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HomeMy WebLinkAboutInsurance Certificate: Outlier Construction, LLC DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 6/24/2026 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: Lisa Steele Anchor Insurance and Surety, Inc PHONE FAX PO Box 2808 ..J No Ext: 503-224-2500 A/C,No):503-224-9830 E-MPortland OR 97208 ADDRESS: certificates@anchorias.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Cincinnati Casualty INSURED OUTLCON-01 INSURERB: SAIF Corporation 36196 Outlier Construction, LLC INSURERC: Continental Insurance Company 35289 2870 Nansen Drive Medford OR 97504 INSURERD: SiriusPoint Specialty Insurance Corporation 16820 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1989155811 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 EPP0532588 4/14/2025 4/14/2028 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y EBA0532588 4/14/2026 4/14/2027 COMBINED SINGLE LIMIT $1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED FIR ERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR EPP0532588 4/14/2025 4/14/2028 EACH OCCURRENCE $5,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n $ B WORKERS COMPENSATION Y 876006 10/1/2025 10/1/2026 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER OR 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 C Excess Liability 8019104036 4/14/2026 4/14/2027 Each Occurrence/Agg 5,000,000 D Professional CPPL D0002338 01 4/14/2026 4/14/2027 Each Claim/Aggregate 2,000,000 Pollution Each Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder and all other entities are additional insureds when specified by written contract.Coverage is primary&non-contributory and includes waiver of subrogation when required by written contract.All subject to the terms,conditions and exclusions of the policies. Endorsements attached: GA472 05/20,AA288 06/20 Professional Pollution SIR: SIR:25,000 Umbrella Excess Liability goes over General Liability,Auto Liability and Employers Liability. EAST MAIN PARK PHASE 1, Project No.2024-16 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, An Oregon municipal corporation 20 East Main St. Ashland OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS AND AUTOMATIC WAIVER OF SUBROGATION WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or cluded in the "products-completed Contractors - Automatic Status For Other operations hazard", but only if: Parties When Required In Written Contract Or Agreement With You (1) The Coverage Part to which this endorsement is attached pro- 1. Section II - Who Is An Insured is vides coverage for "bodily injury" amended to include as an additional in- or "property damage" included sured any person or organization you within the "products-completed have agreed in writing in a contract or operations hazard"; and agreement to add as an additional in- sured on this Coverage Part. Such per- (2) The written contract or written son(s) or organization(s) is an additional agreement requires you to pro- insured only with respect to liability for: vide additional insured coverage included within the "products- a. "Bodily injury', "property damage" or completed operations hazard" "personal and advertising injury" for that person or organization. caused, in whole or in part, by the performance of your ongoing opera- If the written contract or written tions by you or on your behalf, under agreement requires you to provide that written contract or written additional insured coverage included agreement. Ongoing operations does within the "products-completed oper- not apply to "bodily injury"or"proper- ations hazard" for a specified length ty damage"occurring after: of time for that person or organiza- tion, the "bodily injury" or "property (1) All work, including materials, damage" must occur prior to the ex- parts or equipment furnished in piration of that period of time in order connection with such work, on for this insurance to apply. the project (other than service, maintenance or repairs) to be If the written contract or written performed by or on behalf of the agreement requires you to provide additional insured(s) at the loca- additional insured coverage for a tion of the covered operations person or organization per only ISO has been completed; or additional insured endorsement form number CG 20 10, without specifying (2) That portion of'your work"out of an edition date, and without specifi- which the injury or damage aris- cally requiring additional insured es has been put to its intended coverage included within the "prod- use by any person or organiza- ucts-completed operations hazard", tion other than another contrac- this Paragraph b. does not apply to for or subcontractor engaged in that person or organization. performing operations for a prin- cipal as a part of the same pro- 2. If the written contract or written agree- ject; and ment described in Paragraph 1. above specifically requires you to provide addi- b. "Bodily injury" or "property damage" tional insured coverage to that person or caused, in whole or in part, by "your organization: work" performed under that written contract or written agreement and in- a. Arising out of your ongoing opera- tions or arising out of"your work"; or Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Page 1 of 3 b. By way of an edition of an ISO addi- 2. With respect to the insurance afforded to tional insured endorsement that in- the additional insureds described in Para- cludes arising out of your ongoing graph B.1., the following additional exclu- operations or arising out of "your sions apply: work"; This insurance does not apply to: then the phrase caused, in whole or in part, by in Paragraph A.1.a. and/or Para- a. "Bodily injury", "property damage" or graph A.1.b. above, whichever applies, is "personal and advertising injury" aris- replaced by the phrase arising out of ing out of operations performed for the federal government, state or mu- 3. With respect to the insurance afforded to nicipality; or the additional insureds described in Para- graph A.1., the following additional exclu- b. "Bodily injury' or "property damage" sion applies: included within the "products- completed operations hazard." This insurance does not apply to "bodily injury', "property damage" or "personal C. The insurance afforded to additional insureds and advertising injury" arising out of the described in Paragraphs A. and B.: rendering of, or the failure to render, any 1. Only applies to the extent permitted by professional architectural, engineering or law; and surveying services, including: 2. Will not be broader than that which you a. The preparing, approving or failing to are required by the written contract, writ- prepare or approve, maps, shop ten agreement, written permit or written drawings, opinions, reports, surveys, authorization to provide for such addition- field orders, change orders or draw al insured; and ings and specifications; or b 3• Does not apply to any person, organiza- . Supervisory, inspection, architectural tion, state, governmental agency or sub- or engineering activities. division or political subdivision specifically This exclusion applies even if the claims named as an additional insured for the against any insured allege negligence or same project in the schedule of an en- other wrongdoing in the supervision, hir- dorsement added to this Coverage Part. ing, employment,training or monitoring of D. With respect to the insurance afforded to the others by that insured, if the "occurrence" additional insureds described in Paragraphs which caused the "bodily injury" or "prop- A. and B., the following is added to Section III erty damage", or the offense which -Limits Of Insurance: caused the"personal and advertising inju- ry", involved the rendering of, or the fail- The most we will pay on behalf of the addi- ure to render, any professional architec- tional insured is the amount of insurance: tural, engineering or surveying services. 1. Required by the written contract, written 4. This Paragraph A. does not apply to addi- agreement, written permit or written au- tional insureds described in Paragraph B. thorization described in Paragraphs A. and B. For the purpose of determining the B. Additional Insured -State Or Governmental required amount of insurance only,we will Agency Or Subdivision Or Political Subdi- include the minimum amount of any Um- vision - Automatic Status When Required brella Liability or Excess Liability cover- In Written Permits Or Authorizations age required for that additional insured in 1. Section II - Who Is An Insured is that written contract, written agreement, amended to include as an additional in- written permit or written authorization; or sured any state or governmental agency 2. Available under the applicable limits of in- or subdivision or political subdivision you surance; have agreed in writing in a permit or au- thorization to add as an additional insured whichever is less. on this Coverage Part. Such state or gov- ernmental agency or subdivision or politi- This endorsement shall not increase the appli- cal subdivision is an additional insured cable limits of insurance. only with respect to operations performed E. Section IV - Commercial General Liability by you or on your behalf for which the Conditions is amended to add the following: state or governmental agency or subdivi- sion or political subdivision has issued, in Automatic Additional Insured Provision writing, a permit or authorization. Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Page 2 of 3 This insurance applies only if the "bodily inju- scribed in Paragraph A. or B. that this in- ry" or "property damage" occurs, or the "per- surance would be primary to any other in- sonal and advertising injury' offense is com- surance available to the additional in- m itted: sured. 1. During the policy period; and As used in this endorsement, wrap-up insur- ance means a centralized insurance program 2. Subsequent to your execution of the writ- under which one party has secured either in- ten contract or written agreement, or the surance or self-insurance covering some or all issuance of a written permit or written au- of the contractors or subcontractors perform- thorization, described in Paragraphs A. ing work on one or more specific project(s). and B. F. Except when G. below applies, the following is Primary And Noncontributory Insurance When Required By Written Contract, added to Section IV - Commercial General Agreement, Permit Or Authorization Liability Conditions, Other Insurance, and supersedes any provision to the contrary: Except when wrap-up insurance applies to the When Other Additional Insured Coverage claim or "suit' on behalf of the additional in- When this insurance is primary to and will not Applies On An Excess Basis seek contribution from any other insurance This insurance is primary to other insurance available to the additional insured described in available to the additional insured described in Paragraphs A.and B. provided that: Paragraphs A.and B.except: 1. The additional insured is a Named In- 1. As otherwise provided in Section IV - sured under such other insurance; and Commercial General Liability Condi- 2. You have agreed in writing in a contract, tions, Other Insurance, b. Excess In- agreement, permit or authorization de- surance; or scribed in Paragraph A. or B. that this in- 2. For any other valid and collectible insur- surance would be primary and would not ante available to the additional insured as seek contribution from any other insur- an additional insured on another insur- ante available to the additional insured. ante policy that is written on an excess As used in this endorsement, wrap-up insur- basis. In such case, this insurance is also ance means a centralized insurance program excess. under which one party has secured either in- G. The following is added to Section IV - Com- surance or self-insurance covering some or all mercial General Liability Conditions, Other of the contractors or subcontractors perform- Insurance, and supersedes any provision to ing work on one or more specific project(s). the contrary: H. Section IV - Commercial General Liability Primary Insurance When Required By Writ- Conditions, Transfer Of Rights Of Recov- ten Contract, Agreement, Permit Or Au- ery Against Others To Us is amended by the thorization addition of the following: Except when wrap-up insurance applies to the Waiver of Subrogation claim or "suit' on behalf of the additional in- We waive any right of recovery against any sured, this insurance is primary to any other additional insured under this endorsement, insurance available to the additional insured because of any payment we make under this described in Paragraphs A. and B. provided endorsement, to whom the insured has that: waived its right of recovery in a written con- 1. The additional insured is a Named In- tract, written agreement, written permit or writ- sured under such other insurance; and ten authorization. Such waiver by us applies only to the extent that the insured has waived 2. You have agreed in writing in a contract, its right of recovery against such additional in- agreement, permit or authorization de- sured prior to loss. Includes copyrighted material of Insurance GA 472 05 20 Services Office, Inc., with its permission. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CinciPlusO BUSINESS AUTO XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. A. Blanket Waiver of Subrogation This provision does not apply unless the valid SECTION IV - BUSINESS AUTO CONDI- written contract has been: TIONS, A. Loss Conditions, 5. Transfer of 1. Executed prior to the accident causing Rights of Recovery Against Others to Us is "bodily injury'or"property damage"; and amended by the addition of the following: 2. Is still in force at the time of the "accident" We waive any right of recovery we may have causing "bodily injury" or "property dam- against any person or organization because of age". payments we make for "bodily injury" or "property damage" arising out of the operation D. Employee Hired Auto of a covered "auto" when you have assumed 1. Changes in Liability Coverage liability for such "bodily injury" or "property damage" under an "insured contract", provid- The following is added to the SECTION II ed the "bodily injury" or"property damage" oc- - LIABILITY COVERAGE, A. Coverage, curs subsequent to the execution or the "in- 1.Who is an Insured: sured contract". An "employee" of yours is an "insured" B. Noncontributory Insurance while operating an "auto" hired or rented SECTION IV - BUSINESS AUTO CONDI- under a contract or agreement in that TIONS, B. General Conditions, 5. Other In- "employee's" name, with your permission, while performing duties related to the surance c. is deleted in its entirety and re- conduct of your business. placed by the following: C. Regardless of the provisions of Par- 2. Changes in General Conditions agraph a. above, this Coverage SECTION IV - BUSINESS AUTO CON- Form's Liability Coverage is primary DITIONS, B. General Conditions, 5. and we will not seek contribution Other Insurance is deleted in its entirety from any other insurance for any lia- and replaced by the following: bility assumed under an "insured contract" that requires liability to be b. For Hired Auto Physical Damage assumed on a primary noncontributo- Coverage the following are deemed ry basis. to be covered "autos"you own: C. Additional Insured by Contract (1) Any covered "auto" you lease, hire, rent or borrow; and SECTION II - LIABILITY COVERAGE, A. Coverage, 1. Who is an Insured is amended (2) Any covered "auto" hired or to include as an insured any person or organi- rented by your"employee' under zation for whom you have agreed in a valid a contract in that individual "em- written contract to provide insurance as af- ployee's" name, with your per- forded by this policy. mission, while performing duties related to the conduct of your This provision is limited to the scope of the business. valid written contract. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 1 of 4 However, any "auto" that is leased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 is not a covered "auto". days after such date; E. Audio, Visual and Data Electronic Equip- b. Does not apply to "bodily injury' or ment "property damage" resulting from an SECTION III - PHYSICAL DAMAGE COV- "accident" that occurred before you ERAGE, C. Limit of Insurance is amended acquired or formed the organization; by adding the following: c. Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- or formed organization that is a joint venture or partnership; and dio, visual or data electronic equipment and any accessories used with this d. Does not apply to an insured under equipment as a result of any one "acci- any other automobile liability policy or dent" is the lesser of would be an insured under such a policy but for the termination of such a. The actual cash value of the dam- policy or the exhaustion of such poli- aged or stolen property as of the time cy's limits of insurance. of the"accident"; 3. Any of your "employees" while using a b. The cost of repairing or replacing the covered "auto" in your business or your damaged or stolen property with oth- personal affairs, provided you do not own, er property of like kind and quality; or hire or borrow that"auto". c. $2,500. G. Liability Coverage Extensions - Supple- Provided the equipment, at the time of the mentary Payments -Higher Limits "loss" is: SECTION II - LIABILITY COVERAGE, A. a. Permanently installed in or upon the Coverage, 2. Coverage Extensions, a. Sup- covered "auto" in a housing, opening plementary Payments is amended by: or other location that is not normally 1. Replacing the $2,000 Limit of Insurance used by the "auto" manufacturer for for bail bonds with $4,000 in (2); and the installation of such equipment; 2. Replacing the $250 Limit of Insurance for b. Removable from a permanently in- reasonable expenses with $500 in (4). stalled housing unit as described in Paragraph 2.a.above; or H. Amended Fellow Employee Exclusion c. An integral part of such equipment. SECTION II - LIABILITY COVERAGE, B. Ex- clusions, 5. Fellow Employee is modified as follows: SECTION II - LIABILITY COVERAGE, A. Exclusion 5. Fellow Employee is deleted. Coverage, 1. Who is an Insured is amended by adding the following: I. Hired Auto -Physical Damage The following are"insureds": If hired "autos" are covered "autos"for Liability Coverage, then Comprehensive and Collision 1. Any subsidiary which is a legally incorpo- Physical Damage Coverages as provided un- rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- stock on the effective date of this cover- tended to "autos" you hire, subject to the fol- age form. lowing: However, the insurance afforded by this 1. The most we will pay for "loss" to any provision does not apply to any subsidiary hired "auto" is $50,000 or the actual cash that is an "insured" under any other au- value or cost to repair or replace, which- tomobile liability policy or would be an "in- ever is the least, minus a deductible. sured" under such policy but for termina- tion of such policy or the exhaustion of 2. The deductible will be equal to the largest such policy's limits of insurance. deductible applicable to any owned "auto" for that coverage, or$1,000, whichever is 2. Any organization that is newly acquired or less. formed by you and over which you main- tain majority ownership. The insurance 3. Hired Auto - Physical Damage coverage provided by this provision: is excess over any other collectible insur- ance. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 2 of 4 4. Subject to the above limit, deductible, and K. Transportation Expense -Higher Limits excess provisions we will provide cover- SECTION III - PHYSICAL DAMAGE COV- age equal the broadest coverage appli- ERAGE, A. Coverage, 4. Coverage Exten- cable to any covered "auto" you own in- sured under this policy. sions is amended by replacing $20 per day with $50 per day, and $600 maximum with Coverage includes loss of use of that hired au- $1,500 maximum in Extension a. Transpor- to, provided it results from an "accident" for tation Expenses. which you are legally liable and as a result of which a monetary loss is sustained by the L. Airbag Coverage leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- pay for any one "accident"is$3,000. ERAGE, B. Exclusions, 3.a. is amended by If a limit for Hired Auto - Physical Damage is adding the following: shown in the Schedule, then that limit replac- However, the mechanical and electrical es, and is not added to, the $50,000 limit indi- breakdown portion of this exclusion does not cated above and the deductibles shown in the apply to the accidental discharge of an airbag. Schedule are applicable. This coverage for airbags is excess over any J. Rental Reimbursement other collectible insurance or warranty. SECTION III - PHYSICAL DAMAGE COV- M. Loan or Lease Gap Coverage ERAGE is amended by adding the following: 1. SECTION III - PHYSICAL DAMAGE 1. We will pay for rental reimbursement ex- COVERAGE, C. Limit of Insurance is penses incurred by you for the rental of deleted in its entirety and replaced by the an "auto" because of a "loss"to a covered following, but only for private passenger "auto". Payment applies in addition to the type "autos"with an original loan or lease, otherwise applicable amount of each cov- and only in the event of a "total loss" to erage you have on a covered "auto". No such a private passenger type "auto": deductible applies to this coverage. a. The most we will pay for"loss" in any 2. We will pay only for those expenses in- one "accident"is the greater of: curred during the policy period beginning (1) The amount due under the terms 24 hours after the "loss" and ending, re- of the lease or loan to which gardless of the policy's expiration, with your covered private passenger the lesser of the following number of type "auto"is subject, but will not days: include: a. The number of days reasonably re- (a) Overdue lease or loan pay- quired to repair the covered "auto". If ments; "loss" is caused by theft, this number of days is added to the number of (b) Financial penalties imposed days it takes to locate the covered under the lease due to high "auto"and return it to you; or mileage, excessive use or b. 30 days. abnormal wear and tear; 3. Our payment is limited to the lesser of the (c) Security deposits not re- funded by the lessor; following amounts: (d) Costs for extended warran- a. Necessary and actual expenses in- ties, Credit Life Insurance, curred; or Health, Accident or Disabil- b. $50 per day. ity Insurance purchased with the loan or lease; and 4. This coverage does not apply while there are spare or reserve "autos" available to (e) Carryover balances from you for your operations. previous loans or leases, or 5. We will pay under this coverage only that (2) Actual cash value of the stolen amount of your rental reimbursement ex- or damaged property. penses which is not already provided for b. An adjustment for depreciation and under SECTION III - PHYSICAL DAM- physical condition will be made in de- AGE COVERAGE, A. Coverage, 4. termining actual cash value at the Coverage Extensions. time of"loss". Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 3 of 4 2. SECTION V - DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards by adding the following, but only for the SECTION IV - BUSINESS AUTO CONDI- purposes of this Loan or Lease Gap Coverage: TIONS, B. General Conditions, 2. Conceal- ment, Misrepresentation or Fraud is "Total loss" means a 'loss" in which the amended by adding the following: cost of repairs plus the salvage value ex- ceeds the actual cash value. However, if you unintentionally fail to disclose any hazards existing on the effective date of N. Glass Repair-Waiver of Deductible this Coverage Form, we will not deny cover- SECTION III - PHYSICAL DAMAGE COV- age under this Coverage Form because of such failure. ERAGE, D. Deductible is amended by adding the following: Q. Mental Anguish Resulting from Bodily Inju- No deductible applies to glass damage if the rY glass is repaired in a manner acceptable to us SECTION V - DEFINITIONS, C. "Bodily inju- rather than replaced. ry" is deleted in its entirety and replaced by O. Duties in the Event of an Accident, Claim, the following: Suit or Loss -Amended 'Bodily injury' means bodily injury,sickness or SECTION IV - BUSINESS AUTO CONDI- disease sustained by a person, including men- tal anguish and death sustained by the same TIONS, A. Loss Conditions, 2. Duties in the person that results from such bodily injury, Event of Accident, Claim, Suit or Loss, a. is sickness or disease. 'Bodily injury" does not amended by adding the following: include mental anguish or death that does not This condition applies only when the "acci- result from bodily injury, sickness or disease. dent'or"loss" is known to: R. Coverage for Certain Operations in Con- 1. You, if you are an individual; nection with Railroads 2. A partner, if you are a partnership; With respect to the use of a covered "auto" in operations for or affecting a railroad: 3. An executive officer or insurance manag- er, if you are a corporation; or 1. SECTION V - DEFINITIONS, H. 'Insured contract', 1.c. is deleted in its entirety and 4. A member or manager, if you are a lim- replaced by the following: ited liability company. c. An easement or license agreement; 2. SECTION V - DEFINITIONS, H. 'Insured contract', 2.a. is deleted. Includes copyrighted material of ISO AA 288 06 20 Properties, Inc., with its permission. Page 4 of 4 www.saif.com ■ saif Work. Life. Oregon. Carrier no: 20001 Endorsement no: WC000313 (Ed. 04-2025) SAIF policy: 876006 Outlier Construction LLC 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 shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Description: ALL OPERATIONS Contractor name: Persons and/or organizations with whom the insured-employer is required by written contract to waive subrogation rights. This endorsement does not alter the rights of an injured worker to pursue recovery from another party or SAIF to receive a statutory share of recoveries by an injured worker, even from the party listed in the schedule. The premium charge for this endorsement is based on one (1) percent of your manual premium. Effective date: October 01, 2025 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned September 17, 2025 at Salem, Oregon 7 WC000313 Chip Terhune (Ed. 04-2025) President and Chief Executive Officer 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 Pol_PC1_E430B