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2100 - Hardy & Harper, Inc. - Street Resurfacing Project - Ellis Lane from Temple City Blvd. to Guess Street AThis page is part of your :,�,+document if � 20190789208 knit, Recorded/Filed in Official Records ' 1111111IIIIIIYNIVIIYIIIINIIIII '�ao< -VO‘ 08/08/19 AT 08:11AM FEES: 0.00 TAXES: 0.00 OTHER: 0.00 PAID: 0.00 II I II NIN W I ISI I I II I I I II III I I INN II I IIII N I VIII I II N I NII LEADSH ET II11111111 IIII III DII UI I III IIIN II I IIII 20 908083310019 0016978805 SEQ 01 IIIIHAR i Iuiiuiniiir iuuiii a �ifivait iiiuii u � Ilioiiiouiiuu1nniiiiiiiiiuuNuuiiiiiu THIS FORM IS NOT.oaEDUPLICATED RECORDING REQUESTED BY CITY OF ROSEMEAD 08/08/2019 AND WHEN RECORDED MAIL TO: 1111111 111 11 11 11 r 1 Name City of Rosemead 8838 E. Valley Blvd. *20190789208* Street Rosemead, CA 91770 Address ATTN: CITY CLERK City& State L SPACE ABOVE THIS LINE FOR RECORDER'S USE Notice of Completion Notice is hereby given that: City of Rosemead 1. The undersigned is owner of the **- 8838 E. Valley Blvd., Rosemead, Ca 91770 interest or estate stated below in the property hereinafter described. 4s In fee 2. The full name of the undersigned is:* 3. The full address of the undersigned is: Sit 4. The nature of the title of the undersigned is: X (If other than fee,strike"In fee"and insert,for example,"purchaser under contract of purchase,"or"lessee".) 5. The full names and full addresses of all persons, if any,who hold title with the undersigned are: Names Addresses N/A N/A 6. The names of the predecessors in interest of the undersigned, if the property was transferred subsequent to the commencement of the work of improvement herein referred to: Names Addresses N/A N/A (If no transfer made,insert"none".) 7. A work of improvement on the property hereinafter described was May 22, 2019 completed on: Hardy and Harper, Inc. 32 Ranch Circle, Lake Forest, CA 92630 8. The name of the contractor, if any,for such work of improvement was: 9. The property on which said work of improvement was completed is in the City of Rosemead County of Los Angeles , State of California, and is described as follows: Street Resurfacing Project- Ellis Lane from Temple City Blvd to Guess Street 10. The street address of said property is: as listed in No. 9 (If no street address has been officially assigned,insert"none".) Signature of owner named ,;� 1/7 111 I %/ Dated: EY' / in paragraph 2 ��L' AIMPr! Ahmad Ansari, P.E. City Engineer By City of Rosemead I certify (or declare) under penalty of perjury that the foregoing is true and correct. 7FAVIaidr- 'lam= Date Ahmad Ansari, P.E. City Engineer City of Rosemead, California Rosemead, CA Place of Execution CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California f ) County of __( rv5 Zla—S )"�, /� On Au@us4 —71 2e:::4 before me, `t f IBf(IAIldZt2 t dt,b-4/- kJ/0(Lc ��JJ Dater w Here Insert Name and Title of-the Officer personally appeared cr A✓l,5 rt Name ff of Signer((' , who proved to me on the basis of satisfactory evidence to be the ersoncs•'whose name(46, re subscribed to the within instrument and acknow dged to me that a he/they executed the same in 0is er/their authorized capacity�6),and that by is er/their signature on the instrument the person(s), or the entity upon behalf of which the person ac ed, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ERICKA► NANDEZ WITNESS my hand and fficial seal. 1111111%,_ Notary Public-California z 11 : -Ii Los Angeles County z Z`4 '% Commission#2158152 > Signature 7•.�.`_ M/Comm.Eut(Is Jun 24_2020 Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document I Title or Type of Document: 00c- eihlS Ll,I.i Document Date: 5-ZZ/5 Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: Signer's Name: Corporate Officer — Title(s): 1 Corporate Officer — Title(s): Partner — ❑ Limited ❑ General Partner — ! I Limited LJ General Individual LI Attorney in Fact Individual Attorney in Fact Trustee LI Guardian or Conservator 1 Trustee ' Guardian or Conservator I Other: 1 1 Other: Signer Is Representing: Signer Is Representing: L4:✓4,✓,LC✓.44✓4�:4�✓4�✓4V24S•11,7,✓4�=-:\✓4".v4V✓4�✓,4.✓4�.4\±%,4\✓ ,4�✓4�4�4\✓4\=✓4�. ✓4\✓4�,"✓.✓4,4,,i.W✓Lv 4� .,Y,4s.,:''4,S✓q✓4�✓4\✓4,✓4. ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5907 --------11 ® DATE(MMIDD/YYYY) • A o CERTIFICATE OF LIABILITY INSURANCE 9/27/2019 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(les)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: Soham Naik • Newport Beach-Alliant Insurance Services, Inc. PHONE e.Eye):949-527-9818 FAX No):949-756-2713 1301 Dove St Ste 200 E-MAIL Newport Beach CA 92660 ADDREss: Soham.Naik@alliant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Executive Risk Indemnity Inc 35181 INSURED INSURER B:Allied World Assurance Co 19489 Hardy&Harper, Inc. Maas Equipment, LLC INSURER c: Evanston Insurance Company 35378 • 32 Rancho Circle INSURERD:AGCS Marine Insurance Company 22837 Lake Forest CA 92630 INSURER E: Federal Insurance Company 20281 i INSURER F: COVERAGES CERTIFICATE NUMBER:1447140678 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 WLIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY V Y 54309997 7/15/2019 7/15/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $100,000 MED EXP(Any one person) $5,000 • - • PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECT LOC- PRODUCTS-COMP/OP AGG $2,000,000 — OTHER: $ E AUTOMOBILE LIABILITY Y Y 54310018 10/1/2019 10/1/2020 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 PROPERTY DAMAGE ' $ AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X OCCUR Y Y 0311-6679 12/31/2018 12/31/2019 EACH OCCURRENCE $10,000,000 X EXCESS LIAR •CLAIMS-MADE ' AGGREGATE $10,000,000 DED RETENTION$ $ E WORKERS COMPENSATION Y 54310019 10/1/2019 10/1/2020 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under • DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution/Professional Liability MKLV5ENV100621 12/31/2017 12/31/2019 $2,000,000 agg. $1,000,000 Occ. D Rented/Leased Equip SML93020423 `12/31/2018 12/31/2019 $300,000 D Owned Equipment SML93020423 12/31/2018 12/31/2019 $5,914,908 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Street Resurfacing Project-Ellis Lane from Temple City Blvd to Guest Street • Additional Insured: . City of Rosemead . 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 Rosemead 8838 E Valley Blvd AUTHORIZED REPRESENTATIVE Rosemead CA 91770 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 54309997 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT 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 Organization(s) Location(s)Of Covered Operations As Required By Written Contract,Fully Executed Prior To The Named Insured's Work As Required By Written Contract,Fully Executed Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown in.the Declarations. A. Section II — 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", "property 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. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or inthe performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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 20 100413_ © Insurance Services Office, Inc., 2012 Page 1 of 2 Policy#54309997 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall notincrease the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: . 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 ' CG 20 10 0413 POLICY NUMBER: 54309997 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR 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 And Description Of Completed Operations As Required By Written Contract,Fully Executed As Required By Written Contract,Fully Executed Prior To The Named Insured's Work Prior To The Named Insured's Work Information required to complete this Schedule, if not shown above, will be shown,in the Declarations. A. Section II — 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 is added to organization(s) shown in the Schedule, but only Section III-Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement . amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to. the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 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 required by the contract or agreement to provide for such additional insured. CG 20 37 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: 54309997 COMMERCIAL GENERAL LIABILITY 10-02-2461 (Ed. 7-15) • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE FOR SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE • Additional Insured: Location Of Covered Operations: WHERE REQUIRED BY WRITTEN CONTRACT. ALL LOCATIONS (If no entry appears-above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect only to the Additional Insured and at (1)The Additional Insured is a named the Location Of Covered Operations shown in the insuredunder such other insurance;and Schedule,the following is added to SECTION IV— (2)You have agreed in writing in a contract COMMERCIAL GENERAL LIABILITY CONDITIONS, oragreement that this insurance would Paragraph 4.Other Insuranceand supersedes any beprimary and would not seek provision to thecontrary: contributionfrom any other insurance Primary And Noncontributory Insurance available to theAdditional Insured. This insurance is primary to and will not seekcontribution from any other insurance available to the Additional Insured with respect to the Location Of Covered Operations shown in the Schedule under thispolicyprovided that: 10-02-2461 (Ed.7-15) Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Policy Number: 54309997 b. Those statements are based upon a. Copyrighted"advertisement"; or representations you made to us; and b. Registered collective mark, registered service c. We have issued this policy in reliance upon mark or other registered trademarked name, your representations. slogan, symbol or title. 7. Separation Of Insureds 3. "Asbestos" means asbestos in any form, including Except with respect to the Limits of Insurance, and its presence or use in any alloy, by-product, any rights or duties specifically assigned in this compound or other material or waste. Waste Coverage Part to the first Named Insured, this includes materials to be recycled, reconditioned or insurance applies: reclaimed. a. As if each Named Insured were the only 4. "Auto"means: Named Insured;and a. A land motor vehicle, trailer or semitrailer b. Separately to each insured against whom designed for travel on public roads, including claim is made or"suit"is brought. any attached machinery or equipment; or 8. Transfer Or Waiver Of Rights Of Recovery b. Any other land vehicle that is subject to a Against Others To Us compulsory or financial responsibility law or We will waive the right of recovery we would other motor vehicle insurance law where it is otherwise have had against another person or licensed or principally garaged. organization, for loss to which this insurance However, "auto" does not include "mobile applies, provided the insured has waived their equipment". rights of recovery against such person or 5."Bodily injury"means physical: organization in a contract or agreement that is a. Injury; executed before such loss. To the extent that the insured's rights to recover b. Sickness; or all or part of any payment made under this c. Disease; Coverage Part have not been waived, those rights sustained by a person, including resulting death, are transferred to us. The insured must do nothing humiliation, mental anguish, mental injury or shock after loss to impair them. At our request, the at any time. All such loss shall be deemed to insured'will bring "suit" or transfer those rights to occur at the time of the physical injury, sickness or us and help us enforce them. disease that caused it. This condition does not apply to Coverage C. 6. "Coverage territory"means: 9. When We Do Not Renew a. The United States of America (including its. If we decide not to renew this Coverage Part, we territories and possessions), Puerto Rico and will mail or deliver to the first Named Insured .Canada; shown in the Declarations written notice of the b. International waters or airspace, but only if the nonrenewal not fess than 30 days before the injury or damage occurs in the course of travel expiration date. or transportation between any places included If notice is mailed, proof of mailing will be sufficient in Paragraph a.above; or proof of notice. c. AU other parts of the world if the injury or SECTION V—DEFINITIONS damage arises out of: 1. "Advertisement" means an electronic, oral, written (1) Goods or products made or sold by you in or other notice, about goods, products or services, the territory described in Paragraph a. designed for the specific purpose of attracting the above; general public or a specific market segment to use (2) The activities of a person whose home is in such goods, products or services. the territory described in Paragraph a. "Advertisement" does not include any e-mail above, but is away for a short time on your address, Internet domain name or other electronic business; or address or metalanguage. (3) "Advertising injury" or "personal injury" 2. "Advertising injury" means injury,- other than offenses that take place through the "bodily injury", "property damage" or "personal Internet or similar electronic means of injury", sustained by a person or organization and communication caused by an offense of infringing, in that particular part of your "advertisement" about your goods, products or services, upon their: Form 10-02-1800(Rev. 09- Includes copyrighted material of ISO Properties, Inc., witl 17) its permission POLICY NUMBER: 54309997 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s):where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by "occur- damages or under Coverage C for medical rences" under Section I—Coverage A, and for all expenses shall reduce the Designated Con- medical expenses caused by accidents under struction Project General Aggregate Limit for Section I — Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- 1. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the.Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen- completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits"brought; or c. Persons or organizations making claims or bringing"suits". CG 25 03 05 09 ©Insurance Services Office, Inc., 2008 . Page 1 of 2 0 Policy# 54309997 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "occur- "products-completed operations hazard" is pro- rences" under Section I—Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be attrib- the "products-completed operations hazard" will uted only to ongoing operations at a single des- reduce the Products-completed Operations Ag- ignated construction project shown in the Sched- gregate Limit, and not reduce the General Ag- ule above: gregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract- Products-completed Operations Aggregate ing parties deviate from plans, blueprints, de- Limit, whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce. any Desig- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of. Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 ©Insurance Services Office, Inc., 2008 CG 25 03 05 09 0 POLICY NUMBER: 54310018 COMMERCIAL AUTO 16-02-0316 Ed. 10 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY LIABILITY INSURANCE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: Named Insured: Hardy&Harper, Inc. Endorsement Effective Date: 10/01/2019 SCHEDULE • Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Item 5. "Other Insurance"of Item B.—"General Conditions" under Section IV—`Business Auto Conditions": e. Regardless of the provisions of Paragraph 5.a. through d. above, for any liability arising out of the ownership, maintenance, use, rental, lease, loan, hire orborrowing by an "insured" of a covered "auto" for which an "insured" is contractually obligated to provide primary insurance coverage to a client, this Coverage Form will be primary and non-contributory . with respect to the Persons or Organizations in the schedule, regardless of the availability or existence of other collectible insurance under any other Coverage Form or policy that applies on a primary basis. • . 16-02-0316 Ed. 10 14 Page 1 of 1 POLICY NUMBER: 54310018 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Hardy&Harper, Inc. Endorsement Effective Date: 10/01/2019 SCHEDULE . Name Of Person(s)Or Organization(s): As Required by Written Contract 0 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. ' • • CA 20 48 1013 . ©Insurance Services Office, Inc.; 2011 Page 1 of 1 POLICY NUMBER: 54310018 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM borrow in your business or your personal This endorsement modifies the Business Auto Coverage Form. affairs. 1. EXTENDED CANCELLATION CONDITION C. Lessors as Insureds Paragraph A.2.b.—CANCELLATION -of the Paragraph A.1. —WHO IS AN INSURED—of COMMON POLICY CONDITIONS form IL 00 17 is SECTION II—LIABILITY COVERAGE is deleted and replaced with the following: amended to add the following: b. 60 days before the effective date of cancellation if e. The lessor of a covered "auto"while the we cancel for any other reason. "auto" is leased to you under a written 2. BROAD FORM INSURED agreement if: A. Subsidiaries and Newly Acquired or Formed (1) The agreement requires you to Organizations As Insureds provide direct primary insurance for The Named Insured shown in the Declarations is the lessor; and amended to include: (2) The"auto"is leased without a driver. 1. Any legally incorporated subsidiary in which Such leased "auto"will be considered a you own more than 50% of the voting stock on covered "auto"you own and not a covered the effective date of the Coverage Form. "auto"you hire. However, the Named Insured does not include However,the lessor is an "insured"only any subsidiary that is an"insured" under any for"bodily injury"or"property damage" other automobile policy or would be an resulting from the acts or omissions by: "insured" under such a policy but for its 1. You; termination or the exhaustion of its Limit of 2. Any of your"employees"or.agents; Insurance. or 2. Any organization that is acquired or formed by 3. Any person, except the lessor or you and over which you maintain majority any"employee"or agent of the ownership. However,the Named Insured lessor, operating an"auto"with the does not include any newly formed or acquired permission of any of 1. and/or 2. organization: above. (a)That is an "insured" under any other D. Persons And Organizations As Insureds automobile policy; Under A Written Insured Contract (b)That has exhausted its Limit of Insurance Paragraph A.1 —WHO IS AN INSURED—of under any other policy; or SECTION II—LIABILITY COVERAGE is (c) 180 days or more after its acquisition or amended to add the following: formation by you, unless you have given f. Any person or organization with respect to us written notice of the acquisition or the operation, maintenance or use of a formation. covered "auto", provided that you and Coverage does not apply to"bodily injury"or such person or organization have agreed "property damage"that results from an "accident" under an express provision in a written that occurred before you formed or acquired the "insured contract",written agreement or a organization. written permit issued to you by a B. Employees as Insureds governmental or public authority to add Paragraph A.1.—WHO IS AN INSURED—of such person or organization to this policy SECTION II—LIABILITY COVERAGE is amended to as an"insured". add the following: However, such person or organization is d. Any"employee"of yours while using a an"insured" only: covered"auto"you don't own, hire or Form: 16-02-0292 (Rev. 11-16) Page 1 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" POLICY NUMBER: 54310018 (1) with respect to the operation, d. Rental Expense maintenance or use of a covered We will pay the following expenses that you or "auto"; and any of your"employees"are legally obligated (2) for"bodily injury"or"property damage" to pay because of a written contract or caused by an."accident"which takes agreement entered into for use of a rental. place after: vehicle in the conduct of your business: (a) You executed the"insured MAXIMUM WE WILL PAY FOR ANY ONE contract"or written agreement; or CONTRACT OR AGREEMENT: (b) The permit has been issued to 1. $2,500 for loss of income incurred by the you. rental agency during the period of time that 3. FELLOW EMPLOYEE COVERAGE vehicle is out of use because of actual EXCLUSION B.5. - FELLOW EMPLOYEE—of damage to, or"loss"of,that vehicle, including SECTION II—LIABILITY COVERAGE does not apply. 4. PHYSICAL DAMAGE—ADDITIONAL TEMPORARY income lost due to absence of that vehicle for TRANSPORTATION EXPENSE COVERAGE use as a replacement; Paragraph A.4.a.—TRANSPORTATION EXPENSES 2. $2,500 for decrease in trade-in value of the —of SECTION III—PHYSICAL DAMAGE rental vehicle because of actual damage to COVERAGE is amended to provide a limit of$50 per that vehicle arising out of a covered"loss"; and day for temporary transportation expense, subject to;a 3. $2,500 for administrative expenses incurred maximum limit of$1,000. by the rental agency, as stated in the contract 5. AUTO LOAN/LEASE GAP COVERAGE or agreement. Paragraph A. 4.—COVERAGE EXTENSIONS-of 4. $7,500 maximum total amount for paragraphs SECTION III—PHYSICAL DAMAGE COVERAGE is 1., 2. and 3. combined. amended to add the following: 7. EXTRA EXPENSE—BROADENED COVERAGE c. Unpaid Loan or Lease Amounts Paragraph A.4.—COVERAGE EXTENSIONS—of In the event of a total"loss"to a covered"auto",we will SECTION III—PHYSICAL DAMAGE COVERAGE pay any unpaid amount due on the loan or lease for a is amended to add the following: covered "auto"minus: e. Recovery Expense 1. The amount paid under the Physical Damage We will pay for the expense of returning a Coverage Section of the policy; and stolen covered "auto"to you. 2. Any: 8. AIRBAG COVERAGE a. Overdue loan/lease payments at the time of Paragraph B.3.a. - EXCLUSIONS—of SECTION the"loss"; III—PHYSICAL DAMAGE COVERAGE does not b. Financial penalties imposed under a lease for apply to the accidental or unintended discharge of excessive use, abnormal wear and tear or an airbag. Coverage is excess over any other high mileage; collectible insurance or warranty specifically c. Security deposits not returned by the lessor: designed to provide this coverage. d. Costs for extended warranties, Credit Life 9. AUDIO,VISUAL AND DATA ELECTRONIC Insurance, Health, Accident or Disability EQUIPMENT-BROADENED COVERAGE Insurance purchased with the loan or lease; Paragraph C.1.b.—LIMIT OF INSURANCE-of and SECTION III - PHYSICAL DAMAGE is deleted e. Carry-over balances from previous loans or and replaced with the following: leases. b. $2,000 is the most we will pay for"loss" in any We will pay for any unpaid amount due on the loan or one"accident"to all electronic equipment that lease if caused by: reproduces, receives or transmits audio, visual 1. Other than Collision Coverage only if the or data signals which, at the time of"loss", is: Declarations indicate that Comprehensive (1) Permanently installed in or upon the Coverage is provided for any covered"auto"; covered"auto" in a housing, opening or 2. Specified Causes of Loss Coverage only if the other location that is not normally used by Declarations indicate that Specified Causes of the"auto" manufacturer for the installation Loss Coverage is provided for any covered"auto"; of such equipment; or (2) Removable from a permanently installed 3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any housing unit as described in Paragraph covered "auto. 2.a. above or is an integral part of that 6. RENTAL AGENCY EXPENSE equipment; or Paragraph A. 4.—COVERAGE EXTENSIONS—of (3) An integral part of such equipment. SECTION Ill—PHYSICAL DAMAGE COVERAGE is amended to add the following: 10. GLASS REPAIR—WAIVER OF DEDUCTIBLE Form: 16-02-0292 (Rev. 11-16) Page 2 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" POLICY NUMBER: 54310018 Under Paragraph D. - DEDUCTIBLE—of their rights of recovery against such person or , SECTION III—PHYSICAL DAMAGE COVERAGE organization under a contract or agreement the following is added: that is entered into before such"loss". No deductible applies to glass damage if the glass To the extent that the"insured's" rights to is repaired rather than replaced. recover damages for all or part of any 11.TWO OR MORE DEDUCTIBLES payment made under this insurance has not Paragraph D.- DEDUCTIBLE—of SECTION III— been waived,those rights are transferred to PHYSICAL DAMAGE COVERAGE is amended to us. That person or organization must do add the following: everything necessary to secure our rights and If this.Coverage Form and any other Coverage must do nothing after"accident"or"loss"to Form or policy issued to you by us that is not an impair them.At our request, the insured will automobile policy or Coverage Form applies to the bring suit or transfer those rights to us and same"accident", the following applies: help us enforce them. 1. If the deductible under this Business Auto Coverage Form is the smaller(or smallest) 14. UNINTENTIONAL FAILURE TO DISCLOSE deductible, it will be waived; or HAZARDS 2. If the deductible under this Business Auto Paragraph B.2.—CONCEALMENT, Coverage Form is not the smaller(or smallest) MISREPRESENTATION or FRAUD of SECTION deductible, it will be reduced by the amount of IV—BUSINESS AUTO CONDITIONS -is deleted the smaller(or smallest)deductible. and replaced with the following: If you unintentionally fail to disclose any hazards 12.AMENDED DUTIES IN THE EVENT OF existing at the inception date of your policy, we will ACCIDENT, CLAIM, SUIT OR LOSS not void coverage under this Coverage Form Paragraph A.2.a. - DUTIES IN THE EVENT OF because of such failure. AN ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV- BUSINESS AUTO CONDITIONS is 15. AUTOS RENTED BY EMPLOYEES deleted and replaced with the following: Paragraph B.5. -OTHER INSURANCE of a. In the event of"accident", claim, "suit"or SECTION IV—BUSINESS AUTO CONDITIONS- "loss", you must promptly notify us when the is amended to add the following: "accident" is known to: e. Any"auto"hired or rented by your"employee" (1) You or your authorized representative, if on your behalf and at your direction will be you are an individual; considered an "auto"you hire. If an (2) A partner, or any authorized "employee's" personal insurance also applies representative, if you are a partnership; on an excess basis to a covered "auto" hired (3) A member, if you are a limited liability or rented by your"employee"on your behalf company; or and at your direction, this insurance will be (4) An executive officer, insurance manager, primary to the"employee's" personal or authorized representative, if you are an insurance. organization other than a partnership or 16. HIRED AUTO-COVERAGE TERRITORY limited liability company. Paragraph B.7.b.(5). -POLICY PERIOD, Knowledge of an"accident", claim, "suit"or COVERAGE TERRITORY of SECTION IV— "loss" by other persons does not imply that the BUSINESS AUTO CONDITIONS is deleted and persons listed above have such knowledge. replaced with the following: Notice to us should include: (5)A covered "auto"of the private passenger (1) How,when and where the"accident" or type is leased, hired, rented or borrowed "loss"occurred; without a driver for a period of 45 days or (2) The"insured's" name and address; and less; and (3) To the extent possible,the names and 17. RESULTANT MENTAL ANGUISH COVERAGE addresses of any injured persons or Paragraph C. of-SECTION V—DEFINITIONS is witnesses. 13.kWAIVER OF SUBROGATIONdeleted and replaced by the following: ; Paragraph A.5. -TRANSFER OF RIGHTS OF "Bodily injury" means bodily injury, sickness or RECOVERY AGAINST OTHERS TO US of disease sustained by any person, including SECTION IV—BUSINESS AUTO CONDITIONS is mental anguish or death as a result of the"bodily deleted and replaced with the following: injury"sustained by that person. 5. We will waive the right of recovery we would otherwise have against another person or organization for"loss"to which this insurance applies, provided the"insured"has waived Form: 16-02-0292 (Rev. 11-16) Page 3 of 3 "Includes copyrighted material of Insurance Services Office, Inc. with its permission" WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 99 03 04 (Ed. 7- 08) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA • This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need to be completed only when this endorsement is issued subsequent to preparation of the policy.) This.endorsement, effective on 10/01/2019 at 12:01 A. M. standard time, forms a part of (DATE) Policy No. 54310019 of the FEDERAL INSURANCE COMPANY (NAME OF INSURANCE COMPANY) issued to Hardy&Harper, Inc. Endorsement No. 0////.._horizes ntative; 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. The additional premium for the blanket waiver offered by this endorsement shall be 0.00 % of total California premium.. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN WHERE REQUIRED BY WRITTEN CONTRACT. CONTRACT. • • • WC 99 03 04(Ed.7-08)