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HomeMy WebLinkAboutWM CURBSIDE, LLC (4)ip INSURANCE ONPIL� vh WORK MAY PROCEED UNTIL INSURANCE EXPIRE, CLERK OF COUND. DATE: o:JPW�zx���t. FOURTH AMENDMENT TO AGREEMENT TO PROVIDDE SMALL BATTERY -RECYCLING A-2020-105 THIS FOURTH AMENDMENT to the above -referenced agreement is entered into on May 19, 2020 by and between WIvf curbside, LLC ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"), RECITALS A. The parties entered into Agreement No. N-2007-086, dated July 1, 2007, by which Contractor has provided battery removal and recycling services for City residents. The original term of the Agreement was from July 1, 2007 until June 30, 2009. B. In the original Agreement, Contractor was referred to as Curbside, Inc. but is now known as WM Curbside, LLC. C. On September 1, 2009, the parties entered into First Amendment to Agreement No.-N- 2007-08&001 to extend the term of the Agreement through the expenditure of allocated funds. D. On May 4, 2016, the parties entered into Second Amendment No. A-2016-103 to adjust the compensation and further extend the term of the Agreement. E. On May 15, 2018, the parties entered into Third Amendment.No A- 2018-130 to further extend the term of the Agreement. The Agreement remains in effect through June 30, 2021. F. The parties now wish to extend the Agreement through June 30, 2022. The Parties therefore agree: Section 3, Term, is amended to extend the term of the Agreement for an additional one (1) year period through June 30 2022. 2. Except as modified by this Fourth Amendment, and all prior amendments, all terms and conditions of the Agreement shall remain in full force and effect. [signature page to follow] Page 1 of IN WITNESS WHEREOF, the parties hereto have executed this Fourth Amendment to the Agreement on the date and year first written above. ATTEST c �C-P-Z- S Daisy Gomez Clerk of the Council APPROVED AS TO FORM Sonia R. Carvalho, City Attorney By: 7K'• -f.L Jo . Funk Assistant City Attorney RECOMMENDED FOR APPROVAL: tA4% Nabil Saba Executive Director Public Works Agency Page 2 of 2 CITY OF SANTA ANA i me Ridge City Manager WM CURBSIDE, LLC B Larry etter tle: Ar Vice resident CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 1/1/7021 12/6/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(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 lieu of such endorsementls). 3557 BRIARPARK DRIVE, SUITE 700 HOUSTON TX 77042 866-26(3538 INSURED WASTE MANAGEMENT HOLDINGS, I306000 RELATED & SUBSIDIARY COMPANIE COVERAGES r.FRTIFIrATFMtIINIRFR• lin'/AAA1 KCVIRIUN NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN ADoL SUBR L R TYPE OF INSURANCE INSD POLICY NUMBER POD pY EFF POLIMMADNYYY pY.EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y HDOG71237345 1/112020 11/[/2021 EACH OCCURRENCE 5000000 CLAIMS-NMDEFX-1 OCCUR 11 PREMISES EAErrence 5,000,000 }� XCU INCLUDED .... MED EXP An one erson XXXXXXX X ISO FORM CG000 10413 PERSONAL &ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POUCy F--1 % LOC GENERAL AGGREGATE $ 6,000,000 PRODUCTS - COMPIOP AGO $ 6,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y MMT H25290008 1/1/2020 1/1/2021 COMBINEDSINGLE LIMIT Ea eccldor $ 1,000,000 X X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per Person) $ v Va ^VV�/VV�X BODILY INJURY (Per accident $ }[XXX}0Xj( AUTOS ONLY AUTOS X HIRED N-OWNED AUTOS ONLY X AUTNOOS ONLY PROPERTY DAMAGE $ XXXXXXX 7t Mcs-90 $ XXXXXXX D J( UMBRELLA LIAR X OCCUR Y Y XOO G27929242 005 I/I2020 I/l/2021 EACH OCCURRENCE $ 15,000,000 EXCESS LIAB I ICILAIMS-MADE AGGREGATE $ 15,000,000 DED RETENTION$ $ XXXXXXX B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN Y WLR C66043058 (ADS) I/I/2020 1/12021 X STATUTE OER C AOFFICEMdEMUEREXCLUDED? ECUnVE NIA CIF C66043095 ( �'CA & M ) l 112020 111/2020 1 /2021 EL EACH PCGOEM $ 3 000 000 (10Y-datary in N1B EL. mSEASE-EA EMPLOYEE§ 3,000,000 E.L DISEASE -POLICY IIMIT 3,000,000 nESCNPTION OF OPERATIONS babes A EXCESS AUTO LIABILITY Y Y XSA H25289961 1/12020 1112021 COMBINED SINGLE LIMIT $9A 000 H (EACH ACCIDENT) AC DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule. may be attached IF move space is required) BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRA( "I' W I [ERE PERMISSIBLE BYLAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS' COMPEL) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED IN FAVOR OF CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES. AGENTS, VOLOTE RS AND REPRESENTATIVES (ON ALL POUCIES EXCEPT WORKERS' COMPENSATION, EL) WHERE REQUIRED BY WRITTEN WAIVER OF IN FAVOR OF CITY OF SANTA ONNA LL POLICIES WHERE REQUCT IRED BY WRITTEN CONTRACT WHERE PERATION M SSIB EITS IBY LAW. THE INSURANAGENTS, E AFFORDED TO HE TOLUNTEERS ADDITIONAL INSURED AS DESCRIBED IN THIS CERTIFICATE OF INSURANCE FOR WORK PERFORMED BY THE NAMED INSURED IS PRIMARY AND NON-CONTRIBUTORY TO ANY SIMILAR COVERAGE MAINTAINED BY THE ADDITIONAL INSURED WHERE AND TO THE EXTENT REQUIRED BY CONTRACT, rFRTIFIrATF uni Oro .....�_.. -_._-. ,- REVIEWED & A{'t'KU V `' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE By Risk M NAG PENT �ivisiON THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O 11076601 D F AUTHORIZED REPRESENTATNE CITY OF SANTA ANA IF SC01T-LEISTRA RISK MANAGEMENT DIVISI , HWag 20 CIVIC CENTER PLAZA P. 0. BOX 1988 SANTA ANA CA 91701 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All riohts rel l De AuuKu name ana logo are registered marks of ACORD ONrINUATION DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIE%CLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS (Use only if more ALL POLICIES INCLUDE A BLANKET NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS ENDORSEMENT, PROVIDING FOR 30 DAYS' ADVANCE NOTICE IF THE POLICY IS CANCELLED BY THE COMPANY OTHER THAN FOR NONPAYMENT OF PREMIUM, 10 DAYS' NOTICE IF THE POLICY IS CANCELLED FOR NONPAYMENT OF PREMIUM. NOTICE IS SENT TO CERTIFICATE HOLDERS WITH MAILING ADDRESSES ON FILE WITH THE AGENT OR THE COMPANY. THE ENDORSEMENT DOES NOT PROVIDE FOR NOTICE OF CANCELLATION IF THE NAMED INSURED REQUESTS CANCELLATION. REVIEWED & APPROVED By Risk A tEME T DIVISION D •r DEBBIE SCOTT-LEISTRA \CORD 25 (2016103) Certificate Holder ID: 11076601 Attachinent Code: D446557 Master ID: 1306000, Certificate ID: 11076601 POLICY NUMBER: HDO G71237345 Endorsement Number: 39 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. REVIEWED N APPROVED By RISIC M NA E ENT DIVISION DATA DME SCOTT-LEISTRA CG 20 10 1185 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 Attachment Code : D448223 Certificate ID : 11076601 POLICY NUMBER: HDO G71237345 Endorsement Number: 54 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. to comDlete this Schedule, if not shown above, will be shown in The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. REVIEWED 6 APPROVED gy Rtsk M NAG MENT "VISION DATE' E E CO -L STRA CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Digitally signed by Francine R. Francine R. Villareal Villareal ACOR" CERTIFICATE OF LIABILITY INSURANCE l)AT/20DDIYYIY) ., .i. 1/1/2023 2/9/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LOCKTON COMPANIES CONT NAMEACT 3657 BRIARPARK DRIVE, SUITE 700 PHONE FAX Ext : A/C Na HOUSTON TX 77042 E-MAIL 866-260-3538 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # A INSURER A: ACE Alnerlean Insurance Conipany 22667 INSURED WASTE MANAGEMENT HOLDINGS, INC. & ALL AFFILIATE 1306000 INSURER B : Indemnity Insurance Co of North America 43575 RELATED & SUBSIDIARY COMPANIES INCLUDING: INSURER C: ACE Fire Underwriters Insurance Company 20702 INSURER D : ACE Property & Casualty Insurance Co 20699 WM CURBSIDE, LLC 5101 E. LA PALMA AVENUE ANAHEIM CA 92870 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 11076601 REVISION NUMBER: XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y HDO G72492365 1/1/2022 1/1/2023 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE � OCCUR DAMAGER( RENTED PREMISES Ea occurrence $ 5,000,000 X MED EXP (Any one person) $ XXXXXXX XCU INCLUDED X ISO FORM CG00010413 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 JPRO- POLICY XLOC PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y MMT H25550328 1/1/2022 1/1/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ XXXXXXX ANY AUTO X BODILY INJURY (Per accident) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS Xr PROPERTY DAMAGE Per accident $ XrXrXXrXrXrXr HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X $ XXXXXXX MCS-90 D X UMBRELLA LAB X OCCUR Y Y XEUG27929242 007 1/1/2022 1/1/2023 EACH OCCURRENCE $ 15,000,000 AGGREGATE $ 15,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ XXXXXXX B `A C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) NIA Y WLR C68918595 (AOS) WLR C68918558 (AZ, ,N & MA) SCE C68918637 (WI) 1/1/2022 1/1/2022 1/1/2022 1/1/2023 1/1/2023 1/1/2023 X STER- ATUTE OETH E.L. EACH ACCIDENT $ 3,000,000 E.L. DISEASE - EA EMPLOYEE $ 3,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 3,000,000 A EXCESS AUTO Y Y XSA H25550286 1/1/2022 1/1/2023 COMBINED SINGLE LIMIT LIABILITY $9,000,000 (EACH ACCIDENT) DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PRFN'TOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TF.RM(S) REFERENCED. BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BYLAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED (EXCEPT FOR WORKERS' COMP/EL) WHERE AND TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED IN FAVOR OF CITY OF SANTAANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES (ON ALL POLICIES EXCEPT WORKERS' COMPENSATION/EL) WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION IN FAVOR OF CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ON ALL POLICIES WHERE REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. THE INSURANCE AFFORDED TO THE ADDITIONAL INSURED AS DESCRIBED IN THIS CERTIFICATE OF INSURANCE FOR WORK PERFORMED BY THE NAMED INSURED IS PRIMARY AND NON-CONTRIBUTORY TO ANY SIMILAR COVERAGE MAINTAINED BY THE ADDITIONAL INSURED WHERE AND TO THE EXTENT REQUIRED BY CONTRACT. 11076601 CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE RISK MANAGEMENT DIVISION, 4TH FLOOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. P. O. BOX 1988 SANTA ANA CA 91701 AUTHORIZED REPRESENTATIVE e.a.. RAM&flAg7P ere DR4si0R REVIEWED & APPROVED BY. - Cc, 1988-2015 ACORD C .. v ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD _ Risk Management Analyst CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required) Attachment Code: D446557 Master ID: 1306000, Certificate ID: 11076601 POLICY NUMBER: HDO G72492365 Endorsement Number: 39 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS LESSEES OR CONTRACTORS - (Form B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. CG 20 10 1185 Copyright, Insurance Services Office, Inc., 1984 cF RAMwagementDMsian REVIEWED & APPROVED BY: v --� Risk Pjanagement Analyst Attachment Code: D448223 Certificate iD: 1 ] 076601 POLICY NUMBER: HDO G72492365 1 Endorsement Number: 8 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE ime Of Person(s) Or Organization(s):Any person or organization against whom you have agreed to waive ur right of recovery in a written contract, provided such contract was executed prior to the date of loss. lInformation required to complete this Schedule, if not shown above, will be shown in the Declarations. II The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 cF RAManagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk janagement Analyst Miscellaneous Attachment: M504270 Certificate TD: 11076601 POLICY NUMBER: HDO G27860825 NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS ENDT. #26 Named Insured Waste Manage nt, Inc. Endorsement Number 26 Policy Symbol Policy Number Policy Period Effective Date of HDO G27860825 01/01/2017 to Endorsement 01 /01 /2018 01 /01 /2017 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subseauent to the Dreoaration of the DOlicv. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization Additional Insured Endorsement All persons or entities added as additional insureds through an endorsement with the term "Additional Insured" in the title. (If no information is filled in, the schedule shall read: All persons or entities added as additional insureds through an endorsement with the term "Additional Insured" in the title.) For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IVA.a: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a loss we cover under this policy, this insurance will apply to such loss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. LD-20287 (0606) Page 1 of 1 cF RAManagement>< Msian Jy/\'x REVIEWED & APPROVED BY: V"° --� Risk janagement Analyst