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GOLDEN METERS SERVICE INC.
INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 6 3/o7ZU- CITY CLERK N-2024-389 DATE: DEC 17 2024 AGREEMENT WITH GOLDEN METERS SERVICE INC. TO PROVIDE 1 METER TESTING SERVICES FOR THE CITY OF SANTA ANA Heidi CIO" t W IS AGREEMENT is made and entered into this 0 day of January, 2025 by and between Golden Meters Service Inc. ("Contractor"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of Water Meter Testing Services for use by the Public Works Agency. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor underthis Agreement will be performed in compliance with such standards as may reasonably be expected from a professional contracting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES a. Contractor shall perform the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Exhibit A, attached hereto and incorporated by reference. b. On an as -needed basis, Contractor shall provide, at the sole discretion and request of the City, separate proposals for water meter testing, which shall need approval by the City's Public Works Agency. 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services under this Agreement, the rates and charges identified in Exhibit A. The total sum to be expended under the term of this Agreement, including any extension period, shall not exceed $50,000. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Contractor agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Contractor agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Contractor's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. Page 1 of 9 3. TERM This Agreement shall commence on the date first written above and terminate on January 5, 2027 unless terminated earlier in accordance with Section 17, below. The term of this Agreement may be extended for one 1-year period upon a writing executed by the City Manager and City Attorney. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. 5. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. INSURANCE Contractor shall procure and maintain for the duration of the agreement, the following insurance coverages: Page 2 of 9 MINIMUM SCOPE AND LIMIT OF INSURANCE Contractor shall maintain limits of insurance coverage in the following minimum amounts and 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 $1,000,000 per occurrence and $2,000,000 aggregate. Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code l (ally auto), with combined single limits of $1,000,000. In the event Contractor does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance with existing limits, which can be lower than $1,000,000. Workers' Compensation (W/C): 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, per employee, per policy for bodily injury or disease. This requirement can be waived if Vendor has no employees. If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. CGL and AL policies: City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the Permittee including materials, parts, equipment, and personnel furnished in connection with such work or operations. 2. All required insurance policies: Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Permittee for City. 3. All required insurance policies: For any claims related to this contract, Permittee's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Permittee's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Each insurance policy required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or materially changed except after thirty (30) days prior written notice has been given to City. Ten (10) days prior written shall be provided to City for policy cancellation or non - renewal due to non-payment. Page 3 of 9 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Fallon Franklin, Public Works Agency, 20 Civic Center Plaza, M-21, Santa Ana, CA 92701. The name and location of event should be included in the Description of Operations section of each certificate. Self -Insured Retentions Self -insured retentions must be declared to and approved by the City. City may require Contractor 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. Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. Verification of Coverage Permittee shall furnish City 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. However, failure to obtain the required documents prior to the work beginning shall not waive Permittee's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Claims Made Policies If any of the required policies provide coverage on a claims -made basis: 1. The retroactive date must be shown and must be before the date of the contract or the beginning of work. 2. Insurance must be maintained and evidence of insurance must be provided for at least three (3) years after completion of work. 3. 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, Company must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Subcontractors Contractor shall require and verify that all sub -contractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from sub -contractors. Special Risks or Circumstances City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, 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 Page 4 of 9 personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section l of this Agreement; 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 Section or by reason of the terms of, or effects, arising from this Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor'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 of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 9. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor shall defend, indemnify and hold harmless the City, its officers, agents, representatives, and employees against any and all liability, including costs, and attorney's fees, for infringement of any United States' letters patent, trademark, or copyright contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. It. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor 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 Page 5 of 9 available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 13. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 With courtesy copies to: Executive Director, Public Works Agency City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, CA 92702 To Contractor: Golden Meters Service Inc. 107 S. Edward Ave. Fullerton, CA 92833 Attn: Ms. Ana Aguilar A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these timeframes, weekends, federal, state, County or City holidays shall be excluded. Page 6 of 9 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 18. NON-DISCRIMINATION Contractor shall not discriminate because of race, color, creed, relation, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment Page 7 of 9 related activities or in connection with any activities under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 19. JURISDICTION -VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 20. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 21. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [Signature page to follow] Page 8 of 9 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Kyle ' llesen Assistant City Attorney FOR APPROVAL: 4 41— Nabil Saba Executive Director Public Works Agency CITY OF SA TA ANA: Alvaro Nunez City Manager CONTRACTOR: Ana Aguilar Chief Financial Officer Page 9 of 9 EXHIBIT A Golden Meters Service Inc. 107 S Edward Ave Fullerton, CA 92833 +17146532900 Golden MetersService@gmail.com www.GoidenMeters.com ADDRESS City of Santa Ana Public Works Agency City of Santa Ana Public Works Agency City of Santa Ana Public Works Agency 20 Civic Center Plaza, M-21 Santa Ana, CA 92701 LARGE METER TESTING RATES ALL RATES ARE LABOR ONLY, NO PARTS ARE INCLUDED IF REPAIRS ARE REQUIRED, PARTS NEEDED WILL BE SUBMITTED TO CITY REPRESENTATIVE FOR APPROVAL. 3" AND LARGER FIELD TESTING MINIMUM 6 METERS PER DAY IF LESS THAN 6 METERS, TESTING WILL BE BILLED PER HOUR PLUS TRAVEL TIME PORTAL TO PORTAL TEST ONLY: TURBINES & COMPOUNDS IN ADDITION, IF NEEDED: REPAIR/CALIBRATION & RETEST: $115/HOUR PRODUCTION METERS 3" & LARGER PITOT TUBE OR ULTRASONIC TEST ONLY IN ADDITION, IF NEEDED: REPAIR/CALIBRATION & RETEST: $115/HOUR THANK YOU FOR YOUR BUSINESS! 0 220.00 0.00 1 0 220.00 0.00 SMALL METER TESTING TESTING PERFORMED AT OUR FACILITY 5/8" 1" TEST ONLY 1.5"-2" TEST ONLY PICKUP & DELIVERY WILL BE BILLED PER HOUR GMS IS STAFFED AND EQUIPPED TO PERFORM METER REPLACEMENTS OF ALL BRANDS AND SIZES. RATES ARE BASED ON QTY & LOCATION. Thank you for your inquiry. Feel free to reach out to SUBTOTAL us with any questions or concerns. TAX Accepted By Accepted Date THANK YOU FOR YOUR BUSINESS! 70.00 0.00 110.00 0.00 CC] ID: 4MGKV A� oR®® CERTIFICATE OF LIABILITY INSURANCE DATEIMM/OD YYY) 11/1912024 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 WRIS, Inc. dba Western Republic Insurance Services 19900 Beach Blvd. NAMEACT Dustin Keeney PHO(A/C N �). 8884671718 ADDRESS: dustin@wrinsurance.com INSUI AFFORDING COVERAGE NAICB Suite F1 INSURERA: Colony Insurance Company 39993 Huntington Beach CA 92648 INSURED INSURER B: California Automobile Insurance Company 38342 INSURER C: Scottsdale Insurance Company 41297 Golden Meters Service, Inc. INSURER D: Security National Insurance Company 33120 14812 Hunter Ln INSURER E : INSURER F: Midway City CA 92655 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 ANs.DDL SUBR POLICYNUMBER POLICY MMIDDIYVYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS -MADE � OCCUR PREMISES Ea occurren e $ 100,000 MED EXP(Any one person) $ 5,000 A Y Y 600 GL 0217377-00 09/09/2024 09/09/2025 PERSONAL &ADV INJURY $ 1,000,00D GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO- ❑ LOG PRODUCTS - COMPIOP AGO $ 2,000,000 JECT OTHER', $ AUTOMODILELIABILITY COMBINED SINGLE LIMIT $ 1,000,000 _{Ea accident IANY AUTO BODILY INJURY /Per person) $ OWNEDX SCHEDULED Y BA040000088824 04/15/2024 04/15/2025 BODILY INJURY (Per accldenD $ AUTOS ONLY AUTOS --- HIRED NON -OWNED Pe�ec cdon DAMAGE $ AUTOS ONLY X AUTOS ONLY X I UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 4,000,000 C Exc ESS LIAB _ CLAIMS -MADE CXS4032619 09/09/2024 09/09/2025 AGGREGATE $ 4,000,000 DED RETENTION $ WORKERS COMPENSATION X PER ERII- AND EMPLOYERS' LIABILITY —'—'-'— D OFFICE PRICTOWPAR N ER/EXECUTIVE Y❑ NIA Y SWC1481305 03/07/2024 03/07/2025 E.L. EACFI ACCIDENT $ 1,OOD,000 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If Yes, describe under 1,000,D00 DESCRIPTION OF OPERATIONS below E.L. DISEASE � POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Those usual to the insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured per the attached CG 20 10 12 19, CG 20 37 12 19, and MCA20480711. Waiver of subrogation applies per the attached CG 24 04 12 19 and WC 04 03 06. Insurance is primary and non- contributory per the attached CG 20 01 12 19. Provide On -Call Meter Testing Services APPROVE® r•enlrFl I ;•y Cynthia Moraaf 1:58-pm, Nov--27; 2024'. 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. Risk Management Division AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza, 4th Floor Santa Ana CA 92701 ..�..---a""..-rFm- - �.-: y-_-._. ___•''F'I. ,.�. .z„.,,,,V_,�,-_ to 1988-ZUT5 ACURU CORPORATION. ION. An rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD COI ID: 4MGKV POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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) Location(s) Of Covered Operations Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured. contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. 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 contract or agreement to provide for such additional insured. 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 the covered operations has been completed; or 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. APPROVED By Cynthia Mora at 1:58 pm, Nov 27, 2024 CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. APPROVED By Cynthia Mora at 1:58 pm, Nov 27, 2024 Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 POLICY NUMBER: 600 GL 021 7377-00 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured, contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. APPROVE® By Cynthia Mora at 1:58.pm, Nov 27, 2024- CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization required to be included as an Additional Insured on this policy pursuant to written contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. APPROVED By Cynthia Mora at 1 58 pm, Nov 27, 2024 CG 24 0412 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 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 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. APPROVED By Cynthia Mora at 1:58 pm, Nov 27, 2024 CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy #BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following Is added to the Section II — Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any person or organization that you are required to include as additional Insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily;inlury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this Insurance applies and only to the extent that person or organizatlon qualifies as an "insured" under the Who Is An Insured provision contained in Section ll. APPROVED By Cynthia Mora at 1:58 pm, Nov 27, 2024 MCA20480711 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to-reeover ourpayments from anyone liable for an injury covered by this policy. We will not enforce out 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 requlres you to obtain this agreementfiom us.) You must maintain payroll records accurately segregating the reinnneratien of ycirr employees while ongagod in the walk desoribed in the Schedule The additional premium for this endorsement shall be 2%of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract.. APPROVED By Cynthia Mora at 1:58 pm, Nov 27, 2024 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 3/7/2024 Policy No. SWC1481:305 Endorsement No. 0 Insured Golden Meters Service, Inc. Premium°$ 13,251 Insurance Company Security National Insurance Company Countersigned by -- WC 04 03 06 (Ed, 04-84) Generated using Certificial's Smart COI Network TM — Track your Suppliers in real-time at certificial.com/coi COI ID: 4MGKV .-- ® D ACORCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/03/2025 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 Dustin Keeney PAHONNo Ext : 8884671718 FAX No WRIS, Inc. dba Western Republic Insurance Services E-MAIL ADDRESS: dustin@wrinsurance.com 19900 Beach Blvd. INSURER(S) AFFORDING COVERAGE NAIC# Suite F1 INSURERA: Colony Insurance Company 39993 Huntington Beach CA 92648 INSURED INSURER B : California Automobile Insurance Company 38342 Golden Meters Service, Inc. Scottsdale IC INSURER C : Insurance Company Y 41297 14812 Hunter Ln INSURER D: Security National Insurance Company 33120 INSURER E : INSURER F : Midway City CA 92655 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 I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREM SESDAMAGE TOEa olccurrDence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A Y Y 600 GL 0217377-00 09/09/2024 09/09/2025 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC JECT X PRODUCTS-COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ccident a $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B OWNED \/ SCHEDULED AUTOS ONLY I ^ I AUTOS Y Y BA040000088824 04/15/2024 04/15/2025 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ XHIRED Fs,,01 NON -OWNED AUTOS ONLY /� AUTOS ONLY UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 C X EXCESS LIAB CLAIMS -MADE CXS4032619 09/09/2024 09/09/2025 AGGREGATE $ 4,000,000 DED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFCERMEMBEREXCLUDEDXECUTIVE Y❑ (Mandatory in NH) NIA Y SWC1540465 03/07/2025 03/07/2026 X STATUTE OERH E.L.EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 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) Those usual to the insured's operations. City of Santa Ana, officers, agents, employees, and volunteers are named as additional insured per the attached CG 20 10 12 19, CG 20 37 12 19, and MCA20480711. Waiver of subrogation applies per the attached CG 24 04 12 19, MCA04440913, and WC 04 03 06. Insurance is primary and non-contributory per the attached CG 20 01 12 19. Provide On -Call Meter Testing Services D g tally s,n,d - Tu Tran Ngw nrAPPROVED Nguyen 25.03.04 y Tu Tian Nguyen at 2a5 pis, Mar 04, 2025 14:5848-08'00' CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention: Public Works Agency Water, 215 S. Center Street (M-85) Santa Ana CA 92703 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 i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COI ID: 4MGKV Generated using Certificial's Smart COI Network TM — Track your Suppliers in real-time at certificial.com/coi 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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) Location(s) Of Covered Operations Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured. contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. 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 contract or agreement to provide for such additional insured. 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 the covered operations has been completed; or 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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 600 GL 0217377-00 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 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 Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured. contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 600 GL 0217377-00 POLICY NUMBER: 600 GL 0217377-00 COMMERCIAL GENERAL LIABILITY CG24041219 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization required to be included as an Additional Insured on this policy pursuant to written contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 600 GL 0217377-00 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 Page 1 of 1 Policy #BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section II — Liability Coverage, Paragraph A.I. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily ;injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which 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. MCA20480711 Policy #BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION IV — BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us, the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. M CA04440913 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY We have the right to recover our payments from anyone I iable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (Thies agreement applies only to the extent that you perform work under a written contract that requires You to obtain this agreement frorn us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on Such remuneration. Person or Organization Job Description Any person or organization as req&ed by written contract. 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 3/7/2025 Policy No. SWC1540465 Endorsement No. 0 Insured Golden Meters Service, Inc. Premium $ 12,721 Insurance Company Security National Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84) Generated using Certificial's Smart COI Network™ – Track your Suppliers in real-time at certificial.com/coi COI ID: 4MGKV EBUF!)NN0EE0ZZZZ* DFSUJGJDBUF!PG!MJBCJMJUZ!JOTVSBODF 2101803136 UIJT!DFSUJGJDBUF!JT!JTTVFE!BT!B!NBUUFS!PG!JOGPSNBUJPO!POMZ!BOE!DPOGFST!OP!SJHIUT!VQPO!UIF!DFSUJGJDBUF!IPMEFS/!UIJT DFSUJGJDBUF!EPFT!OPU!BGGJSNBUJWFMZ!PS!OFHBUJWFMZ!BNFOE-!FYUFOE!PS!BMUFS!UIF!DPWFSBHF!BGGPSEFE!CZ!UIF!QPMJDJFT CFMPX/!!UIJT!DFSUJGJDBUF!PG!JOTVSBODF!EPFT!OPU!DPOTUJUVUF!B!DPOUSBDU!CFUXFFO!UIF!JTTVJOH!JOTVSFS)T*-!BVUIPSJ\[FE SFQSFTFOUBUJWF!PS!QSPEVDFS-!BOE!UIF!DFSUJGJDBUF!IPMEFS/ JNQPSUBOU;!!Jg!uif!dfsujgjdbuf!ipmefs!jt!bo!BEEJUJPOBM!JOTVSFE-!uif!qpmjdz)jft*!nvtu!ibwf!BEEJUJPOBM!JOTVSFE!qspwjtjpot!ps!cf!foepstfe/ Jg!TVCSPHBUJPO!JT!XBJWFE-!tvckfdu!up!uif!ufsnt!boe!dpoejujpot!pg!uif!qpmjdz-!dfsubjo!qpmjdjft!nbz!sfrvjsf!bo!foepstfnfou/!!B!tubufnfou!po uijt!dfsujgjdbuf!epft!opu!dpogfs!sjhiut!up!uif!dfsujgjdbuf!ipmefs!jo!mjfv!pg!tvdi!foepstfnfou)t*/ DPOUBDU QSPEVDFS Evtujo!Lffofz OBNF; GBY QIPOF XSJT-!Jod/!ecb!Xftufso!Sfqvcmjd!Jotvsbodf!Tfswjdft9995782829 )B0D-!Op*; )B0D-!Op-!Fyu*; F.NBJM 2::11!Cfbdi!Cmwe/evtujoAxsjotvsbodf/dpn BEESFTT; Tvjuf!G2 JOTVSFS)T*!BGGPSEJOH!DPWFSBHFOBJD!$ Ivoujohupo!CfbdiDB:3759Dpmpoz!Jotvsbodf!Dpnqboz4:::4 JOTVSFS!B!; JOTVSFE Dbmjgpsojb!Bvupnpcjmf!Jotvsbodf!Dpnqboz49453 JOTVSFS!C!; Hpmefo!Nfufst!Tfswjdf-!Jod/ Tfdvsjuz!Obujpobm!Jotvsbodf!Dpnqboz2:98: JOTVSFS!D!; 25923!Ivoufs!Mo JOTVSFS!E!; JOTVSFS!F!; Njexbz!Djuz DB:3766 JOTVSFS!G!; DPWFSBHFTDFSUJGJDBUF!OVNCFS;SFWJTJPO!OVNCFS; UIJT!JT!UP!DFSUJGZ!UIBU!UIF!QPMJDJFT!PG!JOTVSBODF!MJTUFE!CFMPX!IBWF!CFFO!JTTVFE!UP!UIF!JOTVSFE!OBNFE!BCPWF!GPS!UIF!QPMJDZ!QFSJPE JOEJDBUFE/!!OPUXJUITUBOEJOH!BOZ!SFRVJSFNFOU-!UFSN!PS!DPOEJUJPO!PG!BOZ!DPOUSBDU!PS!PUIFS!EPDVNFOU!XJUI!SFTQFDU!UP!XIJDI!UIJT DFSUJGJDBUF!NBZ!CF!JTTVFE!PS!NBZ!QFSUBJO-!UIF!JOTVSBODF!BGGPSEFE!CZ!UIF!QPMJDJFT!EFTDSJCFE!IFSFJO!JT!TVCKFDU!UP!BMM!UIF!UFSNT- FYDMVTJPOT!BOE!DPOEJUJPOT!PG!TVDI!QPMJDJFT/!MJNJUT!TIPXO!NBZ!IBWF!CFFO!SFEVDFE!CZ!QBJE!DMBJNT/ BEEMTVCS QPMJDZ!FGGQPMJDZ!FYQ JOTS UZQF!PG!JOTVSBODFMJNJUT QPMJDZ!OVNCFS MUS)NN0EE0ZZZZ*)NN0EE0ZZZZ* JOTEXWE DPNNFSDJBM!HFOFSBM!MJBCJMJUZ 2-111-111 FBDI!PDDVSSFODF% EBNBHF!UP!SFOUFE 211-111 DMBJNT.NBEFPDDVS% QSFNJTFT!)Fb!pddvssfodf* 6-111 NFE!FYQ!)Boz!pof!qfstpo*% BZZ711!HM!1328488.121:01:031361:01:031372-111-111 QFSTPOBM!'!BEW!JOKVSZ% 3-111-111 HFO(M!BHHSFHBUF!MJNJU!BQQMJFT!QFS;HFOFSBM!BHHSFHBUF% QSP. 3-111-111 QPMJDZMPDQSPEVDUT!.!DPNQ0PQ!BHH% KFDU % PUIFS; DPNCJOFE!TJOHMF!MJNJU BVUPNPCJMF!MJBCJMJUZ% 2-111-111 )Fb!bddjefou* BOZ!BVUP CPEJMZ!JOKVSZ!)Qfs!qfstpo*% PXOFETDIFEVMFE CPEJMZ!JOKVSZ!)Qfs!bddjefou*% CZZCB15111119993515026031361502603137 BVUPT!POMZBVUPT OPO.PXOFE IJSFEQSPQFSUZ!EBNBHF % )Qfs!bddjefou* BVUPT!POMZBVUPT!POMZ % VNCSFMMB!MJBC 5-111-111 FBDI!PDDVSSFODF% PDDVS FYDFTT!MJBC BYT539:3611:01:031361:01:031375-111-111 DMBJNT.NBEFBHHSFHBUF% % EFESFUFOUJPO% QFSPUI. 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Ebuf;!3136/21/32! 1:;11;39!.18(11( Ohvzfo CzUvUsboOhvzfobu:;11bn-Pdu32-3136 DFSUJGJDBUF!IPMEFSDBODFMMBUJPO Djuz!pg!Tboub!Bob TIPVME!BOZ!PG!UIF!BCPWF!EFTDSJCFE!QPMJDJFT!CF!DBODFMMFE!CFGPSF Buufoujpo;!!Qvcmjd!Xpslt!Bhfodz!!Xbufs-!326!T/!Dfoufs!Tusffu!)N.96* UIF!FYQJSBUJPO!EBUF!UIFSFPG-!OPUJDF!XJMM!CF!EFMJWFSFE!JO BDDPSEBODF!XJUI!UIF!QPMJDZ!QSPWJTJPOT/ BVUIPSJ\[FE!SFQSFTFOUBUJWF Tboub!BobDB:3814 ª!2:99.3126!BDPSE!DPSQPSBUJPO/!!Bmm!sjhiut!sftfswfe/ BDPSE!36!)3127014*Uif!BDPSE!obnf!boe!mphp!bsf!sfhjtufsfe!nbslt!pg!BDPSE COI ID: 4MGKV Generated using Certificial's Smart COI Network™ – Track your Suppliers in real-time at certificial.com/coi UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/! CMBOLFU!XBJWFS!PG!TVCSPHBUJPO! Uijt!foepstfnfou!npejgjft!jotvsbodf!qspwjefe!voefs!uif!gpmmpxjoh;! CVTJOFTT!BVUP!DPWFSBHF!GPSN! Xjui!sftqfdu!up!dpwfsbhf!qspwjefe!cz!uijt!foepstfnfou-!uif!qspwjtjpot!pg!uif!Dpwfsbhf!Gpsn! bqqmz!vomftt!npejgjfe!cz!uif!foepstfnfou/! TFDUJPO!JW!!CVTJOFTTT!BVUP!DPOEJUJPOT-!B/!Mptt!Dpoejujpot-!6/!Usbotgfs!pg!Sjhiut!Pg Sfdpwfsz!Bhbjotu!Puifst!Up!Vt-!uif!gpmmpxjoh!jt!beefe;! Xf!xbjwf!boz!sjhiu!pg!sfdpwfsz!xf!nbz!ibwf!bhbjotu!boz!qfstpo!ps!pshboj{bujpo!up!uif!fyufou! bqqmjft!pomz!up!uif!qfstpo!ps!pshboj{bujpo!eftjhobufe!jo!tvdi!dpousbdu/! NDB15551:24 XPSLFST!DPNQFOTBUJPO!BOE!FNQMPZFST!MJBCJMJUZ!JOTVSBODF!QPMJDZXD!15!14!17 )Fe/!15.95* )Uif!jogpsnbujpo!cfmpx!jt!sfrvjsfe!pomz!xifo!uijt!foepstfnfou!jt!jttvfe!tvctfrvfou!up!qsfqbsbujpo!pg!uif!qpmjdz/* XD!15!14!17 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 4/17/2026 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: Certificate Team Inszone Insurance Services, LLC PHONE FAX 2721 Citrus Road, Suite A A/C No Ext: 877-308-9663 A/c,No):916-400-2625 E-MRancho Cordova, CA 95742 ADDRESS: certs@inszoneins.com INSURER(S)AFFORDING COVERAGE NAIC# License#:OF82764 INSURERA: Colony Insurance Company 39993 INSURED GOLDMET-05 INSURERB: California Automobile Insurance Co 38342 Golden Meters Service, Inc. 14812 Hunter Ln. INsuRERc:AmTrust Insurance Company 15954 Midway City, CA 92655 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:352599966 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 INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y 600 GL 0217377-01 9/9/2025 9/9/2026 EACH OCCURRENCE $1,000,000 DAMAGES( RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) ccurrence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y BA040000088824 4/15/2026 4/15/2027 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLA LAB X OCCUR XS4289250 9/9/2025 9/9/2026 EACH OCCURRENCE $4,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Y KVVP1433228 3/7/2026 3/7/2027 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 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,maybe attached if more space is required) Additional Insured on the General Liability and Auto Liability. Primary and Non-Contributory on the General Liability and Auto Liability.Waiver of Subrogation on the General Liability,Auto Liability and Workers Compensation. Excess follows form,subject to the terms and conditions of the policy. The aforementioned coverage is provided to the extent in the attached forms for:City of Santa Ana APPROVED By Tu Tran Nguyen at 9:12 am,Apr 27,2026 CERTIFICATE HOLDER CANCELLATION 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 215 S. Center Street(M-85) AUTHORIZED REPRESENTATIVE Santa Ana, CA 92703 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 600 GL 0217377-01 POLICY NUMBER: 600 GL 0217377-01 COMMERCIAL GENERAL LIABILITY CG 20 37 1219 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 Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract.Where no coverage under this policy shall apply for the Named Insured no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule,, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of insurance 1. The insurance afforded to such additional insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. 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 1219 ©Insurance Services Office,Inc.,2018 Page 1 of 1 600 GL 0217377-01 POLICY NUMBER: 600 GL 0217377-01 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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) Location(s) Of Covered Operations Any person or organization required to be included as All locations as required by written contract with the an Additional Insured on this policy pursuant to written Named Insured. contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract.Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodilyinjury" or damage" or "personal and advertising injury" pp y caused, in whole or in part, by: property damage occurring after: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 10 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 600 GL 0217377-01 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III- Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 ©Insurance Services Office, Inc.,2018 CG 20 10 12 19 600 GL 0217377-01 POLICY NUMBER: 600 GL 0217377-01 COMMERCIAL GENERAL LIABILITY CG20011219 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 0112 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 600 GL 0217377-01 POLICY NUMBER: 600 GL 0217377-01 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization required to be included as an Additional Insured on this policy pursuant to written contract with the Named Insured, that is fully executed prior to the commencement of the work that is called for in the contract. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured Information 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 041219 ©Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The following is added to the Section 11- Liability Coverage, Paragraph A.I.Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which 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. MCA20480711 Policy Number: BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Mercury Business Auto Broadening Endorsement This endorsement modifies insurance provided underthe following: BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY (BROAD FORM NAMED INSURED) II. EMPLOYEES AS INSUREDS III. SUPPLEMENTARY PAYMENTS IV. ADDITIONAL TRANSPORTATION EXPENSE V. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE VI. GLASS REPAIR—DEDUCTIBLE WAIVER VI I. TWO OR MORE DEDUCTIBLES VIII. AMENDED DUTIES IN EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS IX. UNINTENTIONAL ERROR, OMISSION, OR FAILURE TO DISCLOSE HAZARDS X. PRIMARY AND NONCONTRIBUTORY IF REQUIRED BY CONTRACT XI. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH XII. PERSONAL EFFECTS COVERAGE XIII. LOSS OF USE EXPENSES XIV. DEVICES DESIGNED FOR USE WITH AUDIO, VISUAL OR DATA ELECTRONIC EQUIPMENT XV. PHYSICAL DAMAGE DEDUCTIBLE—VEHICLE TRACKING SYSTEM XVI. CHAINS, TARPS, AND BINDERS COVERAGE Copyright 2023 Mercury Insurance Services,LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 1 of 4 Policy Number: BA040000088824 BUSINESS AUTO COVERAGE FORM I. NEWLY ACQUIRED OR FORMED ENTITY(Broad Form Named Insured) SECTION II—COVERED AUTOS LIABILITY COVERAGE,A. Coverage, 1.Who Is An Insured, the following is added: Any business entity newly acquired or formed by you during the policy period provided you own 50%or more of the business entity and the business entity is not separately insured for Business Auto Coverage. Coverage is extended up to a maximum of 180 days following acquisition or formation of the business entity. Coverage under this provision is afforded only until the end of the policy period. Coverage does not apply to an "accident" which occurred before you acquired or formed the organization. II. EMPLOYEES AS INSUREDS SECTION II—COVERED AUTOS LIABILITY COVERAGE,A. COVERAGE, 1.Who Is An Insured, the following is added: Any"employee" of yours is an "insured"while using a"covered auto" you do not "own", lease, hire, rent, or borrow, which is used in connection with your business. III. SUPPLEMENTARY PAYMENTS SECTION II—COVERED AUTOS LIABILITY COVERAGE,A. Coverage, 3.Coverage Extensions,a. Supplementary Payments, Subparagraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We are not obligated to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. IV. ADDITIONAL TRANSPORTATION EXPENSE SECTION III -PHYSICAL DAMAGE COVERAGE,A.Coverage, 2. Coverage Extensions, a. Transportation Expenses, is amended by: Replacing$20 per day with $50 per day, and the $600 maximum with $1,000 maximum. If your business shown in the "Declarations"is other than an auto dealership, we will also pay up to $1,000 for reasonable and necessary costs incurred by you to return a stolen "covered auto"from the place where it is recovered to its usual garaging location. V. ACCIDENTAL AIRBAG DEPLOYMENT COVERAGE SECTION III -PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following: This exclusion does not apply to the accidental discharge of an airbag. VI. GLASS REPAIR—DEDUCTIBLE WAIVER SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible,the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. Copyright 2023 Mercury Insurance Services,LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 2 of 4 VII. TWO OR MORE DEDUCTIBLES SECTION III -PHYSICAL DAMAGE COVERAGE, D. Deductible,the following is added: If two or more "company" policies or coverage forms apply to the same accident: 1. If the applicable Business Auto deductible is the smallest, it will be waived; or 2. If the applicable Business Auto deductible is not the smallest, it will be reduced by the amount of the smallest deductible; or 3. If the loss involves two or more Business Auto coverage forms or policies the smallest deductible will be waived. For the purpose of this endorsement "company" means the company providing this insurance and any of the affiliated members of the Mercury Insurance Group of companies. Vill. AMENDED DUTIES IN EVENT OF ACCIDENT,CLAIM,SUIT OR LOSS The requirement in SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit, Or Loss, a., In the event of"accident",you must notify us of an "accident" applies only when the "accident" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. IX. UNINTENTIONAL ERROR,OMISSION,OR FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, B.General Conditions,2.Concealment, Misrepresentation, or Fraud, the following is added: Any unintentional omission of or error in information given by you, or unintentional failure to disclose all exposures or hazards existing as of the effective date or at any time during the policy period shall not invalidate or adversely affect the coverage for such exposure or hazard or prejudice your rights under this insurance. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. X. PRIMARYAND NONCONTRIBUTORY IF REQUIRED BY CONTRACT SECTION IV—BUSINESS AUTO CONDITIONS, B.General Conditions, S. Other Insurance,the following is added and supersedes any provision to the contrary: 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. XI. BODILY INJURY REDEFINED TO INCLUDE RESULTANT MENTAL ANGUISH SECTION V— DEFINITIONS, D. "Bodily Injury" is amended by adding the following: "Bodily injury" also includes mental anguish but only when the mental anguish arises from other bodily injury, sickness, or disease. Copyright 2023 Mercury Insurance Services,LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 3 of 4 XII. PERSONAL EFFECTS COVERAGE SECTION III—PHYSICAL DAMAGE COVERAGE,A.Coverage, 2.Coverage Extensions,the following is added: Personal Effects We will pay up to $500 for"loss" to personal effects which: (1) Are owned by you or a driver listed in the "Declarations"; and (2) Are in or on a "covered auto" at the time of"lass". This coverage applies only in the event of a total theft of a "covered auto". No additional deductible applies to the coverage.Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment are not considered personal effects. XIII. LOSS OF USE EXPENSES If you pay the premium for Hired Auto Physical Damage,we will pay expenses for which you become legally responsible to pay for loss of use of an "auto" due to "loss" or "accident" covered by Hired Auto Physical Damage. However,the most we will pay for any expenses for loss of use is $20 per day,to a maximum of$600.The insurance provided by this provision is excess over any other collectible insurance. XIV. DEVICES DESIGNED FOR USE WITH AUDIO,VISUAL OR DATA ELECTRONIC EQUIPMENT SECTION III—PHYSICAL DAMAGE COVERAGE,B. Exclusions,4.a., is replaced by the following: a. Under Comprehensive Coverage we will pay up to$200 for"loss"to tapes, records, discs or other similar audio, visual, data electronic devices designed for use with audio, visual or data electronic equipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices designed for use with audio, visual or data electronic equipment: (1) Are your property or that of a driver listed in the "Declarations"; and (2) Are in a "covererd auto" at the time of"loss". This coverage applies only in the event of a total theft of a "covered auto". No additional deductible applies to this coverage. XV. PHYSICAL DAMAGE DEDUCTIBLE—VEHICLE TRACKING SYSTEM SECTION III—PHYSICAL DAMAGE COVERAGE,D.Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the "Declarations" will be reduced by 50%for any "loss" caused by theft if the "covered auto" is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of that "covered auto" by the "insured" or law enforcement. XVI. CHAINS,TARPS,AND BINDERS COVERAGE SECTION III— PHYSICAL DAMAGE COVERAGE, C. Limits Of Insurance, the following is added: The most we will pay for the "loss" to chains, tarpaulins, binders, and cargo securing devices will be $500. The chains, tarpaulins, binders, or cargo securing devices must be in or on the "covered auto" at the time of"loss". Copyright 2023 Mercury Insurance Services,LLC. All rights reserved. MCA CABE 08 23 Includes copyrighted material of Insurance Services Office,Inc.,with its permission Page 4 of 4 Policy Number: BA040000088824 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION IV— BUSINESSS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights Of Recovery Against Others To Us,the following is added: We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or"loss", provided that the "accident" or"loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. MCA04440913 Policy Number: XS4289250 COMMERCIAL EXCESS LIABILITY COMMERCIAL EXCESS LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. But: Read the entire policy carefully to determine rights, (1) The amount we will pay for "ultimate net duties and what is and is not covered. loss"is limited as described in SECTION II Throughout this policy the words "you" and "your" - LIMITS OF INSURANCE, and refer to the Named Insured shown in the Declarations, (2) Our right to defend terminates when we and any other person or organization qualifying as a Named Insured under this policy. The words "we", have exhausted the applicable limit of "us" and 'bur" refer to the company providing this insurance in the payment of "ultimate net insurance. The word "insured" means any person or loss" under this Coverage Part. However, organization qualifying as such under the "applicable if any policy of "underlying insurance" underlying insurance". specifies that limits are reduced by Other words and phrases that appear in quotation defense expenses, our right to defend marks in this policy have special meaning. Refer to terminates when we have used up the SECTION IV - DEFINITIONS. Other words and applicable limit of insurance in the phrases that are not defined under this policy but payment of "ultimate net loss" under this defined in the "applicable underlying insurance" will Coverage Part. have the meaning described in the policy of b. An additional insured under "applicable "underlying insurance". underlying insurance" will automatically be an The insurance provided under this policy will follow additional insured under this insurance. If the same provisions, exclusions and limitations that coverage provided to the additional insured is are contained in the "applicable underlying required by a contract or agreement, the most insurance", unless otherwise directed by this we will pay on behalf of the additional insured insurance. To the extent such provisions differ or is the lessor of the amount of insurance conflict, the provisions of this policy will apply. required by the contract or available under the However, this policy will not provide coverage for an limits of insurance provided under this policy, "event" unless all the "applicable underlying less any amounts payable by any "underlying insurance" provides coverage for the "event". Under insurance". no circumstances will coverage provided by this policy ever be broader than coverage provided by all the Additional insured coverage provided by this "applicable underlying insurance". insurance will not be broader than coverage provided by all "applicable underlying SECTION I - COVERAGES insurance". 1. Insuring Agreement a. We will pay on behalf of the insured the 2. Exclusions "ultimate net loss" in excess of the "retained The following exclusions, and any other exclusions limit" because of "injury or damage" for which added by endorsement, apply to this policy. If any the insured is legally obligated to pay and to exclusion of "underlying insurance" conflicts with which this insurance applies. any exclusion in this policy, that exclusion of this We have no duty to investigate any claim, suit policy will apply. However, if that exclusion would or proceeding or defend under this policy. result in broader coverage than is provided by the However, at our sole discretion we have the "underlying insurance", the exclusion of the right and will be given the opportunity to "underlying insurance" will apply. This policy will effectively associate in the defense or not provide broader coverage than that provided investigation of any claim, suit or proceeding. by all "applicable underlying insurance". At our sole discretion we also have the right to This insurance does not apply to: assume charge of, negotiate and settle any claim, suit or proceeding to which this policy applies. In all such circumstances the insured will cooperate with us fully. XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 1 of 6 with its permission. a. Medical Payments e. Asbestos Medical payments coverage, medical (1) any claim for "injury or damage" arising, in expenses coverage, or associated expenses whole or in part, out of the actual, alleged, that are provided without regard to fault, threatened or suspected inhalation of, whether or not provided by the "applicable ingestion of, contact with, exposure to, underlying insurance". existence of, or presence of, asbestos in b. Auto any form. Any loss, cost or expense payable under or (2) any damages, loss, cost or expense resulting from any of the following auto arising, in whole or in part, out of the coverages: abating, testing for, monitoring, cleaning up, removing, containing, treating, (1) First-party physical damage coverage; detoxifying, neutralizing, remediating or (2) No-fault coverage; disposing of, or in any way responding to (3) Personal injury protection or auto medical or assessing the effects of, asbestos in payments coverage; or any form, by any insured or by any other (4) Uninsured or underinsured motorists person or entity. coverage. (3) any claim or suit by or on behalf of a governmental authority for damages, loss, c. Pollution cost or expense arising, in whole or in part, (1) "Injury or damage" which would not have out of the abating, testing for, monitoring, occurred, in whole or in part, but for the cleaning up, removing, containing, actual, alleged or threatened discharge, treating, detoxifying, neutralizing, dispersal, seepage, migration, release or remediating or disposing of, or in any way escape of pollutants at any time. responding to or assessing the effects of, (2) Any loss, cost or expense arising out of asbestos in any form, by any insured or by any: any other person or entity. a. Request, demand, order or statutory or This exclusion shall apply without regard to the regulatory requirement that any source or sources of asbestos, or the basis of insured or others test for, monitor, the insured's liability. This exclusion includes clean up, remove, contain, treat, defects or negligence in design, construction detoxify or neutralize, or in any way or materials, or any other event, conduct or respond to, or assess the effects of, misconduct, which may have or is claimed to pollutants; or have precipitated, caused or acted jointly, concurrently or in any sequence with asbestos b. Claim or suit by or on behalf of a in any form in causing "injury or damage". governmental authority for damages because of testing for, monitoring, f. Obligations of"Underlying Insurance" cleaning up, removing, containing, "Injury or damage" for which the liability or treating, detoxifying or neutralizing, or obligation under "underlying insurance" is in any way responding to, or unlimited by law. assessing the effects of, pollutants. g. Pre-Existing Damage or Injury This exclusion does not apply to the extent (1) Any "injury or damage," whether such that valid "applicable underlying insurance" for "injury or damage" is known or unknown: the pollution liability risks described above exists or would have existed but for the a. Which first occurred prior to the exhaustion of underlying limits for "injury or inception date of this policy (or the damage". retroactive date of this policy, if any, d. Workers'Compensation And Similar Laws whichever is earlier); or b. Which is, or alleged to be, in the Any obligation of the insured under a workers' process of occurring at the inception compensation, disability benefits or date of the policy (or the retroactive unemployment compensation law or any date of this policy, if any, whichever is similar law. earlier) even if the "event" continues during this policy period. (2) Any "injury or damage," whether known or unknown, which is in the process of XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 2 of 6 with its permission. settlement, adjustment or suit as of the 3. If any "underlying insurance" has a policy period inception date of this policy (or the that is different from the policy period of this policy retroactive date of this policy, if any, then, for the purposes of this insurance, the whichever is earlier). "retained limit" will only be reduced or exhausted "Injury or damage" which first occurs during by payments made for"injury or damage" covered this policy period includes any continuation, under this insurance during the policy period of change or resumption of that "injury or this policy. damage" after the end of this policy period. 4. The limits of "underlying insurance" will not be h. Sublimited Coverage deemed to be reduced or exhausted by payments for "injury or damage" not covered under this Any coverage in any underlying insurance policy. which is subject to reduced limits of insurance different from the limits of insurance stated in The Aggregate Limit of this policy applies separately the Schedule of Underlying Insurance, whether to each consecutive annual period of this policy and it be referred to as a sublimit, or any other to any remaining period of this policy of less than 12 basis. months, starting with the beginning of the policy period shown in the Declarations, unless the policy SECTION II - LIMITS OF INSURANCE period is extended after issuance for an additional period of less than 12 months. In that case, the 1. The Limits of Insurance shown in the additional period will be deemed part of the last Declarations, and the rules below fix the most we preceding period for purposes of determining the will pay regardless of the number of: Limits of Insurance. a. Insureds; b. Claims made or suits brought, or number of SECTION III - CONDITIONS vehicles involved; The following Conditions apply. In addition, the c. Persons or organizations making claims or Conditions applicable to any "underlying insurance" bringing suits; or are also applicable to the coverage provided under this insurance. To the extent such conditions differ or d. Coverages or limits available under any conflict, the conditions of this policy will apply. "underlying insurance". 1. Appeals 2. The Limits of Insurance of this policy will apply as follows: If any "underlying insurer" or insured elects not to appeal a judgment in excess of the amount of the a. This insurance only applies in excess of the "retained limit", we may do so at our own "retained limit". expense. We will also pay for taxable court costs, b. The Aggregate Limit is the most we will pay pre- and postjudgment interest and for the sum of all "ultimate net loss", for all disbursements associated with such appeal. In no "injury or damage" covered under this policy. event will this provision increase our liability However, this Aggregate Limit only applies to beyond the applicable Limits of Insurance "injury or damage" that is subject to an described in SECTION II LIMITS OF aggregate limit of insurance under the INSURANCE. "applicable underlying insurance". 2. Bankruptcy c. Subject to Paragraph 2.11b. above, the Each a. Bankruptcy Of Insured Occurrence Limit is the most we will pay for Bankruptcy or insolvency of the insured or of the sum of all "ultimate net loss" under this the insured's estate will not relieve us of our insurance because of all "injury or damage" obligations under this policy. arising out of any one "event". b. Bankruptcy Of Any Underlying Insurer d. If the Limits of Insurance of any "applicable underlying insurance" are reduced by defense Bankruptcy of any "underlying insurer" will not expenses by the terms of that policy, any relieve us of our obligations under this policy. payments for defense expenses we make will However, insurance provided under this policy will reduce our applicable Limits of Insurance. not replace any "underlying insurance" in the event of bankruptcy or insolvency of any "underlying insurer". The insurance provided under this policy will apply as if all "underlying insurance"were in full effect and recoverable. XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 3 of 6 with its permission. 3. Duties In The Event Of An Event, Claim Or Suit At our request, the first Named Insured will furnish a. You must see to it that we are notified as us, as soon as practicable, with a complete copy soon as practicable of an "event", regardless of any "underlying insurance" and any of the amount, which may result in a claim subsequently issued endorsements or policies under this insurance. To the extent possible, which may in any way affect the insurance notice should include: provided under this policy. (1) How, when and where the "event" took 5. Cancellation place; a. The first Named Insured shown in the (2) The names and addresses of any injured Declarations may cancel this policy by mailing persons and witnesses; and or delivering to us advance written notice of cancellation. (3) The nature and location of any "injury or damage" arising out of the "event" b. We may cancel this policy by mailing or delivering to the first Named Insured written b. If a claim is made or suit is brought against notice of cancellation at least: any insured, you must: (1) 10 days before the effective date of (1) Immediately record the specifics of the cancellation if we cancel for nonpayment claim or suit and the date received; and of premium; or (2) Notify us as soon as practicable. (2) 30 days before the effective date of You must see to it that we receive written cancellation if we cancel for any other notice of the claim or suit as soon as reason. practicable. c. We will mail or deliver our notice to the first c. You and any other insured involved must: Named Insured's last mailing address known (1) Immediately send us copies of any to us. demands, notices, summonses or legal d. Notice of cancellation will state the effective papers received in connection with the date of cancellation. The policy period will claim or suit; end on that date. (2) Authorize us to obtain records and other e. If this policy is cancelled, we will send the first information; Named Insured any premium refund due. If (3) Cooperate with us in the investigation or we cancel, the refund will be pro rata. If the settlement of the claim or defense against first Named Insured cancels, the refund may the suit; and be less than pro rata. The cancellation will be effective even if we have not made or offered (4) Assist us, upon our request, in the a refund, or if the refund offered has been enforcement of any right against any incorrectly calculated, person or organization which may be liable to the insured because of "injury or f. If notice is mailed, proof of mailing will be damage" to which this insurance may also sufficient proof of notice. apply g. Notice of cancellation to the first Named d. No insured will, except at that insured's own Insured will serve as notice of cancellation to cost, voluntarily make a payment, assume all insureds. No notice of cancellation will be any obligation, or incur any expense, other provided to anyone other than the first Named than for first aid, without our consent. Insured. 6. Changes 4. First Named Insured Duties This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured is the person or The first Named Insured is authorized by all other organization first named in the Declarations and is insureds to make changes in the terms of this responsible for the payment of all premiums. The Policy with our consent. This policy's terms can first Named Insured will act on behalf of all other be amended or waived only by endorsement. Named Insureds for giving and receiving of notice of cancellation or the receipt of any return premium that may become payable. XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 4 of 6 with its permission. 7. Maintenance Of/Changes To Underlying 9. Policy Premium Insurance We will compute all premiums for this policy in All "underlying insurance" must be maintained in accordance with our rules and rates. The policy full effect without reduction of coverage or limits premium is not subject to audit. except for the reduction of aggregate limits in 10. Loss Payable accordance with the provlslons of such "underlying insurance" that results from "injury or Our obligation to make payment for "ultimate net damage" to which this insurance applies during loss", which is covered under the terms and the policy period of this policy. Such exhaustion or conditions of this policy, does not apply to a given reduction is not a failure to maintain "underlying claim unless and until: insurance". a. The insured or insured's "underlying insurer" The first Named Insured must notify us in writing, has become legally obligated to pay the as soon as practicable, if any "underlying "retained limit"; insurance" is cancelled, not renewed, replaced or b. The obligation of the insured to pay the otherwise terminated, or if the limits or scope of "ultimate net loss" in excess of the "retained coverage of any "underlying insurance" is limit" has been determined by a final changed. You must see to it that the terms and settlement or judgment or written agreement conditions of renewals or replacements of among the insured, claimant, "underlying underlying insurance, shown in the Schedule of insurer" (or a representative of one or more of Underlying, will be materially the same as the these) and us; and prior coverage, unless we agree otherwise. c. All "underlying insurers" have paid the In the event of the Insured's failure to maintain amounts due for the claim under "applicable "underlying insurance" in full force and effect, underlying insurance". coverage hereunder shall not be invalid, but shall 11. Legal Action Against Us apply to the same extent that it would have applied had there been compliance with this No action shall be taken against us unless, as a condition and in no event will our liability be more condition precedent, there has been: than it would have been if there had been no such a. Full compliance with all the provisions of this change in underlying insurance unless we policy, and agreed to the change in writing. 8. Other Insurance b. The amount of our obligation to pay has been finally determined either by final and non- a. This insurance is excess over, and shall not appealable judgment against the Insured after contribute with any other insurance, whether trial, or by written agreement between you, primary, excess, contingent or on any other the claimant and us. basis. This condition will not apply to No person or organization shall have the right insurance specifically written as excess over under this policy to join us as a party to any claim, this policy, suit or proceeding against the insured to When this insurance is excess, if no other insurer determine the Insured's liability, nor shall we be defends, we may undertake to do so, but we will impleaded by any insured or their legal be entitled to the insured's rights against all other representative in any such claim, suit or insurers, proceeding. b. When this insurance is excess over other 12. Subrogation - Recoveries insurance, we will pay only our share of the "ultimate net loss" that exceeds the sum of: a. In the event of any payment under this policy, we shall be subrogated to all your rights of (1) The total amount that all such other recovery against any person or organization, insurance would pay for the loss in the and you shall execute and deliver instruments absence of the insurance provided under and papers and do whatever else is this policy; necessary to secure such rights. (2) The total of all deductible and self-insured b. Any amounts recovered after any payment amounts under all other insurance; and under this policy shall be apportioned as (3) All other mechanisms (including follows: contractual obligations of any person or organization to the Insured) arranged for funding of"ultimate net loss". XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 5 of 6 with its permission. (1) First, we shall receive all amounts 5. "Injury or damage" means any injury or damage, recovered until we have been fully covered in the "applicable underlying insurance" reimbursed for all amounts we have arising from an "event". incurred, including costs or expenses of 6. "Retained limit" means the sum of: such recovery proceedings; a. The limits of"underlying insurance" applicable (2) Then, you are entitled to claim for any to the claim; further amount recovered. b. Any self insured retentions contained therein; 13. When We Do Not Renew and If we decide not to renew this policy, we will mail c. Any amount you must pay because the or deliver to the first Named Insured shown in the "underlying insurance", as represented by Declarations written notice of the nonrenewal not you, is not available for any reason. less then 30 days before the expiration date. If notice is mailed, proof of mailing will be 7. "Ultimate net loss" means the total sum, after sufficient proof of notice. reduction for recoveries, or salvages collectible, that the insured becomes legally obligated to pay SECTION IV- DEFINITIONS as damages by reason of: The definitions of any "applicable underlying a. Settlements entered into with our consent, insurance" also apply to this insurance. In addition, judgments, binding arbitration; or the following definitions apply. b. Other binding alternate dispute resolution 1. "Applicable underlying insurance" means the proceeding entered into with our consent. policy or policies of "underlying insurance" which "Ultimate net loss" includes defense expenses if provide underlying coverage for loss that resulted any"underlying insurance"specifies that limits are in a claim under this insurance. reduced by defense expenses. 2. "Controlling underlying insurance" means 8. "Underlying insurance" means any policy of "applicable underlying insurance". insurance listed on the Schedule of Underlying 3. "Controlling underlying insurer" means any insurer Insurance. who provides any policy of insurance that 9. "Underlying insurer" means any insurer who qualifies as the"applicable underlying insurance". provides any policy of insurance listed on the 4. "Event" means, including but not limited to, an Schedule of Underlying Insurance. occurrence, offense, accident or act, to which the "applicable underlying insurance" applies. XPCOVFORM-0815 Includes copyrighted material of Insurance Services Offices, Inc., Page 6 of 6 with its permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule Person or Organization Job Description Any person or organization as required by written contract. 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 3/7/2026 Policy No. KWP1433228 Endorsement No. 0 Insured Golden Meters Service, Inc. Insurance Company AmTrust Insurance Company Countersigned by WC 04 03 06 (Ed. 04-84)