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HomeMy WebLinkAboutInsurance Certificate: AUMA Actuators, Inc.(4) DATE(MMtDD1YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/16/2026 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 Cooney Arthur J. Gallagher Risk Management Services, LLC PHONE — — FAX (A/C No Ext}_ -- A!C No)-------—.-- 1 Pasquerilla Plaza E-MAIL Suite 100 _ADDRESS: certrequests�5aa�g com — Johnstown PA 15901 _—_ INSURER(S)_AFFORDING COVERAGE NAICf#- _ INSURER A:HDI-Global insurance Company _ 41343_ INSURED AUMAACT-02 INSURER B;The Travelers Indemnity Company of CT 25682 AUMA Actuators, Inc. — — _ — -- 100 Southpointe Boulevard INSURER c:Traveler--__s Casuals and Surer Company _ 19038 Canonsburg PA 15317 INSURER D: - --_ -- INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:1623619713 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. TN-SR­ SUBR — POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I V ADDL POLICY NUMBER MMJDDtYYYY MWDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GLD1066918 11112026 1/112027 EACH OCCURRENCE $1,000,000 CLAIMS-MADE ��OCCUR PREM SE8 a cLccur ence. $100:000 MED 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 JECT LOG _-_ _ -----PRODUCTS-COMP(OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y BA-9N747267-25-14-G 12/31/2025 12/31/2026 COMBINED SINGLE LIMIT $1,000,000 _{_Ea accidentL _ HANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident)$! AUTOS ONLY AUTOS _ HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY iPer accident__— - A X UMBRELLA LIAR X OCCUR Y Y CUD1067018 1I112026 11112027 EACH OCCURRENCE $4,000,000 EXCESS LIAR _ CLAIMS-MADE AGGREGATE— $4,000,000 iiF DED X RETENTION$ _------ ----� --1 $ -- nn C WORKERS COMPENSATION Y UB-9S952683-25-14-G 12/31/2025 12/31/2026 X AND EMPLOYERS'LIABILITY Y I N STATUTE ERH ANYPROPRIETORtPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICERtM EMBER EXCLUDED? N/A ---{----- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE; $1,000,000 If yes,describe under —' DESCRIPTION OF OPERATIONS below j E,L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe 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 form 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 12/19)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 form 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 4VV @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, LLC I Pasquerilla Plaza Ste 100 Johnstown PA 15901 MDG2026 00000508 02 !0`14 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: 1. 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- AUMAA CT-02 4. This Certificate Number: 1623619713 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/eore-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https-.H www.ajg.com/us/privacy-policy/. kSU40O (1010) HDI GLOBAL INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iTCAREFULLY. NOTICE OF CANCELLATION AMENDMENT SCHEDULE Name,Address and E-Mmi|Address uf Other Peromo(e)/Organization(s): Number mf Days Notice: AS REQUIRED BY WRITTEN CONTRACT ORWRITTEN 1O DAYS FOR NON-PAYK8ENT. AGREEMENT 3U DAYS ALL OTHER (if noentry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this*ndoraemenL) 1. If we oanuu| this policy by notice to you for any statutorily permitted reason other than nonpayment of premium, we shall endeavor to mai|, e-mail or deliver a copy of such written notice of cancellation to the person(s) or orgmnizmUon(n)shown in the Schedule above. K. A copy of the notice, per paragraph 1.above,will be mailed, e-mailed or delivered: 1. To the appropriate addresses corresponding to the person(s) orurgonization(a) shown in the Schedule above; and 2. The number of days required for notice of oancn||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. 0O. 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. � � MOM Page 1of1 |L SU4O&0(1V-1Q) COMMERCIAL GENERAL LIABILITY DO 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that, (1) The additional insured is a Named Insured under such other insurance-, and CG 20 01 12 19 O Insurance Services Office, Inc.,2018 Page 1 of 1 POLICY NUMBER: GLD106691809 COMMERCIAL GENERAL LIABILITY CG 20 10 12 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READIT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orpianizationfal Locations 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 11 — Who Is An Insured is amended to B, With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "properly This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by; 1. Your acts or omissions; or 1. All work,including materials,parts or equipment furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the 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 or subcontractor insured only applies to the extent permitted by engaged in performing operations for a principal law; and as a part of the same project. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are o required by the contract or agreement to provide for such additional insured. o O O Q O Q O CG 20 10 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 2 C. With respect to the insurance aMh/&ad to these 2. Available under the applicable limits of additional |nmumdo. the following is added W insurance; Section III—Limits Of|nsuruncm� � whichever ialess. If coverage provided �o the additional insured �'~»^ p This endorsement shall not increase the applicable required bya contract or agreement, the most we limits ofinuunmnoe will pay on behalf ofthe additional insured is the � amount ofinsurance: 1. Required by the contract o/agreement; ur � � Page 2oY2 KDInsurance Services Office, Inc.,2018 SO2U 10 12 19 POLICY NUMBER:GED1066918 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ®® 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 11 — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an 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 to 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 or in part, by you or those acting provide for such additional insured. on your behalf in connection with the ownership, B. With respect to the insurance afforded to these maintenance or use of that part of the premises additional insureds, the following is added to leased to you and shown in the Schedule and Section III—Limits Of Insurance: subject to the following additional exclusions: If coverage provided to the additional insured is This insurance does not apply to: required by a contract or agreement, the most we 1. Any "occurrence" which takes place after you will pay on behalf of the additional insured is the cease to be a tenant in that premises. amount of insurance: 2. Structural alterations, new construction or 1. Required by the contract or agreement;or d 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 is less. However: This endorsement shall not increase the g 1. The insurance afforded to such additional applicable limits of insurance. { insured only applies to the extent permitted by $ law; and 0 0 0 O O CG 20 11 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: GLD1066918 COMMERCIAL GENERAL LIABILITY CG 20 15 12 19 THIS OR T CHANGES 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 Organizations)(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 lb, 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: e, 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 a. "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 ©Insurance Services Office, Inc., 2018 Page 1 of 2 In. C. With respect to the insurance afforded to those out of the sole negligence of the vendor for vendors, the following is added to Section III — its own acts or omissions or those of its Limits QfInsurance: employees or anyone else acting on its |f coverage provided to the vendor is required hYa behalf. However, this exclusion does not ' cnn1nod or agreement, the most we will pay on apply to: behalf nf the vendor ia the amount ofinsurance: (1) The exceptions contained in 1 R�qu|»adbythmoonira/�orageementor Subpanagraphsd.orf; ur ' , 2 Available under the applicable limits of (2) Such |nnpoo'iona' adjustments, tests or ' insurance; servicing an the vendor has agreed to ' make u/normally undertakes to make |n whichever isless. the usual course of business, in This endorsement shall not increase the connection with the distribution or sale applicable limits ufinsurance. uf the products, 2. This insurance does not apply to any insured ��� person or organization, from whom you have @��� acquired such prnducta, or any ingmdiant, part or oon{einer, entering into, accompanying or containing such products, u Page 2of2 Insurance Services Office, |no,. 2O18 CG 20151219 POLICY NUMBER: GLD1066918 COMMERCIAL GENERAL LIABILITY CG 20 28 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |-[ CAREFULLY. ADDITIONAL INSURED — LESSOR OF LEASED ����� N����������� ��m�m����~�� EQUIPMENT m This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persoms)Or Organization(s): ANY WITH RESPECT TO MAINTENANCE, OPERATION OR USE OF LEASED EQUIPMENT Information r hewn in the Declarations, & Section U — Whu Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, this insurance does not apply organization(s) shown in the Suhedu|e, but only to any "occurrence" vvh|oh takes place after the with respect to ||ebiUtyfor"bodily injury", "property equipment lease expires. damage" or "personal and advertising injury" C. With respect to the insurance afforded to these ^a"°""' "' whole "' "' part, "r your maintenance, additional inaupeda, the following is added to operation or use of equipment leased to you by Section U|—Umits Of Insurance: such pemon(o)or organization(a). If coverage provided to the additional insured is However required by a contract nragreement, the most we 1. The insurance afforded to such additional will pay on behalf of the additional insured is the insured only applies tu the extent permitted by amount nfinsurance: law-,' 1. Required by the contract or agreement; or 2. |f coverage provided N 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 ' whichever ioless. 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 12 19 *|nsunence Services Office, Inc.,2018 Page 1 of I POLICY NUMBER: GLD10G8918 COMMERCIAL GENERAL CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. ������0��N������� INSURED �� ���������0�N� LESSEES ���� ADDITIONAL. ~�~ ~~ .� ~~ ~��~ ~~~� ~~ ~ � ~ ~�~~�� ����_~~� �~ ~ CONTRACTORS — COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location Andpe�����. 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 || — VVhm Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the m) or addibonal inounedo, the following is added to organization(s) shown in the Soh*du|e, but only Section III—Limits OfInsurance: with respect bU bi|ity(br''bodi|yinj ry"ur"propehy If coverage provided to the additional insured is damage"caused,in whole orinpart, by"your work" required bya contract u/agreement, the most we at the location designated and dmaudbad in the will pay on behalf nfthe additional insured is the Schedule of this endorsement performed for that amount ofinsurance: additional insured and included in the "products- 1. Required co ntract oomp|*tedopemtionshazand" 2 Available under the applicable limits of However: insurance; 1. The insurance afforded to such additional whichever iuless. insured only applies to the extent permitted by This endorsement shall not increase the applicable law;and limits ofinsurance. 2. If coverage provided iuthe additionalinsured i required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2037 121S Insurance Services Office, |no..2O18 Page of POLICY NUMBER: GLD1066918 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. L AS A 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 Marne 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 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. CG 24 04 12 19 O 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 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 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, ooO O CU 24 03 12 20 @Insurance Services Office, Inc.,2020 Page 1 of 1 A01111k TRAVELERS WORKERS COMPENSATION AND ONE TONER SQUARE HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY 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. DATE OFISSUE: 12-31-25 ST ASSIGN: PAGE 1 OF I COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OFCOVERAGE -Thiuendomementbmodensoovenege. Huwever. covemgeforany 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 to the extent that coverage is excluded or limited by such an endorsement. The following |iadnA is e general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement andthee»stofyourpo|icyoaro/u||ytodeterminerighto. dudeo. andwhotinandianotoovered A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE-LOSS(}F B. BLANKET ADDITIONAL INSURED USE-INCREASED LIMIT |. PHYSICAL �AHdA�� - TRANSPORTATION C. �K8�LOY��H|R��AU�K�' EXPENSES-INCREASED LIMIT U. EMPLOYEES A8INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS - INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO - LIMITED WORLDWIDE COV- L088 ER4GE-INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE-GLASS N. UNINTENTIONAL ERRORS{JROMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that person or organization qualifies as an "insured" An |aaddedto PanagraphA.1.. Who |� unUe/ theVVho Is An Insured provision contained An |nsuned ufS��VO� i| ��OY���OAU�Q8 ' |n Section U, LIABILITY COVERAGE: Any organization you newly acquire or fnnn dup C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 5O% nr more ownership interest and that ianot Who Is An Insured, of SECTION f| - OOV- ueparute|y insured for Business Auto Coverage, ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un' An "employee" of yours is on ^inaured" while d| the 180th day after you acquire or form the op operating an ''ouLo" hired or rented under ganizahon or the end of the policy period, which- contract or agreement in an "employee's" ever im earlier. name, with your permission, while performing duties related to the conduct of your buei- B. BLANKET ADDITIONAL INSURED neuo. The following is added to Paragraph c. in A.I, 2. The following ep|noea Paragraph b. in B.5` Who Is An Insured, of SECTION 11 -COVERED Other Insurance, of SECTION |% - BUS|- AWTQSL|4BiLITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- mwhMen contract or agreement between you and age, the following are deemed ho be oov � thot person or organization, that is signed and amd"auton''you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, � property damage" uuoum and that is in effect rent orbnrmw� and during the policy period, to be named as an eddi- (2) Any covered "auto" hired orrented by � Uono| insured is an "insured" for Covered Autos your "employee" under a contract in 8 � Uebi|i4/ Coverage, but un� for damages 0owhich an'—"e—'|,—''-'' under with your CA T3 53 0215 (D 201s The Travelers Indemnity Company.All rights reserved. Page 1of4 COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made Of "Suit" related to the conduct of your bua|- brought outside the United States of neas. America, the territories and possessions Huwmver, any ''auho" that isleased, hired. of the United States of Amerium. Puerto rented or borrowed with e driver is not Rico and Canada: covered"auto" . (|) You must arrange tn defend the ''in- D. EMPLOYEES AS INSURED aured'' against, and investigate nrset- tle any such claim or "suit" and keep The following is added to Paragraph A.1.. Who Is us advised of all proceedings and ao' An |nsured of SECTION U —COVERED AUTOS bons, LIABILITY COVERAGE: Any "employee" of yours is on "insured" while us' (U) Neither . will make an; settlement nor any other involved inga covered ^auio^you don't own hieorbur�w "insured"'|n your business or your personal affairs. without our consent. E. SUPPLEMENTARY PAYMENTS _ INCREASED (iii)VVe may, eL our discretion, participate U08|TS in defending the "insumd" against, or in the aeNamerk of, any claim or 1. The following replaces Paragraph A.2.a.(2). 'suit' of SECTION U — COVERED AUTOS UAB|L (k)We will reimburse the "insured" for iTYCOVERAGE: sums that the "insured" legally must (2) Up to $3.000 for coat of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury'' ur "property damage" 1owhich tiono) required because of an "accident' this insurance app|ies, that the "in- we cover. We do not have to furnish aurnd" nays with our consent, but these bonds. only upinthe limit described in Pena' 2. The following replaces Paragraph A.2.a.(4)' graph C.. Limits Of |nauronce, of of SECTION U — COVERED AUTOS L|AB|L- SECTION II — COVERED AUTOS |TYCQVERAGE: LIABILITY COVERAGE. (v) We will reimburse the "insured" for 4A All reasonable expenses incurred by Me "insured'' atour request, including actual the reasonable e«panaao incurred |oam of earnings up to $500 a day be- with our consent for your inveahga- oauseof time off from work. honof such claims and your defense of the "insured" against any such F. HIRED AUTO — UKO|TEDVUQRLDVV|DE COV- ''suit', but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C.' Limits Of |naunonce, of graph B.7.. Policy Period, Coverage T� �oq/. — COVERED AUTOS of SECTION |V — BUSINESS AUTO COND|' LIABILITY COVERAGE, and not in T|ONS: addition to such limit, Our duty to make such payments ends when wm (S) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any bode eanction, em- insurance in payments for demagea, bargo, or similar regulation imposed by the settlements or 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 within such Country or jurisdiction, for Cov- and collectible other insurance available eedAutoo Liability Coverage for any covered to the "insured" whether primary, excess, ''uuto" that you |eaue, h|re, rent or borrow contingent uron any other basis. without a driver for a period of30 days or |eao (c) This insurance is not a substitute for re- and that is not mn "euky' You |eame, hire, rent quineU or compulsory insurance in any or borrow from any of your "employees", country outside the United Stabem, its ter- partners (if you are e portnermhip), members rhnrieaand possessions, Puerto Rico and (|f you are e limited liability company) or Canada. members of their households. Page 2of4 m:m1s The Travelers Indemnity Company.All rights reserved. CA T3 530215 Includes copyrighted material of Insurance Services Office,Inc,with its permission � COMMERCIAL AUTO You agree to maintain all required or (2) |noron your covered'auto^ compulsory insurance in any such ouun- This coverage applies only in the event ofatotal try uptothe minimum limits required by theft of your covered''autn" local law. Your failure to comply with compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by c»»erage this po|icy, but mmwill only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3` Euc|u- hmd you complied with the compulsory in- sions. of SECTION III — PHYSICAL DAMAGE ounancerequinaments. COVERAGE: (d) It is understood that we are not on admit- Exclusion 3.o. does not apply to ''|uaa" to one or ted or authorized insurer outside the more airbags inm covered "auto" you own that in- United States of Amerioe, its territories 0ate due to a cause other than a cause of ^|oso^ and possessions, Puerto Rico and Can- yet forth in Paragraphs A.i.b. and A.1.o.. but mda We assume no responsibility for the only: ° + furnishing mf certificates of insurance, or a. |f that''aoto''iaa covered''auto"for Compre- for compliance in any way with the laws heneive Coverage under this policy; of other countries relating toinsurance. h. The airbags are not covered under any war- G. VWA|VEROFOEDUCT|BLE—GLASS nantY� and The following ia added Lo Paragraph D` DedunU- c. The airbags were not intentionally inflated. b|e. of SECTION U| — PHYSICAL DAMAGE We will pay up to e maximum of $1.000 for any COVERAGE: one"loss". No deductible fora covered auto" will apply to L NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a` of H. HIRED AUTO PHYSICAL DAMAGE—LOSS gF SECTION|V—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized mpmoenta' ThufoUn*inQ replaces the last sentence ofPara- tiva prompt notice of the "000ident" or "loss" op- graph A.4.b.. Loss Of Use Expenses, of SEC' plies only when the "accident" or ''|ouo" is known T|ON U|—PHYS|CAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (o) You(if you are an individual); for loss ofuse is $O5 per day, to a maximum of Apadner(if you omapa�nerahip); $75Oforanyonm''am�dent' (o) 4 member (if you are o limited liability com- i PHYSICAL DAMAGE — TRANSPORTATION peny)� EXPENSES—INCREASED LIMIT (d) An executive mffiner, director or insurance The following replaces the first sentence in Para- manager (if you are acorporation o/ other or- graph A.4.a.. Transportation Expeneea, of ganiza(ion); or SECTION U| — PHYSICAL DAMAGE COVER- (e) Any ''emp|oyee^ authorized by you tu give no- AGE: doeof the''aooident^or'1oau" We will pay up to $50 per day to a maximum of M. BLANKET yVA|VER�}FSUBROGAT|{�N $1.500 for temporary transportation expense in- The following replaces Paragraph A.5` Transfer curn*d by you because of the total theft of a oov Of Rights Of Recovery Against i si Cthonm To Uo, e,ed''muLm''of the private passenger type. of SECTION |Y — BUSINESS AUTO CONO|' J. PERSONAL PROPERTY T|C)AS : The following is added to paragraphA.4.. Cover- 5. Transfer Of Right* Of Recovery Against � age Extensions, of SECTION III — PHYSICAL Others ToUs DAMAGE COVERAGE: We waive any right of recovery we may have � against any person or organization totheex- Personal Property 0erk required of you by- o written contract � We will pay up to $400 for ''|usu" to wearing aP- signed and executed prior to any ''accident' 8 � pae|and other personal property which is: nr''|oep" pmv|�ed1hatUhe ''acddonC' or''|ooa'' ' 8 (1) V�nedbyan^�xun�^� and arises out of operations contemplated by CA T3 530216 0uo/s The Travelers indemnity Company.All rights reserved. Page 3of4 Includes copyrighted material m Insurance Services Office,Inc.with its permission, COMMERCIAL AUTO such contract, The waiver applies only to the The unintentional omission of, or unintentional person or organization dcs|Qnokad in such error in, any information given by you shall 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 is added to Paragraph B.2.. Con- |ect additional premium or exercise our right of cea|ment Misrepresentation, Or Fmaud, of cancellation ornon'renowo| SECTION !V~BUSINESS AUTO CONDITIONS: � Page 4of4 Qxu10 The Travelers Indemnity oumv m/.All rights reserved CAC8530215