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HomeMy WebLinkAboutInsurance Certificate: Pacific Electrical Contractors Inc A�� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) I 6/30/202 :K THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. ti CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI ,t BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER; CONTACT Hub International Northwest LLC ,- NAME: KC Ferguson 560 Country Club Parkway LA/C.NN.Ext):541-687-1117 (A/0/XC,No):541-342-8280 Eugene OR 97401 ADDRESS: kc.ferguson@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance Company 24988 INSURED PACIELE-01 INSURER B:Indian Harbor Insurance Company 36940 Pacific Electrical Contractors Inc 920 S. Grape Street INSURER C: Medford OR 97501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:938958522 ' 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 ADDLISUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS!) WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y V A0219976004 7/1/2023 7/1/2024 EACH OCCURRENCE _ $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $10,000 _ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 _ POLICY X jECT LOC PRODUCTS-COMP/OP AGG $2,000,000 _ OTHER: $ A AUTOMOBILE LIABILITY Y Y A0219976001 7/1/2023 7/1/2024 SINGLE LIMIT $1,000,000 — ~ (Ea accident) X ANY AUTO _ BODILY INJURY(Per person) $ OWNED SCHEDULED — — AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ $ A UMBRELLA LIAB X OCCUR Y Y A0219976005 7/1/2023 7/1/2024 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE _ $5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Installation Floater A0219976003 7/1/2023 7/1/2024 Limit:$500,000 Ded:$2,500 B Professional Liability PEC0063738 Limit:$5,000,000 B Contractors Pollution 7/1/2023 1/1/2025 Ded:$10,000 PEC0063738 7/1/2023 1/1/2025 Limit:$5,000,000 Ded:$10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations,auto liability&pollution liability as required by written contract per attached endorsements.Umbrella follows form over General Liability,Auto Liability and Employers Liability.Subject to policy limits,terms,conditions and exclusions. 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 Maintenance Dept 90 N Mountain Avenue Ashland OR 97520 AUTHORIZED REPRESENTATIVE 19e —'' C961 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD $...g_ 1 POLICY NUMBER: A0219976004 COMMERCIAL GENERAL LIABILITY C.With respect to the insurance afforded to these 2. Available under the applicable limits of CG 20 10 12 19 additional insureds, the following is added to insurance; Section III-Limits Of Insurance: whichever is less. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. If coverage provided to the additional insured is This endorsement shall not increase the ADDITIONAL INSURED -OWNERS, LESSEES OR willaycontractbyafoft or eaddeionaliment,themosthe applicable limits of insurance. required pay on behalf the additional insured is twe amount of insurance: CONTRACTORS -SCHEDULED PERSON OR 1. Required by the contract oragreement;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 you are required to , add as an additional insured under a written Jobsites as described in written contracts with contract or written agreement in effect prior to the named insured any loss or damage Information required to complete this Schedule,if not shown above,will be shown in the Declarations. • . A.Section II-Who Is An Insured is amended to B.With respect to the insurance afforded to these r include as an additional insured the person(s)or additional insureds, the following additional # , organization(s)shown in the Schedule,but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to"bodily injury"or "property damage"or"personal and advertising "property damage"occurring after: injury"caused,In whole or in part,by: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs)to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s)at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However. 2. That portion of"your work"out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use an by anyo person or organization insured only applies to the extent permitted by law;and other than another contractor or subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the same is required by a contract or agreement, the project. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 ©Insurance Services Office,Inc.,2018 Page 2 of 2 ©Insurance Services Office,Inc.,2018 CO 20 10 12 19 Ao 201 Page 1 of 2 Middlesex Insurance Company 06126/2023 A0219976 1 00001 0000000000 20177 5 N e700eed9-49ed51a876a.132e5951c005 Middlesex Insurance Company 06/26/2023 L�y ri POLICY NUMBER: A0219976004 COMMERCIAL GENERAL LIABILITY �J • CG 20 3712 19 y' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization you are required to Jobsites and Operations as described in written add as an additional insured under a written contracts with the named insured. contract or written agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III -Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured applicable limits of insurance. is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 3712 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 A0219976 06/26/2023 Middlesex Insurance Company 1 00001 0000000000 23177 0 N efc58ea0-bb2a-4e64-8ff3-adf78e594ff7 Policy Number:A0219976004 COMMERCIAL GENERAL LIABILITY A person's or organization's status as an B.Owners, Lessees Or Contractors - CG 71 25 06 22 additional insured under this endorsement Automatic Status When Required In Written ends when your operations for that Construction Agreement With You THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. additional insured are completed. (Completed Operations) 2) With respect to the insurance afforded to 1) Any person(s) or organization(s) with CONTRACTORS BLANKET ADDITIONAL INSUREDS these additional insureds, the following respect to liability for "bodily injury" or r additional exclusions apply: "property damage"caused,in whole or in PRIMARY& NONCONTRIBUTORY, WAIVER OF This insurance does not apply to: part, by "your work" performed for that SUBROGATION a. "Bodily injury", "property damage" or additional insured and included in the "personal and advertising injury"arising "products-completed operations hazard", out of the rendering of,or the failure to but only when that portion of the This endorsement modifies the coverage provided under the following Coverage Form(s): render, any professional architectural, products-completed operations hazard"is engineering or surveying services, not excluded by endorsement. COMMERCIAL GENERAL LIABILITY COVERAGE PART including: 2) With respect to the insurance afforded to SCHEDULE 1. The preparing,approving,or failing these additional insureds, the following Coverage enhancements are listed below.For details of each coverage,please read the corresponding policy to prepare or approve,maps,shop additional exclusion applies: provisions in the body of this endorsement. drawings, opinions, reports, This insurance does not apply to: surveys,field orders,change orders "Bodily injury" or "property damage" 1. Additional Insureds-Automatic Status for 13 Additional Insured Types or drawings and specifications;or arising out of the rendering of,or the failure A. Owners,Lessees Or Contractors-Automatic Status When Required In A Written Construction 2. Supervisory, inspection, to render, any professional architectural, Agreement With You architectural or engineering engineering or surveying services, - -_ B..Owners,Lessees.Or Contractors-Automatic Status When Required In Written Construction - - activities. - including: - Agreement With You(Completed Operations) This exclusion applies even if the claims a. The preparing,approving,or failing to C.State or Governmental Agency or Subdivision or Political Subdivision—Permits or Authorizations against any insured allege negligence or prepare or approve, maps, shop D.Lessor of Leased Equipment other wrongdoing in the supervision, drawings, opinions, reports, surveys, E. Owners or Other Interests From Whom Land Has Been Leased hiring, employment, training or field orders,change orders or drawings F. Manager or Lessor of Premise monitoring of others by that insured,if and specifications;or G.Mortgagee,Assignee,or Receiver the "occurrence" which caused the b. Supervisory,inspection,architectural or "bodily injury"or"property damage",or engineering activities. H.Controlling Interest I. Co-owner Of Insured Premises the offense which caused the"personal and advertising injury", involved the This exclusion applies even if the claims • J. Executors,Administrators,Trustees Or Beneficiaries rendering of or the failure to render any against any insured allege negligence or K.State Or Governmental Agency Or Subdivision Or Political Subdivision-Permits Or Authorizations professional architectural, engineering other wrongdoing in the supervision,hiring, Relating To Premises or surveying services. employment, training or monitoring of L. Vendors b. "Bodil in'u others by that insured,if the"occurrence" y 1 ry" or "property damage" which caused the "bodily injury" or M.Grantor of Franchise occurring after: "property damage"involved the rendering 2. Primary and Noncontributory-Other Insurance Condition 1. All work, includingmaterials, parts of or the failure to render 3. Waiver Of Transfer Of Rights Of Recovery Against Others To Us(Waiver Of Subrogation) any professional Automatic g ) or equipment furnished in architectural, engineering or surveying connection with such work,on the services. With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless project (other than service, C.State or Governmental Agency or modified by the endorsement. maintenance or repairs) to be Subdivision or Political Subdivision - performed by or on behalf of the Permits or Authorizations 1. Additional Insureds-Automatic Status for 13 A. Owners, Lessees Or Contractors - additional insured(s)at the location of the covered operations has been Any state or governmental agency or Additional Insured Types Automatic Status When Required In A completed;or subdivision or political subdivision,subject to Written Construction Agreement With You the following provisions: Section II-Who Is An Insured is amended to include the following as additional insureds when 1) A person or organization with respect to 2. That portion of"your work"out of you have agreed to add that person or liability for "bodily injury", "pro a which the injury or damage arises 1) This insurance applies only with respect to p has been put to its intended use by operations performed by you or on your organization as an Additional Insured on your damage" or "personal and advertising any person or organization other behalf for which the state or governmental policy in a written contract or written agreement injury"caused,in whole or in part,by: than another contractor or agency or subdivision or political with that person or organization,or because of a a. Your acts or omissions;or subcontractor engaged in subdivision has issued a permit or permit issued by a state or political subdivision; b. The acts or omissions of those actingperforming operations for a principal authorization. provided the injury or damage occurs subsequent to the execution of the contract or agreement or on your behalf; as a part of the same project. 2) This insurance does not apply to: issuance of the permit and while the contract, in the performance of your ongoing agreement or permit remains in effect. operations for the additional insured. CG 71 25 06 22 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 5 Page 2 of 5 Includes copyrighted material of Insurance Services Office,Inc., CG 71 25 06 22 A0219976 with its permission. 06/26/2023 A021997s a with its permission. 06/26/2023Middlesex Insurance Company Middlesex Insurance Cam 1 00003 0000000000 23177 0 N 06696ato2dde4b27-a333-1ee276191602 p ny Policy Number:A0219976004 a. "Bodily injury", "property damage" or F. Manager or Lessor of Premise K. State Or Governmental Agency Or 1) "Bodily injury" or " "personal and advertising injury"arising property damage" for out of operations performed for the Any person(s)or organization(s)with respect Subdivision Or Political Subdivision - which the vendor is obligated to pay to liability for "bodily injury", "property Permits Or Authorizations Relating To damages by reason of the assumption of federal government, state or damage"or"personal and advertisingu Premises municipality;or in 1 rY' liability in a contract or agreement. This caused,in whole or in part,by you or those Any state or governmental agency or exclusion does not apply to liability for b. "Bodily injury" or "property damage" acting on your behalf in connection with the subdivision or political subdivision,subject to damages that the vendor would have in the included within the ownership,maintenance or use of that part of the following additional provision: absence of the contract or agreement; "products-completed operations the premises leased to you by the additional This insurance applies onlywith respect to the 2) Any express warranty unauthorized hazard". insured person(s)or organization(s),subject to pptY by you; D.Lessor of Leased Equipment the following additional exclusions: following hazards a for which the state or 3) Any physical or chemical change in the governmental agency or subdivision or product made intentionally by the vendor; 1) Any person(s) or organization(s) with This insurance does not apply to: political subdivision has issued a permit or 4) Repackaging, except when unpacked respect to liability for "bodily injury", 1) Any"occurrence"which takes place after authorization in connection with premises you solelypurpose inspection, "property damage" or "personal and you cease to be a tenant in that premises. own, rent or control and to which this for the ti ose of ion advertising injury"caused, in whole or in insurance applies: demonstration,testing,or the substitution 2) Structural alterations,new construction or part, by your maintenance, operation or manufacturer,of parts under thenuepac from the use of equipment leased to you by such bemofitof he s performed bon 1) con axion, a maintenance, al of lontai and then repackaged in the person(s)or organization(s). behalf of the person(s)or organization(s) construction, erection or removal of original container; shown in the Schedule. advertising signs,awnings,canopies,cellar 2) With respect to the insurance afforded to G.Mortgagee,Assignee,or Receiver entrances, coal holes, driveways, 5) adjustments,Anyfailureto make such inspections, these additional insureds, this insurance manholes,marquees,hoist away openings, dortitests or servicing as the does nota I to any"occurrence"which Any person(s)or organization(s)with res act vendor has agreed to make or normally apply p sidewalk vaults, street banners or takes place after the equipment lease to their liability as mortgagee, assignee or decorations and similar exposures;or busof expires. receiver and arising out of the ownership, businessness,, ti make in the usual course n connection with the maintenance or use of apremisesby2) The construction, erection or removal of distribution or sale of the products; E.-Owners or you. Other— Interests From Whomelevators;or Land Has Been Leased This insurance does not apply to structural 6) Demonstration, installation, servicing or alterations, new construction and demolition 3) The ownership,maintenance or use of any repair operations,except such operations 1) Any person(s), or organtzalton(s) with elevators covered bythis insurance. - respect to liability for "bodily injury", operations performed by or for such additional performed at the vendor's premises in "property damage" or "personal and insured person(s)or organization(s). L. Vendors connection with the sale of the product; advertising injury"caused, in whole or in H.Controlling Interest 1)Any person(s)or organization(s)(referred to 7) Products which,after distribution or sale part,by you or those acting on your behalf 1) p n throughout this endorsement as vendor), by you,have been labeled or relabeled or y person(s) or organization(s) with ) used as a container, in connection with the ownership, respect to their liability arising out of: but only with respect to liability for"bodily part or ingredient of maintenance or use of that part of the land injury"or"property damage"arising out of any other thing or substance by or for the to you by the additional insured a. Their financial control of you;or "your products"which are distributed or vendor;or leasedsold in the regular course of the vendor's 8) "Bodily injury" or "property damage" person(s)or organization(s). b. Premises they own,maintain or control 2) With respect to the insurance afforded to while you lease or occupy these business. arising out of the sole negligence of the these additional insureds, the following premises. However: vendor for its own acts or omissions or additional exclusions apply: 2) This insurance does not apply to structural a. The insurance afforded to such vendor those of its employees or anyone else alterations, new construction and only applies to the extent permitted by acting on its behalf. However, this. This insurance does not apply to: demolition operationsperformed byor for exclusion does not apply to: P law•,and a. Any "occurrence" which takes place that person or organization. (1)The exceptions contained in b. If coverage provided to the vendor is Subparagraphs d.or f.;or after you cease to lease that land; I. Co-owner Of Insured Premises required by a contract or agreement, b. Structural alterations,new construction Amy persons)or organizations)with respect the insurance afforded to such vendor • or demolition operations performed by to their liability as co-owner of a premises will not be broader than that which you or on behalf of the additional insured co owned byyou and covered under this are required bythe contract or person(s)or organization(s). insurance. agreement to proide for such vendor. J. Executors, Administrators, Trustees Or 2) With respect to the insurance afforded to Beneficiaries these vendors, the following additional Any executor, administrator, trustee or exclusions apply: beneficiary of your estate or living trust while a. The insurance afforded the vendor acting within the scope'of their duties as such. does not apply to: CG 71 25 06 22 Includes copyrightedimaterial of Insurance Services Office,Inc., Page 3 of 5 Page ge 4 of 5 Includes copyrighted material permission.Insurance Services Office,Inc., CG 71 25 06 22 Middlesex Insurance Companywith its permission. 06Y26/2023 A021976Middlesex 3 60003 0000000000 23117 0 N 66696eI0'2dd,ip27a166-n Insurance Company with its 06/26/2023 1 Y/61916e2 $ .' Y a. Policy Number:A0219976004 (2)Such inspections,adjustments,tests or This endorsement shall not increase the servicing as the vendor has agreed to applicable limits of insurance. make or normally undertakes to make in If there is any difference in coverage afforded the usual course of business, in to an additional insured in this endorsement connection with the distribution or sale and that provided under another additional of the products. insured endorsement attached to this policy, b. This insurance does not apply to any the broader coverage will apply to that insured person or organization,from whom additional insured. you have acquired such products,or any 2. Primary And Noncontributory Insurance ingredient,part or container,entering into, accompanying or containing such The following is added to the Other Insurance products. Condition and supersedes any provision to the M.Grantor of Franchise contrary: • Any person(s)or organization(s)with This insurance is primary to and will not seek to their liability asor grantor a franchise respecttpect contribution from any other insurance available to an additional insured under your policy provided However: that: 1.The insurance afforded to such additional (1)The additional insured is a Named Insured insureds only applies to the extent permitted under such other insurance;and by law;and (2)You have agreed in writing in a contract or 2.If coverage provided to the additional Insured is agreement that this Insurance would be required by a contract or agreement, the primary and would not seek contribution from insurance afforded to such additional insured - - any other insurance available to the additional will not be broader than that which you are insured. required by the contract or agreement to 3. Waiver Of Transfer Of Rights Of Recovery provide for such additional insured. Against Others To Us(Waiver Of Subrogation)- With respect to the insurance afforded to Automatic these additional insureds, the following is The following is added to Paragraph 8.Transfer added to Section III-Limits Of Insurance: Of Rights Of Recovery Against Others To Us of If coverage provided to the additional insured Section IV-Conditions: is required by a contract or agreement, the We waive any right of recovery against any most we will pay on behalf of the additional person or organization,because of any payment insured is the amount of insurance: we make under this Coverage Part,to whom the ,_, 1. Required by the contract or agreement;or insured has waived its right of recovery in a 2. Available under the applicable limits of written contract or agreement.Such waiver by us insurance; applies only to the extent that the insured has whichever is less. waived its right of recovery against such person or organization prior to loss. CG 71 25 06 22 Includes copyrighted material of Insurance Services Office,Inc., Page 5 of 5 A0219976 with its permission. 06/26/2023 Middlesex Insurance Company 5 00003 0000000000 23177 0 N 03396afo2dde4027a333-1ee2761916e2 Policy Number:A0219976004 COMMERCIAL GENERAL LIABILITY :4i1,_ CG 20 01 12 19 ttir'T' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE, CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2)You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 A0219976 Middlesex Insurance Company 06/26/2023 1 00001 0000000000 23177 0 N 8f041450-a717-4f62-9ceb-2558d6414c50 POLICY NUMBER: A0219976004 COMMERCIAL GENERAL LIABILITY CG 24 0412 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization to whom you are required to waive your right to recover by a written contract or agreement executed prior to loss 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 Section IV-Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s)or organization(s)prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. CG 24 0412 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 A0219976 Middlesex Insurance Company 06/26/2023 1 00001 0000000000 23177 0 N be177518-113a-4ee9-bfa2-6b91b2731397 f" Policy Number:A0219976004 COMMERCIAL GENERAL LIABILITY B. For all sums which the insured becomes legally CG 71 18 06 20 obligated to pay as damages caused by "occurrences" under Section I - Coverage A, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. and for all medical expenses caused by accidents under Section I-Coverage C,which cannot be EACH CONSTRUCTION PROJECT attributed only to ongoing operations at a single designated construction project shown in the GENERAL AGGREGATE LIMIT Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical This endorsement modifies insurance provided under the following: expenses shall reduce the amount available under the General Aggregate Limit or the COMMERCIAL GENERAL LIABILITY COVERAGE PART Products-completed Operations Aggregate Limit,whichever is applicable;and SCHEDULE 2. Such payments shall not reduce any Each Policy Maximum Each Construction Project General Aggregate Limit: Not Applicable Construction Project General Aggregate Limit provided under this policy. C.When coverage for liability arising out of the Designated Construction Project(s):All construction projects away from premises owned by or rented to the "products-completed operations hazard" is Insured provided,any payments for damages because of "bodily injury"or"property damage"included in the"products-completed operations hazard"will _ - - reduce the Products-completed Operations - • Aggregate Limit, and not reduce the General Information required to complete this Schedule,if not shown above,will be shown in the Declarations. Aggregate Limit nor any Each Construction Project General Aggregate Limit provided under A. For all sums which the insured becomes legally b. Claims made or"suits°brought; or this policy. • obligated to pay as damages caused by c. Persons or organizations making claims or D.If the applicable designated construction project ging"suits". has•been abandoned, delayed, or abandoned . and for all medical expenses caused by accidents and then restarted, or if the authorized . ... ... under Section I Coverage C, which can be 4. Subject to Paragraph 2.above,any payments contracting parties deviate from plans,blueprints, attributed only to ongoing operations at a single made under Coverage A for damages.or designs,specifications or timetables,the project designated construction project shown in the under Coverage C for medical expenses shall will still be deemed to be the same construction - Schedule above: reduce the Each Construction Project project. s_- General Aggregate Limit for that designated 1. Subject to Paragraph 2.below,a separate E.The provisions of Section III - Limits Of construction project.Such payments shall not Each Construction Project General reduce the General Aggregate Limit shown Insurance rsece not otherwise modified l this Aggregate Limit applies to each designatedin endorsement shall continue to apply as construction project,and that limit is equal to other the Each Constnsruction nort shall Projecte Generalee any stipulated. the amount of the General Aggregate Limit Each Construction shown in the Declarations. Aggregate Limit for any other designated construction project shown in the Schedule 2. If shown in the Schedule, the Policy above. Maximum Each Construction Project 5. Subject to Paragraph 2. above, the limits General Aggregate Limit is the most we will shown in the Declarations for Each pay for the sum of all damages paid under all Occurrence, Damage To Premises Rented Each Construction Project General To You and Medical Expense continue to Aggregate Limits included in this policy. apply. However, instead of being subject to 3. Subject to Paragraph 2. above, the Each the General Aggregate Limit shown in the Construction Project General Aggregate Declarations,such limits will be subject to the Limit is the most we will pay for the sum of all applicable Each Construction Project damages under Coverage A,except damages General Aggregate Limit. because of "bodily injury" or "property damage"included in the"products-completed operations hazard",and for medical expenses under Coverage C regardless of the number of: a. Insureds; CG 71 18 06 20 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 2 Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc., CG 71 18 06 20 A0219976 with its permission. 06/26/2023 A0219976 with its permission. 06/26/2023 Middlesex Insurance Company Middlesex Insurance Company 1 00001 0000000000 23177 0 N 17550106.795.-0018-8021-bb58a4e93195 POLICY NUMBER: A0219976004 ti � • IL70600815 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO OTHERS This endorsement modifies the coverage provided under the following: COMMERCIAL AUTO COVERAGE PART COMMERCIAL EXCESS/UMBRELLA COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person(s) Or Organization(s) Number of Days Notice Any person or organization you are required to 30 add as an additional insured under a written contract or written agreement in effect prior to any loss or damage Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following additional condition is added: c. Will not extend the cancellation effective A. Notice of Cancellation to Others date nor impact or negate any cancellation 1. If we send notice of cancellation to the Named of the policy; Insured shown in the declarations,for a reason 3. We are not obligated to notify the person(s) or other than nonpayment of premium, we will organization(s) shown in the schedule of the provide notice of such cancellation to the expiration, renewal on different terms or person(s) or organization(s) listed in the nonrenewal of the policy to which this schedule of this endorsement(the schedule); endorsement is attached; and 2. This notice: 4. The provisions of this endorsement do not a. Will be provided not less than the number entitle the person(s) or organization(s) listed in of days shown in the schedule prior to the the schedule to any benefits, rights nor protections not already provided for under the cancellation effective date indicated in the policy. schedule; All other`terms and conditions of the policy remain b. If mailed,will be sent to the mailing address unchanged. known to us at that time, with proof of mailing constituting sufficient proof of notice; and IL 70 60 08 15 Pae1of1 A0219976 g Middlesex Insurance Company 06/26/2023 1 00001 0000000000 23177 0 N 8b511507-bf66-4377-a679-d6b8d89bec7b _}4, . }��t, t� Policy Number:A0219976001 COMMERCIAL AUTO B. Paragraph 2.a.(4)is amended to pay for loss (2) Specified Causes Of Loss only if the CA 70 57 06 22 of earnings up to$500 a day because of time Declarations indicate that Specified off from work. Causes of Loss Coverage is provided 5. Fellow Employee Bodily Injury Extension for any covered"auto';or The Fellow Employee exclusion contained in (3) Collision only if the Declarations SPECIAL BROAD FORM AUTO ENDORSEMENT Section II-Covered Autos Liability Coverage indicate that Collision Coverage is does not apply. provided for any covered"auto". This endorsement modifies Insurance provided under the following: 6. Accidental Airbag Discharge However, the most we will pay for any expenses for loss of use is$50 per day,to The following is added to Exclusion B.3.a.under a maximum of$1,500. BUSINESS AUTO COVERAGE FORM Section III-PHYSICAL DAMAGE: 9. Rental Reimbursement This exclusion does not apply to the accidental 1. Broadened Who Is An Insured the extent that person or organization qualifies discharge of an airbag in a covered auto for a loss A. For any covered "auto" for which Under Section II - Covered Autos Liabilityas an"insured"under the Who is An Insured that Physical Damage Coverage is shown in the Comprehensive and Collision coverages are Declarations. provided,we will pay for rental reimbursement Coverage,the followingis added to Coverage provision contained in Paragraph Al.. of gg expenses incurred by you for the rental of an A.1.Who Is An Insured: Section II-Covered Autos Liability Coverage 7. Towing "auto"because of"loss"to a covered"auto". in the Business Auto Coverage Form. d. Employees As Insureds We will pay up to the limit shown in the B.We will pay up to the limit shown in the The insurance afforded under this provision Declarations for towing and labor costs incurred Declarations for rental reimbursement Any"employee"of yours is an"insured"while only applies if the"bodily injury"or"property each time a covered "auto" that is aprivate using a covered"auto"you don't own,hire or "auto"expensese incurredaueto you for the rental ofu ". damage"occurs: passenger type, light truck or medium truck is borrow in your business or personal affairs. "auto"because of"loss"to a covered"auto". 1. During the policy period,and disabled.However,the labor must be performed Payment applies in addition to the otherwise e. Newly Acquired Organizations at the place of disablement. y Pp AnyOrganizationyou newlyacquire or form, 2. After the execution of such written applicable amount of each coverage you have g q contract,and 8. Physical Damage Coverage Extensions on a covered"auto".No deductibles apply to other than a partnership, joint venture or this coverage. limited liability company,and over which you 3. Prior to the expiration of the period that the The following.replaces the Coverage Extensions maintain ownership or majority interest, will written contract requires such insurance to under Section III-PHYSICAL DAMAGE: C.We will pay only for those expenses incurred qualify as a Named Insured if there is no other be provided to the additional insured. a. Transportation Expenses during the policy period beginning 24 hours -_ similar insurance available to that organization. B.This insurance is primary to and will not seek We will payupto $75 after the"loss"and ending,regardless of the per day to a policy's expiration, with the lesser of the _-r_ However: contribution from any other auto insurance maximum of $1,500 for temporary following number of days: 1. Coverage under this provision is afforded issued to the person or organization in the . • transportation expense incurred by you 1• The number of days reasonably required to - , only until the 90th day after you acquire or schedule under your policy provided that: . - because of the total theft of a covered • form the organization or the end of the 1. The person or organization is a Named "auto"of the private passenger,truck or repair or replace the covered "auto". If s < policy period;whichever is earlier;and Insured under such other insurance;and van type with a Gross Vehicle Weight of loss"is caused by theft,this number of less than 10,000 pounds. days is added to the number of days it • 2. Coverage does not apply to"bodily injury", 2. Prior to the"accident"you have agreed in takes to locate the covered "auto" and "property damage" or"covered pollution writing in a contract or agreement that this We will pay only for those covered"autos" return it to you. cost or expense"that occurred before you insurance would be primary and would not for which you carry either Comprehensive acquired or formed the organization. seek contribution from any other insurance -. or Specified Causes of Loss Coverage.We 2. The number of days shown in the - f. For Any Covered"Auto": available to the person or organization. . will pay for temporary transportation Schedule. 3Waiver of Transfer of Rights of Recoveryexpenses incurred during the period D.Our payment is limited to the lesser of the . Who Is An Insured is amended to include as g beginning 48 hours after the theft and following amounts: an insured any organization or subsidiary The Transfer of Rights of Recovery Against ending, regardless of the policy's 1. Necessary and actual expenses incurred. thereof which is a legally incorporated entity of Others to Us Condition does not apply to any expiration, when the covered "auto" is 2. The maximum payment stated in the ._ which you own a financial interest of more person(s) or organization(s) for whom you are returned to use or we pay for its"loss". P Y than 50 percent of the voting stock on the required to waive subrogation with the respect to Schedule applicable to"any one day"or effective date of this endorsement. coverage provided under this Coverage Form,but b. Loss Of Use Expenses "any one period". This provision applies only if there is no similar only to the extent that subrogation is waived: For Hired Auto Physical Damage,we will pay expenses for which an "insured" E.This coverage does not apply while there are insurance available to the entity described A. Under a written contract or agreement with spare or reserve"autos"available to you for becomes legally responsible to pay for loss above. such person(s)or organization(s),and your operations. of use of a vehicle rented or hired without a 2. Additional Insured by Contract,Agreement or B. Prior to the"accident"or the"loss." driver under a written rental contract or F. If "loss" results from the total theft of a Permit 4. Broadened Supplementary Payments agreement. We will pay for loss of use covered"auto"of the private passenger type, SECTION II-LIABILITY COVERAGE,Paragraph expense if caused by: we will pay under this coverage only that Coverage Extension 2.a. Supplementary amount of your rental reimbursement A.1.Who is An Insured is amended to include Other Payments under Section II - Covered Autos (1) than collision only if the Yexpenses which is not already provided for the following as an"insured": Declarations indicate that Liability Coverages is amended as follows: Com r under ,the Physical Damage Coverage A.Any person or organization,where you have A.para h 2.a.2 Is amended to a u to p ehensive Coverage is provided Extension. ra agreed by written contract to add as an 9 P ( ) P y P for any covered"auto'; additional insured, is an insured but only to $3,000 for cost of bail bonds;and CA 70 57 06 22 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 4 Page 2 of 4 Includes copyrighted material of Insurance Services Office,Inc., CA 70 57 06 22 A0219976 with its permission. 06/26/2023 A0219976 with itsermission. Middlesex Insurance Company - Middlesex Insurance Company P 06/26/2023 1 00002 0000000000 23177 0 5 bc5318b0-91eb4783-9172-e59236eb5135 Policy Number:A0219976001 G.Our payment under this coverage extension is (e) Carry-over balances from previous (5) Property specifically insured or covered excess over any other rental reimbursement loans or leases. under the Business Personal Property coverage available to you. B.This coverage extension applies to covered Coverage of this policy. 10.Hired Auto Physical Damage autos that are loaned or leased fora period of 13.Glass Deductible six months or longer and which have been A. If you have Comprehensive or SpecifiedUnder Section III - PHYSICAL DAMAGE, the Causes of Loss and Collision Coverages provided Physical Damage Coverage. The followingis added to A.3. Glass Breakage provided on your owned "autos" you may "loss"must be caused by damage for which 9 - covera a is shown in the Declarations. Hitting A Bird Or Animal-Falling Objects Or extend Physical Damage Coverage to any 9 Missiles Coverage: "autos" you lease, hire, rent or borrow; C.For the purposes of this clause,the following The Comprehensive Coverage deductible shown provided you have Liability Coverage for hired is added to the Other Insurance Condition in in the Declarations does not apply to glass "autos". the Business Auto Coverage Form: breakage if such glass is repaired rather than B.The hired"auto"must be of like kind and used The insurance provided by the Auto Loan and replaced. as the"autos"owned and covered under this Lease Gap Coverage is excess over any other 14.Broad Knowledge Of Accident,Claim,Suit Or Coverage Form. collectible insurance including but not limited C.The most we will pay for"loss"to any hired to any coverage provided by or purchased Loss "auto"in any one"accident"is the least of the from the lessor or any financial institution. Under Section IV-Business Auto Conditions, the following is added to Loss Conditions A.2. following amounts: 12.Personal Effects Duties In The Event Of Accident,Claim,Suit Or (1) $75,000 The following is added to A.4. Coverage Loss: (2) The actual cash value of the hired"auto"at Extensions under Section III-Physical Damage Knowledge of an"accident",claim,"suit"or"loss" the time of the"loss" Coverage: 9 A.We will extend Physical by an agent or "employee" of an Insured or (3)The cost of repairing or replacing the hiredy Damage Coverage on receipt of any demand,notice,summons or other - • auto"with other property of like kind and a covered"auto"to include personal property legal paper in connection with a claim or"suit"by quality owned by you,a relative or an"employee"that any agent or"employee"of any insured shall not D.The following deductible provisions apply: is in the covered"auto"at the time of"loss". in itself constitute knowledge of the named The "loss" must be caused by damage for insured or receipt of the named insured,unless a (1) The deductible will be equal to the largest which coverage is shown in the Declarations. partner, member, manager, executive officer or -• deductible applicable to any owned"auto" There must be evidence of forced entry for director shall have such knowledge or shall have for that coverage shown in the loss caused by theft. received such demand,notice,summons or legal Declarations. paper. E.Any "auto" that is leased, hired, rented or B.The exclusion referring to tapes, records, discs or other similar audio, visual or data 15.Unintentional Failure To Disclose Hazards borrowed with a driver is not a covered"auto" electronic devices designated for use with Under Section IV-Business Auto Conditions, - under this coverage extension. audio, visual or data electronic equipment the following is added to General Conditions 11.Auto Loan And Lease Gap Coverage does not apply. 8.2.Concealment,Misrepresentation Or Fraud: > Section III-PHYSICAL DAMAGE is amended by C.The most we will pay for any one"loss"under If in your representations to us you unintentionally the addition of the following: this coverage extension is$2,000.No Physical failed to disclose all hazards and exposures A. In the event of a total "loss" to a covered Damage Coverage deductible applies to this • subject to this insurance,we shall not deny all "auto"shown in the Declarations,we will pay coverage extension. coverage under this policy because of such any unpaid amount due on the lease or loan D.Coverage provided by this Personal Effects oversight. for a covered"auto",less: extension is excess over any other collectible 16.Mental Anguish (1)The amount paid under the policy's insurance. A.The definition of"bodilyinjury" tion Physical Damage Coverage;and E. The coverage extension does nota I to the V V. �1 by the undero Sint (2)Any: following property: pp y Definitions is replaced following: "Bodily injury"means bodily injury,sickness or (a)Overdue or any deferred lease/loan (1)Any device designed or used to detect disease sustained by a person, including payments at the time of the"loss"; speed-measuring equipment such as radar "mental anguish"or death resulting from any or laser detectors and any jamming of these at any time. (b) Financial penalties imposed under a apparatus intended to elude or disrupt lease for excessive use,abnormal wear speed-measurement equipment; B.The following definition is added to Section V and tear or high mileage; -Definitions: (2)Tools; (c) Security deposits not returned by the 3 "Mental anguish" means extreme pain or lessor; ()Jewelry,precious metals and loose gems; distress inflicted upon an individual's (d) Costs for extended warranties, Credit (4) Money and securities;or emotional and intellectual condition with Life Insurance, Health, Accident or regard to the individual's response to the Disability Insurance purchased with the environment. loan or lease;and CA 70 57 06 22 Includes copyrighted material of Insurance Services Office,Inc., Page 3 of 4 Page 4 of 4 Includes copyrighted material of Insurance Services Office,Inc., CA 70 57 06 22 A0219976 with its permission. 06126/2023 AO 19976 with its permission. Ofi/26r2023 Middlesex Insurance Company Middlesex Insurance Company 3 00002 0000000000 23177 9 N beed1eb0-9feb475d9172959210eb5f3b . �'•'k POLICY NUMBER: A0219976001 COMMERCIAL AUTO Nz-. • CA 76 01 06 15 i`'' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Pacific Electrical Contractors Inc Endorsement Effective Date: July 1, 2023 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization you are required to add as an additional insured under a written contract or written agreement in effect prior to any loss or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Each person or organization shown in the B. Primary And Noncontributory Insurance Schedule is an "insured" for Covered Autos This insurance is primary to and will not seek Liability Coverage, but only to the extent that urance issued person or organization qualifies as an "insured" to the contribution son or any o ins the schedule under the Who Is An Insured provision contained under.your policy provided that: in: (1) Paragraph A.1. of Section II - Covered Autos (1) The person or organization is a Named Insured Liability Coverage in the Business Auto and under such other insurance; and Motor Carrier Coverage Forms; or (2) Prior to the "accident" you have agreed in (2) Paragraph D.2. of Section I - Covered Autos writing in a contract or agreement that this insurance would be primary and would not Coverages of the Auto Dealers Coverage Form. seek contribution from any other insurance available to the person or organization. CA 76 01 06 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0219976 with its permission. 06/26/2023 Middlesex Insurance Company 1 00001 0000000000 23177 0 N 73ce7249-5b5-4953-bbf0-7ec3adaf6555 POLICY NUMBER: A0219976001 COMMERCIAL AUTO 5; CA 04 4410 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 endrsement, 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: Pacific Electrical Contractors Inc Endorsement Effective Date: July 1, 2023 SCHEDULE Name(s) Of Person(s)Or Organization(s): Any person or organization from whom you are required to waive your right to recover under a written contract or Any auto per written contract or agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc.,2011 Page 1 of 1 A0219976 06/26/2023 Middlesex Insurance Company 1 00001 0000000000 23177 0 N 6f6fd6c6-9af3-42e4-8905-6a2b7297cbaf • 1.1 POLICY NUMBER:A0219976005 • COMMERCIAL EXCESS/UMBRELLA EU 70 91 05 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS/UMBRELLA COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person Or Organization: Any Additional Insured as required by written contract or written agreement executed prior to loss (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following is added to Paragraph H. Other (4) Affords indemnification and/or defense of Insurance of Section IV-Conditions: the designated person or organization to 1. This insurance is primary to and will not seek the extent permitted by law. contribution from any other insurance available 2. This condition does not apply to: to the person or organization shown in the a. Other insurance, not included in Paragraph 1. Schedule above, provided that such designated above, that may be available to the person or organization: designated person or organization outside of a. Is identified as an additional insured in the your written contract or agreement; or "underlying insurance"; b. Liability which: b. Is a Named Insured under such other (1) May attach to the designated person or insurance; and organization and is not assumed by your c. Has agreed with you in a written contract or written contract or agreement; or agreement that: (2) Is assumed by the designated person or (1) Is signed and effective prior to an organization under any other written "occurrence" to which this insurance contract assuming the obligations of applies; another. (2) This insurance would be primary and would not seek contribution from such other insurance identified in Paragraphs 1.a.and 1.b.above; (3) Agrees to indemnify or defend the designated person or organization for liability and damages covered by the "underlying insurance"; and EU 70 91 0515 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0219976 with its permission. 06/26/2023 Middlesex Insurance Company 1 00001 0000000000 23177 0 N a345f5d2-82df-49bc-a710-e465ca6cd64c POLICY NUMBER: A0219976005 COMMERCIAL EXCESS/UMBRELLA LIABILITY ;,:_ EU 71 01 1219 '� 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 the coverage provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART • SCHEDULE Name Of Person(s)Or Organization(s): Any Additional Insured as required by written contract or written agreement executed prior to loss Information required to complete this Schedule, if not show above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us Condition under Section IV Conditions is amended by the addition of the following: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Suchwaiver by us applies only to the extent that the insured has waived its right of recovery against such person(s)or organization(s)prior to loss. This endorsement applies only to the person(s) or organization(s)shown in the Schedule above. EU 71 01 12 19 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0219976 with its permission. Middlesex Insurance Company 06/26/2023 1 00001 0000000000 23177 0 N 6069f2b1-e6c5-4ece-9a46-3d2e6b967200 HUB INTERNATIONAL NORTHWEST LLC PO BOX 10167 EUGENE OR 97440-2167 *** 1.1 CITY OF ASHLAND MAINTENANCE DEPT 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 1