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HomeMy WebLinkAboutBIG BEN ENGINEERING (2)ti NJSURANCE NOT ON FILE N WORK MAY N T PROCEED Z CLERK OF COUNCIL A-2021-190-03 DATE'. FIRST AMENDMENT TO ON -CALL GENERAL ENGINEERING SERVICES AGREEMENT WITH BIG BEN ENGINEERING 0 :Ow�r3t2-) THIS FIRST AMENDMENT is entered into on this 21" day of September, by and between Big �#Y Ben Engineering ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On December 1, 2020, the City entered into Agreement A-2020-245-03 ("Agreement") with Big Ben Engineering, to provide on -call asphalt pavement, concrete pavement, and stormdrainrepair services for a three (3) year term until November 30, 2023, with an option for the parties to extend the Agreement for up to one (1) two-year period. The Agreement is current and in effect. B. Contactor is one of four selected contractors providing services on an on -call basis and shares an aggregate compensation as detailed in Section 2.a. of the Agreement. C. The parties now wish to amend the Agreement to increase the shared aggregate amount of the compensation to pay for emergency services recently discovered by the City. The Parties therefore agree: 1. Section 2a, COMPENSATION, shall be amended to increase the shared aggregate compensation in the amount of $1,600,000. Therefore, the total shared aggregate amount shall not exceed two million five hundred thousand dollars and zero cents ($2,500,000) to pay for the additional emergency services during the tern of this agreement, including any extension periods. 2. Except as hereinabove modified, the terms and conditions of said Agreement remain unchanged and in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed the First Amendment to the Agreement the date and year first above written. ATTEST: Lpzz a-� Daisy Gomez Clerk of the Council CITY OF SANTA ANA _5rL I 4 Kristine Ridge City Manager [Signatures continue on the next page] APPROVED AS TO FORM: Sonia R. Carvalho City Attorney By: m A Jose M&toya Deputy City Attorney FOR APPROVAL ,.-4 Nabil Execute e Director Public Works Agency CONTRACTOR: 3¢ 3z,4�. Name: Sep Sharifi Title: president Francine R. Dlglrally,ynetl by Frandne N. Villareal Dale: 2021 nat 19:5691 a7W BIGBENC-01 CTYLER .a►`oRo CERTIFICATE OF LIABILITY INSURANCE DATW6121`DIYYYY) 4/6/2021 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 endorsements). PRODUCER License # OM70471 CONTACT Orion Risk Management Insurance Services, An Alera Group Insurance Aggency, LLC 1800 Quail Street, Suite 110 Newport Beach, CA 92660 PHONE FAx (A/C, No, Ext: (949) 263-8850 FAX. ND):(949) 263-8860 E-MAIL Daess: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. Co. 13604 INSURED INSURER B : INSURERC: Big Ben, Inc. 4790 Irvine Blvd. #105-404 Irvine, CA 92620 INSURER D INSURER E : 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 CONTRACTOR OTHER DOCUMENTWITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLEUBR INSO WeD POLICY NUMBER POLICY EFF 4/5/2021 POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ X] OCCUR X X 1000066896201 4/5/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEDPREMISES ar a 100,000 5,000 MED EXP (My one arson PERSONAL B ADV INJURY 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY jERo- LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea andilgoll ANY OWNED O OWNED SCHEDULED AUTOS ONLY AUTOSS AUT 09 ONLY AIDITN0G 0 Y BODILY INJURY Per arson S INJURY Per accident) $ BODILY Pe P.E"' YegrAMAGE $ A UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE 1000337275201 4/5/2021 4/5/2022 EACH OCCURRENCE $ 4,000,000 X AGGREGATE 4,000,000 DIEDRETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE FICEWMEMBER EXCLUDED? El If QQF�yes. desctlbe under ory lD NH) # yes. NIA PER OTH. UTE ER E.L. EACHACCIDENT E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE- POLICY LIMB DESCRIPTION OF OPERATIONS below _[J_ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORDID1,Additional Remarks schedule, ma be attached if more space is required) City of Santa Ana, its officers, employees, agents and representatives are Additional'lnsureds With respect is named as additional insured when required by written contract per the attached General Liability endorsement. Primary and non-contributory coverage applies when required by written contract per the attached General Liability endorsement. Waiver of subrogation applies when required by written contract per the attached General Liability endorsement. 30 Days Notice of Cancellation (non -reporting if applicable) apply per policy provisions. City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 ACORD 25 (2016/03) 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 REPRESENTATIVE 1tLkMmagemalEEMdmL RE�nEwEn6MPRovEO BY: C ©1988-2015 ACORD C®, The ACORD name and logo are registered marks of ACORD I I V Ruk Managernent Analyst *Starr Surplus Lines Insurance Company Notice of Cancellation and Material Changes Amendatory Endorsement Policy Number: 1000066896201 Effective Date: April 5, 2021 at 12:01 A.M. Named Insured: Big Ben, Inc. This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the Declarations page. Please read the endorse ment and respective policy(ies) carefully. Commercial General Liability Coverage Form It is hereby agreed that if we: cancel this Policy: a. for any reason other than non-payment of premium or b. at the request of the Named Insured, or 2. reduce coverage, except for the reduction of the applicable limit of insurance by the payment of judgments or settlements under Coverages A or B or medical expenses under Coverage C, then we will send 30 (thirty) days' written notice to the entity designated in the Schedule below. Failure to provide such notice shall not affect our right to cancel the Policy, nor shall it affect the cancellation of this Policy with respect to any entity not listed below. Scheduled Designated Entity City of Santa Ana, California All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY Steve Blakey, President Nehemiah E. Ginsburg, Genera Counsel MANUSCRIPT (06/10) Includes copyrighted material of ISO Properties, Inc., used with Its permission. �,. _„, RlakMmagemenfD[Nelmt ;.,,,�i REmEww&APPRovEDBV: it �^ .a f4Md4� P. V:. &4&4Ll Risk Management Analyst Big Ben, Inc. POLICY NUMBER: 1000066896201 Effective 04/05/2021 - 04/05/2022 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) =ocation Organizations :Operations And Description Of Completed Where Required By Written Contract Where Required By Written Contract 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: 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 37 04 13 C Insurance Services Office, Inc., 2012 gy=s tr RiafcM�agemmt DiNelart REMt o & MPRov® By. Risk Management Matyst Big Ben, Inc. POLICY NUMBER: 1000066B96201 Effective 04/05/2021 - 04/05/2022 COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for 'bodily injury', "property damage" or "personal and advertising injury' caused, in whole or in part, 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. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury', involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 04 13 © Insurance Services Office, Inc., 2012 pea«a� R1dcMnwgemartD(vinfmt �% Btnexm&APPRwmBY.. Risk Management Analyst 2. 'Bodily injury" or "property damage' occurring after: a. 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 the covered operations has been completed; or b. 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: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 RbkMwagzmmtDM91on �� rM4NGN.[ R. VKifAKC Ruk Managemen[Malyst *Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 5. Subject to 2 above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization. 6. Subject to 2 or 3 above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C because of all 'bodily injury' and "property damage" arising out of any one "occurrence". 7. Subject to 5 above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission by the owner. 8. Subject to 5 above, the Medical Expense Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury' sustained by any one person. 9. Subject to 2, 4, 5, 6, and/or 7 above, the Per Project Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical expenses under Coverage C arising out of the any single Location described above. 10. Subject to 2, 4, 5, 6, and/or 7 above, the Per Location Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: d. Damages under Coverage A; e. Damages under Coverage B; and f. Medical expenses under Coverage C arising out of the any single Location described above. 11. The Overall Policy Aggregate is the most we will pay in any policy period regardless of number of projects or locations. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. III. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by the Limits of Insurance set forth below. 0—.Ptpe Risk Management DiWelen R5VIEWm & APPRovin ar. sL 739 (07111) Faa W 2. V EPA �l CopydghtO C. V.Starr&Company and Start Surplus Lines Insurance Company. Alldghtsresemed. '� Ruk Management Analyst Includes copyrighted material of ISO Properties, Inc., used with its permission. *Starr Surplus Lines Insurance Company Chicago, IL 1-646-227-6300 Limits of Insurance General Aggregate Limit N/A Each Occurrence Limit $ 1,000,000 Products -Completed Operations Aggregate Limit $ 2,000,000 Personal & Advertising Injury Limit $ 1,000,000 Damage to Premises Rented to You $ 100,000 Medical Expense Limit $ 5,000 Overall Policy Aggregate Limit Capped At $ 10,000,000 SECTION V — DEFINITIONS: is amended to include the following: 23. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right-of-way railroad All other terms and conditions of this Policy remain unchanged. Signed for STARR SURPLUS LINES INSURANCE COMPANY &�" - Steve Blakey, President 11K-&Itr.9 Nehemiah E. Ginsburg, Genera' ounsel SL 739 (07111) Copyright © C. V. Start & Company and Starr Surplus Lines Insurance Company. All rights reserved. Includes copyrighted material of ISO properties, Inc., used Wffi its permission. .gy_ ", xakMaug�tn[wran REAexm & A TRovtD BY. MMIM Risk Management Analyst A� �® CERTIFICATE OF LIABILITY INSURANCE DnTe(mmloDm ) 12/23/2020 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((es) 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 R Taylor Insurance Solutions, LLC 15068 Rosecrans Ave., #114 La Mirada CA 90638 CONTA T NAME: Rea Taylor PHONE FA% (562) 758-34a2 AIC No: E-MAIL t@ktaylorinBurance.com ADDRESS: INSURE S AFFORDING COVERAGE NAIC# INSURERA: Travelers Property Casualty Cc 25674 INSURED (949) 400-1BDO INSURER B: INSURER C Big Ben, Inc. INSURER O: 4790 Irvine Blvd INSURER E: Irvine CA 92620 NSURER F: COVERAGES CERTIFICATE NUMBER: Cart ID 415 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 ADOL SUBR POLICY NUMBER MMI�OY� MMID�rYYYY LYEXP IMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE El OCCUR D A E TED PREMISES Ea occurrence $ MED UP (Any me person) $ PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ PRODUCTS -COMP/OPAGG $ POLICY ❑ JECOT LOC $ OTHER I AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accident $ 1, 000, 000 BODILY INJURY (Per person) $ A % ANY AUTO Y Y 810-1R20261A-20-26-G 07/01/2020 07/01/2021 BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS % HIRED % NON -OWNED AUTOS ONLY AUTOS ONLY PPROPPERde OAMAGE $ UMBRELLA LIAB OCCUR EACHOCCURRENCE $ AGGREGATE $ EXCE$SLIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PRIET RMARTECLITIVE Y IIB-1922558A-20-26-0 07/01/2020 07/01/2021 ER STATUTE ER EE.L.EACH ACCIDENT $ 11000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 OFFICE U ED ❑ (Mandatory In NH) NIA E.L. DISEASE -POLICY LIMIT $ 1,000,000 If yes, desaibe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured when required by written contract per form CA T3 53 02 15. A waiver of subrogation applies as required by written contract per form CA T3 53 02 15 s WC 99 03 76 ( A). 30 day NOC applies per form WC 99 06 R3 (00) and IL T4 05 05 19. Primary and Non -Contributory wording applies per form CA 00 01 10 13. Policies shall not be cancelled or reduced in coverage or changed in any other material aspect, by contractor, without thirty (30) days prior written notice to the City. 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 Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE floor Risk Management Division Santa Ana SalCA 92701 % RENEWED 6 APPRCN®BV: ©1988.2015 ACORD C 110 f4A*4N44 Z, (/;,(j ad ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD LIQ�111&0w' Risk Management Analyst Page 1 of 1 00 TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) — 001 POLICY NUMBER: U B-1 R22558A-20-26-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2 .0 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS 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 Policy No. Endorsement No. Insured Premium Insurance Company DATE OF ISSUE: ST ASSIGN: Countersigned by Rkk ManagwtmdDMs1m REVIEWED&APPROVEDBY: inu,il.ic-�+ F�hi.(M4' h. VrU�CAIbL Risk Management Malyst COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employe ' " CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. yrvs« ''Y 2 11 1 RiekMmsgan&dDMsion ftevley/m & APPROVm Bv: fir c n z R. V CL 44d �89M=__' Risk Management Analyst COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". D. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS —INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION II — COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION IV — BUSINESS AUTO CONDI- TIONS: (5) Anywhere in the world, except any country or jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a) With respect to any claim made or "suit" brought outside the United States of America, the territories and possessions of the United States of America, Puerto Rico and Canada: (1) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement without our consent. (iii) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or "suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in- sured" pays with our consent, but only up to the limit described in Para- graph C., Limits Of Insurance, of SECTION II — COVERED AUTOS LIABILITY COVERAGE. (v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION 11 — COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c) This insurance is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada. Page 2 of 4 ® 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. Wai Mmugrn,mtDivalan p: [REVEWm&(AP1PIRO/V/EDBY/. �' Ruk Management Malyst You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have been liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way with the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT The following replaces the last sentence of Para- graph AA.b., Loss Of Use Expenses, of SEC- TION III — PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident'. I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property We will pay up to $400 for loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and AA.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage underthis policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV — BUSINESS AUTO CONDITIONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident' or 'loss" ap- plies only when the "accident' or "loss" is known to: (a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d) An executive officer, director or insurance manager (if you are a corporation or other or- ganization); or (e) Any "employee" authorized by you to give no- tice of the "accident' or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract signed and executed prior to any "accident' or "loss", provided that the "accident' or "loss" arises out of operations contemplated b CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. ry"an ey. eo RI&k Mwwg¢a1adDNhIan Ae&M S(ryAPPRI�0(V(ED BY.(r: � rrRE rA�i�G�is R. VKr/�lPFC ®' Risk Management Analyst COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col - The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non -renewal. SECTION IV — BUSINESS AUTO CONDITIONS: Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. xvknduPulon =I REVIEWED 6 APPROVED Sr f4.wL" R. Vj&-vcf �. Risk Management Analyst