed this policy. The Declarations page has also been countersigned by our duly authorized representative. .1g4/4± ,4-deciev,.. Brian S. Becker, Secretary David Zwiener, President • Page2of2 1L 00 17 11 98 POLICY NUMBER: 72 UEN ILS06 THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT OF 2002. THIS ENDORSEMENT DOES NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER THE POLICY. DISCLOSURE PURSUANT TO TERRORISM RISK O INSURANCE ACT OF 2002 r1 0 TERRORISM PREMIUM (CERTIFIED ACTS) H - NCoverage: Premium(if Covered): 0 0 AUTO $ 0.00 TOTAL $ 0.00 A. Disclosure Of Premium B. Disclosure Of Federal Participation In Payment In accordance with the federal Terrorism Risk Of Terrorism Losses Emi Insurance Act of 2002, we are required to provide The United States Government, Department of the you with a notice disclosing the portion of your Treasury, will pay a share of terrorism losses premium, if any, attributable to coverage for insured under the federal program. The federal terrorist acts certified under that Act. The portion of share equals 90% of that portion of the amount of your premium attributable to such coverage is such insured losses that exceeds the applicable shown above in this endorsement. insurer retention. mem Imes NEE Form IN 09 85 02 03 Page 1 of 1 0 2003, The Hartford (Includes copyrighted material of the Insurance Services Office, Inc., with its permission.) / 1. : ,` ' • IL 00210702 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) C o This endorsement modifies insurance provided under the following: 0 COMMERCIAL AUTOMOBILE COVERAGE PART r, COMMERCIAL GENERAL LIABILITY COVERAGE PART ) FARM COVERAGE PART .°o LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILRY COVERAGE PART -0 POLLUTION LIABILITY COVERAGE PART NPRODUCTS/COMPLETED OPERATIONS UABILITY COVERAGE PART n PROFESSIONAL LIABILITY COVERAGE PART c RAILROAD PROTECTIVE LIABILITY COVERAGE PART C3 UNDERGROUND STORAGE TANK POLICY m 4. 1. The insurance does not apply: B. Under any Medical Payments coverage, to A. Under any Liability Coverage,to'bodily injury' or expenses incurred with respect to 'bodily Injury' 'properly damage': resulting from the 'hazardous properties' of a iiiiii 'nuclear material' and arising out of the operation (1) With respect to which an 'insured' under the of a 'nuclear facility' by any person or policy is also an insured under a nuclear a' organization. = energy liability policy issued by Nuclear B Energy Liability Insurance Association,Mutual C. Under any Liability Coverage,to 'bodily injury' or Atomic Energy Liability Underwriters, Nuclear 'property damage' resulting from 'hazardous a� of'nuclear material',if: Insurance Association of Canada or any of properties' their successors, or would be an insured -(1) The 'nuclear material' (a) Is at any 'nuclear sm under any such policy but for its termination facility'owned by,or operated by or on behalf upon exhaustion of its limit of liability;or of,an'insured'or(b)has been discharged or ® (2) Resulting from the 'hazardous properties' of dispersed therefrom; �: 'nuclear material' and with respect to which (2) The 'nuclear material' is contained in 'spent M (a) any person or organization is required to fuel' or 'waste' at any time possessed, maintain financial protection pursuant to the handled, used, processed,stored,transported Atomic Energy Act of 1954, or any law or disposed of,by or on behalf of an'insured'; ® amendatory thereof,or(b).the 'insured' is, or or had this policy not been issued would be, . is entitled to indemnity from the United States of (3) The bodily injury' or property damage' m America, or any agency thereof, under any arises out of the furnishing by an 'insured' of agreement entered Into by the United States services, materials, parts or equipment in a� Enga connection with the planning, construction, liNe of America, or any agency thereof, with any maintenance,operation or use of any''nuciear Me person or organization. facility',but if such facility is located within the United States of America, its territories or swam possessions or Canada, this exclusion (3) EBBE applies only to 'property damage' to such — 'nuclear facility'and any property thereat. IL 00 21 07 02 0 ISO Properties,Inc., 2001 Page 1 of 2 2. As used in this endorsement: (c) Any equipment or device used for the 'Hazardous properties' includes radioactive, toxic or processing, fabricating or alloying of 'special explosive properties. nuclear material' If at any time the total amount of such material In the custody of the 'Nuclear material' means 'source material', 'Special 'Insured' at the premises where such nuclear material'or"by-product material'. equipment or device is located consists of or 'Source material' 'special nuclear material', and contains more than 25 grams of plutonium or 'by-product material' have the meanings given them uranium 233 or any combination thereof, or in the Atomic Energy Act of 1954 or in any law more than 250 grams of uranium 235; amendatory thereof. (d) Any structure, basin, excavation, premises or 'Spent fuel' means any fuel element or fuel place prepared or used for the storage or component, solid or liquid, which has been used or disposal of"waste"; exposed to radiation In a'nuclear reactor'. and includes the site on which any of the foregoing is 'Waste' means any waste material (a) containing located,all operations conducted on such site and all 'by-product material' other than the tailings or premises used for such operations. wastes produced by the extraction or concentration Nuclear reactor' means any apparatus designed or of uranium or thorium from any ore processed used to sustain nuclear fission in a self-supporting primarily for its 'source material' content, and (b) chain reaction or to contain a critical mass of resulting from the operation by any person or fissionable mateiial. organization of any 'nuclear facility' Included under the first two paragraphs of the definition of 'nuclear 'Property damage' includes all forms of radioactive facility'. contamination of property. Nuclear facility'means: (a) Any'nuclear reactor'; (b) Any equipment or device designed or used for • (1) separating the Isotopes of uranium or plutonium, (2).processing.or utilizing 'spent fuel',or(3)handling,processing or packaging waste'. • • Page 2 of 2 0 ISO Properties,Inc., 2001 IL 00 2107 02 , i • 0 IL 02 7011 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: BOILER AND MACHINERY COVERAGE PART cm CAPITAL ASSETS PROGRAM(OUTPUT POLICY)COVERAGE PART o COMMERCIAL AUTOMOBILE COVERAGE PART o COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART .--I CRIME AND FIDELITY COVERAGE PART c, EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART o FARM COVERAGE PART -0 LIQUOR LIABILITY COVERAGE PART H POLLUTION LIABILITY COVERAGE PART c.4 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART c PROFESSIONAL LIABILITY COVERAGE PART 0 • V A. Paragraphs 2. and 3. of the Cancellation 3. All Policies In Effect For More Than 60 Common Policy Condition are replaced by the Days following: ,, a. If this policy has been in effect for more si 2. All Policies In Effect For 60 Days Or Less: than 60 days, or is a renewal of a policy Ira If this policy has been in effect for 60 days or we issued, we may cancel this policy only less, and is riot a renewal of a policy we have upon the occurrence, after the effective gwa previously issued, we may cancel this policy date of the policy, of one or more of the by mailing or delivering to the first Named following: ® Insured at the mailing address shown in the (1) Nonpayment of premium, including a policy and to the producer of record, advance payment due on a prior policy we ___ written notice of cancellation, stating the issued and due during the current lima reason for cancellation,at least: policy term covering the same risks. a. 10 days before the effective date of (2) Discovery of fraud or material ® cancellation if we cancel for. misrepresentation by: (1). Nonpayment of premium;or (a) Any insured or his or her (2) Discovery of fraud by: representative in obtaining this ..� insurance;or t� (a) Any insured or his or her representative in obtaining this (b) You or your representative in NEM insurance;or Ili Emm pursuing a claim under this policy. (b) You or your representative in (3) A judgment by a court or an ® administrative tribunal that you have Ima pursuing a claim under this policy. violated a California or Federal law, b. 30 days before the effective date of having as one of its necessary elements ® cancellation if we cancel for any other an act which materially increases any of reason. •the risks insured against. mica mom (4) Discovery of willful or grossly ® negligent acts or omissions, or of any M violations of state laws or regulations establishing safety standards, by you IL 02 7011 04 Copyright, Insurance Services Office, Inc.,2004 Page 1 of 3 • • or your representative, which materially a. If such coverage has been in effect for 50 increase any of the risks insured days or less, and is not a renewal of against. coverage we previously issued, we may (5) Failure by you or your representative cancel this coverage for any reason, to implement reasonable loss control except as provided in b.and c.below. requirements, agreed to by you as a b. We may not cancel this policy solely condition of policy issuance, or which because the first Named Insured has: were conditions precedent to our use of a particular rate or rating plan, if (1) Accepted an offer of earthquake that failure materially increases any of coverage; or the risks insured against. (2) Cancelled or did not renew a policy (6) A determination by the Commissioner issued by the California Earthquake of Insurance that the: Authority (CEA) that included an (a) Loss of, or changes in, our earthquake policy premium surcharge. reinsurance covering all or part of the risk would threaten our However, we shall cancel this policy if the financial integrity or solvency;or first Named Insured has accepted a new (b) Continuation of the policy or renewal policy issued by the CEA that coverage would: includes an earthquake policy premium (i) Place us In violation of California surcharge but fails to pay the earthquake law or the laws of the state policy premium surcharge authorized by where we are domiciled;or the CEA. (ii) Threaten our solvency. c. We may not cancel such coverage solely (7) A change by you or your because corrosive soil conditions exist on representative in the activities or the premises. This restriction (C.) applies property of the commercial or only if coverage is subject to one of the industrial enterprise;which results in a following, which exclude loss or damage. materially added, increased or caused by or resulting from corrosive soil changed risk, unless the added, conditions: increased or changed risk is included in the policy. (1) Capital Assets Program Coverage Form b. We will mail or.deliver advance written (Output Policy); notice of cancellation, stating the reason (2) Commercial Property Coverage Part- for cancellation, to the first Named Causes Of Loss=Special Form; or Insured, at the mailing address shown in the policy, and to the producer of record, (3) Farm Coverage Part- Causes of Loss at least: Form - Farm Property, Paragraph D. (1) 10 days before the effective date of Covered Causes of Loss-Special. cancellation if we cancel for nonpayment C. The following is added and supersedes any of premium or discovery of fraud;or provisions to the contrary: (2) 30 days before the effective date of NONRENEWAL cancellation.if we cancel for any other 1. Subject to the provisions of Paragraphs Cl. reason listed in Paragraph 3.a. and C.3. below, if we elect not to renew this B. The following provision is added to the policy, we will mail or deliver written notice Cancellation Common Policy Condition: stating the reason for nonrenewal to the first 7. Residential Property Named Insured shown in the Declarations and This provision applies to coverage on real to the producer of record, at least 60 days, but property which is used predominantly for not more than 120 days, before the expiration residential purposes and consisting of not more or anniversary date. than four dwelling units, and to coverage on We will mail or deliver our notice to the first tenants' household personal property in a Named Insured, and to the producer of record, residential unit, if such coverage is written under at the mailing address shown in the policy. one of the following: Commercial Property Coverage Part Farm Coverage Part - Farm Property - Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form Page 2 of 3 IL 02 7011 04 • • r� 2. Residential Property the Commissioner has approved a - This provision applies to coverage on real plan for the nonrenewals that is fair property used predominantly for residential and equitable, and that is responsive purposes and consisting of not more than four to the changes in our reinsurance dwelling units, and to coverage on tenants' position. household property contained in a residential c. We will not refuse to renew such coverage unit, if such coverage is written under one of solely because the first Named Insured the following: has cancelled or did not renew a policy, Capital Assets Program (Output Policy) issued by the California Earthquake Coverage Part Authority that included an earthquake Commercial Property Coverage Part policy premium surcharge. Farm Coverage Part - Farm Property - Farm d. We will not refuse to renew such coverage oDwellings, Appurtenant Structures And solely because corrosive soil conditions c Household Personal Property Coverage Form. exist on the premises. This restriction (d.) a. We may elect not to renew such coverage applies only if coverage is subject to one r., for any reason,except as provided in b.,c, of the following, which exclude loss or and d. below: damage caused by or resulting from .°c b. We will not refuse to renew such coverage corrosive soil conditions: solely because the first Named Insured has (1) Cap r�al Assets Program Coverage Form a "accepted an offer of earthquake coverage. ( Policy); nHowever, the following applies only to (2) Commercial Property Coverage Part - c insurers who are associate participating Causes Of Loss-Special Form; or o insurers as established by Cal. Ins. Code (3) Farm Coverage Part-Causes Of Loss * Section 10089.16. We may elect not to Form - Farm Property, Paragraph D. renew such coverage after the first Named Covered Causes Of Loss-Special. • — Insured has accepted an offer of earthquake 3. We are not required to send notice of ® coverage, if one or more of the following nonrenewal in the following situations: reasons applies: • (1) a. If the transfer or renewal of a policy, tl= ( ) The nonrenewal is based on sound without any changes in terms, conditions, underwriting principles that relate to the nom coverages or rates, is between us and a member of tB g provided by this policy and our insurance group. that are consistent with the approved sum rating plan and related documents filed b. If the policy has been extended for 90 with the Department of Insurance as days or less, provided that notice has • required by existing law; been given in accordance with Paragraph MEM ® (2) The Commissioner of Insurance finds that C'1' the exposure to potential losses will c. If you have obtained replacement ___ threaten our solvency or place us in a coverage,or if the first Named Insured has ia hazardous condition. A hazardous agreed, in writing, within 60 days of the ® condition includes, but is not limited to, a termination of the policy, to obtain that condition in which we make claims coverage. ® payments for losses resulting from an d. If the policy is for a period of no more than ® earthquake that occurred within the 60 days and you are notified at the time of mem NM preceding two years and that required a issuance that it will not be renewed. reduction in policyholder surplus of at e. If the first Named Insured requests a least 25%for payment of those claims;or IM sei (3) We have: change in the terms or conditions of risks covered by the policy within 60 days of the MIN (a) Lost or experienced a substantial end of the policy period. reduction in the availability or tams f. If we have made a written offer to the first scope of reinsurance coverage;or Named Insured, in accordance with the — (b) Experienced a substantial timeframes shown in Paragraph C.1., to increase in the premium charged renew the policy under changed terms or for reinsurance coverage of our conditions or at an increased premium residential property insurance rate,when the increase exceeds 25%. policies;and iL 02 7011 04 Page 3 of 3 • Quick Reference Commercial Auto Coverage Part Business Auto Coverage Form READ YOUR POLICY CAREFULLY BUSINESS AUTO COVERAGE FORM in DECLARATIONS rn 0 .--1 o Named Insured And Address 0 o Coverages,Covered Autos And Limits Of Insurance CD o Rating Exposures,Rates And Estimated Premium 0 %o BUSINESS AUTO COVERAGE FORM N Beginning on Page Beginning on Page N PREAMBLE SECTION IV-Business Auto Conditions °• o Definitions of"You"and"We" 1 o Loss Conditions ul ✓ - Appraisal For Physical Damage Loss 7 SECTION I Autos - Duties In The Event of Accident,Claim, ill o Description of Covered Auto Designation Suit or Loss 7 ie Symbols 1 EOM o Owned Autos You Acquire After the Policy - Legal Action Against Us 8 Begins 2 - Loss Payment-Physical Damage o Certain Trailers,Mobile Equipment And Coverages 8 saw - Transfer Of Rights Of Recovery� Temporary Substitute Autos 2 ry Against Others To Us 8 am= SECTION 11-Liability Coverage o General Conditions o Coverage 2 - Bankruptcy 8 _ o Who is An Insured 2 - Concealment,Misrepresentation Or Fraud 8 o Coverage Extensions - Liberalization 8 - Supplementary Payments 3 - No Benefit To Bailee-Physical Damage ® - Out of State Coverage Extensions 3 Coverages 8 ® o Exclusions 3 - Other Insurance 8 o Umit of Insurance 5 - Premium Audit 9 ® - Policy Period,Coverage Territory 9 ® Mail SECTION 111-Physical Damage Coverage - Two Or More Coverage Forms Or Policies ® o Coverage 5 issued By Us 9 me o Exclusions 6 SECTION V-Definitions 9 IM o Limit of Insurance 7 o Deductible 7 NMI SEEM 0 Form HA00040302 0 2001,The Hertford(includes copyrighted material of ISO Properties,Inc.,with Its permission.) e COMMERCIAL AUTOMOBILE COVERAGE PART- DECLARATIONS THE A"' BUSINESS AUTO COVERAGE FORM HARTFORD POLICY NUMBER: 72 UEN 1L4406 This COMMERCIAL AUTOMOBILE COVERAGE PART consists of: c • A. This Declarations Form; B. Business Auto Coverage Form;and C. My Endorsements issued to be a part of this Coverage Form and listed below. ,) ITEM ONE-NAMED INSURED AND ADDRESS N The Named Insured is stated on the Common Policy Declarations. N 111 f+1 ADVANCE PREMIUM: $ 36,414.00 l AUDIT PERIOD: Ems mama Q Except in this Declarations,when we use the word"Declarations".In this Coverage Part,we mean this"Declarations"or ® the"Common Policy Declarations s_ Form Numbers of Coverage Forms,Endorsements and Schedules that are part of this Coverage Part: HA00040302 HA00340200 HA00120200T CA00011001 HA21020692 M CA99030797 CA21540204 CA00381202 CA01430297 CA20380297 CA20480299 CA99100902 CA99231293 HA00241290 HA20070200 HA99040187 HA99081290 HA99160302 1H12011185 a.� tt� C Form HA 00 25 OS 02 Pegs 1 of 4 0 2001 The Hertford(Includes copyrighted matedal of ISO Properties,Inc.,with Its permission.) • • COMMERCIAL AUTOMOBILE COVERAGE PART-DECLARATIONS - - BUSINESS AUTO COVERAGE FORM(Continued) POLICY NUMBER: 72 UEN IL4406 ITEM TWO-SCHEDULE OF COVERAGES AND COVERED AUTOS This policy provides only those coverages where a charge is shown in the advance premium column below. Each of these coverages will apply only to those"autos"shown as covered"autos.""Autos"are shown as covered"autos"for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. Limit Coverages Covered The Most We Will Pay for Any One Advance Premium Autos Accident or Loss LIABILITY 01 $ 1,000,000 $ 25,827.00 • PERSONAL INJURY PROTECTION Separately stated in each Personal Injury (or equivalent No-Fault coverage) Protection Endorsement. ADDED PERSONAL INJURY Separately stated in each Added Personal PROTECTION(or equivalent added Injury Protection Endorsement. - No-Fault coverage) OPTIONAL BASIC ECONOMIC $25,000 each eligible Injured person. LOSS(New York only) PROPERTY PROTECTION Separately stated in the Property Protection INSURANCE(Michigan only) Insurance Endorsement AUTO MEDICAL PAYMENTS 02 $ or the limit separately stated for $ 2,518.00 each'auto'in ITEM THREE. UNINSURED MOTORISTS 02 $ $ 2,776.00 SEE FORM HA2102 OR STATE FORM(S) UNDERINSURED MOTORISTS $ (When not Included In Uninsured Motorist Coverage) • • • • Form HA 00 25 03 02 Page 2 of 4 • • COMMERCIAL AUTOMOBILE COVERAGE PART-DECLARATIONS BUSINESS AUTO COVERAGE FORM(Continued) POLICY NUMBER: 72 MEN 1L4406 REM TWO-SCHEDULE OF COVERAGES AND COVERED AUTOS(Continued) • Limit Coverages Covered The Most We Will Pay for Any One Advance Premium o Autos Accident or Loss 0 PHYSICAL DAMAGE See ITEM FOUR for hired or borrowed"autos". c COMPREHENSIVE 07, Actual Cash Value,Cost of Repair,or the Stated $ 1,018.00 c COVERAGE 08 Amount shown In ITEM THREE,whichever is smallest,minus any deductible shown In ITEM a THREE for each covered"auto". N SPECIFIED CAUSES OF Actual Cash Value,Cost of Repair,or the Stated °o LOSS COVERAGE Amount shown in ITEM THREE,whichever is Lil smallest,minus$ deductible for 41 each covered"auto"for'loss"caused by mischief i= or vandalism. COLLISION COVERAGE 07, Actual Cash Value,Cost of Repair,or the Stated $ 2,820.00 IESMi 08 Amount shown in ITEM THREE,whichever is smallest,minus any deductible shown in ITEM• THREE for each covered"auto". TOWING AND LABOR $ or the amount separately stated for each 'auto'in ITEM THREE,whichever is greater,for each disablement. elga • NESE li= Endorsement Premium $ 730.00 • ® (Not included above) s TOTAL ADVANCE PREMIUM: $ 36,414.00 FonnHA0025O302 Page Sof4 • I COMMERCIAL AUTOMOBILE COVERAGE PART-DECLARATIONS BUSINESS AUTO COVERAGE FORM(Continued) POLICY NUMBER:72 UEN IL4406 ITEM THREE-SCHEDULE OF COVERED AUTOS YOU OWN Applicable only If"Schedule of Covered Autos You Own"Is issued to form a part of this Coverage Form. FORM HA0012 ATTACHED ITEM FOUR-SCHEDULE OF HIRED OR BORROWED AUTO COVERAGE AND PREMIUMS LIABILITY COVERAGE RATING BASIS IS COST OF HIRE. Cost of hire means the total amount you incur for the hire of'autos'you don't own(not including'autos'you borrow or rent from your partners or'employees'or their family members). Cost of hire does not Include charges for services performed by motor carriers of property or passengers. State Estimated Cost of Hire Rate Per Each$100 Cost of Hire Advance Premium IF ANY 1.984 $ 22.00 MP • TOTAL ADVANCE PREMIUM: $ 22.00 MP ITEM FIVE-SCHEDULE FOR NON-OWNERSHIP LIABILITY Named insured's Business Rating Basis Number Advance Premium Other than a Social Service Agency Number of Employees 25 $ 87.00 Number of Partners • Social Service Agency Number of Employees Number of Volunteers TOTAL ADVANCE PREMIUM: $ 87.00 MP Form HA 00 25 03 02 Page 4 of 4 SUPPLEMENTARY SCHEDULE FOR COMMERCIAL AUTOMOBILE • dir - COVERAGE PART DECLARATIONS d BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM (Hired Auto Physical Damage) ITEM FOUR-SCHEDULE OF HIRED OR BORROWED AUTO COVERAGE AND PREMIUMS The Declarations Is changed to Include the following Coverages: en PHYSICAL DAMAGE COVERAGE ° Limit Estimated Total Rate Per Advance Coverages The Most We WIII Pay for Any One Type Auto Auto/Days Accident or Loss of Hired Autos AukilDaY Prem(ton dam° Comprehensive $ 50,00 Oor Actual Cash Value Private Passenger SEE HA2 007 or Cost of Repair,whichever is smallest, minus$ 500 deductible for each All Other Types SEE HA2 007 c, covered auto. N Lel l+1 * Specified $ or Actual Cash Value or Cost of Private Passenger Causes Repair,whichever Is smallest,minus of Loss $ deductible for each covered auto All Other Types for loss caused by mischief or sam vandalism. ® Collision $ 50,000orActual Cash Value Private Passenger SEE HA2007 EINEI or Cost of.Repair,whichever Is smallest, minus$ 500 deductible for each All Other Types SEE HA2 007 covered auto. TOTAL ADVANCE PREMIUM: tin. NEM sait SIMMI 1 Ism Form HA 00 34 02 00 01999 The Hartford (Includes copyrighted material of Insurance Services Office,Inc., with Its permission. Copyright Insurance Services Office,Inc.,1997) . • It 110 SCHEDULE OF COVERED AUTOS YOU OWN - (ITEM THREE OF THE DECLARATIONS) lir POUCY NUMBER: 72 UEN IL4406 Absence,If any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. • NO. 00001 88 FORD F250 PU ID NO. 1FTHF25HOJPB56043 GARAGED: CARSON CA TERR: 015 CLASS: 01481 .4, ORIG. COST NEW: $ 11,288 c TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 10000 c COVERAGES: SEQ. NO. 00003 PREMIUMS LIABILITY $ 1,889.00 c AUTO MEDICAL PAYMENTS $ 5,000 EACH °INSURED° $ 187.00 CD UNINSURED MOTORISTS $ 188.00 c) COMPREHENSIVE $ 500 DEDUCTIBLE $ 53.00 COLLISION $ 500 DEDUCTIBLE $ 145.00 °O ENDORSEMENT PREMIUM cif ME RENTAL REIMBURSEMENT $ 21.00 N n c NO. 00002 96 FORD PU ID NO. 1FTDR1OU6TV808972 CD GARAGED: CARSON CA TERR: 015 CLASS: 01481 ul ORIG. COST NEW: $ 10,555 * TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 6000 COVERAGES: SEQ. NO. 00008 PREMIUMS i,= LIABILITY $ 1,889.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH °INSURED° $ 187.00 = UNINSURED MOTORISTS $ 188.00 IM COMPREHENSIVE $ 500 DEDUCTIBLE COLLISION $ 500 DEDUCTIBLE $ LL 145.00 ii= ENDORSEMENT"PREMIUM RENTAL REIMBURSEMENT $ 21.00 ear ® NO. 00003 90 FORD F250 PU ID NO. 2FTHF25GXLCB24762 GARAGED: CARSON CA TERR: 015 CLASS: 01481 ORIG. COST NEW: $ 10,037 TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 10000 • _ COVERAGES: SEQ. NO. 00009 PREMIUMS LIABILITY $ 1,889.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH °INSURED° $ 187.00 ® . UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE COLLISION $ 500 DEDUCTIBLE $ 145.00 MEE ENDORSEMENT PREMIUM ism RENTAL REIMBURSEMENT $ 21.00 ilm • ie MEI imam men Cam M Form HA 001202 00T PAGE 1 (CONTINUED ON NEXT PAGE) . SCHEDULE OF COVERED A YOU OWN (ITEM THREE OF THE DECLARATIONS)(Continued) POLICY NUMBER: 72 UEN 1L4406 Absence,If any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00004 95 FORD F250 PU ID NO. 2FTHF25HXSCA00420 GARAGED: CARSON CA TERR: 015 CLASS: 01481 ORIG. COST NEW: $ 15,102 TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 10000 COVERAGES: SEQ. NO. 00010 PREMIUMS LIABILITY • $ 1,889.00 • AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 187.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 62.00 COLLISION $ 500 DEDUCTIBLE $ 173.00 ENDORSEMENT PRE IIUM RENTAL REIMBURSEMENT $ 21.00 NO. 00005 90 FORD F250 PU ID NO. 1FTHF25G3LRB26560 GARAGED: CARSON CA TERR: 015 CLASS: 01481 ORIG. COST NEW: $ 12,472 TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 10000 COVERAGES: SEQ. NO. 00012 PREMIUMS LIABILITY $ 1,889.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 187.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 53.00 COLLISION $ 500 DEDUCTIBLE $ 145.00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 NO. 00006 98 FORD F150 PU ID NO. 1FTZX1763WKB79442 GARAGED: SAN PEDRO CA TERR: 013 CLASS: 01481 ORIG. COST NEW: $ 22,483 TAX LOC: ZIP CODE: 90731 RADIUS: .L SIZE: 10000 COVERAGES: SEQ. NO. 00013 PREMIUMS LIABILITY $ 1,510.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 149.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 71.00 COLLISION $ 500 DEDUCTIBLE $ 184.00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 Form HA 0012 02 Off PAGE 2 (CONTINUED ON NEXT PAGE) • � SCHEDULE OF COVERED AUTOS YOU OWN .z (ITEM THREE OF THE DECLARATIONS)(Continued) POLICY NUMBER: 72 UEN IL4406 Absence,if any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00007 00 FORD F350 ID NO. 3FTSW31S2YMA33499 GARAGED: BUENA PARK CA TERR: 086 CLASS: 01481 ORIG. COST NEW: $ 36,103 PI CD TAX LOC: ZIP CODE: 90621 RADIUS: L SIZE: 10000 TA 0 COVERAGES: SEQ. NO. 00016 PREMIUMS TA LIABILITY $ 1,241.00 ri AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 122.00 c) WD UNINSURED MOTORISTS $ 130.00 • c) COMPREHENSIVE $ 500 DEDUCTIBLE $ 80.00 a COLLISION $ 500 DEDUCTIBLE $ 225.00 H ENDORSEMENT PREMIUM cq N RENTAL REIMBURSEMENT $ 21.00 O O in * NO. 00008 01 FORD PU ID NO. 1FTNX2OLX1EB28497 GARAGED: BUENA PARK CA TERR: 086 CLASS: 01481 ORIG. COST NEW: $ 25,943 TAX LOC: ZIP CODE: 90621 RADIUS: L SIZE: 10000 ammic ® COVERAGES: SEQ. NO. 00020 PREMIUMS LIABILITY $ 1,241.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH °INSURED° $ 122..00 UNINSURED MOTORISTS $ 130.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 80.00 COLLISION $ 500 DEDUCTIBLE $ 225.00 ENDORSEMENT PREMIUM rat RENTAL REIMBURSEMENT $ 21.00 NO. 00009 01 CHEV TAHOE ID NO. 1GNEK13T81R130303 GARAGED: RANCHO PALOS VERDES CA TERR: 017 CLASS: 01481 = ORIG. COST NEW: $ 34,428 ® TAX LOC: ZIP CODE: 90275 RADIUS: L SIZE: 10000 SEEM COVERAGES: SEQ. NO. 00021 PREMIUMS LIABILITY $ 1,603.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 158.00 UNINSURED MOTORISTS $ 188.00 OMR COMPREHENSIVE $ 500 DEDUCTIBLE $ 80.00 COLLISION $ 500 DEDUCTIBLE $ 225.00 cor Ham ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 Fonn HA 00 1 2 02 001 PAGE 3 (CONTINUED ON NEXT PAGE) SCHEDULE OF COVERED AUIWYOU OWN (ITEM THREE OF THE DECLARATIONS)(Continued) POLICY NUMBER: 72 UEN IL4406 Absence,If any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00010 79 FORD PU ID NO. F6OCVGA1013 GARAGED: CARSON CA TERR: 015 CLASS: 01481 ORIG. COST NEW: $ 1,750 TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 5000 COVERAGES: . SEQ. NO. 00022 PREMIUMS LIABILITY $ 1,889.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 187.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 8.00 COLLISION $ 500 DEDUCTIBLE $ 49,00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 NO. 00011 03 FORD F250 ID NO. 1FTNF2OLO3EA24039 GARAGED: LONG BEACH CA TERR: 014 CLASS: 01481 ORIG. COST NEW: $ 21,120 TAX LOC: ZIP CODE: 90814 RADIUS: L SIZE: 8800 COVERAGES: SEQ. NO. 00033 PREMIUMS LIABILITY $ 1,510.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 149.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 91.00 COLLISION $ 500 DEDUCTIBLE $ 240.00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 NO. 00012 98 FORD F250 ID NO. 1FTRF2765WXB97983 GARAGED: CARSON CA TERR: 015 CLASS: 01481 ORIG. COST NEW: $ 16,710 TAX LOC: ZIP CODE: 90745 RADIUS: L SIZE: 6600 COVERAGES: SEQ. NO. 00036 PREMIUMS LIABILITY $ 1,889.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 187.00 UNINSURED MOTORISTS $ 188.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 62.00 COLLISION $ 500 DEDUCTIBLE $ 173.00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 Form HA 0012 02 OOT PAGE 4 (CONTINUED ON NEXT PAGE) SCHEDULE OF COVERED AUTOS YOU OWN • - (ITEM THREE OF THE DECLARATIONS)(Continued) POLICY NUMBER: 72 UEN IL4406 Absence,if any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00013 98 FORD F250 ID NO. 1FTRF2761WKB98001 GARAGED: OCEANSIDE CA TERR: 042 CLASS: 01481 mo ORIG. COST NEW: $ 16,710 0 TAX LOC: ZIP CODE: 92054 RADIUS: L SIZE: 6600 vi 0 COVERAGES: SEQ. NO. 00037 PREMIUMS LIABILITY C2 AUTO MEDICAL'PAYMENTS $ 5,000 EACH °INSURED" $ 989.00 °o UNINSURED MOTORISTS $ 130.00 CD COMPREHENSIVE $ 500 DEDUCTIBLE $ 62.00 a COLLISION $ 500 DEDUCTIBLE $ 173.00 N ENDORSEMENT PREMIUM N RENTAL REIMBURSEMENT $ 21.00 0 0 In rfl 41 NO. 00014 99 FORD F250 ID NO. 1FTNF20L3XEA72141 GARAGED: PARAMOUNT CA TERR: 014 CLASS: 01481 ORIG. COST NEW: $ 16,290 IMIEI TAX LOC: ZIP CODE: 90723 RADIUS: L SIZE: 7700 EINEM = 1 COVERAGES:IA SEQ. NO. 00038 PREMIUMS,510.00 ® AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED' $ 1149.00 UNINSURED MOTORISTS $ 188.00 ® COMPREHENSIVE $ 500 DEDUCTIBLE $ 62.00 ® COLLISION $ 500 DEDUCTIBLE $ 173.00 ENDORSEMENT PREMIUM ffiem RENTAL REIMBURSEMENT $ 21.00 t, ® NO. 00015 95 GMC ID NO. 1GDM7H1J3SJ509186 GARAGED: LONG BEACH CA TERR: 014 CLASS: 31481 �® ORIG. COST NEW: $ 30,000 TAX LOC: ZIP CODE: 90814 RADIUS: L SIZE: 21200 RIM mi COVERAGES: SEQ. NO. 00039 PREMIUMS Fa LIABILITY $ 1,731.00 es AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 149.00 = UNINSURED MOTORISTS $ 188.00 = COMPREHENSIVE $- 500 DEDUCTIBLE $ 57.00 ram a COLLISION $ 500 DEDUCTIBLE $ 160.00 ismsa ENDORSEMENT PREMIUM ® RENTAL REIMBURSEMENT = $ 21.00 • Form HA 0012 02 OOT PAGE 5 (CONTINUED ON NEXT PAGE) SCHEDULE OF COVERED AOU OWN w (ITEM THREE OF THE DECLARATIONS)(Continued) POLICY NUMBER: 72 um 1L4406 • Absence,if any,of a limit entry below means that the limit entry shown in the corresponding ITEM TWO of the Declarations Limit Column applies instead. NO. 00016 03 FORD F150 ID NO. 1FTRX17W23NB15807 GARAGED: SAN BERNARDINO CA TERR: 059 CLASS: 01481 ORIG. COST NEW: $ 21,365 TAX LOC: ZIP CODE: 92402 RADIUS: L SIZE: 6050 COVERAGES: SEQ. NO. 00041 PREMIUMS . LIABILITY $ 1,237.00 AUTO MEDICAL PAYMENTS $ 5,000 EACH "INSURED" $ 122.00 UNINSURED MOTORISTS $ 130.00 COMPREHENSIVE $ 500 DEDUCTIBLE $ 91.00 • COLLISION $ 500 DEDUCTIBLE $ 240.00 ENDORSEMENT PREMIUM RENTAL REIMBURSEMENT $ 21.00 • • • Form HA 0012 02 00T PAGE 6 .„ • • COMMERCIAL AUTO CA00011001 BUSINESS AUTO COVERAGE FORM Various provisions in this policy restrict coverage. Read SECTION I—COVERED AUTOS the entire policy carefully to determine rights, duties Item Two of the Declarations shows the 'autos' that and what Is and is not covered. are covered 'autos' for each of your coverages. The Throughout this policy the words'you'and'your' refer following numerical symbols describe the 'autos' that to the Named insured shown in the Declarations. The may be covered'autos'.The symbols entered next to a words 'we', 'us' and 'our' refer to the Company pro- coverage on the Declarations designate the only viding this insurance. 'autos'that are covered'autos'. Other words and phrases that appear in quotation A. Description Of Covered Auto Designation marks have special meaning. Refer to Section V — Symbols Definitions. .--� Symbol Description Of Covered Auto Designation Symbols 1 Any'Auto' 2 Owned'Autos' Only those'autos'you own(and for Uability Coverage any'trailers'you don't own a Only while attached to power units you own).This includes those'autos'you acquire own- 1-1 (NI ership of after the policy begins. 3 Owned Private Only the private passenger'autos'you own.This includes those private passenger o° Passenger 'autos'you acquire ownership of after the policy begins. 1:1 'Autos'Only 4 Owned'Autos' Only those'autos'you own that are not of the private passenger type(and for Uability gggs Other Than Pri- Coverage any'trailers'you don't own while attached to power units you own).This vate Passenger includes those'autos'not of the private passenger type you acquire ownership of after 'Autos'Only the policy begins. 5 Owned'Autos' Only those'autos'you own that are required to have No-Fault benefits in the state Subject To No- where they are licensed or principally garaged.This includes those'autos'you acquire Fault ownership of after the policy begins provided they are required to have No-Fault bane= fits in the state where they are licensed or principally garaged. 6 Owned'Autos' Only those'autos'you own that because of the law in the state where they are II- = Subject To A censed or principally garaged are required to have and cannot reject Uninsured Mo- ra= Compulsory Un- torists Coverage.This includes those'autos'you acquire ownership of after the policy insured Motorists begins provided they are subject to the same state uninsured motorists requirement. tiM Law • sma 7 Spedficaily De- Only those'autos'described in item Three of the Declarations for which a premium scribed'Autos' charge is shown(and for Liability Coverage any'trailers'you don't own while attached to any power unit described in item Three). 8 Hired'Autos' Only those'autos'you lease,hire,rent or borrow.This does not include any'auto'you Only lease,hire,rent,or borrow from any of your'employees',partners(if you are a part- nership),members(if you are a limited liability company)or members of their house- holds. C 9 Nonowned Only those'autos'you do not own,lease,hire,rent or borrow that are used in connec- 'Autos'Only Von with your business.This Includes'autos'owned by your'employees',partners(if you are a partnership),members(if you are a limited liability company),or members of their households but only while used in your business or your personal affairs. loam CA 00 01 10 01 O ISO Properties,Inc., 2000 Page 1 of 11 . • • - _. , B. Owned Autos You Acquire After The Policy We will also pay all sums an 'insured' legally must Begins pay as a'covered pollution cost or expense'to which 1. if Symbols 1,2,3,4,5 or 6 are entered next to a this insurance applies, caused by an 'accident' and coverage in Item Two of the Declarations, then resulting from the ownership, maintenance or use of you have coverage for'autos'that you acquire of covered 'autos'. However, we will only pay for the the type described for the remainder of the policy 'covered pollution cost or expense' if there is either period. 'bodily Injury' or property damage to which this 2. But, if Symbol 7 is entered next to a coverage in dent'. in- surance applies that is caused by the same 'acci- 2. Item Two of the Declarations, an 'auto' you ac- quire We have the right and duty to will be a covered 'auto' for that coverage against a the ri ht n for defend any 'insured' only if: g asking damages or a cow- . ered pollution cost or expense'. However, we have a. We already cover all 'autos'that you own for no duty to defend any 'insured' against a 'suit' that coverage or it replaces an'auto'you pre- seeking damages for 'bodily Injury' or 'property viously owned that had that coverage;and damage' or a 'covered pollution cost or expense' to b. You tell us within 30 days after you acquire it which this insurance does not apply.We may inves- that you want us to cover ft for that coverage. tigate and settle any claim or 'suit' as we consider C. Certain Trailers, Mobile Equipment And appropriate. Our duty to defend or settle ends when Temporary Substitute Autos the Uability Coverage Umft of insurance has been exhausted by payment of judgments or settlements. If Uability Coverage is provided by this Coverage Form, the following types of vehicles are also cov- ered 1' o insured 'autos'for Uability Coverage: The following are'insureds': 1. 'Trailers'with a load capacity of 2,000 pounds or a. You for any covered'auto'. less designed primarily for travel on public roads. b. Anyone else while using with your permission 2. 'Mobile equipment'while being carried or towed a covered'auto'you own, hire or borrow ex- by a covered'auto'. cept 3. Any 'auto' you do not own while used with the (1) The owner or anyone else from whom you permission of its owner as a temporary substitute hire or borrow a covered 'auto'. This ex- for a covered'auto'you own that is out of service ception does not apply if the covered because of its: 'auto'is a'trailer'connected to a covered a. Breakdown; 'auto'you own. b. Repair (2) Your 'employee' if the covered 'auto' is owned by that'employee'or a member of c. Servicing; his or her household. d. 'Loss ;or • (3) Someone using a covered 'auto'while he • e. Destruction. or she is working in a business of selling, SECTION II—LIABILITY COVERAGE servicing, repairing, paridng or storing 'autos'unless that business is yours. A. Coverage (4) Anyone other than your 'employees', We will pay all sums an'insured'legally must pay as partners (if you are a partnership), mem- damages because of 'bodily injury' or 'property bets(if you are a limited liability company), damage'to which this insurance applies, caused by or a lessee or borrower or any of their an 'accident' and resulting from the ownership, 'employees', while moving property to or maintenance or use of a covered'auto'. from a covered'auto'. (5) A partner (if you are a partnership), or a member(If you are a limited liability com- pany) for a covered 'auto' owned by him or her or a member of his or her house- hold. Page 2 of 11 0 ISO Properties,Inc., 2000 CA 00 01 10 01 .n . t • • • t _ c. Anyone liable for the conduct of an insured' B. Exclusions - described above but only to the extent of that This insurance does not apply to any of the following: liability. • 2. Coverage Extensions 1• Expected Or Intended Injury a. Supplementary Payments 'Bodily injury' or 'property damage' expected or intended from the standpoint of the'insured'. in addition to the Limft of insurance, we will 2. Contractual pay for the'Insured': (1) All expenses we incur. Liability assumed under any contract or agree- ment. (2) Up to $2,000 for cost of ball bonds (in- But this exclusion does not apply to liability for eluding bonds for related traffic law viola- damages: tions) required because of an 'accident' co we cover.We do not have to furnish these a. Assumed in a contract or agreement that Is an cbonds. 'insured contract' provided the 'bodily injury' or 'property damage' occurs subsequent to (3) The cost of bonds to release attachments the execution of the contract or agreement;or In any 'suit' against the 'insured' we de- .--1 fend,but only for bond amounts within our b. That the'insured'would have in the absence o Limit of Insurance. of the contract or agreement. (4) All reasonable expenses incurred by the S• Waiters'Compensatia! 'Insured' at our request, Including actual Any obligation for which the 'Insured' or the In- '-r loss of earnings up to$250 a day because sured's' Insurer may be held liable under any 01 of time off from work. workers' compensation, disability benefits or un- o (5) All costs taxed against the'insured'in any employment compensation law or any similar law. In 'suit'against the'insured'we defend. 4. Employes Indemnification And Employer's * (6) All Interest on the full amount of any judg- Liability ment that accrues after entry of the judg- 'Bodily injury"to: • ment in any'suft'against the'insured'we defend, but our duty to pay interest ends a. An 'employee' of the 'insured'arising out of iiiCii w ils hen we have paid, offered to pay or de- and in the course of: = posited In court the part of the judgment (1) Employment by the'insured';or that is within our Limit of Insurance. (2) Performing the duties related to the con- __ b. Out-Of-State Coverage Extensions duct of the'insured's'business;or While a covered'auto'is away from the state b. The spouse, child, parent, brother or sister of where it is licensed we will: - that 'employee' as a consequence of Para- ® (1) Increase the Limit of Insurance for Liability graph a.above. numa Coverage to meet the limits specified by a This exclusion applies: compulsory or financial responsibility law (1) Whether the 'insured'may be liable as an _ of the jurisdiction where the covered employer or in a g_ 'auto' is being used.This extension does any other capacity;and I= not apply to the limit or limits specified by (2) To any obligation to share damages with �• any law governing motor carriers of pas- or repay someone else who must pay sengere or property. damages because of the injury. im (2) Provide the minimum amounts and types But this exclusion does not apply to'bodily Injury' Emma ME of other coverages, such as no-fault, re- to domestic 'employees` not entitled to workers' +� compensation benefits or to liability assumed by e� quired of out-of-state vehicles by the juris- t= diction where the covered 'auto' is being the'insured' under an 'insured contract'. For the used. purposes of the Coverage Form,a domestic'em- ___ ployee' Is a person engaged in household or do- = We will not pay anyone more than once for mastic work performed principally in connection MU the same elements of loss because of these with a residence premises. raja extensions. M CA 00 01 10 01 0 ISO Properties,Inc., 2000 Page 3 dill • • 5. Fellow Employee (2) When all of the work to be done at the site 'Bodily Injury'to any fellow'employee'of the 'in- has been completed if your contract calls - 4 sured' arising out of and in the course of the fel- for work at more than one site. low'employee's'employment or while performing (3) When that part of the work done at a job duties related to the conduct of your business. site has been put to its intended use by 6. Care,Custody Or Control any person or organization other than an- other contractor or subcontractor working 'Properly damage' to or 'covered pollution cost on the same project. or expense' involving property owned or trans- ported by the 'insured'or In the 'insured's" care, Work that may need service, maintenance, custody or control. But this exclusion does not correction,repair or replacement, but which is apply to liability assumed under a sidetrack otherwise complete, will be treated as corn- agreement. plated. 7. Handling Of Property 11. Pollution 'Bodily injury or 'property damage' resulting 'Bodily injury'or'property damage'arising out of from the handling of property: the actual, alleged or threatened discharge, dis- persal, seepage, migration, release or escape of a. Before it is moved from the place where it is 'pollutants': accepted by the 'insured' for movement into a. That are,or that are contained in any property or onto the covered'auto";or that is: b. After it is moved from the covered 'auto' to the place where it Is finally delivered by the (1) Being transported or towed by,handled,or 'insured'. handled for movement into, onto or from, S. Movement Of Property By Mechanical Device the covered auto'; 'Bodily Injury' or 'property damage' resulting (2) Otherwise in the course of transit by or on g behalf of the insured';or -from the movement of property by a mechanical device (other than a hand truck)i unless the-de- (3) Being stored,disposed of,treated or proc- vice is attached to the covered'auto'. eased in or upon the covered'auto'; 9. Opp b. Before the 'pollutants' or any property In which the 'pollutants' are contained are 'Bodily injury'or'property damage'arising out of moved from the place where they are ac- the operation of any equipment listed in Para- cepted by the 'insured'for movement into or graphs 6.b. and 6.c..of the definition of 'mobile onto the covered'auto':or equipment'. 10. Completed Operations c. After the'pollutants'or any property in which the'pollutants'are contained are moved from 'Bodily injury'or'property damage'arising out of the covered'auto'to the place where they are your work after that work has been completed or finally delivered,disposed of or abandoned by abandoned. the'insured'. in this exclusion,your work means: Paragraph a. above does not apply to fuels, a. Work or operations performed by you or on lubricants, fluids,exhaust gases or other your behalf;and similar'pollutants' that are needed for or r sult from the normal electrical, hydraulic or b. Materials, parts or equipment furnished in mechanical functioning of the covered'auto' connection with such work or operations. or its parts,if: Your work includes warranties or representations (1) The'pollutants' escape,seep, migrate, or made at any time with respect to the fitness, are discharged, dispersed or released di- quality, durability or performance of any of the redly from an 'auto' part designed by its items included In Paragraphs a.orb.above. manufacturer to hold, store, receive or Your work will be deemed completed at the earn- dispose of such'pollutants';and est of the following times: (2) The 'bodily injury', 'property damage' or (1) When all of the work called for In your 'covered pollution cost or expense' does contract has been completed. not arise out of the operation of any equipment listed in Paragraphs 611. and 6.c. of the definition of 'mobile equip- ment'. Page Al of 11 O ISO Properties,Inc., 2000 CA 00 01 10 01 t . S • Paragraphs b. and c. above of this exclusion SECTION III—PHYSICAL DAMAGE COVERAGE do not apply to 'accidents' that occur away A. Coverage from premises owned by or rented to an 'in- sured' with respect to 'pollutants' not in or 1. We will pay for 'loss' to a covered 'auto' or its upon a covered:auto'if: equipment under. (1) The 'pollutants' or any property in which a. Comprehensive Coverage the 'pollutants' are contained are upset, From any cause except: overturned or damaged as a result of the maintenance or use of a covered 'auto'; (1) The covered'auto's'collision with another and object;or (2) The discharge, dispersal,seepage, migra- (2) The covered auto's'overturn. tion, release or escape of the 'pollutants' b. Specified Causes Of Loss Coverage ON .Is caused directly by such upset, overturn Caused by: .., or damage. ° 12. War (1) Fire,lightning or explosion; (2) Theft; o 'Bodily Injury' or 'property damage' due to war, (3) Windstorm,hail or earthquake; r, whether or not declared, or any act or condition q o incident to war. War includes civil war, insurrec- (4) Flood; o tion, rebellion or revolution. This exclusion ap- (5) Mischief or vandalism;or -r plies only to liability assumed under a contract or F'a., agreement. (6) The sinking, burning, collision or derail- N ment of any conveyance transporting the CNi 18. RacMg covered'auto'. C5Covered'autos'while used In any professional or c. Coloslon Coverage r„ organized racing or demolition contest or stunting * activity,or while practicing for such contest or ac- Caused by: tivity. This insurance also does not apply while (1) The covered'auto's'collision.with another that covered 'auto' is being prepared for such a object;or' •OEM contest or activity. C. Lim ft Of insurance (2) The covered'auto's'overturn. 2. Towing Regardless of the number of covered 'autos', 'in- We will pay up to the limit shown in-the Declara- sureds', premiums.paid,claims made or vehicles in- lions for towing and labor costs incurred each �e finalth�mccident',the most we will pay for the time a covered 'auto' of the private passenger damages and 'covered pollution cost or type is disabled. However, the labor must be i expense' combined, resulting from any one scot- performed at the place of disablement. i= dent' Is the Limit of insurance for Liability Coverage miiishown in the Declarations. S. Glass Breakage—Hitting A Bird Or Animal— All 'bodily Injury', 'property damage' and 'covered Falling Objects Or Missiles pollution cost or expense,resulting from continuous If you carry Comprehensive Coverage for the ® or repeated exposure to substantially the same con- damaged covered 'auto', we will pay for the fol- ditions will be considered as resulting from one 'ac- lowing under Comprehensive Coverage: cadent'. a. Glass breakage; • No one will be entitled to receive duplicate payments b. 'Loss'caused by hitting a bird or animal;and ® for the same elements of'loss' under this Coverage rii Form and any Medical Payments Coverage En C. 'Loss'caused by falling objects or missiles. IMEM dorsement, Uninsured Motorists Coverage Endorse- However, you have the option of having glass IIM ment or Underinsured Motorists Coverage Endorse- breakage caused by a covered 'auto's' collision ® ment attached to this Coverage Part. or overturn considered a 'loss' under Collision IMI Coverage. M, res UMW SIMESI IIMM I' CA 00 01 10 01 0 ISO Properties,Inc., 2000 Page 5 of 11 i+ • 4. Coverage Extensions b. War Or Military Action a. Transportation Expenses (1) War,including undeclared or civil war, We will pay up to$20 per day to a maximum (2) Warlike action by a military force,including of$600 for temporary transportation expense action in hindering or defending against an incurred by you because of the total theft of a actual or expected attack, by any govern- covered 'auto' of the private passenger type. ment, sovereign or other authority using We will pay only for those covered'autos'for military personnel or other agents;or which you cany either Comprehensive or (8) insurrection, rebellion, revolution, usurped Specified Causes of Loss Coverage. We will power or action taken by governmental pay for temporary transportation expenses in- authority in hindering or defending against curred during the period beginning 48 hours any of these. • after the theft and ending, regardless of the policy's expiration,when the covered'auto' is 2. while lllsnotin pay for loss' to any covered 'auto' returned to use or we pay for its'loss'. any professional or organized rac- ing Loss Of Use Expenses ing or demolition contest or stunting activity, or while practicing for such contest or activity. We For Hired Auto Physical Damage,we will pay will also not pay for'loss' to any covered 'auto' expenses for which an 'insured' becomes le- while that covered 'auto' is being prepared for gaily responsible to pay for loss of use of a such a contest or activity. vehicle rented or hired without a driver, under 3. We will not pay for 'loss' caused by or resulting a written rental contract or agreement.We will from any of the following unless caused by other pay for loss of use expenses If caused by: 'lam'that is covered by this insurance: (1) Other than collision only if the Declare- a. Wear and tear, freezing, mechanical or elec- tions indicate that Comprehensive Cover- trical breakdown. age is provided for any covered'auto'; (2) Specified Causes Of Loss only if the b. Blowouts, punctures or other road damage to Declarations Indicate that Specified tip' Causes Of Loss Coverage is provided for 4. We will not pay for'loss'to any of the following: any covered'auto';or a. Tapes, records, discs or other similar audio, (3) Collision only if the Declarations indicate visual or data electronic devices designed for that Collision Coverage is provided for any use with audio, visual or data electronic covered'auto'. equipment. However, the most we will pay for any ex- b. Any device designed or used to detect speed penes for loss of use is $20 per day, to a measuring equipment such as radar or laser maximum of$600. detectors and any Jamming apparatus In- B. Exclusions tended to elude or disrupt speed measure- ment equipment. 1. We will not pay for'loss' caused by or resulting c. Any electronic equipment, without to from any of the following.Such loss Is excluded whether this eqipent is permanently in- regardless of any other cause or event that con- stalled,that receives or transmits audio,visual tributes concurrently or in any sequence to the or data signals and that is not designed•solely for the reproduction of sound. a. Nuclear Hazard d. Any accessories used with the electronic (1) The explosion of any weapon employing equipment described in Paragraph c.above. atomic fission or fusion;or (2) Nuclear reaction or radiation, or radioac- tive contamination,however caused. • Page 6 of 11 O ISO Properties,Inc., 2000 CA 00 0110 01 : •• • . Exclusions 4.c.and 44.do not apply to: SECTION IV–BUSINESS AUTO CONDIiiONS a. Equipment designed solely for the reproduc- The following conditions apply in addition to the Corn- lion of sound and accessories used with such mon Policy Conditions: equipment, provided such equipment is per- A. Lou Conditions manently installed in the covered'auto'at the time of the 'loss' or such equipment is re- 1. Appraisal For Physical Damage Loss movable from a housing unit which is perma- If you and we disagree on the amount of 'loss', nently installed in the covered 'auto' at the either may demand an•appraisal of the 'loss'. In time of the 'loss', and such equipment is de- this event,each party will select a competent ap- signed to be solely operated by use of the praiser.The two appraisers will select a compe- power from the'auto's'electrical system,in or tent and impartial umpire. The appraisers will upon the covered'auto';or state separately the actual cash value and b. Any other electronic equipment that is: amount of loss'. If they fall to agree, they will c (1) Necessary for the normal operation of the submit their differences to the umpire. A decision covered 'auto' or the monitoring of the agreed to by any two(will be binding. Each party covered'auto's'operating system;or will: (2) An integral part of the same unit housing. a. Pay its chosen appraiser;and c any .sound reproducing equipment de- b. Bear the other expenses of the appraisal and CZscribed in a. above and permanently in- umpire equally. -r stalled in the opening of the dash or con- If we submit to an appraisal,we will still retain our Nsole of the covered 'auto' normaly used right to deny the claim. by the manufacturer for installation of a 2. Duties In The Event Of Accident, Claim, Suit c radio. Or Loss cD in 5. We will not pay for loss'to a covered'auto' due We have no duty to provide coverage under this to'diminution in value'. policy unless there has been full compliance with ll= C. Lhnit Of Insurance - the following duties: 1. The most we will pay for loss' in any one 'acct- a In the event of 'accident', claim, 'suit' or dent'Is the lesser of: 'loss',you must give us or our authorized rep- .... a. The actual cash value of the damaged or resentative prompt notice of the'accident' or stolen property as of the time of the loss';or 'loss'.Include: Isnot • b. The cost of repairing or replacing the dam- (1) How, when and where the:'accident' or "— aged or stolen property with other property of 'loss'occurred: • ® like kind and quality. (2) The'insureds'name and address;and tai 2. An adjustment for depreciation and physical con- (3) To the extent possible, the names and dltion will be made In determining actual cash addresses of any injured persons and wit- IL value In the event of a total'loss'. names, Mi 3. If a repair or replacement results in better than b. Additionally, you and any other involved In- = like'kind or quality,we will not pay for the amount sured'must of the betterment. D. Deductible (1) Assume no obligation, make no payment --- or Incur no expense without our consent, For each covered 'auto', our obligation to pay for, except at the'insureds'own cost. repair, return or replace damaged or stolen property (2) Immediately send us copies of any re- = will be reduced by the applicable deductible shown in quest,demand,order,notice,summons or ® the Declarations. Any Comprehensive Coverage de- legal paper received concerning the claim ductibie shown in the Declarations does not apply to or'suit'. Ea loss'caused by fire or lightning. (3) Cooperate with us in the Investigation or settlement of the claim or defense against BMW„� the'suit'. sis (4) Authorize us to obtain medical records or isimm r_ other pertinent information. CA 00 01 10 01 0 ISO Properties,Inc., 2000 Page T of 11 • • . , . . . (5) Submit to examination,at our expense,by B. General Conditions physicians of our choice, as often as we 1. Banlauptcy reasonably require. c. If there is 'loss' to a covered 'auto' or its Bankruptcy or Insolvency of the 'insured' or the equipment you must also do the following: 'insureds'estate will not relieve us of any oblige= bons under this Coverage Form. (1) Promptly notify the police if the covered 2. Concealment,Misrepresentation Or Fraud 'auto'or any of Its equipment is stolen. (2) Take all reasonable steps to protect the This Coverage Form Is void in any case of fraud covered 'auto' from further damage. Also by you at any time as it relates to this Coverage keep a record of y expenses for con- Form. It is also void if you or any other'Insured"; kee kee ration In the of your oe settlement of the claim. at any time,intentionally conceal or misrepresent a material fact concerning: (3) Permit us to inspect the covered 'auto' a. This Coverage Form; and records proving the 'loss' before its •repair or disposition. b. The covered'auto'; (4) Agree to examinations under oath at our c. Your interest in the covered.'auto';or request and give us a signed statement of d. A claim under this Coverage Form. your answers. 3. Liberalization S. Legal Action Against Us If we revise this Coverage Form to provide more No one may bring a legal action against us under coverage without additional premium charge, •this Coverage Form until: your policy will automatically provide the addl- e. There has been full compliance with all the tonal coverage as of the day the revision is ef- terms of this Coverage Form;and fective in your state. b. Under Liability Coverage,we agree in writing 4. No. Benefit To Bailee — Physical Damage that the'insured' has an obligation to pay or Coverages until the amount of that obligation has finally We will not recognize any assignment or grant been determined by judgment after trial. No any coverage for the benefit of any person or or- one has the right under this policy to bring us ganization holding, storing or transporting prop- into an action to determine the 'Insureds' Ii- arty for a fee regardless of any other provision of ability. this Coverage Form. 4. Loss Payment—Physical Damage Coverages 5. Other!narrows At our option we may: a. For any covered 'auto' you own, this Cover- a. Pay for, repair or replace damaged or stolen age Form provides primary insurance.For any property; covered 'auto' you don't own, the insurance b. Return the stolen property, at our expense. provided by this Coverage Form is excess over any other collectible insurance.However, We will pay for any damage that results to the while a covered 'auto' which is a 'trailer' is 'auto'from the theft;or connected to another vehicle, the Liability c. Take all or any part of the damaged or stolen Coverage this Coverage Form provides for property at an agreed or appraised value. the'trailer'Is: If we pay for the 'loss', our payment will include (1) Excess while it Is connected to a motor the applicable sales tax for the damaged or stolen vehicle you do not own. property. (2) Primary while it is connected to a covered 5. Transfer Of Rights Of Recovery Against . 'auto'you own. Others To Us b. For Hired Auto Physical Damage Coverage, If any person or organization to or for whom we any covered 'auto' you lease, hire, rent or make payment under this Coverage Form has borrow is deemed to be a covered'auto'you rights to recover damages from another, those own. However, any 'auto' that is leased, rights are transferred to us. That person or or- hired,rented or borrowed with a driver is not a ganization must do everything necessary to se- covered'auto'. cure our rights and must do nothing after 'acd- c. Regardless of the provisions of Paragraph a. dent'or'loss'to impair them. above, this Coverage Form's Liability Cover- age is primary for any liability assumed under an'insured contract'. • Page 8 of 11 0 ISO Properties,Inc., 2000 CA 00 01 10 01 • , " r e • d. When this Coverage Form and any other We also cover 'loss' to, or'accidents' involving, Coverage Form or policy covers on the same a covered'auto'while being transported between basis, either excess or primary, we will pay any of these places. only our share. Our share is the proportion 8. Two Or More Coverage Forms Or Policies that the Limit of insurance of our Coverage issued By Us Form bears to the total of the limits of all the Coverage Forms and policies covering on the If this Coverage Form and any other Coverage same basis. Form or policy issued to you by us or any com- b. Premium Audit pany affiliated with us apply to the same 'acci- dent',the aggregate maximum Limit of insurance a. The estimated premium for this Coverage under all the Coverage Forms or policies shall not Form is based on the exposures you told us exceed the highest applicable Limit of Insurance you would have when this policy began. We under any one Coverage Form or policy. This %-i will compute the final premium due when we condition does not apply to any Coverage Form c determine your actual exposures. The esti- or policy issued by us or�an affiliated company mated total premium will be credited against specifically to apply as excess Insurance over this the final premium due and the first Named In- Coverage Form. .-1 sured will be billed for the balance,If any.The SECTION V—DEFINITIONS -1 due date for the final premium or retrospective o premium is the date shown as the due date A. 'Accident'includes continuous or repeated exposure vi on the bill. If the estimated total premium ex- to the same conditions resulting in 'bodily injury' or a coeds the final premium due,the first Named 'property damage'. N Insured will get a refund. B. 'Auto' means a land motor vehicle, 'trailer' or semi- N b. if this policy is issued for more than one year, trailer designed for travel on public roads but does o° the premium for this Coverage Form will be not Include'mobile equipment'. in computed annually based on our rates or C. 'Bodily injury' means bodily injury, sickness or dis- c." premiums In effect at the beginning of each ease sustained by a year of the policy. person including death resulting from any of these. 7. Policy Period,Coverage Territory D. 'Covered pollution cost or expense' means any cost Under this Coverage Form,we cover'accidents' or expense arising out of: and losses'oawrring: 1. My request, demand, order or statutory or regu- a. During the policy period shown in the Dacia.- latory requirement;or rations;and 2. My claim or 'suit' by or on behalf of a govem- b. Within the coverage territory. mental authority demanding cal The coverage territory is: that the'insured'or others test for,monitor,clean up, a. The United States of America; remove, contain, treat, detoxify or neutralize, or In any way respond to, or assess the effects of'pollut- ® b. The territories and possessions of the United ants'. States® of America; 'Covered pollution cost or expense'does not Include _ C. Puerto Rico; any cost or expense arising out of the actual, alleged d. Canada;and or threatened discharge, dispersal, seepage, migra- s. Anywhere in the world if: tion,release or escape of'pollutants': (1) A covered 'auto' of the private passenger a. That are,or that are contained in any property ®� type is leased, hired, rented or borrowed that is: ® without a driver for a period of 30 days or (1)' Being transported or towed by,handled,or Nan less;and handled for movement into, onto or from ® (2) The 'insureds' responsibility to pay dam- the covered auto'; NEM ON ages is determined in a 'suit' on the mer- (2) Otherwise in the course of transit by or on its, in the United States of America, the behalf of the insured'; 36= territories and possessions of the United (S) Being stored,disposed of, treated or proe- m States of America,Puerto Rico,or Canada essed in or upon the covered'auto'; MEM or in a settlement we agree to. M CA 00 0110 01 0 ISO Properties,Inc., 2000 Page 9 of 11 1 • • • b. Before the 'pollutants' or any property in H. Insured contract'means: which the 'pollutants' are contained are 1. A lease of premises; _ moved from the place where they are ac- cepted by the 'insured' for movement into or 2. A sidetrack agreement; onto the covered'auto';or S. Any easement or license agreement, except in c. After the 'pollutants' or any property In which connection with construction or demolition opera- the'pollutants'are contained are moved from lions on or within 50 feet of a railroad; the covered'auto'to the place where they are 4. An obligation, as required by ordinance, to in- finally delivered,disposed of or abandoned by demnify a municipality, except in connection with the'insured'. work for a municipality; Paragraph a. above does not apply to fuels, 5. That part of any other contract or agreement lubricants, fluids, exhaust gases or other pertaining to your business (including an indem- similar 'pollutants' that are needed for or re- nificatlon of a municipality in connection with work suit from the normal electrical, hydraulic or performed for a municipality)under which you as- mechanical functioning of the covered 'auto' sumo the tort liability of another to pay for'bodily or its parts,if: injury or'property damage'to a thins party or or- (1) The 'pollutants' escape, seep, migrate, or ganizatlon. Tort liability means a liability that are discharged, dispersed or released di- would be imposed by law in the absence of any redly from an 'auto' part designed by its contract or agreement manufacturer to hold, store, receive or 6. That part of any contract or agreement entered dispose of such'pollutants';and into, as part of your business, pertaining to the (2) The 'bodily Injury', 'property damage' or rental or lease, by you or any of your 'employ- 'covered pollution cost or expense' does ees', of any 'auto'. However, such contract or not arise out of the operation of any agreement shall not be considered an 'Insured equipment listed In Paragraphs 6.b.or 6.c. contract'to the extent that it obligates you or any of the definition of'mobile equipment'. of your'employees'to pay for'property damage' Paragraphs b. and a above do not apply to to any 'auto' rented or leased by you or any of 'accidents' that occur away from premises your employees . owned by or rented to an 'Insured' with re- An insured contract'does not include that part of sped to'pollutants'not in or upon a covered any contract or agreement 'auto'it a. That indemnifies a railroad for 'bodily injury' (1) The 'pollutants' or any property in which or'property damage' arising out of construc- the 'pollutants' am contained are upset, Lion or demolition operations,within 50 feet of overturned or damaged as a result of the any bridge property and affecting any rail- . maintenance.or use of a covered 'auto'; dge or trestle, tracks, roadbeds, tun- and nel,underpass or crossing;or (2) The discharge,dispersal,seepage, migra- b. That pertains to the loan,lease or rental of an lion, release or escape of the 'pollutants' 'auto' to you or any of your 'employees', if is caused directly by such upset, overturn the 'auto' is loaned, leased or rented with a or damage. driver;or E. 'Diminution In value' means the actual or perceived c. That holds a person or organization engaged loss in market value or resale value which results in the business of transporting property by from a direct and accidental'loss'. 'auto'for hire harmless for your use of a cov- ered'Employee' includes a 'leased worker'. 'Employee' ered 'auto' over a route or tenttory that per- does not include a"temporary worker', son or organization is authorized to serve by Public authority. G. 'Insured' means any person or organization qualify- authority.. ing as an insured In the Who Is An Insured provision L 'Leased worker means a person leased to you by a of the applicable coverage. Except with respect to labor leasing firm under an agreement between you and the labor leasing firm, to perform duties related the Limit of insurance,the coverage afforded applies to the conduct of your business. 'Leased worker' separately to each insured who is seeking coverage does not include a"temporary worker'. or against whom a claim or'suit'is brought. J. 'Loss'means direct and accidental loss or damage. Page 10 of 11 O ISO Properties,Inc., 2000 CA 00 01 10 01 . • • . • K. 'Mobile equipment'means any of the following types b. Cheny pickers and similar devices mounted of land vehicles,including any attached machinery or on automobile or truck chassis and used to equipment: raise or lower workers;and 1. Bulldozers, farm machinery, forklifts and other c. Air compressors, pumps and generators, in- vehicles designed for use principally off public eluding spraying, welding, building cleaning, roads; geophysical exploration, lighting or well serv- 2. Vehicles maintained for use solely on or next to icing equipment premises you own or rent; L 'Pollutants' means any solid, liquid, gaseous or 3. Vehicles that travel on crawler treads; thermal irritant or contaminant, including smoke, va- por,soot,fumes,acids,alkalis,chemicals and waste. 4. Vehicles, whether self-propelled or not, main- Waste includes materials to be recycled, recondi- tained primarily to provide mobility to permanently tioned or reclaimed. N mounted: M. Property damage' means damage to or loss of use c a. Power cranes, shovels, loaders, diggers or of tangible property. drills;or N. 'Suit'means a civil proceeding in which: b. Road construction or resurfacing equipment 1. Damages because of 'bodily o such as graders,scrapers or rollers. 9 ly injury' or property 5. Vehicles.not described In Paragraphs 1.,2.,3.,or damage';or 4. above that are not self-propelled and are 2. A covered pollution cost or expense , maintained primarily to provide mobility to perma- to which this insurance applies,are alleged. H nenty attached equipment of the following types: 'Suit'includes: a. Air compressors, pumps and generators, in- CV eluding spraying, welding, building cleaning, arbitration proceeding in which such damp geophysical exploration, lighting and well ages or'covered pollution costs or expenses servicing equipment;or are claimed and to which the 'insured' must submit or does submit with our consent or b. Cheny pickers and similar devices used to pro- raise or lower workers. b. Any other alternative dispute resolution pro- ceeding in which such damages or covered 6. Vehicles not described in Paragraphs 1.,2., S.or pollution costs or expenses' are claimed and • 4.above maintained primarily for purposes other to which the insured submits with our consent than the transportation of persons or cargo. How- 0. 'Temporary worker' means a person who is fur- .. ever, self-propelled vehicles with the following nished to you to substitute for a permanent 'em- types of permanently attached equipment are not ployee' on leave or to meet seasonal or short-term mobile equipment' but will be considered workload conditions. autos : a. Equipment designed primarily for: railer'includes semitrailer. r. 'Trailer' (1) Snow removal; ® (2) Road maintenance,but not construction or resurfacing;or (3) Street cleaning; ami moo ram!tom l.� CA 00 0110 011 0 ISO Properties,Inc., 2000 Page 11 of 11 . • POLICY NUMBER: 72 UEN 1L4406 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULE OF LIMITS UNINSURED MOTORISTS COVERAGE AND UNDERINSURED MOTORISTS COVERAGE rn This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM cp TRUCKERS COVERAGE FORM o This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated below. 1-4 Endorsement effective cat CV Named Insured Countersigned by (Authorized Representative) III The Limit shown in ITEM TWO of the Declarations for Uninsured Motorists Coverage and for Underinsured Motorists Coverage (when not included in Uninsured Motorists Coverage) Is replaced by the limits shown below for the state C Indicated. SCHEDULE COVERAGE LIMIT STATE UNINSURED MOTORISTS t� $ 1,000 ,000 each"accident" •CA $ ,000 each"accident' $ ,000 each"accident' JIM $ ,000 each"accident' ® ,000 each"accident' $ ,000 each"accident' UNDERINSURED $ ,000 each"accident' MOTORISTS (when not included in Uninsured $ ,000 each"accident' Motorists Coverage) s� $ ,000 each"accident" Nem masa $ ,000 each"accident' $ ,000 each"accident' $ ,000 each"accident The state limit shown above completes the limit entry required on the endorsement(s)applicable in the same state. Ram HA 2102 08 92 Printed in U.S.A. . 1I - ® i COMMERCIAL AUTO CA 99 03 07 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO MEDICAL PAYMENTS COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM T-1 TRUCKERS COVERAGE FORM c With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the .-i endorsement. 0 .°• A. Coverage 4. 'Bodily injury' to your °employee" arising out of diWe will pay reasonable expenses incurred for and in the course of employment by you. a necessary medical and funeral services to or for an However, we will cover 'bodily injury' to your c4 'insured' who sustains 'bodily injury' caused by domestic 'employees" if not entitled to workers' ca 'accident'. We will pay only those expenses incurred, compensation benefits. For the purposes of this o for services rendered within three years from the date endorsement, a domestic 'employe" Is a person en of the'accident'. engaged in household or domestic work performed .le B. Who Is An Insured principally in connection with a residence premises. les 1. You while 'occupying' or, while a pedestrian, . 5. 'Bodily injury' to an 'insured' while working In a when struck by any'auto'. business of selling, servicing, repairing or parking 2. If you are an Individual,any'family member'while 'autos'unless that business is yours. .I= 'occupying'or,while a pedestrian,when struck by 6. 'Bodily injury' caused by declared or undeclared imi any'auto'. war or Insurrection or any of their consequences. 3. Anyone else 'occupying' a covered 'auto' or a 7. 'Bodily Injury'to anyone using a vehicle without a temporary substitute for a covered 'auto'. The reasonable belief that the person is entitled to do t covered 'auto' must be out of service because of so. its breakdown, repair, servicing, loss or 8. 'Bodily injury' sustained by an 'insured' while sim destruction. 'occupying' any covered 'auto'while used In any as C. Exclusions professional racing or demolition contest or stunting activity, or while practicing for such This Insurance does not apply to any of the following: contest or activity. This Insurance also does not 1. 'Bodily Injury' sustained by an 'Insured' while apply to any 'bodily injury' sustained by an 'occupying' a vehicle located for use as a 'insured' while the 'auto' is being prepared for premises. such a contest or activity. ® 2. 'Bodily Injury' sustained by you or any 'family D. Limit Of Insurance OEM member' while 'occupying' or struck by any Regardless of the number of covered 'autos', IM vehicle (other than a covered 'auto') owned by 'insureds', premiums paid, claims made or vehicles le you or furnished or available for your regular use. Involved in the 'accident', the most we will pay for 3. 'Bodily Injury' sustained by any 'family member' 'bodily injury' for each 'insured' Injured In any one BM while 'occupying' or struck by any vehicle (other 'accident' is the Umit Of Insurance for Auto Medical ® than a covered 'auto') owned by or furnished or Payments Coverage shown In the Declarations. ss -- available for the regular use of any 'family No one will be entitled to receive duplicate payments ® member'. for the same elements of 'loss' under this coverage and any Liability Coverage Form, Uninsured Motorists Coverage endorsement or Underinsured Motorists Coverage Endorsement attached to this Coverage Part. CA 99 03 07 97 Copyright,Insurance Services Office,Inc.,1996 Page 1 of 2 • • • . � E. Changes In Conditions F. Additional Definitions The Conditions are changed for Auto Medical As used in this endorsement: Payments Coverage as follows: 1. 'Family member' means a person related to you 1. The Transfer Of Rights Of Recovery Against by blood,marriage or adoption who is a resident of Others To Us Condition does not apply. your household,including a ward or foster child. 2. The reference in Other Insurance in the Business 2. 'Occupying' means in, upon, getting in, on, out or Auto and Garage Coverage Forms and Other off. Insurance - Primary And Excess Insurance Provisions in the Truckers and Motor Carrier Coverage Forms to 'other collectible insurance' applies only to other collectible auto medical payments insurance. • • • • Page 2 of 2 Copyright,Insurance Services Office,Inc.1996 CA 99 06 07 97 • S • POLICY NUMBER: COMMERCIAL AUTO CA 21 54 02 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA UNINSURED MOTORISTS COVERAGE - BODILY INJURY For.a covered "auto" licensed or principally garaged in or "garage operations" conducted in California this endorsement modifies insurance provided under the following: ,mod, BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM C:0 MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM °-� With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the Inception date of the policy unless another date is a indicated below. 1-4 N C4 Endorsement Effective: Countersigned By: 0 Ln Named Insured: (Authorized Representative) SCHEDULE Limit Of Insurance $ Each"Accident" _ Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Coverage B. Who Is An Insured ® 1. We will pay all sums the "insured" is legally If the Named Insured is designated in the entitled to recover as compensatory damages Declarations as: from the owner or driver of an "uninsured 1. An individual,then the following are"insureds": motor vehicle". The damages must result from a. The Named Insured and any "family "bodily injury sustained by the insured Y y caused by an "accident". The owners or members". drivers liability for these damages must result b. Anyone else "occupying" a covered "auto" from the ownership, maintenance or use of the or a temporary substitute for a covered "uninsured motor vehicle". "auto". The covered "auto" must be out of 2: We will pay only after the limits of liability service because of its breakdown, repair, MEE under any liability bonds or policies have been servicing,"loss"or destruction. exhausted by payment of judgments or c. Anyone for damages he or she is entitled to settlements. recover because of"bodily injury"sustained gums 3. Any judgment for damages arising out of a by another"Insured". "suit"brought without our written consent is not binding on us. CA 2154 02 04 0 ISO Properties, Inc., 2003 Page 1.of 4 • • ~ 2. A partnership, limited liability company, 5. "Bodily injury" sustained by an Individual corporation or any other form of organization, Named Insured or any "family member„ while then the following are"insureds": "occupying" any vehicle leased by that Named a. Anyone "occupying" a covered "auto" or a Insured or any "family member" under a temporary substitute for a covered "auto". written contract for a period of 6 months or The covered "auto" must be out of service more that is not a covered"auto". because of its breakdown, repair, servicing, 6. Anyone using a vehicle without a reasonable "loss"or destruction. belief that the person is entitled to do so. b. Anyone for damages he or she is entitled to 7. "Bodily injury" sustained by an Insured" while recover because of"bodily injury"sustained "occupying" any "auto" that is rented or leased by another"Insured". to that "Insured" for use as a public or livery C. Exclusions conveyance. However, this exclusion does not This apply if the "insured" is in the business of his insurance does not apply to any of the following: providing public or livery conveyance. D. Limit Of Insurance • 1. Punitive or exemplary damages. • 1. Regardless of the number of covered "autos", 2. Any claim settled without our consent. "insured?, premiums paid, claims made or • However, this exclusion does not apply to a vehicles involved in the "accident", the most settlement made with the insurer of a vehicle we will pay for all damages resulting from any described in Paragraph b. of the definition of one "accident" is the Limit of Insurance for "uninsured motor vehicle". Uninsured Motorists Coverage shown in the 3. The direct or indirect benefit of any insurer or Schedule or Declarations. self-insurer under any workers' compensation, 2. For a vehicle described in Paragraph b. of the disability benefits or similar law or to the direct definition of "uninsured motor vehicle", our benefit of the United States, a state or its Limit of Insurance shall be reduced by all sums political subdivisions. paid because of"bodily in pa y jury"by or for anyone 4. "Bodily injury"sustained by: who is legally responsible, including all sums a. An individual Named Insured while paid or payable under this policy's Liability "occupying" or when struck by any vehicle Coverage. owned by that Named Insured that is not a 3. No one will be entitled to receive duplicate • covered "auto" for Uninsured Motorists payments for the same elements of "loss" Coverage under this Coverage Form; under this Coverage and any Liability b. Any "family member" while "occupying" or Coverage form or Medical Payments when struck by any vehicle owned by that Coverage endorsement attached to this • "family member" that is not a covered Coverage Part. "auto" for Uninsured Motorists Coverage We will not make a duplicate payment under under this Coverage Form; or this Coverage for any element'of "loss" for c. Any "family member" while "occupying" or which payment has been made by or for when struck by any vehicle owned by the anyone who is legally responsible. Named Insured that is insured for We will not pay for any element of "loss" If a Uninsured Motorists Coverage on a primary person is entitled to receive payment for the basis under any other Coverage Form or same element of "loss under any workers' policy. compensation,disability benefits or similar law. However, Exclusion 4. shall not apply to E. Changes In Conditions "bodily injury" sustained by an individual The Conditions are changed for California Named Insured or "family member" when Uninsured Motorists Coverage - Bodily Injury as struck by a vehicle owned by that "insured" follows: and operated or caused to be operated by a 1. Duties In The Event Of Accident, Claim, person without that "insured's" consent in quit Or Loss is changed by adding the connection with criminal activity that has been • documented in a police report and to which following: that"insured"is not a party to. a. Promptly notify the police if a hit-and-run driver is involved; and Page 2 of 4 0 ISO Properties, Inc., 2003 CA 2154 02 04 S 0 b. Send us copies of the legal papers if a 3. Transfer Of Rights Of Recovery Against `' • "suit" is brought. In addition, a person Others To Us is replaced by the following: seeking coverage under Paragraph b. of a. With respect to Paragraphs a., c. and d. of the definition of "uninsured motor vehicle" the definition of "uninsured motor vehicle", must: if we make any payment, we are entitled to (1) Provide us with a copy of the complaint recover what we paid from other parties. by personal service or certified mail if Any person to or for whom we make the "insured" brings an action against payment must transfer to us his or her the owner or operator of such rights of recovery against any other party. "uninsured motor vehicle"; This person must do everything necessary (2) Within a reasonable time, make all to secure these rights and must do nothing pleadings and depositions available for that would jeopardize them. . up -421 copying•by us or furnish us copies at our b. With respect to Paragraph b. of the .-.4 expense; and definition of "uninsured motor vehicle", if (3) Provide us with proof that the limits of we make any payment and the "insured" o insurance under any applicable liability recovers from another party, the "insured" c) bonds or policies have been exhausted shall hold the proceeds in trust for us and by payment of judgments or pay us back the amount we have paid. c) settlements. 4. Other Insurance in the Business Auto and a 2. Legal Action Against Us is replaced by the Garage Coverage Forms and Other N following: Insurance - Primary And Excess Insurance v No legal action may be brought against us Provisions in the Truckers and Motor Cancer o under this Coverage Form until there has been Coverage Forms are replaced by the following: _ • full compliance with all the terms of this If there is other applicable insurance available * Coverage Form and with respect to under one or more policies or provisions of I -.- Paragraphs a., c. and d. of the definition of coverage: r= "uninsured motor vehicle" unless within two a. The maximum recovery under all Coverage years from the date of the"accident": Forms or policies combined may equal but a. Agreement as to the amount due under this not exceed the highest applicable limit for insurance has been concluded; any one vehicle under any Coverage Form EM b: The "insured" has formally instituted or policy providing coverage. on either a primary or excess basis. arbitration proceedings against us. In the MEM event that the "insured" decides to b. Any insurance we provide with respect to a isia arbitrate, the "insured" must formally begin vehicle the Named Insured does not own arbitration proceedings by notifying us in shall be excess over any other collectible imm writing, sent by certified mail, return receipt uninsured motorists insurance providing was requested;or . coverage on a primary basis. iii asomi C. "Suit" for "bodily injury" has been filed c. If the coverage under this Coverage Form against the uninsured motorist in a court of is provided: competent jurisdiction. (1) On a primary basis, we will pay only our Written notice of the"suit"must be given to share of the "loss" that must be paid us within a reasonable time after the under insurance providing coverage on "insured" knew, or should have known,that a primary basis. Our share is the MSS EmEl the other motorist is uninsured. In no event proportion that our limit of liability bears will such notice be required before two to the total of all applicable limits of ® years from the date of the accident. Failure liability for coverage on a primary basis.. E of the "insured" or his or her representative (2) On an excess basis we will pay only our to give us such notice of the "suit" will share of the "loss" that must be paid ® relieve us of our obligations under this tinder insurance providing coverage on mug MEM Coverage Form only if the failure to give an excess basis. Our share is the notice prejudices our rights. proportion that our limit of liability bears to the total of all applicable limits of liability for coverage on an excess basis. CA 2154 02 04 0 ISO Properties, Inc., 2003 Page 3 of 4 • S • ~ ` - 5. The following Condition is added: b. That is an underinsured motor vehicle. An ARBITRATION underinsured motor vehicle is a land motor vehicle or "trailer" for which the sum of all a. If we and an"insured"disagree whether the liability bonds or policies at the time of an "insured" is legally entitled to recover "accident" provides at least the amounts damages from the owner or driver of an required by the applicable law where a "uninsured motor vehicle" or do not agree covered "auto" is principally garaged but as to the amount of damages that are that sum is less than the Limit of Insurance recoverable by that "insured", the for this coverage; disagreement will be settled by arbitration. Such arbitration may be initiated by a c. For which an insuring or bonding company written demand for arbitration made by denies coverage or refuses to admit either party. The arbitration shall be coverage except conditionally or with conducted by a single neutral arbitrator. reservation or becomes insolvent; or However, disputes concerning coverage d. That is a hit-and-run vehicle and neither the under this endorsement may not be driver nor owner can be identified. The arbitrated. Each party will bear the vehicle must make physical contact with an expenses of the arbitrator equally. "insured", a covered "auto" or a vehicle an b. Unless both parties agree otherwise, "Insured"is"occupying". arbitration will take place in the county in e. That is owned by an individual Named which the "insured" lives. Local rules of law Insured or "family member" and operated as to arbitration procedures and evidence or caused to be operated by a person will apply. The-decision of the arbitrator will without the owners consent in connection be binding. with criminal activity that has been • F. Additional Definitions documented in a police report. The following are added to the Definitions However, "uninsured motor vehicle" does not Section: include any vehicle: 1. "Family member" means the individual Named a. Owned or operated by.a self-Insurer under Insured's spouse, whether or not a resident of any applicable motor vehicle law except a the individual Named insured's household, and self-Insurer who is or becomes insolvent any other person related to such Named and cannot provide the amounts required • Insured by blood, marriage or adoption who.is by that motor vehicle law; a resident of such Named Insured's household, b. Owned by a-govemmental unit or agency; including a ward or foster child. c. Designed or modified for use primarily off 2. "Occupying"means In, upon, getting in, on, out public roads while not on public roads. or off. 3. "Uninsured motor vehicle" means a land motor vehicle or trailer. a. For which no liability bond or policy at the time of an "accident" provides at least the amounts required by the applicable law . where a covered "auto" is principally garaged. • • Page 4 of 4 ®ISO Properties, Inc., 2003 CA 21 54 02 04 • , , .. ,-' 1 4 a ' 0 • COMMERCIAL AUTO - CA00381202 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAR EXCLUSION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM r• MOTOR CARRIER COVERAGE FORM c SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY o TRUCKERS COVERAGE FORM r..r With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless a-4 modified by the endorsement. o • UT) A. Changes In Liability Coverage (3) Insurrection, rebellion, revolution, a The War exclusion under Paragraph B. usurped power, or action taken by N Exclusions of Section II—Liability Coverage is governmental authority in hindering or N replaced by the following: defending against any of these. o° WAR C. Changes In Auto Medical Payments "' e If the Auto Medical Payments Coverage"Bodily injury", "property damage" or"covered y g pollution cost or expense" arising directly or endorsement is attached, then Exclusion C.6. Is I1 indirectly, out of: replaced by the following: a. War, including undeclared or civil war, 6. "Bodily injury", arising directly or indirectly, out of: b. Warlike action by a military force, including action In hindering or defending against an a. War, including undeclared or civil war; actual or expected attack, by any b. Warlike action by a military force;including 6 government, sovereign or other authority action in hindering or defending against an using military personnel or other agents; or actual or expected attack, by any ii c. Insurrection, rebellion, revolution, usurped government, sovereign or other authority power, or action taken by governmental using military personnel or other agents; or authority in hindering or defending against c. Insurrection, rebellion, revolution, usurped any of these. power, or action taken by governmental inim B. Changes In Garagekeepers Coverage authority in hindering or defending against If the Garagekeepers Coverage endorsement or any of these. I3 the Garagekeepers Coverage — Customers' D. Changes In Uninsured/Underinsured Motorists = Sound Receiving Equipment endorsement is Coverage im attached,the following exclusion is added: If Uninsured and/or Underinsured Motorists rem We will not pay for "loss" caused by or resulting Coverage is attached, then the following exclusion r� rafrom the following. Such "loss" is excluded is added: regardless of any other cause or event that This insurance does not apply to: �_ contributes concurrently or in any sequence to the WAR ll= "loss": WAR 1. "Bodily Injury" or "property damage", if rm applicable, arising directly or indirectly, out of: (1) War, including undeclared or civil war, imam a. War, including undeclared or civil war; (2) Warlike action by a military force, b. Warlike action by a military force, including including action in hindering or action in hindering or defending against an defending against an actual or expected actual or expected attack, by any attack, by any government,sovereign or other authority using military personnel government, sovereign or other authority or other agents; or using military personnel or other agents; or CA 00 38 12 02 0 ISO Properties, Inc., 2003 Page 1 of 2 C. Insurrection, rebellion, revolution, usurped F. Changes In Single Interest Automobile power, or action taken by governmental Physical Damage Insurance Policy authority in hindering or defending against The War exclusion is replaced by the following: any of these. E. Changes In Personal Injury Protection a. War, induding undeclared or civil war Coverage b. Warlike action by a military force, including action in hindering or defending against an 1. If Personal Injury Protection, no-fault, or other actual or expected attack, by any similar coverage is attached, and: government, sovereign or other authority a. Contains, in whole or in part, a War using military personnel or other agents; or exclusion, that exclusion is replaced by c. Insurrection, rebellion, revolution, usurped Paragraph 2. power, or action taken by governmental b. Does not contain a war exclusion, authority in hindering or defending against Paragraph 2.is added. any of these. 2. This insurance does not apply to: WAR "Bodily injury" or "property damage", if applicable,arising directly or indirectly, out of: a. War, including undeclared or civil war, b. Warlike action by a military force, including action In hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents;or c. Insurrection, rebellion,. revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. • • Page 2 of 2 0 ISO Properties, Inc., 2003 CA 00 3812 02 • , No • .. • COMMERCIAL AUTO ti CA 0143 02 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES For a covered "auto" licensed or principally garaged in or "garage operations" conducted in California this endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM co BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM o GARAGE COVERAGE FORM o MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM cWith respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the ‘0 endorsement. `"a A. The Other Insurance Condition is changed by adding a. When this Coverage Form and any other N the following: Coverage Form or poll " "cy providing liability c.1 d. When this Coverage Form and any other coverage apply to an auto and: Coverage Form or policy providing liability 1. One provides coverage to a Named Insured coverage apply to an"auto"and: engaged in the business of selling, repairing, 1. One provides coverage to a Named Insured servicing, delivering, testing, road-testing,mom engaged In the business of selling, repairing, parking or storing"autos,"and servicing, delivering, testing, road-testing, 2. The other provides coverage•to a person not parking or storing"autos,"and engaged in that business,and 2. The other provides coverage to a person not S. At the time of an "accident' an '"Insured" engaged in that business,and under the Coverage Form described In 1. is S. At the time of an "accident," a person operating an "auto" owned by a person described In 2. is operating an "auto" owned described in 2., then the Coverage Form by the business described in 1., then that issued to the business described in 1. Is person's liability coverage is primary and the primary and the Liability Coverage Issued to a Coverage Form Issued to a business person described in 2. is excess over any described In 1. is excess over any coverage coverage available to the business. ism available to that person. m k. liaME 91 NMI Mays igNia MEM CA 01 45 02 97 Copyright,Insurance Services Office,Inc., 1996 Page 1 of 1 . _ ., J . . COMMERCIAL AUTO tt CA 20 38 02 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA - LEASING OR RENTAL CONCERNS - PRIMACY OF COVERAGE This endorsement modifies Insurance provided under the following: ON BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM c With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the :., endorsement. A. The Other Insurance Condition in the Business Auto B. As used in this endorsement a Coverage Form and the Other Insurance - Primary "Commercial vehicle" means an "auto" of a type And Excess Insurance Provisions in the Truckers required to be registered under the California Vehicle Cl Coverage Form,are changed by adding the following: Code,and: 0 1. Notwithstanding Paragraph a. in the Business 1. Used or maintained for the transportation of e Auto Coverage Form and Paragraphs a. and c. In persons for hire,compensation or profit,other than the Truckers Coverage Form,when this Coverage . a van pool vehicle; l�• Form and any other Coverage Form or policy aa� providing liability coverage apply to a"commercial 2. Designed, used or maintained primarily for the vehicle"and: transportation of property;or a. One provides such coverage to a Named 3. Leased for a period of six months or more. Insured engaged in the business of renting or B leasing "commercial vehicles" without operators,and b. The other provides such coverage to a person not engaged in that business,and c. At the time of an "acddent", a person who is not the Named Insured of the policy described in Paragraph A.1.b.,and who is not the agent or employee of such Named Insured is operating a "commercial vehicle" provided by the business covered by the Coverage Form or policy described in Paragraph A.1 a., then the liability coverage provided by the aa� Coverage Form or policy described In Paragraph A.1.b. is primary, and the liability coverage provided by the Coverage Form or mem policy described in Paragraph A.1.8.Is excess over any coverage available to that person. Immo 1=a CA 20 38 02 97 Copyright,Insurance Services Office,Inc., 1996 Page 1 01 , POLICY NUMBER: 72 UEN 1146 • COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM I El, With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. c This endorsement.identifies person(s)or organization(s)who are "insureds"under the Who Is An Insured Provision of o the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. c This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. nr 01 Endorsement effective Named Insured Countersigned by (Authorized Representative) SCHEDULE Name of Persons)or Organization(s): M (SEE FORM IH12011185 ATTACHED) • ;ramp (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) ENE Each person or organization shown in the Schedule is an "insured"for Liability Coverage, but only to the extent that person or organization qualifies as an"insured"under the Who Is An Insured Provision contained in Section II of the Coverage Form. IEENI lam OEM sa_ CA 20 48 02 99 Copyright, Insurance Services Office, Inc.,1998 Page 1 of 1 • 3 J, • • POLICY NUMBER: 72 UEN 1L4406 COMMERCIAL AUTO CA99100902 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DRIVE OTHER CAR COVERAGE - BROADENED COVERAGE FOR NAMED INDIVIDUALS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM o MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by o the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date Is indicated be- ,a low. H CV Endorsement Effective: Countersigned By: r se Named Insured: • (Authorized Representative) Immo SCHEDULE SEE SUBSEQUENT PAGE Auto Medical ERE Name Of Individual Liabiliity Payments Limit Premium Limit Premium mmmi saa Physical Uninsured Underinsured Damage to= Name Of Individual Motorists . Motorists Comp. Coll. Limit Premium Limit Premium Note—When uninsured motorists is provided at limits higher than the basic limits required by a financial responsibility law, underinsured motorists Is included, unless otherwise noted. If Underinsured Motorists Coverage is provided as a separate coverage,make appropriate entry in the Schedule above. NENE ® (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) CA 99100902 0 ISO Properties,Inc., 2002 PAGE 1 (CONTINUED ON NEXT PAGE) • • i i .,c_ ,_ A. This endorsement changes only those coverages D. Changes In Physical Damage Coverage where a premium Is shown in the Schedule. My private passenger type 'auto' you don't own, B. Changes in Liability Coverage hire or borrow.is a covered 'auto'while in the care, 1. Any 'auto' you don't own, hire or borrow is a custody or control of any individual named in the covered 'auto' for Liability Coverage while being Schedule or his or her spouse while a resident of the used by any individual named In the Schedule or same household except by his or her spouse while a resident of the same 1. Any 'auto' owned by that individual or by any household except member of his or her household. a. Any'auto'owned by that individual or by any 2. Any 'auto' used by that individual or his or her member of his or her household. spouse while working in a business of selling, b. Any'auto'used by that individual or his or her servicing,repairing or parking'autos'. spouse while working in a business of selling, E. Additional Definition servicing,repairing or parking'autos'. As used in this endorsement 2. The following is added to Who Is An Insured: 'Family member'means a person related to the indi- Any individual named in the Schedule and his or vidual named in the Schedule by blood, marriage or her spouse, while a resident of the same house- adoption who is a resident of the individual's house- hold, are 'insureds' while using any covered hold,including a ward or foster child. 'auto' described In Paragraph B.1. of this en- dorsement. C. Changes hi Auto Medical Payments And Uninsured And Underinsured Motorists Coverages The following Is added to Who Is An Insured: My individual named in the Schedule and his or her 'family members' are 'insured'while 'occupying' or while a pedestrian when being struck by any 'auto' you don't own except Any'auto'owned by that individual or by any'family member'. SCHEDULE LIABILITY LIMITS: REFER TO ITEM TWO OF THE DECLARATIONS $5,000 FOR °BODILY INJURY" FOR AUTO MEDICAL PAYMENTS EACH °INSURED° $1,000,000 EACH °ACCIDENT° - CA UNINSURED MOTORISTS LIMITS: 0 ISO Properties,Inc., 2002 CA 99 10 09 02 . PAGE 2 (CONTINUED ON NEXT PAGE) 1 DRIVE OTHER CAR COVERAGE-BROADENED COVERAGE FOR NAMED INDIVIDUALS(Continued) POLICY NUMBER: 72 UEN IL4406 PREMIUMS PER NAMED INDIVIDUAL Auto $50 Medical Uninsured Underinsured Deductible Liability Payments Motorists Motorists Comprehensive Collision $110.00 $9.00 $220.00 $16.00 $39.00 N c NAME OF INDIVIDUAL c JOHN S. MEEK o ' H Cl Lri • • muss N m .�L se@aa 0 ISO Properties,Inc., 2002 CA 9910 09 02 PAGE 3 w y POLICY NUMBER 72 URN IL4 6 COMMERCIAL AUTO CA 99281295 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RENTAL REIMBURSEMENT COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM n MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM ° BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM o With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. %/2 This endorsement changes the policy effective on the Inception date of the policy unless another date is Indicated below. a Endorsement effective H N N Named Insured Countersigned by 0 (Authorized Representative) SCHEDULE SEE SUBSEQUENT PAGE Maximum Payment Each Covered"Auto" • Designation or Description of Auto Covered"Autos"to which Any One No.of Any One Coverages No. this Insurance applies Day Days Period Premium Comprehensive 1 $ $ $ 2 $ $ $ ala Collision 1 $ $ $ ttt;= 2 $ $ $ t;= Specified 1 $ $ $ t� ® Causes of Loss 2 $ $ $ ssM Total Premium M` (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. This endorsement provides only those coverages B. We will pay for rental "reimbursement expenses was where a premium is shown In the Schedule. It applies incurred by you for the rental of an "auto" because of only to a covered"auto"described or designated In the "loss" to a covered "auto". Payment applies in sem Schedule. addition to the otherwise applicable amount of each coverage you have on a covered "auto." No deductibles apply to this coverage. • Copyright,Insurance Services Qfflce,Inc.,1993 CA 99 23 1295 PAGE 1 (CONTINUED ON NEXT PAGE) C. We will pay only for those expenses incurred during D. Our payment Is limited to the lesser of the following . the policy period beginning 24 hours after the "loss" amounts: and ending, regardless of the policy's expiration, with 1. Necessary and actual expenses incurred. the lesser of the following number of days: 1. The number of days reasonably required to repair 2. The maximum payment stated In the Schedule or replace the covered"auto". If'loss" is caused aPPlicable to"any one day"or"any one period". by theft, this number of days is added to the E. This coverage does not apply while there are spare or number of days it takes to locate the covered reserve"autos"available to you for your operations. "auto"and return it to you. F. If"loss" results from the total theft of a covered"auto" 2. The number of days shown in the Schedule. of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which Is not already provided • for under the PHYSICAL DAMAGE COVERAGE •Coverege.Extension. SCHEDULE • MAXIMUM PAYMENT EACH COVERED AUTO AUTO ANY ONE NO. OF ANY ONE NO. COVERAGE DAY DAYS PERIOD PREMIUM 1 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 2 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 • COLLISION $ 13.00 • 3 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 4 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 5 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 6 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 7 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 8 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 9 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 • 10 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 Copyright,Insurance Services Office,Inc., 1993 CA 99 23 12 93 PAGE 2 (CONTINUED ON NEXT PAGE) • RENTAL REIMBURSEMENT CO GE(Continued) POLICY NUMBER: 72 UEN IL4406 SCHEDULE MAXIMUM PAYMENT EACH COVERED AUTO AUTO ANY ONE NO. OF ANY ONE NO. COVERAGE DAY DAYS PERIOD PREMIUM 11 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 ul c COLLISION $ 13.00 r4 0 12 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 r-i COLLISION $ 13.00 0 r-4 c) 13 COMPREHENSIVE $ 30 30 $ 900 $ 8.-00 c) COLLISION $ 13.00 N14 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 N COLLISION $ 13.00 CD n 15 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 * COLLISION $ 13.00 16 COMPREHENSIVE $ 30 30 $ 900 $ 8.00 COLLISION $ 13.00 ina Er eela VMS lei CA 99 2312 93 PAGE 3 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHANGES IN HIRED CAR PHYSICAL DAMAGE - LIMIT OF INSURANCE iThis endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM TRUCKERS ENDORSEMENT • ■ N A. The BUSINESS AUTO COVERAGE FORM is C. The TRUCKERS COVERAGE FORM is changed as N changed as follows: follows: o 1. PHYSICAL DAMAGE COVERAGE for covered 1. PHYSICAL DAMAGE COVERAGE for covered Lel "autos" you hire or borrow Is excess unless "autos° you hire or borrow is excess unless primary physical damage coverage for such primary physical damage coverage for such i� autos is specifically provided In the policy autos is specifically provided in the policy a Declarations Declarations. 2. Paragraph b. of the OTHER INSURANCE 2. Paragraph d. of the OTHER INSURANCE - imm Condition does not apply to Hired Auto Physical PRIMARY AND EXCESS INSURANCE Damage Coverage. Condition regarding Hired Auto Physical Iowa B. The GARAGE COVERAGE FORM is changed as Damage does not apply. follows: D. The TRUCKERS ENDORSEMENT is changed as maw 1. PHYSICAL DAMAGE COVERAGE for covered follows: "autos" you hire or borrow is excess unless 1. PHYSICAL DAMAGE COVERAGE for covered primary physical damage coverage for such "autos" you hire or borrow is excess unless ti= autos is specifically provided in the policy primary physical damage coverage for such Declarations. autos Is specifically provided to the policy 2. Paragraph b. of the OTHER INSURANCE Declarations. Condition regarding Hired Auto Physical 2. Paragraph d. of the OTHER INSURANCE Damage Coverage does not apply Condition regarding Hired Auto Physical • Damage Coverage does not apply. ear m isms • mos Noma Fenn HA 00 24 12 90 Printed in U.S.A. . 4'OLICY NUMBER: 72 UEN IL06 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY HIRED AUTO INSURANCE This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM cp TRUCKERS COVERAGE FORM o LABILITY COVERAGE C%. AUTOS NOT USED IN YOUR TRUCKING OPERATIONS(Under Motor Carrier or Truckers Coverage Forms) ao Q If this box is marked,for any covered'auto'leased,hired,rented or borrowed by you this Coverage Form provides primary insurance. CN1 Q If this box is marked,for a covered'auto'leased,hired,rented or borrowed by you from a person or organization named below this Coverage Form provides primary insurance. State Estimated Cost of Hire Primary Rate Per Each$100 Cost of Hire Advance Premium TOTAL ADVANCE PREMIUM: B PHYSICAL DAMAGE COVERAGE © If this box is marked,for any covered'auto'leased,hired,rented or borrowed b � y by you this Coverage Form provides primary insurance. er 0 if this box is marked,for a covered'auto'leased,hired,rented or borrowed by you from a person or organization named below this Coverage Form provides'primary insurance. Coverages Type Auto Estimated Total Auto/Days Primary Rale Per Advance of Hired Autos Auto/Day Premium .., Comprehensive Private Passenger 150 .868 13 0.0 0 •--- Ali Other Types 150 .409 61.0 0 Specified Causes of Loss Private Passenger All Other Types Collision Private Passenger 150 2.006 301.00 mai All Other Types 150 1.553 233.00 e!� ll_ TOTAL ADVANCE PREMIUM 725.00 ra NAMED PERSON(S)OR ORGANIZATION(S): irmgm 1:= Form HA 200702 00 01999 The Hartford (Includes copyrighted material of insurance Services Office,Inc. with its permission. Copyright,Insurance Services Office,Inc.,1997) POLICY NUMBER: w _ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MEXICO COVERAGE r- This endorsement modifies insurance provided under the following: o BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM Endorsement effective 1—I Named Insured Countersigned by N c (Authorized Representative) 0 ch " The coverage provided by this policy will apply while your covered"auto"is being used in the Republic of Mexico for no more than 10 days at any one time. However,such coverage shall be excess over any other collectible insurance. WARNING: The Republic of Mexico considers an auto accident a criminal offense as well as a civil matter. Unless you have automobile insurance written by a Mexican insurance Company,you may spend many hours or days In Jail if you have an accident In Mexico. Insurance coverage should be secured from a company licensed under the laws of Mexico to write such insurance in order to avoid complications and some other penalties possible under the laws of Mexico,Including the possible Impoundment of your automobile. imamI a' Q iC C I� Form HA 99 04 0187 Printed In U.S.A e. • y 0 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY COVERAGE PRIVATE PASSENGER TYPE AUTOS co This endorsement modifies insurance provided under the following: 0 BUSINESS AUTO COVERAGE FORM .-i GARAGE COVERAGE FORM 2 TRUCKERS COVERAGE FORM 'd"a Section A. The BUSINESS AUTO COVERAGE FORM is C. The GARAGE COVERAGE FORM is changed changed as follows: as follows: For LIABILITY COVERAGE for "private For LIABILITY COVERAGE for "private e ... passenger type autos", paragraph a. of the passenger type autos", paragraph a. of the POLLUTION EXCLUSION applies only to POLLUTION EXCLUSION APPLICABLE TO liability assumed under a contract or agreement. "GARAGE OPERATIONS" - COVERED B. The TRUCKERS COVERAGE FORM is "AUTOS" applies only to liability assumed under changed as follows: a contract or agreement. For LIABILITY COVERAGE for "private Section II mom passenger type autos", paragraph a. of the The following Is added to the DEFINITIONS POLLUTION EXCLUSION applies only to Section: Es= liability assumed under a contract or agreement. "Private passenger type auto" means a private passenger or station wagon type "auto" and includes an "auto" of the pick-up or van type if not used for business purposes. If you are an Individual, business purposes does not include 8 farming or ranching. Ira seam omon Form HA 99 08 12 90 Printed in U.S.A. COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: 0, BUSINESS AUTO COVERAGE FORM 0 o To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form,the provisions of this endorsement apply. 0 0 1. BROAD FORM INSURED B. Employees as Insureds .o c) A. Subsidiaries and Newly Acquired or Paragraph A.1. - WHO IS AN INSURED - of "0 Formed Organizations SECTION II - LIABILITY COVERAGE is a H The Named Insured shown in the Declarations amended to add: Cg r-• is amended to include: d. Any 'employee' of yours while using a o (1) Any legally incorporated subsidiary In covered 'auto' you don't own, hire or m which you own more than 50% of the borrow in your business or your personal voting stock on the effective date of the affairs. Coverage Form. However, the Named C. Lessors as Insureds Insured does not Include any subsidiary Paragraph A.1. - WHO IS AN INSURED - of that is an 'insured' under any other Section II - Liability Coverage is amended to im automobile policy or would be an'insured' add: under such a policy but for its termination e. The lessor of a covered 'auto" while the mi or the exhaustion of Its Limit of Insurance. "auto" Is leased to you under a written (2) Any organization that is acquired or agreement if: a= formed by you and over which you maintain majority ownership. However, (1) The agreement requires you to the Named Insured does not include any provide direct primary Insurance for ® newly formed or acquired organization: the lessor and (a) That is a partnership,joint venture or (2) The"auto"is leased without a driver. limited liability company Such a leased 'auto" will be considered a (b) That is an 'insured' under any other covered "auto" you own and not a covered policy, 'auto"you hire. (c) That has exhausted its Limit of 2. AUTOS RENTED BY EMPLOYEES Insurance under any other policy,or Any "auto' hired or rented by your'employee" on EMI = (d) 180 days or more after its acquisition your behalf and at your direction will be considered or formation by you, unless you have an'auto"you hire. given us notice of the acquisition or The OTHER INSURANCE Condition is amended iIM formation. by adding the following: ® Coverage does not apply to 'bodily injury' if an"employee's' personal insurance also applies MC or 'property damage' that results from an on an excess basis to a covered "auto" hired or C "accident" that occurred before you rented by your "employee" on your behalf and at = formed or acquired the organization. your direction,this insurance will be primary to the "employee's"personal Insurance. Foram HA 9916 03 02 Page 1 of S 0 2001,The Hartford(Includes copyrighted material of ISO Properties,Inc.,with Its permission.) - 3. AMENDED FELLOW EMPLOYEE EXCLUSION 6. LEASE GAP COVERAGE EXCLUSION 5. - FELLOW EMPLOYEE - of Under SECTION III - PHYSICAL DAMAGE SECTION II - LIABILITY COVERAGE does not COVERAGE, if a long-term leased 'auto' is a apply if you have workers'compensation insurance covered 'auto' and the lessor is named in the in force covering all of your"employees". policy as a Loss Payee,we will pay in the event of Coverage is excess over any other collectible a total "loss" your additional legal obligation to the Insurance. lessor for any difference between the actual cash 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE value of the 'auto'at the time of the"loss" and the 'outstanding balance'of the lease. If hired 'autos' are covered 'autos' for Liability 'Outstanding balance' means the amount you owe Coverage and if Comprehensive,Specified Causes on the lease at the time of"loss" less any amounts of Loss,or Collision coverages are provided under representing taxes; overdue payments; penalties, this Coverage Form for any 'auto' you own, then Interest or charges resulting from overdue the Physical Damage Coverages provided are extended to 'autos' you hire or borrow, subject to payments; additional mileage charges; excess the following limit. wear and tear charges;lease termination fees. The most we will pay for'loss'to any hired'auto' 7. AIRBAG COVERAGE is: Under Paragraph B. EXCLUSIONS - of SECTION (1) $50,000; Ili - PHYSICAL DAMAGE COVERAGE, the following is added: (2) The actual cash value of the damaged or The exclusion relating to mechanical breakdown stolen property at the time of the'loss';or does not apply to the accidental discharge of an (3) The cost of repairing or replacing the damaged airbag. or stolen property, 8. SOUND RECEIVING AND TRANSMITTING whichever is smallest, minus a deductible. The EQUIPMENT-BROADENED COVERAGE deductible will be equal to the largest deductible applicable to any owned 'auto' for that coverage. Paragraphs 8.4.c. & d. - EXCLUSIONS - of No deductible applies to 'loss' caused by fire or SECTION III - PHYSICAL DAMAGE COVERAGE do lightning. Hired Auto Physical Damage coverage not apply to equipment designed solely for is excess over any other collectible insurance. receiving or transmitting sound and accessories Subject to the above limit, deductible and excess used with such equipment, provided such provisions, we will provide coverage equal to the equipment is permanently installed in the covered broadest coverage applicable to any covered "auto"at the time of the "loss" or such equipment • 'auto'you own. is removable from a housing unit which is permanently installed in the covered "auto" at the We will also cover loss of use of the hired 'auto' if time of the"loss",and such equipment Is designed It results from an "accident",you are legally liable to be solely operated by use of the power from the and the lessor incurs an actual financial loss, "auto's" electrical system, in or upon the covered subject to a maximum of$1000 per'accident". "ate". This extension of coverage does not apply to any 9. EXTRA EXPENSE-BROADENED COVERAGE `auto" you hire or borrow from any of your Under Paragraph A. - COVERAGE - of SECTION "employees", partners (if you are a partnership), Ill-PHYSICAL DAMAGE COVERAGE,we will pay members (If you are a limited liability company), or for the expense of returning a stolen covered members of their households. 5. PHYSICAL DAMAGE-ADDITIONAL 'auto'to you. TEMPORARY TRANSPORTATION EXPENSE 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE COVERAGE Under Paragraph D.-DEDUCTIBLE-of SECTION Paragraph A.4.a. of SECTION 111 - PHYSICAL III - PHYSICAL DAMAGE COVERAGE, the following is added: DAMAGE COVERAGE is amended to provided a limit of$50 per day and a maximum limit of$1,000. No deductible applies to glass damage if the glass is repaired rather than replaced. Fonn HA 99 1608 02 Page 2 of 3 I • 11. TWO OR MORE DEDUCTIBLES 14. HIRED AUTO-COVERAGE TERRITORY Under Paragraph D.-DEDUCTIBLE-of SECTION Paragraph e. of GENERAL CONDITIONS 7. - III - PHYSICAL DAMAGE COVERAGE, the POLICY PERIOD, COVERAGE TERRITORY - of following is added: SECTION IV- BUSINESS AUTO CONDITIONS is If another Hartford Financial Services Group, Inc. replaced by the following: company policy or coverage form that is not an e. For short-term hired 'autos', the coverage automobile policy or coverage form applies to the territory with respect to Liability Coverage Is same"accident",the following applies: anywhere in the world provided that if the (1) If the deductible under this Business Auto "insured's" responsibility to pay damages for Coverage Form is the smaller (or smallest) 'bodily Injury' or 'property damage' is deductible,it will be waived; determined in a 'suit,' the 'suit' is brought in the United States of America, the territories (2) If the deductible under this Business Auto and possessions of the United States of o Coverage Form is not the smaller(or smallest) America, Puerto Rico or Canada or in a deductible, it will be reduced by the amount of settlement we agree to. the smaller(or smallest)deductible. 12. AMENDED DUTIES IN THE EVENT OF 15. WAIVER OF SUBROGATION ACCIDENT,CLAIM,SUIT OR LOSS TRANSFER OF RIGHTS OF RECOVERY % The requirement In LOSS CONDMONS 2.a. - AGAINST OTHERS TO US - of SECTION IV - -4' DUTIES IN THE EVENT OF ACCIDENT, CLAIM, BUSINESS AUTO CONDITIONS is amended by adding the following: SUiT OR LOSS - of SECTION IV -•BUSINESS AUTO CONDITIONS that you must notify us of an We waive any right of recovery we may have c 'acddent' applies only when the 'accident' is against any person or organization with whom you known to: have a written contract that requires such waiver because of payments we make for damages under (1) You,if you are an individual; this Coverage Form. (2) A partner,if you are a partnership; 16. RESULTANT MENTAL ANGUISH COVERAGE t� (3) A member, if you are a limited liability The definition of 'bodily injury'• in SECTION V company;or DEFINITIONS is replaced by the following: .I= (4) An executive officer or insurance manager, if 'Bodily Injury' means bodily injury, sickness or you are a corporation. disease sustained by any person, Including mental M 13. UNINTENTIONAL FAILURE TO DISCLOSE anguish or death resulting from any of these. HAZARDS 17. EXTENDED CANCELLATION CONDMON INS= If unintentionally fail to disclose any hazards E Paragraph 2, of the COMMON POLICY existing at the Inception date of your policy,we will CONDITIONS -CANCELLATION - applies except not deny coverage under this Coverage Form as follows: because of such failure. If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. c elm eeetl= cs Form Ha99isose2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE R• EAD IT CAREFULLY. POLICY CHANGES This endorsement forms a part of the Policy numbered below: Policy Number Named Insured 072 UEN IL4406 K2 JOHN S. MEEK COMPANY, INC. Policy Change Effective Date Change No. Agent or Broker 08/14/2006 004 AON RISK SERVICES, INC OF SO CALIF-254300 CHANGE(S) THE FOLLOWING FORM ARE HEREBY ADDED TO THE POLICY: HA 99 13 01 87—ADDITIONAL INSURED AND RIGHTS OF RECOVERY AGAINST OTHERS CA 20 48 02 99—DESIGNATED INSURED Any changes in your premium will be reflected in your next statement. THIS IS NOT A BILL. Additional Return Due at Policy Change effective date: $ 250. $ Installment Premium Schedule Due Dates Prior to this change Result of Change *Revised Additional Return Installment $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Revised installments, if not shown on this endorsement, will be shown in the Declarations or on Form HM 99 01. *If Future Annual Installments, this exclude Automobile Premium. This endorsement does not change the policy except as shown. This endorsement will not be binding unless countersigned by a duly authorized agent of the company. Policy Expiration Date 01/01/2007 Countersigned by BAP(SABC)8/15/06 Authorized Agent Form HM 12 01 01 91 Printed in U.S.A. © 1997, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AND RIGHTS OF RECOVERY AGAINST OTHERS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. Any person or organization whom you are required by contract to name as additional insured is an "insured" for LIABILITY COVERAGE but only to the extent that person or organization qualifies as an "insured"under the WHO IS AN INSURED provision of Section II-LIABILITY COVERAGE. B. For any person or organization for whom you are required by contract to provide a waiver of subrogation, the Loss Condition-TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is applicable. Form HA 9913 01 87 Printed in U.S.A.