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HomeMy WebLinkAboutUNITED STATES SOCCER FOUNDATION, INC.INSURANCF NOT ON BILE WORK MAY NOT PROCEED CLERK OF COUNCIL A-2021-108 JUL 1 3 2021 DATE: MINI PITCH PROGRAM GRANT AGREEMENT — FISCAL YEAR 2022 0. (Parka\J ue7 Coew&%) (Tr) C17 Pursuant to this Mini Pitch Program Grant Agreement ("Agreement"), dated as of the 6" of July 2021 ("Effective Date"), the United States Soccer Federation Foundation, Inc. ("Foundation") agrees to award the Grant ("Grant") to the City of Santa Ana, ("Grantee") FY21-723, and Grantee accepts such Grant, in accordance with the terms and conditions set forth herein. 1. Foundation: U.S. Soccer Foundation Attn: Grants Department 1140 Connecticut Ave. NW, Suite 1200 Washington, DC 20036 Grantee: City of Santa Ana Attn: Kristine Ridge, City Manager 20 Civic Center Plaza, M-30 P.O. Box 1988 Santa Ana, CA 92702 2. Grant: This Grant, awarded in the form of an acrylic mini pitch surface with goal and lighting installation ("Mini Pitch"), supplied by Musco Sports Lighting ("Vendor"), which shall be valued by Foundation, in its sole and absolute discretion, in an amount up to $100,000. 3. Acrylic Mini Pitch: Consistent with Foundation's interests in promoting youth soccer, particularly within vulnerable communities, this Grant will provide the Mini Pitch at Delhi Park (the "Grant Project"). Grantee will determine the appropriate location for installation of the Mini Pitch. 4. Execution of the Grant Agreement: Grantee must return an executed copy of this Agreement to the Foundation by the 16' of July 2021. 5. Grantee Covenants: In order to induce Foundation to enter into this Agreement, and to award the aforementioned Grant, Grantee covenants as follows: (a) The Foundation's afterschool soccer program, Soccerfor Success, will receive scheduling priority on the Mini Pitch for a minimum of 20 weeks per year, 3 days per week, should Grantee and the Foundation agree upon a suitable program operator. Should Grantee elect to run the Soccer for Success program itself, a separate agreement will be initiated to enumerate Foundation support and Grantee obligations for program operation. (b) Foundation will be granted usage of the Mini Pitch for one (1) day per year over the first five (5) years following its completion, including, without limitation, for Special Events (as defined below) that are organized by Foundation. Foundation will make best efforts to schedule such usage for dates and times mutually agreed upon with the Grantee, and Grantee will not unreasonably withhold play space time for such usage. For purposes of this Agreement, "Special Events" shall be defined as tournaments, clinics, events, training sessions, media functions and any other similar event the Foundation so determines. Foundation agrees to comply with City's procedures for use of its fields by third parties including any necessary waivers or proof of insurance required. (c) Upon completion, the Mini Pitch will be maintained in accordance with Vendor's recommendations for user safety which Foundation will provide to Grantee. Grantee acknowledges and agrees that it will be responsible for the maintenance and operation of the Mini Pitch following its completion. (d) Grantee presently owns, or is currently tenant to an appropriate long-term lease of, the property on which the Mini Pitch will be built. An appropriate long-term lease shall mean a lease of at least ten (10) years in length following the Effective Date. (e) Prior to commencing installation of the Mini Pitch, Grantee will obtain, or shall assist (where necessary) in obtaining, all permits, authorizations and consents from third parties, including governmental entities, necessary for the installation of the Mini Pitch. 6. Facts and Representations True and Correct: Grantee hereby affirms the representations made in its conversations and communications with Foundation are true and correct and that Foundation may rely upon the truth and correctness of the representations made in all conversations and communications regarding this Grant Project, without further independent investigation. Grantee further affirms that it has not omitted any material facts, the knowledge of which would adversely impact the awarding of the Grant to Grantee. Grantee avows that no adverse events have occurred since the latest communication which have materially and adversely altered the truth or reliability of the Grant Project, including the tax status of Grantee and the Grantee's ability to allow successful completion of the Grant Project. Grantee agrees to immediately inform the Foundation within five (5) business days of any material change, in Grantee or the Grant Project, which might affect any terms of this Agreement. 7. Grantee Books and Records: Grantee agrees to maintain sufficient operating and financial books, records and related documentation regarding the activities of Grantee and other evidence sufficient for Foundation to satisfy its fiduciary, public and governmental responsibilities and duties. Foundation shall have reasonable access to the books and records of Grantee for inspection purposes and shall be entitled to copies, as they relate to the Grant Project. 8. Installation of the Mini Pitch. At least thirty (30) days prior to installation of the Mini Pitch ("Installation"), Foundation and Grantee will agree in writing on a mutually acceptable process for Installation including a time table, exchange of necessary information for Installation, safety precautions, and any planning or building requirements necessary to comply with applicable laws including but not limited to permits, traffic safety, park safety, design and construction considerations. Any failure to agree on any substantive term will be grounds for either Party to terminate this Agreement with fourteen (14) days' notice to the other Party. The Parties will both make best efforts to resolve any disagreements and facilitate Installation. 9. Grantee Reports: (a) Impact Reports: Following completion of the Mini Pitch, Grantee shall complete to Foundation a report, provided by the Foundation, describing the impact of the Mini Pitch. Such report shall be submitted to Foundation annually, for five (5) years after completion of the Mini Pitch and shall include photographs of the Mini Pitch in use by youth soccer players and provide information on play space usage rates, stories of impact on the community, and any other information reasonably requested by Foundation. (b) Site Visits: Grantee will use its best efforts to accommodate any representative of Foundation who requests to conduct a site visit, at the sole cost of Foundation, for the purposes of collecting information about the Grant's impact. (c) Photottraphs/Videos/Stories/Testimonials: In addition to submitting digital photographs, videos, stories and testimonials relating to the Grant Project in the aforementioned Impact Reports, the Grantee shall submit the same to the Foundation upon request by the Foundation, including before and after photographs, both in daytime and at night, of the Mini Pitch site area. 10. Publicity Material and Recognition: (a) Grantee, upon written approval by the Foundation, shall recognize the Foundation and acknowledge the Grant in Grantee's written materials, news releases, website and related marketing or publicity. (b) The Foundation shall have the right to publicize, show photographs of, and use the name of the Mini Pitch and otherwise promote its contributions in any and all media, including the Internet. Grantee authorizes the Foundation to utilize those logo or logos, owned or controlled by Grantee and associated with the Grant Project, for related marketing and/or publicity. Foundation will indemnify Grantee for any claim of intellectual property, trademark or copyright infringement related to the use of Foundation's marks or logos. (c) Grantee agrees to fully assist and cooperate in a mutually acceptable dedication event, should the Foundation request such, which may include appearances by athletes affiliated with the Foundation. 11. Awareness Opportunities: Grantee grants to Foundation the right to permanently place Foundation's trademark, trade name or any design/logo owned or controlled by Foundation (each, a "Mark" and together, the "Marks"), and/or that of its funding partners, on the surface of the Mini Pitch. Unless Foundation chooses to forego the right, standard Marks will be included during installation of the Mini Pitch, per the rendering found in Attachment A. Foundation may change its Marks at any time in its sole discretion and at its sole cost. Each Mark will remain on the surface of the Mini Pitch for as long as the Mini Pitch is operational, unless removed by Foundation or unless Foundation otherwise gives its written consent to the removal of such Mark. Foundation will indemnify Grantee for any claim of intellectual property, trademark or copyright infringement related to the use of Foundation's marks or logos. Additionally, Grantee will allow Foundation to install signs/banners on the premises on which the Mini Pitch is built, per the rendering found in Attachment A, in order to promote and recognize the Foundation and other funders for their contribution to the Mini Pitch. 12. Grant Not Assignable: Grant is intended solely for the benefit of Grantee. No benefit of the Grant may be delegated, assigned or otherwise transferred without the advance, written consent of Foundation, which consent shall be in the sole and absolute discretion of Foundation. 13. Proper Authority: Each of the parties and its officers represent and warrant that they are authorized to enter into this Agreement and execute the same without further authority. 14. Absence of Warranties: FOUNDATION MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY HIND, EITHER EXPRESS OR IMPLIED, AS TO ANY MATTER INCLUDING, BUT NOT LIMITED TO, IMPLIED WARRANTIES OF FITNESS FOR A PARTICULAR PURPOSE, MERCHANTABILITY OR OTHERWISE RELATING TO THE MINI PITCH OR ANY COMPONENT PART THEREOF, OR ANY OTHER ENTITIES AND THEIR ASSOCIATED SERVICES. IN NO EVENT WILL FOUNDATION BE LIABLE FOR ANY DAMAGES OF ANY KIND INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, LOST PROFITS, OR OTHER CONSEQUENTIAL, EXEMPLARY, INCIDENTAL OR PUNITIVE DAMAGES ARISING OUT OF THIS AGREEMENT OR PERFORMANCE OF THE OBLIGATIONS HEREUNDER. 15. Assumption of Risk: Grantee hereby agrees to assume all risks and liabilities associated with the use, operation, maintenance, safety and condition of the Mini Pitch. 16. Indemnification: (a) Grantee agrees to indemnify, defend and hold harmless Foundation, its parent, subsidiary and affiliated companies, sponsors, benefactors, donors, officers, directors, employees, accountants, attorneys, agents, successors and assigns ("Foundation Parties") from and against any and all third party claims, demands, losses, damages, liabilities, costs and expenses (including reasonable legal/attorneys' fees and expenses arising out of or related to any legal proceeding and any legal appeal) ("Claim" or "Claims") related to the Grant, the Mini Pitch or this Agreement and liabilities of any kind or nature whatsoever, whether in contract, tort, or otherwise, resulting from any claim (including, without limitation, personal injury, death, or property damage) actually or allegedly arising out of or in connection with the maintenance, location, or condition of the Mini Pitch, or any person's use of the Mini Pitch, whether authorized or unauthorized, proper or improper. Grantee's indemnification obligation hereunder shall survive the expiration or earlier termination of this Agreement. Without limiting this obligation, Grantee will maintain the insurance described in Section 17 of this Agreement. Grantee represents to Foundation that the Mini Pitch does not violate any applicable law, regulation, ordinance, lease, or otherwise violate the rights of any person or entity. (b) Grantor agrees to indemnify Grantee during the installation of the Mini Pitch by Foundation or its subcontractors and when Foundation or third parties at the direction of Foundation utilizes the Mini -Pitch thereafter as follows: Foundation agrees to defend, and shall indemnify and hold harmless the Grantee, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Foundation, its subcontractors, agents, employees, or other persons acting on its behalf, and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Sub - Section or by reason of the terms of, or effects, arising from this Agreement. Notwithstanding the foregoing, to the extent Foundation, its agents or subcontractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Foundation, its agents or subcontractors. 17. Insurance Requirements: (a) Insurance Requirements of the Mini Pitch. At all times while the Mini Pitch is in place, Grantee shall provide and maintain, at its expense, the following insurance, or appropriate self-insurance, which shall protect Grantee and the Foundation on a primary basis from any and all Claims arising out of or in connection with the Grant Project and the Mini Pitch pursuant to this Agreement: (i) Commercial General Liability insurance with limits not less than $1,000,000 each occurrence and $2,000,000 in the aggregate. Such insurance shall include coverage for contractual liability, premises liability, products -completed operations, personal and advertising injury, property damage and bodily injury liability (including death). Said policy shall be endorsed to naive the Foundation and Foundation Parties as Additional hisureds. (ii) Automobile Liability insurance covering liability arising out of the Grantee's use, operation and/or maintenance of any auto (including trucks and other construction vehicles), with limits not less than $1,000,000 each accident combined single limit for bodily injury. (iii) Workers' Compensation insurance covering employees of Grantee involved with the use and maintenance of the Mini Pitch, with limits as required by statutory law, including Employer's Liability coverage with limits not less than $1,000,000 each accident, $1,000,000 disease - each employee and $1,000,000 disease -policy limit. (iv) Umbrella and/or Excess Liability insurance with limits not less than $2,000,000 each occurrence shall apply in excess of the Commercial General Liability, Automobile Liability and Employer's Liability (v) Participant Accident insurance covering all Participants and other individuals using the Mini Pitch with limits not less than $5,000 per participant for Accident Medical coverage and $1,000 per participant for AD&D coverage. All such insurance required above shall be (1) considered primary with respect to Claims arising out of the use and maintenance of the Mini Pitch. Upon execution of this Agreement, Grantee shall provide Foundation with Evidence of Coverage confirming that the appropriate insurance is in place and that the policies have been properly endorsed to meet the insurance requirements as set forth above. (b) Insurance Requirements for Installation of the Mini Pitch. At all times during the installation of the Mini -Pitch, the Foundation and its Installation Vendor shall provide and maintain, at its expense, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder and the results of that work by the Foundation, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE: Coverage shall be at least as broad as: Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Foundation, its agents or subcontractors have no owned autos, hired, (Code 8) and non -owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. If the Foundation, its agents, or subcontractors maintain broader coverage and/or higher limits than the minimums shown above, Grantee requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Foundation, its agents or subcontractors. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the Grantee. ii. Other Insurance Provisions- The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status- The Grantee, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Foundation, its agents, and subcontractors including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Foundation, its agents, and subcontractors insurance (at least as broad as ISO Form CG 20 10 1185 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CO 20 38; and CG 20 37 if a later edition is used). 2. Primary Coverage- For any claims related to this contract, the Foundation Foundation's vendor, its agents and its subcontractors' insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the Grantee, its officers, officials, employees, and volunteers. Any insurance or self- insurance maintained by the Grantee, its officers, officials, employees, or volunteers shall be excess of the Foundation, its agents and subcontractor's insurance and shall not contribute with it. 3. Notice of Cancellation- Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the Grantee. 4. Waiver of Subrogation- The Foundation, Foundation's vendor, its agents and subcontractors hereby grant to Grantee a waiver of any right to subrogation which any insurer of said Foundation, its agents and subcontractors may acquire against Grantee by virtue of the payment of any loss under such insurance. Foundation, its agents and subcontractors agree to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the Grantee has received a waiver of subrogation endorsement from the insurer. 5. Self -Insured Retentions- Self -insured retentions must be declared to and approved by the Grantee. The Grantee may require the Foundation, its agents and/or its subcontractors to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self -insured retention may be satisfied by either the named insured or Grantee. 6. Acceptability of Insurers- Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the Grantee. Claims Made Policies (applicable only to professional liability, see below)- If any of the required policies provide claims -made coverage: a. The Retroactive Date must be shown, and must be before the date of the contract or the beginning of contract work. b. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. c. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Foundation, it's agents and/or subcontractors must purchase "extended reporting" coverage for a minimum of five (5) years after completion of work. 8. Verification of Coverage- The Foundation, Foundation's vendor„ its agents and/or subcontractors shall furnish the Grantee with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to Entity before work begins on installation of the Mini Pitch. However, failure to obtain the required documents prior to the work beginning shall not waive the Foundation, its agents or subcontractors obligation to provide them. The Grantee reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Failure of the Foundation, Foundation's vendor its agents and/or subcontractors to provide the required verification of coverage prior to the start of any work on installation of the Mini -Pitch shall be grounds for immediate termination of this Agreement. 9. Special Risks or Circumstances- Grantee reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 18. Participant Waiver and Release Forms: To the extent that Grantee requires Participants in its programs or others who use the Mini Pitch to sign waiver and release forms, Grantee shall include the Foundation and the Foundation Parties as released parties in the form. 19. Use of Mark: Notwithstanding anything in this Agreement to the contrary, in the event Grantee desires to use a Mark owned or controlled by Foundation in a manner consistent with this Agreement, Grantee shall first submit a sample of the concept of the proposed use to Foundation for prior written approval, which approval may be withheld in the sole discretion of Foundation. Any such use by Grantee shall create no rights for Grantee in or to the Mark. Each Mark shall remain at all times the sole and exclusive intellectual property of Foundation, and Foundation shall have the right, from time to time, to request samples of use from which it may determine compliance with these terms and conditions. Notwithstanding any provision of this Agreement to the contrary, Foundation reserves, in its sole and absolute discretion, the right to prohibit use of its Marks. 20. Applicable Law; Jurisdiction: This Agreement shall be governed by and construed in accordance with the laws of the state of California, without regard to principles of conflict of laws. Each party agrees that any action or proceeding with respect to this Agreement may only be brought in a federal or state court situated in the state of California, and by execution and delivery of this Agreement, such party irrevocably consents to jurisdiction and venue in each such court. 21. Attorneys' Fees: Grantee agrees to pay all costs and expenses, including reasonable attorneys' fees, incurred by Foundation in connection with any litigation concerning this Agreement should Foundation prevail against Grantee in such litigation, whether commenced by Foundation or Grantee. 22. Third Party Beneficiaries: It is expressly agreed and by this statement specifically intended by the parties that nothing within this Agreement shall be construed as indicating any intent by either party to benefit any other entity or person not a party signatory to this Agreement by any provision or to entitle any such third party to any right of action on account hereof. 23. Notices: Any notices or communications given under this Agreement must be made in writing (a) if to Foundation, at the address of Foundation as hereinabove set forth or at such other address as Foundation may designate by notice, or (b) if to Grantee, at the address of Grantee as hereinabove set forth or at such other address as Grantee may designate by notice 24. Entire Agreement; Modifications: This Agreement contains the entire agreement between Foundation and Grantee and cannot be changed, modified, amended, waived or canceled except by an agreement in writing and executed by each of the parties hereto. 25. Confidentiality: If either Party receives from the other Party information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Each Party agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of Either Party disclosed in a publicly available source; (c) is in rightful possession of the Party without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Party without reference to information disclosed by the other Party. 26. Non -Discrimination: Foundation shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Foundation affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 27. Counterparts and Facsimile Signatures: This Agreement may be executed in one or more counterparts each of which shall be deemed an original but all of which together shall constitute one and the same instrument. This Agreement may be executed by facsimile signature by any party and such signature will be deemed binding for all purposes hereof without delivery of an original signature being thereafter required. p-2021-108 IN WITNESS WHEREOF, the parties have executed this Agreement by their duly authorized signatories as of the date first above written. U.S. Soccer Foundation By: L Name: Rob Kaler Title: COO & General Counsel Date: 6/24/21 /:VWM_331 I � Z DA-ISY GOMEZ Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: dawn- A. k LAURA A. ROSSINI Chief Assistant City Attorney FOR APPROVAL Executive Director, Parks, Recreation and Community Services Agency CITY OF SANTA ANA KRI�INE RIDGV City Manager E. Francine R. Dig nairysigned byFrandners. Villareal Villareal Date: 2021.10.051227:18 07'00' USSOCC E-01 J R302827 ACORO �,CERTIFICATE OF LIABILITY INSURANCE DAT7(MM/DDNYYY) 7/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 194467 CONTACT NAME: PHONE FAX (A/C, No, EXt): (678) 324-3300 (A/C, No):(678) 324-3303 Edgewood Partners Insurance Center 2727 Paces Ferry Road Building Two, Suite 1500 Atlanta, GA 30339 IL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA : Arch Insurance Company 11150 INSURED INSURER B : Hartford Insurance Company of the Midwest 37478 U.S. Soccer Foundation, Inc. dba U.S. Soccer Foundation 1140 Connecticut Ave. N.W. INSURERC: Suite 1200 INSURER D : INSURER E : Washington, DC 20036 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR X X SBCGL0283404 7/1/2021 7/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 $ X IVIED EXP (Any oneperson) $ 0 Participant Legal PERSONAL &ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 5,000,000 X OTHER: Per Event A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO SBAUT0038004 7/1/2021 7/1/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident) ccident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS -MADE SBFXS0045204 7/1/2021 7/1/2022 AGGREGATE $ 3,000,000 DED X RETENTION $ 0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEM BER EXCLUDED? (Mandatory in NH) N / A 20WECZS4698 7/1/2021 7/1/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,UUU If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder is additional insured as required by written contract or agreement subject to the provisions and limitations of Form CG 2026 (04 13) Additional Insured - Designated Person or Organization and Form CG2037 (04 13) Additional Insured - Owners, Lessees or Contractors - Completed Operations. Primary and Non-contributory provisions apply as per Form CG2001 (04/13) - Primary and Noncontributory - Other Insurance Condition. A Waiver of Subrogation applies where required by written contract or written agreement as per FormSGL003100 (10/16) Commerical General Liability Enhancement Endorsement - Blanket Waiver of Subrogation. 30 days Notice of Cancellation (10 days for nonpayment) will be sent out in accordance with the policy provisions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th floor Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE RisieMallagementDiviaian ,�oRaN� REVIEWED & APPROVED BY.- oI �' v� ACORD 25 (2016/03) © 1988-2015 ACORD C ' The ACORD name and logo are registered marks of ACORD RlskManagementAnalyst POLICY NUMBER: SBCGL0283404 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured to this policy by written contract or written agreement which is currently in effect or coming into effect during the term of this policy; and Executed prior to the occurrence of any "property damage", "bodily injury", or "personal and advertising injury". 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf 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. CG 20 26 04 13 © ISO Properties, Inc., 2004 �oRaN } z RAMmWmedDMsian REVIEWED & APPROVED BY.- f R. V;&wd Risk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED As of the effective date hereof, it is hereby understood and agreed that the attached Forms CG 2026 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION are added to the policy. It is further understood and agreed that Form CG 2037 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS is added to the policy. No additional premium due. All other terms and conditions of this Policy remain unchanged. Company: Arch Insurance Company Endorsement Number:03 Policy Number: SBCGL0283404 Named Insured: U.S. Soccer Foundation, Inc. dba U.S. Soccer Foundation Endorsement Effective Date: 07/01/21 Issued by: LH July 13, 2021 00 ML0207 00 11 03 President �oRaN } z a RiskMmVmentDMsian REVIEWED & APPROVED BY.- p R. vj&wd Risk Management Analyst POLICY NUMBER: SBCGL0283404 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 but only with respect to Mini -Pitch Project 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf 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. CG 20 26 04 13 © ISO Properties, Inc., 2004 �oRaN } z RiskMmWmedDMsfan REVIEWED & APPROVED BY.- f R. V;&wd Risk Management Analyst POLICY NUMBER: SBCGL0283404 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations City of Santa Ana, Risk Management, ifs Officers, Employees, Agents, Representatives and Volunteers 1 New Soccer Mini -Pitch at Dehli Park 2314 S. Halladay St. Santa Ana, CA 92707 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement 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. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to required by a contract or will pay on behalf of the amount of insurance: the additional insured is agreement, the most we additional insured is the 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 37 04 13 © Insurance Services Office, Inc., 2012 �oRaN } z RiskMmWmedDMsfan REVIEWED & APPROVED BY.- f R. V;&wd Risk Management Analyst COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 �oRaN } z RiskMmWmedDMsfan REVIEWED & APPROVED BY.- f R. V;d Risk Management Analyst ��j Arch Insurance r ARCH INSURANCE COMPANY (A Missouri Corporation) Home Office Address: 2345 Grand Blvd, Suite 900 Kansas City, MO 64108 Administrative Address: Harborside 3 210 Hudson Street, Suite 300 Jersey City, NJ 07311-1107 Tel: (866) 413-5550 COMMERCIAL EXCESS LIABILITY CERTIFICATE HOLDER DECLARATIONS Certificate Number: This Certificate Forms a Part of Master Policy Number: SBFXS0045204 SJ FXS0000904 Policy Period: FROM: 07/01 /21 TO: 07/01 /22 at 12:01 A.M., Standard Time at your mailing address shown below. Named Insured: U.S. Soccer Foundation, Inc. dba U.S. Soccer Foundation Named Insured Mailing Address: 1140 Connecticut Ave., NW, Suite 1200, Washington, DC 20036 Business Description: Soccer Foundation Form of Business: Organization, including a Corporation Producer Name: American Specialty Insurance & Risk Services, Inc. Producer Mailing Address: 7609 W. Jefferson Blvd., Suite 100, Fort Wayne, IN 46804 Retroactive Date (if any): N/A (Applicable to Claims -Made Coverage Only) IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE TO PROVIDE YOU WITH THE INSURANCE AS STATED IN THIS POLICY. Excess Policy — Limits Of Insurance Each Occurrence Limit $3,000,000. Aggregate Limit $3,000,000. Other: $ Excess Policy - Premium Certificate Premium (including premium subject to audit) Certificate Premium for Certified Acts of Terrorism: (Included within the Certificate Premium) Audit Period (if applicable) ❑ Annual ❑ Semi -Annual ❑ Quarterly ❑ Monthly 05 SXS0002 00 10 Includes copyrighted material from Insurance Service 16 Office, Inc., with its permission. �oRaN or RAMmWmedDMsfan REVIEWED & APPROVED BY.- f R. W&Wd Risk Management Analyst Schedule A - Schedule Of Controlling Underlying Insurance Type Of Coverage: ® Occurrence ❑ Claims -made Company: Arch Insurance Company Policy Number: SBCGL0283404 Policy Period: 07/01 /21-07/01 /22 General Liability Limits Of Insurance: Each Occurrence $ 1,000,000 Personal And Advertising Injury $ 1,000,000 Any one person or organization Products -Completed Operations $ 5,000,000 Aggregate General Aggregate $ 5,000,000 Per Event Company: Arch Insurance Company Policy Number: SBAUT0038004 Policy Period: 07/01 /21-07/01 /22 Commercial Auto Limits Of Insurance: Liability Garage Aggregate Limit For Other Than $ Autos (if applicable) Each Accident $ 1,000,000 NOHA only Company: Hartford Insurance Company of the Midwest Policy Number: 20 WEC ZS4698 Policy Period: 07/01 /21-07/01 /22 Employer's Liability Limits Of Insurance: Bodily Injury By Accident Each Accident $ 1,000,000 Bodily Injury By Disease Policy Limit $ 1,000,000 Bodily Injury By Disease Each Employee $ 1,000,000 Type Of Coverage: ® Occurrence ❑ Claims -made Company: Arch Insurance Company Other Policy Number: SBCGL0283404 Coverages Policy Period: 07/01/2021-07/01/2022 Limits Of Insurance: Abuse -Molestation Each Occurrence Limit $ 1,000,000 Aggregate Limit $ 2,000,000 05 SXS0002 00 10 Includes copyrighted material from Insurance Service 16 Office, Inc., with its permission. �oRaN or RAMmWmedDMsfan REVIEWED & APPROVED BY.- f R. W&Wd Risk Management Analyst Type Of Coverage: ❑ Occurrence ® Claims -made Company: Arch Insurance Company Other Policy Number: SBCGL0283404 Coverages Policy Period: 07/01 /2021-07/01 /2022 Limits Of Insurance: Employee Benefits Liability Each Employee Limit (subject to $1,000 $ 1,000,000 deductible) Aggregate Limit $ 2,000,000 THESE DECLARATIONS, TOGETHER WITH COMMERCIAL EXCESS LIABILITY POLICY PROVISIONS, SCHEDULE OF CONTROLLYING UNDERLYING INSURANCE AND SCHEDULE OF FORMS AND ENDORSEMENTS, IF ANY, ARE ISSUED AS PART OF, AND IN COMPLETION OF THE ABOVE NUMBERED POLICY. 05 SXS0002 00 10 Includes copyrighted material from Insurance Service 16 Office, Inc., with its permission. �oRaN or RAMmWmedDMsfan REVIEWED & APPROVED BY.- f R. W&Wd Risk Management Analyst Francine R. Villareal Digitally signed by Francine R. Villareal Date: 2021.10.05 12:29:45 -07'00' � ® �`� o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09/14/2021 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 Aon Risk services Central, Inc. Omaha NE Office CONTACT NAME: (A/CN No.Ext): (402) 697-1400 A/C No : (402) 697-0017 E-MAIL ADDRESS: 17807 Burke street suite 401 Omaha NE 68118 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: sentry Insurance Company 24988 Musco sports Lighting, LLC c/o Musco Corporation 100 1st Ave W INSURER B: Sentry Casualty Company 28460 INSURERC: Travelers Property Cas Co of America 25674 Oskaloosa IA 52577 USA INSURERD: Indian Harbor Insurance Company 36940 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570089135831 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE I N S DI WVD I POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 000 CLAIMS -MADE X❑ OCCUR PREMISES Ea occurrence)$300, 000 MED EXP (Any one person) $10 , 000 PERSONAL& ADV INJURY $1, 000, 000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY x PRO El LOC JECT PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 90-16877-003 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT Ea accident $1, 000, 000 BODILY INJURY ( Per person) ANY AUTO XHI BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS RED AUTOS IX NON -OWNED X PROPERTY DAMAGE Per accident ONLY AUTOS ONLY C X UMBRELLALIAB X OCCUR CUP3s63336021NF 07101120210710112022 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10, 000, 000 DED I X RETENTION $10, 000 B WORKERS COMPENSATION AND 9016877001 07101120210710112022 X PER STATUTE OTH- EREMPLOYERS' LIABILITY Y/ N ADS E.L. EACH ACCIDENT $1, 000 , 000 B ANY PROPRIETOR / PARTNER, EXECUTIVE 9016877002 07/01/2021 07/01/2022 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A AZ, WI E.L. DISEASE -EA EMPLOYEE $1, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000, 000 D Archit&Eng Prof CEo742113901 07/01/2021 07/01/2022 Aggregate $5,000,000 Claims -Made SIR $250,000 SIR applies per policy terns & condi ions Each Claim $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Musco Project 211811- Delhi Park Mini -Pitch. City of Santa Ana and U.S. soccer Foundation are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary and Non -Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. A Waiver of subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the General Liability, Automobile Liability and Workers' Compensation policies. c+� M 00 0 0 I- CERTIFICATE HOLDER CANCELLATION 5< SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana AUTHORIZED REPRESENTATIVE Risk Management Division 20 Civic Center Plaza -� Santa Ana CA 92702 USA �„ortaNc RAMwagementDMsian ©1988-2015 ACORD CO 3 z R�ED &APPROVED BY.- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Analyst SENTRY INSURANCE A MUTUAL COMPANY STEVENS POINT, WISCONSIN (A PARTICIPATING MUTUAL COMPANY) A MEMBER OF THE SENTRY FAMILY OF INSURANCE COMPANIES COMMERCIAL GENERAL LIABILITY NAMED INSURED MUSCO CORPORATION ENDORSEMENT EFFECTIVE POLICY NUMBER 07-01-21 90-16877-04 ADDITIONAL�INSURED - OWNERS', LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE +-----------------------------------------------------------------------+ INAME OF ADDITIONAL.INSURED PERSON(S) OR ORGANIZATIONS) I +-----------------------------------------------------------------------+ ZANY 8 ALL OWNERS, LESSES OR CONTRACTORS I +----=-------------------- ------------- ----------------------------------+ ILOCATION(S) OF COVERED OPERATIONS I +-----------------------------------------------------------------------+ ZANY AND'ALL PROJECTS FOR WHICH THE CONTRACT REQUIRES.COVERAGE I IFOR COMPLETED OPERATIONS I +1----------------------------------------------------------------- -----+ (Information:required to complete this Schedule, if not shown above, I (will be shown in the Declarations. I +-----------------------------------------------------------------------+ CG 20 10 04 13 Copyright, Insurance Services Office, Inc., 2012 MUS 90-16877-04 01 191 PAGE 0.01 of 002 #03 Risk Management Division 3 REVIEWED & APPROVED BY. Risk Management Analyst OIT18ORG ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - CONTINUED A. Section II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. 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 contractor agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of has been completed; or the covered operations 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the.insurance afforded to these additional insureds, the following is added to SECTION:III - LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf 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. CG 20 10 04 13 Copyright; Insurance Services Office, Inc., 2012 MUS 90-16877-04 01 191 PAGE _002 of 002 Ride Managemail Division i REVIEWED & APPROVED BY. - Risk Management Analyst 01T16ORG COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 POLICY NUMBER: 90-16877-04 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE +------------------------------------+----------------------------------+ NAME OF ADDITIONAL INSURED PERSON(S) LOCATION AND DESCRIPTION OR ORGANIZATION(S) I OF COMPLETED OPERATIONS -------------------------------------- -------------------------------- + ANY AND ALL OWNERS, LESSEES OR CONTRACTORS ANY AND ALL PROJECTS FOR WHICH THE CONTRACT REQUIRES COVERAGE FOR COMPLETED OPERATIONS ------------------------------------I--------------------------------- 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement 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. CG 20 37 04 13 Copyright, Insurance Services Office, Inc., 2012 MUS 90-16877-04 01 191 PAGE 001 OF 002 #01 �ortaN � RiskMwaganadDMsfan REVIEWED & APPROVED BY.- Risk Management Analyst COMMERCIAL GENERAL LIABILITY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - CONTINUED B. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III - LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf 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. CG 20 37 04 13 Copyright, Insurance Services Office, Inc., 2012 MUS 90-16877-04 01 191 PAGE 002 OF 002 �ortaN 3 z Risk MwaganadDMsiun REVIEWED & APPROVED BY.- Risk Management Analyst COMMERCIAL AUTO CA 04 44 10 13 POLICY NUMBER: 90-16877-03 00 191 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.: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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 indicated below. +----=----------------------- ------------------------------ -------------+ INAMED INSURED: MUSCO-CORPORATION I ENDORSEMENT EFFECTIVE DATE: 07-01-21 +-----------------------------------------------------------------------+ SCHEDULE +-----------------------------------------------------------------------+ INAME(S) OF PERSON(S) OR ORGANIZATIONS(S): I IALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR I ITO LOSS. I I I I I I I I I I I +-----------------------------------------------------------------------+ (Information required to complete this°.Schedule, if not shown above, I twill be shown in the Declarations. +-----------------------------------------------------------------------+ The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition does not apply to the person(s) or organizations(s) shown in the Schedule, but only to the extent that subrogation is.waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13. Copyright, Insurance Services Office, Inc., 2011 MUS 90-16877-03 00 191 Page �01 a a orz,N F Risk Mouganimi Division REVIEWED & APPRovED By. �rf Risk Management Analyst 01T1RORG NAMED INSURED MUSCO CORPORATION COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 ENDORSEMENT EFFECTIVE POLICY NUMBER 07-01-21 90-16877-04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE +------------------------------------------------------------------ - - - - -+ (NAME OF PERSON OR ORGANIZATION: I TALL WRITTEN CONTRACTS PROVIDED SUCH I (CONTRACT WAS MADE PRIOR TO LOSS. +------------------------------------------------------------------ - - - - -+ IIn-formation required to complete this Schedule, if not shown above, (will be shown in the Declarations. +-----------------------------------------------------------------------+ 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 organi- zation 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. CG 24 04 05 09 Copyright, Insurance Services Offices, Inc., 2008 MUS 90-16877-04 01 201 PAGE 001 HortaN Risk MmRgemendDMsian r� ^ecoG< REVIEWED & APPROVED BY.- k,CMUM f. V� Risk Management Analyst 01T1SORG SENTRY CASUALTY COMPANY Carrier Code No. 37877 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY POLICY NUMBER: 90-16877-01 00 201 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule "ALL WRITTEN CONTRACTS PROVIDED SUCH CONTRACT WAS MADE PRIOR TO LOSS" WC 00 03 13 (Ed. 04-84) Copyright 1983 National Council on Compensation Insurance. MUS 90-16877-01 00 201 PAGE 001 MUSCO CORPORATION RiskMmWmendDMsian REVIEWED & APPROVED BY. - Risk Management Analyst 01T1SORG COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the OTHER INSURANCE Condition and supersedes any provision to the contrary: PRIMARY AND NONCONTRIBUTORY INSURANCE This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 04 13 Copyright, Insurance Services Office, Inc., 2012 MUS 90-16877-04 01 191 PAGE 001 ortaN RiskMwaganedDMsian REVIEWED & APPROVED BY. - Risk Management Analyst 01T1SORG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ'IT CAREFULLY. NOTICE OF CANCELLATION - CERTIFICATE HOLDERS This endorsement modifies the coverage provided under the following: BUSINESSOWNERS COVERAGE FORM COMMERCIAL AUTOMOBILE COVERAGE PARTS COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PARTS COMMERCIAL EXCESS/UMBRELLA LIABILITY'COVERAGE FORM EMPLOYMENT RELATED:PRACTICES LIABILITY POLLUTION LIABILITY COVERAGE ERRORS AND OMISSIONS COVERAGE FORM In the event we can cancel this policy, we shall endeavor to also. mail to the person(s) or.organization(s)-listed in the Schedule for this endorsement, advance written notice of cancellation. This notification of cancellation of -the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown,in the Schedule will•not.extend any policy cancel- lation date nor impact or negate any cancellation of the policy. This endorsement does not entitle :the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancellation to -the person(s) or organization(s) listed or described in the Schedule below -will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice, of cancellation of the insurance in this endorsement is changed by this statement to comply with the law. SCHEDULE Person(s) or Organization(s) including mailing address: PER SCHEDULE ON FILE WITH AGENT 30 DAY NOTICE OF CANCELLATION All other terms and conditions of this policy remain unchanged. IL 70 58 02 14 MUS 90-16877-03 00 191 PAGE 001 Risk MaTaag=a& Division i REVIEWED & APPROVED BY: �t-cur,-i-i-sr� Risk Management Analyst 01TIGORG NAMED INSURED ENDORSEMENT EFFECTIVE POLICY NUMBER MUSCO CORPORATION 07-01-21 90-16877-01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELATION-CERTIFICATE HOLDERS WORKERS COMPENSATION The person(s) or organization(s) listed or described in the Schedule below have requested that they receive written notice of cancelation-when this policy is cancelled by us. We will mail or deliver to the Person(s) or Organization(s) listed or described in the Schedule a copy of the written notice of cancelation that we sent to you. Such copies of the notice will be mailed as soon as practicable to the address or addresses provided by your broker or agent. This notification of cancelation of the policy is intended as a courtesy only. Our failure to provide such notification to the person(s) or organization(s) shown in the Schedule will not extend any policy cancela- tion date nor impact or negate any cancelation of the policy. This endorsement does not entitle the person(s) or organization(s) listed or described in the Schedule below to any benefit, rights or protection under this policy. Failure by us to provide this notice of cancelation to the person(s) or organization(s) listed or described in the Schedule below will not impose liability of any kind upon us. Any of these provisions that conflict with a law that controls the notice of cancelation of the insurance in this endorsement is changed by this statement to comply with the law. SCHEDULE Person(s) or Organization(s) including mailing address: PER LIST ON FILE WITH AGENT 30 DAY NOTICE OF CANCELLATION All other terms and conditions of this policy remain unchanged. WC 99 06 72 09 11 MUc 90-16877-01 00 191 Page 001 RiskMwagementDivision REMEWED & APPROVED BY. - Risk Management Analyst 01TIRORG One Tower Square, Hartford- Connecticut 0,6183 POLICY DECLARATIONS EXCESS FOLLOW! -FORM AND UMBRELLA POLICY NO.: =-3S63336D-21-NF LIABILITY INSURANCE POLICY ISSUE DATE: 07/16/2021 I NSUR I N G COM PANT: 7 RAVE LER S PROPERTY CASUALTY COMPANY OF AMER ICA 1, NAMED INSURED AND MAILING ADDRESS: MUSCO CORPORATION 100 1ST AVE91JE WEST OSKALOOSA :IA 52537 i 2, POLICY PERIOD: F•, r­l ^,'C1:'2321 to 07J01/202.212:01 A.M. Standard Time at your mailing address_ 3, LIMITS OF INSURANCE; C OV ERA G ES LIMITS OF LIABILITY AGGREGATE LIMITS OF LIABILITY $10, 000, 000 GeneralAggregate EXCESS FOLLOW- PORM AND UMBRELLA LIABILITY CRISIS MANAGEMENT SERVICE EXPENSES 4, SELF -INSURED RETENTION; 5, PREMIUM: $ 154, 515 6, TAXES AND SURCHARGES: 10, 000, 000 Products -Completed 0perat io'ns Aggregate ;10, 000, 000 Occurrence Limit $1041 G00 all Crisis ManagementE-rents ; 10, 000 any one occurrence or event x Flat Charge Adjustable (See Premium Schedule) 7, On die effecliye date shown in Item i., the Excess Follorv�-Forrn And Umbrella Liability Insurance Policy n-mbered above includes this Declarations Page and any forms and endorsements shown on the Listing Of Forms, Endorsements And Schedule Numbers. a, f the Schedule Of Underlying Insurance includes any coverage provided on a claims -made basis, then the crtia; ng d sclaimer applies. COVERAGE WILL APPLY ON A CLAIMS -MADE BASIS WHEN FOLLOWING CLAIMS -MADE UNDERLYING INSURANCE. 9. If the Schedule Of Underfying Insurance ncludes any coverage which includes, defense expenses with°n the I mits of liabilirty- then the follov,ing disclaimer applies: DEFENSE EXPENSES ARE PAYABLE WITHIN, AND ARE NOT IN ADDITION TO, THE LIMITS OF INSURANCE WITH RESPECT TO SOME R ALL OF THE COVERAGES PROVIDED. NAME AND ADDRESS OF AGENT OR BROKER: AON RISK SERV L'HTRAL-NEB - CF260 17807 3URRE ST STE 401 O[{ kL? NE 613118 COUNTERSIGNED BY: Authorized Representative DATE: OFFICE, SP-ST 9AUL Risk ManagementDiviaian } % z REVIEWED & APPROVED BY: EU 00 02 09 20 : _ . g The Travek-n Indemnity Company. ,4. rights •eser: ed. �. p+aye R. V; ad Risk Management Analyst POLICY NUMBER: CLIP-3S6333460-21-NF UMBRELLA ISSUE DATE. 07111*12021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAM IT CAREFULLY. SCHEDULE OF UNDERLYING INSURANCE This endorsement modifies insurance provided under the following. EXCESS FO)LLC1W-FARM AND LIMBRELLA LIABILITY INSURANCE Emplcyara Liahility Limits Of Liability CamerSENTRY CASUALTY COMPANY Bodily Injury By Accident Each Acc ide.ut PollcyNumber 90-16877-001 Bodily Injury Ely Diaeaae Policy Limit Policy Peeiud From: 07/GI/21)21 Bodily In�u*-y By Diaeaee Each 8rnpl�oyee ��: 07�Q1J�0�2 Employee Benefits Liability Limits Of Liability CarreT SENrRY INSURANCE A IrS ]Cr Each laployee COMPANY Aggregate Pol-icyrNumber, 90-16877-004 Rol icy Period From. 07/01f 2021 to', 07/01/2022 Commercial General Liability Limits Of Liability Ca.rT'eT SENTRY INBTTR.ANCE A III=AL General Aggregate COMPANY Products -Completed P of icy Nii mbar 90-16877-004 Operations Aggregate Policy Period P'ci ¢a -P.Li sl �Uutl Adve£'tioing Injury From: 07f 01�f��12i to: 07/01 2(322 Each CDccurrenca PRODJC.ER.AON RISK SERV CNTRAL-NEB OFFICE:SP-ST PAUL 06R EU 00 03 08 18 0 2D18 Th=Tmelers lrbWmnity D:impany. A# rights resened. $ir0001000 511 0001 0013 all 01]0 1 000 $1. D00. 001E $2MD00, 000 S2,D JhJY'000 82,000,000 $i, DO101 000 SirD001000 Ride Management DMsian REVIEWED & APPROVED BY. - Risk Management Analyst