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HomeMy WebLinkAboutARRO AUTOGAS-2014INSURANCE ON FILE WORK MAY PROCEED *H—EAK OF COUNCIL DATE 9—e—l(l AGREEMENT FOR PROVISION [)F EQUIPMENT AND COMMODITY PROPANE FUELING STATON TH|OAGREEMENT,coedmaDdoUt8r8dinb1th|n1«mdayofMurch/2Ui4bvmVdbebweanSanLUiy B:hxnoDistributors, dbaArru/\o|Vgao'aC%l�onliuonrpnraUok/horyiD8�er^CuDtrado�>/ and the City ufSanta Ana, a charter city and municipal corporation organized and existing under the Constitution and laws nfthe State Vf California (hereinafter ''Oity''), 0-:0]� 1� The City desires to retain 8 Contractor having special skill and knowledge in the field ofPropane Fueling Station Equipment, Facility Servicing, Propane Supply and Distribution, 2^ C$oVauWr represents that Contractor io able and willing [vprovide such services tu the City and |a licensed by the State of California to provide Propane Fueling Station Sarvilcing, Propane Supply and %. In undertaking Vf this Contract, Contractor represents that it is knowledgeable ioits field and that any services performed bvCoUbacb>uDdortli8OnUtna(dVVi|hypedbrm*d|n compliance with such standards, NOW THEREFORE, In consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: i SCOPE DFSERVICES Contractor shall 1\ provide and install a propane fueling station 81 the Santa Ana Corporate Yard; provide maintenance of the fueling statlon| and 3) supply the propane commodity, as set forth in RFP ia-0i2 "Propane Fueling 3\8tnn"/attached hereto us Exhibit /\. and Incorporated bv this reference. Contractor shall provide specifications for the tark to be provided, and shall assist with the coordination and approval of site work necessary to accommodate the propane fuel facility. 1|. CONTRACT DOCUMENTS This Contract consists of this Agreement, the Special Provisions set forth in Exhibit A and the Maintenance specification attached hereto os Exhibit B. U|, OWNERSHIP OF DRAWINGS, SPECIFICATIONS, PROGRAMS AND SYSTEMS Contractor's contribution to tire Project, including drawings and specifications tobo produced bv Contractor hereunder, will not infringe nr misappropriate the proprietary orpersonal rights u[ any third person cir party. Any and all records, papers, drawings, specifications, prograrns, systems and other materiels prepared by Contractor pursuant to this Contract shall be the property of City, Contractor agrees io provide City with any such materials upon request ofCity. |Y TERM The term of this contract shall commence on the date oi award by City Council, however, to work shall commence until all required bonds and insurance oertifimateahave been approved by the City Attnrn ^ The installation nunbmct shall terminate upon the City's delivery to Contractor of written acceptance of the propane fueling station, at which time the five year maintenance and fuel delivery term shall CO[8Neooa. V. COMPENSATION a City agrees to pay and contractor agrees to accept as total payment for its services: 1. Provision of the propane tank(s), consultation services necessary to ensure the facility is buHt to acoommodato0nntraotnr'oeqV|pmont.ondinuta|ationuftheequ|pmuni.o(ota|uf$iV/508, 2. Maintenance and Repair services shall be provided at the rate of $412 per month. Said charges shall not exceed $4,950.00, annually, during the term of this agreement, S. Commodity purchase shall be charged as set forth in Contractor's February 5, 2014 letter, attached hereto as Exhibit B, setting forth the agreed method of setting the propane price. b. Invoices 1, The contractor shall submit a monthly invoice by the fifteenth of the month to the City for the services rendered in the prior month. 2. All Invoices forwork performed underthis contract shall be submitted in a format approved by the City. Invoices shall include the following information at a minimum: I. Contractor's invoice number I. Beginning and ending dates for services iii, City project number and /or name (if applicable) IV. Work site address/location (if applicable) V. Unit cost, subtotals and total for invoice 3, Payment by City shall be made within forty -five (45) days following receipt of proper invoice, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance of a professional parking control enforcement services. VI. INDEPENDENT CONTRACTOR Contractor shall during the entire term of this contract, be construed to be an independent contractor and not an employee of the City. This contract is not intended nor shall It be construed to create an employer - employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the manner in which contractor performs the services required by this contract. However, the services to be provided by contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's Social Security taxes, unemployment insurance, and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. VII. INSURANCE Prior to undertaking performance of work under this contract, contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal Injury, including. death resulting there from and damage to property, resulting from any act or occurrence arising out of contractor's operations In the performance of this agreement, Including, without limitation, acts Involving vehicles, The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of One Million Dollars ($1,000,000) per occurrence, Two Million Dollars ($2,000,000) in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers, and representatives as additional insured(s); (b) be primary and not contributory with respectto insurance or self- insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than One Million Dollars ($1,000,000) per occurrence. Such insurance shall Include coverage for owned, hired and nonowned automobiles. Propa n Psu pply2 /24114 Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, contractor Is required to be insured against liability for Workers' Compensation or to undertake self - Insurance. Prior to commencing the performance of the work under this contract, contractor agrees to obtain and maintain any employer's liability insurance with limits not less than One Million Dollars ($1,000,000) per accident. 4. The following requirements apply to the insurance to be provided by contractor pursuant to this section: a. Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this agreement. b. Certificates of insurance shall be furnished to the City upon execution of this contract and shall be approved in form by the City Attorney. C. Certificates and policies shall state that the policies shall not be canceled or reduced In coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. 5. If contractor fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and Is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this contract. Such termination shall not affect contractor's right.to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. VIII. HOLD HARMLESS/ INDEMNIFICATION To the fullest extent permitted by law, contractor shall indemnify, defend and hold harmless City, Its officers, agents and employees (collectively, the "indemnified parties') from and against any and all claims (Including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, suits, losses, judgments, fines, penalties, liabilities, costs and expenses (including, without limitation, attorney's fees, disbursements and court costs) of every kind and nature whatsoever (individually, a claim; collectively, "claims "), which may arise from or in any manner related (directly or indirectly) to any work performed or services provided under this contract (Including, without limitation, defects In workmanship and/or materials) or contractor's presence or activities conducted performing the work (including the negligent and /or willful acts, errors and/or omissions of contractor, its principals, officers, agents, employees, vendors, suppliers, contractors, subcontractors, anyone employed directly or indirectly by any of them or for whose acts they may be liable for any or all of them). Notwithstanding the foregoing, nothing herein shall be construed to require contractor to indemnify the indemnified parties from any claim arising from the sole negligence or willful misconduct of the indemnified parties. Nothing in this indemnity shall be construed as authorizing any award of attorney's fees in any action on or to enforce the terms of this contract. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by the contractor. IX. NOTICE Any notice, tender, demand, delivery or other communication pursuant to this agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or P ropan es upply2 /24/14 certified mail, postage prepaid, sent by telefacslmile communication, or via e -mall to the following persons: To City: Clerk of the Council City of Santa Ana 20'Civid Center Plaza (M' -30) Santa Ana, CA 92701 Fax 714 - 647 -6956 With courtesy copy to:Public Works Agency— Design Engineering City of Santa Ana 20 Civic Center Plaza (M -36) Santa Ana, CA 92701 Fax 714 - 647 -5635 To Contractor: Arro Autogas 1960 Ramada Dr Paso Robles, CA 93446 Fax 805 - 239 -1237 X. TERMINATION The City reserves the right to terminate the contract as follows: 1. In the event contractor fails or refuses to timely perform any of the provisions of this agreement in the manner required, or if contractor violates any provision of this agreement, contractor shall be deemed in default. City shall provide written notice of such default to contractor's project manager. Contractor shall cure said default within a period of two (2) working days. If such cure is not completed in a timely manner, City may terminate the agreement forthwith by giving written notice to contractor's project manager. Contractor shalt be responsible for all costs incurred by City, including replacement costs of equipment and labor required to provide service during contractor's default. In the event of such termination for cause, City shall pay contractor that portion of compensation specified in the agreement that is earned and unpaid prior to the effective date of termination. Contractor shall not be entitled to any compensation for lost profits w If terminated for cause. 2. This agreement may be terminated without cause by City upon thirty (30) days written notice delivered to the contractor either personally or by mail. Upon termination, City shall pay to contractor that portion of compensation specified in the agreement that is earned and unpaid prior to the effective date of termination. XI. CONTRACTOR OPTION FOR TERMINATION The contractor may request termination of the contract when conditions during the contract imake it impossible to perform or when prevented from proceeding with the contract by act of God, by law or official action of a public authority or in the event on nonpayment by the City. Such request will require one - hundred eighty (180) days written notice prior to contract termination date requested. In the event of nonpayment of undisputed sums by the City, contractor shall give the City thirty (30) working days to cure the alleged breach, XI 1. COMPLIANCE WITH APPLICABLE LAWS AND REGULATIONS Contractor shall perform all requirements under this contract in strict observance of and in compliance with all applicable environmental, traffic, safety and any other laws, regulations, ordinances, codes and any other legislative or statutory requirements. Prapznesupply212A114 ' 2. Contractor warrants that the performance of services under this contract shall be compliant with the current codes and requirements as adopted by Federal, State, County and City jurisdictions and as it may be amended or updated throughout the term of this contract. / F'WWWAf l Inasmuch as this contract Is intended to secure the specialized services of contractor, contractor may not assign, transfer, delegate or subcontract any interest herein without the prior written consent of City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. XV. JURISDICTION —VENUE This contract has been executed and delivered In the State of California and the validity, interpretation, performance and enforcement of any of the clauses of this contract shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this contract. XVI. FINES The contractor shall be liable for all violation fines levied against the City by federal, state, or local agencies with regulatory authority related to contractor provided services. XVII. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be Incorporated as if fully set forth in the body of this Agreement. /// Fropanesupply2 /241'14 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council SONIA CARVAHALO City Attorney M1 \ By: - Laura Sheedy Assistant City Attorney RECOMMEN Interim Executive pffrE Public Works Agency Props nesupply2 /24/14 PROVAL: CITY 05-SANTA ANA DAVID CZO City Manager EXHIBIT A RFP — PROPANE FUELING FACILITY Scope of services Assessment of Existing Conditions Contractor shall review and analyze the location of the proposed project and shall compare existing facilities and conditions with that which is requested by City, Contractor has clarified and made City aware of any errors, omissions, or discrepancies found. Coordination Contractors shall assist with coordination and approval of site work by others, as required to prepare the site to Install the propane dispensing system. III. Refueling Station: Contractor shall provide all equipment, materials and incidentals to provide a propane fueling station, complete and in place, which meets the following requirements: • Regulations: Project shall meet all regulations as set by the National Fire Protection Agency (NFPA), the Department of Transportation (DOT), the Occupational Safety and Health Administration (OSHA) the California Fire Code Article 58, Santa Ana Municipal Code Chapter 14, City of Santa Ana Planning and Building Agency and the Orange County Fire Authority. Bulk Storage Tank (Vessel): Provide (1) 2,000 gallon capacity horizontal tank. Bulk storage tank shall be constructed of steel in accordance with (American Society of Mechanical Engineers (ASME) and the requirement of state and local building and fire codes. Tank installation shall meet requirements of state and local building and fire codes. Tank shall be installed proper distance from other tanks, building, property lines and other structures as outlined in Codes. Tanks shall be painted a light, reflective color. "Propane" shall be stenciled on sides. Dispenser: Shall serve two vehicles, from two sides. Provide propane refueling dispenser, double hose, with fully integrated electronics to interface with the City of Santa Ana Corporate Yard "Fuelmaster" fuel management system. Key card system shall be pre - certified. IV. Service and Purchase Agreement Contractor shall provide 5 -year service and propane purchase agreement. Service shall include necessary maintenance and repair as required to ensure safety, proper function and use, All equipment, including but not limited to, hose, fittings, piping, valves, adapter thread, tank, shall be inspected on a monthly basis for leaks, corrosion, dents, bulging, rust and /or other damage and repaired /replaced when necessary. Fuel provider must provide qualified technicians for the dispenser. Documentation shall be provided evidencing that personnel who will be dispensing propane have been properly trained on safe propane handling procedures. Qualified trainings include, but are not limited to: Department of Transportation Hazmat Training, National Propane Gas Association's Certified Employee Training Program (CETP), and the GAS Check training Program. OSHA mandates that protective equipment be worn. Fuel will be re- filled and charged by gallon. Contractor shall provide a revenue share of $.10 per gallon of propane sold to Arro Autogas customers to enable City to recover costs associated - - - -- City of Santa Ana RFP 13 -012 Page 1 with providing propane fuel. Contractor will provide the data required by City to audit the accuracy of City revenue share receipts. Contractor shall monitor fuel supply in the propane tank and the reorder /refill process without downtime to City facility. V, Fuel: Propane must meet the California Air Resources Board (CARE) propane motor fuel specified levels. Fuel provider must provide alternative refueling locations with public access and 24 -hour card reader electronic point of sale (EPOS) system throughout Southern California. VI. Erosion Control Plan ( SWPPP For construction related projects having less than one (1) acre of disturbed soil, contractor shall prepare an erosion and sediment control plan immediately after award of the contract, for approval by the Agency. The erosion control plan shall remain in effect until approval to remove is granted by the Agency. VII. Record Drawings: Contractor shall provide record drawings of facility as installed, and all related permits, Licenses And Permits Contractor shall apply for and obtain all necessary permits as required by the City and all other regulatory agencies including Federal, State, and County jurisdictions, including the Orange County Fire Authority. City permits will be "no fee" permits. All fees required by other jurisdictions, within the Contractor's Scope of Work as described in RFP 13 -012 shall be the responsibility of the contractor, OWNERSHIP Fueling Station: Contractor to pay for, provide and install equipment (bulk storage tank, dispensing unit, motor /pump, key card system), which will be property of contractor /vendor for term of contract. When contract period ends, vendor shall remove said equipment from site. Commodity Purchase: City of Santa Ana will purchase propane fuel for City of Santa Ana Fleet Service vehicles at agreed upon cost. Contractor shall contract independently with private companies for their fuel purchase Contractor shall obtain business and seller's permits as outlined in this RFP. —City of Santa Ana RFP 13 -012 —_ -._ .. ---- - --- -_ Page 2 EXHIBIT B PRICE PROPOSAL February 5, 2014 City of Santa Ana 20 Civic Center Plaza Santa Ana, Ca 92702 Dear Suzi Furjanic / AIA,LEED Green Assoc!ate,Assoc. PL Planner; Re: New propane Fueling Station -Fleet Services This letter is In response to your email dated February 4, 2014 to the following questions in bold. Will we purchase fuel monthly? Will the rack price be revisited and taken into account at that time. Is "rack price" the correct language to use? Arro Autogas will bill the City of Santa Ana twice a month for all transactions during any two week period. All transactions will be recorded through the on -site Fuel Master Unit. The price Arro quoted on RFP #13 -012 was (Propane price to be $0.30 over Arro Autogas's laid in cost on date of delivery + taxes) Laid in is what it cost to truck the propane from the oil refinery to our Pomona facility, currently laid in Is $0.11. This equals a total margin /delivery cost of $0.41. The correct language is "AePEX Los Angeles rack on the date of transaction ". Did we agree that we would pay: Rack price + .30 ( +tax) for 0.50k gallons Rack price + .25 ( +tax) for 50 -75k gallons Rack price + .20 ( +tax) for 75k+ gallons Arro Autogas will offer a discount for volume as stated below. The discount will be based on gallons sold to the City of Santa Ana during each and every twelve month period of the five year term. The gallons will be calculated once the propane infrastructure is installed and approved for service by all local jurisdictions. This is not a cumulative number, but based on twelve months. The discount will be as follows: AePEX LA Rack +$0.41( +tax) for 0- 50,000 gallons within 12 months as described above. AePEX LA Rack +$0.36( +tax) for 50,001- 75,000 gallons within 12 months as described above. AePEX LA Rack +$0.31( +tax) for 75,001 + gallons within 12 months as described above. Thank You, Ted Olsen Market Manager Arro Autogas Propanesupply2 /24/14 '``C °RO CERTIFICATE OF LIABILITY INSURANCE `✓'� DATE /5 /2014 Y) 6/5/2014 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 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 0009892 Adler Belmont Dye Insurance Services, Inc. 369 Marsh Street Spite 200 San Luis Obispo CA 93401 CONTACT B NAME: xitni Parsons PNONE (805)540 -3900 aC NO•I005)$40 -3901 ik:.b;ar;ons@adlerbGlmontdye.com INSURERS AFFORDING COVERAGE NAtC4 INSURERA:North River Insurance Company 1105 INSURED San Luis Butane Distributors, Inc. (See attached for Additional Named Insureds) 1960 Ramada Drive Paso Robles CA 93446 INSURERB;United States Fire Insurance CO 21113 INSURER C:Insurance Company of the West 27847 INSURCRD;Lexington Insurance Company 9437 INSURER E: $ 1,000,000 1 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:13 -14 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE DDLSUOR POLICY NUMBER_ POLICY EFF MMIbDNYYY POUCYEXP IDp LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea $ 50, 000 A CLAIMS-MADE OCCUR X 06- 0746414 /29/2033 /29/2034 MEO EXP(An one Person) S 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS AGG $ 2,000,000 X POLICY PRO- LOG $ AUTOMOBILE LIABILITY MBCN-D INGLE 1 I 11000,000 A ANY AUTO BODILY INJURY (Per person) $ Ix ALL OWNED SCHEDULED AUTOS AUTOS 06- 8746414 /29/2013 /29/2014 pODILV INJURY Per eccldont ( I $ HIRED AUTOS X AUTOS (Per accident AMAGE $ Medical memo $ 5,000 UMBRELLA LIA6 X OCCUR EACH OCCURRENCE $ 9,000,000 AGGREGATE $ 9,000,000 B X EXCESS UAB CLAIMS-MADE OED I X I RETENTION$ 10,00 $ 23- 7081046 /29/2013 /29/2014 C WORKERS COMPENSATION X I WCSTATU- I O7H- FR AND EMPLOYERS' UABIUTY YIN E.L. EACH ACCIDENT $ 1 000 000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERNEMBER EXCLUDED? NIA E.L. DISEASE • EA EMPLOYE $ 1 000 000 (Mandatory in NH) SA 5006073 02 0/1/2013 0/1/2014 H yes, descnbo under E.L. DISEASE- POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS twl. D Excess Liability 49883239 /29/2013 /29/2014 Aggregate Liability 6,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom apace is to ad) City of Santa Ana, its officers, employees, agents, volunteers, an v itional Insured with respects to General Liability per form CG2026 (07/04). RE: Now propane Fueling Station -Fleet Services lase Sandov S nior Assistant City Attorney CERTIFICATE HOLDER CANcELLATIdN ACORD 25 (2070105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 Go1oo5).o1 The ACORD name and logo are registered marks of ACORD 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. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 Dave Belmont /CINDY ACORD 25 (2070105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 Go1oo5).o1 The ACORD name and logo are registered marks of ACORD POLICY NUUMt 506-8746414 COtIAUMIAL OMERAL. WERLI1Y 00 20 20 07 04 THIS CHANGES THE POLICY. PLEASE HEAD R CAREFULLY. F-Wol i Ire r r, d► Ttds eadomerraant mod@tas insurance provided under the foUmft- Loi r N � «a• '. ' a� . CG W 280704 0 ISO Properdes, Inc,, 2004 tie 1 oft Q Additional Named Insureds Other Named Insureds AePEX Energy Doing Business As ARRO Autogas Doing Business As Delta Liquid Energy Doing Business As DLE Holdings Doing Business As PL Holdings Doing Business As PLatz Leasing Doing Business As Propano Properties Doing Business As OFAPPINF (0212007) COPYRIGHT 2007, AMS SERVICES INC ACCOR " CERTIFICATE OF LIABILITY INSURANCE 1 9/DATE (MM/DD YYYY) 26/2014 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 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 0G09892 Adler Belmont Dye Insurance Services, Inc. 369 Marsh Street Suite 200 San Luis Obispo CA 93401 CONTACT Britni Parsons NAME: A/C NNo Ext: (805)540 -3900 A/C No: (805) 540 -3901 E -MAIL bparsons@adlerbelmontdye.com ADDRESS: e.com INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:North River Insurance Company 1105 INSURED San Luis Butane Distributors, Inc. (See attached for Additional Named Insureds) 1960 Ramada Drive Paso Robles CA 93446 INSURERB:United States Fire Insurance Co 21113 INSURER C: Insurance Company of the West 7847 INSURERD:Certain Underwriters at Lloyd's INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:14 -15 Master All Lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYY POLICY EXP MM /DD /YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED PREM SESOEa occurrrence $ 100,000 A CLAIMS -MADE Fx_1 OCCUR X 5068779732 9/29/2014 9/29/2015 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 Fx-]POLICYF—] PRO LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 068779732 9/29/2014 9/29/2015 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ X NON -OWNED HIRED AUTOS AUTOS Medical payments $ 5,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 B EXCESS LAB CLAIMS -MADE 5238005121 DED RETENTION$ $ 9/29/2014 9/29/2015 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N/A SA500687303 10/1/2014 10/1/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Excess Liability 14RENMA14000156068700 9/29/2014 9/29/2015 Aggregate Liability $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) See forms attached as triggered by written contract: GL: AI- CG2026 0704, PNC- FM101.0.1206 0111, 30DNOC- To follow from carrier. RE: New propane Fueling Station -Fleet Services. Desr U1191-g IDr'v M36 - ?age Of 13 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 (201005).01 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 Britni Parsons /BRITNI ACORD 25 (2010/05) INS025 (201005).01 © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds AePEX Energy Doing Business As ARRO Autogas Doing Business As Delta Liquid Energy Doing Business As Delta Liquid Energy Holdings Doing Business As PL Holdings Doing Business As PLatz Leasing Doing Business As Propano Properties Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC POLICYNUMBFR 506 - 8779732 COMMERCIAL GENERAL LIMLITY CG 20260704 THIS ENDORSBOENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifines insurance provided under the foilowing: ANY PERSON OR ORGANIZATION WHOM YOU ARE REQUIRED TO ADD AS AN ADDITIONAL INSURED TO THIS POLICY BY WRITTEN CONTRACT OR AGREEMENT UNLESS SUCH CONTRACT OR AGREEMENT IS EXECUTED AFTER THE DATE OF LOSS. be Section 11 — Who, Is An hmned Is amended to include as an add0tonal insured the persm(s) or crganb* dm(s) shown in the Schedule. but only with respect to liability for °bodily lnNry°, `property damage° or In .n by you acts orb emissions or the'acis or whole a r slans of those acting on your behalf: A In the performance of your ongoing operatlorW or IL In conneollon wlih your premises owned by or rented to you. CO 20 26 07 04 0 ISO Properties. Inc.. 2004 Page 1 of 1 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Expected Or Intended Injury 14. Newly Acquired Organizations 2. Amended Defense Coverage For Indemnitees 15. Additional Insureds By Written Contract 3. Non -Owned Watercraft 16. Additional Insured — Lessors of Leased Equipment Additional Insured —State Or Governmental 4. Non -Owned Aircraft 17. Agency Or Subdivision Or Political Subdivision — Permits Or Authorizations 5 Property Damage Liability — Borrowed Equipment 6. Property Damage Liability — Elevators 7. Damage To Premises Rented To You 8 Contractual Liability For Personal And Advertising Injury 9. Medical Payments 10. Supplementary Payments 11. Broad Form Named Insured 12. Fellow Employee Coverage 13. Incidental Medical Malpractice Liability 18. Additional Insured — Vendors 19. Broad Knowledge 1 Notice Of Occurrence 20 Waiver Of Transfer Of Rights of Recovery Against Others To Us 21. Unintentional Failure To Disclose Hazards 22. Mental Anguish, Mental Injury Or Humiliation 23. Mobile Equipment 24. Waiver Of Sovereign Immunity 25. Liberalization Clause 26. Application Of This Endorsement FM 101.0.1206 01 11 Page 1 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. 1. Expected Or Intended Injury Exclusion a. Expected Or Intended Injury under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: "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. 2. Amended Defense Coverage For Indemnitees Supplementary Payments - Coverages Aand B is amended as follows: Paragraph 2.d. under Section I - Supplementary Payments - Coverages Aand B is hereby deleted. Paragraph 2.e. under Section I - Supplementary Payments - Coverages Aand B is hereby deleted and replaced by the following: The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit ". In the event we agree a conflict exists between the interests of the insured and the interests of the indemnitee, we will select and assign separate defense counsel forthe indemnitee and pay reasonable attorney fees and necessary litigation expenses; and 3. Non -Owned Watercraft Paragraph (2)(a) of Exclusion g. Aircraft, Auto Or Watercraft under Section I - Coverage A - Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (a) Less than 55 feet in overall length; and 4. Non -Owned Aircraft Exclusion g. Aircraft, Auto Or Watercraft under Section I - Coverage A - Bodily Injury And Property Damage Liability does not apply to an aircraft, in which you have no ownership interest, provided: a. It is: (1) Loaned to; (2) Rented by; or (3) Hired or chartered by the insured with a paid and licensed crew; b. It is not being used to carry persons or property for a charge; and FM 101.0.1206 01 11 Page 2 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. c. The pilot in command holds a currently effective license, issued by the duly constituted authority of the United States of America or Canada, designating him or her as a commercial airline pilot for the particular aircraft being flown. 5. Property Damage Liability - Borrowed Equipment Paragraph (4) of Exclusion j. Damage To Property under Section I - Coverage A - Bodily Injury And Property Damage Liability is amended to include the following: This exclusion does not apply to equipment which you borrow from a person or entity, other than an insured, unless the "property damage" occurs while such equipment is being used by an insured at a job site. Subject to all terms of Section III - Limits Of Insurance, the maximum limit in any one "occurrence" is $25,000 subject to an annual aggregate of $50,000 for all 'occurrences ". The insurance provided by this exception to Exclusion j.(4) as set forth in Paragraph 5. of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. 6. Property Damage Liability - Elevators Exclusion j. Damage To Property under Section I - Coverage A - Bodily Injury And Property Damage Liability is amended to include the following: Paragraphs (3) and (4) of this exclusion do not apply to liability arising out of the use of elevators. The insurance provided by this exception to Exclusions j.(3) and j.(4) as set forth in Paragraph 6. of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. 7. Damage To Premises Rented To You a. The last paragraph of 2. Exclusions under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (1) With respect to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through n., do not apply. (2) With respect to damage by other than fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through n., except for Exclusion f., do not apply unless the damage arises out of "your work ". A separate limit of insurance applies to the coverage set forth in (1) and (2) above as FM 101.0.1206 01 11 Page 3 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. described in Section III - Limits Of Insurance. b. Section III - Limits Of Insurance is amended by deleting Paragraph 6. and replacing it with the following: 6. 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 the permission of the owner. The Damage To Premises Rented To You Limit is the amount set forth in the Declarations or $300,000, whichever is greater. 8. Contractual Liability For Personal And Advertising Injury Exclusion e. Contractual Liability under Section I- Coverage B - Personal And Advertising Injury Liability is amended to add the following after the last sentence: This exclusion also does not apply to that part of any contract or agreement pertaining to your business under which you assume the 'fort liability" of another party to pay for "personal and advertising injury" to a third party or organization, provided the "personal and advertising injury" offense occurs subsequent to the execution of the contract oragreement. For the purposes of this provision, "tort liability" means a liability that would be imposed by law in the absence of any contract or agreement. 9. Medical Payments Section I - Coverage C - Medical Payments is amended to include the following only if Coverage C - Medical Payments is not otherwise excluded from this coverage part: The Medical Payments Limit is changed to the greater of: a. $15,000; or b. The Medical Expense Limit shown in the Declarations of this coverage part. Paragraph 1.a.(3 )(b) under Section I - Coverage C - Medical Payments is hereby deleted and replaced by the following: The expenses are incurred and reported to us within three years of the date of the accident; and 14. Supplementary Payments Supplementary Payments - Coverages Aand B under Section I - Coverages is amended as follows: a. The bail bonds limit shown in Paragraph 1.b. is increased from $250 to $2,500. b. The actual loss of earnings limit shown in Paragraph 1.d. is increased from $250 to $1,000. FM 101.0.1206 01 11 Page 4 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. 11. Broad Form Named Insured Paragraph 1.d. under Section II — Who Is An Insured is amended to include the following: If you are an organization other than a partnership, limited liability company or joint venture, any of your subsidiary companies or any company over which you exercise control and actively manage will qualify as an insured only if other valid and collectible insurance does not apply. 12. Fellow Employee Coverage Paragraph 2.a. (1)(a) under Section II — Who Is An Insured is hereby deleted. 13. Incidental Medical Malpractice Liability Paragraph 2.a. (1)(d) under Section II — Who Is An Insured does not apply to "employees" who are employed as nurses or other "employees ", excluding physicians and medical doctors, who provide incidental health care services within the scope of their employment by you. 14. Newly Acquired Organizations Paragraph 3.a. under Section II — Who Is An Insured is hereby deleted and replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. 15. Additional Insureds By Written Contract Section II — Who Is An Insured is amended to include as an additional insured, any person or organization whom you are required to add as an additional insured to this policy by written contract or written agreement that is: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury ", "property damage" or "personal and advertising injury ". 1. The insurance provided to the additional insured applies as follows: (a) That person or organization is only an additional insured with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused by your negligent acts or omissions at or from: (i) Premises you own, rent, lease or occupy; or (ii) Your ongoing operations performed for the additional insured at the jobsite indicated by the written contract or written agreement. (b) The limits of insurance applicable to the additional insured are those specified in the FM 101.0.1206 01 11 Page 5 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. written contract or written agreement or in the Declarations of this policy, whichever are less. These limits of insurance are inclusive of, and not in addition to, the limits of insurance shown in the Declarations of this policy. 2. If the additional insured is an architect, engineer or surveyor, the insurance provided to the additional insured does not apply to "bodily injury ", "property damage" or "personal and advertising injury" caused by: (a) The rendering of or failure to render any professional services including preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (b) Any supervisory, inspection or engineering services. 3. With respect to the insurance afforded these additional insured(s), the following additional exclusion applies: This insurance does not apply to "bodily injury ", "property damage" or "personal and advertising injury ": (a) Occurring after all work (including materials, parts or equipment furnished in connection with such work) on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) Occurring after that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. Paragraph a. Primary Insurance of Condition 4. Other Insurance under Section IV - Commercial General Liability Conditions is amended by the addition of the following: Regardless of whether other insurance is maintained by an additional insured on a primary basis, the coverage provided by Paragraph 15. of the General Liability Enhancement Endorsement will be primary to and noncontributing with other insurance maintained by the additional insured if the written contract between you and the additional insured specifically requires that this insurance be primary. 16. Additional Insured - Lessors Of Leased Equipment Section II - Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease equipment and with whom you have agreed to add as an additional insured to this policy by written contract or written agreement but only with respect to "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of the equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insured(s), this insurance does not apply to any "occurrence" which takes place after the equipment lease expires or is FM 101.0.1206 01 11 Page 6 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. terminated. 17. Additional Insured - State Or Governmental Agency Or SubdMsion Or Political Subdivision - Permits Or Authorizations Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision which has issued a permit or authorization to you. a. This applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. b. This insurance does not apply to: (1) "Bodily injury ", "property damage" or "personal and advertising injury" arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or (2) "Bodily injury" or "property damage" included within the "products- completed operations hazard ". 18. Additional Insured -Vendors Section II - Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) whom you have agreed to add as an additional insured to this policy by written contract or written agreement but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed orsold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations FM 101.0.1206 01 11 Page 7 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its "employees" or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. This insurance does not apply to any insured person or organization, from whom or which you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. The coverage afforded the additional insured under this provision will be excess over any valid and collectible insurance available to the additional insured as an additional insured under a policy issued to a manufacturer or distributor for products manufactured, sold, handled or distributed unless you require that this insurance be primary and non- contributory. 19. Broad Knowledge I Notice Of Occurrence Section IV — Commercial General Liability Conditions is amended to include the following: The requirement in Condition 2.a., which states that you must see to it that we are notified of any "occurrence" or offense, applies only when the "occurrence" or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "executive officer ", manager or supervisor if you are a corporation; or 5. A member, if you are a limited liability company. The requirement in Condition 2.b., which states that you must see to it that we receive notice of a claim or "suit ", will not be considered breached unless the breach occurs after such claim or "suit" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "executive officer ", manager or supervisor if you are a corporation; or 5. A member, if you are a limited liability company. If you report an accident to your Workers Compensation insurance carrier which later develops into a claim or "suit" for a liability "occurrence" for coverage which is provided by FM 101.0.1206 01 11 Page 8 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. this policy, failure to report such 'occurrence" to us at the time of the accident shall not be a violation of the notification of loss condition (Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV — Commercial General Liability Conditions) contained in this policy. It is agreed, however, that you shall give notification of such claim or "suit" to us as soon as you are made aware of the fact that the particular accident has developed into a claim or "suit ". 20. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV— Commercial General Liability Conditions is amended to include the following: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under contract with that person or organization and included in the "products - completed operations hazard" when you have waived such right of recovery under a written contract with that person or organization. Such written contract must be: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury ", "property damage" or "personal and advertising injury ". Alternatively, the written contract may be executed after the 'bodily injury ", "property damage" or "personal and advertising injury" but only if: (i) The terms and conditions of the written contract or written agreement had been agreed upon prior to the "bodily injury ", "property damage" or "personal and advertising injury'; and (ii) The insured can definitively establish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon prior to the "bodily injury ", "property damage" or "personal and advertising injury ". 21. Unintentional Failure To Disclose Hazards Section IV — Commercial General Liability Conditions is amended to include the following: 9. Unintentional Failure To Disclose Hazards Your unintentional failure to disclose all hazards or prior "occurrences" existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy. 22. Mental Anguish, Mental Injury Or Humiliation The definition of "bodily injury" in Paragraph 3. under Section V— Definitions is hereby deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including FM 101.0.1206 01 11 Page 9 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. mental anguish, mental injury, humiliation or death resulting from any of these at any time. 23. Mobile Equipment Paragraph 12. under Section V - Definitions is amended to include the following: Paragraph f.(1) does not apply to self - propelled vehicles of less than 1,000 pounds gross vehicle weight. 24. Waiver Of Sovereign Immunity The following provision applies if you are a "governmental entity" or we have added a "governmental entity "to your policy as an additional insured, and the "governmental entity" requires us to obtain permission prior to asserting a defense involving governmental immunity or the jurisdiction of the tribunal over the "governmental entity ": We shall not raise any defense involving, in any way, the jurisdiction of the tribunal over the "governmental entity ", the immunity of the "governmental entity" or its commissioners, officers, agents or employees, the governmental nature of such entity, or the provisions of any statutes respecting suits against the "governmental entity" without first obtaining express advance permission from the designated representative of the "governmental entity ". Application of this provision shall not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. For the purposes of this provision, "governmental entity" means a state, county, district, municipality, town, township, borough, parish, village, or other political subdivision or governmental agency or subdivision. 25. Liberalization Clause If we adopt a change in the coverage form, CG 00 01, which broadens coverage without an additional premium charge, the broader coverage will apply to this policy on the effective date of approval in the state shown in the Named Insured's address in the Declarations of this policy. 26. Application Of This Endorsement The coverage enhancements provided by this endorsement apply to the Commercial General Liability Coverage Part. If your policy includes other endorsements in addition to this General Liability Enhancement Endorsement, and there is a conflict between any of the terms of such endorsement(s) and this General Liability Enhancement Endorsement, the terms of the other endorsement(s) shall be given priority and control over the terms set forth in this General Liability Enhancement Endorsement, even if the terms of such other endorsement(s) have the effect of limiting, excluding or reducing the coverage provided under this General Liability Enhancement Endorsement. All other terms and conditions remain unchanged. FM 101.0.1206 01 11 Page 10 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. , ,,,,.., ARRO AUTOGAS A- 2014 -075 REVIEWED BY: EUNICE HEREDIA (PG I OF 13) ,aC"Rbr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 9%25/2015 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 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 G09892 CONTACT Dave Belmont NAME Adler Belmont Dye Insurance Services, Inc. PHONE (605)540 -3900 1 FAX Iaosl540 --3901 ?�d�n rvg..��Sl.;- tAPG EVot. 369 Marsh Street A R�ESS ,DBelmont @AdlerBelmontDye.com INSURERi§J AFFORDING COVERAGE _m.._._. NAIC A Suite 200 IINSURERA.North River Insurance Company 2',1105 San Luis Obispo CA 93401 INSURED INSURER B_United States Fire Insurance Cc 21113 San Luis Butane Distributors, Inc., DBA: Delta INSURER C: Insurance Company Of the West __ __. – 2.7647 1960 Ramada Dr. INSURER DRSUI Indemnity Company $ 50,000 '..... INSURER E INSURER F Paso Robles CA 93446 COVERAGES CERTIFICATE NUMBER :15- 16GL,AL,WC,UMB REVISION NUM'BEIR= 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. 1NSR LTR TYPE OF INSURANCE AD ®L INSD SUBR WVD _.'.'..'.....' POLICY NUMBER PCbLICY EPF MMIDDIYYYY POLICY' EXP MM. DDIYYYY �... ... LIMITS X COMMERCIAL GENERAL. LIABiLIITY OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR rEACH AGE TO RENTED MiS � E k $ 50,000 X 5068826649 9/29/2015 9/29/2016 ... EXP (Any one person) $ 10 , 400 SONAL 8 ADV INJURY $ �. 1 , 000, 000 GEN L AGGREGATE LIMIT APPLIES PER': GENERAL. AGGREGATE $ 2,000,000 X POLICY 1-1 PEQ II LOC PRODUCTS - COMPIOP AGG _ ..$...,.. 2,000,000 Employee Benefits S 1,000,000 OTHER: AUTOMOBILE. LIABILITY COM II BINED SINGLE LIMIT' Ea a.'oenk $ 1,000,000 ._ BODILY INJURY (Per person) ._. $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED AUHEDLVLED AUTOS AUTOS ._X__ JX 5068826649 9/29/2015 9/29/2016 NON-OWNED PROPERTY- bAN1AGE $ HIRED AUTOS AUTOS AUTOS I'er accident. $ X UMBRELLA LDAB – OCCUR EACH OCCURRENCE $ 14 Ci44 440 B EXCESS LAS CLAIMS-MADE AGGREGATE ...$._._ 10 000 000 DED ,...'RETENTION$ $ 5238031671 9/29/2015 9/29/2016 WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN '... STATUTE, m.m I ER E . L. EACH ACCIDENT $ 1 _L 044 ANY ?ECUTIVE LT-"T NIA' C OPFICERIMEMBERI EXCLUDED E:.L...DYSEAS. E .E - EA EMPLOYE .. $ 1,000,000 (Mandatory in NH) WSA500687304 10/1/2.015 10/1/2016 If yea, describe under. -_ ---- -- _..- _....� DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1.000 000' ''.. D Excess Liability NEA,238774 09/29/2015 09/29/2016 Aggregate Liability Limit. $5,000,440 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) See forms attached as triggered by written contract: GL: AI- CG2026 0704, PNC- FM101.0.1206 01,1,1, 30DNOC- Co .fallow from carrier. RE: New propane Fueling Station -Fleet Services,. City of Santa Ana 24 Civic Center plaza Santa Arta, CA 92702 ACORD 25 (2014101) INS025120140II I L'i -11l11111111 IlIN W=71[iJ@ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Dave 13e11mc:)nt /LAURA @ 1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ARRO AUTOGAS A-2014-075 REVIEWED BY EUNICE HEREIDIA (PG 3 OF '13) Jv N y-jr N, Illitm AM PERSON OR ORMAMEATION WHO14 YOU ME REQUIRED TO ADD AS AN =ITIONAL INSURED TO THIS POLICY BY WRITTEN CONTRACT OR AGREEMENT MESS SUCH CONTRACT OR AGREEMMT IS EXECUTED ApTER THE, DATE Op LOSS. CG 20 20 07 04 0 180 Prop wiles. Inc., MM page 1 ARRO AU TOGAS A-2014-075 REVIEWED BY: EUNCE HEREDIA (PG 4 OF 13) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Expected Or Intended Injury 2. Amended Defense Coverage For Indemnitees 3. Non -Owned Watercraft 4. Non-Owned Aircraft 5. Property Damage Liability — Borrowed Equipment 6. Property Damage Liability —Elevators 7, Darnage To Premises Rented To You 8. Contractual Liability For Personal And Advertising Injury 9, Medical Payments 10. Supplementary Payments 11. Broad Form Named Insured 12, Fellow Employee Coverage 13. Incidental Medical Malpractice Liability 14. Newly Acquired Organizations 15. Additional Insureds By Written Contract 16, Additional Insured —Lessors of Leased Equipment Additional Insured —State Or Governmental 17. Agency Or Subdivision Or Potltical Subdivision — Permits Or Authorizations 18, Additional Insured — Vendors 19. Broad Knowledge I Notice Of OCCUrrence 20 Waiver Of Transfer Of Rights of Recovery Against Others To Us 21. Unintentlonal Failure To Disclose Hazards 22. Mental Anguish, Mental Injury Or Humiliation 23. Mobile Equipment 24. Waiver Of Sovereign Immunity 25, Liberalization Clause 26. Application Of This Endorsement FM 101.00206 01 11 Page 1 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission, ARRO AUTOGAS A-2014-075 REVIEWED BY� EUNICE HEREDIA (PG 5 OF 13) 1. Expected Or Intended Injury Exclusion a. Expected Or Intended Injury under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: "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. Supplementary Payments - Coverages Aand B is amended as follows: Paragraph 2.d. under Section I - Supplementary Payments - Coverages Aand B is hereby deleted. Paragraph Ze. under Section I - Supplementary Payments - Coverages Aand B is hereby deleted and replaced by the following: The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit". In the event we agree a conflict exists between the interests of the insured and the interests of the indemnitee, we will select and assign separate defense counsel for the indemnitee and pay reasonable attorney fees and necessary litigation expenses; and 3. Non-Owned Watercraft Paragraph (2)(a) of Exclusion g. Aircraft, Auto Or Watercraft under Section I- Coverage A - Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (a) Less than 55 feet in overall length; and 4. Non-Owned Aircraft Exclusion g. Aircraft, Auto Or Watercraft under Section I - Coverage A- Bodily Injury And Property Damage Liability does not apply to an aircraft, in which you have no ownership interest, provided: a. It is: (1) Loaned to; (2) Rented by; or (3) Hired or chartered by the insured with a paid and licensed crew; b. It is not being used to carry persons or property for a charge; and FM 101.0.1206 01 11 sa� r� Includes copyrighted material of Insurance Service Office, Inc, with its permission. EUNICE HEREDIA (PG 6 OF 13) ARRO AUTOGAS A-2014-075 REVI EVVED BY z 1' t Vim: �>' / c. The pilot in command holds a currently effective license, issued by the duly constituted authority of the United States of America or Canada, designating him or her as a commercial airline pilot for the particular aircraft being flown, Paragraph (4) of Exclusion j. Damage To Property under Section I - Coverage A- Bodily Injury And Property Damage Liability is amended to include the following: This exclusion does not apply to equipment which you borrow from a person or entity, other than an insured, unless the "property damage" occurs, while such equipment is being used by an insured at a job site. Subject to all terms of Section III - Limits Of Insurance, the maximum limit in any one "'occurrence" is $25,000 subject to an annual aggregate of $50,000 for all "occurrences". The insurance provided by this exception to Exclusion j.(4) as set forth in Paragraph 5. of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. 211= Exclusion j. Damage To Property under Section I - Coverage A- Bodily Injury And Property Damage Liability is amended to include the following: Paragraphs (3) and (4) of this exclusion do not apply to liability arising out of the use of elevators. The insurance provided by this exception to Exclusions, j.(3) and j.(4) as set forth in Paragraph 6. of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. a. The last Paragraph of 2. Exclusions under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (1) With respect to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through n,, do not apply, (2) With respect to damage by other than fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through n., except for Exclusion f- do not apply unless the damage arises out of "'your work". A separate limit of insurance applies to the coverage set forth in (1) and (2) above as FM 101.0. 1206 01 11 Includes copyrighted material of Insurance Service Office, Inc with its permission. ARRO AUTOGAS A-2014-075 REVYEWED BY: EUNICE HEREDIA (PG 7 OF 13) described in Section III - Limits Of Insurance, lb. Section III - Limits Of Insurance is amended by deleting Paragraph 6. and' replacing it with the folloW Ing: 6. 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 the permission of the owner. The Damage To Premises Rented To You Limit is the amount set forth in the Declarations or $3010,1000, whichever is greater. 8. Contractual Liability For Personal And Adverfising Injury Exclusion e. Contractual Liability under Section I- Coverage B - Personal And Advertising Injury Liability is amended to add the following after the last sentence: This exclusion also does not apply to that part of any contract or agreement pertaining to your business under which you assume the "tort liability" of another party to pay for "personal and advertising injury"' to a third party or organization, provided the "personal and advertising injury" offense occurs subsequent to the execution of the contract or agreement. For the purposes of this provision, "tort liability" means a liability that would be imposed by law in the absence of any contract or agreement. MEMEELE= Section I - Coverage C - Medical Payments is amended to include the following only if Coverage C - Medical Payments is not otherwise excluded from this coverage part: The Medical Payments Limit is changed to the greater of: a. $15,000; or b. The Medical Expense Limit shown in the Declarations of this coverage part. Paragraph 1.a.(3)(b) under Section I - Coverage C - Medical Payments is hereby deleted and replaced by the following: The expenses are incurred and reported to us within three years of the date of the accident; and 10. Supplementary Payments Supplementary Payments - Coverages Aand B under Section I - Coverages is amended as follows: a. The bail bonds limit shown in Paragraph I.b. is increased from $25'0 to $2,500. b. The actual loss of earnings limit shown in Paragraph I.d, is increased from $250 to $1,000. FM 101.0.1206 01 11 Page 4 of 10 Includes copyrighted material of insurance Service Office, Inc. with its permission. ` 8RROAUnOGAGA-014-073 REVIEWED GY� /^/L~ �V 1/ �- EUN|CEHERED|A (PG 8OF13) 11. Broad Form Named Insured Paragraph 1.d. under Section 11 - Who Is An Insured is amended to include the following: If you are mm organization other than a partnership, Uimited liability company or joint venture. any of your subsidiary companies or any company over which you exercise control and actively manage will qualify as am insured only if other valid and collectible insurance does not apply, 12. Fellow Employee Coverage Paragraph 2.e./1Va\ under Section 0- Who |sAm Insured is hereby deleted. 13. Incidental Medical Malpractice Uabilit/ Paragraph 2.a. (1)(d) under Section 11- Who Is An Insured does not apply tm "employees" who are employed as nurses mr other "ernp|oyees".excluding physicians and medical doctors, who provide incidental health care services within the scope of their employment byyn�. 14. Newly Acquired Organizations Paragraph 3.a. under Section Q- Who |sAn Insured bs hereby deleted and replaced bythe a. Coverage under this provsimnhs afforded only until the end nf the policy period. Section N - Who Is An Insured is amended to include as an additional insured, any person mr organization whom you are required hzadd as an additional insured to this policy by written contract or written agreement that is� a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the "bodily injury", "property damage"' or "personal and advertising 1. The insurance provided to the additional insured applies as follows bA That person or organization is only an additional insured with respect to liability for "bodily injoryp, "property damage" or "personal and advedisjnA injury" mauseU by your negligent acts or omissions a±orfrom: (i) Premises you own, rent, lease or occupy; or 00 Your oogoinQ operations performed for the additional insured ot the j bsite indicated by the written cointract or written agreement. (b) The limits of insurance applicable to the additional insured are those specified in the Page 5 of 10 Includes copyrighted rnater4 of lrisurance Service Office, Inc. with its perrnissbn. ^ A'--A-T---A-~ 14-` REVIEWED ~ ` w =kruYvr u/ written contract or written agreement or in the Declarations of this policy, whichever are less. These limits of insurance are inclusive of, and not in addition to, the limits ofimsmmance shown in the Declarations mf this policy. 2. If the additional insured isam architect, engineer mr surveyor, the insurance rovded tm the additional insured doles not apply k» "bodily injury", "property damage" or "'personal and advertising injury" caused by: (a) The rendering mfnr failure to render any professional services including preparing, ap inQorfmUimgtopmspomaorapprpvenaps.drawinqs,opin|ons, reports, surveys, change orders, designs or specifications; mr (b) Any supervisory, immoeo$omoremgi services. 3. With respect to the insurance afforded these additional insured(s), the following additional exclusion applies: This insurance does not apply ho "bodily i jom","o�ropertydamaoe"or~oerunna|amd advertising injury": (a) Occurring after all work (including materials, parts or equipment furnished in connection with such work) wnthe project (other than service, maintenance mr repairs) tmbe performed byVron behalf of the additional insured (s) atthe location of the covered operations has been completed ,or (b) Occurring after that portion of "your work" out of which the injury or damage arises has been put to its intended use bY any person or organization other than another contractor or subcontractor engaged in per-forming operations for a principal as part mf the same project. Paragraph a. Primary Insurance of Condition 4. Other Insurance under Section IIV - Commercial General Liability Conditions is amended by the addition of the following: Regardless of whether other ins,urance is maintained by an additional insured on a primary basis, the coverage provided by Paragraph 15. of the General Liability Enhancement Endorsement will be primary to and noncontributing with other insurance maintained by the additional insured if the written contract between you and the additional insured specifically requires that this insurance be primary, 16. Additimmd|mmumd - LessorsDfLeasedEquipment Section U - Who Is An insured is amended to include as an additional insured any person or organization from whom you lease equipment and with whom you have agreed to, add as am additional insured to this policy by written contract pr written agreement but only with respect to "bodily in'ury". "property damage" or"personel and advertising injury" caused, im whole or in part, by your maintenance, operation or use of the equipment leased to you by such person nrorganization. WiKhrespect tm the insurance afforded to these additional [nsum*d(a)' this insurance does not apply tn any '�mccumenoe" which takes place after the equipment lease expires oria FM1O1.(l12O8O1 11 Page 8oJ1O Includes copyrighted materiaf of Insurance Service Office, Inc. with its permission, ARRO AUTOGAS A- 2014 -075 REVIEWED BY- EUNICE HEREDIA (PG 10 OF 113) V terminated. 17. Addifiorml Insured - State Or Governmental Agency Or Subdmsion Or Political Subdivision - Permits Or ALdhorizations Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision which has issued a permit or authorization to you. a. This applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. b. This insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or (2) "Bodily injury" or "property damage" included within the " "products- completed operations hazard". 18. Addiltional Insured - Vendors Section 1'1- Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) whom you have agreed to add as an additional insured to this policy by written contract or written agreement but onlywith respect to "bodily injury" or "property damage" arising out of "your products" which are distributed orsold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement-, b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the Substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations FM 101.0120601 11 Page 7 of 10 Includes copyrighted materiel of Insurance Servuce Office, Inc. with its, permission, ARROAVTOGASA-2014-O75 REVIEWED III � ' EVW|CEHERED|A (PG 11OF13) performed at the vendor's premises in connection with the sale oft he product; 9. Products which, after distribution orsale by you, have been labeled mrrelabeled or used as, a container, part or ingredient of any other thing or substance by or for the vendor; or h` "Bodily injury" or"oropertydanlage~adsingoutnf§heso|emeo|iBemceofthevendmrfnr KsmvvmaotsmrmmmhasiwmsmrthoseoJhs,°erm9|Vyees°oranyone*Aeeadimgonitsbehalt However, this exclusion does not apply to: (1) The exceptions contained im subparagraphs d.ort;mr (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course mf business, in connection with the distribution or sale of the products, This insurance does not apply to any insured person or organization, from whom or which you have acquired such products, or any ingredient, part or container, entering into, accompanying mr containing such products. The coverage afforded the additional insured under this provision will be excess over any valid and collectible insurance available to the additional' insured as an additional insured under a policy issued to a manufacturer or distributor for products manufactured, sold, handled or distributed unless you requin* that this insurance bw primary and non- contributory. 19l Broad Knowledge / Nmfiue0fOccurrence Section IV – Commercial General Liability Conditions is amended to include the following: The requirement inCunditimm2.a.'vvhichstmteethetyournuetuee0uitthetweorencdifiednf any "occurrence" or offense, applies only when the "occurrence" or offense is known to� 1. You, if you are amindividual; 2.A partner, if you are a partnership; 3. A memmber, if you are a joint venture; 4.An "executive offiner", manager mr supervisor if you are acorporation; or 5.A member, |f you are a limited liability company. The requirement in Condition; 2.b`,which states that you must see hoit that vmareceive notice mfa claim or"auk"' will not be considered breached unless the breach occurs after such claim mr~smft"iaknown to: 1. You, if you are amindividual; 2./4 partner, if you are apartnership; 3.A member, if you are u— joint ventum� 4~ An "'executive officer", manager or supervisor if you area corporation; or 5. A member, if you are a limited liability company. If you report an accident to your Workers Compensation insurance carrier which later develops into a claim or "suit"for a liability "occurrence" for coverage which is provided by FM 10U.1206 01 11 Page 8 of 10 Includes copyrighted materaln[ Insurance Service Office, Inc. with its perrniseimm. ARRO AUTQGASA-2O14875REVEVVEDBY: ` EUN[CEHEREDLA (PG 12QF13) this policy, failure to report such "occurrence" to us at the time of the accident shall not be a violation of the notification of loss condition (Condition 2, Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV — Commercial General Liability Conditions) contained in this po|ioy. R in agreed, however, that you shall give notification of such claim or "suit" to us as soon as you are made aware of the fact that the particular accident has developed into o claim or"suit" 20. Waiver [M Transfer 0fRights Of Recovery Against Others TmUs Condition 8. Transfer OfRights Of Recovery Against Others To Us under Section IV— Commercial General Liability Conditions is amended to include the following: We waive any right ofnammverywemayhaveegainstaperaonornrganizatiombecauseof payments we make for injury ordamageohaingou(ofyourmngningooarotonsnr"vour work" done under a contract with that person mr organization and included im the "products- completed operations hazard" when you have waived such right of recovery under awritten! contract with that person ororganization, Such written contract must be� a. Currently in effect or becoming effective during the term of this policy; and kz Executed prior tm the "bodily in' nf."oropertydennaQe"or"oermmmdend advertising injury"'. Alternutiweyy,thevvhttenoontnactnmayheewecutedefterthe"bodi|yimjury",°property damage" mr "personal and advertising im'mrV" but only if: (1) The terms and conditions of the written contract or written agreement had been agreeduponpriortnthe"bodi|yinjmrv',."propertydemage" or"peroono]und advertising injury"; and (iA The Insured can definitively establish that the terms and conditions Vf the written nomfnactorwrittenu0re*nnemtoltima1*lyexecutedaretheaomeamtho*ewhiuhhed been agreed upon pdnrto the "bodily injmry","property damage" or "personal and advertising injury". Section K/— Commercial General Liability Conditions is amended toinclude the following: 9. Unintentional Failure To Disclose Hazards Your unintentional failure to disclose all hazards or prior "occurrences" existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy, 22 Mental Anguish, Mental Injury Or HundNabon The definition uf "bodily injury" imParaonaph8.uud*rSeotiom\/—DeDmitionoiahoreby deleted anid replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including FM '101.0.1206 01 11 Page 9 of 10 Includes copyrighted mmter4 of Insurance Service Office, Inc. with its permission, ARR]AUTOGAGA-U14-Q'5 REVIEWED GY� ` EUN|CEHERED&4 (PG 13OF13) mental anguish, mental injury, humiliation or death resulting from any of these at anytime, 23. Mobile Equipment Paragraph 12.under Section \/— Definitions is amended to include the following: Paragraph f.M\ does not apply to self-propelled vehicles of less than 1.UOOpnwmdsgross *ehic:leweight. 24. Waiver Of Sovereign Urnnnunitw The following provision applies if you are a "governmental entity" cxmmhave added ~gmvermrneota|entitv"toyomrpoUoyasamodditimmalinsunad.amdthe~omvernmnenta v requires mntn obtain pernninsimnph o o�0annorhmQode��nmeimmo|�mgqovernrmenba| immunity or the jurisdiction of the tribunal over the "governmental entity": We shall not raise any defense involving, im any way, the jurisdiction mfthetdbunal over the "governmental entity", the immunity of the "governmental entity" mrits commissioners, officers, agents or employees, the governmental nature of such entity, or the provisions cf any statutes respecting suits against the "governmental entity" without first obtaining express advance permission from the designated representative of the "governmental erMity" Application of this provision shall not subject msto liability for any portion nfmclaim or judgment in excess nfthe applicable limit Vfinsurance. For the purposes ofthis provision, "governmental entity" means a state, county, district, municipality, town, township, borough, parish, village, or other political subdivision or governmental agency orsubdivision. 25. UberaKzatiomClause Ifweadopt a change im the coverage form, CGOD81' which broadens coverage without an additinnopmsmmiurmcbarSe.the broader coverage will apply to this policy on the effective date pf approval |nthe state shown in the Named Unoored's address in the Declarations of this policy. The coverage enhancements provided by this endorsement apply tn the Commercial General Liability Coverage Part. K your policy includes other endorsements im addition tothis General Liability Enhancement Endorsement, and there is a conflict between any of the herms of such endorsement(s) and this General Liability Enhancement Endorsement, the terms of the other endorsemnent(s)shall be given priority and control over the terms set forth in this General Liability Enhancement Endorsement, even if the terms of such other endmrsement/�) have the ef�^�nf limiting, excluding or reducing the coverage prn� {} dedonderthisenems|' ' Liability Enhancement Endorsement. All other terms and conditions remain unchanged. FM 101.0.1206 01 11 Includes copyrighted material of Insurance Semico,Of&ce, |no, with bn permission.