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HomeMy WebLinkAboutMISSION LINEN & UNIFORM SUPPLYA-2017-346-01 JAN 2 8 2 02 1 MAYOR Vicente Sarmiento MAYOR PRO TEM David Penaloza COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez Jessie Lopez Nelida Mendoza Thai Viet Phan CITY OF SANTA ANA FINANCE AND MANAGEMENT SERVICES 20 Civic Center Plaza • P.O. Box 1988 i (6 ZL2� Santa Ana, California 92702 - .-.•�� www.santa-ana.om 0. F1N (ENa Fll 0) % Mission Linen Supply 5400 Alton St. Chino, CA 91710 Attn: Government Sales December 21, 2020 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez Re: Extension of Agreement to Provide Uniform Rental and Cleaning Services, No. A-2017-346 Pursuant to Section 3 ("Term") of the above —referenced Agreement, entered into by Mission Linen Supply and the City of Santa Ana, dated December 19, 2017, the time period of the Agreement is hereby extended for an additional one-year period, from January 01, 2021 through December 31, 2021. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Respectfully, Eva Pierce Buyer, Finance and Management Services Agency CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM -f�L An M.Funk Senior Assistant City Attorney Vicente 5armlento David Pension Thai Viet Phan Mayor Mayor Pro Tel Ward 2 Ward I vsarmlentorotsanlaana.om doenaloraNlsarlaana.oro Johanra�sanla-ana.ora ATTEST 4 L /llift Daisy Gomez Clerk of the Council MISSION LINEN SUPPLY N e ordan Parker It Area Manager SANTA ANA CITY COUNCIL Jessie Lopez Phil eaceira Johnal Ryan Hemandez Nelida Mendoza Ward Want4 Ward Ward me?Azanlaanaorn pdazarraro)sanW2na.ord Lmirtas dedeZasanall.a.ON Sendozareaanlaana.orn rldnUllC n. VIIIIIII, Date: 2021.01.2616:16:15 -0ebP ACORO® CERTIFICATE OF LIABILITY INSURANCE 1/l/2022 DATE(MMmDIYYYY) 1 2/11/2020 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 endorsement(s). PRODUCER Lockton Insurance Brokers, LLC 777 S. Figueroa Street, 52nd Fl. CA License #OF15767 Los Angeles CA 90017 CONTACT NAME: PHONE FAX A/C No ExINC.No: E-MAIL ADDRESS: (213) 689-0065 INSURERS AFFORDING COVERAGE NAIC If INSURER A: Safe National Casualty Corporation 15105 INSURED Mission Linen Supply 1346478 702 E. Montecito St. INSURERS: INSURER C : Santa Barbara CA 93103 INSURER D : NSURER E INSURERF: COVERAGES MISLI06 CERTIFICATE NUMBER: 15085893 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 ADDLSUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY) POLICY EXP (MMsoDIyyM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR Y N GL4045506 I/l/2021 1/l/2022 EACH OCCURRENCE $ 2000000 PREMISES Ea oN unence $ 500,000 X MED EXP(My one person) $ Not A licable SIR:$250,000 PERSONAL &ADV INJURY $ 2 000 000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMP/OP AGG $ 2 000 000 $ OTHER: A A AUTOMOBILE LIABILITY ANY AUTO Y N CAS4045508 CAS4056505 l/l/2021 1/I/2021 I/l/2022 l/1/2022 COMBINED SINGLE LIMIT Ea accident) $ 5,000,000 X BODILY INJURY (Per Person) $ XXXX�{XX BODILY INJURY accident) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accitlent $ XXXX7iXX X Como./Coll. Ded $ 1,000 SIR $250,000 UMBRELLA LIAR OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX EXCESS LV CLAIMSWADE DIED I I RETENTION$ $ XXXXXXX A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? N/A Y LDS4041104 I/1/2021 I/l/2022 PER OTH- 'Y S7AME ER EL EACH ACCIDENT $ 1000000 E.L DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS helow DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FORTHIS HOLDER, APPLICABLE TOTHE CARRIERS LISTEDAND THE POLICY TERM(S) REFERENCED. Re: Agreement Nos. A-2017-172 and A-2017-290. City of Santa Ana, its officers, employers, agents, and representatives are an Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. Waiver of Subrogation applies per attached endorsement(s) or policy language. Notice of Cancellation applies per the applicable policy language or endorsements. 15085893 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016103) See SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR � � RukMwgarlatt Dleiawt °= REVIEVOm& APPRw® Br. ©1as.20t t-ACORD c ct r,o !,�� Fµrc R. Vct6 4"t The ACORD name and logo are registered marks of ACORD '�� ® Risk Management Analyst Attachment Code: D541534 Certificate 11): 15085893 POLICY NUMBER: GL4045506 COMMERCIAL GENERAL LIABILITY CG 20 15 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) (Vendor Your Products As required by written contract or All your Products agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to throughout this endorsement as vendor) shown in the Schedule, but only with respect to "bodily injury" or "property damage" arising out of "your products" shown in the Schedule which are distributed or sold in the regular course of the vendor's business. However: 1. The insurance afforded to such vendor only applies to the extent permitted by law; and 2. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. C. With respect to the insurance afforded to these vendors, the following additional exclusions apply: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; CG 20 15 04 13 © Insurance Services Office, Inc., 2012 7�1 sWn REVEWma RD sr. V' Rak Managenrent Analyst Attachment Code: D541534 Certificate ID: 15085893 POLICY NUMBER: GL4045506 e. Any failure to make such inspections, adjustments, tests 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; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. 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; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or COMMERCIAL GENERAL LIABILITY CG 20 15 04 13 (2) Such inspections, adjustments, tests 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. 2. This insurance does not apply to 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 III — Limits Of Insurance: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor 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. CG 20 15 04 13 © Insurance Services Office, Inc., 2012 .' ff REvEw6 nrrnav®sr m ����� Risk Management Analyst Attachment Code: D488922 Certificate ID: 15085893 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED BY CONTRACT OR AGREEMENT - PRIMARY BASIS This endorsement modifies insurance provided under the following Coverage Form: COMMERCIAL GENERAL LIABILITY PRODUCTS/COMPLETED OPERATIONS LIABILITY LIQUOR LIABILITY POLLUTION LIABILITY This endorsement changes the policy effective on the inception date of the policy unless another endorsement effective date is indicated below. SCHEDULE Name of Additional Insured Person(s) or Organization(s): As required by written contractor agreement when written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Designated Project, Location, or Work of Covered Operations: As per written contract or agreement with the above described person(s) or organization(s). CHANGES SECTION II - WHO IS AN INSURED is amended to include: 4. The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: a. Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury", "property damage" or "personal and advertising injury" caused by your acts or omissions while actively engaged in the performance of your ongoing operations involving the project(s), Iocations(s), or work designated in the Schedule and as specified in the contract between you and the above scheduled Additional Insured(s). b. The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (1) If the 'occurrence" or offense takes place subsequent to the execution and effective date of such written contract: and, (2) While such written contract is in force, or until the end of the policy period, which ever occurs first. c. How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (1) The limits of insurance specified in the written contract or written agreement; or, (2) The Limits of Insurance provided by the Coverage Form. SNGL 023 1209 Safety National Casualty Corporation Page 1 of 2 .., RldeMangonodpMeimt y RElIEWm S APPROO®ar �� Risk Management Analyst j Attachment Code: D488922 Certificate ID: 15085893 The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form. d. Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. SECTION IV - CONDITIONS is amended by deleting item a. Primary Insurance under 4. Other Insurance and replacing such item by the following, only with respect to insurance provided to the Additional Insured(s) shown in the above Schedule: a. Primary Insurance and/or Primary and Non -Contributory Insurance This insurance is primary if you have agreed in a written contract that this insurance is to be primary. If you have agreed in a written contract that this insurance is primary and non-contributory with the Additional Insured(s) own insurance, this insurance is primary and we will not seek contribution from that other insurance. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2021 Policy No. GL4045506 Endorsement No. Named Insured MISSION LINEN SUPPLY Premium $ Included Insurance Company Safety National Casualty Corporation Page 2 of 2 Safety National Casualty Corporation SNGL 023 1209 WwED& PPRavi Br ' RE�nEWEDSAPPRU�®8Y: ® Risk Management Analyst 1111 Attachment Code: D565301 Certificate ID: 15085893 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL AUTO COVERAGE FORM SCHEDULE Name of Additional Insured Persons or Or anization s : Person(s) or Organization(s) as required by written contract. Any individually scheduled Designated Additional Insured shall not be construed to override nor negate this blanket Designated Additional Insured. CHANGE The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: (1) Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury" or "property damage" arising out of your operations and resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are on premises owned or leased by the above scheduled Additional Insured(s). (2) The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (a) If the "accident' takes place subsequent to the execution and effective date of such written contract: and, (b) While such written contract is in force, or until the end of the policy period, which ever occurs first. 3) How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (a) The limits of insurance specified in the written contract or written agreement; or, (b) The Limits of Insurance provided by the Coverage Form. The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form. (4) Exclusions (a) This endorsement does not apply to liability of the Additional Insured which arises out of the ownership of transportation operating rights granted to the Additional Insured by public authority. (b) This endorsement does not apply to the liability of the owner or anyone else from whom you hire or borrow a covered auto. SNCA 026 0410 Safety National Casualty Corporation Page 1 of 2 R®ItMuft mod oividun REvlEwm&Ae ovm r. Risk Management Analyst Attachment Code: D565301 Certificate ID: 15085893 (5) Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other that for first aid, without consent. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 1/1/2021 Policy No. CAS4045508 Insured: Mission Linen Supply Premium $ INCL. Insurance Company: SAFETY NATIONAL CASUALTY CORPORATION Endorsement No. SNCA 026 0410 Safety National Casualty Corporation Page 2 of 2 _ RAMmugmiadDivision REVEWM 6 A"Rw®Br: f �ZV&ud '�' Risk Management Matyst Attactunent Code: D565304 Certificate ID: 15085893 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL AUTO COVERAGE FORM SCHEDULE Name of Additional Insured Persons or Or anization s : Person(s) or Organization(s) as required by written contract. Any individually scheduled Designated Additional Insured shall not be construed to override nor negate this blanket Designated Additional Insured. CHANGE The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: (1) Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for "bodily injury" or "property damage" arising out of your operations and resulting from the ownership, maintenance or use of covered "autos" by you while the covered "autos" are on premises owned or leased by the above scheduled Additional Insured(s). (2) The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (a) If the "accident' takes place subsequent to the execution and effective date of such written contract: and, (b) While such written contract is in force, or until the end of the policy period, which ever occurs first. 3) How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of: (a) The limits of insurance specified in the written contract or written agreement; or, (b) The Limits of Insurance provided by the Coverage Form. The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form. (4) Exclusions (a) This endorsement does not apply to liability of the Additional Insured which arises out of the ownership of transportation operating rights granted to the Additional Insured by public authority. (b) This endorsement does not apply to the liability of the owner or anyone else from whom you hire or borrow a covered auto. SNCA 026 0410 Safety National Casualty Corporation Page 1 of 2 RiekMmrganod DM dm REVIEWED fi APPRovao Sr. ® Risk Management Analyst Attachment Code: D565304 Certificate ID: 15085893 (5) Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other that for first aid, without consent. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 1/1/2021 Policy No. CAS4056508 Insured: Mission Linen Supply Premium $ INCL. Insurance Company: SAFETY NATIONAL CASUALTY CORPORATION Endorsement No. SNCA 026 0410 Safety National Casualty Corporation Page 2 of 2 s , , RieltMouganedElMailm REmEwED6nrpRavmOr. 1 Rtsk Management Analyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description WHERE A WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS IS REQUIRED BY WRITTEN CONTRACT, SUCH ADDITIONAL ENTITIES SHALL BE CONSIDERED AUTOMATICALLY SCHEDULED BY THE COMPANY. INDIVIDUALLY SCHEDULED WAIVERS SHALL NOT BE CONSTRUED TO OVERRIDE NOR NEGATE THIS BLANKET WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2021 Policy No. LDS4045504 Endorsement No. Insured MISSION LINEN SUPPLY Premium $ INCL. Insurance Company Safety National Casualty Corporation WC 04 03 06 (04 84) Page 1 of 1 © 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Attachment Code: D471832 Certificate ID: 15085893 t 11�1.,11.IF_A REVIEWD]6M Rav®BMm%pncnEDMdv: f� R. V.ttfaut Risk Management Analyst Attachment Code: D551366 Certificate TO: 15085893 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT -RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by following: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation If we cancel for: 1) Nonpayment of premium; or 2) Discovery of fraud by: a. Any insured or his or her representative in obtaining this insurance; or b. You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks: (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative in pursuing a claim under this policy. (3) Ajudgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. IL 02 70 09 12 © Insurance Services Office, Inc., 2012 ® Risk Management Analyst Attachment Code: D551366 Certificate 1D: 15085893 (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: (1) Place us in violation of California law or the laws of the state where we are domiciled; or (ii) Threaten our solvency. (7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: III )10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2) 30 days before the effective date of cancellation if we cancel for any other reason listed in paragraph 3.a. B. The following provision is added to the Cancellation Common Policy Condition: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. If such coverage has not bee in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b. We may not cancel this policy solely because the first Named Insured has: 3) Accepted an offer of earthquake coverage; or 4) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: 1) Commercial Property Coverage Part— Causes Of Loss —Special Form; or 2) Farm Coverage Part —Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes of Loss —Special. IL 02 70 09 12 © Insurance Services Office, Inc., 2012 ,gy RIAMmaganadDWhi. REnEwm 6 MPRovvEo ft. cRMF Risk M anagement Malys[ Attachment Code: D551366 Certificate ID: 15085893 C. The following is added and supersedes any provisions (1) to the contrary: Nonrenewal 2. Subject to the provisions of paragraphs C.2. and C.3. below, if we elect not to renew this policy, we will mail or deliver written notice stating the reason for nonrenewal, to the first Named Insured shown in the Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured, and to the producer of record, at the mailing address shown in the policy. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenant's household property contained in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part The Commissioner of Insurance finds that the exposure of potential losses will threaten our solvency or place us in a hazardous condition. A hazardous condition includes, but is not limited to, a condition in which we make claims payments for losses resulting from an earthquake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25% for payment of these claims; or (2) We have a. Lost or experience a substantial reduction in the availability or scope of reinsurance coverage; or b. Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies; and the Commissioner has approved a plan for the nonrenewals that is fair and equitable, and that is responsive to the changes in our reinsurance position. C. Farm Coverage Part — Farm Property — Farm d Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. We may elect not to renew such coverage for any reason, except as provided in b., c. and d. below: b. We will not refuse to renew such coverage solely because the first Named Insured has accepted an offer of earthquake coverage. However, the following applies only to insurers who are associate participating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such coverage after the first Named Insured has accepted an offer of earthquake coverage, if one or more of the following reasons applies: (1) The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the approved rating plan and related documents filed with the Department of Insurance as required by existing law: b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy, issued by the California Earthquake Authority that included an earthquake policy premium surcharge. We did not refuse to renew such coverage solely because corrosive soil conditions exist on the premises. This restriction (d.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions. I. Commercial Property Coverage Part — Causes Of Loss — Special Form; or ii. Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes ofLoss- Special 3. We are not required to sent notice of nonrenewal in the following situations: a. If the transfer or renewal of a policy, without any changes in terms, conditions, or rates, is between us and a member of our insurance group. e. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy IL 02 70 09 12 OO Insurance Services Office, Inc., 2012 :a iEwEsk vogwnmtDD8y. rsenEwEnanrrRov®sr Risk Management Malys[ Attachment Code: D551366 Certificate ID: 15085893 with paragraph C.1. c. If you have obtained replacement coverage, or if the f first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. within 60 days of the end of the policy period. If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in paragraph C.1., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25%. IL 02 7009 12 © Insurance Services Office, Inc., 2012 Wale Mwganmt DiWon REvEwED 6 APPRov®8v: Risk Management Malys[ Attachment Code: D572922 Certificate ID: 15085893 SAFETY NATIONAL CASUALTY CORPORATION ST. LOUIS, MISSOURI WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 23 90 DAY CANCELLATION ENDORSEMENT - CALIFORNIA This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Under Part Six - Conditions, Item 2 of Paragraph D. Cancellation is amended to read: 2. We must mail or deliver to you not less than 90 days advanced written notice stating when the cancellation is to take effect, except for when cancellation of the policy is for non-payment of premium. If cancellation of the policy is for non-payment of premium, we must mail or deliver to you not less than ten days advance written notice stating when the cancellation is to take effect. Mailing such notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 1/1/2021 Insured MISSION LINEN SUPPLY Policy No. LDS4045504 Insurance Company Safety National Casualty Corporation WC 99 04 23 (07 11) Endorsement No. Premium $ Included o 1. REmEwED I`ve r.. ®. Risk Management Analyst