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HomeMy WebLinkAboutINLAND ROUNDBALL OFFICIALS, INC. (2) INSURANCE ON FILE ran;, f.1f++" ' �CEED N-2025-193-01 CITY CLEr DATE:MAR 2 0 2926 FIRST AMENDMENT TO AGREEMENT WITH INLAND ROUNDBALL,INC. FOR SPORTS W RECREATION OFFICIATING SERVICES America kobt?,clo b) THIS FIRST AMENDMENT to the above-referenced agreement is entered into on February 26, 2026, by and between Inland Roundball Officials, Inc., a California corporation ("Contractor") and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement No. N-2025-193, dated May 16, 2025, by which Contractor agreed to provide officiating services for various youth and adult sporting leagues in the City("Agreement"). B. The Agreement is current and in-effect, and expires on May 31, 2027. C. The parties now wish to amend Exhibit A, as referenced in the Scope of Services section of the Agreement to add additional officiating services to be provided by Contractor. No other changes are contemplated by this First Amendment. The Parties therefore agree: 1. Exhibit A, as referenced in Section 1, Scope of Services, is amended to add the following language to the "Proposed Rates" list of services: Adult/Youth Soccer: o $45 per official for a one-hour game ■ Example (7pm, 8pm, 9pm): ■ I official— $135 ■ 2 officials=$270 o $30 per official for a 30-minute game ■ Example (7:30pm, 8pm, 8:30pm): ■ 1 official=$90 ■ 2 officials =$180 2. Except as modified by this First Amendment, all terms and conditions of the Agreement shall remain in full force and effect. [signatures appear on,following page] Page I of 2 SIGNATURE PAGE: FIRST AMENDMENT TO AGREEMENT WITH INLAND ROUNDBALL,INC. FOR SPORTS RECREATION OFFICIATING SERVICES ATTEST CITY OF SANTA A tl 7� vw NN� E ALL ='' ALVARO NUNEZ City Cler City Manager APPROVED AS TO FORM CONTRACTOR Sonia R. Carvalho City Attorney By: Ja n cgan(Mar 2,2026 19:45:30 EST) JONATHAN T. MA TINEZ By: Jason Logan Assistant City Attorney Title: Owner-Inland Roundball RECOMMENDED FO ROVAL HAW O Exec u e erect Parks, Recreation and Community Services Agency Page 2 of 2 ACOR" CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIODIYYYY) 09/0712025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: American Specialty Insurance 8,Risk Services,Inc. PHONE FAX A/C No Ezt: AIC Na: dba A.S.I.R.S.I. Insurance Agency(CA License#0E72661) A MAIL - DRESS: 7609 W.Jefferson Blvd.,Suite 100 INSURER(S)AFFORDING COVERAGE NAIL# Fort Wayne IN 46804 INSURERA: Arch Insurance Company 11150 INSURED INSURER B National Association of Sports Officials(NASD) INSURERC: 2017 Lathrop Avenue INSURER D: INSURER E: Racine WI 53405 INSURER F COVERAGES CERTIFICATE NUMBER: 1002394555 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 (NDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMiDDNYYY) (MWDDNM LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGET TED CLAIMS-MADE OCCUR PREM[SES Ea REN occurrence $ 1,000,000 MED EXP(Any one person) $ Excluded A Y Y SBCGL0279608 08/01/2025 08/01/2026 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ECOT- LOG PRODUCTS-CCMPIOP AGG $ 5,000,000 X OTHER: OFFICIAL $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS ( I $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE SBFXS0044408 08/01/2025 08/01/2026 AGGREGATE S 9,000,000 DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRI FTORIPARTN ERIEXECUTIV E OFFICERIMEMBEREXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Myyandatory in NH) F.L.DISEASE-EA EMPLOYEE $ If s.describe under DESCR PTION OF OPERATIONS below — APPROVED E.L. I..L.DISEASE-POLICY MIT S -7 By Tu Tran Nguyen at 7:34 am,Sep 10,2025 Tran Digitally signed b Tu Tran Nguyen Date:2025.09.10 u en 07:34:42-0TOO' DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) -Coverage applies to JASON LOGAN,3925 SCARLET OAK CT,SAN BERNARDINO,CA 92407. -The Certificate Holder shall be an Additional Insured,but only with respect to the operations of the Named Insured,and subject to the provisions and limitations of Form CG 2026-Additional Insured-Designated Person or Organization,effective September 07,2025. CERTIFICATE HOLDER CANCELLATION City of Santa Ana,Parks, Recreation and Community Services SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE - Santa Ana CA 92701 I 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC 4: Ac"®V ADDITIONAL REMARKS SCHEDULE Pagel of 1 AGENCY NAMED INSURED American Specialty Insurance&Risk Services,Inc. National Association of Sports Officials(NASD) POLICY NUMBER 2017 Lathrop Avenue SBCGL0279608 CARRIER NAIL CODE Racine,Wl 53405 Arch Insurance Company 11150 EFFECTIVE DATE: 08/01/2026 ADDITIONAL.REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE-Certificate#1002394555 -Unintentional Errors&Omissions,$100,000 each occurrence/$100,000 Annual Aggregate per official/assignor (included in,and not In addition to,the limits shown in the Declarations of this policy) -Other Named Insured: National Association of Sports Officials(NASD)&NASO-member officials,including officials enrolled by associations,contracted with NASO,judges, referees,evaluators or other administrative staff of the officiating crew acting in an officiating capacity. -Other Named Insured(cont'd):NASD-member officials are only Named Insureds while acting in their capacity as officials during sports events organized by a recognized sanctioning body or organized by another entity,where the rules of a recognized sanctioning body are followed,such as a local Park Department or any formal organized association and/or while attending seminars,conferences,and similar meetings designed -Other Named Insured(confd):to improve their officiating knowledge and skills and/or mentoring or providing instruction to or evaluation of another official. -Other Named insured(cont'd):LLC's that are created by an NASD member officials for the sole purpose of handling payments from officiating and assigning activities.It Is further understood and agreed that NASO member officials and his/her respective LLC is considered to be one entity for the purposes of coverage throughout the policy and all amendatory endorsements. -The excess Aggregate Limit applies separately to each"official"insured under this policy. However,in the event of a suit by one or more plaintiffs against more than eight"officials",the Aggregate Limit will not apply separately to each"official",and a single aggregate limit of$20,000,000 will apply collectively to all Individual"officials"covered under this policy. -The general liability policy does not contain an exclusion for sexual abuse,molestation, misconduct,or simillar offenses. -The General Liability policy includes Waiver of Subrogation as per Form CG 2404 Waiver of Transfer of Rights of Recovery Against Others to Us. ACORD 701 (2048I01) ®2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:SBCGL0279608 COMMERCIAL GENERAL LIABILITY CG 20 2612 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 Certificate Holder identified as an additional insured on a Certificate of Insurance issued by American Specialty Insurance & Risk Services, Inc. dba A.S.I.R.S.I. Insurance Agency, American Specialty Insurance & Risk Services Agency, and A S Insurance& Risk Services Agency Information required to complete this Schedule, If not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these Include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury", '"property If coverage provided to the additional insured is damage or personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable limits of 2. In connection with your premises owned by or insurance; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable limits of insurance. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 2612 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: SBCGL0279608 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 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: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): The person or organization with whom the insured has executed an agreement or contract prior to the loss. Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 0412 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 CITY OF SA►1►TA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I Jason A. Logan (`Representative"),attest that I am an authorized {Name and Title of Vendor Representative) representative Inland Roundball Officials Inc. p ("Company") and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following,as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide sports recreation officiating services ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana,Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum professional liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be full liable for an and all damages. n,ranVED P y y g By ru rrare VJguyart at'10:40 am,Mar 17,2026 3/11 /2026 100, Signature h,mte Jason A. Logan Print Name Owner Title 714-330-0779. Inland round ballofficials@a gmail.com Contact Information,i.e.,Telephone Number and/or Email Address WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($I00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR.IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for workers'Compensation Insurance 11.12.2024 CITY OF SANTA ANA Risk Management a division of Human Resources , Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR AUTOMOBILE LIABILITY INSURANCE I, Jason A. Logan ("Representative"),attest that I am an authorized (Name and Title of vendor Representative) representative of Inland Roundball Officials Inc. ("Company"), and (Consultant/Company Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number ("Agreement")to provide sports recreation officiating services ("Services"): (Services to be provided under agreement/contract) During the course and scope of Company's agreement with the City of Santa Ana, Company employees, consultants, representatives, and agents will not use and/or drive any Company owned/rented/leased/borrowed vehicles to perform Services to, for,or on behalf of City of Santa Ana. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum automobile liability insurance coverage as required in the Agreement, it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. _ 3/11/2026 Signature Q,3 to Jason A. Logan Print Name Owner Title 714-880-0779. lnlandroundballofficials@gmail.com Contact Information,i_e.,Telephone Number and/or Email Address Affidavit of Exemption for Automobile Liability Insurance 11.12.2024 ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/05/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: American Specialty Insurance&Risk Services, Inc. ONE FAX A CC No Ext: A/C,No): dba A.S.I.R.S.I. Insurance Agency CA License#OE72661 E-MAIL 9 Y( ) ADDRESS: 7609 W.Jefferson Blvd.,Suite 100 INSURER(S)AFFORDING COVERAGE NAIC# Fort Wayne IN 46804 INSURERA: Arch Insurance Company 11150 INSURED INSURER B: National Association of Sports Officials(NASO) INSURERC: 2017 Lathrop Avenue INSURER D: INSURER E: Racine WI 53405 INSURER F: COVERAGES CERTIFICATE NUMBER: 1002506490 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE � OCCUR PREM SES DAMAGE TOE.occurrence) ccurrrence $ 1,000,000 MED EXP(Any one person) $ Excluded A Y Y SBCGL0279609 08/01/2026 08/01/2027 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 5,000,000 X OTHER: OFFICIAL $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LAB CLAIMS-MADE SBFXS0044409 08/01/2026 08/01/2027 AGGREGATE $ 9,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICE R/M EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) APPROVED By Tu Tran Nguyen at 11:03 am,Aug 06,2026 Coverage applies to JASON LOGAN, 3925 SCARLET OAK COURT, SAN BERNARDINO,CA 92407. The Certificate Holder shall be an Additional Insured,but only with respect to the operations of the Named Insured,and subject to the provisions and limitations of Form CG 2026-Additional Insured-Designated Person or Organization,effective August 05,2026. CERTIFICATE HOLDER CANCELLATION City of Santa Ana, Parks, Recreation and Community Services SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED American Specialty Insurance&Risk Services,Inc. National Association of Sports Officials(NASO) POLICY NUMBER 2017 Lathrop Avenue SBCGL0279609 CARRIER NAIC CODE Racine,WI53405 Arch Insurance Company 11150 EFFECTIVE DATE: 08/01/2026 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE-Certificate#1002506490 -Unintentional Errors&Omissions,$100,000 each occurrence/$100,000 Annual Aggregate per official/assignor (included in,and not in addition to,the limits shown in the Declarations of this policy) -Other Named Insured:National Association of Sports Officials(NASO)&NASO-member officials,including officials enrolled by associations,contracted with NASD,judges, referees,evaluators or other administrative staff of the officiating crew acting in an officiating capacity. -Other Named Insured(cont'd):NASO-member officials are only Named Insureds while acting in their capacity as officials during sports events organized by a recognized sanctioning body or organized by another entity,where the rules of a recognized sanctioning body are followed,such as a local Park Department or any formal organized association and/or while attending seminars,conferences,and similar meetings designed Other Named Insured(cont'd):to improve their officiating knowledge and skills and/or mentoring or providing instruction to or evaluation of another official. Other Named Insured(cont'd):LLC's that are created by an NASO member officials for the sole purpose of handling payments from officiating and assigning activities.It is further understood and agreed that NASO member officials and his/her respective LLC is considered to be one entity for the purposes of coverage throughout the policy and all amendatory endorsements. -The excess Aggregate Limit applies separately to each"official"insured under this policy. However, in the event of a suit by one or more plaintiffs against more than eight"officials",the Aggregate Limit will not apply separately to each"official",and a single aggregate limit of$20,000,000 will apply collectively to all individual"officials"covered under this policy. -The General Liability policy includes Form 00 SGLO143 00 Sexual Abuse or Molestation Coverage Endorsement with the following limits:$1,000,000 Each Occurrence,$2,000,000 Aggregate.These limits are included in and are not in addition to the limits shown for Each Occurrence and General Aggregate Limit on this policy. -The General Liability policy includes Waiver of Subrogation as per Form 00 SGL0031 00 Commercial General Liability Extension Endorsement.The Waiver of Subrogation applies when required by a written contract executed prior to loss. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:SBCGL0279609 COMMERCIAL GENERAL LIABILITY CG20261219 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 Certificate Holder identified as an additional insured on a Certificate of Insurance issued by American Specialty Insurance & Risk Services, Inc. dba A.S.I.R.S.I. Insurance Agency, American Specialty Insurance & Risk Services Agency, and A S Insurance & Risk Services Agency Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III —Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable limits of 2. In connection with your premises owned by or insurance; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable limits of insurance. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: SBCGL0279609 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us" and "our" refer to the company providing this insurance. The following is a summary of the Limits of Insurance and additional coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Unless otherwise stated herein, the terms, conditions, exclusions and other limitations set forth in this endorsement are solely applicable to coverage afforded by this endorsement, and this endorsement amends the policy as follows: A. Expected or Intended Injury — removed exclusion for "property damage" resulting from the use of reasonable force to protect persons or property; B. Non-owned Watercraft Extension —coverage length is increased to 58 ft.; C. Supplementary Payments — bail bonds increased to $5,000/Loss of earnings increased to $1,000 each day; added employee indemnification defense coverage D. Who Is An Insured — broadened to include newly acquired or formed organizations until policy expiration; added blanket additional insured status for funding source; E. Notice and Knowledge of Occurrence; F. Unintentional Failure To Disclose Hazards —coverage is not prejudiced; G. Broadened definition of Advertising Injury— includes televised or videotaped publication; H. Bodily Injury—extension of coverage; I. Personal Injury—amended definition to include abuse of process/discrimination; J. Liberalization Clause K. Damage To Premises Rented To You Extension • Perils of fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 7 with its permission. • Limit increased to $300,000 L. Blanket Waiver of Subrogation M. Incidental Medical Malpractice Injury N. Injury to Co-Employees and Co-Volunteer Workers A. Expected Or Intended Injury Section I — Coverages, Coverage A Bodily Injury and Property Damage Liability, 2. Exclusions, a. Expected Or Intended Injury is deleted and replaced by the following: a. Expected Or Intended Injury "Bodily injury" or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. Non-owned Watercraft Extension Section I — Coverages, Coverage A Bodily Injury and Property Damage Liability, 2. Exclusions, g. Aircraft, Auto Or Watercraft, (2) is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge. This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. The coverage provided by this non-owned watercraft extension is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. C. Supplementary Payments Section I —Coverages, Supplementary Payments—Coverages A and B is amended as follows: a. The limit for the cost of bail bonds is changed from $250 to $5,000; and b. The limit for loss of earnings is changed from $250 a day to $1,000 a day. c. The following is added: 3. We will pay on your behalf defense costs incurred by an "employee" in a criminal proceeding. However, you must have a prior written agreement with such "employee" whereby you agree to indemnify the "employee" for such defense costs and the agreement includes a provision for repayment of defense costs in the event of an adverse judgment. The most we will pay for any "employee" who is alleged to be directly involved in a criminal proceeding is $25,000 regardless of the number of employees, claims or "suits" brought or persons or organizations making claims or bringing "suits". D. Who Is An Insured Section II —Who Is An Insured is amended as follows: 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 2 of 7 with its permission. 1. If coverage for newly acquired or formed organizations is not otherwise excluded from this Coverage Part, 3., a. is amended to read as follows: a. Coverage under this provision is afforded until the end of the policy period. 2. The following is added: 4. Any person or organization with respect to their liability arising out of: a. Their financial control of you; and b. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for that person or organization. E. Notice and Knowledge of Occurrence 1. If you report an accident, injury, or "occurrence" to your workers' compensation insurer or your auto liability insurer and later you discover that you should have reported the accident or "occurrence"to us, we will not consider your failure to report the accident or"occurrence" earlier a violation of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 2. Duties in The Event of an Occurrence, Offense, Claim or Suit, as long as you give us notice as soon as you are aware that the "occurrence" may be a general liability claim rather than an auto liability claim or a workers' compensation claim. 2. Section IV — Commercial General Liability Conditions, 2. Duties In The Event of Occurrence, Offense, Claim or Suit, subparagraph a. is deleted and replaced by the following: a. You must see to it that we are notified promptly of an "occurrence" or an offense which may result in a claim. You, or someone acting on your behalf, must give this notice to us or any of our authorized agents as soon as practicable after you know of the "occurrence" or offense if you are an individual; after one of your partners knows of the "occurrence" or offense if you are a partnership; or after one of your executive officers or your insurance manager knows of the "occurrence" or offense if you are a corporation. Notice should include: (1) How, when, and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses, and (3) The nature and "location" of any injury or damage arising out of the "occurrence" or offense. However, knowledge of an "occurrence", offense, claim or "suit" by an agent, servant, or "employee" of any insured, and receipt of any demand, notice, summons, or other legal paper in connection with a claim or"suit" by any agent, servant, or"employee" of any insured, shall not in itself constitute your knowledge unless one of your officers, managers or partners has received such demand, notice, summons, or legal paper from the agent, servant, or "employee." F. Unintentional Failure To Disclose Hazards Section IV — Commercial General Liability Conditions, 6. Representations is amended to include the following: d. Your failure to disclose all hazards or prior "occurrences" known or existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, provided such failure to disclose all hazards or prior"occurrences" is not intentional. 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 7 with its permission. G. Advertising Injury—Televised Or Videotaped Publication 1. Section V— Definitions, 14. d and e are deleted and replaced by the following: 14. "Personal and advertising injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: d. Oral, written, televised or videotaped publication, in any manner, of material that slanders or libels a person or organization or disparages a person's or organization's goods, products or services; e. Oral, written, televised or videotaped publication, in any manner, of material that violates a person's right of privacy; 2. Section I —Coverages, Coverage B Personal and Advertising Injury Liability, 2. Exclusions, b. and c. are deleted and replaced by the following: b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral, written, televised or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral, written, televised or videotaped publication of material whose first publication took place before the beginning of the policy period. H. Bodily Injury— Extension of Coverage Section V— Definitions, 3. is deleted and replaced by the following: 3. "Bodily injury" means bodily injury, sickness or disease sustained by a person, and includes mental anguish, mental injury, shock or humiliation resulting from these. Except for mental anguish, mental injury, shock or humiliation, "bodily injury" also includes death resulting from such bodily injury, sickness or disease. I. Personal Injury— Abuse Of Process/Discrimination If Personal and Advertising Injury Liability Coverage (Coverage B) is not otherwise excluded from this Coverage Part, Section V— Definitions, 14. is amended as follows: 1. Item b. is deleted and replaced by the following: b. Malicious prosecution or abuse of process; 2. The following is added: h. Discrimination based on race, color, religion, gender, marital status, sexual orientation or preference, physical or mental condition, age, national origin or other protected class or characteristic established by any federal, state or local statues, rules or regulations, except when: (1) Done intentionally by or at the direction of, or with the knowledge or consent of: (a) Any insured; or (b) Any executive officer, director, stockholder, partner or member of the insured; or 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 4 of 7 with its permission. (2) Directly or indirectly related to the employment, former or prospective employment, termination of employment, or application for employment of any person or persons by an insured; or (3) Directly or indirectly related to the sale, rental, lease or sub-lease or prospective sales, rental, lease or sub-lease of any room, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling. The insurance afforded by this paragraph h. does not apply to fines or penalties imposed because of discrimination. J. Liberalization If we revise or replace our policy form to provide more coverage without additional premium charge, we will automatically provide the additional coverage as of the day the revision is effective in your state. K. Damage To Premises Rented To You Extension 1. The last paragraph of 2. Exclusions of Coverage A. Bodily Injury And Property Damage Liability of Section I -Coverages is deleted and replaced by the following: Exclusions c. through n. do not apply to damages to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, lightning, explosion, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. 2. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 3. Paragraph 6. of Section III — Limits of Insurance is deleted and replaced by the following: 6.a.Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire, explosion, lightning, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from fire, explosion, lightning, smoke, aircraft or vehicle or riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage or any combination of any of these. b. The Damage to Premises Rented to You Limit will be the higher of: (1) $300,000; or 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 7 with its permission. (2) The amount shown on the Declarations for Damage to Premises Rented to You Limit. 4. Paragraph 9.a. of the definition of"insured contract" under Section V— Definitions, is deleted and replaced by the following: "Insured contract" means a contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, aircraft or vehicle, riot or civil commotion, vandalism, leakage from fire extinguishing equipment or water damage to premises while rented to you, or temporarily occupied by you with the permission of the owner is not an "insured contract". 5. This Extension does not apply if coverage for Damage to Premises Rented to You of Coverage A. Bodily Injury And Property Damage Liability of Section I—Coverages is excluded by endorsement. L. BLANKET WAIVER OF SUBROGATION The following is added to Section IV—Commercial General Liability Conditions: Waiver of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. M. INCIDENTAL MEDICAL MALPRACTICE INJURY 1. For insurance applicable to this Extension, the definition of"bodily injury" in Section V— Definitions is amended to include, "Incidental medical malpractice injury". 2. The following definition is added to Section V— Definitions: "Incidental medical malpractice injury" means "bodily injury", mental anguish, sickness or disease sustained by a person, including death resulting from any of these at any time, arising out of the rendering of, or failure to render, the following services: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; b. The furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances; c. First aid; or d. "Good Samaritan Services". As used in this Extension, "Good Samaritan Services" are those medical services rendered or provided in an emergency and for which no remuneration is demanded or received. 3. Paragraph 2.a.(1)(d) of Section II -Who Is An Insured does not apply to any registered nurse, licensed practical nurse, emergency medical technician or paramedic employed by you, but only while performing the services described in Paragraph 2. above and while acting within the scope of their employment by you. Any "employees" rendering "Good Samaritan Services" will be deemed to be acting within the scope of their employment by you. 4. The following exclusion is added to Paragraph 2. Exclusions of Coverage A. — Bodily Injury And Property Damage Liability of Section I — Coverages: 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 6 of 7 with its permission. This insurance does not apply to liability arising out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuticals by or with the knowledge or consent of the insured. 5. For the purposes of determining the applicable Limits of Insurance of this Extension, any act or omission, together with all related acts or omissions in the furnishing of services described in Paragraph 2.a. through 2.d. above to any one person, will be considered one "occurrence". 6. This Extension does not apply if you are in the business or occupation of providing any of the services described in Paragraph 2. above. 7. The insurance provided by this Extension shall be excess over any other valid and collectible insurance available to the insured, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by you to be excess of this policy. N. INJURY TO CO-EMPLOYEES AND CO-VOLUNTEER WORKERS 1. Section II— Who Is An Insured is amended to include your "employees" as insureds with respect to "bodily injury" to a co-"employee" in the course of the co-"employee's" employment by you, or to your "volunteer workers" while performing duties related to the conduct of your business, provided that this coverage for your"employees" does not apply to acts outside the scope of their employment by you or while performing duties unrelated to the conduct of your business. 2. Section II— Who Is An Insured is amended to include your "volunteer workers" as insureds with respect to "bodily injury"to a co-"volunteer worker" while performing duties related to the conduct of your business, or to your"employees" employment by you, provided that this coverage for your "volunteer workers" does not apply while performing duties unrelated to the conduct of your business. All other terms and conditions remain unchanged. 00 SGL0031 00 10 16 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 7 with its permission.