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HomeMy WebLinkAboutNBS GOVERNMENT FINANCE GROUP, INC.INSURANCE ON FILE WORT( MAY PROCEED MAYOR UNTIL INS RAN .0 E PIRF.. Miguel A, Pulldo 74 MAYOR PRO TEM Michele Martinez CLC OF COUNCIL COUNCILMEMBERS DATE: P,. David Benavides JUL 3 �� Vicente Sarmiento •.�;;;;;,;• - Jose Solorio FSal Tin iJuan lero C � l(es CITY OF SANTA ANA X �• ..t,'Z. 20 Civic Center Plaza • PA. Box 1988 , ,,,® '•'� lP Santa Ana, California 92742 714.847-8900 w mLMt ta-ana,W June 5, 2018 Ms, Amanda Mitchell Contract Administrator NBS 32605 Temecula Parkway, Suite 100 Temecula, CA 92592 Re: Extension of Agreement A-2017-263 Dear Ms. Mitchell: A-2017-263-01 CITY MANAGER Raul Godinez 11 CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Marla D. Huizar Pursuant to Agreement A-2017-263 entered by into by NBS and the City of Santa Ana dated October 3, 2017, the time period of said Agreement (Section 3 TERM) is hereby extended for six (6) months through December 31, 2018. The insurance certificates and additional insured endorsement are to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. If you have any questions regarding this matter, please contact Robert Cortez, Deputy City Manager, at 714-647-5200. Sincerely, — - _......._ CITY OF SANTA Raul Godinez I1 `fir City Manager APPROVED AS TO FORM: ATTEST: Sonia R. Carvalho Maria D. iluizar Clerk of the Council NBSOOVE-01 _._SADPATRATHREE .49CtiLC3" CERTIFICATE OF LIABILITY INSURANCE a"TE'MM'Da""" 9/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the Certificate holder In Ilou of such andorsemont(s), PRODUCER CO CT NFP Property & Casualty Services, Inc. 6165 Greenwich Dr Suite 200 Sen Diego, CA 92122 PHONE FAX (a c, Na Ea : 868 869-6500 (Arc, Na :866 669.6301 IiIhAI INSURERS) AFFORDING COVERAGE NAILS NSURERA:HangyprInsurance Company 22292 INSURED INSURE :Allmeric n'] Benefit Ins Co 41 §40 INSURER C; Gemini Insurance 10633 NBS Government Finance Group INSURER D 32606 TorlIs Parkway, Sults 100 & 101 Temecula, CA 92692 INBURER E: INSURER F: _ COVERAGES CERTIFICATlENUMBISR: REVISION NUMBER __ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRINSR --- TYPE OF INSURANCE ADDL INSO AND, „_, POLICY NUR99ER POLICY EFF POLICY ERCP LIMITS A X COMMERCIAL GENERAL LIABILITY CLRIA9s-MARE JPCCUR X X OH3A431963 09/24/2017 09124/2018 ERCH OCCURRENCE -""--�-- 2,000000 'DAMAGE'rG RENTED s MEDEXP An ane rap .2_ 2,000,000 10+000 ..... PERSONAL$ADVINJ R _ ..$„ 2,000,000 ELAGGREPAT LIMIT APPLIES PER: G,,, JE.LPT ❑ LOC,"„„---"- G 4,000,000 B AUTOMOBILE LIABILITY COMBINED BINGLE LIMI7.. Eeaoclde 1_._ AL 1,000,000 BODILY INJURY Per era0n X ANY NAUTO AIW r0�p9b04NLY SCHEDULED X X AW3A427460 09/24/2017 09/24/2018 BODILY INJURY Peracduee _$ AKA ONLY ABTOSONLY PeO®ccRtlent MAGE .$ A X U MaRELLA LIAB EXCESS LIAa X I OCCUR CLAIMS -MADE OH3A431963 0912412017 .._.•.........- 0912412018 EACH OCCURRENCE 9,U001000 AGGREGATE 1,000,000 DELT RETENTIONS A WORK 5Rgop.p�g,pJSA,naN ANa @MPLtlYeRsrLiABIDTv ANY PROPRIETOR/PARTNER/EXECUTIVE Y� (MandaSa/ryP7n�V�l) EXCLUDEDe If as describe under D TL,pN,q_F OPERATIONS below N/A X WH3A42746704 0912412017 09/24/2018 X PER O h4 ATUrE --� E.L. EAC CCIDENT 1,000,000 E.L DISEASE -EA EMPLOY ^ 1,000,000 EL DISEASE -POLICY IT _ 1,000,000 C E& / rofesslonal Lia VCPL068286 09/24/2017 00/24/2018 Annual Aggregate"'�' 2,000,000 C E&OMrofoselonal Lia VOPLOGS286 09/24/2097 09/24/2018 Each Wrongful Act 2,000,000 DESCRIPTION OP OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, AddlOanal Remarke Schedule, maybe altaandd Irmam space is required) City e( Santa Ana, Its officers, employees, agents, volunteers and representatives are named additional Insured regarding General Liability. Blanket forms apply when required by written contract: GENERAL LIABILITY: Additional Insured -Special Broadening Endt: 391.1006 00 16 Additional Insured -Completed Operations: 391-1602 0816 ,^^y Primary & Non-Oontributory: 391.1003 0816 Waiver of Subrogation: 391.1003 08 16 SEE ATTACHED ACORD 101 d IC)r.— CFRTIFICATE HOLDER CANCELLATION ACORD 26 (2016103) ©19882096 ACORD CORPORATION, All tights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE D58CRIS50 POLICIES BE CANCELLED BEFORE Cif Ana City THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN of Santa ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza (14140) P.O. Bax 1988 ----•^ AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702.1988 ACORD 26 (2016103) ©19882096 ACORD CORPORATION, All tights reserved. The ACORD name and logo are registered marks of ACORD #0113A431963 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract, Agreement or Permit Included 1 , Ad t ons Inst ured-LL�roie ormen ora nc uded _ 2 ».- '3. Alienated Premises Included 3 4, road Form Property6m$ge 'i"orrowa qu pmont, Cue Omer$ Goode and Use of Elevators Included 3 `3. Incidental Malpractice`(Employed Nurses, EMT"$ and Paramedics) Included _..._ 3 _ 8. Pereahal and Advarfising Injury - Broad Form Included - 4 .7. Included 4 Product Recall Expense Each Occurrence Limit $25,000 Occurrence 5 Product Recall Expense Aggregate Limit 50,000 Aggregate 5 Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included 6 _ 8, Unintentional Failure to Notify Included '6 This endorsement amends coverages provided under the Buslnessowners Coverage Form through now coverages and broader coverage grants. This coverage Is subject to the provisions applicable to the Suainessowners Coverage Form, except as provided below. The following changes are made to SECTION II . LIABILITY: 1. Additional insured by Contract, Agreement or Permit The following is added to SECTION 11 - LIABILITY, C. Who Is An Insured: Additional Insured by Contract, Agreement or Permit a, Any person or organization with whomyou agreed In a written contract, written agreement or permit to add such person or organization as an additional insured on your policy is an additional Insured only with respect to liability for "bodily Injury", "property damage", or "personal and advertising Injury" caused, In whole or In part, byyour acts or omissions, or the acts or omisslons of those acting on your behalf, but only with respect to: (1) "Your work" for the additional Insured($) doaignated In the contract, agreement or porm It; (2) Promises you own, rent, lease or occupy; or (3) Your maintenance, operation or use of equipment leased to you, b, The Insurance afforded to such additional Insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional Insured. (3) Applies on a primary basis if that Is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other Insured. (5) Does not apply it the "bodily injury", "property damaga" or "personal and advertising Injury"is otherwise excluded from coverage under this Coverage Part, Including any endorsements thereto, 891.1006 08 16 Includes copyrighted materiels of Insurance Services Offices, Inc., with Its permission. Page i of 6 (3) Any phcal or chemical change In the productyelmade Intentionally by the vendor; (4) Repackaging, unless unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under Instruction from tha manufacturer, and then repackaged in the original container; (5) Any failure to make such Inspection, adjustments, te,61s, or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; (6) Demonstration, Installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (i) Products which, after distribution or sale by you, have been labeled or relabeled or used as' a container, part or Ingredient of any other thing or substance by or for the vendor; (a) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for Its own acts or omissions or those of Its amployass or anyone else acting on Its behalf. However, this exclusion does not apply to: (a) The exceptions contelhisd' Within the exclusion in subparagrgplye R) or (6) above; or (b) Such inspections, adjustments, testa or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, In connection with the distribution or sale of the products, (9) "Bodily Injury" or "property damage" place before you have signed the contract or agreement with the vendor. (10)To any person or organization' Included as an insured by another endorsement Issued by us and mado part of this Coverage Part. (11)Any Insured person or organization, from whom ,you have acquired such products, or any Ingredient, part or container, entering Into, accompanying or containing such products. d. With respect to the Insurance afforded to these vendors, the following is added to SECTION II - LIABILITY, D. Liability and Medical Expense Limits of Insurance, The most we will pay on behalf of the vendor for a covered claim Is the lesser of the amount of Insurance: 1. Required by the contract or agreement described in Paragraph a.; or 2. Available under the applicable Limits of Insurance shown In the Declarations; This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations. 3. Alienated Premises SECTION 11 - LIABILITY, B. Exclusions, 1. ApplWble To Busihsss. Liability Coverage L Damltggp to Property, paragraph (2) Is repfa .d by the toltowing: (2) Premises you sell, give away or abandon, If the "property damage" arises out of any part of thceo premises slid occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods, Use of Elevators a. The following Is added to SECTION II - LIABILITY, B. Exclusions, 1. Applicable To Business Liability Coverage, k. Damage to Property: Paragraph (4) does not apply to "property damage" to borrowed equipment while at a jobelta and not being used to perform operations. Paragraph (3), (4) and (6) do not apply to "property damage" to "customers goods" while on your premises nor to the use of elevators. b. For the purposes of this endorsement, the followingp definition Is added to SECTION It - LIABILITY, F. Liability and Medical Expenses Definitions: 1, "Customers goods" meansproperty of your customer on your premixes for the purpose of being; a. Worked on; or b. Used In your manufacturing process. c. The insurance afforded under this provision Is excess over any other valid and collectible property Insurance (Including deductible) available to the Insured whether primary, excess, contingent or on any other basis. S. Incidental Malpractice - Employed Nurses, EMT's and Paramedics SECTION II_ LIABI ITY, C. Who Is An Insured, paragraph 2,a.(1)(d) �t o not apply to a nurse, 881.1006 08 18 Inaludoe copyrighted materlals of Insurance Services Offices, Inc„ with Its permission. Page 3 of 8 c. The following Is added to SECTION 11 - LIABILITY, D. Liability and Medical Expenses Limits of Insurance: Product Recall Exponsa Limits of Insurance a. The Limits of Insurance shown in the SUMMARY OF COVERAGES of this endorsement and the rules stated below fix the most that we will pay under this Product Recall Expense Coverage regardless of the number of: (1) Insureds; (2) "Covered Recalls" initiated; or (8) Number of "your products" withdrawn. b. The Product Recall Expense Aggregate Limit Is the most that we will reimburse you for the sum of all "product recall expenses" Incurred for all "covered recalls" initiated during the policy period. c. The Product Recall Each Occurrence Limit is the most we will pay In connection with any one defect or deficiency. d. All "product recall expenses" in connection with substantially the same general harmful condition will be deemed to arise out of the same defect or deficiency and considered one "'occurrence". e. Any amount reimbursed for "product recall expenses" In connection with any one "occurrence" will reduce the amount of the Product Recall Expense Aggregate Limit available for reimbursement of "product recall expenses" In connection with any other defect or deficiency, f. If the Product Recall Expense Aggregate Limit has bean reduced by reimbursement of "product recsil expenses" to an amount that Is less than the Product Recall Expense Each Occurrence Limit, the remaining Aggregate Limit is the most that will be available for reimbursement of "product recall expenses" in connection with any other defect or deficiency, p. Product Recall Deductible We will only pay for the amount of "product recall oifpenses" which are in excess' of the $513(11 Product Recall Deductible. The Product Recall Deductible applies separately to each "covered recall The limits of Insurance will not be reduced by the amount of this deductible, We msy, or will if required by law, pay all or any part of any deductible amount, if applicable, Upon notice of our payment of a deductible amount, you shall promptly reimburse us for the part of the deductible amount we paid. The Product Recall Expense Limits of Insurance apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown In the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for the purposes of determining the Limits of Insurance, d, The following Is added to SECTION II R LIABILITY, E. Llabilitlr and Medical Expense General Conditions, 1 Duties In the Event of Occurrence, Offense, Claim or Suit; You must see to It that the following are done in the event of an actual or anticipated "covered recall" that may result In "product recall expense"; (1) Give us prompt notice of any discovery or notification that "your product" must be withdrawn or recalled. Include a description of "your product" and the reason for the withdrawal or recall; (2) Cease any further release, shipment, consignment or any other method of distribution of like or similar products until it has been determined that all such products are free from defects that could be a cause of loss under this Insurance. a. For the purpose of this endorsement, the following definitions are added to SECTION If - LIABILITY, F. Liability and Medical Expenses Definitions; 1. "Covered recall" means a recall made necessary because you or a government body has determined that a known or suspected defect, deficiency, inadequacy, or dangerous condition In "your product" has resulted or will result In "bodily injury" or "property damage". 2. "Product recall expense(s)" means; a. Necessary and reasonable expenses for: (1) Communications, including radio or television announcements or printed advertisements including stationary, envelopes and postage; 891-100608 18 Includes copyrighted materials of Insurance services Offices, Inc., with Its permlaslon. Page 5 of 6 10R3A431963 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following; BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of person Or Organization Location And Description Of Completed Operations ANY PERSON OR ORGANIZATION 1111 WH11 EN REQUIR AS REQUIRED BY CONTRACT (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION II - LIABILITY: A. The following is added to SECTION It - LIABILITY, C. Who Is An Insured: Anyarson or organization shown In the Schedule above Is also an additional Insured, but only with respect to liability for 11bodlly Injury" or "property damage" caused, In whole or In part, by 'your work" at the location designated and described In the Schedule above, performed for that additional Insured and Included In the "products -completed operations hazard". However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the Insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. B. The following is added to SECTION II - LIABILITY, D. Liability And Medical Expenses Limits Of Insurance: If coverage provided to the additional insured Is required by a contract or agreement, the most we will pay on beh sit of the additional insured is the amount of Insurance: 1. Required by the contract or agreement, or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations, ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED, 391.1602 06 16 Inoludee copyrighted material of Insurance services Office, Inc„ with Its,parmlealon. Page 1 of 1 insured's rights against all those other Insurers, c, When this Insurance Is excess over other Insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of; (1) The total amount that all such other Insurance would pay for the loss in the absence of this Insurance; and (2) The total of all deductible and self -Insured amounts under all that other insurance. d. We will share the remaining lose, If any, with any other Insurance that is not described in this provision and was not bought specifically to apply In excess of the Limits of Insurance shown in the Declarations for this Coverage. e. Method of Sharing If all of the other Insurance permits contribution by equal shares, we will follow this method also, Under this approach each Insurer contributes equal amounts until it has paid Its applicable Limit of Insurance or none of the 1083 remains, whichever comes first, If anyof the other Insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share Is based on the ratio of its applicable Limit of Insurance to the total applicable limits of insurance of all Insurers. f. When this Insurance Is excess, we will have no duty under Business Liability Coverage to defend any claim or "suit" that any .other Insurer has a duty to defend. If no other Insurer defends, we will undertake to do so; but we will be entitled to the Insured's rights against all those other insurers. Premiums 1. The first Named Insured shown in the Declarations: a, Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was Issued. On each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium In accordance with our rates and rules then in effect 3. With our consent, you may continue this policy In force by paying a continuation premium for each successive one-year period, The premium must be: a. Paid to us prior to the anniversary date; and b. Determined In accordance with paragraph 2. above. Our forms then In effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Undeclared exposures or change In your business operation, acquisition or use of locations may occur. during the policy period that Is not shown in the Declarations. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then In effect, J. Premium Audit 1, This policy is Subject to audit if a premium designated as an advance premium Is shown In the Declarations. We will compute the final premium due when we determine your actual exposures. 2. Premium shown In this policy as advance premium is a deposit premium only. At the close of each audit period, we will compute the earned premium for that period and sand notice to the first Named Insured, The due date for audit premiums Is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. 3, The first Named Insured must keep records of the Information we need for premium computation and send us copies at such times as we may request, K. Transfer of Rights of Recovery Against Others to Us 1, Applicable to SECTION I - PROPERTY Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment, That person or organi2atl6n must do everything necessary to secure our rights and roust do nothing after loss to impair them. But you may waive your rights against another party in writing: 301.1008 08 18 Includes copyrighted material of Insurance Services Office, Inc., with Its permission, Page 00 of 81 in6�ialC `f. P. AW3A427456 p 1001654 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY This endorsement modifies Insurance provided under the following; BUSINESS AUTO COVERAGE PART A. The following is added to SECTION II - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured; Additional Insured If Required by Contract If you agree In a written contract, written agreement or written permit that a person or organization be added as an additlonal "Insured" under this Coverage Part, such person or organization is an "Insured"; but only to the extent that such person or organization qualifies as an "Insured" under paragraph A.1.c. of this Section. It you agree In a written contract, written agreement or written permit that a person or organization be added as an additional "Insured" under this Coverage Part, the most we will pay on behalf of such additional "insured" is the lesser of: (1) The Limits of Insurance for liability coverage specified In the written contract, written agreement or written permit; or (2) The Limits of Insurance for Liability Coverage shown in the Declarations applicable to this Coverage Part. Such amount shall be part of and not In addition to the Limits of Insurance shown In the Declarations applicable to this Coverage Part. Regardless of the number of covered autos", "Insureds", premiums paid, claims made or vehicles involved In the "accident", the most we will pay for the total of all damages and "covered pollution cost or expense" combined resulting from any one "accident' is the Limit of Insurance for Liability Coverage shown in the Declarations. B. The following Is added to SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B, General Conditions, subparagraph & Other Insurance: Primary and Non -Contributory If you agree in a written contract, written agreement or written permit that the Insurance Provided to a person or organization who qualifies as an additional "Insured" under SECTION II - LIABILITY COVERAGE, Paragraph A.1, Who Is An Insured, subparagraph Additional Insured If Required by Contract Is primary and non-contributory, the following applies; The liability coverage provided by this Coverage Part is primary to any other insurance available to the additional "Insured" as a Named Insured, We will not seek contribution from any other Insurance available to the additional "Insured" except: (1) For the sole negligence of the additional "insured"; or (2) For negligence arising out of the ownership, maintenance or use of any "auto" not owned by the additional "insured" or by you, unless that "auto" is a "traller" connected to an "auto" owned by the additional "insured" or by you; or (a) When the additional "Insured" to also an additional "Insured" under another liability policy. C. This endorsement will apply only if the "accident" occurs; 1. During the policy period; 2. Subsequent to the execution of the written contract or written agreement or the Issuance of the written permit; and 3. Prior to the expiration of the period of time that the written contract, written agreement or written permit requires such Insurance to be provided to the additional "Insurad". D. Coverage provided to an additional "Insured" will not be broader than coverage provided to any other "Insured" under this Coverage Part. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED, 481-0478 12 12 Includes copyrighted material of ISO Insurance Services Office, Inc., with Its permission Page 1 of 1 M71 Hanover lnsuraete Group.. WH3A427457 1001554 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA We have the right to recover our payments from anyone liable for an Injury covered byy this policy. We will not enforce our right against the person or organization named In the Schedule, (This agreement app lea only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Sohsdule. The additional premium for this endorsement shelf b®J_ % of the California workers' compensation premium otherwise due on such remuneration, Schedule Person or Organization Job Description ONLY WHERE REQUIRED BY CONTRACT This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated., (The information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.) EndoreementEffectIve 9/24/17 Policy No. W10 -A427457 -Q4 Endorsement No. Insured NNS GOVERNHIM BINANGE GROUP Premium $ Insurance Company'Ci#t. HANOVck tNSURANCG CCM?ANY CountersignedBy,, 1 f m WC 04 03 06 (Ed. 04-84)