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HomeMy WebLinkAboutInsurance Certificate: Pacific Crest Surveying Inc DATE(MM/DD/YYYY) ACCOR" CERTIFICATE OF LIABILITY INSURANCE 8/14/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 NAME: Sarah Culbertson AssuredPartners Design Professionals Insurance Services, LLC PHONE Ext: 360-626-2961 FAX,No:360-626-2961 3697 Mt. Diablo Blvd Suite 230 (AMAIL Lafayette CA 94549 ADDRESS: sarah.culbertson@assuredpartners.com INSURER(S)AFFORDING COVERAGE NAIC# License#:6003745 INSURERA: RLI INSURANCE COMPANY 13056 INSURED PACICRE-04 INSURER B: Pacific Crest Surveying Inc 131 Helman Street INSURERC: Ashland OR 97520 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1798065300 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y PSB0009917 1/8/2025 1/8/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y PSA0003195 1/8/2025 1/8/2026 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLALIAB X OCCUR Y Y PSE0005236 1/8/2025 1/8/2026 EACH OCCURRENCE $4,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Y PSW0005416 1/8/2025 1/8/2026 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liab,Claims Made RDP0057027 1/8/2025 1/8/2026 Per Claim $1,000,000 Aggregate $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The certificate holder is an additional insured per the attached. The following policies are included in the underlying schedule of insurance for umbrella/excess liability:General Liability. Project#2024-23-On Call Surveying Services. City of Ashland, Oregon and its elected officials,officers and employees are additional insureds per the attached.General Liability is Primary/Non-Contributory per the attached.30 days Notice of Cancellation per the attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 a @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy Number: PSE0005236 RLI Insurance Company Pacific Crest Surveying THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR DESIGN PROFESSIONALS EXCESS LIABILITY ENHANCEMENT SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT A. General Aggregate Limit— Per Project Or Per Location B. Additional Insured— Primary/Non-contributory C. Waiver Of Transfer Of Rights Of Recovery Against Others To Us This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE FORM A. General Aggregate Limit — Per Project Or Per (3) premises where operations are performed in Location sections, stages or phases as a continuation Paragraph 2.a. of C. Limits of Liability of SECTION of the same contract or agreement, even if — INSURING AGREEMENT is deleted and the premises do not involve connecting lots. replaced by the following: B. Additional Insured— Primary/Non-contributory a. The limit of liability stated in the Declarations as Paragraph K. Other Insurance of SECTION IV — general aggregate is the most we will pay during CONDITIONS is deleted and replaced by the each policy period for all ultimate net loss, following: except ultimate net loss because of: K. Other Insurance (1) injury and damage included in the products- If other insurance, whether collectible or not, is completed operations hazard or; available to the insured covering a loss also (2) any coverage included in underlying covered by this policy, the insurance afforded by insurance to which no underlying aggregate this policy shall be in excess of, and shall not applies. contribute with, such other insurance. However, The general aggregate applies separately to if the underlying insurance provides coverage each of your "projects" away from premises to an additional insured on a primary basis, or a owned by or occupied by you or to each of your primary and non-contributory basis, this insur- locations owned by or occupied by you. ance shall be available to such additional insured on an excess basis over the underlying "Projects" mean an area away from premises insurance. We will not share with other owned by or rented to you at which you are insurance which covers such additional insured performing operations pursuant to a contract or as a named insured. agreement. For the purposes of determining the C. Waiver Of Transfer Of Rights Of Recovery applicable aggregate limit of insurance, each "project" at the same "location" shall be Against Others To Us considered a single "project". Paragraph L. Subrogation of SECTION IV — For the purposes of this provision, "location" CONDITIONS is deleted and replaced by the means following: (1) premises involving the same or connecting lots; (2) premises where connection is interrupted only by a street, roadway, waterway or right- of-way of a railroad; or PPU 304 06 10 Page 1 of 2 L. Subrogation Any amount recovered through subrogation or In the event of any payment under this policy, the otherwise shall be apportioned in the inverse order insured must notify us of any of the insured's rights of payment of the claim or claims involved to the of recovery against any person or organization. We extent of actual payment thereof by all interests. The shall be subrogated to all such rights. The expenses of all such recoveries and proceedings in insured shall execute and deliver instruments connection therewith shall be apportioned in the and papers and do whatever else is necessary to ratio of respective recoveries. With respect to secure such rights. The insured shall do nothing proceedings conducted solely by us, if there is no after loss to prejudice such rights. However we recovery, we will bear the expense thereof. If there waive any rights of recovery we may have is a recovery, we shall be reimbursed in full from against any person or organization if the such recovery for the amount of all expenses underlying insurance also waives such rights. incurred by us before apportionment of such recovery as herein provided. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPU 304 06 10 Page 2 of 2 Policy Number: PSA0003195 RLI Insurance Company Named Insured: Pacific Crest THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° BUSINESS AUTO ENHANCEMENT SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT A. Broad Form Named Insured B. Employees As Insureds C. Blanket Additional Insured D. Blanket Waiver Of Subrogation E. Employee Hired Autos F. Fellow Employee Coverage G. Auto Loan Lease Gap Coverage H. Glass Repair—Waiver Of Deductible I. Personal Effects Coverage J. Hired Auto Physical Damage Coverage K. Hired Auto Physical Damage—Loss Of Use L. Hired Car—Worldwide Coverage M. Temporary Transportation Expenses N. Amended Bodily Injury Definition— Mental Anguish O. Airbag Coverage P. Amended Insured Contract Definition— Railroad Easement Q. Coverage Extensions—Audio,Visual And Data Electronic Equipment Not Designed Solely For The Production Of Sound R. Notice Of And Knowledge Of Occurrence S. Unintentional Errors Or Omissions T. Towing Coverage PPA 300 03 13 Page 1 of 5 This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. Broad Form Named Insured of the operations contemplated by such contract. The The following is added to the SECTION II — waiver applies only to the person or organization COVERED AUTOS LIABILITY COVERAGE, Para- designated in such contract. graph A.1.Who Is An Insured Provision: E. Employee Hired Autos Any business entity newly acquired or formed by you 1. The following is added to the SECTION II — during the policy period, provided you own fifty COVERED AUTOS LIABILITY COVERAGE, percent (50%)or more of the business entity and the Paragraph A.1.Who Is An Insured Provision: business entity is not separately insured for Bus-iness An "employee" of yours is an "insured" while Auto Coverage. Coverage is extended up to a „ operating an "auto hired or rented under a maximum of one hundred eighty(180)days following contract or agreement in that"employee's" name, the acquisition or formation of the business entity. with your permission, while performing duties This provision does not apply to any person or related to the conduct of your business. organization for which coverage is excluded by 2. Changes In General Conditions: endorsement. B. Employees As Insureds Paragraph 5.b. of the Other Insurance Con- dition in the BUSINESS AUTO CONDITIONS is The following is added to the SECTION II — deleted and replaced with the following: COVERED AUTOS LIABILITY COVERAGE, Para- b. For Hired Auto Physical Damage Coverage, graph A.1.Who Is An Insured Provision: the following are deemed to be covered Any"employee"of yours is an "insured"while using a "autos" you own: covered "auto" you don't own, hire or borrow in your (1) Any covered "auto" you lease, hire, rent business or your personal affairs. or borrow; and C. Blanket Additional Insured (2) Any covered "auto" hired or rented by The following is added to the SECTION II — your "employee" under a contract in that COVERED AUTOS LIABILITY COVERAGE, Para- individual "employee's" name, with your graph A.1.Who Is An Insured Provision: permission, while performing duties Any person or organization that you are required to related to the conduct of your business. include as an additional insured on this coverage form However, any"auto"that is leased, hired, in a contract or agreement that is executed by you rented or borrowed with a driver is not a before the"bodily injury"or"property damage"occurs covered "auto". is an "insured" for liability coverage, but only for F. Fellow Employee Coverage damages to which this insurance applies and only to SECTION II — COVERED AUTOS LIABILITY the extent that person or organization qualifies as an COVERAGE, Exclusion B.S. does not apply if you "insured" under the Who Is An Insured provision pp y contained in SECTION II — COVERED AUTOS have workers compensation insurance in-force LIABILITY COVERAGE. covering all of your employees. The insurance provided to the additional insured will G. Auto Loan Lease Gap Coverage be on a primary and non-contributory basis to the SECTION III — PHYSICAL DAMAGE COVERAGE, additional insured's own business auto coverage if C. Limit Of Insurance, is amended by the addition of you are required to do so in a contract or agreement the following: that is executed by you before the "bodily injury" or "property damage"occurs. In the event of a total"loss"to a covered "auto"shown in the Schedule of Declarations, we will pay any D. Blanket Waiver Of Subrogation unpaid amount due on the lease or loan for a covered "auto", less: The following is added to the SECTION IV— BUSI- 1. The amount paid under the PHYSICAL NESS AUTO CONDITIONS,A. Loss Conditions, 5. DAMAGE COVERAGE section of the policy; and Transfer Of Rights Of Recovery Against Others To Us: 2. Any: We waive any right of recovery we may have against a. Overdue lease/loan payments at the time of any person or organization to the extent required of the"loss"; you by a contract executed prior to any "accident" or "loss", provided that the"accident"or"loss"arises out PPA 300 03 13 Page 2 of 5 b. Financial penalties imposed under a lease for (2) An adjustment for depreciation and physical excessive use, abnormal wear and tear or condition will be made in the event of a total high mileage. "loss". c. Security deposits not returned by the lessor; (3) If a repair or replacement results in better d. Costs for extended warranties, Credit Life than like kind or quality,we will not pay for the Insurance, Health, Accident or Disability betterment. Insurance purchased with the loan or lease; (4) A deductible equal to the highest Physical and Damage deductible applicable to any owned e. Carry-over balances from previous loans or auto will apply. leases. (5) This Coverage Extension will not apply to: H. Glass Repair—Waiver Of Deductible (a) Any "auto" that is hired, rented or SECTION III — PHYSICAL DAMAGE COVERAGE, borrowed with a driver; or D. Deductible is amended by adding the following: (b) Any "auto" that is hired, rented or No deductible for a covered "auto" will apply to glass borrowed from your"employee". damage if the glass is repaired rather than replaced. K. Hired Auto Physical Damage—Loss Of Use I. Personal Effects Coverage The following is added to SECTION III — PHYSICAL The following is added to SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions: Extensions: e. We will pay sums which you legally must pay to c. Personal Effects Coverage the lessor of a covered "auto" which you have leased without a driver for thirty (30)days or less In the event of a total theft loss of your covered for the lessor's loss of use of the covered "auto", "auto"we will pay up to$400 for"loss"to wearing provided: apparel and other personal effects which are: (1) This insurance provides comprehensive, (1) Owned by an "insured"; and specified causes of loss or collision covered (2) In or on your covered "auto"; on the covered "auto"; (2) The loss of use results from the covered No deductible applies to Personal Effects "auto" being damaged in an "accident" while Coverage. you are leasing it. J. Hired Auto Physical Damage Coverage We will pay up to a maximum limit of$1,500 for The following is added to SECTION III — PHYSICAL this covered extension. DAMAGE COVERAGE, A. Coverage, 4. Coverage L. Hired Car—Worldwide Coverage Extensions: d. Hired Auto Physical Damage Coverage The following is added to SECTION II — COVERED AUTOS LIABILITY COVERAGE, A.2. Coverage If hired "autos" are covered "autos" for Liability Extensions: Coverage and this policy also provides Physical f. Hired Car—Worldwide Coverage Damage Coverage for an owned "auto", then the Physical Damage Coverage is extended to (1) We will pay all sums an"insured" legally must "autos"that you hire, rent or borrow subject to the pay as damages because of"bodily injury"or following: "property damage" to which this insurance (1) The most we will pay for "loss" in any one applies, caused by an "accident" which "accident" to a hired, rented or borrowed occurs outside of the United States of "auto" is the lesser of: America, the territories and possessions of the United States of America, Puerto Rico (a) $60,000 and Canada resulting from the maintenance, (b) The actual cash value of the damaged or or use of any covered "auto" of the private stolen property as of the time of the passenger type you lease, hire, rent or borrow without a driver for thirty (30)days or "loss"; or less. (c) The cost of repairing or replacing the (2) With respect to any claim made or "suit" damaged or stolen property with other instituted outside the United States of property of like kind and quality. America, the territories and possessions of the United States of America, Puerto Rico, and Canada: PPA 300 03 13 Page 3 of 5 (a) You shall undertake the investigation, M. Temporary Transportation Expenses settlement and defense of such claims SECTION III — PHYSICAL DAMAGE COVERAGE, and "suits" and keep us advised of all proceedings and actions. A.4. Coverage Extensions, subparagraph a. Transportation Expenses is deleted and replaced (b) You will not make any settlement without by the following: our consent. a. Transportation Expenses (c) We will reimburse you: (1) We will pay up to a maximum of $1,500 for (i) For the amount of damages be- temporary transportation expense incurred cause of liability imposed upon you by you because of Physical Damage to a by law on account of"bodily injury"or covered "auto". "property damage" to which this insurance applies, and (2) We will pay only for those covered "autos"for (ii) For all reasonable expenses incurred which you carry Comprehensive, Colli-sion or with our consent in connection with Specified Case of Loss Coverage. the investigation, settlement or (3) We will pay only for those expenses incurred defense of such claims or "suits". by you during the period of time that begins Reimbursement for expenses will be twenty-four (24) hours after the covered part of the Limit of Insurance for "loss" and ends at the time when the covered liability coverage shown in the "auto" can be reasonable repaired or Business Auto Coverage replaced. Declarations, and not in addition to such limits. (4) This coverage does not apply while there are spare or reserve "autos" available to you for (3) The limit of Insurance for Liability Coverage your operations. shown in the Business Auto Coverage Declarations is the most we will reimburse N. Amended Bodily Injury Definition — Mental you for the sum of all damages imposed on Anguish you, as set forth in paragraph 2.c. above, and The following is added to SECTION V — all expenses incurred by you arising out of DEFINITIONS, Definition C.: any single "accident' or"loss". "Bodily injury" also includes mental anguish, but only (4) You must maintain the greater of the follow- when the mental anguish arises from other bodily ing primary auto liability insurance limits: injury, sickness or disease. (a) Compulsory admitted insurance with O. Airbag Coverage limits required to be in force to satisfy the legal requirements of the jurisdiction The following is added to SECTION III — PHYSICAL where the accident occurs; or DAMAGE COVERAGE B. Exclusions 3.a.: (b) Insurance limits required by law and However, this exclusion will not apply to accidental issued by a government entity or by an discharge of an airbag due to mechanical or electrical insurer licensed or permitted by law to do breakdown. business in the jurisdiction where the "accident"occurs; or P. Amended Insured Contract Definition — Railroad Easement (c) Auto liability insurance limits of at least $300,000 combined single limit or SECTION V— DEFINITIONS paragraph H. "Insured $100,000 per person/$300,000 per acci- contact' is modified as follows: dent Bodily Injury, $100,000 Property 1. Paragraph H.3. is replaced by the following: Damage. If you fail to comply with the above, this 3. Any easement or license agreement. insurance is not invalidated. However, in the 2. Paragraph H.6.a. is deleted. event of a"loss",we will pay only to the extent that we would have been liable had you so Q. Coverage Extensions — Audio, Visual And Data complied. Electronic Equipment Not Designed Solely For The Production Of Sound (5) The insurance provided by this coverage extension is excess over any other collec- SECTION III—PHYSICAL DAMAGE COVERAGE B. tible insurance available to you whether on a Exclusions, exception paragraph a.to exclusion 4.c. primary, excess contingent or any other and 4.d. is deleted and replaced with the following: basis. PPA 300 03 13 Page 4 of 5 a. Equipment and accessories used with such (2) A partner if you are a partnership; or equipment, except for tapes, records, discs or other electronic media device, provided such (3) An executive officer or insurance manager, if equipment is permanently installed in the covered you are a corporation. "auto" at the time of the "loss" or is removable S. Unintentional Errors Or Omissions from the housing unit which is permanently SECTION IV— BUSINESS AUTO CONDITIONS, B. installed in the covered "auto" at the time of the General Conditions; 2. Concealment Misrepre- "loss", and such equipment is designed to be sentation Or Fraud is amended by adding the solely operated by use of the power from the "autos" electrical system, in or upon the covered following: "autos"; or The unintentional omission of, or unintentional error R. Notice Of And Knowledge Of Occurrence in, any information given by you shall not prejudice your rights under this insurance. However this pro- SECTION IV — BUSINESS AUTO CONDITIONS, vision does not affect our right to collect additional A.2. Duties In The Event Of Accident, Claim Suit premium or exercise our right of cancellation or Or Loss, subparagraph a. is deleted and replaced nonrenewal. with the following: T. Towing Coverage a. In the event of "accident", claim, "suit" or "loss", SECTION III — PHYSICAL DAMAGE COVERAGE, you must give us or our authorized repre- A.2. Towing, is deleted and replaced by the sentative prompt notice of the "accident"or"loss" following: including: (1) How,when and where the"accident"or"loss" 2. We will pay up to$750 for towing and labor costs occurred; incurred each time a covered "auto" is disabled due to a covered cause of loss. However: (2) The "insured's" name and address; and a. All labor must be performed at the place of (3) To the extent possible, the names and disablement; and addresses of any injured person and witnesses. b. If the covered auto is a private passenger type no deductible applies; and Your duty to give us or our authorized c. If the covered auto is not of the private representative prompt notice of the "accident or "loss"applies only when the"accident"or"loss" is passenger type our obligation to pay will b known to: reduced by a $250 deductible per disablement. (1) You, if you are an individual; ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPA 300 03 13 Page 5 of 5 Policy Number: PSB0009917 RLI Insurance Company Named Insured: Pacific Crest Surveying THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. RLIPack° FOR PROFESSIONALS BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM-SECTION II—LIABILITY 1. C. WHO IS AN INSURED is amended to include as additional insured under this policy must apply on a an additional insured any person or organization that primary basis, or a primary and non-contributory you agree in a contract or agreement requiring basis, this insurance is primary to other insurance insurance to include as an additional insured on this that is available to such additional insured which policy, but only with respect to liability for "bodily covers such additional insured as a named insured, injury", "property damage" or "personal and and we will not share with that other insurance, advertising injury" caused in whole or in part by you provided that: or those acting on your behalf: a. The "bodily injury" or "property damage" for a. In the performance of your ongoing operations; which coverage is sought occurs after you have b. In connection with premises owned by or rented entered into that contract or agreement; or to you; or b. The "personal and advertising injury" for which c. In connection with "your work" and included coverage is sought arises out of an offense within the "product-completed operations committed after you have entered into that hazard". contract or agreement. 2. The insurance provided to the additional insured by 4. The following is added to SECTION III K. 2. this endorsement is limited as follows: Transfer of Rights of Recovery Against Others to Us — COMMON POLICY CONDITIONS (BUT a. This insurance does not apply on any basis to APPLICABLE TO ONLY TO SECTION II — any person or organization for which coverage LIABILITY) as an additional insured specifically is added by We waive any rights of recovery we may have another endorsement to this policy. against any person or organization because of b. This insurance does not apply to the rendering payments we make for "bodily injury", "property of or failure to render any "professional damage" or "personal and advertising injury" arising services". out of "your work" performed by you, or on your c. This endorsement does not increase any of the behalf, under a contract or agreement with that limits of insurance stated in D. Liability And person or organization. We waive these rights only Medical Expenses Limits of Insurance. where you have agreed to do so as part of a contract or agreement with such person or 3. The following is added to SECTION III H.2. Other organization entered into by you before the "bodily Insurance — COMMON POLICY CONDITIONS injury"or"property damage"occurs, or the "personal (BUT APPLICABLE ONLY TO SECTION II — and advertising injury"offense is committed. LIABILITY) However, if you specifically agree in a contract or agreement that the insurance provided to an ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. PPB 304 02 12 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description All persons or organizations that are party to a contract that Jobs performed for any person or organization that you requires you to obtain this agreement, provided you executed have agreed with in a written contract to provide this the contract before the loss. agreement. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/08/2025 policy No. PSW0005416 Endorsement No. Insured Pacific Crest Surveying Insurance Company RLI Insurance Company Countersigned By ©1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved.