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HomeMy WebLinkAbout4LEAF (2) INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES A-2022-072-01A MAY 7 7075 MAYOR CITY MANAGER Jtt Valerie Amezcua y�r,�� Alvaro Nunez MAYOR PRO TEM .A; _,y�+ CITY ATTORNEY U Benjamin Vazquez Sonia R.Carvalho COUNCILMEMBERS I _ CITY CLERK Phil Bacerras Jennifer L.Hall Johnathan Ryan Hernandez Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA PLANNING AND BUILDING AGENCY 20 Civic Center Plaza•P.O.Box 1988 Santa Ana,California 92702 www.santa-ana.ora April 29,2025 4LEAF, Inc. Attn: Kevin Duggan 5140 Birch Street, 2„d Floor Newport Beach, CA 92660 Re: Extension of Agreement A-2022-072-01 for On-Call Building Safety Inspection Services Pursuant to Section 3 ("Term") of the above-referenced Agreement, entered into by 4LEAF, Inc. ("Consultant") and the City of Santa Ana, dated May 17, 2022, the time period of the Agreement is hereby extended for an additional one-year period until May 16, 2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Ali Pezeshlcpour Acting Executive Director Planning and Building Agency CITY OF SAN ANA ATTEST Alvaro Nunez ennifei L all City Manager City Cl APPR AS TO CONSULTANT Me issa M. Crosthwaite Kevin Duggan Senior Assistant City Attorney President SANTA ANA CITY COUNCIL Valera Amezwe Benjamin Vazquez Thai Vial Phan Jessie Lopez Phil Bacerra Johnalhan Ryan Hernandez David Penaloza Mayor Mayor Pro Tern-Ward 2 Ward 1 Ward 7 Ward 4 Wartl 5 Ward B nrnezwarIDsanlaana.om �b-zauersanla-ana.ora lohanr05vnla-ana.ora iessielooezft3anta-ana.ora obacerra&sanla-ana.ore irvanhemandezcafsanla-ans.om dpenalozaAsanta-anaom 4LEAINC-01 MINEDI ,d►��RO CERTIFICATE OF LIABILITY INSURANCE DATDlYYYY) 3/18/218/2025 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 License!f OC41366 CONTACT NAME: Granite Professional Insurance Brokerage,Inc. (A//C,N,Ext):(925)462-8400 jac,No):(925)462-8888 360 Lindbergh Avenue Livermore,CA 94551 E-MAIL li commerca ADDRESS: @graniteins.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Casualty Company of America 25674 INSURED INSURER B:Travelers IndemnityCompany of Connecticut 25682 4LEAF,Inc. INSURER C:Berkshire Hathaway Homestate 20044 2126 Rheem Dr INSURER D:HDI Global Specialty SE Pleasanton,CA 94588 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. ILT R I TypE OF INSURANCE ADOL SUER POLICY NUMBER POLICY EFF POLICY EXP L D IDD M D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X OCCUR 6806XG31656 3/15/2025 3/1512026 DAMAGE TO RENTED 1,000,000 X X PREMISES Ea occurrence S MED EXP(Any oneperson) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[XJ JECT 7 LOG PRODUCTS-COMP/OP AGG S 2,000,000 OTHER, S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident S X ANY AUTO X X BA6X632782 3/15/2025 3/1512026 BODILY INJURY Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident S X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ I $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 EXCESS LIAB CLAIMS-MADE CUP6X635599 3/15/2025 3/15/2026 AGGREGATE $ 6,000,000 DED 1 X I RETENTIONS 0 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STAT YIN LITEER ANY PROPRIETOR/PARTNER/EXECUTIVE X FOWC623693 3l15l2025 3/15/2026 1,000 000 E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? F7 N/A $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S D Professional Liab X FRS-H-P-PL-00012109-01 3/1512025 3/15/2026 Each Claim 2,000,000 D FRS-H-P-PL-00012109-01 3/15/2025 3/15/2026 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule may be attached if more space is required) The attached forms apply as required per written contract or written agreements between the listed parties and the Insured,which are subject to the policy provisions.In the absence of such written contract or written agreement the attached form may not be applicable. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are Additional Insured on General Liability policy and Automobile Liability policies per attached endorsements CG D3 81 09 15 and CA T3 53 02 15. General Liability is Primary and Non-Contributory per Form CG D3 81 09 15. Waivers of Subrogation apply to General Liability,Automobile Liability,Workers Compensation and Professional Liability Policies per attached endorsements CG D3 81 09 15,CA T3 53 02 15,WC 99 04 10 C and AE POL 90001 MU 05 24. 30 Day Notice of Cancellation applies on Workers'Compensation and General Liability policies. CERTIFICATE HOLDER APPROVED CANCELLATION By Tu Tran Nguyen at 10:35 am,Mar 21,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ogaany,g ed ACCORDANCE WITH THE POLICY PROVISIONS. Planning and Building Agency Tu Tran by TLTm N 20 Civic Center Plaza Nguyen gateguyen 2025.03,21 Santa Ana,CA 92701 10:35 45-0200 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number 6806X631656 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL. INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following Is added to SECTION I1.—WHO IS h. This insurance does not apply to "bodily AN INSURED: Injury" or"property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance"to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for"bodily injury", coverage for that additional Insured, and then "properly damage" or"personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the Injury or Insured applies only to such "bodily Injury" or damage is caused by acts or omissions of "property damage"that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of"your work" to which the "written contract contract requiring Insurance" requires you to requiring insurance" applies, or in connection provde such coverage or the end of the with premises owned by or rented to you. policy period,whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph A.a. of additional Insured: SECTION IV -- COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily Injury", "property damage" or Is excess over any valid and collectible other "personal injury" for which such person or Insurance, whether primary, excess, contingent or on any other basis, that is available to the organization has assumed liability in a additional insured for a loss we cover. However, if contract or agreement, you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this Insurance provided is limited as follows: to the additional insured under this Coverage Part e, This insurance does not apply on any basis to must apply on a primary basis or a primary and any person or organization for which non-contributory basis, this insurance is primary coverage as an additional insured specifically to other insurance available to the additional is added by another endorsement to this insured which covers that person or organizations Coverage Part. as a named insured for such loss, and we will not f. This insurance deer not apply to the share with the other insurance, provided that: rendering of or failure to render any (1) The "bodily injury" or "property damage" for "professional services".. which coverage is sought occurs; and g. In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage Is Coverage Part shown in the Declarations sought arises out of an offense committed; exceed the limits of liability required by the after you have signed that "written contract "written contract requiring Insurance", the requiring insurance", But this insurance provided Insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other Insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that Is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an additional insured Limits Of Insurance, under any other insurance. CG D3 81 0916 ©2016 The Travelers Indemnity company,All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Ofiico,Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily Injury" and "property damage" or "personal injury" arlsing out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused by an offense committed: under a"written contract requiring insurance"with that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you c. Before the end of the policy period. before, and in effect when, the bodily injury or "property damage" occurs, or the"personal Injury" offense is committed. Page 2 of 2 ®2M The Travelers indemnity company.All rights reserved. CG D3 81 QS 16 Includes the copyrighted material of Insurance Services Oflico,Inc.,with its permission POLICY# BA6X632782 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE— LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II —COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness, The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.S., Who Is An Insured, of SECTION II —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 O 2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission, COMMERCIAL.AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any"auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured"against, and investigate or set- The following is added to Paragraph A.1., Who Is tle any such claim or "suit" and keep An Insured, of SECTION II —COVERED AUTOS us advised of all proceedings and ac- LIABILITY COVERAGE: tions. (ii) Neither you nor any other involved Any "employee" of yours is an "insured"while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii)We may, at our discretion, participate in defending the "insured" against, or LIMITS in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II —COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II —COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses, hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 OO 2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered"auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered"auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A,1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION Ill — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE— LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager(if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the"accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.S., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered"auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or"loss", provided that the"accident" or"loss" (1) Owned by an"insured"; and arises out of operations contemplated by CA T3 53 02 15 C 2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 O 2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc,with its permission. POLICY NUMBER: 6806X631656 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION -- NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW(Nonrenewal): Number of Days Notice: 30 PERSON OR ORGANIZATION: CITY OF SANTA ANA ADDRESS: 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA CA 92701 PROVISIONS B. If we do not renew this policy for any legally A. If we cancel this policy for any legally permitted permitted reason other than nonpayment of reason other than nonpayment of premium, and a premium, and a number of days is shown for number of days is shown for Cancellation in the When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of Schedule above, we will mail notice of cancellation to the person or organization shown nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the in such Schedule. We will mail such notice to the address shown in the Schedule above at least the address shown in the Schedule above at least the number of days shown for Cancellation in such number of days shown for When We Do Not Schedule before the effective date of cancellation. Renew(Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T4 00 05 19 ©2019 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 i _WORKERS COMPENSATION.AIy[Z Eh1lPLOYFRS I IARII ITYINSUgANCE_POLICY_.. WC 99 AA 90 C LEd.0�1-19) WAIVER OF OUR RIGHT TO RECOVER.ERQM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an Injury covered by this policy.We will not_enfarre. 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. The additional premium for this endorsement shall be calculated by applying a factor of 2%to the total manual premium,with a minimum initial charge of$3E then applying all other pricing factors for the pa kbis ralrulatad charge to derive the final cast of this endorsemen. This agreement shall not operate directly or Indirectly to benefit anyone not named In the Schedule. SchedulSlanksMabw Person/Organization Blanket Waiver—Any person or organization for whom the Named Insured he wed by written contract to furnish this waiver. Job Dsserloti.oU _ Waiver Premium(priorto adjustments) All CA Operations $4 209 This endorsement changes the poll to which It is attached and Is effective an 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: 3l11512025 PoIIcyNo.: _ FOWC623693 Endomemant-N .: Insured: Premium Insurance Company: Berkshire Hathaway Homestate Ins Co Countersigned by WC990410-C _(Ed.01-19) POLICY NUMBER: BA6X632782 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: CITY OF SANTA ANA, ITS OFFICERS, AGENTS ADDRESS: EMPLOYEES AND REPRESENTATIVES 20 CIVIC CENTER PLAZA, 4TH FLOOR SANTA ANA CA 92701 PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 ©2019 The Travelers Indemnity Company,All rights reserved. Page 1 of 1 Qp,l C A , w HDI SEµ 14 NOTICE: 1. THE INSURANCE POLICY THAT YOU [HAVE PURCHASED] [ARE APPLYING TO PURCHASE] IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE TOLL-FREE TELEPHONE NUMBER: 1-800-927-4357 OR INTERNET WEBSITE www.insurance.ca.gov. ASK WHEHER OR NOT THE INSURER is licensed AS A FOREIGN OR NON- UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORG. AE BDE 91998 MU 07 24 Page 1 of 6 LCp N DI p n W aEnll 5. FOREIGN INSURER SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. YOU CAN FIND A LINK TO EACH STATE FROM THIS NAIC INTERNET WEBISTE: https://content.naic.org/state web map.htm 6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. 7. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE EFFECTIVE IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. AE BDE 91998 MU 07 24 Page 2 of 6 ILCO'l- p W HDI �SER4 Binder Date: 03/14/2025 California Premium: 113,517.00 RE: Architects&Engineers Professional Liability Non-Taxable Fees: 1500.00 Taxable Fees: Named Insured: 4Leaf, Inc. Surplus Lines Tax:_ 3,405.51 2126 Rheem Drive, Pleasanton,California 94566 Stamping Fee: 204.33 Renewal of: New Business Policy Number FRS-H-P-PL-00012109-01 Insurer: HDI Global Specialty SE AM Best Financial Strength Rating of A+ (Superior),a Financial Size Category of XV Policy Period: 03/15/2025 to 03/15/2026 12:01 a.m.local time at Named Insured's Principal Address. Policy Form: AE POL 90001 MU 05 24-Architects&Engineers Professional Liability Policy Broker Agency: Amwins Insurance Brokerage, LLC Broker Agency 2010 Main Street,Suite Address: 600, Irvine,California 92614 AE BDE 91998 MU 07 24 Page 3 of 6 �P'L C Oti A w HDI SI"I COVERAGE SCHEDULE: Limit of Liability: Each Limit of Liability:Aggregate Deductible: Each Deductible:Aggregate Claim for all Claims Claim for all Claims: $2,000,000 $2,000,000 $50,000 $150,000 Pollution Liability: Included © Excluded ❑ Retroactive Date: 04/01/2007 Please refer to the Schedule of Forms and Endorsements for any Supplemental Insuring Agreements SUPPLEMENTAL PAYMENTS: Coverages: Limit of Liability: Limit of Liability: Deductible: Each Expense Event Aggregate for all Expense Events Crisis Management Expenses: $100,000 $100,000 $0 Appearance at Proceedings: $10,000 $100,000 $0 Disciplinary Proceedings: $25,000 $100,000 $0 Subpoena Assistance: $15,000 $15,000 $0 ADA, FHA,OSHA Legal $25,000 $25,000 $0 Expense Requirement: Supplementary Cleanup Costs $25,000 $25,000 $0 Coverage: Covered Professional Service: Professional Services,as defined in the Policy; Total Premium: $113,517 Schedule of Forms and Endorsements FA OTH 0001 MU 1122 - Policy Jacket AE DEC 90000 MU 07 23 -Architects&Engineers Declarations AE POL 90001 MU 05 24-Architects &Engineers Professional Liability Policy FA SCH 0003 MU 1122 - Schedule of Forms FA NOT 0007 MU 0124- Privacy Notice FA NOT 0006 MU 1122-TRIA Notice AE BDE 91998 MU 07 24 Page 4 of 6 ccp,t C O,� p HDI SERJ FA NOT 0005 MU 1122 -OFAC Notice FA NOT 0019 MU OS 23 -Sanction Limitation and Exclusion Clause FA NOT 0022 MU 0124-Fraud Notice FA NOT 0010 MU 05 23 -Service of Suit FA NOT 0042 CA 0125 -California Consumer Complaint Notice AE AMD 90014 MU 12 23 -Supplemental Payments Amended-Withheld Fees Assistance Endorsement AE AMD 90015 MU 12 23 -Professional Services Amendment-Construction Management Endorsement AE EXC 90012 MU 08 23 -Cyber Exclusion Endorsement PR AMD 96005 MU 05 23 -Amendment-Consent to Settle Endorsement PR AMD 96035 MU 05 23 -Specific Client Excess Limit of Liability PR AMD 96088 MU 12 23-Minimum Earned Premium Endorsement PR AMD 96090 MU 12 23-Risk Management Services Endorsement PR AMD 96104 MU 04 24-Pre-Claims Assistance Coverage PR AMD 96108 MU 05 24-General Liability Or Excess Requirement Endorsement PR AMD 96084 MU 12 23 -Blanket Modified Deductible Endorsement PR AMD 96071 MU 06 24-Notice of Claim Provision Amended -Management or Executive Committee PR AMD 96067 MU 10 23 -Additional Insured (Related) Endorsement This binder,subject to acceptable receipt and review of the following: Extended Reported Period Options: 12 months-100% 24 months- 150% 36 months-225% AE BDE 91998 MU 07 24 Page 5 of 6 �ptco4- P MIDI +SE R.4♦ Additional information must be received within (30) thirty days of the date of this binder at which time, the company, in reliance upon such information will make a determination as to policy issuance. Failure to remit all requested information within (30) thirty days of the date of this binder may result in the termination of this binder. This binder is strictly conditioned upon any subjectivities listed above and upon there being no material change in the risk occurring between the date of this binder letter and the inception date of the proposed policy(including any claim or notice of circumstances which may be reasonably expected to give rise to a claim under any policy of which the policy being proposed is a renewal, replacement or excess of). Office of Foreign Assets Control(OFAC)Disclosure Notice: This quote,binder,the continuation of any bound insurance,and any benefit or payments to you,to a claimant or to another third party,may be affected by the administration and enforcement of U.S. economic embargoes and trade sanctions by the Office of Foreign Assets Control (OFAC),if we determine that any such party is on the"Specially Designated Nationals or Blocked Persons"list as maintained by OFAC. Michael Sacco Authorized Representative National Producer License# 16862567 Falcon Risk Services National Producer License#19972129 AE BDE 91998 MU 07 24 Page 6 of 6 2. The premium for this Policy will become fully earned and non-refundable as of the effective date of such Change of Control;and 3. the Named Insured shall give the Insurer written notice of such Change of Control as soon as practicable but not later than thirty(30) after the effective date of the Change of Control. B. Acquisitions If during the Policy Period,the Named Insured acquires or forms a new entity that performs Professional Services,coverage under any Insuring Clause shall apply with respect to the newly acquired or formed entity for Wrongful Acts committed after the Named Insured acquired or formed such entity. Coverage for such entity will end the earlier of 90 days after the acquisition or formation of such entity or the end of the Policy Period,unless the Insurer has agreed to provide such coverage by endorsement subject to the terms, conditions and premium that it shall determine in its sole discretion. XL SUBROGATION AND RECOUPMENT In the event of any payment under this Policy,the Insurer shall be subrogated to the extent of such payment to all the Insureds'rights of recovery. The Insureds shall execute all papers required and shall do everything necessary to secure and preserve such rights,.including the execution of such documents necessary to enable the Insurer to bring suit in the name of the Insureds. Any sums recovered by the Insurer through subrogation or recoupment,less costs incurred by the Insurer to obtain the recovery,will be applied to the Limit of Liability under this Policy that was eroded or exhausted by such paid Loss. Notwithstanding the above,the Insurer hereby waives such subrogation rights against any client of the Insured,to the extent that the Insured had,prior to any Claim or circumstance that might reasonably be expected to be the basis of a Claim,a written agreement to waive such rights,provided that prior to such written agreement,no Insured had a basis to believe that any matter asserted in such Claim or circumstance might reasonably be expected to he the basis of a Claim. In no event will any Insured waive any of its rights of subrogation after it has become aware of any Claim,or of any circumstances that may give rise to a Claim,against any Insured. XII. AUTHORIZATION The Named Insured agrees to act on behalf of all Insureds with respect to (i) providing or receiving any notice; (ii) the payment of any premiums; (iii) receiving any applicable return premiums; (iv) agreeing to and accepting any endorsements; and (v) exercising or declining to exercise a right to an Extended Reporting Period, XIII. ACTION AGAINST INSURER,ALTERATION,AND ASSIGNMENT A. No action shall be brought against the Insurer unless,as a condition precedent thereto,there shall have been compliance with all of the terms and conditions of this Policy. No person or organization shall have any right under the Policy to join the Insurer as a party to any legal action against the Insureds to determine their liability,nor shall the Insurer be impleaded by the Insureds or their legal representative. B. The Insurer will not be bound by any assignment of interest under this Policy unless the assignment is specifically endorsed to this Policy. C. The provisions of this Policy cannot be waived or changed except by written endorsement issued to form a part of this Policy. AE POL 90001 MU 05 24 18 of 20 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 03/31/2026 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 Brent Nishikawa NAME: The Liberty Company Insurance Brokers HCNNo Ext: (888)918-3960 (FAX ,No Lic#OD79653 E-MAIL bnishikawa@libertycompany.com ADDRESS: 5955 De Soto Ave,Ste 250 INSURER(S)AFFORDING COVERAGE NAIC# Woodland Hills CA 91367 INSURERA: Travelers Property Casualty Co ofAmerica 25674 INSURED INSURER B: The Travelers Indemnity Co of CT 25682 4Leaf,Inc. INSURERC: Berkshire Hathaway Homestate Insurance Company 20044 2126 Rheem Dr INSURER D: Pacific Insurance Company,Limited 10046 INSURER E: Pleasanton CA 94588 INSURER F: COVERAGES CERTIFICATE NUMBER: 2026 NEW REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDrence $ 1,000,000 MED EXP(Any one person) $ 5,000 A Y Y 6600519865A 03/15/2026 03/15/2027 PERSONAL&ADV INJURY $ 1,000,000 MOTHER LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED �/ SCHEDULED Y Y BA-C4831196-26-43-G 03/15/2026 03/15/2027 BODILY INJURY(Pe r accide nt) $ AUTOS ONLY /� AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 6,000,000 A EXCESS LIAB CLAIMS-MADE CUPC4831922 03/15/2026 03/15/2027 AGGREGATE $ 6,000,000 DED I X1 RETENTION $ 0 $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABI LI TY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? N/A Y FOWC726350 04/01/2026 04/01/2027 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability Per Claim $5,000,000 D Retro Date:04/01/2007 Y 130HOS81505-26 03/15/2026 03/15/2027 Aggregate $5,000,000 Retention $50,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Agreement N-2025-278. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as an Additional Insured under the Commercial General Liability(Including completed operations)and Auto Liability on a Primary/Non-Contributory basis when required by written contract.A Waiver of Subrogation in favor of the Additional Insured applies to the General Liability,Auto Liability,Workers Compensation and Professional Liability when required by written contract.30 Notice of cancellation applies. -4APPROVED CERTIFICATE HOLDER CANCELLATION !Tu Tran Nguyen at 11:32 am,Apr 02,2026 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. Planning and Building Agency AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana CA 92701 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds 4LEAF CONSULTING INC. 4LEAF CONSULTING, LLC OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC Policy Number: 6600519865A COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS h. This insurance does not apply to "bodily AN INSURED: injury" or "property damage" caused by "your Any person or organization that you agree in a work" and included in the "products- "written contract requiring insurance"to include as completed operations hazard" unless the an additional insured on this Coverage Part, but: "written contract requiring insurance" specifically requires you to provide such a. Only with respect to liability for"bodily injury", coverage for that additional insured, and then "property damage" or"personal injury"; and the insurance provided to the additional b. If, and only to the extent that, the injury or insured applies only to such "bodily injury" or damage is caused by acts or omissions of "property damage" that occurs before the end you or your subcontractor in the performance of the period of time for which the "written of "your work" to which the "written contract contract requiring insurance" requires you to requiring insurance" applies, or in connection provide such coverage or the end of the with premises owned by or rented to you. policy period, whichever is earlier. The person or organization does not qualify as an 2. The following is added to Paragraph 4.a. of additional insured: SECTION IV — COMMERCIAL GENERAL c. With respect to the independent acts or LIABILITY CONDITIONS: omissions of such person or organization; or The insurance provided to the additional insured d. For "bodily injury", "property damage" or is excess over any valid and collectible other "personal injury" for which such person or insurance, whether primary, excess, contingent or on any other basis, that is available to the organization has assumed liability in a additional insured for a loss we cover. However, if contract or agreement. you specifically agree in the "written contract The insurance provided to such additional insured requiring insurance" that this insurance provided is limited as follows: to the additional insured under this Coverage Part e. This insurance does not apply on any basis to must apply on a primary basis or a primary and any person or organization for which non-contributory basis, this insurance is primary coverage as an additional insured specifically to other insurance available to the additional is added by another endorsement to this insured which covers that person or organizations Coverage Part. as a named insured for such loss, and we will not share with the other insurance, provided that: f. This insurance does not apply to the 1 The "bodilyinjury" or "property dama e" for rendering of or failure to render any g "professional services". which coverage is sought occurs; and g. In the event that the Limits of Insurance of the (2) The "personal injury" for which coverage is Coverage Part shown in the Declarations sought arises out of an offense committed; exceed the limits of liability required by the after you have signed that "written contract "written contract requiring insurance", the requiring insurance". But this insurance provided insurance provided to the additional insured to the additional insured still is excess over valid shall be limited to the limits of liability required and collectible other insurance, whether primary, by that "written contract requiring insurance". excess, contingent or on any other basis, that is This endorsement does not increase the available to the additional insured when that limits of insurance described in Section III — person or organization is an additional insured Limits Of Insurance. under any other insurance. CG D3 81 09 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 8., Transfer 4. The following definition is added to the Of Rights Of Recovery Against Others To Us, DEFINITIONS Section: of SECTION IV — COMMERCIAL GENERAL "Written contract requiring insurance" means that LIABILITY CONDITIONS: part of any written contract under which you are We waive any right of recovery we may have required to include a person or organization as an against any person or organization because of additional insured on this Coverage Part, payments we make for "bodily injury", "property provided that the "bodily injury" and "property damage" or "personal injury" arising out of "your damage" occurs and the "personal injury" is work" performed by you, or on your behalf, done caused b an offense committed: under a "written contract requiring insurance" with y that person or organization. We waive this right a. After you have signed that written contract; only where you have agreed to do so as part of b. While that part of the written contract is in the "written contract requiring insurance" with effect; and such person or organization signed by you before, and in effect when, the "bodily injury" or c. Before the end of the policy period. "property damage" occurs, or the "personal injury" offense is committed. Page 2 of 2 ©2015 The Travelers Indemnity Company.All rights reserved. CG D3 81 09 15 Includes the copyrighted material of Insurance Services Office, Inc.,with its permission Policy Number: 6600519865A COMMERCIAL GENERAL LIABILITY 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 (1) The additional insured is a Named Condition and supersedes any provision to the Insured under such other insurance; and contrary: Primary And Noncontributory Insurance (2) You have agreed in writing in a contract or agreement that this insurance would This insurance is primary to and will not seek be primary and would not seek contribution from any other insurance available contribution from any other insurance to an additional insured under your policy available to the additional insured. provided that: CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Policy Number: 6600519865A COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR ARCHITECTS, ENGINEERS AND SURVEYORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Non-Owned Watercraft—75 Feet Long Or Less H. Blanket Additional Insured — Governmental B. Who Is An Insured —Unnamed Subsidiaries Entities — Permits Or Authorizations Relating To Premises C. Who Is An Insured — Retired Partners, Members, Directors And Employees I. Blanket Additional Insured — Governmental D. Who Is An Insured — Employees And Volunteer Entities — Permits Or Authorizations Relating To Workers — Bodily Injury To Co-Employees, Co- Operations Volunteer Workers And Retired Partners, J. Incidental Medical Malpractice Members, Directors And Employees K. Medical Payments— Increased Limit E. Who Is An Insured — Newly Acquired Or Formed L. Amendment Of Excess Insurance Condition — Limited Liability Companies Professional Liability F. Blanket Additional Insured —Controlling Interest M. Blanket Waiver Of Subrogation —When Required G. Blanket Additional Insured — Mortgagees, By Written Contract Or Agreement Assignees, Successors Or Receivers N. Contractual Liability—Railroads PROVISIONS uses or is responsible for the use of a A. NON-OWNED WATERCRAFT — 75 FEET watercraft that you do not own that is: LONG OR LESS (1) 75 feet long or less; and 1. The following replaces Paragraph (2) of (2) Not being used to carry any person Exclusion g., Aircraft, Auto Or Watercraft, or property for a charge; in Paragraph 2. of SECTION I — B. WHO IS AN INSURED — UNNAMED COVERAGES — COVERAGE A — BODILY SUBSIDIARIES INJURY AND PROPERTY DAMAGE The following is added to SECTION II —WHO IS LIABILITY: AN INSURED: (2) A watercraft you do not own that is: Any of your subsidiaries, other than a partnership (a) 75 feet long or less; and or joint venture, that is not shown as a Named (b) Not being used to carry any person Insured in the Declarations is a Named Insured or property for a charge; if: 2. The following replaces Paragraph 2.e. of a. You are the sole owner of, or maintain an SECTION II—WHO IS AN INSURED: ownership interest of more than 50% in, such e. Any person or organization that, with subsidiary on the first day of the policy your express or implied consent, either period; and CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY b. Such subsidiary is not an insured under Unless you are in the business or occupation similar other insurance. of providing professional health care No such subsidiary is an insured for "bodily services, Paragraphs (1)(a), (b), (c) and (d) injury" or "property damage" that occurred, or above do not apply to "bodily injury" arising out of providing or failing to provide first aid personal and advertising injury caused by an or"Good Samaritan services" by any of your offense committed: retired partners, members, directors or a. Before you maintained an ownership interest "employees", other than a doctor. Any such of more than 50% in such subsidiary; or retired partners, members, directors or b. After the date, if any, during the policy period "employees" providing or failing to provide that you no longer maintain an ownership first aid or "Good Samaritan services" during interest of more than 50% in such subsidiary. their work hours for you will be deemed to be acting within the scope of their employment For purposes of Paragraph 1. of Section II —Who by you or performing duties related to the Is An Insured, each such subsidiary will be conduct of your business. deemed to be designated in the Declarations as: (2) "Personal injury": a. A limited liability company; (a) To you, to your current or retired b. An organization other than a partnership, partners or members (if you are a joint venture or limited liability company; or partnership or joint venture), to your c. A trust; current or retired members (if you are a as indicated in its name or the documents that limited liability company), to your other current or retired directors or govern its structure. "employees" while in the course of his or C. WHO IS AN INSURED— RETIRED PARTNERS, her employment or performing duties MEMBERS, DIRECTORS AND EMPLOYEES related to the conduct of your business, The following is added to Paragraph 2. of or to your other "volunteer workers" while performing duties related to the SECTION II—WHO IS AN INSURED: conduct of your business; Any person who is your retired partner, member, (b) To the spouse, child, parent, brother or director or"employee"that is performing services sister of that current or retired partner, for you under your direct supervision, but only for member, director, "employee" or acts within the scope of their employment by you "volunteer worker' as a consequence of or while performing duties related to the conduct Paragraph (2)(a) above; of your business. However, no such retired (c) For which there is any obligation to partner, member, director or "employee" is an share damages with or repay someone insured for: else who must pay damages because of the injury described in Paragraph (2)(a) (1) "Bodily injury": or(b) above; or (a) To you, to your current partners or (d) Arising out of his or her providing or members (if you are a partnership or failing to provide professional health care joint venture), to your current members services. (if you are a limited liability company) or to your current directors; (3) "Property damage" to property: (b) To the spouse, child, parent, brother or (a) Owned, occupied or used by; or sister of that current partner, member or (b) Rented to, in the care, custody or control director as a consequence of Paragraph (1)(a) above; of, or over which physical control is being exercised for any purpose by; (c) For which there is any obligation to share damages with or repay someone you, any of your retired partners, members else who must pay damages because of or directors, your current or retired the injury described in Paragraph (1)(a) "employees" or "volunteer workers", any or(b) above; or current partner or member (if you are a (d) Arising out of his or her providing or partnership or joint venture), or any current failing to provide professional health care member (if you are a limited liability services. company) or current director. Page 2 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY D. WHO IS AN INSURED — EMPLOYEES AND organization will be deemed to be VOLUNTEER WORKERS — BODILY INJURY designated in the Declarations as: TO CO-EMPLOYEES, CO-VOLUNTEER WORKERS AND RETIRED PARTNERS, a. A limited liability company; MEMBERS, DIRECTORS AND EMPLOYEES b. An organization other than a partnership, The following is added to Paragraph 2.a.(1) of joint venture or limited liability company; or SECTION II—WHO IS AN INSURED: Paragraphs (1)(a), (b) and (c) above do not c. Atrust; apply to "bodily injury" to a current or retired co- as indicated in its name or the documents "employee" while in the course of the co- that govern its structure. "employee's" employment by you or performing F. BLANKET ADDITIONAL INSURED — duties related to the conduct of your business, or CONTROLLING INTEREST to "bodily injury" to your other "volunteer 1. The following is added to SECTION II — workers" or retired partners, members or WHO IS AN INSURED: directors while performing duties related to the conduct of your business. Any person or organization that has financial E. WHO IS AN INSURED— NEWLY ACQUIRED control of you is an insured with respect to OR FORMED LIMITED LIABILITY COMPANIES liability for "bodily injury", "property damage" or "personal and advertising injury" that The following replaces Paragraph 3. of arises out of: SECTION II—WHO IS AN INSURED: a. Such financial control; or 3. Any organization you newly acquire or form, b. Such person's or organization's other than a partnership or joint venture, and ownership, maintenance or use of of which you are the sole owner or in which premises leased to or occupied by you. you maintain an ownership interest of more than 50%, will qualify as a Named Insured if The insurance provided to such person or there is no other similar insurance available organization does not apply to structural to that organization. However: alterations, new construction or demolition a. Coverage under this provision is operations performed by or on behalf of such afforded only: person or organization. (1) Until the 180th day after you acquire 2. The following is added to Paragraph 4. of or form the organization or the end SECTION II —WHO IS AN INSURED: of the policy period, whichever is This paragraph does not apply to any earlier, if you do not report such premises owner, manager or lessor that has organization in writing to us within financial control of you. 180 days after you acquire or form it; G. BLANKET ADDITIONAL INSURED — or MORTGAGEES, ASSIGNEES, SUCCESSORS (2) Until the end of the policy period, OR RECEIVERS when that date is later than 180 days The following is added to SECTION II —WHO IS after you acquire or form such AN INSURED: organization, if you report such organization in writing to us within Any person or organization that is a mortgagee, 180 days after you acquire or form it; assignee, successor or receiver and that you b. Coverage A does not apply to "bodily have agreed in a written contract or agreement injury" or "property damage" that to include as an additional insured on this occurred before you acquired or formed Coverage Part is an insured, but only with the organization; and respect to its liability as mortgagee, assignee, successor or receiver for"bodily injury", "property c. Coverage B does not apply to "personal damage" or "personal and advertising injury" and advertising injury" arising out of an that: offense committed before you acquired a. Is "bodily injury" or "property damage" that or formed the organization. occurs, or is "personal and advertising injury" For the purposes of Paragraph 1. of Section caused by an offense that is committed, II — Who Is An Insured, each such CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY subsequent to the signing of that contract or openings, sidewalk vaults, elevators, street agreement; and banners or decorations. b. Arises out of the ownership, maintenance or I. BLANKET ADDITIONAL INSURED — use of the premises for which that GOVERNMENTAL ENTITIES — PERMITS mortgagee, assignee, successor or receiver OR AUTHORIZATIONS RELATING TO is required under that contract or agreement OPERATIONS to be included as an additional insured on The following is added to SECTION II —WHO IS this Coverage Part. AN INSURED: The insurance provided to such mortgagee, Any governmental entity that has issued a permit assignee, successor or receiver is subject to the or authorization with respect to operations following provisions: performed by you or on your behalf and that you a. The limits of insurance provided to such are required by any ordinance, law, building code mortgagee, assignee, successor or receiver or written contract or agreement to include as an will be the minimum limits that you agreed to additional insured on this Coverage Part is an provide in the written contract or agreement, insured, but only with respect to liability for or the limits shown in the Declarations, "bodily injury", "property damage" or "personal whichever are less. and advertising injury" arising out of such b. The insurance provided to such person or operations. organization does not apply to: The insurance provided to such governmental (1) Any "bodily injury" or "property damage" entity does not apply to: that occurs, or any "personal and a. Any "bodily injury", "property damage" or advertising injury" caused by an offense "personal and advertising injury" arising out that is committed, after such contract or of operations performed for the agreement is no longer in effect; or governmental entity; or (2) Any"bodily injury", "property damage" or b. Any "bodily injury" or "property damage" "personal and advertising injury" arising included in the "products-completed out of any structural alterations, new operations hazard". construction or demolition operations J. INCIDENTAL MEDICAL MALPRACTICE performed by or on behalf of such mortgagee, assignee, successor or 1. The following replaces Paragraph b. of the receiver. definition of "occurrence" in the H. BLANKET ADDITIONAL INSURED — DEFINITIONS Section: GOVERNMENTAL ENTITIES — PERMITS OR b. An act or omission committed in AUTHORIZATIONS RELATING TO PREMISES providing or failing to provide "incidental The following is added to SECTION II —WHO IS medical services", first aid or "Good AN INSURED: Samaritan services" to a person, unless you are in the business or occupation of Any governmental entity that has issued a permit providing professional health care or authorization with respect to premises owned services. or occupied by, or rented or loaned to, you and 2. The following replaces the last paragraph of that you are required by any ordinance, law, Paragraph 2.a.(1) of SECTION II — WHO IS building code or written contract or agreement to AN INSURED: include as an additional insured on this Unless you are in the business or occupation Coverage Part is an insured, but only with of providing professional health care respect to liability for "bodily injury", "property services, Paragraphs (1)(a), (b), (c) and (d) damage" or "personal and advertising injury" above do not apply to "bodily injury" arising arising out of the existence, ownership, use, out of providing or failing to provide: maintenance, repair, construction, erection or removal of any of the following for which that (a) "Incidental medical services" by any of governmental entity has issued such permit or your "employees" who is a nurse, authorization: advertising signs, awnings, nurse assistant, emergency medical canopies, cellar entrances, coal holes, technician, paramedic, athletic trainer, driveways, manholes, marquees, hoist away audiologist, dietician, nutritionist, Page 4 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY occupational therapist or occupational that is available to any of your "employees" therapy assistant, physical therapist or for "bodily injury" that arises out of providing speech-language pathologist; or or failing to provide "incidental medical (b) First aid or "Good Samaritan services" services" to any person to the extent not by any of your"employees" or"volunteer subject to Paragraph 2.a.(1) of Section II — workers", other than an employed or Who Is An Insured. volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS— INCREASED LIMIT or"volunteer workers" providing or failing The following replaces Paragraph 7. of to provide first aid or "Good Samaritan services" during their work hours for you SECTION III — LIMITS OF INSURANCE: will be deemed to be acting within the 7. Subject to Paragraph 5. above, the Medical scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any 3. The following replaces the last sentence of one person, and will be the higher of: Paragraph 5. of SECTION III — LIMITS OF a. $10,000; or INSURANCE: For the purposes of determining the b. The amount shown in the Declarations of applicable Each Occurrence Limit, all related this Coverage Part for Medical Expense acts or omissions committed in providing or Limit. failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION — PROFESSIONAL LIABILITY services" to any one person will be deemed to be one "occurrence". The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — 4. The following exclusion is added to COMMERCIAL GENERAL LIABILITY Paragraph 2., Exclusions, of SECTION I — CONDITIONS: COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE This insurance is excess over any of the other LIABILITY: insurance, whether primary, excess, contingent Sale Of Pharmaceuticals or on any other basis, that is Professional Liability or similar coverage, to the extent the "Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B. ordinance relating to the sale of M. BLANKET WAIVER OF SUBROGATION — pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACT knowledge or consent of the insured. OR AGREEMENT 5. The following is added to the DEFINITIONS Section: The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, "Incidental medical services" means: of SECTION IV — COMMERCIAL GENERAL a. Medical, surgical, dental, laboratory, x LIABILITY CONDITIONS: ray or nursing service or treatment, If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right of furnishing of food or beverages; or recovery against any person or organization, we b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances. because of: 6. The following is added to Paragraph 4.b., a. "Bodily injury" or "property damage" that Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY occurs; or CONDITIONS: b. "Personal and advertising injury" caused by This insurance is excess over any valid and an offense that is committed; collectible other insurance, whether primary, subsequent to the signing of that contract or excess, contingent or on any other basis, agreement. CG D3 79 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL GENERAL LIABILITY N. CONTRACTUAL LIABILITY—RAILROADS 1. The following replaces Paragraph c. of the definition of "insured contract" in the DEFINITIONS Section: c. Any easement or license agreement; 2. Paragraph f.(1) of the definition of "insured contract" in the DEFINITIONS Section is deleted. Page 6 of 6 ©2017 The Travelers Indemnity Company.All rights reserved. CG D3 79 02 19 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Policy Number: BAC4831196 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE— INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES— INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE— INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II —COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II — COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos" you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any "auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II —COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured" while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii) in may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II — COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE— INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV— BUSINESS AUTO CONDITIONS: USE— INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III— PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES— INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph A.4., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- We will a u to $400 for "loss" to wearing a tent required of you by a written contract pay p 9 p- signed and executed prior to any "accident" parel and other personal property which is: or"loss", provided that the "accident" or"loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV— BUSINESS AUTO CONDITIONS: Page 4 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. Policy Number: BAC4831196 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE O This endorsement modifies insurance provided under the following: O BUSINESS AUTO COVERAGE FORM s PROVISIONS 2. The following is added to Paragraph B.5., Other 1. The following is added to Paragraph A.1.c., Who Insurance of SECTION IV — BUSINESS AUTO C Is An Insured, of SECTION II — COVERED CONDITIONS: AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement between you and that person or applicable other insurance under which an organization, that is signed by you before the additional insured person or organization is the "bodily injury" or "property damage" occurs and first named insured when the written contract or .� that is in effect during the policy period, to name agreement between you and that person or as an additional insured for Covered Autos organization, that is signed by you before the Liability Coverage, but only for damages to which "bodily injury" or "property damage" occurs and this insurance applies and only to the extent of v pp y that is in effect during the policy period, requires othat person's or organization's liability for the this insurance to be primary and non-contributory. sy conduct of another"insured". O O w O w O O O A CA T4 74 02 16 u 2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.with its permission. (D) If the Insurer cancels this Policy, unearned premium shall be calculated on a pro rata basis. If the Named Entity cancels this Policy, unearned premium shall be calculated at the Insurer's customary short rates. Payment of any unearned premium shall not be a condition precedent to the effectiveness of a cancellation. The Insurer shall make payment of any unearned premium which it received from the Named Entity as soon as practicable. XV. CHANGES IN EXPOSURE Solely with respect to all Liability Coverage Parts: (A) Acquisitions or Created Subsidiaries If, before or during the Policy Period,any Insured Entity acquires or creates an entity then such acquired or created entity, and any natural persons that would qualify as Insured Persons thereof, shall be an Insured to the extent such entities and persons would otherwise qualify as an Insured under the Liability Coverage Parts, but only for Wrongful Acts occurring after the Effective Time of such acquisition or creation. No coverage shall be available for any Wrongful Act of such Insured occurring before the Effective Time of such acquisition or creation, or for any Interrelated Wrongful Acts thereto. The Insured Entity shall give the Insurer written notice and full, written details of the acquisition or creation as soon as practicable: (1) prior to the expiration or termination date of this Policy; or (2) within ninety (90) days of such acquisition or creation; whichever date is later. The Insurer shall be entitled to impose such additional terms, conditions, and premium as the Insurer, in its absolute discretion, chooses. (B) Mergers If, before or during the Policy Period, any Insured Entity merges with another entity such that the Insured Entity is the surviving entity, then such merged entity and any natural persons that would qualify as Insured Persons thereof, shall be an Insured to the extent such entities and persons would otherwise qualify as an Insured under the Liability Coverage Parts, but only for Wrongful Acts occurring after such merger. This coverage shall remain in force for 90 days beginning with the date of the merger. No coverage shall be available for any Wrongful Act of such Insured occurring before the Effective Time of such merger or for any Interrelated Wrongful Acts thereto. The Insured Entity shall give the Insurer written notice and full, written details of the merger as soon as practicable: (1) prior to the expiration or termination date of this Policy; or (2) within ninety (90) days of such merger; whichever date is later. If the Insured Entity is not the surviving entity then coverage shall terminate on the effective date of the merger. The Insurer shall be entitled to impose such additional terms, conditions, and premium as the Insurer, in its absolute discretion, chooses. XVI. SUBROGATION The Insurer shall be subrogated to all of the Insured's rights of recovery regarding any payment of Loss by the Insurer under this Policy. The Insured shall execute all papers required and do everything necessary to secure and preserve AE 00 H003 01 0621 ©2021, The Hartford Page 7 of 9 13 OH 0881505-26 03/15/2026 such rights, including the execution of any documents necessary to enable the Insurer to effectively bring suit in the name of the Insured. The Insured shall do nothing to prejudice the Insurer's position or any potential or actual rights of recovery. If the Insured has waived its rights to recovery in a written contract or agreement executed prior to a Claim being made, then the Insurer will waive its rights to subrogation to the same extent as the Insured's waiver. XVII. APPLICATION (A) The Insured represents that the declarations and statements contained in the Application are true, accurate and complete. This Policy is issued in reliance upon the Application. (B) If the Application contains misrepresentations or misrepresentations that materially affect the acceptance of the risk by the Insurer: (1) no coverage shall be afforded under this Policy for any Insured who knew on the Inception Date of this Policy of the facts that were so misrepresented, provided that knowledge possessed by any Insured Person shall not be imputed to any other Insured Person; and (2) knowledge possessed by any principal, partner, chief executive officer, chief operating officer, general counsel, chief financial officer, risk manager, human resources director or any position equivalent to the foregoing of the Insured Entity, or anyone signing the Application, shall be imputed to all Insured Entities. No other person's knowledge shall be imputed to an Insured Entity. XVIII. ACTION AGAINST THE INSURER Solely with respect to all Liability Coverage Parts: (A) No action shall be taken against the Insurer unless there shall have been full compliance with all the terms and conditions of this Policy. (B) No person or organization shall have any right under this Policy to join the Insurer as a party to any Claim against the Insured nor shall the Insurer be impleaded by the Insured in any such Claim. XIX. ASSIGNMENT 00, Assignment of interest under this Policy shall not bind the Insurer without its consent as specified in a written endorsement issued by the Insurer to form a part of this Policy. XX. BANKRUPTCY OR INSOLVENCY Bankruptcy or insolvency of any Insured shall not relieve the Insurer of any of its obligations under this Policy. XXI. AUTHORIZATION OF NAMED ENTITY The Named Entity shall act on behalf of all Insureds with respect to all matters under this Policy, including, without limitation, giving and receiving of notices regarding Claims, cancellation, election of the Extended Reporting Period, payment of premiums, receipt of any return premiums, and acceptance of any endorsements to this Policy. XXII. CHANGES This Policy shall not be changed or modified except in a written endorsement issued by the Insurer to form a part of this Policy. XXIII. ENTIRE AGREEMENT AE 00 H003 01 0621 ©2021, The Hartford Page 8 of 9 13 OH 0881505-26 03/15/2026 (3) is fifty-five (55)years of age or older; and (4) notifies us in writing if this coverage is desired within sixty (60) days after the termination of the policy. This retirement extended reporting period does not apply to claims that are covered under any subsequent insurance you purchase, or that would be covered but for exhaustion of the amount of insurance applicable to such claims. XI. INTERRELATIONSHIP OF CLAIMS Solely with respect to all Liability Coverage Parts: All Claims based upon, arising from, or in any way related to the same Wrongful Act, or Interrelated Wrongful Acts, shall be deemed to be a single Claim for all purposes under this Policy first made on the earliest date that: (A) any of such Claims was first made, regardless of whether such date is before or during the Policy Period; (B) notice of any Wrongful Act described above was given to the Insurer under this Policy pursuant to the section titled Notice Of Claim found in the applicable Liability Coverage Part; or (C) notice of any Wrongful Act described above was given under any prior management liability, professional liability or errors and omissions insurance policy if such notice is accepted under such other policy. XII. ALLOCATION With respect to all Liability Coverage Parts: Where Insureds who are afforded coverage for a Claim incur an amount consisting of both Loss that is covered by this Policy and also loss that is not covered by this Policy because such Claim includes both covered and uncovered matters, then coverage shall apply as follows: (A) with respect to a covered Claim for which the Insurer has the duty to defend: (1) 100% of the Insured's Defense Costs shall be allocated to covered Loss; and (2) All other Loss shall be allocated between covered Loss and non-covered loss based upon the relative legal exposure of all parties to such matters. XIII. OTHER INSURANCE If Loss arising from any Claim is insured under any other valid and collectible policy or policies, then this Policy shall apply only in excess of the amount of any deductibles, retentions and limits of liability under such other policy or policies, whether such other policy or policies are stated to be primary, contributory, excess, contingent or otherwise, unless such other insurance is written specifically excess of this Policy by reference in such other policy or policies to this Policy's Policy Number. Any payments made under any such policy(ies) will serve to offset any applicable retention amounts set forth in the Declarations. XIV. CANCELLATION & NON-RENEWAL (A) The Insurer may cancel this Policy for non-payment of premium by sending notice to the Named Entity not less than 10 calendar days prior to the date of cancellation. The Insurer may cancel this policy, for reasons other than non- payment of premium, by sending notice to the Named Entity not less than 90 days prior to the date of cancellation. (B) The Insurer may non-renew this Policy by sending written notice to the Named Entity no less than 60 days before the expiration of the Policy. (C) The Named Entity may cancel this Policy by sending written notice of cancellation to the Insurer. Such notice shall be effective upon receipt by the Insurer unless a later cancellation time is specified therein. AE 00 H003 01 0621 ©2021, The Hartford Page 6 of 9 13 OH 0881505-26 03/15/2026 (D) If the Insurer cancels this Policy, unearned premium shall be calculated on a pro rata basis. If the Named Entity cancels this Policy, unearned premium shall be calculated at the Insurer's customary short rates. Payment of any unearned premium shall not be a condition precedent to the effectiveness of a cancellation. The Insurer shall make payment of any unearned premium which it received from the Named Entity as soon as practicable. XV. CHANGES IN EXPOSURE Solely with respect to all Liability Coverage Parts: (A) Acquisitions or Created Subsidiaries If, before or during the Policy Period,any Insured Entity acquires or creates an entity then such acquired or created entity, and any natural persons that would qualify as Insured Persons thereof, shall be an Insured to the extent such entities and persons would otherwise qualify as an Insured under the Liability Coverage Parts, but only for Wrongful Acts occurring after the Effective Time of such acquisition or creation. No coverage shall be available for any Wrongful Act of such Insured occurring before the Effective Time of such acquisition or creation, or for any Interrelated Wrongful Acts thereto. The Insured Entity shall give the Insurer written notice and full, written details of the acquisition or creation as soon as practicable: (1) prior to the expiration or termination date of this Policy; or (2) within ninety (90) days of such acquisition or creation; whichever date is later. The Insurer shall be entitled to impose such additional terms, conditions, and premium as the Insurer, in its absolute discretion, chooses. (B) Mergers If, before or during the Policy Period, any Insured Entity merges with another entity such that the Insured Entity is the surviving entity, then such merged entity and any natural persons that would qualify as Insured Persons thereof, shall be an Insured to the extent such entities and persons would otherwise qualify as an Insured under the Liability Coverage Parts, but only for Wrongful Acts occurring after such merger. This coverage shall remain in force for 90 days beginning with the date of the merger. No coverage shall be available for any Wrongful Act of such Insured occurring before the Effective Time of such merger or for any Interrelated Wrongful Acts thereto. The Insured Entity shall give the Insurer written notice and full, written details of the merger as soon as practicable: (1) prior to the expiration or termination date of this Policy; or (2) within ninety (90) days of such merger; whichever date is later. If the Insured Entity is not the surviving entity then coverage shall terminate on the effective date of the merger. The Insurer shall be entitled to impose such additional terms, conditions, and premium as the Insurer, in its absolute discretion, chooses. XVI. SUBROGATION The Insurer shall be subrogated to all of the Insured's rights of recovery regarding any payment of Loss by the Insurer under this Policy. The Insured shall execute all papers required and do everything necessary to secure and preserve AE 00 H003 01 0621 ©2021, The Hartford Page 7 of 9 13 OH 0881505-26 03/15/2026 ENDORSEMENT NO:O This endorsement, effective 12:01 am, 03/15/2026 forms part of policy number 13 OH 0881505-26 issued to: 4LEAF, INC. by: PACIFIC INSURANCE COMPANY, LTD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUALLY REQUIRED ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under: DESIGN PROFESSIONALS LIABILITY COVERAGE PART In consideration of the premium charged, it is understood and agreed that the definition of Insured(s) in SECTION III. DEFINITIONS, (K), is amended to include any entity for whom an Insured is required by written contract or agreement to provide insurance coverage under this Policy (herein, an "Additional Insured"), but coverage under this Policy is only with respect to Claims: • for any actual or alleged act, error or omission committed or alleged to have been committed solely in the Insured Entity's performance of Professional Services; and • first made after the Insured and the Additional Insured entered into such written contract or agreement. No Additional Insured shall be an Insured with respect to any Claim arising out of such Additional Insured's act, error or omission. Furthermore, Exclusion (E) in SECTION IV. EXCLUSIONS APPLICABLE TO ALL INSURING AGREEMENTS is amended to include the following: Solely for the purposes of this exclusion, Insured shall not include any Additional Insured. All other terms and conditions remain unchanged. r (i A. Morris Tooker, President AE 00 M008 01 0422 ©2022, The Hartford Page 1 of 1 POLICY NUMBER: 660-0519865A ISSUE DATE: 3/15/2026 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: ADDRESS: PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 ©2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization: Blanket Waiver- Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium All CA Operations 0.00 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: 04/01/2026 Policy No.: FOWC726350 Endorsement No.: Insured: Premium $ Insurance Company: Berkshire Hathaway Homestate Ins Co WC 00 03 13 Countersigned by (Ed. 4-84) ©1983 National Council on Compensation Insurance WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization: Blanket Waiver-Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium All Other States Operations 9.00 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: 04/01/2026 Policy No.: FOWC726350 Endorsement No.: Insured: Premium$ Insurance Company: Berkshire Hathaway Homestate Ins Co WC 00 03 13 Countersigned by (Ed. 4-84) ©1983 National Council on Compensation Insurance WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 07 E (Ed. 0 1-22) CALIFORNIA CANCELLATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancellation condition in Part Six (Conditions)of the policy is replaced by these conditions: Cancellation: 1. You may cancel this policy.You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non-payment of premium; b. Failure to report payroll; c. Non-payment of deductible billing; d. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; e. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; f. Material misrepresentation made by you or your agent; g. Failure to cooperate with us in the investigation of a claim; h. Material failure to comply with Federal or State safety orders; i. Material failure to comply with written recommendations of our designated loss control representatives; j. The occurrence of a material change in the ownership of your business; k. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; I. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; m. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3. If we cancel your policy for any of the reasons listed in (a)through (g),we will give you 10 days advance written notice, stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to provide notice. If we cancel your policy for any of the reasons listed in Items (h)through (m),we will give you 30 days advance written notice; however,we agree that in the event of cancellation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. 5. The policy period will end on the day and hour stated in the cancellation notice. 6. A short rate penalty applies if you cancel this policy or if we cancel due to non-payment of premium, failure to report payroll, or non-payment of deductible billing. First, the standard premium, defined as the base premium (computed in accordance with Part 1, Section 2, Subsection 2 of the WCIRB's California Basic Underwriting Manual) adjusted for the experience modification factor and all other pricing factors except for premium discount and expense constant, will be multiplied by the quotient of the number of days for which the policy was written divided by the number of days the policy remained in force to produce the full standard premium.Second,the extended number of days will be determined by dividing the number of days the policy was in force by the number of days for which the policy was written and multiplying the quotient by 365 days. When the policy is written for a one-year period, the extended number of days will equal the number of days the policy remained in force.Third,the short rate percentage corresponding to the extended number of days will be obtained from the short rate cancellation table. Fourth,the short rate premium will be equal to the product of the full standard premium times the short rate percentage. The short rate table below will be used in computing the short rate premium. In no event will the final earned premium be less than the policy minimum premium. WC 99 06 07 E Page 1 of 2 (Ed. 01-22) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 07 E (Ed. 01-22) Short Rate Table Extended Percent of Extended Percent of Extended Percent of Number of Full Policy Number of Full Policy Number of Full Policy Days Premium Days Premium Days Premium 1 . .... . 5% 95-98 ..... . 37% 219-223 . .... . 69% 2 . .... . 6% 99-102 ..... . 38% 224-228 . .... . 70% 3-4 ..... . 7% 103-105 . .... . 39% 229-232 ..... . 71% 5-6 . .... . 8% 106-109 . ..... 40% 233-237 . ... . . 72% 7-8 . .... . 9% 110-113 . ..... 41% 238-241 . ... . . 73% 9-10 . .... . 10% 114-116 . ..... 42% 242-246 (8 mos.) 74% 11-12 ..... . 11% 117-120 . .... . 43% 247-250 ..... . 75% 13-14 . .... . 12% 121-124 (4 mos.) 44% 251-255 . .... . 76% 15-16 . .... . 13% 125-127 ..... . 45% 256-260 . .... . 77% 17-18 ...... 14% 128-131 .. ... . 46% 261-264 ...... 78% 19-20 ...... 15% 132-135 .. ... . 47% 265-269 ...... 79% 21-22 . .... . 16% 136-138 ..... . 48% 270-273 (9 mos.) 80% 23-25 . .... . 17% 139-142 ..... . 49% 274-278 . .... . 81% 26-29 ...... 18% 143-146 . .... . 50% 279-282 ..... . 82% 30-32 (1 mo.) 19% 147-149 . .... . 51% 283-287 . .... . 83% 33-36 . .... . 20% 150-153 (5 mos.) 52% 288-291 . .... . 84% 37-40 . .... . 21% 154-156 . .... . 53% 292-296 . .... . 85% 41-43 ..... . 22% 157-160 . .... . 54% 297-301 ...... 86% 44-47 . .... . 23% 161-164 ..... . 55% 302-305 (10 mos.) 87% 48-51 . .... . 24% 165-167 ..... . 56% 306-310 . .... . 88% 52-54 ...... 25% 168-171 .. ... . 57% 311-314 ...... 89% 55-58 ...... 26% 172-175 .. ... . 58% 315-319 ...... 90% 59-62 (2 mos.) 27% 176-178 ..... . 59% 321-323 . .... . 91% 63-65 . .... . 28% 179-182 (6 mos.) 60% 324-328 . .... . 92% 66-69 ...... 29% 183-187 . .... . 61% 329-332 ...... 93% 70-73 . .... . 30% 188-191 . ..... 62% 333-337 (11 mos.) 94% 74-76 . .... . 31% 192-196 . ..... 63% 338-342 . .... . 95% 77-80 . .... . 32% 197-200 . ..... 64% 343-346 . ... . . 96% 81-83 ...... 33% 201-205 . .... . 65% 347-351 ...... 97% 84-87 ..... . 34% 206-209 ..... . 66% 352-355 . .... . 98% 88-91 (3 mos.) 35% 210-214 (7 mos.) 67% 356-360 . .... . 99% 92-94 ...... 36% 1 215-218 .. ... . 68% 1 361-365 12 mos. 100% 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: 04/01/2026 Policy No.: FOWC726350 Endorsement No.: Insured: Premium$ Insurance Company: Berkshire Hathaway Homestate Ins Co Countersigned by WC 99 06 07 E Page 2 of 2 (Ed. 01-22)