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Insurance Certificate: Peterson Machinery Co.
P52600213002 :..P a A �� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/29/2021 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 w BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. u, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(Ies)must have ADDITIONAL INSURED provisions or be endorsed. O 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 CA LIC OB29370 1-925-798-3334 CONTACT ME: Susan J. Peragallo co Edgewood Partners Insurance Center (EPIC) PHONE FAX `D [Concord - Branch In 15469] (AIC.No.Ext):925-822-9033 (A/c,No):925-609-5366 '^ E-MAIL susan.pera alio@e is Z P.O. Box 5668 ADDRESS: g p brokera.cola DJ INSURER(S)AFFORDING COVERAGE MAIC# Concord, CA 94524 INSURERA:NATIONAL UNION FIRE INS CO OF PITTS - 19445 INSURED INSURERS: LEXINGTON INS CO 19437 Peterson Machinery Co. INSURER C: INSURANCE CO OF THE STATE OF PA 19429 Peterson Holding Company P.O. Box 5258 ; INSURER D:NEW HAMPSHIRE INS CO 23841 INSURERE: TRAVELERS PROP CAS CO OF AMER 25674 San Leandro, CA 94577. INSURERF:-WESTCHESTER SURPLUS LINES INS CO 10172 COVERAGES CERTIFICATE•NUMBER:61765025 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. MSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP. INSD WVD POLICY NUMBER (MMIDDIYYY`) (MMIDDIYYYY) LIMITS A X COMMERCIALGENERALLIABILITY X X 0L5268175. 04/01/21 04/01/22 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 500,000 • MED EXP(Any one person) $ Excluded PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIEIS PER: GENERAL AGGREGATE $ 4,000,000 POLICY X JEC I ILOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILELIABILITY X X CA4489668 04/01/21: 04/01/22, COMBINEDSINGLELIMIT $ 5,000,000 (Ea accident) _ . X ANYAUTO - BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED• PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X. OCCUR 080877677 04/01/21 04/01/22 EACH OCCURRENCE $ 4,000,000 • EXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERSCOMPENSATION X PEROTH- C AND EMPLOYERS'LIABILITY X WC015893697 - Other Stats04/01/21 04/01/22STATUTE ER D ANYPROPRIETORIPARTNER/EXECUTIVE NIA WC015893698 - CA ONLY 04/01/21 04/01/22 E.L.EACHACCIDENT $ 1,000,000 OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Prop & Equip of Others QT6307387B447TIL21 04/01/21 04/01/22 Blanket Limit 10,000,000 Deductible 10,000 F Excess Liability 071796000001 • 04/01/21 04/01/22 Oce & Aggregate 10,000,000 DESCRIPTOR OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) RE: All Contracts/Written Agreements between the Certificate Holder and the Insured. Additional Ineured(s): City of Ashland, Oregon, its officers, agents and employees. where required by written contract per policy form attached. GL and Auto coverage is Primary and Waiver of Subrogation applies per,the attached where required by contract per policy form. WC Waiver of Subrogation Applies for California if required by written contract per the attached.policy . form. Excess Policy is follow-form. . CERTIFICATE HOLDER CANCELLATION Account #1044350 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N. Mountain Ave. AUTHORIZED REPRESENTATIVE Ashland, OR 97520 S1?%` I USA ' ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SPeragallo 61765025 , J • P5260028002 s DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 03/29/2021 NAME OF INSURED:Peterson Machinery Co. ,,, Peterson Holding Company w 0 N Additional Description of Operations/Remarks from Page 1: 00 Additional Information: SUPP(05/04) P5260028002 o COMMERCIAL GENERAL LIABILITY POLICY NUMBER:. GL 52681f75I� •� CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 M ADDITIONAL, INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations "ANY PERSON OR ORGANIZATION WHOA YOU, 'PER TIDE CONTRACTtOR AGREEMENT BECOME OBLIGATED TO INCLUDE AS�AN � � r � ADDITIONAL INSURED AS ArRESULT:OF-kANY CONTRACT OR�AGREEMYOU HAVE ENTERED ' r b 7 r 4v Kw x..f ytt ENT 9 `k INTO ° r g 4 j t � 7a � '"i} .,r x $ x �„i J � „�.5 ."!+1 d u kr3✓ a�r< �,t s <a r 7 , .., 7 �� 'i .t } r `�. I� 45"?'!': f,,? r aM. i ,� ,xpa r� �,v� , . < s,=. $ C Z �x.�3v ry r a �r a '"� `�x"�rxyt s ,aaht vis y, P°� hY Y" . v 9��.a �r�� a'�,2 ,w..e �.. �'.;N.c�,4 y;" s� . ,a � �Ar�.�.�x. +, ;.4,. 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 that which you are required by the contract include as an additional insured the porson(s) or or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury", B. With respect to the insurance afforded to these property damage or "personal and advertising additional insureds, the following additional injury" caused, in whole or in part, by: exclusions apply: 1. Your acts or omissions; or This insurance does not apply to "bodily injury" 2. The acts or omissions of those acting on or "property damage" occurring after: your behalf; • 1. All work, including materials, parts or in the performance of your ongoing operations equipment furnished in connection with such for the additional insured(s) at the location(s) work, .on the project (other than service, designated above. maintenance or repairs) to be performed by However: or onbehalf of the additional insured(s) at 1. The insurance afforded to such additional the location of the covered operations has insured only applies to the extent permitted been completed; or by law; and 2. That portion of "your work" out of which 2. If coverage provided to the additional the injury or damage arises has been put to insured is required by a contract or its intended use by any person or agreement, the insurance afforded to such organization other than another contractor or additional insured will not be broader than subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 ®Insurance Serivces Office,Inc. 2012 Page 1 of 2 P5260028002 P C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most applicable Limits of Insurance shown in the we will pay on behalf of the additional insured Declarations. M is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Serivces Office, Inc.2012 CG 20 10 04 13 P5260028002 • s POLICY NUMBER: '',GEf&lkiiiiigd-WW;afinnrt COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: z COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Operations Or Organization(s) "A Y PERSON OR ORGANIZATION WHOM YOU BECOME\, "PER THE CONTRACTOR AGREEMENT � fry✓ OB IGATED`TO INCLUDE AS AN ADDITIONAL INS RED AS', }% RESULT oF'pNY CONTRACT,ORSAGREEMENT,YOUE�HA�/E � a�, q#1 SV pK WE, t F x' VP r kr� •x � y".^�.� >. � r �'2 is ria �.:F. c Y`. r r a. a,�rr" \. a^�Sat" °r � x' r '�f' � s t � ENTERED INTO "v ¢- a * > d + a� �" 1 It 4 a,$ & �a $ s< k F tit r r txgf,+ u5. ; ✓�}/,r v�4x ':r�'c.�^,;.S. lV 'u," '>y"� ..:;.�}A�.. `4 .i �-' .�7 M f �5�°'a�" t,[4'Yes :- s�G:4?{'`"*i 1' '4 h't— 4'z�'3V:y y✓{.a`r `. qo r�> 5 s� tt > 'gig''x3 � o- g : : t`#.�`'��"�Y�xS.�`.?� s�'+r �t�- aMw.n > a �� �. & x� k+ �'`e �. Yx . 4f"` ..,r�`�a� �' r 4 -� , � , 3 x � *«} �j's a / r.� �S�xr ups � r;' �� s 4,.�`a$ :,, mss � s v' .,;''tZ,,,,.rtA. ''�a ; „ a....a., p . ,"nF..�s«c,..a..,,z ,,:. r..a44,5^,,�.,";a, i+:,ar a gil6 ," .:r r?'u ;.'r.,,.x'k''Y`>}40,3t;S.,t�`°.ilggv„"' ,s.'.��°..t;'� �'T MA 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 which you are required by the contract or include as an additional insured the person(s) or agreement to provide for such additional organization(s) shown in the Schedule, but only insured. with respect to liability for "bodily injury" or B: With respect to the insurance afforded to these property damage caused, in whole or in part, additional insureds, the following is added to by "your work" at the location designated and Section III- Limits Of Insurance: described in the Schedule of this endorsement : If coverage provided to the additional insured is performed for that. additional insured and requiredby a contract or agreement, the most included in the "products-completed operations we will pay on behalf of the additionalinsured hazard". is the amount of insurance: However: 1. Required by the contract or agreement; or 1. The insurance afforded to such additional 2. Available under the applicable Limits of Insu- insured only applies to the extent permitted rance shown in the Declarations; by law; and whichever is less. 2. If coverage provided to the additional This endorsement shall not increase the appli insured is required by a contract or agree- cable Limits of Insurance shown in the Decla- ment, the insurance afforded to such addi- rations. tional insured will not be broader than that CG 20 37 04 13 ©Insurance Serivces Office, Inc. 2012, Page 1 of 1 P5260028002 • • . . , . . 0 Thip-oodostnot;.eNotiv6 agyoll2021 „forms rip-trpf . . 'P'okcy io OL 526-81-7 issUed to PETERSON••tiOL.plicp'c,Ott.Attoy:. .0 SyNTIOMAL uNoN FER4: )1!10404.'01PANY.OF•PIT:TAIVAGH'i: PA „ tlii$,ENP00OrtCKANGSg .THE,PPlite)r. P..4EA$E K4'.4!”IT PAOE.P.utk:*, LIIVII:tED ADVIdt'OPeANCELLATION 1410V16.E11 VIA' ..-611AIL. -To ENT014*.OTOgRifklAN•11.WfmsT:NAmgp.',0$uREo Thii,:ptilit.si.:it•'aiihehifed#fhilaWsi,. • • In \ „ thti;e4gtint that*InWterd'aiitelsAhi§;0110 f0ryEison OfhersiNid rfo.WO4V.iffo'ht,Of Ofe'rriiuttii.• . 44p,cancellation,olfggtive datois prior tp this polrcy8s pspfrAffiph.:(late;. .the First N4004:1004#04::is urde an eating contractual.ob1igtion to•;,fltitifya)-000900 holder when this arid has provid'ed to the Insurer, either dieebtIV-tethiotiOtt ii&sbtakei.of record,the email address f ja:4•,601)00I-Iiteiich$206,h-;01.1Aq,ghtf . • . 3 The Insurer fPPONO:d.IhiSinfoifttAktotf after be First NameOlinsve4 receives of Pance04090 of this policy and prior tp this gplI4W.,q cancellation effective date,Yta an. the Insurer will provide advice of q4610011006,:#0 such,000.00405, Holders within ;3Q days after the Named Insured provides such Irfi00041041!'fp:ihe [400(4 'firovid60) however,.ftibt if a speciñc number of days is not Achtfcii.iiiIr be ,proiided to-such,'Ciaftifjdato as reasonably practicable after•thtiff,Fitst Namedi toilfiOntOtet. 0.1'94PtithR Insurer ):44‘11SAi'yqk10.13-9.,i9IPIR14tiPP prpvided ImitlAt,h7st Named insured, 4411,1::,,090 Alk.gi..9,0fAhat.4,40.10s9f.o.!hasrfi4y P3 igfiP0•14,4?bAgoliOn$1. -0,90,1tik.PPOPMPIPOP*,• . This endorsement does 'hrpt, affect,.in: any way coverage proiideci ohtle? this:.•,p0110if, or the thhttilltititififdf this policy or the effective date thereof,nor'shalf,tiiiiiiiddtieiherftitAtef,'ihy:4116 in,Arty firititOot ihitfteirk.th.derefil 43016V-'. • The following qefirlitiPRAAPPIY:t.PytWqr.10Prs,PfnenV '00t-001;!4.10s0.00'means th !'(400**),400 Oa*PPthe Declarations Page of this policy • • • • - .2. Insurer inethr;?thii insurance company shown in the btaVet on the Declarations page of this . 'Allpthgriforhp•i,'cp.hOitioosi.:antf,ocjiliph 000‘rfigto10,411e;,$.a,fflo. • Authorized fteWesintatitre• 10741.4(0311.1,Y P5260028002 P ENDORSEMENT This endorsement, effective 12:01 A.M. • 41 1/ *y21 *V Ak ' , forms a part of Policy No 4:01341110ERZ12E2 issued toPeterson HHoldingCompanny.1 , . a �..- �,, l ;M y;...r, by 401:0-40:0010:06i:0744-4401:060000:6 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF LIMITS OF INSURANCE (Per Project or Per Location Aggregate Limit) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM I. Your ' policy is amended to include either a Per Project General Aggregate Limit,. a Per Location General Aggregate Limit or a Per Project and Per Location General Aggregate Limit. Please select only one of the following: c Per Project General Aggregate Limit $ r al Per Location General Aggregate Limit $ ` d Per Project and Per Location General Aggregate Limit $ 4,000,OOOk IF NEITHER OF THESE BOXES ARE CHECKED,- THIS ENDORSEMENT IS VOID. IF -MORE THAN ONE OF THE THESE BOXES ARE CHECKED, THIS ENDORSEMENT IS VOID. II. SECTION III - LIMITS OF INSURANCE , is amended to include the following: 1. The Limits of Insurance and the rules below fix the most we will pay regardlessof the number of: a. Insureds; - b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the products-completed operations hazard"; and c. Damages under Coverage B. 3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the products-completed operations hazard. 4. Subject to 2. above, the Personal and Advertising Injury Limit is the most we will pay under Coverage B for the sum, of all damages because of all "personal and advertising injury" sustained by any one person or organization. 5. Subject to 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a. Damages under Coverage A; and b. Medical expenses under Coverage C 86681 (9/04) Page 1 of 2 P5260028002 NI because of all "bodily injury" and "property damage" arising out of any one "occurrence". 6. Subject to 5. above, the Damage to Premises Rented To You Limit is the most we will pay under Coverage A because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with �4 permission of the owner. 7. Subject to 5. above, the Medical Expense Limit is the most . we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. 8. Subject to 2., 4., 5., 6., and/or 7. above, the Per Project Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b. Damages under Coverage B; and c. Medical Expenses under Coverage C arising out of any single Project described above. 9. Subject to 2., 4., 5., 6., and/or 7. above, the Per Location Aggregate Limit is the most we will pay under Coverages A, B, and C combined for the sum of: a. Damages under Coverage A; b.Damages under Coverage B; and c. Medical expenses under Coverage C arising out of the any single Location described above. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. III. The Limits of Insurance shown in the Declarations are deleted in their entirety and replaced by the Limits of Insurance set forth below. Limits of Insurance General Aggregate Limit $ 10,000,0 0 Each Occurrence Limit $ .2,000;0(0 ; Products-Completed Operations Aggregate Limit $4,000,000 Personal &Advertising Injury Limit $ 2,0000006 Damage to Premises Rented to You $,500,000 v : Medical Expense Limit $ Excluded F < Per Project General Aggregate Limit, Per Location $ 4,000,000 ' General Aggregate Limit or Per Project and Per Location General Aggregate Limit IV. SECTION V- DEFINITIONS, is amended to include the following: 23. "Location" means premises involving the same or, connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway, or right-of-way railroad. All other terms and conditions of this policy remain the same. Authorized Representative or Countersignature(in States Where Applicable) 86681 (09/04) Page 2 of 2 • P5260028002 • POLICY NUMBER: GL 626B175' x COMMERCIAL GENERAL LIABILITY CG 20 11 04 13 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • 0 1/40• ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART • SCHEDULE Designation Of Premises (Part Leased To You): f• i n sf de'' �s ys� Vin.. �, r. k3. { 3 '• ay p ✓�,r,.,n r?, ""�y y„� s"y r °".y f x y< v MW<',a s. ¢��r n5' f�' .:a4 ,'"' i( ,r sS� s>��A ✓}q.#�.�'�y�1 xyi i�,.t5G"re ,*u�e✓`xJ�+^'h. ri ,r}*.i��..�y,sz .#omnuS.Y'3. rZ EdP" ° FkY ii<M t kAt n .%; cr,.. fi,y 'A,4si 4,14Vg`-$4,4;t1 y W 1 "4 t!"' t ?fY +, afi . • fi` '.9 i �& r ;4 . vs b 4' �. .ws ✓k:,.,,, n: S Sys, n # � 41• .-q �5 t � ✓r� c�?✓ ,xr �r �,�` � :rx r "�" ,n ✓.' e v� ..+ • € t � r tx T s � y� a� ''�` ��' /0 �d � 5 4 less ✓ r 3rf sp ' H , �z . t - W a) x '',4 ,4A:n { 5 k >y ✓`.f i d x t 2 a",� rr` ✓r d ,� .�a � ,tE` � x?e CXit � �°,c• '� ��1 "�s+.`l�� 1 r c l'.,,M e � �< �'r r�' ✓�31 '�,3� yXr ro s '�t e✓� rEaynY,Nl�? ire#�e�� z,�s� �rc�4X! az J,C `� � �"�45"'°f. .�,^�.:.,i rd �: t*�<.���t��x.�7z.,�";�?r;,��..,_ ✓�'"�.D r• ,u�a+1r� �"*,(r�..ai�k "`'fir,+,.� e..�3�.'. .� N�t� .y.�,P.�;,r .�.k.�r.:7�s5�;�'zza5r4`f.:f�.✓�✓..i S<:.\,,,�k,�'}ua�, Name Of Person(s) Or Organization(s) (Additional Insured): • _ 'AIVY4 PERSON OR ORGANIZATI01 FROM�WHOM YOU LEASE PRE VII5ES OR WHO"MANA0GES�PREMISES YOU OWN`: � � � S�rFs ✓` X§ r v 5�+ §�' � r: AND TO WHOM YOU BE'COMEO)BLIGATED TO'INOLUDE AS ANTADDITIONAL 1NSURED Ur4DER THiS<POLICY hS W r ''s ✓c .za, , s" t ^ty.rx F + ✓c r"K' RESULT OF ANY, LEASE OR MANAGEMENT AGREEMENT YO J ENTER 1NT0 WITH SKUCSI#MRTIES• �, � � t J ✓� '..F s ✓ � j9' "r..If C 5✓.f"'@ ,� ,'V �31r*.``k I ; 0,1x 1 rfiPy F`Y ✓ �` tt `M �}hy.� S ryf��, 9 ,x .s 4 S` G s r3' ,<y� s t j a+ " 3'm4 r �t'.' k 7 x f..*A.✓a ry..fi4 +'` t'4�L,' 3i� "$<wk �� .,▪ sff s r�� .ri t �,: s� q:3, ✓ -▪ : �:t F . :s i�a,�,bs �',� ,.+a�,� � w41 i,,,.5r � �.v � sf sv+'` "�. K l'" `d.ti 3bcu a,� - 5�, F F r > ,„� �" t ffa ✓ rx 6 P :�S<+, .€ Xn z��4 §y e >J€ '} ' x � a p ":�.-� �;. A• r• sr7 p r n -E` * ��F.�k y'�gg{R" `p al. ✓, � r r�' `'�,w,�✓'k? '` �rt,p4 u v X/'` #�7'. `A r ,yo ^,� ,;1 "� 5r. L..cX < x-•h ▪ ky,Y;.y ae 4� �:.r sc nib PS ` Y£`^ i ay , '�" fi E `kN �, /#Y. .rXo�. ,;f^xrt *. S>«;,.z..�.r. ,5,..fi.,s�rroro.2,...•:.k. 5s..�A,.,'. vim'6'�,....'3*✓ a .-.?..� .:�.t!,LS'ts..5-'�sw'a:: ..�Fk_3,<,..a.'dr'S r`, '� :'�3< S�` S.:a. .5.,`,'n`` .a�: .,4�.;`5t'"l...z �"�" Additional Premium: S INCLUDED .� " s 9 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 Schedule and, subject to the following additional include as an additional insured the person(s) or exclusions: organization(s) shown in the Schedule, but only This insurance does not apply to: with respect to liability arising out of the 1. Any" "occurrence" which takes place after ownership, maintenance or use of that part of you cease to be a tenant,in that premises. the premises leased to you and shown in the • CC 20 11 04 13 • ©Insurance Serivces Office, Inc. 2012 Page 1 of 2 P5260028002 sP 2. Structural alterations, new construction or B. With respect to the insurance afforded to these demolition operations performed by or on additional insureds, the following is added to behalf of the person(s) or organization(s) Section III - Limits Of Insurance: shown in the Schedule. If coverage provided to the additional insured is However: required by a contract or agreement, the most `O 1. The insurance afforded to such additional insured we will pay on behalf of the additional insured only applies to the extent permitted by is the amount of insurance: law; and 1. Required by the contract or agreement; or 2. If coverage provided to the additional in- 2. Available under the applicable Limits of sured is required by a contract or ag- Insurance shown in the Declarations; reement, the insurance afforded to such whichever is less. additional insured will not be broader than This endorsement shall not increase the that which you are required by 'the contract applicable Limits of Insurance shown in the or agreement to provide for such additional Declarations. insured. Page 2 of 2 ©Insurance Serivices Office, Inc. 2012 CG 20 11 04 13 P5260028002 a � ENDORSEMENT This endorsement, effective 12:01 A.M. 4/01/2021 forms a part of policy No.GL 526-81-75 issued to PETERSON HOLDING COMPANY 00 by NATIONAL UNION FIRE I N$URANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTROLLED INSURANCE PROGRAM (CIP) EXCLUSION -WITH LIMITED EXCEPTIONS This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Form I. The following exclusion is added to Paragraph 2, Exclusions of Coverage A- Bodily Injury And Property Damage Liability: This insurance does not apply to "bodily injury" or "property damage" arising out of any project that is or was subject to a Controlled Insurance Program ("CIP") in which you are or were an enrollee. This exclusion applies whether or not the "CIP": (1) Provides coverage identical to that provided by this policy; (2) Has limits adequate to cover all claims; or (3) Remains in effect. This exclusion does not apply: (1) to "bodily injury" or "property damage" which occurs at anylocation owned by, or rented to, you that is outside the project site for that project, and is not covered by the terms of the "CLP" for that project, or (2) to "bodily injury" which occurs during ongoing operations for work being performed on a project subject to a "CIP" after such program has terminated or is no longer in effect. These exceptions, 1 and 2 above, do not apply to "bodily injury".or "property damage" included in the "products completed operations hazard" even if you are required to provide such coverage for an additional insured by written contract or agreement. II. The following is added to Section V- Definitions: A. A Controlled Insurance Program ("CIP") is also known as an "Owner-Controlled Insurance Program (OCIP), a Contractor-Controlled Insurance Program (CCIP) or a Wrap-Up Insurance Program. "CIP" means an insurance program under which one party procures insurance on behalf of all enrolled contractors performing work on a construction project or on a specific site. All other terms, conditions, and exclusions shall remain the same. 119201 (04/15) Includes copyrighted information of Insurance Services Office, Page 1 of 1' Inc., with its permission. P5260028002 POLICY NUMBER: GL 526$175 f2N _LL gu COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 0 PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance policy provided that: Condition and supersedes any provision to the (1) The additional, insured is a Named Insured contrary: under such other insurance; and Primary And Noncontributory Insurance (2) You have agreed in writing in a contract This insurance is primary to and will not or agreement that this insurance would seek contribution from any other insurance be primary and would not seek contribu- available to an additional insured underyour tion from any, other insurance available to the additional insured. CG 20 01 04 13 @Insurance Serivces Office, Inc. 2012. Page 1 of 1 P5260028002 yY ,71 O - POLICY NUMBER: =GL5268175 'u s r COMMERCIAL GENERAL LIABILITY CG24040509 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS:TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: ?"PURSUANT TOAPPLICABLEAWRITTEN CONTRACT.EORnAGREEMENTYOU ENTER INTO." � '" ✓. + r: > �I X'r`�/��G„ t'} "'"�,�.fi':�, `�,�r f4 �dot .y�ty�� y �a��,�,f,..^`v.�, � ,� � rk, �a3 ��¢�✓ k, M ,� t , � ss.. ✓'.� �t �' _ !: a , _ ti�x �w'vZ",:i'k2r£ 5'S'2ek9,4 a,tty gerE , z 1140�k f k'A Wr k k,•t,6 Vktrx44 t 7y i p l 4 � v �.a `. ✓ -. v 'c+ 4R? tk y s`� z • A• a.. vd i".y�' x ? � x ` 3."�"°.s � x� '"' S {'. k E ^�' ._�4�t .• .'�'�''" _.�&3� � ^``n' "4 t�'.v � �. .ay. _� >y .r1..r ' n�: a. .�'4_:�.,,:,,,x. s '�'4 < asyC�`,��;,a''✓"�yx ,�v ` .�c-. ✓� ✓<}7 ✓t'" � ,+`F '7Y �, �` s Y #ar.4�5�,`� $,�,� $"sdr�✓ w2.fi ���, � ,�"+'r ,,'�� h,, �' �til�, esy, § s"r, "fi R4 k �.6 M S' "$�/d{ �C`r r-,,. 7 r `t s„ i 7 �' .' ' 7,N✓f x r,.i,,:.6`c,s`�''hh+� r ..k '�fi` k,`E r" ti" er. t a tx � i '?- r r :z vt xs .,.. ,r"'�et` r •'�.r `�s a , �� ,� -3�,s�s�i s �s � v ,��,5 s yr,s ':� x't,.'S�• v } r--. *sr" ..•.,+'a v r.�,"LW C S YA ?,^{ cz 4i -x`�4'.�� i�xn a� si s t�" .r 3 �"c. � �:rte � -aah s �' a a,4 ,r'P.,42�, a _ i y.""�..?^�;.K.r g�'�v a.�.�tJ''r7��.✓r.`•..?,.�X�y,�g SXR`�',�.,�� usyr 3�'a x��X;^;S�J... �����.E'{ �;^...,�ti�.c��.tX-�f&����.� . ,.�s�,n`?�W�r �f�'.r�' ie"� g, Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of, Sec- tion IV-Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing opera- tions or "your work" done under a contract with that person or organization and included in the products-completed operations hazard. This , waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008- Page 1 of 1 P5260028002 3 ENDORSEMENT This endorsement, effective 12:01 A.M. 4/1402n , 5 "T;, forms a part of w Policy No ;CA 4489668 ,' , xm ,N =issued to Peterson Holding Companys 0 by NationalUKion`Fre'InsurancoCompariy°<f ittburgh;SPA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ` ANX PERSON OR ORGANIZATION(TOMHOM*burARETdok RACTUi4 liN OUIiD Tp PROViiti*Ti]I7)ONAL,, 4) INaSURED STATUS .BUT ONLY{TOyTHE EXTENT ASzSUCH PERSON'S OR ORGANIpAT1gNSpABIL1Ty ARISING tiux , OF USE OE A OVEREtvA �; < . s 5R: {��u y. � � �,�'£ : �r w'"� .0 `" a r.: , ru, ..,x ✓a. n a 'a. . a, ��x �` Y{ �r� �a fur,. �f��3,. � i � � ��� w '�� �. I. SECTION II -' COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However,the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. AUTHORIZED REPRESENTATIVE 87950 (9/14) Includes copyrighted information of Insurance Services Office, Inc., Page 1 of 1 with its permission. P5260028002 7 POLICY NUMBER: 4h89668 COMMERCIAL AUTO • CA 20 01 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LESSOR-ADDITIONAL INSURED AND LOSS PAYEE 00 This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM • BUSINESS AUTO COVERAGE FORM • MOTOR CARRIER COVERAGE FORM • With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. - • This endorsement changes the policy effective on the.inception date of the policy unless another date is indicated below. Named Insured: Peterson Holding Company r y sa ig.•. , z''t a* nnagy.i,.." Endorsement Effective Date: r *' au.h V. i A S x� 4/32021.. .. � a«,.,.� ,,�. �,_ `�fi. ...�..�,,s..�.„� .�..�`.� a��.. �,�. ,A:. SCHEDULE , Insurance Company Alatianal Unlorr Fire insuranep Company ofPitfsfufgh PA'' j ° Policy Number A,4.489668gg,igi;,; `' vg ,s <, Effective Date:. 4J4I20.21 i,. q:, 55_.,,;;i•I".r Expiration Date: 411(20,22• a w y g Named Insured: Peterson,Hoid i g CQirii5any 'NSEPAIN.WM*V'ticAa ''e4 ''v w ti.r 3n.& fn.F•.`'0, F Sla.^en 4'7i3', _ i^i.' ` 'r.5 v b j. 'A .m tri-'M1P •Wti Address: l 'S ax Cys 9 . a _ x a. ;,. y, '+ x Y>i '.S,gt'.y5 WAr r 'Additional Insured . ,,, ,1 ,'," : 0> (Lessor): \�`` 9 b Address: , F u'r z k C x 4 aR , <.,.+ K ,x.:x 2. a �' 1 2k '-�: s .�h gt*Ca.1 e.,. ?� '.,i - << �r� Designation Or Description4 g Of"Leased Autaa": ALL AUTO$UNDEf lA LEASING OFC RENTAL A4REEMENT�BEftI I EN THE,INSURED"ANDTHE�I.ESSOfl`Li$TW QB0.7E AS TWE ADDITIONt1k INSURED THAT REQ,UIRESDIRECT PRIMAS YANSURANce4 v awv,zim CA 20 01 10 13 ®Insurance Serivices Office,Inc.2011 , Page 1 of 2 P5260028002 ggH d _ F", o � v', Coverages Limit Of Insurance u, Covered Autos Liability $ ,;M ,gin r r,,;`Each"Accident" 0 Actual Cash Value Or Cost Of Repair,Whichever Is Less,Minus Comprehensive $ < ' , , , Deductible For Each Covered"Leased Auto" Actual Cash Value Or Cost Of Repair,Whichever Is Less,Minus ,"', Collisiona $•_? b;, �;A t)eductible For Each Covered"Leased Auto" Specified Actual Cash Value Or Cost Of Repair,Whichever Is Less,Minus Causes Of Loss $ 't' ,+,u , w Deductible For Each Covered"Leased Auto" Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A.Coverage 2. The insurance covers the interest of the lessor 1. Any "leased auto" designated or described in unless the "loss" results from fraudulent acts or the Schedule will be considered a covered omissions on your part. auto you own and not a covered "auto" you 3. If we make any payment to the lessor, we will hire or borrow. obtain his or her rights against any other party. 2. For a "leased auto" designated or described in C.Cancellation the Schedule, the Who Is An Insured 1. If we cancel the policy, we will mail notice to provision under Covered Autos Liability thelessor in accordance with the Cancellation Coverage is changedto include as an Common Policy Condition. insured the lessor named, in the Schedule. 2. If you cancel the policy, we will mail notice to However, the lessor is an "insured" only forthe lessor. bodily injury or "property damage" resulting 3.Cancellation ends this agreement. from the acts or omissions by; D. The lessor is not liable for payment of your a.You; premiums. b. Any of your "employees" or agents; or E.Additional Definition c. Any person, except the lessor or any As used in this endorsement employee or agent of the lessor, operating Leased auto means an "auto" leased or rented to a "leased auto" with the permission of any you,including any substitute,replacement or extra of the above. auto needed to meet seasonal or other needs, 3. The coverages provided under this under a leasing or rental agreement that requires endorsement apply to any "leased auto" you to provide direct primary insurance for the described in the Schedule until the expiration lessor. date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B.Loss Payable Clause 1. We will pay, as interest may appear;you and . the lessor named in this endorsement for"loss" to a"leased auto". Page 2 of 2 ©Insurance Services Office,Inc.2011 CA 20 01 10 13 yY P5260028002 PAENDORSEMENT This endorsement,effective 12:01A.M. 4/1/2029 forms a part of C policy No. CA4489668 issued to PETERSON HOLDING COMPANY, ET AL Co by NATIONAL UNION FIRE INSURANCE COMPANY,OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ.IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the additionof the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. 111) Authorized Representative or Countersignature (in States Where Applicable) 74445 (10/99) Page 43 P5260028002 ENDORSEMENT CO This endorsement, effective 12:01 A.M. 4/1/2021 ? forms a part of Policy No.SCA 4x496613 * „ n; 'V ' issued to I*elson,lid(dmg4Gom`an s:` " ` ,,;'h , . p.ry. ,y. co By ,National Unroit Fire'I4urariae CornpaiyofyP`ittsburgli, pA` 6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided,under the following: BUSINESS AUTO COVERAGE FORM Section IV - Business Auto Conditions, A. - Loss Conditions, 6. - Transfer of Rights of Recovery Against Others to Us, is amended to add: However, we will waive any right of recover we have against any person or organization with whom you have entered into a contract or agreement because ofpayments we make under this Coverage Form arising out of an "accident" or "loss" if:. (1) The "accident" or "loss" is due to operations undertaken in accordance with the contract existing between you and such person or organization; and (2) The contract or agreement was entered into prior to any "accident" or "loss". No waiver of the right of recovery will directly or indirectly apply to your employees or employees, of the person or organization, and we reserve our rights or lien to be reimbursed from any recovery funds obtained by any injured employee. _ _ 1 Authorized Representative 62897 (6/95) P5260028002 'a ENDORSEMENT# • w This endorsement, effective 12:01 A.M. 04/01/2021 forms a part of Policy No.CA 448-96-68 issued to PETERSON HOLD]NG COMPANY 00 by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES.THE POLICY. PLEASE READ IT CAREFULLY. EARLY NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under-the following: AUTO DEALERS COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM COMMON POLICY CONDITIONS,A, -Cancellation, 2. is amended to read: 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. TEN ( 10)* days before the effective date of cancellation if we cancel for nonpayment of premium; or b. SIXTY ( 6Q)* days before the effective date of cancellation if we cancel for any other reason. * The notice period provided shall not be less than that required by applicable state law(s). AUT ORIZED REPRESENTATIVE 99307 (9/14) Includes copyrighted information of Insurance Services Office,Inc., Page 1 of 1 with its permission. P526002S002 Ya O _ POLICY NUMBER: QT6307387B447TIL:21 NAMED INSURED: Peterson Holding Company (per policy) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DELUXE PROPERTY COVERAGE PART AMENDATORY ENDORSEMENT LOSS PAYABLE PROVISIONS This endorsement modifies insurance provided under the following: DELUXE PROPERTY COVERAGE FORM The following is added to the LOSS CONDITIONS- (1) Pays any premium due under this Loss Payment provision as indicated by an "X"in the Coverage Part at our request if you Schedule below: have failed to do so: A. LOSS PAYABLE (2) Submits a signed,sworn proof of loss For Covered Property in which both you and a within 60 days after receiving notice Loss Payee shown in the Schedule below have an from us of your failure to do so;and insurable interest,we will: (3) Has notified us of any change in own- 1. Adjust losses with you;and ership, occupancy or substantial 2. Pay any claim for loss or damage jointly to change in risk known to the Loss you and the Loss Payee, as interests may Payee. appear. All of the terms of this Coverage Part will B. LENDER'S LOSS PAYABLE then apply directly to the Loss Payee. 1. The Loss Payee shown in the Schedule below d. If we pay the Loss Payee for any loss or is a creditor, including. a mortgageholder or damage and deny payment to you be- trustee,whose interest in Covered Property is facause of your acts or because you have established by such written instruments as: ve to comply with the terms of this Coverage Part: a. Warehouse receipts: (1) The Loss Payee's rights will be trans- b. A contract for deed: ferred to us to the extent of the c. Bills of lading: amount we pay;and d. Financing statements;or (2) The Loss Payee's rights to recover e. Mortgages, deeds of trust, or security the full amount of the Loss Payee's claim will not be impaired. agreements. 2. For Covered Property in which both you and a At our option,we may pay to the Loss Loss Payee have an insurable interest: Payee the whole principal on the debt plus any accrued interest. In this a. We will pay for covered loss or damage to event, you will pay your remaining each Loss Payee in their order of prece- debt to us. deuce,as interests may appear. 3. If we cancel this policy, we will give written b. The Loss Payee has the right to receive notice to the Loss Payee at least: loss payment even if the Loss Payee has a. 10 days before the effective date of can- started foreclosure or similar action on the cellation if we cancel for your non-pay- Covered Property. ment of premium;or c. If we deny your claim because of your b. 30 days before the effective date of can- acts or because you have failed to comply cellation if we cancel for any other reason. with terms of this Coverage Part,the Loss Payee will still have the right to receive 4. If we elect not to renew this policy, we will loss payment if the Loss Payee: give written notice to the Loss Payee at least 10 days before the expiration date of this pol- icy. DX T3 79 03 98 Page 1 of 2 P5260028002 • POLICY NUMBER: QT6307387B447TIL21 NAMED INSURED: Peterson Holding Company (per policy) O C. CONTRACT OF SALE b. Pay any claim for loss or damage jointly 1. The Loss Payee shown in the Schedule below to you and the Loss Payee, as interest is a person or organization you have entered may appear. a contract with forthe sale of Covered Prop- 3. The following is added to the OTHER INSUR- erty. ANCE Condition: w 2. For Covered Property in which both you and For Covered Property that is the subject of a the Loss Payee have an insurable interest,we contract of sale, 'the word "you" includes the will: Loss Payee. a. Adjustlosses with you;and D. SCHEDULE Prem. Bldg. No. No. Description of Property Loss Payee(Name&Address) ALL LEASED LOCATIONS_ ' ANY ENTITY WITH AN OWNERSHIP OR FINANCIAL INTEREST IN REAL AND/OR ALL FINANCED REAL AND/OR PERSONAL PROPERTY COVERED UNDER- - - PERSONAL PROPERTY THIS POLICY All OWNED LOCATIONS Loss Lenders ' Contract Payable Loss Payable of Sale Provisions Applicable: Page 2 of 2 DX T3 79 03 98 J P5260028002 s POLICY NUMBER: QT6307387B447TII21, COMMERCIAL INLAND MARINE NAMED INSURED: Peterson Holding Company (per policy) O THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET LOSS PAYEES This endorsement modifies insurance provided under the IM PAK COVERAGE FORM. The following is added to Section E —ADDITIONAL b. Pay any claim for loss or damage jointly to you COVERAGE CONDITIONS: and the Loss Payee asyour interests may ap- Loss Payable Provision pear. In the event of a Covered Cause of Loss to Covered This endorsement applies to all Covered Property for Property in which both you and a Loss Payee share which a Loss Payee is on file with us or your insur- an insurable interest,we will: ance agent or insurance broker. a. Adjust the loss or damage with you;and CM T5 60 01 10 ©2009 The Travelers Indemnity Company Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. • P5260028002 s ENDORSEMENT BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12;01 AM 04/01/2021 forms a part of Policy No. WO 158-93-698 Issued to Peterson Holding Company V By New Hampshire Insurance Company We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce cur right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00%of the total estimated workers compensation premium for this policy. WC 04 03 61 (11/90) P5260028002 �' 11• ENDORSEMENT oa WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following'attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy). 6 This endorsement, effective 12:01 AM 04/01/2021 forms a part of Policy No. WC 0158-93-697 Issued to Peterson Holding Company By Insurance Company of the State of Pennsylvania We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule.This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY WRITTEN CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS. This form is not applicable in California, Kentucky, New Hampshire,New Jersey, North Dakota, Ohio,Tennessee,Texas, Utah,or Washington. WC 00 03 13 (4/84) • Countersigned by Authorized Representative P5260028002 3 CALIFORNIA ADVANCE NOTICE OF CANCELLATION OR NON-RENEWAL BY US EXTENDED Tori This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 04/01/2021 forms a part of Policy No. WC 015-89-3698 Issued to PETERSON HOLDING COMPANY By NEW HAMPSHIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY PART SIX-CONDITIONS, D.-Cancellation,2. is deleted in its entirety and replaced with: We may cancel or non-renew this policy. We will mail or deliver to you not less than 10 days advance written notice of cancellation for reasons (a) through (g) and 30 days advance written notice of cancellation for reasons (h) through (m) of California Cancellation Endorsement WC990017. We will mail or deliver to you not less than 30 days and not more than 120 days advance written notice of non-renewal. Except for non-payment of premium and non-payment of loss reimbursement or non-delivery of satisfactory security or collateral when due, for which we will provide advance written notice in accordance with the provisions of any applicable statute or regulation,we shall not provide less than the number of days set forth below. Mailing that notice to you, at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. Cancellation: 60 Days Non-Renewal: 60 Days • WC 99 04 11 Countersigned by (Ed. 08103) Authorized Representative P5260028002 Excerptfrom Policy Number.080877677 Named Insured:Peterson Holding Company etal Effective:4/1/2021-4/1i2022 2. You have failed to fulfill the terms of a contract or agreement; if such property can be restored to use by: m 1. The repair, replacement,adjustment or removal of"your product" or "your work"; or 2. Your fulfilling the terms of the contract or agreement. J. "Insured" means: 1. The "Named Insured";. 2. Except for liability arising our of the ownership, maintenance,or use of"covered autos"; a. If you are designated in the Declarations as: (1) An individual, you and your spouse are "Insureds", but only with respect to the conduct of a business of which you are the sole owner; (2) A partnership or joint venture, you are an "Insured". Your members and your partners, and their spouses are also "Insureds", but only with respect to the conduct of your business; (3) A limited liability company, you are an "Insured". Your members are also "Insureds", but only with respect to the conduct of your business. Your managers are "Insureds", but only with respect to their duties as your managers; (4) An organization other than a partnership, joint venture or limitedliability company, you are an "Insured". Your "executive officers" and directors are "Insureds", but only with respect to their duties as your officers or directors. Your stockholders are also "Insureds", but only with respect to their liability as stockholders; (5) A trust, you are an "Insured". Your trustees are also "Insureds", but only with respect to their duties as trustees; b. Your "volunteer workers" only while performing duties related to the conduct of your business.Your "employees" other than your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or.while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" in the course of his or her employment or performing duties related to the conduct of your business or to your other "volunteer workers" while performing duties related to the conduct of your business; or any claim or "suit" brought by or on behalf of the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of such "bodily injury" or "personal and advertising injury",or; (b) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)0) above. (2) "Property damage" to property: (a) Owned,occupied or used by, (b) Rented to, in the care,custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). C. Any person (other than your "employee" or "volunteer worker") or organization while acting as your real estate manager; ' d. Your legal representative if you •die, but only with respect to duties as such. That representative will have all your rights and duties under this policy; OC-UMBR SPEC/MEN LX9799(10/05) Page 14 of 24 P5260028002 5. Excerpt from Policy Number: 080877677 Named Insured: Peterson Holding Company etal Effective :4/1/2021-4/1/2022 e. Any person or organization, other than the "Named Insured", included as an additional "Insured" under "scheduled underlying insurance", but not for broader coverage than would be afforded by such "scheduled underlying insurance". 3. Only with respect to liability arising out of the ownership, maintenance, or use of "covered autos": a. You are an "Insured"; b. Anyone else while using with your permission a "covered auto" you own, hire, or borrow isoo also an "Insured" except; (1) The owner or anyone else from whom you hire or borrow a "covered auto". This exception does not apply if the "covered auto" is a trailer or semi-trailer connected to a "covered auto" you own; (2) Your "employee" if the "covered auto" is owned by that "employee" or a member of his or her household; (3) Someone using a "covered auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours; (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a "covered auto"; (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a "covered auto" owned by him or her or a member of his or her household; (6) "Employees" with respect to "bodily injury" to any fellow"employee" of the "Insured" arising out of and in the course of the fellow "employee's" employment or while performing duties related to the conduct of your business; C. Anyone liable for the conduct of an "Insured" described above is also an "Insured", but only to the extent of that liability. 4. Notwithstanding any of the above: J — a. No person or organization is an "Insured" with respect to the conduct of any current, past or newly formed partnership,joint venture or limited liability company that is not designated as a "Named Insured" in Item 1 of the Declarations;and b. No person or organization is an "Insured" under this policy who is not an "Insured" under "scheduled underlying insurance". K. "Insured contract" means that part of any contract or agreement pertaining to your business under which any"Insured" assumes the tort liability of another party to pay for"bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. "Insured contract" does not include that part of any contract or agreement: 1. That indemnifies a railroad for "bodily injury" or "property damage" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle,tracks, road-beds,tunnel, underpass or crossing; 2. That indemnifies an architect,engineer or surveyor for injury or damage arising out of: a. Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications; or b. Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage;or 3. Under which the "Insured", if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the "Insured's" rendering or failure to render professional services, including those shown in subparagraph 2 above and supervisory, inspection, architectural or engineering activities. OC-UMBR SPEC/MEN LX9799(10105) Page 15 of 24 P5260028UU2 O IIII_ ENDORSEMENT This endorsement,effective 12:01 AM 04/01/2021 Forms a part of policy no.: 080877677 Issued to: PETERSON HOLDING COMPANY oeoe By:LEXINGTON INSURANCE COMPANY • PRIMARY AND NON-CONTRIBUTORY IF REQUIRED BY WRITTEN CONTRACT ENDORSEMENT This endorsement modifies insuranceprovided under the following: COMMERCIAL UMBRELLA LIABILITY POLICY Provided that, all of the following conditions are met 1. The written contract or written agreement requiring that the additional insured be added to this insurance also requires that this insurance be primary and non-contributory with respect to any other insurance carried by the additional insured; 2. Such written contract or written agreement is in effect during this "policy period" and executed prior to the "occurrence" of the "bodily injury"or "property damage"; and 3. Coverage required by such written contract or written agreement is provided in the applicable and collectible "scheduled underlying insurance" or would have been provided but for the exhaustion of the underlying limits of insurance; then notwithstanding any other provisions of this policy to the contrary, including, Paragraph K., Other Insurance of SECTION VI - CONDITIONS, with respect to those additional insureds added through written contract or written agreement for which coverage is provided pursuant to Subparagraph J.2.e. of SECTION V - DEFINITIONS, insurance provided under this policy shall be primary and non-contributory with respect to any other insurance providing coverage to such additional 'insureds, other than "scheduled underlying insurance". - Notwithstanding the foregoing under no circumstances will coverage provided to such additional insureds under this policy be broader than the coverage provided under the "scheduled underlying insurance". This endorsement shall not reinstate or increase the limits of insurance shown on the Declarations. All other terms and conditions of the policy remain the same. 7/,/_ Authorized Representative LX4305(06/14) Page 1 of 1 • • P5260028002 Edgewood Partners Insurance Center(EPIC) P.O.Box 5668 Concord,CA 94524 • r4.42 - 202104013914 Electronic Service Requested EBI)//� B p O 1— o MIXED AADC 975 '- 5685 2.7440 MB 0.436 • �I��Ilil�nll.1111"IIJ�III�'iII11IIhiluuui�rIIII1ellI I.iIII'1 City of Ashland 152 90 N MOUNTAIN AVE ASHLAND, OR 97520-20]4 W This document was brought to you by CertificatesNow. - If you have questions regarding the content of this document, - please call (800)234-6363 and ask for Susan Peragallo.- For new certificate requests or if you need changes made to an — „ existing certificate, please forward the current certificate - issued with requested changes via E-Nail: - susan.peragallo@epicbrokers.com- Please Note: Ail requests for new certificates or changes to - existing certificates must.be requested by the Named Insured. • cc: • • • • • • The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. • • Certificate Relivery by CertificatesNow-www.ConfirmNet.com-877.669.8600