Loading...
HomeMy WebLinkAboutDFK SOLUTIONS GROUP, LLC. (2)INSURANCE ON FILE WORK MAY PROCEED UNTIL INSIRAN E EXPIRES CITY CLER YaR MAY 4 102� DATE: Yalsft Ama¢wa MAYOR PRO TEM ThN 41M Phon COUNCIUMEMBERS Pho ana dohmthan Ryan Hwnmioez Jamie Lopez Vdlda Mendota naHo NPaIWA 0 CITY OF SANTA ANA (� p PUBLIC WORKS AGENCY O r W 1 1 L2-) 10 C'm Cwaar Plaza * P.O. Box 1 W Sena Ana, Calffemia 92702 vt, March l 1, 2024 DKF Solutions Group, LLC 170 Dogwood Lane Vallejo, CA 94591 Attn: David Patzcr, Managing Partner N-2023-263-01 CITY MANAGER CITY ATTORNEY Soria R. Ceniiiho CITY CLERK Jermfw K A Re: Extension of Agreement no. N-2023-163 to nrovide environmental and <af r% tralnlne courses Pursuant to Section 3 ("Term") of the above-referenecd Agreement, entered into by DKF Solutions Group, LLC, and the City of Santa Ana, dated April 19, 2023, the term of the Agreement is hereby extendcd for an additional one-year period through April 18, 2023. Any insurance certificates are required to be extended andior renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, \abil Saba, P.E, Executive Director, Public Works Agency CITY OF SANTA ANA why // Alvaro Nunez ./ Acting City Manager �ITI,()� k 1)ASTOFORM Jonathan T. Mardneig Assistant City Attorney ATTFST City DKF Solutions Grouo. LLC s•id Parncr Managing Palmer 9AWA ANA CITY COUNCIL v... n,.w. tti xwnv M,a.wau aa{rrvre WI'+ n.N AVTw MMI N'Is, ynF� .a¢�Y+�V�+ Marwu tA,Y� NW{ au{s{{b{etanap YO06{01� M4i MlnreaYatFRlP49 96gY{ 6Yf .AffiY.bidaltmLMl ACC o CERTIFICATE OF LIABILITY INSURANCE Ill FDATE(MMIDDNYYY) 1 o3/042024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certific no kl •i i of uc en o e t( Angie PRODUCER ragon Comrlercial In ranee Brokers l,gi�t S� evedo Date: 02 San Francisco _WARI ME: PHDNE t _ 415 971-9111 uc 415 358-9410 Info(iacommerdalrisk mu .mm ?RAIL oxolxc covERAGE xAlca INSURERA: Travelers Insurance Company 38130 INSURED DKF Solutions Group, LLC 170 Dogv\ood Lane Vallejo CA 94591 INSURER B: Travelers Insurance Company 38130 INSURERC: RU Insurance Company 13056 INSURER D: INSURER E : INSURERF: 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 TYPE OF INSURANCE ADDL lamPOLICY SUER NUMBER POLICY SEE POUCYEXP LIMITS X COMMERCIALGENERALLIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,000,000 DAMAGETORIENIM PREMISES ,ocorrmer $ 1,000,000 MED EXP (Any are person) $ 10.000 PERSONAL &ADV INJURY $ 2.000.000 A Y Y 880-BX785120-24-42 03/19/2024 03/192025 APPDESPER. POLICY JECT LOC GENERAL AGGREGATE $ 4,000,000 GEN-LAGGREGATELIMIT X PRODUCTS - 4.000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED S$ Ea accident 2000,000 ANY AUTO BODILY INJUperson)$ Wamdent)$ A OWNED SCHEDULED AUTOS ONLY AUTOS 680-BX765120-2442 03/T92024 03/192025 BODILY INJU$ HIRED NON-0NMED ONLY X AUTOS ONLY PROPERTY DAUTOS Peraccitlenl X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000.000 AGGREGATE $ 1.000.000 B EXCESS LMB CLAIMS-MaDE CUR-8X785943-24A2 03/192024 03/192025 X DEO I I RETENTION 10.000 WORKERS COMPENSATION PER OTH- ANDEMPLOYERS-LIABLITIf YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER!MEMBER EXCLUDED? NIA ISTATUTE FA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E_L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below C Professional Liability RTPOO41705 03/192024 03/192025 Aggregate Oocurrence $2,000.000 $2.000,000 DESCRIPTION OF OPERATONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space le required) City Of Santa Ana 20 Chic Center Plaza Email: AUTHORIZED REPRESENTATVE W 1988-2015 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF Nnnr•P will GC nri weeen IN ACCORDANCE WITH THE POLICY PR( 1i MwugalDhidun REVIEIVm&APPROV®Br L����rrgg����' A+.� "44 �. Risk Management Speaahst ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS' COMPENSATION INSURANCE CERTIFICATION TO: City of Santa Ana RE: Safety Training Agreement The Consultant shall execute the following form as required by the California Labor Code, Sections 1860 and 1861: I am aware of the provisions of Section 3700 of the California Labor Code that requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code. As a Managing Partner of DKF Solutions Group, LLC, I verify that we do not have any employees who will perform work under this agreement. In the event that DKF Solutions Group hires any employees to perform work under this agreement, I will comply with the provisions of Section 3700 of the California Labor Code before commencing or continuing the performance of the work under this contract, including supplying City of Santa Ana with proof of Workers' Compensation Insurance and a Waiver of Subrogation thereto. DKF Solutions Group, LLC Na seai%3 rporation) Signature of Authorize presentative Kay Patzer, Managing Partner Name & Title of Authorized Representative 22 April 2024 Date of Signing Rule Me aBeme dDhisiom w/ REVIEWED&APPRO BY: STATE OF THE ART RISK MANAGEMENT TOOLS FOR PUBLIC AGEN .9 ` Risk Management Spa TRAVELERSJ� COMMON POLICY DECLARATIONS OFFICE PAC BUSINESS:INSURANCE AGENT One Tower Square, Hartford, Connecticut 06183 POLICY NO.: 680-8X765120-24-42 ISSUE DATE: 02/16/2024 INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA 1. NAMED INSURED AND MAILING ADDRESS: DRF SOLUTIONS GROUP LLC & AND AS PER IL T8 00 170 DOGWOOD LN VALLEJO CA 94591-8056 2. POLICY PERIOD: From 03/19/2024 to 03/19/2025 12:01 A.M. Standard Time at your mailing address. 3. DESCRIPTION OF PREMISES: PREM. LOC. BLDG. ADDRESS NO. NO. OCCUPANCY (same as Mailing Address unless specified otherwise) 001 001 INSURANCE AGENT 170 DOGWOOD LN VALLEJO CA 94591-8056 4. COVERAGE PARTS AND SUPPLEMENTS FORMING PART OF THIS POLICY AND INSURING COMPANIES COVERAGE PARTS and SUPPLEMENTS Businessowners Coverage Part INSURING COMPANY ACJ 5. The COMPLETE POLICY consists of this declarations and all other declarations, and the forms and endorse - ments for which symbol numbers are attached on a separate listing. 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions. POLICY DIRECT BILL 7. PREMIUM SUMMARY: Provisional Premium Due at Inception Due at Each NAME AND ADDRESS OF AGENT OR BROKER GORST AND COMPASS INS SERV 5850 CANOGA AVE STE 650 CQW00 POLICY NUMBER $ 619.00 WOODLAND HILLS CA 91367-6573 IL TO 19 02 05 (Page 1 of 01) Office: BREA/LA/ORANGE CA DOWN COUNTERSIGNED BY: Authorized DATE: 02/16/202, INSURING COMPANY R1AMmsgmwdDM,1on REVIE &AV Room BY: ® Risk Management spenAist AM TRAVELEM One Tower Square, Hartford, Connecticut 06183 BUSINESSOWNERS COVERAGE PART DECLARATIONS OFFICE PAC POLICY NO.: 680-BX765120-24-42 ISSUE DATE: 02/16/2024 INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA POLICY PERIOD: From 03-19-24 to 03-19-25 12:01 A.M. Standard Time at your mailing address FORM OF BUSINESS: LIMITED LIAB CORP COVERAGES AND LIMITS OF INSURANCE: Insurance applies only to an item for which a "limit" or the word "included" is shown. COMMERCIAL GENERAL LIABILITY COVERAGE OCCURRENCE FORM LIMITS OF INSURANCE General Aggregate (except Products -Completed Operations Limit) $ 4,000,000 Products -completed Operations Aggregate Limit $ 4,000,000 Personal and Advertising Injury Limit $ 2,000,000 Each Occurrence Limit $ 2,000,000 Damage to Premises Rented to You $ 300,000 Medical Payments Limit (any one person) $ 51000 BUSINESSOWNERS PROPERTY COVERAGE DEDUCTIBLE AMOUNT: Businessowners Property Coverage: $ 1,000 per occurrence. Building Glass: $ 1,000 per occurrence. BUSINESS INCOME/EXTRA EXPENSE LIMIT: Actual loss for 12 consecutive months Period of Restoration -Time Period: Immediately ADDITIONAL COVERAGE: Fine Arts: $ 25,000 Other additional coverages apply and may be changed by an endorsement. Please read the policy. SPECIAL PROVISIONS: COMMERCIAL GENERAL LIABILITY COVERA IS SUBJECT TO A GENERAL AGGREGATE L MP TO 01 02 05 (Pagel of 2 ) �. Risk MaigewtodDhbla: REVIEWED&APPRO By. ' A,.0 Acw40 ® Risk Management Spedalis[ BUSINESSOWNERS PROPERTY COVERAGE PREMISES LOCATION NO.: 001 BUILDING NO.: 001 LIMIT OF INFLATION COVERAGE INSURANCE VALUATION COINSURANCE GUARD BUSINESS PERSONAL PROPERTY $ 30,200 RC* N/A 0.0% *Replacement Coat COVERAGE EXTENSIONS: Accounts Receivable $ 25,000 Valuable Papers $ 25,000 Other coverage extensions apply and may be changed by an endorsement. Please read the policy. MP TO 01 02 05 (Page 2 of 2 ) Risk Menage..dDl U[. REVIEWED & APPROVM Br ' A,,gu A,wa. Risk Management Speci Mist of �CXM POLICY NUMBER: 680-SX765120-24-42 EFFECTIVE DATE: 03/19/2024 ISSUE DATE: 02/16/2024 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 19 02 05 COMMON POLICY DECLARATIONS MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS IL TB 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS � L T3 15 09 W COMMON POLICY CONDITIONS BUSINESSOWNERS MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP T1 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 67 08 15 PROFESSIONAL SERVICES PREMIER ENDORSEMENT MP TS 22 OB 07 CALIFORNIA AMENDATORY PROVISIONS MP T3 25 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS MP T4 90 05 10 LIMIT OF INS/OCCURRENCE ENDT - CALIFORNIA MP T5 08 02 20 CALIFORNIA CHANGES COMMERCIAL GENERAL LIABILITY CG TO 34 02 19 CG Tl 00 02 19 CG D3 09 02 19 CG D9 10 09 21 CG D1 05 04 94 CG D2 03 12 97 CG US 42 02 19,; CG D4 21 07 08 CG DS 59 02 19 CG D6 1S 10 11 CG D6 39 05 12 CG D9 44 01 23 CG D1 42 02 19 TABLE OF CONTENTS - COMMERCIAL GENSRAL LIABILITY COVERAGE FORM CG T1 00 02 19 COMMERCIAL GENERAL LIABILITY COVERAGE FORM AMENDATORY ENDORSEMENT - PRODUCTS -COMPLETED OPERATIONS HAZARD AMENDMENT OF INTELLECTUAL PROPERTY EXCLUSION BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS AMRND - NON CUMULATION OF EACH OCC XTEND ENDORSEMENT FOR SMALL BUSINESSES AMEND CONTRAL LIAR EXCL - EXC TO NAMED INS EXCLUSION - PORTFOLIO COMPANY EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS EXCLUSION - PROFESSIONAL FINANCIAL SERVICES EXCLUSION - VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS EXCLUSION - DISCRIMINATION MULTIPLE SUBLINE ENDORSEMENTS CG T3 33 11 03 LIMITATION WHEN TWO OR MORE POLICIES A^^T" IL T8 01 01 01 PAGE: 1 Rink MmwgementDMslpn firmEwED & APPRowD BY: A+{�, Aaw44 ® Risk Management Specialist POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: INTERLINE ENDORSEMENTS 680-8X765120-24-42 03/19/2024 02/16/2024 IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 21 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL T4 40 10 20 PROTECTION OF PROPERTY IL T3 82 05 13 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA IL T8 00 03 24 GENERAL PURPOSE ENDORSEMENT IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 01 04 07 20 CALIFORNIA CHANGES IL 02 70 07 20 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL POLICY HOLDER NOTICES PN T4 54 01 08 PN MP 38 01 11 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS Rink ManagmadDKislnn ' REVIEWED & APPROVED BY: �. ® Risk Manzgemen[Speci nlisl IL T8 01 01 01 PAGE: 2 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured") whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work' or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, whichever is less. b. This insurance is excess over any valid and collectible insurance unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy. b. to "bodily injury," "property damage," "per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and 2. Supervisory, inspection or engineering services. CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Includes Copyrighted Material from Insurance Services Office, Inc. %.yjII i11lld Z- RIA MwagementDlwinn RenexR o 6 MPRw® Br. 4j. t Aav44 Risk Management Specialist COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions: A. B. CANCELLATION 1. The first Named Insured shown in the Decla- rations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy or any Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of can- cellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of can- cellation if we cancel for any other rea- son. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. If the policy is cancelled, that date will become the end of the policy period. If a Coverage Part is cancelled, that date will become the end of the policy period as respects that Coverage Part only. 5. If this policy or any Coverage Part is can- celled, we will send the first Named Insured any premium refund due. If we cancel, the re- fund will be pro rate. If the first Named In- sured cancels, the refund may be less than pro rate. The cancellation will be effective even if we have not made or offered a re- fund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. CHANGES This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown In the Declara- tions is authorized to make changes in the terms of this policy with our consent. This policy's terms can be amended or waived only by endorsement issued by us as part of this policy. C. EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and re- cords as they relate to this policy at any time dur- ing the policy period and up to three years after- ward. D. INSPECTIONS AND SURVEYS 1. We have the right to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. We are not obligated to make any inspec- tions, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. Paragraphs 1. and 2, of this condition apply not only to us, but also to any rating, advi- sory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. 4. Paragraph 2. of this condition does not apply to any inspections, surveys, reports or rec- ommendations we may make relative to certi- fication, under state or municipal statutes, or- dinances or regulations, of boilers, pressure vessels or elevators. E. PREMIUMS 1. The first Named Insured shown in the Decla- rations: a. Is responsible for the payment of all pre- miums; and b. Will be the payee for any return premi- ums we pay. IL T3 15 09 07 (Rev. 03-11) hwludes the copyrighted material of Insurance Servlces Office, Inc. with its permissic ,yew„ 2 `: 0 ltlekMmagenwttDlrislrnt iVEVIE &APPRovED By: A, fe Auiwta _®' RA Management Specialist COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. (1) The "bodily injury' or "property damage" for 8• Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must subsequent to the signing of that contract or do nothing after loss to impair them. At our request, agreement by you. the insured will bring "suit" or transfer those rights to us and help us enforce them. S. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or speck market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. RWeMmugemadDWon Page 16 of 21 © 2017 The Travelers Indemnity Company, All rights reserved. A AcW4:c Includes copyrighted material of Insurance services Office, Inc. with Its permission. i ', Risk Management Speceist COMMERCIAL GENERAL LIABILITY there is no other similar insurance available to that organization. 2. The following replaces the last sentence of Paragraph 3. of SECTION II — WHO IS AN INSURED: For the purposes of Paragraph 1. of Section II — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. D. INCIDENTAL MEDICAL MALPRACTICE 1, The following replaces Paragraph b. of the definition of "occurrence" in the DEFINITIONS Section: b. An act or omission committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2,a.(1) of SECTION II —WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) 'Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services' by any of your "employees' or "volunteer workers', other than an employed or volunteer doctor. Any such "employees' or "volunteer workers' providing or failing to provide first aid or "Good Samaritan services' during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph 5. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals "Bodily injury" or "property damage" arising out of the violation of a penal statute or ordinance relating to the sale of pharmaceuticals committed by, or with the knowledge or consent of, the insured. S. The following is added to the DEFINITIONS Section: 'Incidental medical services' means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. E. BLANKET WAWER OF SUBROGATfOIY The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, Page 2 of 3 ® 2018 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Walt Manage nad Division REvexm&APa Eo By., �'. ® Risk Management Specialist of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: COMMERCIAL GENERAL LIABILITY a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury' caused by an offense that is committed: subsequent to the execution of the contract or agreement. ",4 Menvgement Dlvtekm �"� � �������`` fb nE &Avvaaw®Br. CG DB 42 02 19 02019 The Travelers Indemnity Company. All rights resh its p '�i Includes copyrighted material of Insurance Services Office, Inc., with as permission. A-,p Aav44 MWRisk Management Specialist AcoR©> CERTIFICATE OF LIABILITY INSURANCE DATE(MMYDDYYYYY) 03/31/2025 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 CONTACT NAME: HONE Paragon Commercial Insurance Brokers arc No Ext: (415)971-9111 Fare No: (415)358-9410 One Sansome Street Suite 3500 ADDRESS:E-MAIL C� 9 p•commercialrisk rou info com INSURER(S)AFFORDING COVERAGE NAIC# San Francisco CA 94104 INSURERA: Travelers Insurance Company 38130 INSURED INSURERB: Travelers Insurance Company 38130 DKF Solutions Group. LLC INSURERC: RLI Insurance Company 13056 170 Dogwood Lane INSURERD: INSURER E: Vallejo CA 94591 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMYDDIYYYY MMYDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 — AMAGETO RENTED CLAIMS-MADE X OCCUR D PREMISES Ea occurrence $ 300,000 MED EXP(Anyone person) $ 5,000 A Y 680-8X765120-25-42 03/19/2025 03/19/2026 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO JEOT LOC PRODUCTS-COMPIOPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A AUTO OWNES ONLY AUTOS D SCHEDULED 680-8X765120-25-42 03/19/2025 03/19/2026 BODILY INJURY(Per accident) $ X HIRED X I NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Peraccident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE CUP-8X765943-25-42 03/19/2025 03/19/2026 AGGREGATE $ 1,000,000 X DED RETENTION 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y r N STATUTE ER ANY PROPRIETORIPARTNERIEXEOUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (MandatoryinNH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Aggregate $2,000,000 C RTP0046370 03/19/2025 03/19/2026 Occurrence $2,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Tu Tran Tu Trally signed by Tu Tran Nguyen Date:2025.05.12 Nguyen 09:23:40-07'00' APPROVED By Tu Tran Nguyen at 9:23 am,May 12,2025 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. ATTN:Water Resources 215 S.Center St. AUTHORIZED REPRESENTATIVE Santa Ana CA 92703 FBX_ Email O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 170 Dogwood Lane Solutions Group Vallejo, CA 94591-8056 www.dkfsolutions.com WORKERS' COMPENSATION INSURANCE CERTIFICATION TO: City of Santa Ana RE: Annual Safety Training The Consultant shall execute the following form as required by the California Labor Code, Sections 1860 and 1861: 1 am aware of the provisions of Section 3700 of the California Labor Code that requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code. As a Managing Partner of DKF Solutions Group, LLC, I verify that we do not have any employees who will perform work under this agreement. In the event that DKF Solutions Group hires any employees to perform work under this agreement, I will comply with the provisions of Section 3700 of the California Labor Code before commencing or continuing the performance of the work under this contract, including supplying City of Santa Ana with proof of Workers' Compensation Insurance and a Waiver of Subrogation thereto. DKF Solutions Group, LLC Na F' qTi son„Firm, or Corporation)me Signature of Authorize epresentative Kay Patzer, Managing Partner Name & Title of Authorized Representative 3 April 2025 Date of Signing STATE OF THE APT P.ISK MANAGEMENT TOOLS FOPS PUBLIC AGENCIES POLICY NUMBER: 680-8X765120-25-42 EFFECTIVE DATE: 03/19/2025 ISSUE DATE: 01/31/2025 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS IL TO 19 02 05 COMMON POLICY DECLARATIONS MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 15 09 07 COMMON POLICY CONDITIONS BUSINESSOWNERS MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP T1 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 67 08 15 PROFESSIONAL SERVICES PREMIER ENDORSEMENT MP T5 22 08 07 CALIFORNIA AMENDATORY PROVISIONS MP T3 25 01 21 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS MP T4 90 05 10 LIMIT OF INS/OCCURRENCE ENDT - CALIFORNIA MP T5 08 02 20 CALIFORNIA CHANGES COMMERCIAL GENERAL LIABILITY CG TO 34 02 19 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG T1 00 02 19 CG T1 00 02 19 COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG D3 09 02 19 AMENDATORY ENDORSEMENT - PRODUCTS-COMPLETED OPERATIONS HAZARD CG D9 10 09 21 AMENDMENT OF INTELLECTUAL PROPERTY EXCLUSION CG D1 05 04 94 BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC CG D8 42 02 19 XTEND ENDORSEMENT FOR SMALL BUSINESSES MP T1 25 11 03 HIRED AUTO AND NON-OWNED AUTO LIABILITY CG D4 21 07 08 AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS CG D5 59 02 19 EXCLUSION - PORTFOLIO COMPANY CG D6 18 10 11 EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS CG D6 39 05 12 EXCLUSION - PROFESSIONAL FINANCIAL SERVICES CG D9 44 01 23 EXCLUSION - VIOLATION OF BIOMETRIC INFORMATION PRIVACY LAWS CG D1 42 02 19 EXCLUSION - DISCRIMINATION MULTIPLE SUBLINE ENDORSEMENTS IL T8 01 01 01 PAGE: 1 OF 2 POLICY NUMBER: 680-8X765120-25-42 EFFECTIVE DATE: 03/19/2025 ISSUE DATE: 01/31/2025 MULTIPLE SUBLINE ENDORSEMENTS (CONTINUED) CG T3 33 11 03 LIMITATION WHEN TWO OR MORE POLICIES APPLY INTERLINE ENDORSEMENTS IL T4 12 03 15 AMNDT COMMON POLICY COND-PROHIBITED COVG IL T4 14 01 21 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL T4 40 10 20 PROTECTION OF PROPERTY IL T3 82 05 13 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA IL T8 00 03 25 GENERAL PURPOSE ENDORSEMENT IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 01 04 07 20 CALIFORNIA CHANGES IL 02 70 07 20 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL POLICY HOLDER NOTICES PN MP 59 04 19 IMPORTANT NOTICE - PRODUCT AVAILABILITY PN T4 54 01 08 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION PN MP 64 10 23 IMPORTANT INFORMATION ABOUT YOUR CALIFORNIA WILDFIRE RISK CLASSIFICATION PN MP 38 01 11 IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS IL T8 01 01 01 PAGE: 2 OF 2 COMMERCIAL GENERAL LIABILITY c. Method Of Sharing a. The statements in the Declarations are If all of the other insurance permits contribution accurate and complete; by equal shares, we will follow this method also. b. Those statements are based upon Under this approach each insurer contributes representations you made to us; and equal amounts until it has paid its applicable c. We have issued this policy in reliance upon limit of insurance or none of the loss remains, your representations. whichever comes first. The unintentional omission of, or unintentional error If any of the other insurance does not permit in, any information provided by you which we relied contribution by equal shares, we will contribute upon in issuing this policy will not prejudice your by limits. Under this method, each insurer's rights under this insurance. However, this provision share is based on the ratio of its applicable limit does not affect our right to collect additional of insurance to the total applicable limits of premium or to exercise our rights of cancellation or insurance of all insurers. nonrenewal in accordance with applicable insurance d. Primary And Non-Contributory Insurance If laws or regulations. Required By Written Contract 7. Separation Of Insureds If you specifically agree in a written contract or Except with respect to the Limits of Insurance, and agreement that the insurance afforded to an any rights or duties specifically assigned in this insured under this Coverage Part must apply on Coverage Part to the first Named Insured, this a primary basis, or a primary and non- insurance applies: contributory basis, this insurance is primary to a. As if each Named Insured were the only other insurance that is available to such insured Named Insured; and which covers such insured as a named insured, b. Separately to each insured against whom claim and we will not share with that other insurance, is made or"suit" is brought. provided that: (1) The "bodily injury" or "property damage" for 8. Transfer Of Rights Of Recovery Against Others which coverage is sought occurs; and To Us (2) The "personal and advertising injury" for If the insured has rights to recover all or part of any which coverage is sought is caused by an payment we have made under this Coverage Part, offense that is committed; those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, subsequent to the signing of that contract or the insured will bring "suit" or transfer those rights agreement by you. to us and help us enforce them. S. Premium Audit 9. When We Do Not Renew a. We will compute all premiums for this Coverage If we decide not to renew this Coverage Part, we will Part in accordance with our rules and rates. mail or deliver to the first Named Insured shown in b. Premium shown in this Coverage Part as the Declarations written notice of the nonrenewal advance premium is a deposit premium only. At not less than 30 days before the expiration date. the close of each audit period we will compute If notice is mailed, proof of mailing will be sufficient the earned premium for that period and send proof of notice. notice to the first Named Insured. The due date SECTION V—DEFINITIONS for audit and retrospective premiums is the date 1, "Advertisement" means a notice that is broadcast or shown as the due date on the bill. If the sum of published to the general public or specific market the advance and audit premiums paid for the segments about your goods, products or services policy period is greater than the earned for the purpose of attracting customers or premium, we will return the excess to the first Named Insured. supporters. For the purposes of this definition: c. The first Named Insured must keep records of a• Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication; and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services for the purposes of attracting customers or By accepting this policy,you agree: supporters is considered an advertisement. Page 16 of 21 ®2017 The Travelers Indemnity Company.All rights reserved. CG T1 00 02 19 Includes copyrighted material cf Insurance Services Office,Inc.with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- t. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cluding: liability apply: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. COMMERCIAL GENERAL LIABILITY there is no other similar insurance available scope of their employment by you or to that organization, performing duties related to the conduct 2. The following replaces the last sentence of of your business. Paragraph 3. of SECTION II — WHO IS AN 3. The following replaces the last sentence of INSURED: Paragraph S. of SECTION III — LIMITS OF For the purposes of Paragraph 1. of Section INSURANCE: II — Who Is An Insured, each such For the purposes of determining the organization will be deemed to be applicable Each Occurrence Limit, all related designated in the Declarations as: acts or omissions committed in providing or a. A limited liability company; failing to provide "incidental medical services", first aid or "Good Samaritan b. An organization other than a partnership, services" to any one person will be deemed joint venture or limited liability company; to be one"occurrence". or 4. The following exclusion is added to c. A trust; Paragraph 2., Exclusions, of SECTION I — as indicated in its name or the documents COVERAGES — COVERAGE A — BODILY that govern its structure. INJURY AND PROPERTY DAMAGE D. INCIDENTAL MEDICAL MALPRACTICE LIABILITY: 1. The following replaces Paragraph b. of the Sale Of Pharmaceuticals definition of "occurrence" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or b. An act or omission committed in ordinance relating to the sale of providing or failing to provide "incidental pharmaceuticals committed by, or with the medical services", first aid or "Good knowledge or consent of, the insured. Samaritan services" to a person, unless S. The following is added to the DEFINITIONS you are in the business or occupation of Section: providing professional health care "Incidental medical services" means: services. a. Medical, surgical, dental, laboratory, x- 2. The following replaces the last paragraph of ray or nursing service or treatment, Paragraph 2.a.(1) of SECTION II —WHO IS advice or instruction, or the related AN INSURED: furnishing of food or beverages; or Unless you are in the business or occupation b. The furnishing or dispensing of drugs or of providing professional health care medical, dental, or surgical supplies or services, Paragraphs (1)(a), (b), (c) and (d) appliances. above do not apply to "bodily injury" arising out of providing or failing to provide: fi. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — (a) "Incidental medical services" by any of COMMERCIAL GENERAL LIABILITY your "employees" who is a nurse, nurse CONDITIONS: assistant, emergency medical This insurance is excess over any valid and technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, collectible other insurance, whether primary, occupational therapist or occupational excess, contingent or on any other basis, therapy assistant, physical therapist or that is available to any of your "employees" speech-language pathologist; or for "bodily injury" that arises out of providing or failing to provide "incidental medical (b) First aid or "Good Samaritan services" services" to any person to the extent not by any of your"employees" or"volunteer subject to Paragraph 2.a.(1) of Section II — workers", other than an employed or Who Is An Insured. volunteer doctor. Any such "employees" or"volunteer workers" providing or failing E. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan The following is added to Paragraph 8., Transfer services" during their work hours for you Of Rights Of Recovery Against Others To Us, will be deemed to be acting within the Page 2 of 3 ®2018 The Travelers Indemnity Company.All rights reserved. CG D8 42 02 19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY of SECTION IV — COMMERCIAL GENERAL a. "Bodily injury" or "property damage" that LIABILITY CONDITIONS: occurs; or If the insured has agreed in a contract or b. "Personal and advertising injury" caused by agreement to waive that insured's right of an offense that is committed; recovery against any person or organization, we subsequent to the execution of the contract or waive our right of recovery against such person agreement. or organization, but only for payments we make because of: CG D8 42 02 19 ®2018 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation we issued, we may cancel this policy Common Policy Condition are replaced by the only upon the occurrence, after the following: effective date of the policy, of one or 2. All Policies In Effect For 60 Days Or Less more of the following: If this policy has been in effect for 60 days or (1) Nonpayment of premium, including less, and is not a renewal of a policy we have payment due on a prior policy we previously issued, we may cancel this policy issued and due during the current by mailing or delivering to the first Named policy term covering the same risks. Insured, at the mailing address shown in the (2) Discovery of fraud or material policy, and to the producer of record, misrepresentation by: advance written notice of cancellation, stating (a) Any insured or his or her the reason for cancellation, at least: representative in obtaining this a. 10 days before the effective date of insurance; or cancellation if we cancel for: (b) You or your representative in (1) Nonpayment of premium; or pursuing a claim under this (2) Discovery of fraud by: policy. (a) Any insured or his or her (3) A judgment by a court or an representative in obtaining this administrative tribunal that you have insurance; or violated a California or Federal law, (b) You or your representative in having as one of its necessary pursuing a claim under this elements an act which materially policy. increases any of the risks insured b. 30 days before the effective date of against. cancellation if we cancel for any other (4) Discovery of willful or grossly reason. negligent acts or omissions, or of any 3. All Policies In Effect For More Than 60 violations of state laws or regulations establishing safety standards, by you Days or your representative, which a. If this policy has been in effect for more materially increase any of the risks than 60 days, or is a renewal of a policy insured against. IL 02 70 07 20 0 Insurance Services Office, Inc., 2020 Page 1 of 4