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Home My WebLink AboutInsurance Certificate: AUMA Actuators, Inc.(3) 0 DATE(MM/DD/YYYY) AC"REX CERTIFICATE OF I LIABILITY INSURANCE 2/26/2026 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_ Owen Connell Arthur J.Gallagher Risk Management Services, LLC PHONE --_-- 1 Pasquerilla Plaza _{A/C.No.Ext —� _N _ —_--___-- E-MAIL Suite 100 ADDRESS_Certrequests�aj�cam _ _-- — — Johnstown PA 15901 _ __INSURERS)AFFORDING COVERAGE _ NAIL# _ INSURER A:HDI-Global Insurance Come 41343 INSURED AUMAACT-02 INSURER B:The Travelers Indemnity Company of CT__� 25682 AUMA Actuators, Inc. — -- --- _ — -- 100 SOuthpointe Boulevard INSURER C:Travelers Casuals and Surety Company ___ 19038 Canonsburg PA 15317 INSURER-D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:717686428 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 ADDL SUER _ POLICY EFFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDIYYYY MM/DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GLD1066917 1/1/2026 1/1/2027 EACH OCCURRENCE $1,000,000 _ DAMA aE O REN'ED CLAIMS-MADE OCCUR ( _PREMISEStEaoccurrencPJ_ $100,000 ME_D EXP(Any one person) $5,000 _ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000_000 _— X POLICY-_JE� EI LOC PRODUCTS-COMP/OP AGG _$2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y BA-9N747267-25-14-G 12/31/2025 12/31/2026 COMBINEDdenth SINGLE LIMIT Ea accidents $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS �X HIRED X NON-OWNED PROPERTY DAMAGE $ u� AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR Y Y CUD1067017 1/112026 1/112027 EACH OCCURRENCE $4,000,000 EXCESS LIAB _ CLAIMS--MADE AGGREGATE $4,0.00,000_ _ DID �E RETENTION$in nnn $ C W0IKERSCOMPENSATION Y UB-9S952683-25-14-G 12131/2025 12/31/2026 X STATUTE -- OTRH AND EMPLOYERS'LIABILITY Y/N E.L. --- --- -- --- ANYPROPRIETOR/PARTNERIEXECUTIVE E .EACH ACCIDENT — $1,000,000 OFFICERIMEMBER EXCLUDED? NIA — — --- --- --- ------ (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 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Additional insured status is provided to all entities required by written contract to be included as additional insureds but only with respect to ongoing and completed operations performed by the Named Insured or on their behalf with respect to general liability(per form CG 2037 12/19),auto liability(per farm CA T3 53 02 15),and Umbrella Liability(follow form of underlying additional insured provisions). A Waiver of Subrogation is provided in favor of the additional insureds as required by written contract and applies with respect to general liability(per form CG 2404 12/19),auto liability(per form CA T3 53 02 15), employers liability(per form WC 00 03 13 00-001),and Umbrella Liability(per form CU 24 03 12 20). Coverage afforded by the general liability(per form CG 2001 12f19)is primary and non-contributory in favor of the additional insured per written contract.A 30 Day Notice of Cancellation will be provided where required by written contract,per General Liability farm IL SU 4004(10-10)and Umbrella form IL SU 4004(10-10). Additional Insured:The City of Ashland,Oregon,its officers,agents and employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE USA '- / 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, LLC 1 Pasquerilla Plaza Ste 100 Johnstown PA 15901 MDG2026 00000639 02 City of Ashland 20 East Main Street Ashland, OR 97520 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing: I. Confirmation that a certificate of insurance is no longer required; or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code: AUMAACT-02 4. This Certificate Number: 717686428 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https:// www.ajg.com/us/privacy-policy/. IL SQ40D (10-10) HDI GLOBAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ|TCAREFULLY. �� CANCELLATION �0�� AMENDMENT 01 SCHEDULE Name,Address and E-Mmi|Address ofOther Penaon(s)/«]q]anization(s): Number of Days Notice: A8 REQUIRED BY WRITTEN CONTRACT ORWRITTEN 1D DAYS FOR NON-PAYK4EWT. AGREEMENT 3U DAYS ALL OTHER (if no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endoroementj 1. If we cancel this policy by nc4iu* to you for any statutorily permitted reason other than nonpayment of pmmium, we shall endeavor to mai|, e-mail or deliver a copy of such written notice of cancellation to the person(s) or orgonizatinn(a)shown in the Schedule above. ID. A copy of the notice, per paragraph|. above,will bm mailed,e'mai|edurdelivered: 1. To the appropriate addresses corresponding 0othe person(s) urorganization(s) shown in the Schedule above; and 2. The number of days required for notice of canoe||ation, as provided in paragraph A.2. of the Common Policy Conditions or as amended by an applicable state cancellation endorsement or by the date as shown in the Schedule above. Ill. Our failure to provide such advance notification to the person(s) or organization(s) shown in the Schedule of this endorsement will not extend any policy cancellation date nor negate any cancellation of the policy. All other terms and conditions of this policy remain unchanged. � � Page 1mf1 |LSU4O&0(10-10) COMMERCIAL GENERAL LIABILITY CG20011219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READIT 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 additional insured. 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 CG 20 01 12 19 O Insurance Services Office, Inc.,2018 Page 1 of 1 POLICY NUMBER: GLD10O0S18O9 COMMERCIAL GENERAL LIABILITY CG 20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. ��N��/��0 �� ~ 4�� LESSEES �� mmm��n�� mw��m�� m��~m��v ��~��~�� m� CONTR��/��u�� SCHEDULED �� m�� ACTORS ��mm�_��m��_�� PERSON ��m� ��0��|� ��mv��m�m�� mm��m� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART HA SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations ANY PERSON OR ORGANIZATION ANY LOCATION WHERE REQUIRED WHERE REQUIRED BY WRITTEN BY WRITTEN CONTRACT CONTRACT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section || — VVho 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 inoureds, the following additional organization(s) shown in the 8ohedu|e, but only exclusions apply: with respect to liability for"bodilyinjury", "property This insurance does not apply to "bodily injury" or damage" or "personal and edxed1einA injury" "property damage"occurring after: cauaed, in whole u/in part, by: 1. All work,including materials,parts orequipment 1 Your ' ' furnished in connection with such work, on the 2. The mcLo or omissions of those acting on your project (other than aemice, maintenance or behalf; repairs) to be performed by or on behalf ofthe in the performance of your ongoing operations for additional insured(s) at the location of the the additional insured(s) at the location(s) covered operations has been completed;or designated above. 2. That portion of 'your work' out of which the However: injury or damage arises has been put to its intended use by any person or organization 1. The insurance afforded to such additional other than another contractor orsubcontractor insured only applies to the extent permitted by engaged in performing operations for eprincipal law; and a»e part o(the same project. 2. |f coverage provided ha the additional insured ia required by o 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 toprovide for such additional insured. � � CG 20101219 Insurance Services Office, |no.. 2U1O Page of 2 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional inaumda, the following is added to insurance; Section" ' whichever|oless. If coverage provided to the additional insured �'"»= p This endorsement shall not increase the applicable required bya contract or agreement, thmmumtwe limits ofinsurance. will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required by the contractor agreement; or Page 2 of @ Insurance Services Office, |no..2O1D CG 20101213 POLICY NUMBER: 8LD10008i8 COMMERCIAL GENERAL LIABILITY CG 20 11 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [TCAREFULLY. ��N�N4��N �� mmm��m�� mm��m�� u�m��m��m�� m� 0 �� m��m^�� m m m��~m�mm��~�� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE MA Designation Of Premises(Part Leased To You): ALL LOCATIONS OWNED, RENTED OR OCCUPIED BY THE INSURED Name Of Person(s)Or Organization(s)(Additional Insured): AS REQUESTED BY WRITTEN CONTRACT Additional Premium: INCL. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section || — Who |eAn Insured in amended to 2. |f coverage provided to the additional insured |a include aoan additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect liability for"bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole urin part, by you or those acting provide for such additional insured. on your behalf in connection with the ownership, B. With mapuo1 to the insurance afforded to these maintenance or use of that part of the premises additional inounadu, the following in added t/ leased to you and shown in the Schedule and Section III—Limits Of Insurance: subject ho the following additional exclusions: |f coverage provided io the additional insured ia This insurance does not apply to: required by a contract or agreement, the most we I. Any ''000urmnma" which takes place after you will pay on behalf of the additional insured is the cease hobea tenant in that premises. amount ofinsurance: 2. Structural o|bam|iona, new construction or i. Required by the contract or agreement;or " demolition operations performed by or on 2. Available under the applicable limits of � behalf of the person(s) or organization(s) insurance; � shown in the Schedule. whichever ialess. However: This endorsement shall not increase the � 1. The insurance offbndad to such additional applicable limits ofinsurance. � insured only applies tnthe extent permitted by � law;and u � CG 2011 1219 0 Insurance Services Office, |nu..2O18 Page of POLICY NUMBER: GLD1066918 COMMERCIAL GENERAL LIABILITY CO 20 15 12 1 THIS A THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS 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)(Vendor Your Products ALL VENDORS OF THE INSURED'S ALL PRODUCTS MANUFACTURED, PRODUCTS WHEN REQUIRED BY SOLD OR DISTRIBUTED BY THE WRITTEN CONTRACT INSURED Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to In. Any express warranty unauthorized by you; include as an additional insured any person(s) or c. Any physical or chemical change in the organization(s) (referred to throughout this product made intentionally by the vendor; endorsement as vendor) shown in the Schedule of d. Repackaging, except when unpacked solely this endorsement, but only with respect to liability for the purpose of inspection, for"bodily injury" or"property damage" arising out demonstration, testing, or the substitution of of "your products" shown in the Schedule of this parts under instructions from the endorsement which are distributed or sold in the manufacturer, and then repackaged in the regular course of the vendor's business. original container; However: a. Any failure to make such inspections, 1. The insurance afforded to such vendor only adjustments, tests or servicing as the applies to the extent permitted by law; and vendor has agreed to make or normally 2. If coverage provided to the vendor is required undertakes to make in the usual course of by a contract or agreement, the insurance business, in connection with the distribution afforded to such vendor will not be broader or sale of the products; than that which you are required by the f. Demonstration, installation, servicing or contract or agreement to provide for such repair operations, except such operations vendor. performed at the vendor's premises in B. With respect to the insurance afforded to these connection with the sale of the product; vendors,the following additional exclusions apply: g. Products which, after distribution or sale by 1. The insurance afforded the vendor does not you, have been labeled or relabeled or apply to: used as a container, part or ingredient of "Bodily injury" or "property damage" for any other thing or substance by or for the which the vendor is obligated to pay vendor; or damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; CG 20 15 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 2 h. C. With respect to the insurance afforded to these out m the sole negligence for vendors, the following is added to Section |U — Ue own acts or omissions or those of its Limits OfInsurance: employees or a�`-� - else acting on d� |f coverage provided tn the vendor io required bya behalf, However. this exclusion does not contract or egnmement, the most we willpay on apply to: behalf uf the vendor io the amount ofinsurance: (1) The exceptions contained in Subparagraphs d.nrf.; mr 1. Required by the contract nr agreement; or (2) Such inspections, adjustments, tests or 2. Available under the applicable limits of � servicing icing as the vendor has agreed to make or normally undertakes to make in whichever is less. the usual course of business, in This endorsement shall not increase the connection with the distribution orsale applicable limits ofinsurance. of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such pmducta, or any ingnedient, pad or ounto1ner, entering into, accompanying or containing such products. � � Page of Insurance Services Office, |nu.. 2Oi8 CG 2015 1219 POLICY NUMBER: GLDiDOOD10 COMMERCIAL GENERAL LIABILITY CG2D281219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��N��N INSURED �� LESSOR �� mmm��m��m� mm��m�� w~��m� ��m LEASED EQUIPMENT m�� This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): ANY WITH RESPECT TO MAINTENANCE, OPERATION OR USE OF LEASED EQUIPMENT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. X Section |l — VVhm Is An Insured is amended to & With respect to the insurance afforded to theme include as an additional insured the o) or additional innureds, this insurance does not apply organization(s) shown in the Schadu|m, but only to any "occurrence" which takes place after the with respect to liability for"bodilyinjury", "property equipment lease expires. damage" or "personal and advertising injury" C. With respect to the insurance afforded to Name u*u*vu, v/ whole w in vau, by your mau/°,uux;e, additional innuredo, the following is added to operation of equipment |ease to you by Section |U—Limits Of Insurance: such-- '--n�' or organization— —``. K coverage provided to the additional insured is However: required bya contract magreement, the most we 1. The insurance afforded to such additional will puy on behalf of the additional insured is the insured only applies to the extent permitted by amount ofinsurance: law; and 1. Required by the contract or agreement;or 2. |f coverage provided to the additional insured ia 2. Available under the applicable limits of required by a contract or agreement, the insurance; insurance afforded to such additional insured whichevaris|eea will not be broader than that which you are � required by the contract or agreement to This endorsement shall not increase the provide for such additional insured. applicable limits ofinsurance. CG 2028 1219 Insurance Services Office, |nc..2U18 Page 1of1 POLICY NUMBER: 8LD1U66Q18 COMMERCIAL GENERAL CG 20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��0��0��N INSURED ~ �� LESSEES �� mmm��w�� mm��m�� m��m�� m� �� ~ COMPLETED ��m�� CONTRACTORS m�m�.�� m ��m�� m�wm m�� m �� OPERATIONS m m��m�� 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 ANY LOCATION WHERE REQUIRED WHERE REQUIRED BY WRITTEN BY WRITTEN CONTRACT CONTRACT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section || — #Vhm Is An Insured is amended to IS. With mopeoi to the insurance afforded to these include oaenadditional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, b Section|U—LimitsQyinaurance: ithma ��to liability fbr^bodi| injury" If coverage provided to the additional insured is damage"caused,in whole orin part,by"your work" required byo contract or agreement, 1hmmma(we at the location designated and described in the will pay on behalf ofthe additional insured is the Schedule of this endorsement performed for that amount ofinsurance: additional insured and included in the "products- 1. Requ�edby the contnadorag�emant;or comp{miedop*naUonohezand^ 2. Available under the applicable limits of However: insurance; 1. The insurance afforded to such additional whichever isless. insured only applies to the extent permitted by This endorsement shall not increase the applicable law; and limits ofinsurance. 1 |f coverage provided hm the additional insured io � required by a oordmci or agreement, the � insurance afforded to such additional insured � will not be broader than that which you are required by the contract or agreement toprovide � for such additional insured. � POLICY NUMBER: GLD1066918 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE CL Y® 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 WHERE A WAIVER IS REQUIRED PRIOR TO THE EXECUTION OF ANY CONTRACT OR AGREEMENT 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 d Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payrnents 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 04 12 19 0 Insurance Services Office, Inc.,2018 Page 1 of 1 POLICY NUMBER:CUD1067018 COMMERCIAL LIABILITY UMBRELLA CU 24 03 12 20 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 LIABILITY UMBRELLA COVERAGE PART SCHEDULE Name Of Person(s)Or Organ ization(s): ANY PERSON OR ORGANIZATION WHERE A WAIVER IS REQUIRED PRIOR TO THE EXECUTION OF ANY CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 9. 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. rn CU 24 03 12 20 @ Insurance Services Office, Inc., 2020 Page 1 of 1 A016, TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13(00)®001 POLICY NUMBER: UB-9S952683-25-14-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule, SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. ®ATE OFISSUE: 12-31-25 ST ASSIGN: PAGE 1 OF 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��NN�� BN�� 0�� W�� mm�� AUTO�� EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —Thia endorsement broadens coverage. Hovvever, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement tothe Coverage Part, and these coverage broadening provisions do not apply tn the extent that coverage is excluded or limited by such on endorsement. The following listing is e general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- domementendthsneotofyuu/po|icyoarefuUy0odeterminerightn. duUaa. ondvvhatisundianotuovered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE—LOSSOF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO |' PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. ��DY��A� |W�U�ED' J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV' LOSS ER4GE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCT|BLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the euhani that person or organization qualifies as an "insured" The following |ooddedto �aragraPhA.i,. Who 1�An Insured, under the VVho Is An Insured provision contained of��T\�7� || —��V��EDAUTO� 'LIABILITY COVERAGE: in Section U Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO inQ the policy period over which you maintain i. The following is added to Paragraph A.1.. 50% or more ownership interest and that is not Who of SECTION || — COVc separate|y insured for Business Auto Coverage. ERED AUTOS LIABILITY C00ERAGE.- Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while ti| the 180th day after you acquire or form the op oPenehnQ an ''euho" hired or rented under m ganization or the end of the policy perind, which- contract or agreement in an "employee's" ever ioearlier. nume, with your pe/mianion, while performing duties related to the conduct of your buoi- B. BLANKET ADDITIONAL INSURED naoa. The following is added to Paragraph c. in A.1.. 2. The following replaces Paragraph b. in B.5.. Who Is An Insured, of SECTION H —COVERED Other Insurance, o/ SECTION |y — BUS|- AUTOS LIABILITY COVERAGE: 0ESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Covep avvritten contract or agreement between you and age, the following are deemed tn beoov- � that person or organizotion, that is signed and ered^autna''you own: executed by you before the "bodily injury" or (1) Any covered ^euho' you |eene. him. � pnnpedY damage" occurs and that is in effect rent orborrow; and during the policy p*xiod tobenmmedaaonaddi' � ' (2) Any covered "auto" hired or rented by " dona| insured is an "insured" for Covered Autos your "employee" under a contract in � Liability Coverage, but only for damages howhich an ..emp|oyee'a" name, with your � CA T3530215 mzu15 The Travelers Indemnity Company.All rights reserved. Page 1of4 - Includes copyrighted material of Insurance Services Office,Inc.with its permission, COMMERCIAL AUTO pennimsion, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United Staten of nenm. Americe, the territories and poaemou|ona of the United States o/ America, PuertoHowever. any "auto" that |s leased, hired. ' � nan�dorbonowedvv�hodh RicnendCanada� driver covered"auto". (i) You must arrange (o defend the ^in' D. EMPLOYEES AS INSURED mured"againat, and investigate or set- tle any such claim or ''auit' and keep The following is added to Paragraph A.1` Who Is us advised of all proceedings and eo- An Insured, of SECTION U—COVERED AUTOS Uona. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any 'emp�yee" of yours � an ^insunad^ while us- "insured" will make any settlement1ngaoovenad ''au�''youdon'town. hire o' bormw w�houtouroonserd� io your business or your personal affairs. (iii)We may. c� our discretion, participate E. �UpPL�D0�MT��Y P��08�NT� � |��A��' LIMITSin defending the "inoumd" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2). "euit' of SECTION U — COVERED AUTOS LIAB!L, (iv)We will reimburse the ''inaured" for ITYCOVERAGE: sums that the ''inauned'' legally must (2) Up to $3.000 for cost of bail bonds (in' pay as damages because of "bodily duding bonds for related traffic law viola- injury" or "property damage" 1owhich tiona) required because of an ''anddenC' this insurance eppUeo, that the "in- ye cover. We do not have to furnish nured" pays with our conmert, but these bonds. only up to the limit described in Pane- 2. The following replaces Paragraph A.2'a'(4)' graph C.' Limits Of Insurance, of of SECTION || — COVERED AUTOS UAB|L- SECTION || — COVERED AUTOS |TYCOVERAGE: LIABILITY COVERAGE. h/) We will reimburse the "insured" har WU All reasonable expenses incurred by the "insured" at our reqummt the reasonable expenses incurred actual' with our consent for your inveo'iga' loss of earnings up to $500 a day be tion of such claims and your defense oau�aofUmeo�homwmrk� of the ''|naumd" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "ouit'', but only up to and included EHAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C.. Limits Of |nuurenoe, of graph B.7.. Policy Period, Coverage Territory, SECTION !| — COVERED AUTOS LIABILITY COVERAGE and not in of SECTION |V — BUSINESS AUTOC�DW0- ' T|ONS: addition to such limit. Our duty to make such payments ends when wm (5) Anywhere in the world, except any country ur have used up the applicable limit of jurisdiction while any trade oenction, em' insurance in payments for dmmogao, bargo, or similar regulation imposed by the settlements o/defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid collectible other insurance available and oo within such country or jurisdiction, for Cov'enadAuhoo Liability Coverage for any covered to the "insured" whether primary. excess, ^auto" that you |eaue, hire, rent or borrow contingent nron any other basis. without driver for o period of30 days or|enn (c) This insurance is not a substitute for re- and that is not an "mubi' you |eaoe, hina, rent quinad or compulsory insurance in any o, borrow from any of your ^emp|oyeeo", country outside the United Stahas, its ter- partners (if you are a partnerehip), members ritohem and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2of4 @cm1sThe Travelers Indemnity Company.All rights reserved. CAT3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO You age* to maintain all required or CA |noron your covered^auto" compulsory insurance in any such ooun- This coverage applies only in the event ofatotal try uptothe minimum limits required by theft of your covered^au\o" local law. Your failure to comply with � compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. this policy, but*e will only bo liable Nthe K. AIRBAGS some extent we would have been liable The following is added to Pa - B.l. Exdu' hadynu complied with the compulsory in sioma. of SECTION ||| - PHYSICAL DAMAGE auranuerequ|ementa. COVERAGE: (d) It is understood that we are not on admit- Exclusion la. does not apply to "|oaa" to one or ted or authorized insurer outside the more airbags in a covered ''auto'' you own that in- United GtoLee of Amehca, its territories flute duo to a cause other than e cause of"loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.i.c.. but adm. We assume no responsibility for the only: ° + furnishing f certificatesof insurance, or m. |f that"auto^iea covered''auto^for Compre- kxcompliance in any way with the laws henniwy Coverage under this policy- of othercountrieem|aUngtoinaunanue. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE-GLASS ranty; and The following ia added to Paragraph D.. Deducti- u. The airbags were not intentionally inflated. b|e. of SECTION |U - PHYSICAL DAMAGE We will pay up to a maximum nf $1.0UO for any COVERAGE: one"loss". No deductible for e covered "auto" will apply to L. NOTICE AND KNOWLEDGE QF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.e.. of H. HIRED AUTO PHYS|CALDAMAGE-LOSSOF SECTION|V-BUSINESS AUTO CONDITIONS: USE-|NCREASED UKU!T Your duty to give uaor our authorized repreaenta- Thefo||mwing replaces the last sentence of Para- Uve prompt notice of the ^aondort' or ^|000" ep' gnoph A.4.b.. Loss Of Use Expenses. of SEC' plies only when the ''ooddenf' ur ''|osa" is known T|(3N III-PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You(if you are anindiv|dua|); for loss of use io $05 per day, 0oa maximum nf (b) A partner(if you are opartnorehip); $75O for any one"mouiden(^ . (c) A member (if you are a limited liability uom' |. PHYSICAL DAMAGE - TRANSPORTATION peny); EXPENSES |M�RE��E�LIMIT- (d) An executive offioer, director or insurance The fu||ovvinA replaces the first sentence in Para- manager (if you are a corporation or other or- graph AA.a.. Transportation Expenses, of ganization); or SECTION U| - PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: hceof the^acoident'or^|moe" VVe will pay upto $5O per day toa maximum of M. BLANKET WAIVER(�F SUBROGATION $1.500 for temporary transportation expense in- The following nap|amys Paragraph A0 Transfer oorred by you because of the total theft of a oov' Of Rights Of Recovery Against O-'h~-na To Us ened''auto''of the private passenger type. of T|O@ |V - -" BUSINESSAUTO CONO|' J. PERSONAL PROPERTY T|K]NS : The following ia added to PanagmphA.4.. Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION U| - PHYSICAL Others ToUs � DAMAGE COVERAGE: We waive any right of recovery we may have � against any person or organization \o the ex- Personal PnmpeM7 tent required of you by o written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" Q pera|and other personal property which is: or"|osa" provided � ' � ~~-~ (1) Owned byan''inoured"; and arises outof operations contemplated by CAT3530215 Con1s The Travelers Indemnity Company.All rights reserved. Page 3of4 - /no/uu*uovm,r/omeumate,/mu,mnvrannoeom/onsomoe./nn.with its permission. COMMERCIAL AUTO such contract. The waiver applies only tothe The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you aho|| not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following ia added bo Paragraph B.2.. Coe- |ect additional premium or eme/oiea our right of oea|ment' Misrepresentation, Or Fmmud, of cancellation ornon-rene*e| SECTION |V—BUSINESS AUTO CONDITIONS: Page 4nf4 @oo,s The Travelers Indemnity ovmpanv.All rights reserved CAT3 53 02 16