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HomeMy WebLinkAboutInsurance Certificate: Nexgen Risk Management LLC (2)Client#: 1496150 NEXGETEA ACORM CERTIFICATE OF LIABILITY INSURANCE DATDlYYYY) 8/14120412024 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(fes) 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER COACT Bambi Brown, CIC, CRM USI Insurance Services NW CL1 AIC PHONNo E Exl : 503.295.8312 610.362.8189 AlC, No ; 825 NE Multnomah, Suite 1500 ADDRESS: bambi.brown@usi.com Portland, OR 97232 --...- INSURER(S) AFFORDING COVERAGE NA1C $ 503 224-8390 INSURER A. Crestbrook Insurance Company 18961 INSURED INSURER B: AXIS Surplus Insurance Company 26620 Nexgen Risk Management LLC INSURER a Evanston Insurance Company135378 (See Schedule of Named insureds Below) INSURER D: Endurance American Specialty Ins Co 41718 PO Box 309 Gemini Insurance Com an 10833 Ontario, OR 97914 INSURERE: Compan COVERAGES CERTIFICATE NLJMRER- RFVI%ION Nt1MRFR- 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 CONTRACTOR 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. NTR TYPE OF INSURANCE DDL INSR SUB WVO POLICY NUMBER _ _ POLICY EFF (MWDDNYYY) POLICY EXP (MMfODNYrO LIMITS A X COMMERCIAL GENERAL LIABILITY CPP142504B 0310112024 03/0112025 EACH OCCURRENCE $1,000,000 CLAItAS-MADE f X OCCUR PREM isEaE Nr ence� $300 OOO X hIEOFXP(Any meperson) s0 BI1PD Ded:$250,000 I PERSONAL & ADV INJURY $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY JECT [..-_j LOC GENERAL AGGREGATE s2,000,000 PRODUCTS -COMPIOPAGG $2,000,000 OTHER: 3/0112024 Stop Gap $1,000,000 AUTOMOBILE LIABILITY CPP1425048 03/011202 EnsINGLEAIrA $1,00O,OOD X BODILY INJURY (Per person) S ANY AUTO _ OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY INJURY (Per aecidenl) S mm HIRED NON -OWNED AUTOS ONLY AUTOS ONLY _PROPeaacident AGE $ $ B UMBRELLA LIAB X OCCUR POOI OU135672701 3/01/2024 0310112025 EACH OCCURRENCE s2,000,400 X AGGREGATE s2,000,000 EXCESSLIAB _ OVER GL _CLAINIS-MADE OED X RETENTION $0 S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y! N ANY PROPR!ETORIPARTNERIEXECUTIVE I.. -�'-"' OFFICER/MEMBER EXCLUDED? N I A PER OTH- STAT LIT E E.L. EACH ACCIDENT $ S (Mandatory In NH) -_ E.L. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS helow E.L. DISEASE - POLICY LIMIT $ C D E Excess 3x2 GL Excess OVER AUTO Excess 4x1 AUTO MKLV5XPROO1987 EXT30054142700 GVE700197607 3/01/2024 3/01/2024 3101/2024 03101/2021J 031011202'_J 03/01/2025 $3,000,000 Limit $1,000,000 Limit $4,000,000 Limit DESCRIPTION OF OPERATIONS! LOCATIONS! VEHICLES (ACORO fOf, Addillonal Remarks Schedule, may he attached If more space Is required) Named Insured Schedule: Nexgen Risk Management LLC; CECO Inc; Woodbury Energy Company (WECO) NEXGEN Logistics, LLC; NEXGEN Team, LLC; Carson Oil Company, Inc; NEXGEN Propane, LLC; Carson Transload, LLC; Carson*********** The General Liability and Automobile Liability policies include an automatic Additional Insured endorsement (See Attached Descriptions) City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N Mountain Ave ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ILL- O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S45866340/M45860601 DYGZP DESCRIPTIONS (Continued from Page hat provides Additional Insured status to the Certificate Holder, only when there is a written contract that VIC requires such status, and only with regard to work performed on behalf of the named insured. The General Liability and Automobile Liability policies contain a special endorsement with Primary and Noncontributory wording, when required by written contract. The General Liability, Automobile Liability and Workers Compensation policies include a Waiver of Subrogation endorsement in favor of the Certificate Holder as referenced above. All policies include an endorsement providing that 30 days notice of cancellation wiilbe given to the Certificate Holder by the Insurance Carrier. RE: Delivery of Fuel. SAGITTA 25.3 (2016103) 2 of 2 #5458663401M45860601 CPP142504B COMMERCIAL GENERAL LIABILITY CG 20.43 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 -• Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) for whom you have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for: 1. "Bodily injury" or "property damage" not included in the "products -completed operations hazard'; or 2. "Personal and advertising injury"; caused by, in whole or in part, your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your operations. B. The insurance afforded to such additional insured described in Paragraph A. of this endorsement: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. C. With respect to insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" due to rendering of or failure to render any professional service. This includes but is not limited to: 1. Legal, accounting or advertising services; 2. Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings or specifications; 3. Inspection, supervision, quality control, architectural or engineering activities done by or for you on a project on which you serve as construction manager; 4. Engineering services, including related supervisory or inspection services; 5. Medical, surgical, dental, X-ray or nursing services treatment, advice or instruction; 6. Any health or therapeutic service treatment, advice or instruction; 7. Any service, treatment, advice or instruction for the purpose of appearance or skin enhancement, hair removal or replacement, or personal grooming or therapy; 8. Any service, treatment, advice or instruction relating to physical fitness, including service, treatment, advice or instruction in connection with diet, cardiovascular fitness, bodybuilding or physical training programs; 9. Optometry or optical or hearing aid services including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic lenses and similar products or hearing aid devices; 10. Body piercing services; 11. Services in the practice of pharmacy; 12. Law enforcement or firefighting services; and 13. Handling, embalming, disposal, burial, cremation or disinterment of dead bodies. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional service. CG 20 43 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 Insuwed Copy D. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall applicable limits of insurance. not increase the Page 2 of 2 © Insurance Services Office, Inc., 2018 Insured copy CG 20 43 12 19 CPP1425048 �:Ln COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 Wc 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 Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek 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 (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Msurcd Copy Page 1 of 1 CPP14250413 ,•;, COMMERCIAL GENERAL LIABILITY CG 24 53 12 1- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) AUTOMATIC 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 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Lis of Section IV — Conditions: We waive any right of recovery against any person or organization, because of any payment we make under this Coverage Part, to whom the insured has waived its right of recovery in a written contract or agreement. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person or organization prior to loss. CG 24 53 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 insured Copy CPP142504B COMMERCIAL AUT( THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM is amended to include the following additions and extensions of coverage: A. NEWLY ACQUIRED OR FORMED ENTITIES B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE C. BLANKET ADDITIONAL INSURED - REQUIRED BY CONTRACT D. EMPLOYEES AS INSUREDS - NONOWNED AUTOS E. EMPLOYEE HIRED AUTOS F. SUPPLEMENTARY PAYMENTS - BAIL BONDS G. SUPPLEMENTARY PAYMENTS - LOSS OF EARNINGS H. FELLOW EMPLOYEE COVERAGE I. PROPERTY OF OTHERS J. PERSONAL EFFECTS COVERAGE K. AUTO MEDICAL PAYMENTS COVERAGE - INCREASED LIMITS L. EXPANDED TOWING COVERAGE M. AUTO LOAN OR LEASE COVERAGE N. RENTAL REIMBURSEMENT COVERAGE O. EXPANDED TRANSPORTATION EXPENSE P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE R. PHYSICAL DAMAGE - TWO OR MORE DEDUCTIBLES S. BLANKET WAIVER OF SUBROGATION T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS A. NEWLY ACQUIRED OR FORMED ENTITIES The Named Insured shown in the Declarations is amended to include any organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority (more than 50%) interest; if there is no other similar insurance available to that organization. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization, or the end of the policy period, whichever comes first. B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE The following is added to Paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I -- COVERED AUTOS: If Physical Damage Coverage is provided on a covered "auto' you own that is out of service because of its breakdown, repair, servicing, "loss", or destruction, then you have coverage for any "auto" you do not own, while used with the permission of its owner as a temporary substitute for the covered out of service "auto". The deductible for the temporary substitute "auto" will be the same as the applicable deductible for the covered "auto" it replaces. Includes copyrighted material of Insurance Services office, Inc., with its permission. CCAB191 1013 Page 1 of fi 0 Insured Copy C. BLANKET ADDITIONAL INSURED —REQUIRED BY CONTRACT COMMERCIAL AUT{ 1 The following is added to Paragraph A.I. Who Is An Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person(s) or organization(s) is an additional "insured" with whom you have agreed in a valid written contract or agreement, executed prior to any "accident" or "loss", that such person(s) or organization(s) be added as an additional "insured" on your policy. Such persons or organizations are additional "insureds", but only with respect to liability for "bodily injury" or "property damage" caused by an "accident" that is, in whole or in part, caused by your acts or omissions or the acts or omissions of those acting on your behalf and resulting from the ownership, maintenance or use of a covered "auto". D. EMPLOYEES AS INSUREDS -- NONOWNED AUTOS The following is added to the SECTION If — COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. EMPLOYEE HIRED AUTOS 1. Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the BUSINESS AUTO COVERAGE FORM is replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: a. Any covered "auto" you lease, hire, rent or borrow; and b. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". F. SUPPLEMENTARY PAYMENTS -- BAIL BONDS The following replaces Paragraph A.2.a. (2) of SECTION II -- COVERED AUTOS LIABILITY COVERAGE: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. G. SUPPLEMENTARY PAYMENTS -- LOSS OF EARNINGS The following replaces Paragraph A.2.a. (4) of SECTION ll -- COVERED AUTOS LIABILITY COVERAGE: Includes copyrighted material of Insurance services Office, Inc., with Its permission. CCABI91 1013 Page 2 of 6 Insuied Copy COMMERCIAL AUTf (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earning: up to $500 a day because of time off from work. H. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion contained under the COVERED AUTOS LIABILITY COVERAGE does not apply. PROPERTY OF OTHERS The Care, Custody Or Control Exclusion in SECTION II — COVERED AUTOS LIABILITY COVERAGE does not apply to "property damage" to property, other than your property, up to an amount not exceeding $3,000 in any one "accident". This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. J. PERSONAL. EFFECTS COVERAGE The following is added to Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $1,000 for the "loss" to personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto'. This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. K. AUTO MEDICAL PAYMENTS COVERAGE — INCREASED LIMITS In the event of a covered "loss" where Auto Medical Payments Coverage applies, we will double the Limit Of Insurance for Medical Payments shown in the Declarations for each "insured" who was wearing a seat belt at the time of the "accident". This limit is the most we will pay for all covered medical expenses regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident". L. EXPANDED TOWING COVERAGE The following replaces Paragraph A.2. of SECTION III -- PHYSICAL DAMAGE COVERAGE: We will pay up to: 1. $100 for a covered "auto" you own of the private passenger type; or 2. $500 for a covered "auto" you own that is not of the private passenger type; for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. M. AUTO LOAN OR LEASE COVERAGE Physical Damage Coverage is amended by the addition of the following: 1. In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan, including up to a maximum of $500 for early termination fees or penalties, for a covered "auto", less: Includes copyrighted material of Insurance Services Office, Inc., with its permission. CCAB191 1013 Inswed copy Page 3 of 6 a. The amount paid under the policy's Physical Damage Coverage; and COMMERCIAL_ AUTf b. Any: (1) Overdue leaselloan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs of extended warranties, Credit Life insurance, Health, Accident, or Disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. 2. This coverage only applies to a "loss" which is also covered under this policy for Comprehensive, Specified Causes Of Loss, or Collision Coverage. 3. Coverage does not apply to any unpaid amount due on a loan for which the covered "auto" is not the sole collateral. 4. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. N. RENTAL REIMBURSEMENT COVERAGE 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 2. This coverage applies only to a covered "auto" for which Physical Damage Coverage is provided on this policy. 3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. b. 30 days. 4. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses incurred. b. $75 for any one day or for a maximum of 30 days. 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Expanded Transportation Expense Coverage Extension in this form. 7. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. O. EXPANDED TRANSPORTATION EXPENSE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE is replaced by the following: Includes copyrighted material of insurance Services office, Inc., with its permission. CCAB191 1013 Insured Copy Page 4 of 6 COMMERCIAL ALIT( We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred b,. you because of the total theft of a covered "auto" of the private passenger type. We will pay only fo those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO The following is added to Paragraph A.4. of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $5,000 for the expense of recovering a stolen covered "auto" to you. We will pay only for those covered "autos" for which you carry Comprehensive or Specified Causes Of Loss Coverage. Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE The following is added to Paragraph B.3.a. of SECTION III — PHYSICAL DAMAGE COVERAGE: Mechanical breakdown does not include the accidental discharge of an airbag. R. PHYSICAL DAMAGE — TWO OR MORE DEDUCTIBLES The following is added to Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE: When two or more covered "autos" sustain "loss" in the same collision, the "loss" will be reduced by the largest single deductible that applies. For purposes of this coverage, an "auto" and its attached "trailer" are two separate "autos". S. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply, but only when the Named Insured agrees that subrogation is waived prior to the "accident" or the "loss" under the terms of a written contract entered into between the Named Insured and an entity that is part of that contract. T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The following replaces Paragraph A.2.a. Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV— BUSINESS AUTO CONDITIONS: We have no duty to provide coverage under this policy unless there has been full compliance with the following duties: a. In the event of "accident", claim, "suit", or "loss', your insurance manager or any other person you designate as responsible for insurance -related matters must notify us promptly of an "accident" or a "loss", regardless of the amount, which may result in a claim. Include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Paragraph A.2.b.(2) Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: b. Additionally, you and any other involved "insured" must: Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 6 a CCAB191 1013 Ensured Copy COMMERCIAL AUT( }.v (2) Notify us and send us copies of any request, demand, order, notice, summons or legal paper: received concerning the claim or "suit" as soon as practicable. For the purposes of this coverage provided, you are presumed to have knowledge of the "accident" or "loss" when it has been reported to the insurance manager or any other person you designate as responsible for insurance -related matters. U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following Condition is added to SECTION IV — BUSINESS AUTO CONDITIONS. Unintentional Failure To Disclose Hazards Failure by you to disclose to us all hazards existing as of the inception date of this policy shall not prejudice us with respect to the coverage afforded by this policy, provided such error or omission is not intentional. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. CCAB191 1013 Page 6 of 6 Insured Cody CPP142504B COMMERCIAL AUT THIS ENDORSEMENT CHANGES YOUR POLICY, PLEASE READ IT CAREFULLY. COMPOSITE RATE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. Paragraph 6. Premium Audit under B. General Conditions of Section IV - Business Auto Conditions is deleted and replaced by the following: 6. PREMIUM AUDIT We will compute the premium(s) for this coverage part in accordance with the rate(s) shown in the Schedule below. The deposit premium shown in the Schedule below is an estimate, based on the number of "autos" you told us you would have at the beginning of the policy period. At the end of the policy period, we will compute the final earned premium for that period and send notice to the first Named Insured. The final premium(s) will be determined using your average number of "autos" during the policy period. The average number of "autos" will be calculated by adding the number of your "autos" at the beginning of the policy period to the number of your "autos" at the end of the policy period, and dividing that sum by two. Any fractional average number of autos will be rounded up to the nearest whole number. To calculate the final premium, your average number of "autos" will be multiplied by the rates shown in the Schedule below. If the final premium(s) is more than the estimated premium(s) you paid to us, you must pay us the balance. The due date for the final premium is the date shown as the due date on the bill. If the final premium(s) is less than the estimated premium(s), we will refund the balance to you. The first Named Insured must keep records of the information we need for premium computation, and make available or send us copies as we may request upon expiration of this policy. Coverage Covered Autos Liability Including PIP, Med Pay and/or UM/UIM (As shown in the Declarations Page) Coverage Physical Damage (As shown in the Declarations Page) SCHEDULE Description Number of Units Rate Premium POWERED UNITS 283 $4,616.65 $1,306,513 Description Number of Units Rate Premium COVERED UNITS 333 $1,070.57 $356,501 ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. CCAB192 1013 Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 9 Insured Copy CPP142504B COMMERCIAL AUTO CA99481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS -- BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: 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. A. Covered Autos Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto", or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: 2. Any claim or "suit' by or on behalf of a (1) The "pollutants" or any property in governmental authority for damages which the "pollutants" are contained because of testing for, monitoring, cleaning are upset, overturned or damaged as up, removing, containing, treating, a result of the maintenance or use of detoxifying or neutralizing, or in any way a covered "auto"; and responding to or assessing the effects of (2) The discharge, dispersal, seepage, "pollutants". migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 insured copy FORM MCS-90 OMB No.: 2126-0008 Expiration: 05/31/2024 USDOT Number: Date Received: 01 Please note, the expiration date as stated on this form relates to the process for renewing the information Collection Request for th form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire. For quesdons, please contact the Office of Registration and Safety information, Registration, Licensing, and Insurance Division. A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements ofthe Paperwork Reduction Act unless that collection of information displays a current valid OMB Control lumber. `17ie OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of inforuation, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590. 1; United States Department of Transportation ' - / Federal Motor Carrier Safety Administration Endorsement for Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980 FORM MCS-90 Issuedto NEXGEN LOGISTICS, LLC (hlolorCarrier uarne) Of PO BOX 10948 (,HntorCarrier state orprovince) 3125 NW 35TH AVE PORTLAND, OR USA 97296 Dated at Des Moines, IA on this 01 day of March, 2024 Amending Policy Number:CPP142504A Effective Date:03/01/2024 Name of Insurance Company: CRESTBOOK INSURANNCE COMPANY filCountersigned by: � 2(`,�,w�,, (authorized courpany representative) The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one): X This insurance is priutwy and the company shall not be liable for amoin rs in excess of $1 , 0 0 0 , 0 0 0 for each accident. This hisrtrance is excess and the company shall not be liablefor amounts In excess of $ underlying limit of $ ______for each accident. each accident in excess of the Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA , to verify that the policy Is in force as of a particular date. The telephone number to call is: (800) 228-6700. Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA's registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC). Filings must be transmitted online via the Internet at htto://www.fmcsa.dot.clovlurs. FORM MCS-90 Page 1 of 3 (continued on next page) Rev 613t2o2i Insured Copy FORM MCS-90 OMB No.: 2126-0008 Expiration: 05/31/2024 DEFINITIONS AS USED IN THIS ENDORSEMENT Accident Includes continuous or repeated exposure to conditions or which results in bodily Injury, property damage, or environmental damage which the insured neither expected nor intended. Motor Vehicle means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof. Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these. Property Damage means damage to or loss of use of tangible property. The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA). In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured's employees while engaged in the course of their employment, or property transported by the Insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the polity, this endorsement, or any other endorsement thereon, 91 Environmental Restoration means restitution for the loss, damage, or destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife. Public Liability means liability for bodily injury, property damage, and environmental restoration. or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the Insured. However, all terms, conditions, and limitations In the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit Involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement. It is further understood and agreed that, upon failure of the company to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment. The limits of the company's liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of anyone accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident. (continued on next page) FORM MCS-90 Page 2 of 3 Ensured Copy FORM MCS-90 OMB No.: 2126-0008 Expiration: 05/31/2024 SCHEDULE OF LIMITS --- PUBLIC LIABILITY ft Type of carriage Commodity transported January 1, 1985 (1) For -hire (in interstate or foreign commerce, with a Property (nonhazardous) $750,000 gross vehicle weight rating of 10,001 or more pounds). (2) For -hire and Private (in interstate, foreign, or Hazardous substances, as defined in 49 CFR 171.8. $510Im1000 intrastate commerce, with a gross vehicle weight rating of transported in cargo tanks, portable tanks, or hopper- 10,001 or more pounds). type vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403. (3) For -hire and Private (in interstate or foreign Oil listed in 49 CFR 172,101; hazardous waste, $1,000,000 commerce, in any quantity; or in intrastate commerce, hazardous materials, and hazardous substances in bulk only; with a gross vehicle weight rating of defined in 49 CFR 171.8 and listed in 49 CFR 172.101, 10,001 or more pounds), but not mentioned in (2) above or (4) below. (4) Far -hire and Private (In Interstate or foreign Any quantity of Division 1,1, 1.2, or 1.3 material; any $5,000,000 commerce, with a gross vehicle weight rating of less quantity of a Division 2.3, Hazard zone A, or Division than 10,001 pounds). 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403. * The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only FORM M@SuWPage 3 of 3