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HomeMy WebLinkAboutGREYHOUND LINES, INC. (14) INSUI„li, A-2023-090B WORK MAAYY PROCEEL' UNTIL INSUR4,mCE FxplpkS MAYOR —I--II-I -__ CITY MANAGER Valerie Amezcuai�ITY CLERK �" MAYOR PRO TEM NTT Alvaro Nunez CITY ATTORNEY Benjamin Vazquez J U N 12 2025 Sonia R.Carvalho COUNCILMEMBERS LJ CITY CLERK Phil Bacerra Jennifer L. Hall Johnathan Ryan Hernandez ' Jessie Lopez David Penaloza Thai Viet Phan CITY OF SANTA ANA CITY ATTORNEY'S OFFICE 20 Civic Center Plaza •P.O.Box 1988 Santa Ana,California 92702 www.santa-ana.org May 13, 2025 Greyhound Line, Inc. Attn: Real Estate P.O. Box 660362 Dallas, TX 72566 Re: Extension of License Agreement(A-2023-090) for Use of the Santa Ana Regional Transportation Center(SARTC) Facilities Pursuant to Section 1.3 ("Commencement Date of Agreement") of the above-referenced Agreement, entered into by Greyhound Lines, Inc. ("Licensee"), and the City of Santa Ana, dated May 16, 2023, the time period of the Agreement is hereby extended for an additional one-year period through June 30,2026. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement, including the Consent to Sub-License Agreement (#A-2023-090-01)dated February 29, 2024, remain unchanged and in full force and effect. Sincerel a it Saba, PE Executive Director, ]*P-ublic Works Agency CITY OF SANTA ANA _ ATTEST cv_ _, Alvaro NunezClenynifer aCity Manager Cit APPROVED AS TO FORM GREYHOUND LINES, INC. L Foyle Neilesen By: Rodney Surber Assistant City Attorney Title thief Operations Officer SANTA ANA CITY COUNCIL Valene Amezwa Benjamin Vazquez Thai Viet Phan Jessie Lopez Phil Bacerra Johnalhan Ryan Hernandez David Penaloza Mayor Mayor Pro Tem,Ward 2 Ward 1 Ward 3 Ward 4 Ward 5 Ward 6 vamezcua0santaana.oro bvazauez(a)santa-ana.ora Iphanl anta-ana or, iessielup4Asanta-ana.oro pbacenaCdsamaana.oro irvanhemandez(alsanta-ana.org doenalozaCu7santa-ana ora CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 04/0212025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER NAME: Vijay VOng50Ufy McGdff,a Marsh&McLennan Agency LLC company PHONE 503-943-6621 FAX, 503-943 6622 5400 SW Meadows Road,Suite 240 AIC No E AICNo Lake Oswego,OR 97035 EMAIL ADDRESS:Vilay.Vongsoury@mcgriff.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Bus Risk Retention Group 17324 INSURED INSURER B:AIU Insurance Company Greyhound Lines,Inc. 19399 PO Box 660632 INSURER c:National Union Fire Insurance Company of Pittsburgh,PA 19445 Dallas,TX 75266.0362 INSURER D;New Ham shire Insurance Company 23841 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER.,5HT4CDUU REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR D wVD POLICY NUMBER MMIDDIYYYY) (MMII30IYYYYI LIMITS A X COMMERCIAL ENERAL LIABILITY GL-RRO-001023 01/01/2025 01/01/2026 EACH OCCURRENCE $ 10,OD0,000 G D ED X T CLAIMS-MADE OCCUR PREMISES ER occurrence) $ 5,000,000 MED EXP(Any one person) $ PERSONAL&ADV INJ URY $ 10,000,000 GHN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 10,000,U00 PRO- 10,000,000 POLICY JECT LOC PRODUCTS-COMNOPAGG $ OTHER: $ A AUTOMOBILE LIABILITY AL-RRG-OD 023 01/01/2025 01/01/2026 COMBINED SINGLE LIMIT Ea accident 10,000,000 X ANY AUTO BODILY INJURY(Per parson) $ OWNHO SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Par accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ D wORKERS COMPENSATION 62790879 AOS 04/01/2025 04/01/2026 PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUT (; ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT3,000,000 OFFICERIMEM DER EXCLUDED? ❑ NIA $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 3,000,000 tryes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 3,000,000 B Auto Liability AL7281073 AOS) 04/01/2025 04/01/2026 Combined Single Limit 10,100,000 C AL7281072(MA) $ $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS/Vt:H1CLrzS (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Contractual Liability coverage is included under the General LlabiHty policy, RE:Leased Location:The Depot at Santa Ana;1000 East Santa Ana Boulevard,Santa Ana,CA.City of Santa Ana,its agents,officers,empioyees and volunteers are included as Additional Insured in accordance with the policy provisions of the General Liability policy.General Liability policy evidenced herein is Primary and Non-Contributory to other insurance available to an Additional Insured,but only in accordance with the policy's provisions.A Waiver of Subrogation is granted in favor of Certificate Holder in accordance with the policy provisions of the Workers'Compensation policy.Should General Liability policy be cancelled before the expiration date thereof,the policy provisions will govern how notice of canoelfation may be delivered to Certificate holders in accordance with the policy provisions, nise�eysi9 edeyT-T— Tu Train Nguyen Nguy" D,lm202s.D4e216<56s1 -mroo APPROVED . CERTIFICATE HOLDER CANCELLATION -By-Tu-Tran-NguyGn—at 4*5€-pin,-.Apr-02. 4g$ 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. Attention: PWA Facilities 20 Civic Center PI,M11 AUTHORIZED REPRESENTATIVE Santa Ana,CA 92701 USA � . Page 1 of @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AC® DATE tMMIDDIYYYY) i*. EVIDENCE OF PROPERTY INSURANCE 5HT4CDUU 04/02/2025 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. AGENCY PHONE 503-943-6621 COMPANY A!C No Ext McGriff,a Marsh&McLennan Agency LLC company Lexington Insurance Co. 5400 SW Meadows Road,Suite 240 Lake Oswego,OR 97035 Vilay Vongsoury aIC Na): 503-943-6622 p DRless; Vilay.Vongsoury@mcgriff.com CODE: sua coDE: AGENCY CUSTOMER ID& INSURED LOAN NUMBER POLICY NUMBER Greyhound Lines,Inc. 14627205 PO Box 660632 Dallas,TX 75266-0362 EFFECTIVE DATE EXPIRATION DATE 04/01/2025 04/0112026 CONTINUED UNTIL TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATI 0NID ESC RI PTI ON 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 RESPECTTO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, COVERAGE INFORMATION PERILS INSURED aASIC BROAD SPECIAL COVERAGE I PERILS I FORMS AMOUNT OF INSURANCE DEDUCTIBLE Building/Business Personal Property-Occurrence Limit $10,000,000 $1,000,000 Vehicles-Physical Damage-Any One Vehicle $700,000 Vehicles-Physical Damage-Any One Occurrence $10,000,000 $1,000,000 REMARKS(Includina S ecial Conditions CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAME AND ADDRESS ADDITIONAL INSURE❑ LENDER'S LOSS PAYABLE LA LOSS PAYEE MORTGAGEE City of Santa Ana LOAN# Attention: PWA Facilities 20 Civic Center PI,M11 AUTHORIZED REPRESENTATIVE Santa Ana,CA 92701 �7 USA -A& ACORD 27(2016/03) ©1993-2015 ACORD CORPORATION.All rights reserved. Page 2 of 2 The ACORD name and logo are registered marks of ACORD WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. This endorsement, effective 12:01 AM 04/01/2024 forms a part of Policy No. WC 062-79-0879 Issued to GREYHOUND L I NES, INC. By A I U INSURANCE COMPANY We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1 . PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY; OR, 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable in Kansas for private construction contracts as defined in K.S.A. 16-1801 through K.S.A. 16-1807 or public construction contracts as defined in K.S.A. 16-1901 through 16-1908, except where permitted by statute or other applicable law, such as for use in wrap-up insurance programs. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas, or Utah. WC 00 03 13 Countersigned b O Y (Ed. 04184) Authorized Representative ENDORSEMENT This endorsement, effective 12:01 A.M. 1/1/25 forms a part of Policy No. GL-RRG-001023 issued to GREYHOUND LINES, INC by BUS Risk Retention Group,Inc. PRIMARY COVERAGE FOR SPECIFIED PERSONS OR ORGANIZATIONS NAMED AS ADDITIONAL INSUREDS - ONGOING AND COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following paragraph is added to SECTION 11 - WHO IS AN INSURED and applies only to persons or organizations we have added to your policy as additional insureds by endorsement to comply with insurance requirements of written contracts relative to: a) the performance of your ongoing operations for the additional insureds; or b) "your work" performed for the additional insureds and included in the "products-completed operations hazard": This insurance is primary over any similar insurance available to any person or organization we have added to this policy as an additional insured. However, this insurance is primary over any other similar insurance only if the additional insured is designated as a named insured in the Declarations of the other similar insurance. We will not require contribution of limits from the other similar insurance if the insurance afforded by this endorsement is primary. This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, if it is not primary as defined in the paragraph above. All other terms and conditions of the policy are the same. 90533 (3/06) Page 1 of 1 POLICY NUMBER:GL-RRG-001023 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED AS A RESULT OF ANY CONTRACT OR AGREEMENT YOU HAVE ENTERED INTO. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 -- Who Is An Insured is amended to agreement, the insurance afforded to such include as an additional insured the person(s) or additional insured will not be broader than organization(s) shown in the Schedule, but only that which you are required by the contract with respect to liability for "bodily injury", or agreement to provide for such additional "property damage" or "personal and advertising insured. injury" caused, in whole or in part, by your acts B. With respect to the insurance afforded to these or omissions or the acts or omissions of those additional insureds, the following is added to acting on your behalf: Section IN — Limits Of Insurance: 1. In the performance of your ongoing If coverage provided to the additional insured is operations; or required by a contract or agreement, the most 2. In connection with your premises owned by we will pay on behalf of the additional insured or rented to you. is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable limits of insured only applies to the extent permitted insurance; by law' and whichever is less. 2. If coverage provided to the additional This endorsement shall not increase the insured is required by a contract or applicable limits of insurance. CG 20 26 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 1l1l25 forms a part of Policy No. GL-RRG-001023 issued to GREYHOUND LINES, INC by BUS Risk Retention Group,Inc. NOTICE OF CANCELLATION [SCHEDULED NOTICE] This endorsement modifies insurance provided under the following. AUTO DEALERS COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM snwnt 11_E NOTICE WILL BE MAILED TO: TO THE ATTENTION OF: COMMON POLICY CONDITIONS, A. - Cancellation, 2. is amended to read: 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. THIRTY 3 * days before the effective date of cancellation if we cancel for nonpayment of premium, or b. TH I RTY 3 * days before the effective date of cancellation if we cancel for any other reason in the event this policy is cancelled for any reason other than non-payment of premium, notice will be provided as set out in this endorsement to those Schedule entities. * the notice period provided shall not be less than that required by applicable state law(s). 97285 (9114) Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 COMMERCIAL AUTO CA04491116 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM 1lUith respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance — Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under such an insured under your policy provided that: other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 0 Insurance Services Office, Inc., 2016 Page 1 of 1 POLICY NUMBER COMMERCIAL AUTO AL-RRG-0010230 CA 20 48 1013 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM .._With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured; Greyhound Lines, Inc. Endorsement Effective Date: 01/01/25 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization that you agree in a"written contract requiring insurance" to include as an additional insured on this Coverage Part. "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a.After the signing and execution of the contract or agreement by you; b.While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section ill — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 4810 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 ENDORSEMENT This endorsement, effective 12:01 A.M. 1/101/01/25 forms a part of Policy No. AL-RRG-001023 issued to Greyhound Lines,Inc. by BUS Risk Retention Group, Inc. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, H., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. 74445 (10/99) Page 1 of 1 POLICY NUMBER: AL-RRG-001023 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Greyhound Lines,Inc. Endorsement Effective Date: 01/01/25 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED 1S REQUIRED TO PROVIDE A WAIVER. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person{s) or organization(s)shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 01nsurance Services Office, Inc., 2011 Pagel of 1 POLICY NUMBER: GL-RRG-001023 COMMERCIAL GENERAL LIABILITY CG24041219 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTSMOMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph B. Transfer Of Rights Of Recovery Against Others To Us of Section IV— Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 7