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Insurance Certificate: Dowl LLC (3)
C� DATE(MM/DD/YYYY) ,4R o CERTIFICATE OF LIABILITY INSURANCE 04/30/2021 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 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 CONTACT NAME: Parker,Smith&Feek,Inc. PHONE 509-789-8350 FAx 509-931-0794 16201 E Indiana Ave,Suite 1000 (AIC.E-MAILNo,Ext): (AIC,No): Spokane Valley,WA 99216 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A National Fire Ins.Hartford INSURED INSURER B: Continental Insurance Co. N DOWL,LLC 5000 Meadows Road,Suite 420 INSURER c: American Casualty Co.of Reading,PA Lake Oswego,OR 97035 INSURER D: a INSURER E: m INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM!DD/YYYY) A GENERAL LIABILITY 6080818241 05/01/2021 05/01/2022 EACH OCCURRENCE _ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PRS RENTED 500 000 X X PREEMIMI E SES l(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 15,000 X BI/PD DED:$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 POLICY X jT X LOC $ A AUTOMOBILE LIABILITY 608088183905/01/2021 05/01/2022 (Ea aBcideL SINGLE LIMIT 1 000 000 X ANY AUTO X X BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident)_ _ B — UMBRELLA LIAB X OCCUR 6080818255 05/01/2021 05/01/2022 EACH OCCURRENCE $ 1,000,000 X EXCESSLIAB CLAIMS-MADE X X AGGREGATE $ 1,000,000 DED X RETENTION$ $10,000 $ WORKERS COMPENSATION 6080818238 WC STATU- X OTH- C AND EMPLOYERS'LIABILITY Y/N 05/01/2021 05/01/2022 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE USL&H,WC,Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA X Included (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under **USL&H,WC,Stop Gap 1,000,000 DESCRIPTION OF OPERATIONS below ,,-_, - , E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 2023.15141.00,Independent Fee Estimate Review of Scope for the Design of the Taxiway Rehabilitation Project City of Ashland is an additional insured on the general liability,automobile,and excess liability policies per the attached endorsements/forms... (See Attached Description) CERTIFICATE HOLDER CANCELLATION 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 Ashland 20 East Main St AUTHORIZED REPRESENTATIVE Ashland,OR 97520 f` 4.1104, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD THIS PAGE INTENTIONALLY LEFT BLANK DESCRIPTIONS (Continued from. Page 1 ) Coverage is primary and non-contributory on the general liability,automobile,and excess liability policies per the attached endorsements/forms. Waiver of subrogation applies on the general liability,automobile,workers compensation,and excess liability policies per the attached endorsements/forms. Notice of cancellation for the general liability,automobile,workers compensation,and excess liability policies per the attached forms. 0 N X tE C ' N , .,,i_l,ILL._`.'L>'_l '..iLt_L.L,LL,.,_L LLLbIJ_LCJ LVL'LLCCL, LcLLCC (_?.L ' ( (..:1_LLLLt_L'i_.u.-t, ' V,!L`L L L'LLCLLLC_L -LCILLIA LLd `, �,(,l lL�1 1 '-,1, C l ti.,( C L,L;I( C. I. 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LI IL L[L(LLC,[L t(.* [Iloltic'L` , L ket `11(3ni on 'Jin Oif'(ciiv0 Pith OI _inid runs/ _lt 1111 ilULIi __,I,1L),L[ii uLIL I 'otley, u[llue,:.LL[idtiCI Cl]L'etVE dutu LL= O.hC�wii h,ii)y1J,.,In ] ;).X;)]1 `r cOncurret1t{y::1/id1I . _:11(,1.1 ,..)1,1.,,1,', cN]A750 :92 X(10.-1:)) uhl,(Pe[c• ac: PAPP [L24 :: JO> O C I l :) III(•iliI (): In:L,1('( (;I Ioirr)n; I)O\!\/I,, I,I,13 l-ficnPk'c I)v.icr, 05/01/2021 G'i;J'/1ir'1ir[(2,k _mill<ieiuL (',S?..tit=.L_`, ','.1.1.'V1 '-I('1..Y111I11( i1,,p1(-rir_I(,1lull .ur(-;;(,•I,'i(,iO.Ofiu,(. Ii(',Willi its I)(=rlfli:a:i(,u, THIS PAGE INTENTIONALLY LEFT BLANK 0 N CD X 0) l0 CL CNA Architects, Engineers and Surveyors General Liability Extension Endorsement services performed for the Named Insured under the Named Insured's direct supervision. All limitations that apply to employees and volunteer workers also apply to anyone qualifying as an Insured under this Provision. 24. SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000. limit; and B. Paragraph 1.d. is amended to delete the limit of $250 shown for daily loss of earnings and replace it with a $1,000. limit. 25. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the. Named Insured's Coverage Part, the Insurer will not deny coverage under this Coverage Part because of such failure. 26. WAIVER OF SUBROGATION -BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part; and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 27. WRAP-UP EXTENSION: OCIP, CCIP,OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) insurance program by applicable state statute or regulation. If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O.C.I.P.) or Contractor Controlled Insurance Programs (C.C.I.P.) is attached, then the following changes apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures. B. Condition 4. Other Insurance is amended to add the following subparagraph 4.b.(1)(c): This insurance is excess over: CNA74858XX(1-15) Policy No: :171:1111:11] Page Page ❑i of in Endorsement No: ❑ Effective Date: 05/01/2021 L.Ilhsured Name: +1'.l i 1 illhI1_-D Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. THIS PAGE INTENTIONALLY LEFT BLANK CNA CNA PARAMOUNT Cancellation I Non-Renewal —Washington Wherever used in this endorsement 1) Insurer means "We",%is", "our"or the"Company" as those terms may be defined in the policy:.and 2) Named Insured means the first person or entity named on the declarations-page; and 3) "Insureds" means all persons or entities afforded coverage under the policy. Any dancellatien, non-renewal or termination provisions in the.policy are deleted in their entirety and replaced with the following: CANCELLATION AND'NONRENEWAL A. CANCELLATION 1, The:Named Insured may cancel the policy at arty time.To do so,the Named Insured must: LT_ a. returnthe policy to the Insurer or any of its authorized representatives indicating the effective date of cancellation:'or b. provide a written notice by mail fax or e-mail to the Insurer or any of its authorized representative stating when thecancellation is to be effective: c. provide verbal notice to the Insurer or any of its authorized representative indicating when the cancellationis to be effective. The Insurer will promptly cancel the policy upon notice of cancellation from the Named Insured the date the Notice is received or the date the Named Insured requests cancellation. 2. The Insurer may cancel the policy by mailing, or delitieringlo the Named Instred and to its producer Written notice of caridellation, including tho°acttial reason for the Cancellation;at the last mailing address known to the Insurer,at least a. ten (10) days before the effective date of cancellation if the insurer cancels for non-payment of premium;or b. silty (60) days before the effective'date of cancellation if the Insurer cancels for any other reason. 3, Like notice of cancellation will also be Mailed to any mortgage holder, pledge or other person shown in the policy with an interest in any toss'which may occur thereunder,at their last mailing address knOwn to the Insurer. 4. Notice of cancellation will state the effective dateof cancellation. The poticyperiod will end on that date. If notice is mailed,proof of mailing will be sufficient proof of notice. B. PREMIUM REFUND If.this policy is canceled, the Insurer will send the Named Insured any premium refund due. lithe Insurer cancels, the refund will be pro rata. If the,Named Insured cancels,the refund will be on ashort rate basis.The cancellation will be effective even if the Insurer has not made or not offered a refund. Onomni• 1••••••••10 CNA62814WA,(9-12) Policy No:, 6080818241 Page 1 of 2 Endorsement No: 26 Nat I Fire Ins Co of Hartford Effective Date: 05/01/2021 Insured Name: BOWL, LLC Copyright CNA Ali RightP Reserved. THIS PAGE INTENTIONALLY LEFT BLANK 19 Mobile Only those "autos"that are land vehicles and that would qualify under the definition Equipment of"mobile equipment" under this policy if they were not subject to a compulsory or Subject To financial responsibility law or other motor vehicle insurance law where they are Compulsory Or licensed or principally garaged. Financial Responsibility Or Other Motor Vehicle Insurance Law Only N B. Owned Autos You Acquire After The Policy SECTION II—COVERED AUTOS LIABILITY Begins COVERAGE 1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered. A. Coverage. next to a coverage in Item Two of the We will pay all sums an "insured" legally must pay Declarations, then you have coverage for as damages because of"bodily injury" or"property "autos" that you acquire of the type described damage" to which this insurance applies, caused for the remainder of the policy period. by an "accident" and resulting from the ownership, 2. But, if Symbol 7 is entered next to a coverage maintenance or use of a covered "auto". in Item Two of the Declarations, an "auto" you We will also pay all sums an "insured" legally must acquire will be a covered "auto" for that pay as a "covered pollution cost or expense" to coverage only if: which this insurance applies, caused by an a. We already cover all "autos" that you own "accident" and resulting from the ownership, for that coverage or it replaces an "auto" maintenance or use of covered "autos". However, you previously owned that had that we will only pay for the "covered pollution cost or coverage; and expense" if there is either "bodily injury" or b. You tell us within 30 days after you acquire "property damage" to which this insurance applies it that you want us to cover it for that that is caused by the same "accident". coverage. We have the right and duty to defend any C. Certain Trailers, Mobile Equipment And "insured" against a "suit" asking for such damages Temporary Substitute Autos or a "covered pollution cost or expense". However, we have no duty to defend any"insured" against a If Covered Autos Liability Coverage is provided by "suit" seeking damages for "bodily injury" or this Coverage Form, the following types of "property damage" or a "covered pollution cost or vehicles are also covered "autos" for Covered expense" to which this insurance does not apply. Autos Liability Coverage: We may investigate and settle any claim or "suit" 1. "Trailers" with a load capacity of 2,000 pounds as we consider appropriate. Our duty to defend or or less designed primarily for travel on public settle ends when the Covered Autos Liability roads. Coverage Limit of Insurance has been exhausted 2. "Mobile equipment" while being carried or by payment of judgments or settlements. towed by a covered "auto". 1. Who Is An Insured 3. Any "auto" you do not own while used with the The following are "insureds": permission of its owner as a temporary a. You for any covered "auto". substitute for a covered "auto" you own that is out of service because of its: b. Anyone else while using with your permission a covered "auto" you own, hire a. Breakdown; or borrow except: b. Repair; (1) The owner or anyone else from whom c. Servicing; you hire or borrow a covered "auto". d. "Loss"; or This exception does not apply if the e. Destruction. covered "auto" is a "trailer" connected to a covered "auto"you own. Page 2 of 12 © Insurance Services Office, Inc., 2011 CA 00 01 10 13 (2) Your "employee" if the covered "auto" is These payments will not reduce the Limit of owned by that "employee" or a member Insurance. of his or her household. b. Out-of-state Coverage Extensions (3) Someone using a covered "auto" while While a covered "auto" is away from the he or she is working in a business of state where it is licensed, we will: selling, servicing, repairing, parking or storing "autos" unless that business is (1) Increase the Limit of Insurance for yours. Covered Autos Liability Coverage to meet the limits specified by a (4) Anyone other than your "employees", compulsory or financial responsibility partners (if you are a partnership), law of the jurisdiction where the covered members (if you are a limited liability "auto" is being used. This extension company) or a lessee or borrower or does not apply to the limit or limits any of their "employees", while moving specified by any law governing motor property to or from a covered "auto". carriers of passengers or property. (5) A partner (if you are a partnership) or a (2) Provide the minimum amounts and member (if you are a limited liability types of other coverages, such as no- company)for a covered "auto"owned by fault, required of out-of-state vehicles by him or her or a member of his or her the jurisdiction where the covered "auto" household. is being used. c. Anyone liable for the conduct of an We will not pay anyone more than once for "insured" described above but only to the the same elements of loss because of extent of that liability. these extensions. 2. Coverage Extensions B. Exclusions a. Supplementary Payments This insurance does not apply to any of the We will pay for the"insured": following: (1) All expenses we incur. 1. Expected Or Intended Injury (2) Up to $2,000 for cost of bail bonds "Bodily injury" or "property damage" expected (including bonds for related traffic law or intended from the standpoint of the violations) required because of an "insured". "accident" we cover. We do not have to 2. Contractual furnish these bonds. (3) The cost of bonds to release Liability assumed under any contract or agreement. attachments in any "suit" against the "insured" we defend, but only for bond But this exclusion does not apply to liability for amounts within our Limit of Insurance. damages: (4) All reasonable expenses incurred by the a. Assumed in a contract or agreement that is "insured" at our request, including actual an "insured contract", provided the "bodily loss of earnings up to $250 a day injury" or "property damage" occurs because of time off from work. subsequent to the execution of the contract (5) All court costs taxed against the or agreement; or "insured" in any "suit" against the b. That the "insured" would have in the "insured" we defend. However, these absence of the contract or agreement. payments do not include attorneys' fees 3. Workers'Compensation or attorneys' expenses taxed against the Any obligation for which the "insured" or the "insured". "insured's" insurer may be held liable under (6) All interest on the full amount of any any workers' compensation, disability benefits judgment that accrues after entry of the or unemployment compensation law or any judgment in any "suit" against the similar law. "insured"we defend, but our duty to pay interest ends when we have paid, offered to pay or deposited in court the part of the judgment that is within our Limit of Insurance. CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 3 of 12 4. Loss Payment—Physical Damage 5. Other Insurance Coverages a. For any covered "auto" you own, this At our option,we may: Coverage Form provides primary a. Pay for, repair or replace damaged or insurance. For any covered "auto" you don't stolen property; own, the insurance provided by thisrta Coverage Form is excess over any other b. Return the stolen property, at our expense. collectible insurance. However, while a We will pay for any damage that results to covered "auto" which is a "trailer" is the "auto"from the theft; or connected to another vehicle, the Covered c. Take all or any part of the damaged or Autos Liability Coverage this Coverage stolen property at an agreed or appraised Form provides for the"trailer" is: N value. (1) Excess while it is connected to a motor If we pay for the "loss", our payment will vehicle you do not own; or include the applicable sales tax for the (2) Primary while it is connected to a damaged or stolen property. covered "auto"you own. 5. Transfer Of Rights Of Recovery Against b. For Hired Auto Physical Damage Coverage, Others To Us any covered "auto" you lease, hire, rent or If any person or organization to or for whom we borrow is deemed to be a covered "auto" make payment under this Coverage Form has you own. However, any "auto" that is rights to recover damages from another, those leased, hired, rented or borrowed with a rights are transferred to us. That person or driver is not a covered "auto". organization must do everything necessary to c. Regardless of the provisions of Paragraph secure our rights and must do nothing after a. above, this Coverage Form's Covered "accident"or"loss"to impair them. Autos Liability Coverage is primary for any B. General Conditions liability assumed under an "insured 1. Bankruptcy contract". Bankruptcy or insolvency of the"insured" or the d. When this Coverage Form and any other "insured's" estate will not relieve us of any Coverage Form or policy covers on the obligations under this Coverage Form. same basis, either excess or primary, we will pay only our share. Our share is the 2. Concealment, Misrepresentation Or Fraud proportion that the Limit of Insurance of our This Coverage Form is void in any case of Coverage Form bears to the total of the fraud by you at any time as it relates to this limits of all the Coverage Forms and Coverage Form. It is also void if you or any policies covering on the same basis. other "insured", at any time, intentionally 6. Premium Audit conceals or misrepresents a material fact a. The estimated premium for this Coverage concerning: Form is based on the exposures you told us a. This Coverage Form; you would have when this policy began. We b. The covered "auto"; will compute the final premium due when we determine your aThe c. Your interest in the covered "auto"; or. estimatedw total premium I Ilp es.be rcredited d. A claim under this Coverage Form. against the final premium due and the first 3. Liberalization Named Insured will be billed for the If we revise this Coverage Form to provide balance, if any. The due date for the final premium or retrospective premium is the more coverage without additional premium date shown as the due date on the bill. If charge, your policy will automatically provide the estimated total premium exceeds the the additional coverage as of the day the revision is effective in your state. final premium due, the first Named Insured will get a refund. 4. No Benefit To Bailee—Physical Damage b. If this policy is issued for more than one Coverages year, the premium for this Coverage Form We will not recognize any assignment or grant will be computed annually based on our any coverage for the benefit of any person or rates or premiums in effect at the beginning organization holding, storing or transporting of each year of the policy. property for a fee regardless of any other provision of this Coverage Form. CA 00 01 10 13 © Insurance Services Office, Inc., 2011 Page 9 of 12 THIS PAGE INTENTIONALLY LEFT BLANK POLICY NUMBER: 6080881839 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DOWL, LLC Endorsement Effective Date: 05/01/2021 SCHEDULE Name(s) Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT REQUIREMENT PRIOR TO LOSS Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule,. but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 441013 ©Insurance Services Office, Inc., 2011 Page 1 of 1 THIS PAGE INTENTIONALLY LEFT BLANK CNA Business Auto Policy y dorsela e tt 1 ,, '.,CAI CEI ,&'TIOt51 $ ,: „` li , € � ° . :- t = ^.. ,. m'.:�si� •4 _''. ae_ ••s $ g€ -='�m,5' A F v . c .... . ,---:-.,,%:11,44 ra THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insuranceprovided under the following: BUSINESS,AUTO COVERAGE FORM m GARAGE COVERAGE FORM TRUCKERS' COVERAGE FORM N : Paragraph 2. of Cancellation (Common Policy Conditions) is replaced by the following: LI 2. We may cancel this Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for non-payment of premium, or b. 60 days before the effective date of cancellation if we cancel for any other-reason, All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy, Effective date of saidpolicy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date)is,shown,below, and expires concurrently with said policy. Form No: G-17832-8.I12-2010) Policy No:BUA 6080881839 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:Os/Om/202T Endorsement No: 28;Page: 1 at 1 Policy Page: 136 of 393 I Underwriting Company: National Fire Insurance Company of Hartford. 151 N Franklin St, Chicago,IL 60606 Copyright CNA All Rights,Reserved. THIS PAGE INTENTIONALLY LEFT BLANK NA CNA Paramount Excess. and Umbra)la, Liability Polley D. Coverage D -"key Employee;Exclusions, With:respect to,Coverage 0 —.Key Employee, this insurance does not apply to any actual or alleged: 1. Death'or Disability death or Permanent dis,abilitY ore key employee relating:to, or arising:out of: a. nuctearreactiori or radiation or'radioactive contamination, however causerzl', b. sickness or diSease, 4'101u:ding Mental,illness or.nientaLinjUry, C. pregnancy, childbirth, Miscarriage or abOrtiom d. 4urdide.,,ottoripted anieide:Of self inflicted'bOdilY inIcieN6 While Sane Or iriaane; e. the keyemployee's intoxication, irripairrhenterrOtherWise being under the influertee f aleo,hOl or controlled aphstantes, f. war,including undeelared or'civil war; g: warlike action.by a military. force,. ipeluding.actiOn in hindering or defending 0941.nat an, actual or expected attack; by any government, sovereign or other authority using military personnel or other agents;-or h. insurrection, rebellion, revolution, usurped power, or action taken by governmental-authority in hindering.ordefending'against any.of::these. 2. Other Expenses a. expenses the Named Insured. incurs.whienthe Namedinsured would,not,have.incurred if'the Named Ineured, had used all.reasonable-means,to: i. 'find a perritanent ,rePlabeinent forthe,key employee;-and ii. reduce or discOntinue the key ernaloyeetePlaCemeritexPerfse; as soon as possible afto.th6-Nanied.lhatired.kfiermenent loss of the services' of thekeY ernplOyee-eaused by a coVeredaCcidert. b: additional expenses incurred c.ie te the.Named Insured's loss of the services of a-Pennerient replacement appointed or hired'to replace A key employee however cauSed, HOWever, this. exclusion does not o[ily. if thereplacement employee is included in the definition ap-a.key ernployee'and the Named inatned'eloSa.Of the Servidesofthe replacement emplOyee caused uy a covered accident, IV: WHO IS.AN INSURED The following persons or organizations are Insureds. A. With respect to'Coverage.A` Excess Follow.Form liability, the Named Insured and any persons or organizations included as an.insured under the:provisions'of underlying insurance are Insureds, and then only.forthesame coverage;except limitS ofinsurance;.afforded'undefauch underlying insurance. B. With respect-to the Coverage Umbrella Liability: 1.. If the Named !panted is designated in the Declarations:of this]Policy as:, a.. an ifidiVidtial, the Named Insured and the Named Insured!'s.anouseare Insureds,.but only V.rith .respect to the conduct Of a buainess:of Which the Nettled In-Sated is the sole owner. b. a paftherShib or"joint Venture the Named Insured is.an Insured, The, Named Inatirecra.members, the,NamedInsureds:partners,:antrtheir--SbOuseS are.Alsp.Ih§mtods',-1)0t Only with respect to the Conduct orthe'Nerneci lnatireda'business. I Form N,19:!•ciSip.7,55.Q4XX:(030:1'S) folicy,1\iof' 'Policy Pogg:, Policy Elfoctiye -UriiI6evirrifinO-COMOony::, Contirlerital 05, -33,3 AvO,,Chi'dagb ,IL'60a0.4 Pd'11.dy Pdgeir of 51 NA All'Rldfik:ResOr*I.' THIS PAGE INTENTIONALLY LEFT BLANK CNA CNA Paramount Excess and Umbrella Liability Policy or organization which may be liable to the Insured because of injury or damage towhich this insurance may also apply; and vi. will not voluntarily make a payment, except atits own cost, assume any obligation, or incur any expense, other than for first aid, without the Insurer's prior consent. 3. Cooperation With respect to both Coverage A= Excess Follow Form,Liability and Coverage-B - Umbrella Liability, the Named Insured will cooperate With the Insurer in addressing all claims required to be reported to the Insurer in accordance with this paragraph O. Notice of Claims/Crisis Management Event/Covered N Accident, and refuse, except solely at its own cost, to voluntarily.,without the Insurer's approval, make any payment, admit liability, assume any obligation or incur any, expense related thereto. P. Notices u_ Any notices required to,be given by an Insured'shall be submitted in writing to the Insurer'at the address set forth in the Declarations of this Policy. Q. Other Insurance If the. Insured is entitled to be indemnified or otherwise insured in whole or in part for any damages or defense costs by any valid and collectible other insurance for which the. Insured otherwise would have been indemnified or otherwise insured in whole or in part by this Policy, the limits of insurance'specified in the Declarations of this Policy shall apply in excess of, and shall not contribute to a claim, incident or such event covered by such other insurance. With respect to,Coverage A - Excess Follow Form Liability only, if: a. the Named Insured has agreed in writing in.a contract or agreement with a person or entity that this insurance would be primary and would'.not seek contribution from any other insurance available; b. Underlying Insurance includes that person or entity as an additional insured; and c. Underlying Insurance provides coverage on a primary and noncontributory basis as respects that person or entity; then this insurance is primary to and will hot seek contribution front any insurance policy where that person or entity is a named insured. R. Premium All premium charges under this Policy will be computed according to the Insurer's'rules and rating plans that apply at,the inception of thecurrent policy period. Premium charges may be paid to the Insurer or its authorized representative. S. In Rem Actions A quasi in rem action against,any vessel owned or operated by or for a Named Insured, or chartered by or for a Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. T. Separation of Insureds Except with respect to the limits of insurance, and any rights or duties specifically assigned in this Policy to,the First Named.Insured, this insurance applies. 1. as if each Named Insured were the only Named Insured;'and 2. separately to each Insured against whom a claim is made. U. Transfe?of Interest Form No:CNA75504XX 1Q3-2015) Policy No: Policy Page: 21 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co, 333 S Wabash Ave;Chicago, IL 60604 Palicy'Page: 32 of 51 c Copyright CNA All Rights Reserved. THIS PAGE INTENTIONALLY LEFT BLANK C�� CNA Paramount Excess and Umbrella Liability Policy Assignment of interest under this policy shall not bind the Insurer unless its consent isendorsed hereon. V. Unintentional Omission Based on Insurer's reliance on the Named Insured's representations as to existing hazards, if the Named II Insured should unintentionally fail to disclose all such hazards at the effective date of this Policy, the Insurer will not deny coverage under this Policy because of such failure. W. Waiver of Rights of Recovery payments the insurer makes under this Policy if the Named Insured has-agreed in writ n because sos The Insurer waives any right of recovery it may have against any person or organization writing to waive such rights of recovery in a contract or agreement, and only if'the contract or agreement: 1. is in effect or becomes effective during the policy period; and 2. was.executed prior to loss. VII.DEFINITIONS For purposes of this Policy, words in bold face type; whether expressed in the:singular or the plural, have the meaning set forth below. Advertisement means a notice that is broadcast or published to the general public Or specific market segments about the Named Insured's goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: A. notices that are published include material placed-on the Internet or on similar electronic means of communication; and, B. regarding web-sites, only that part of a web-site that is about the.Narned,insured's goods, products or services for the purposes of attracting:customers or supporters is considered an advertisement. Aircraft means any machine or device that is capable of atmospheric flight. Arbitration proceeding means a formal alternative dispute resolution proceeding or,administrative hearing to which an Insured is required to submit by statute or court rule or to which an Insured has submitted with the Insurer's consent.. Asbestos means the mineral in any form whether or not the asbestos was at any time airborne as a fiber, particle or dust, contained in or formed a part of a product, structure or other real or personal property, carried on clothing, inhaled or ingested, or transmitted by any other means. Authorized Insured means any'executive officer, member of the Named Insured's risk management or in-house general counsel's office, or any employee authorized by the.Named Insured to give or receive notice of a claim. Auto means: A. a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or B. any other land vehicle that is subject to a oo'mpulsory or financial responsibility law or other motor vehicle insurance law where it islicensed or principally garaged. However, auto does not include mobile,equipment. Bodily injury means bodily injury, sickness or disease sustained bya`person,'including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the bodily injury, sickness or disease. Claim means a: A. suit; or Form No:CNA75504XX(03-2015) Policy No: Policy.Page: 22 of 32 Policy Effective Date: Underwriting Company: Continental Ins,Co, 333 S Wabash Ave,Chicago, IL 60604 Policy Page: 33 of 51 ,. Copyright CNA All Rights Received. THIS PAGE INTENTIONALLY LEFT BLANK CNA . , CNA Paramount. Excess and Umbrella Liability Policy EndoEndorsement T '� ,, rte` I a u Wherever used in this'endorsement: 1.I.Insurer means"We". "us", "our-or-the ":Company"as these terms may be defined in tte policy; and 2) Named.Insured means the first person or entity named on the-declarations page; and.3} "Insureds" means all persons or entities.afforded ver under the policy. Any cancellation, non-renewal or terminaton provisions in the,policy are deleted in their entirety and replaced' with the following: N co CANCELLATION AND-NON-RENEWAL N , I. CANCELLATION ;; L A. The Named Insured may cancel the policy'at any time,.To-do so,`the Named Insured must: 1. return:the policy to the;Insurer or any of its authorized representatives indicating the effective.date of cancellation, or 2. provide a written notice by mail fax or e-mail to the.Insurer or=any of its authorized representative stating when the cancellation is to be effective, 3. provide verbal notice to the Insurer or any of its.auth"orized representative indicating when the cancellation.is to be effective. The Insurer will prOmcitly cancel the polity upon notice of cancetlatiorifrorn the Named irfsured the date the Notice is received or'the date the Named Insured_requests cancellation. B. The Insurer may`cancel the policy by mailing or delivering to.the Named Insured and to its producer written notice of cancellation, including;the actual reason far the cancellation, at the.lastmailing address known to the insurer, at least: 1. ten (1'0) days before the effective.date of cancellation if the insurer cancels for iron-payriient:of premium; or 2. sixty (60) days before the effective date of cancellation if,'the Insurer cancels for any other reason. C. Like notice of cancellation'will also be mailed'to any rirortgage-.holder, pledge or other person shown in the policy With an interestin any loss.which may occur thereunder, at their last mailing address known to the InsUrer. D. Notice.of cancellation will state the effective date of cancellation. The policy period will end on that date. If noticis mailed, proof of mailing will be sufficient,proof of notice. iI. PREMIUM REFUND If this policy is canceled, the Insurer will send_the Named Insured any premium refund due. lithe-Insurer 'cancels, the refund will be pro rata. If the Named Insured cancels Inc refund will be On a. short rate basis. The cancellation will be effective even if the insurer.-has not made or not offered a refund. III. NON-RENEWAL A. The Insurer can nen-renew the policy by givitig,written notice to the Nanied Insured-and.to its.,producer, at the last mailing address known, at least sixty (60) days before the expirations dere.`If notice is ittailed, WOO. of retailing will be sufficientprc of of notice. Forrn No: CNA6281.4WA iO.20121 Polley No.'CUE 508081825.6 Endors"emernt Effective Date: Endorsement ExPiratioryDole: Policy Effective Date:05/01/2021 Ender`semeatNo: 1;Page: 1 rzf 2 Policy Pagdi'4'4 of 51 Underwriting Company:The.Cantinent:al Insurance Company, 15,1 N Fratikl sr St,"Chicago,1;.,60606 CoPYrlght.CNA,All Right:Reserved. CNA CNA Paramount Excess and Umbrella Liability Polity Endorsement B. The-notice of non-renewal will state the actual reason for non-renewal. The Insurer will also mail written notice of non-renewal to any mortgage holder or other perSon shown in the policy with an interest in any loss which may occur thereunder, at-their last mailing address known to the Insurer. C. The Insurer must provide to the Named Insured its renewal terms including the premium due at least twenty (20) days prior to the expiration date of the current policy. If the Named Insured subsequently fails to pay the premium when due or procures cOverage acceptable to it, then the coverage is nonrenewed. IV OTHER PROVISIONS The Insurerwill Mail notice of any change in rates or coverage to the Named Insured at least sixty (60) days prior to the expiration date of the policy. ,All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and Fs for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy'at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date IS shown below. Form No:CNA62814WA 109.2012) PoliCy No:CUE 6(380E318255 • Endorsement Etfective Date: Endorsernerit Expiration Dote; Policy Effective Date; 05/01/2021 I Endorsement No: 1: Page: 2 or2 Policy,Page: 45 ul 51 Untiurwriting Company: The Continental Insurance Coinpany, 151 N rianklin Si.Chicago, IL 50600 CoPyright CNA All Rights Reserved. Workers Compensation And Employers Liability Insurance sem, Policy Endorsement 41Z 6;0r of 4 :46 A• p �k a ' y`1.fix 4 4 P ' ✓ ;"'"L ' ' a.n4. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. 0 0 Schedule N Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. ro The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. !This endorsement, which forms a part of and is.for"attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No:WC 00 03 13(04-1984) Policy No:WC 6 80818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/2021 Endorsement No: Policy Page: Underwriting Company:American Casualty Company of Reading, Pennsylvania Copyright 1983 National Council on Compensation Insurance. CNA Workers Compensation And Employers Liability Insurance. Poky Endorsement 'et-4y 7--:1* 14::ZIAr1;3-Iikt4 `-'1a15 ';'!7 This endorsement applies only tOthe insurance provided by the policy because Colorado is shown in Item 3.A. of the Information Page. Part Six lConclitions) Condition D. Cancellation is replaced by the following: D. Cancellation 1. You may cancel this policy. You mustmail or deliver advance written notice tons stating when the cancellation is to take effect, 2. We may,cancel this.policy. We must mailbycertified,rnail or deliver to you advance written notice stating when the cancellation is to take effect..If we cancel for any of the following reasons, we will mail or deliver not less than 10 days advance written notice: (1) Fraud; (2) Material Misrepresentation; (3) Non-payment of premium; or (4) Other reasons approved by the COmmissioner. If we cancel for any other reason, we will mail or deliver not less than 30 days.,advance written'notice. 3. The policy will end on the day and hour stated in the cancellationnotice:. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy isohanged by-this statement to comply with the law. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown beloW. Form No:C-18840-A (07-1992t PolicY NO1WC 6 80818238 Endorsement Effective Date; Endorsement Expiration Date: Pulley Effective Date;05/01/2021 Endors,eirient No: 1;Page: 1 of 1 Policy Page:73 of 117 Underwriting Company: American Casualty.Cortipany of Readeig. Pennsylvania, 151 N Franklin Si, Chicago, IL,60606 Copyright CNA Ali Rights Reserved, CNA Workers Compensation And Employers Liability Insurance Policy Endorsement I y: p > i #,RA1�' 2 LTy ;T; " -`'5 Vsr g l ' k aS;;:'t, iP g .: l a v----0-4-7W-4• a7 $ , ati. f1- o - � � � �9 � � ` Ir . a This endorsement applies because Arizona is shown in. Item 3.A. of the:.Information Page. Part Six-Conditions, Section D. (Cancellutionl, of the policy is replaced by the following: D. Cancellation and Nonrenewal 1. You may cancel this'policy. You must mail or deliver advance written notice to us-stating when the cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due, or when one or both of the parties to a professional employer agreement terminate the agreement. 4. If we cancel or nonrenew this policy, we must mail or deliver to you and the Industrial Commission of Arizona at least 30 days' notice.of the cancellation or nonrenewal. Mailing that notice to you at your mailing address shown in Item 1. of the Information Page will be sufficient to prove notice. If we nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the policy period. 5, The policy period will end on the day and hour stated in the cancellation or nonrenewal notice. All other terms and conditions ofthe policy remain unchanged. This endorsement, whic.h forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the.Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No:WC 02 06 01 A 109;20.151 Policy No:WC 6,110818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/2021 Endorsement No: 15;Page: 1 of I Policy Page: 68 of 17 Underwriting Company:American Casualty Company at Reading.Pennsylvania, 161 ISI Frahktin 61,. Chicago, IL 60606 Copyright 2015 Motional Council on Cornpensahon Insurance,inc.An Rights laeserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 4fig9mulAt*iikm'ENPA'laRePIPPRIEMER-444 This endorsement aPplies because Montana is shown in Item 3.A. Of the Information Page. General Section, Section C. (Workers Coradiensation Lavv).of the policy is changed by adding the following: The provisions of this policy conform to the minanum requirements'of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this pplicy. cr, Part Six-Conditions, Section D. (Cancellation} of the policy is replaced by the follOvving: D. Cancelation 1. You may cancel this policy. You will mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We will 1;trovide you arid the Montana Department of Lab,or and.Incluatry not less than 20 days advance written notice stating when the cancellation is to take effect. We will provide the notice to you via mail or via electronic delivery in accordance with the Electronic Delivery of Insurance Notices or Documents Act (MCA 33-15,.601 et sec ). Mailing notice to you at your last known address or delivery via electronic means in compliance with the Electronic Delivery of Insurance Notices or-Documents Act will be sufficient to prove notice. 3. If this policy has been in effect for 60 days or more, we may cancel only for one of the following reasons: a. A nonpayment of premium; b. A material misrepresentation; c. A substantial change in the risk we assumed under the policy unless it was,reasonable for us to foresee the change or contemplate the risk when we issued the policy; d. A substantial breach of the duties, conditions or warranties under the policy; • e. The Commissioner has determined that continuation of the policy would place us in violation of the laws of Montana; I. We are financially impaired; or g. Any other reason that is approved by the Commissioner. 4. Our notice of cancelation will state our reasons for canceling. Part Six-Conditions of the policy is changed by adding the following: F. Nonrenewal 1. We may elect not to renew. We will provide you and your agent not less then 45 days advance written notice stating our intention not to renew this policy. We will provide the notice to you via mail or via electronic delivery in accordance with the Electronic Delivery of Insurance Notices or Documents Act. Mailing notice to you at your last known address or delivery via electronic means in compliance with the Electronic Delivery of Insurance Notices or Documents Act will be suffidient to prove notice. 2. We do not have to renew the policy if you are insured elsewhere, accept replacement insurance, Or request or agree to nonrenewal, or if the policy is expressly designated as being nonrenewable. 3. Our notice of nonrenewal will state our reasons for not renewing, ; Form No:WC 25 0691 B(04,.2016) 'Policy No:WC 6 80818238 Endorsement Effective;Dam: Endorsement Expiration Date: Policy Effective Date:05/01/2021 Endorsement No: 19;Page: 1 of 2 • Policy Page: 92,of 117 Underwriting Company:American CastialtY Company of Reading. Pennsylvania, 15 1 N Frooklin ST. Chicago. 11 60606 v'Copytight 2015 National Counciron Compensation,Insurance, Inc.Alt Rightp Reserved. CVA WorkersCompensation And Employers Liability.Insurance Policy Endorsement All other terrnsf,and-conditions•of,the policy remain unchanged. This endorsement, which forms a part of and is for.attachment to the policy issued by the designated Insurers, takes effect on-the policy Effective Date of said policy at the hour-stated in said policy, unless another effective date (the Endorsement Effective, Date),isshown belew, and expires concurrently,withsAid policy unless another expiratlian date is shownelovv. Voila No: WC.26 06,01 fO4.2016). Policy No:VC 6 os18238 Endorsement Eflectve i. ,DatO!.. Endorsement 8Nititatibo Onte Pohoyz'.ertve Date 05/01/2021 Endorsement No: 1 ;Page: 2 of 2 Policy'Page::93 1 317 1foctetwiitirig Cortwarly:t American Casealsy CompOify.o Reading,Pertrisylvania,151 N Ftenklin St. Chicago. IL,60606 cotiy'right 2015 NatiOnal cotiOdit on.Compensation Insurance,hic, ill Rights'titiServed. CNA Workers Compensation And Employers Liability Insurance Policy Endorserrienc ;10114.44nitikrWtt',i 7;i:4x .914.130Ew#LANDP,13sgtv!EXTvl *17 ; 54-Ljt This endorsement applies to the insurance provided by,this policy, because Nevada is,shown.in Item 3.A. of the Information Page. Part Six—Conditions, D. Cancellation of the policy is replaced by the following: A. Midterm Cancellation 1. You may cancel this policy by mailing or delivering advance written notice to us stating when the cancellation is to take effect. 7, LB' 2_ We will provide you not less than 10 days notice ifthis policy is cancelled because you failed to pay a premium Of remit an amount due because of an endorsement for a.deductible when due. 3. We will provide you not less than 30-days netiCe for any-other cancellation reason permittedunder Nevada law, including failure to pay additional premium charged due to an audit of any payroll under the terms of the current or previous policy. 4. No policy of industrial insurance thathas been in effect for at least.70 days or that has been renewed may be cancelled, except on any one of the following grounds: a. A failure by the policyholder to pay a premium for the policy of industrial insurance when due, including the failure of the policyholder to remit an amount due because of an enclOrsernent for a deductible; b. A failure by the policyholder to: (1) Report any payroll; (2) Allow the insurer to audit any payroll in atbordance with the terms of,the policy Or any previous policy issued by the insurer; or (3) Pay any additional premium charged because of an'audit of any payroll as required by the terms of the policy or any previous policy issued by the insurer; c. A material failure by the policyholder to comply with any federal or state order concerning safety or any written recommendation of the insurer's designated representative for loss prevention; d. A material change in ownership of the policyholder or any change in the policyholder's business or operations that: (1) Materially increases tho hazard for frequency or severity of loss; (2) Requires additional or different classifications for the calculation of premiums; or (3) Contemplates an activity that'is excluded by any reinsurance treaty of the.insurer; e. A material misrepresentation made by the policyholder; or f. A failure by the policyholder to cooperate with the insurer in'conducting an investigation of a claim. 5. We cannot cancel the policy when the referenced reasons are corrected by you within thotime specified in the written notice of cancellation. B. Nonrenewal 1. We may elect not to renew the policy, We wilt provide to you a written notice of our intention not to renew at least 60 days before the expiration date. Form No:WC 27 06 01 C110.2008) Policy No:WC 6 soai B238 Endorsement Effective Date: Endorsement Eitpiration Date: Policy Effective Date: 05/01/2021 Endorsement No: 21;Page: 1 of%2 Policy Page: 95 of 117 Underwriting Company: American Casualty Company of Reading, Pennsylvania., 151 N Franklin Si. Chica,fro, 11,60606 Copyright 2008 National Council an Compensation Insurance, Inc. All Rights Reserved, CNA Workers Compensation And Employers Liability insurance %MA Policy Endorsement 2. We need not provide notice of our intention riot to renew if You have.accepted replacement coVerage, if you`have requeeted or agreed to nonrenevval, or if the policy is expressly designated as nonrenevvable. C. Information About Claims Paid 1. If you request information for the renewal of the policy, we will provide you with information regerdirig claims paid on your behalf. 2. We will provide the information within 30 working days after we receive your written request. We may charge a reasonable fee for providing the information. D. Notices 1. We will provide advance written notice of cancellation or nonrenewales provided in A and B above,This notice must be served personally on.or sent by first-class mail or electronic transmission to the employer. 2. Notices will state the effective date of the cancellation or nonrenewal and will be accompanied by:a written explanation of the specific reasons for the,cancellation or nonrenewal. 3. A written notice of cancellation is not required if we mutually agree with you to cancel the policy and reissue a new policy based upon a material change in the ownership or operation of your business.. E. Compliance With Law 1. Any of-these provisions that conflict with a law that controls the cancellation or renewal or nonrenewal of the insurance in this policy is changed by this statement to comply with the law. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for, attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date {the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below: Form No:WC 27 09 01 C110-2008) Policy.Nn:WC 6 80818238 Endorsement Effective Date: Endorsement Egpiretion Date: Policy Effective Date:05/01/2021 Endorsement No* 21:4'age: 2 of 2 Policy Page: 96 of HI . Underwriting Company: American Casualty Company of Readmg; Pennsylvania, 151 N Franklin Sr Chicago, IL 60606 r-Copyright 2006 NationatCouncil on Compensation Insurance, Inc,Ail Rights Reserved, CNA Workers Compensation And Employers. Liability insurance Policy Endorsement 'OKLAHOMA.GANCE ,�# 'ION,,N . �E +CWAt.A E;i!CA ' G y C.fCIEiSEM f It -°-=',t;-z.°' . °. b A -. a Aik -s� , e,q,. ani 't i .a 3¢8 NSA 1_ rt giuv This endorsement applies to the insurance provided by the policy because Oklahoma is shown in Iterrt 3.A. of the Information Page. The Cancellation Condition in Part Six (Conditions) of the policy isreplaced by the following condition: D. Cancellation 1. You may cancel this policy. You must mail.or deliver to us not less than 30 days advance written notice N stating when'the cancellation is.to take effect. Cancellation of coverage will be effective at 12:01 a.rn. ;, thirty (30) days after the date the cancellation notice is received by us, unless a later date is specified in ,-.Ti the notice to us. You may cancel this policy effective less than 30 days after written notice is received LT. by us where•you have obtained other coverage or have become a self-insurer. 2. We may cancel this policy. We will mail to you advance written notice stating when the cancellation`is to take effect. a. At any time during the policy period, we may cancel for nonpayment of premium. If we cancel for nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 10 days before the cancellation is to take effect. b. If we cancel this policy for a reason other than nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 30.days before the cancellation is to take effect. c. If this policy has been in effect for more than 45 business days'or is a renewal policy, we may cancel for only one or more of the following reasons: (1) Nonpayment of premium; (2) Discovery of fraud or material misrepresentation in the procurement of the insurance or with respect to any.claims submitted under it; (3) Discovery of willful or reckless acts or omissions on the part of the named insured which increase any hazard insured against; (4) The occurrence of a change in the risk which substantially increases any hazard insured against afterinsurance coverage has been issued or renewed; (5) A violation of any local fire, health, safety, building, or construction regulation or ordinance with respect to any insured property or the occupancy thereof which substantially increases any hazardinsured against; (3) A determination by the Insurance Commissioner that the continuation of the policy would place theinsurer in violation of the insurance laws of this state;' (7) Conviction of the named insured of a crime having as one of its necessary elements an act ncreasing any hazard insured against; or (8) Loss'of or substantial changes in applicable reinsurance, 3. Mailing notice of cancellation to you.at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 4, The policy period will end on the day and hour stated in the cancellation notice. Form No: WC 35.06 01 F102.2014) Policy No:WC 6 8081823E Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date:05/01/2021 Endorsement No: 23: Page: 1 of 3 Policy Page: 98 of 1 17 Underwriting Company: Antericart.Cosuafty.Company of Reading. Pennsylvania 151 N Franklin St, Chicago, IL 50606 °Copyright 2013 National Council on Compensation.Insurance, Inc. All Rights Reserved. CNA Workers Compensation And Employers Liability insurance Policy Endorsement 5. Any of these provisions that"conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with the law. Part 8 (Conditions) of the policy is amended by adding the following;provisions: F. Nonrenewal 1. If we elect not to renew this policy, we will mail or deliver written notice of nonrenewal to you at least 45 days before: a. The expiration date of this:policy;'or b. An anniversary date of this policy, if.it is written for a term longer than one year or with no fixed expiration date. 2. Any notice of nonrenewal will be mailed or delivered to you at the mailing address shown in Item 1 of the Information Page. If notice is mailed: a. It will be considered to have been given to you on the day it is mailed: b. Proof of mailing will be sufficient proof of notice. 3. If notice of nonrenewal is not mailed'or delivered at least 45 days before the expiration:date'or an anniversary dateof this°policy, coverage will remain in effect until 45days after notice is given. Earned premium for such extended period of coverage will be calculated pro rata based on the rates applicable to the expiring policy. 4: We will not provide notice of nonrenewal if: a. We, or another company within the same insurance group, have offered to issue a renewal policy; or b. You have obtained replacement coverage or have-agreed in writing to obtain replacement coverage. 5. If we have provided the required notice of nonrenewal as described above, and thereafter extend the policy for a period of 90 days or less; we will not provide an additional nonrenewal notice with respect to the period of extension. G. Notice of Premium or Coverage Changes Upon Renewal 1. If we elect to renew this policy, we will give written notice of any premium increase, change in deductible, or reduction in limits or coverage, to you, at the mailing address shown in Item 1 of the Information Page. 2. Any such`notice will be mailed or delivered to you at least 45 days before: a. The expiration date of this policy; or bAn"anniversary date of this policy, if it iswrittenfor a term longer than one year or with no fixed expiration date, 3. If notice is mailed: a. It will be considered to have been given to you on the day it is mailed. b. Proof of mailing will be sufficientproof of notice. 4. If you accept the:renewal, the premium increase or deductible, limits or coverage changes will be effective the day following the prior policy's expiration or anniversary date. 5. If notice is not mailed or delivered at least 45 days before the expiration date or anniversary date of this policy, the premium, deductible, limits and coverage in effect prior to the changes will remain in effect until the earlier of Form No:WC 35 05 01 F(02.2014) Policy No:WC 6 10818238 Endorsement Effective Date_ Endorsement Expiration Date:` Policy Effective Dale:05/01/2021 Endorsement No: 23; Page: 2 of 3 Policy Page: 99 of 1 1 7 Underwriting Company: American.Casualty Company of Reading,Penn'ylvania.,181 N Frandtn St, Chicago,it. 60606 Copyright 2013 National Council on Compensation Insurance;Inc:All Rights Reserved. CrNWorkers CopensattiOn And Employers Liability Insurance m PoUcy Endorsement a. 45 days after notice is given; or b. The effective date of replacernent coverage Obtained by YOu. 6. If you then elect not to renew, any earned premium for the resulting extended period of coverage will be calculated pro rata at the lower:of the new rates or rates applidable to the expiring policy. 7. We will not provide notice of The following: a. Changes in a rate or plan filed with or approved by the Insurance'Commissioner or filed pursuant to the Property and Casualty CoMpetitive Loss Cost Rating Act and applicable to an entire class of business; or b. Changes based upon the altered nature of extent of the risk:insured -or cs, c. Changes in policy forms filed with or approved by the Insurance Commissioner and applicable to an entire class of business. u_ All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) isshown below, and expires cpncurrently. with said policy unless another expiration date,is shown below. Form No: WC 35 06.01 F102.2014) Policy No:WC 6 B0818238 Endorsement pfeetive Date: Endorsement Expiration Date: Policy Effective Date:05/01/2021 Endorsement No: 23: Page:3 of 3 Policy Page: 100 of 117 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 16I N Frahldin 51, chipao_IL.60606 Copyright 2013 National C01161:11 on Compensation Insurance,Inc'. All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement f =espy � :ro f ll e• 's, a +3 $ °.c°s • " oL j f4Ea CANGf: LATtQ Ntl Efi�EN r z - ..,::12 . ." I g ed*,.%sra.: _e,.z _.� ' i a- ::4''',,f °tea-a This endorsement applies only to the insurance provided by the policy because Oregon is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is replaced by this Condition: D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us, stating when the cancellation is to take effect. If you provide for other insurance or-self:insurance, your cancellation of coverage will take effect upon the effective date of that insurance. 2. We may cancel this policy. We will mail to you advance written notice stating when the cancellation is, to take effect. a. If we cancel based on our decision not to offer insurance to all employers within your premium category, we will mail the notice of cancellation at least 90 daysbefore the,cancellation is,to take effect. b. If we cancel for other reasons, we•will mail the notice of cancellation at least 45 days before the cancellation is to take effect. c. If we cancel for nonpayment, we will mail notice of cancellation at least 10 days-before-the cancellation is to take effect. 3. Mailing notice to you at your last known mailing address will be sufficient to prove notice. 4. The policy period will end at 12:00 midnight on the day stated in the cancellation notice. 5. When coverage is placed with another carrier as of the policy expiration date, a rejected renewal policy shall be withdrawn without charge, provided notice of nonrenewal is mailed and postmarked on or` before the expiration date and is received from the insured by the insurer no later than 10 calendar days after said expiration date. All.other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date fthe Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. i Form No: WC 38 06 01 E(01-10081 Policy No:WC 6 80818238 1 Endorsement Effective Date: Endorsement Expiration Bate: Policy Effective Date:05/01/2021 I Endorsement Na:27: Page; 1 of 1 Policy Page: 104 of 117 Underwriting Company'.American Casualty Company of Heading,Pennsylvania, 151 N Franklin St, Chicago, IL 60606 Copyright.2007 National Council on Compensation Insurance,.inc_All Rights Reserved. CNA Workers Compensation And Employers Liability insurance Policy Endorsement 1Ik,w1,4C CI Lf Ti(+11f 11 E61E.W;AL,ENDPF1,§ -. This endorsement applies only`to'the insuranceprovided by the policy because Wisconsin is shown in Item 3.A. of the Information Page. The Cancellation Section ID) of the Part Six —'Conditions is.deleted and replaced by the following: A. Cancellation m co 1. You may cancel this policy: You must.mail or deliver advance;written.'notice to us stating when the N cancellation is to take,effect. If you purchase replacement insurance, the cancellation becomes effective on the date the new coverage becomes effective; If no replacement coverage is purchased,the, e cancellation will be effective thirty(30) days after receipt of Written notice by the Wisconsin Compensation Rating Bureau. 2. We may cancel this policy for any reason if the policy has been in effect for less than sixty(60) days. If the policy is issued for a term longer than one year or for an indefinite term, we may cancel the policy for any reason on an annual anniversary of the policy effective date, We may cancel the policy at any other time for the following reasons:` a. You fail to pay all premiums when due, however; we.must deliver or mail, first class, not less than thirty (30) days advance written notice stating when the cancellation is to take effect; b. A material misrepresentation; c. A substantial breach of the obligations, conditions or warranties under the policy; or d. A substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or expect the risk when we issued the policy. 3. If we cancel for any permissible reason other than non-payment of premium, we must deliver or mail, first class, not less than 'thirty (30) days notice stating when the cancellation is to take effect. Mailing that notice to you at'your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 4. The policy period will end on the day and hour stated in a notice of cancellation. B. Nonrenewal 1. You have the right to have the insurance renewed unless we deliver or mail to you not less than 'sixty (60) days advance written notice stating our intention not to renew this policy. 2. We do not have to renew the insurance if you do not pay the renewal premium billing by the due date or if you accept replacement insurance, are insured elsewhere, requested or agree to nonrenewal, or if the.policy is expressly designated as.being nonrenewable. 3. If we renew the insurance, we may use the policy forms, rates and rating plans we are then using for similar risks. We may limit the,policy to a term equivalent to the term of the expiring policy or one year, whichever is less. 4. If we offer to renew the policy on less favorable terms, we will mail or deliver written notice of the new terms by first class mail to you, the policyholder, at least sixty (60) days prior to the renewal date. The definition of "terms" does not include manual rates, experience modification factors, or classification of risks. • Form No: WC 48 06 06 B 101.20021 Policy Nu:'WC 6:60818238 I Endorsement Effective Date: Endorsement Expiration Policy Effective Dale:05/01/2021 Endorsement No:32:Page: 1'of 2 Policy Pagp;'109 of 117 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St Chicago, iL 60606 'Copyright 200'2'Natianal Council or Compensation Insurance; Inc_All Rights Reserved. CNA Workers Compensation And Employers Liability. Insurance Policy Endorsement If we provide such notice within sixty.(60) days prior to the.renewal date, the new,terms wilknot take effect until sixty (60) days after the notice is mailed or delivered, in which case, you, the policyholder, may elect to cancel the renewal policy-at,any time during,the Sixty (60)day period.The notice will include,a statement of your right to cancel If you elect to cancel the renewal policy during the sixty (60) day period, the return premium or additional premium charges,shall be calculated proportionally on the basis of the old premiums. We need not mail or deliver this notice if the.only change adverse to you is a premium increase that; (a) is less-,than 2541);-or, Ib) results from a change based on your action that alters the nature and extent of the risk insured against, including, but not limited to, a change in the classifications for the business. • Any written agreement attached to and made p part of the policy, between the insurance carrier and policyholderwhichextends the cancellatien or nonrenewal notification timeframe, will supercede the aforementioned notification requirements found in items A.3., and B.1., respectively. All other terms and conditions of the policy remain unchanged. _ — This endorsement, which forms a part of and-is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Form No: WC 48 06 06E1(01-2002) • Policy No:WC 6 80(118238 Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Dale'.05/01/2021 Endorsement:No:02;Page: 2 of 2 Policy Page: 11.0 of 117 Underwriting company: American Casualty Company of Peening.Pennsylvania, 151 N Franklin St. Chicago, IL 60606 Copyright 2002 National Council on Compensation Insurance, Inc, All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement AI As kcANCELA11611 AND ION ENE1ftfAL.se ft PORSEIVIl ,Ng rtg This endorsement applies'only tothe insurance provided by the policy because'Alaska is shown in Item 3.A. of the Information Page. The Cancelation Condition, as well as Part Five, Paragraph'8.2., of the policy is replaced by this Condition: D. Cancelation/Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the N cancelation is to take effect. If you cancel, the final premium will be calculated pro rata based on the time the policy was in force, and increased by a cancelation fee equal to 7.5 percent of the unearned LL premium, provided thatthe final premium will not be less.than the applicable minimum premium. 2. We may cancel this policy. We must mail or deliver to you and the agent or broker of record advance written notice stating the reason for cancelation and when the cancelation is to take'effect. Such notice will be mailed or delivered not less than: a. 10.days before the effective date of cancelation if we cancel for'conviction of the insured of a crime having as one of its necessary elements an act increasing a hazard insured against, or for discovery of fraud or material misrepresentation made by the insured or a representative of the insured in obtaining the insurance or by the insured in pursuing a claim under the policy; or b. 20 days before the effective date of cancelation if we cancel for nonpayment of premium, or for failure or refusal of the insured to provide the information necessary to confirm exposure or determine the policy premium;or c. 60 days before the effective date of cancelation if we cancel for any other reason.. 3. We will mail or deliver the notice to your last known address and the last known address of the agent or broker of record. 4. A post office certificate of mailing or certified mailing receipt will be sufficient to prove notice. 5. The policy period will end on the day and hour stated in the cancelation notice. 6. If we decide not to renew this policy, we will mail written notice of nonrenewal, by first class mail, to you and the agent or broker of record at least 45 days before: a. the expiration date; or b. the anniversary date if this policy has-been written for more than one year or with no fixed expiration date. 7. We need not mail notice of nonrenewal if: a. we have manifested in good faith-our willingness to renew; or b. you have failed to pay any premium required for this policy; or c. you fail to pay the premium required for renewal of this policy. 8. Any notice of nonrenewal will be mailed to your last known address and the last known address of the agent or broker of record. A post office certificate of mailing or certified mailing receipt will be sufficient proof of notice. Form No: WC'54 06 02 (04.19961 Policy No:WC 6 80818238 Endorsement Effective Date: Endorsement Expiration Date: Policy Etlective Date:os/m/zozi Endorsement No: 35: Page: 1 of 2 Policy, Page: 113 of 117 Underwriting Company: American Casualty Company of Heeding, Pelmsylvania, 151-N Franklin St, Chicago,.11 60606 Copyright 1995 National Council on Compensation Insurance, Inc. CNA Workers,Compensation And Employers Liability Insurance Policy Endorsement All tither terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and iS for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Dateofsaid policy al the hour stated in said policyunless another effective date (the EndorsementEffective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below, : Form No:WC 54 06 02 (04-1995) Policy No:WC 6 8081823ff Endorsement Effective Date: Endorsement Expiration Date: Policy Effec1ive Date:05/01/2021 Endorsement No: 45; Page 2 of 2 Policy Page: 114 of 117 Underwriting Company: American Casualty Company af Reading,Pennsylvania, 161 N Franklin St. Chikage, IL,60606 Copyright 19.95 Natal Council on Compensation Insurance, Inc. Liberty Mutual Insurance PO Box 188065 Fairfield,OH 45018 INSURANCE City of Ashland Sender: Gina Martin 20 E. Main St. Ashland OR 97520 Phone; 800-962-7132 Subject: Cert No.61506659-Certificate of Liability: • American Industrial Door LLC-City of Ashland Date: 5/3/2021 No. of Pages: 20 URL: If you have any questions or need any amendments, please contact us via email: BusinessService@LibertyMutual.com or call:800-962-7132. Sincerely, Gina Martin Associate Service Representative Business Service Center Liberty Mutual Insurance Phone:800-962-7132 Fax:800-845-3666 BusinessService@LibertyMutual.com Learn more about our privacy policy at Libertymutual.com/privacy This e-mail and any attachment is intended only for the use of the addressee(s) named herein and may contain legally privileged and/or confidential'information. If you are not the intended recipient of this e-mail, you are hereby notified that any dissemination, distribution or copying of this e-mail, and any attachments thereto, is strictly prohibited. If you have received this e-mail in error please notify me via return e-mail, and please permanently delete the original and any copy of any e-mail and any printout thereof. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH ITIS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED,CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW.IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT,OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT,YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION,DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED.IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR,PLEASE NOTIFY US IMEDIATELY BYTELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions,Inc.All rights reserved. Parker, Smith & Feek, Inc. 2233 112th Avenue NE Bellevue,WA 98004 Flat-9x12-Q01330-16-285 CITY OF ASHLAND 20EMAIN ST ASHLAND OR 97520-1814 iIIiIIIIIIiiInluiIIIuilluIiililiIidid.IuIiIiIIuiIiiiIIiiIiIII f0 LL THIS PAGE INTENTIONALLY LEFT BLANK