Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Exhibit 5
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
5/5/2025
AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd., Suite 230
Lafayette CA 94549
Maurice Thornton
510-272-1476
[email protected]
License#: 6003745
Travelers Property Casualty Company of America
25674
RUGGERI-02
The Travelers Indemnity Company of Connecticut
25682
Ruggeri-Jensen-Azar
4690 Chabot Drive, Suite 200
Pleasanton CA 94588-2747
Underwriters at Lloyd's, London
32727
Arch Insurance Company
11150
102878437
A
X
1,000,000
X
1,000,000
X
Contractual Liab
10,000
Included
1,000,000
2,000,000
X
Y
Y
6802J195036
6/19/2024
6/19/2025
2,000,000
B
1,000,000
X
X
X
Y
Y
BA8R565397
6/19/2024
6/19/2025
A
X
X
1,000,000
Y
CUP9B546956
6/19/2024
Y
6/19/2025
1,000,000
X
0 A
X
N
Y
UB3J886238
6/19/2024
6/19/2025
1,000,000
1,000,000
1,000,000
D
C
Professional Liability
Cyber Liability
PAAEP0168500
ESM0339980960
6/19/2024
6/19/2024
6/19/2025
6/19/2025
Per Claim
Aggregate Limit
$1,000,000 Per Claim
$2,000,000
$2,000,000
& Aggregate Limit
The following policies are included in the underlying schedule of insurance for Umbrella/Excess Liability: General Liability/Auto Liability/Employer's Liability.
RE: Alameda Civil Engineering On Call --
The City of Alameda, City, its City Council, boards, commissions, officials, employees, agents and volunteers are named as Additional Insured for General and Automobile Liability as required by written contract. General and Auto Liability Insurance is Primary and Non-Contributory and a Cross Liability Clause applies per policy form. A Waiver of Subrogation applies to General Liability, Automobile Liability and Workers' Compensation. 30 Days Notice of Cancellation. 30 Day Notice of Cancellation
City of Alameda
Public Works Department
950 West Mall Square #110
Alameda CA 94501
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B 5/14/2025
Ð Ñ Ô × Ý ÇÒ Ë Ó Þ Û Î
COMMERCIAL GENERAL LIABILITY
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Ì ¸ · » ² ¼ ± ® » ³ » ² ¬ ³ ± ¼ · º · » · ² « ® ¿ ² ½ » ° ® ± ª · ¼ » ¼ « ² ¼ » ® ¬ ¸ » º ± ´ ´ ± © · ² ¹ æ Ý Ñ Ó Ó Û Î Ý × ß Ô Ù Û Ò Û Î ß Ô Ô × ß Þ × Ô × Ì ÇÝ Ñ Ê Û Î ß Ù ÛÐ ß Î Ì
ø × ² º ± ® ³ ¿ ¬ · ± ² ® » ¯ « · ® » ¼ ¬ ± ½ ± ³ ° ´ » ¬ » ¬ ¸ · Í ½ ¸ » ¼ « ´ » ô · º ² ± ¬ ¸ ± © ² ¿ ¾ ± ª » ô © · ´ ´ ¾ » ¸ ± © ² · ² ¬ ¸ » Ü » ½ ´ ¿ ® ¿ ¬ · ± ² ò ÷ Í » ½ ¬ · ± ² × ×
ɸ ± × ß ² × ² « ® » ¼ · ¿ ³ » ² ¼ » ¼ ¬ ± · ² ó Ì ¸ · · ² « ® ¿ ² ½ » ¼ ± » ² ± ¬ ¿ ° ° ´ § ¬ ± þ ¾ ± ¼ · ´ § · ² ¶ « ® § þ ± ® ½ ´ « ¼ »¿ ¿ ²¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² « ® » ¼¬ ¸ »° » ® ± ² ø ÷ ± ® þ ° ® ± ° » ® ¬ § ¼ ¿ ³ ¿ ¹ » þ ± ½ ½ « ® ® · ² ¹ ô ± ® ° » ® ± ² ¿ ´ · ² ¶ « ® § Œ ± ® ¹ ¿ ² · ¦ ¿ ¬ · ± ² ø ÷ ¸ ± © ²· ²¬ ¸ »Í ½ ¸ » ¼ « ´ » ô ¾ « ¬ ± ² ´ § ± ® ¿ ¼ ª » ® ¬ · · ² ¹· ² ¶ « ® § Œ ¿ ® · · ² ¹± « ¬ ± º ¿ ² ± º º » ² » © · ¬ ¸ ® » ° » ½ ¬ ¬ ± ´ · ¿ ¾ · ´ · ¬ § º ± ® þ ¾ ± ¼ · ´ § · ² ¶ « ® § þ ô þ ° ® ± ° » ® ¬ § ½ ± ³ ³ · ¬ ¬ » ¼ ô ¿ º ¬ » ® æ ¼ ¿ ³ ¿ ¹ » þ ô þ ° » ® ± ² ¿ ´ · ² ¶ « ® § Œ ± ® ¿ ¼ ª » ® ¬ · · ² ¹· ² ¶ « ® § þ ß ´ ´ © ± ® µ ô · ² ½ ´ « ¼ · ² ¹³ ¿ ¬ » ® · ¿ ´ ô ° ¿ ® ¬ ± ® » ¯ « · ° ó½ ¿ « » ¼ ô · ² © ¸ ± ´ » ± ® · ² ° ¿ ® ¬ ô ¾ § æ ³ » ² ¬ º « ® ² · ¸ » ¼· ² ½ ± ² ² » ½ ¬ · ± ²© · ¬ ¸ « ½ ¸© ± ® µ ô Ç ± « ® ¿ ½ ¬ ± ® ± ³ · · ± ² å ± ® ± ² ¬ ¸ » ° ® ± ¶ » ½ ¬ ø ± ¬ ¸ » ®¬ ¸ ¿ ² » ® ª · ½ » ô ³ ¿ · ² ¬ » ó ² ¿ ² ½ »± ® ® » ° ¿ · ® ÷ ¬ ±¾ »° » ® º ± ® ³ » ¼¾ §± ® ± ² Ì ¸ » ¿ ½ ¬ ± ® ± ³ · · ± ² ± º ¬ ¸ ± » ¿ ½ ¬ · ² ¹ ± ² § ± « ® ¾ » ¸ ¿ ´ º ± º ¬ ¸ » ¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² « ® » ¼ ø ÷ ¿ ¬ ¬ ¸ » ´ ± ½ ¿ ó¾ » ¸ ¿ ´ º å ¬ · ± ² ± º ¬ ¸ » ½ ± ª » ® » ¼ ± ° » ® ¿ ¬ · ± ² ¸ ¿ ¾ » » ² ½ ± ³ ó · ² ¬ ¸ » ° » ® º ± ® ³ ¿ ² ½ » ± º § ± « ® ± ² ¹ ± · ² ¹ ± ° » ® ¿ ¬ · ± ² º ± ®° ´ » ¬ » ¼ å ± ® ¬ ¸ »¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² « ® » ¼ ø ÷ ¿ ¬ ¬ ¸ »´ ± ½ ¿ ¬ · ± ² ø ÷ ¼ » · ¹ ó Ì ¸ ¿ ¬ ° ± ® ¬ · ± ²± º þ § ± « ® © ± ® µ þ ± « ¬ ± º © ¸ · ½ ¸¬ ¸ »² ¿ ¬ » ¼ ¿ ¾ ± ª » ò · ² ¶ « ® § ± ® ¼ ¿ ³ ¿ ¹ » ¿ ® · » ¸ ¿ ¾ » » ² ° « ¬ ¬ ± · ¬ · ² ó É· ¬ ¸® » ° » ½ ¬ ¬ ±¬ ¸ »· ² « ® ¿ ² ½ »¿ º º ± ® ¼ » ¼¬ ±¬ ¸ » » ¬ » ² ¼ » ¼ « » ¾ § ¿ ² § ° » ® ± ² ± ®± ® ¹ ¿ ² · ¦ ¿ ¬ · ± ²¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² « ® » ¼ ô ¬ ¸ » º ± ´ ´ ± © · ² ¹ ¿ ¼ ¼ · ¬ · ± ² ¿ ´ » ¨ ½ ´ « ó± ¬ ¸ » ® ¬ ¸ ¿ ²¿ ² ± ¬ ¸ » ® ½ ± ² ¬ ® ¿ ½ ¬ ± ® ± ® « ¾ ½ ± ² ¬ ® ¿ ½ ó · ± ² ¿ ° ° ´ § æ ¬ ± ® » ² ¹ ¿ ¹ » ¼ · ² ° » ® º ± ® ³ · ² ¹ ± ° » ® ¿ ¬ · ± ² º ± ® ¿ ° ® · ² ½ · ° ¿ ´ ¿ ¿ ° ¿ ® ¬ ± º ¬ ¸ » ¿ ³ » ° ® ± ¶ » ½ ¬ ò Ý ± ° § ® · ¹ ¸ ¬ î ð ð ë Ì ¸ » Í ¬ ò Ð ¿ « ´ Ì ® ¿ ª » ´ » ® Ý ± ³ ° ¿ ² · » ô × ² ½ ò ß ´ ´ ® · ¹ ¸ ¬ ® » » ® ª » ¼ ò Ð ¿ ¹ » ï ± º ï × ² ½ ´ « ¼ » ½ ± ° § ® · ¹ ¸ ¬ » ¼ ³ ¿ ¬ » ® · ¿ ´ ± º × ² « ® ¿ ² ½ » Í » ® ª · ½ » Ñ º º · ½ » ô × ² ½ ò © · ¬ ¸ · ¬ ° » ® ³ · · ± ² ò Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part, provided that such written contract was signed by you before, and is in effect when, the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed.
Any project to which a written contract with the Additional Insured Person(s) or Organization(s) in the Schedule applies.
CG T8 01 XX XX
DATE OF ISSUE:
6802J195036
06/19/2024
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Ð Ñ Ô × Ý ÇÒ Ë Ó Þ Û Î æ
COMMERCIAL GENERAL LIABILITY
Ì Ø × ÍÛ Ò Ü Ñ Î Í Û Ó Û Ò Ì Ý Ø ß Ò Ù Û ÍÌ Ø ÛÐ Ñ Ô × Ý Ç ò Ð Ô Û ß Í ÛÎ Û ß Ü× Ì Ý ß Î Û Ú Ë Ô Ô Ç ò
Ì ¸ · » ² ¼ ± ® » ³ » ² ¬ ³ ± ¼ · º · » · ² « ® ¿ ² ½ » ° ® ± ª · ¼ » ¼ « ² ¼ » ® ¬ ¸ » º ± ´ ´ ± © · ² ¹ æ Ý Ñ Ó Ó Û Î Ý × ß Ô Ù Û Ò Û Î ß Ô Ô × ß Þ × Ô × Ì ÇÝ Ñ Ê Û Î ß Ù ÛÐ ß Î Ì
× ² º ± ® ³ ¿ ¬ · ± ² ® » ¯ « · ® » ¼ ¬ ± ½ ± ³ ° ´ » ¬ » ¬ ¸ · Í ½ ¸ » ¼ « ´ » ô · º ² ± ¬ ¸ ± © ² ¿ ¾ ± ª » ô © · ´ ´ ¾ » ¸ ± © ² · ² ¬ ¸ » Ü » ½ ´ ¿ ® ¿ ¬ · ± ² ò
· ¿ ³ » ² ¼ » ¼¬ ±· ² ó ´ ± ½ ¿ ¬ · ± ²¼ » · ¹ ² ¿ ¬ » ¼¿ ² ¼¼ » ½ ® · ¾ » ¼· ²¬ ¸ » ½ ¸ » ¼ « ´ »± º ½ ´ « ¼ »¿ ¿ ²¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² « ® » ¼¬ ¸ »° » ® ± ² ø ÷ ± ® ± ® ó ¬ ¸ · » ² ¼ ± ® » ³ » ² ¬° » ® º ± ® ³ » ¼ º ± ®¬ ¸ ¿ ¬¿ ¼ ¼ · ¬ · ± ² ¿ ´ · ² ó ¹ ¿ ² · ¦ ¿ ¬ · ± ² ø ÷ ¸ ± © ² · ²¬ ¸ »Í ½ ¸ » ¼ « ´ » ô ¾ « ¬ ± ² ´ §© · ¬ ¸ « ® » ¼ ¿ ² ¼ · ² ½ ´ « ¼ » ¼ · ² ¬ ¸ » þ ° ® ± ¼ « ½ ¬ ó ½ ± ³ ° ´ » ¬ » ¼ ± ° » ® ¿ ó ® » ° » ½ ¬ ¬ ± ´ · ¿ ¾ · ´ · ¬ § º ± ® þ ¾ ± ¼ · ´ § · ² ¶ « ® § þ ± ® þ ° ® ± ° » ® ¬ § ¼ ¿ ³ ó ¬ · ± ² ¸ ¿ ¦ ¿ ® ¼ þ ò ¿ ¹ » þ ½ ¿ « » ¼ ô · ² © ¸ ± ´ » ± ® · ² ° ¿ ® ¬ ô ¾ § þ § ± « ® © ± ® µ þ ¿ ¬ ¬ ¸ »
× Í ÑÐ ® ± ° » ® ¬ · » ô × ² ½ ò ô î ð ð ì Ð ¿ ¹ » ï ± º ï Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the "products- completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs.
Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies.
CG T8 02 XX XX
DATE OF ISSUE:
6802J195036
06/19/2024
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B
COMMERCIAL GENERAL LIABILITY
c. Method Of Sharing
If all of the other insurance permits contribution
by equal shares, we will follow this method also.
Under this approach each insurer contributes
equal amounts until it has paid its applicable
limit of insurance or none of the loss remains,
whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will contribute
by limits. Under this methoo, each insurer's
share is based on the ratio of its applicable limit
of insurance to the total applicable limits of
insurance of all insurers.
d. Primary And Non-Contributory Insurance If
Required By Written Contract
If you specifically agree in a written contract or
agreement that the insurance afforded to an
insured under this Coverage Part must apply on
a primary basis, or a primary and non
contributory basis. this insurance is primary to
other insurance that is available to such insured
which covers such insured as a named insured,
and we will not share with that other insurance,
provided that:
(1) The "bodily injury'' or "property damage" for
which coverage is sought occurs; and
(2) The "personal and advertising injury" for
which coverage is sought is caused by an
offense that is committed;
subsequent to the signing of that contract or
agreement by you.
5. Premium Audit
a. We will compute all premiums for this Coverage
Part in accordance with our rules and rates.
b. Premium shown in this Coverage Part as
advance premium is a deposit premium only. At
the close of each audit perioo we will compute
the earned premium for that period and send
notice to the first Named Insured. The due date
for audit and retrospective premiums is the date
shown as the due date on the bill. If the sum of
the advance and audit premiums paid for the
policy period is greater than the earned
premium, we will return the excess to the first
Named Insured.
c. The first Named Insured must keep records of
the information we need for premium
computation, and send us copies at such times
as we may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are
accurate and complete;
b. Those statements are based upon
representations you made to us; and
c. We have issued this policy in reliance upon
your representations.
The unintentional omission of, or unintentional error
in, any information provided by you which we relied
upon in issuing this policy will not prejudice your
rights under this insurance. However, this provision
does not affect our right to collect additional
premium or to exercise our rights of cancellation or
nonrenewal in accordance with applicable insurance
laws or regulations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named Insured, this
insurance applies:
a. As if each Named Insured were the only
Named Insured; and
b. Separately to each insured against whom claim
is made or "suit" is brought.
8. Transfer Of Rights Of Recovery Against Others
To Us
If the insured has rights to recover all or part of any payment we have made under this Coverage Part,
those rights are transferred to us. The insured must
do nothing after loss to impair them. At our request,
the insured will bring "suit" or transfer those rights
to us and help us enforce them.
9. When We Do Not Renew
If we decide not to renew this Coverage Part, we will
mail or deliver to the first Named Insured shown in
the Declarations written notice of the nonrenewal
not less than 30 days before the expiration date.
If notice is mailed, proof of mailing will be sufficient proof of notice.
SECTION V - DEFINITIONS
1. "Advertisement" means a notice that is broadcast or
published to the general public or specific market
segments about your goods, products or services
for the purpose of attracting customers or
supporters. For the purposes of this definition:
a. Notices that are published include material
placed on the Internet or on similar electronic
means of communication; and
b. Regarding websites, only that part of a website
that is about your goods, prooucts or services
for the purposes of attracting customers or
supporters is considered an advertisement.
Includes copyrighted material of Insuran ce Services Office, Inc. with its permiss ion.
Policy #
6802J195036
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B
COMM E RCI AL G ENERA L LIAB ILI T Y
that i s av a ilab le to any o f y our " em p loyee s "o ccup at ional therapi st or o ccup at ional fo r "bod i ly injury " that ari s e s out o f pr ov idin gthe rapy as s ist an t, p h y s i c a l ther ap i s t o r or f a i li ng t o prov ide "i ncidental me dic a ls p ee c h- language p a th olo gi st ; or s e r v i c e s " to any p e rs on t o the e x tent n ot(b ) F i rst ai d o r "Good Sama ri tan s e r v i c e s " s ubje c t to P ar ag r ap h 2.a. (1) o f S e c tio n II –by any o f y our " em p loyee s " or " v olunteer Wh o I s An Insur ed.w orke rs ", oth e r th an an em ployed o r v o lunteer d o ctor. An y s uc h " em p loyee s " K. M ED I C AL PAYM EN T S – INCREASE D LI M IT or " v ol untee r w orkers" prov idin g or fa il in g The f o llo wing r e pla ces P aragrap h 7. o fto prov ide fi r s t aid or "Good Sama ri tan SE CTI O N II I – L IMIT S O F I N SURA NCE :s e r v i c e s " during th ei r w ork h ours fo r yo u
7. Su bje ct to P aragrap h 5. abov e, th e Medic a lwil l b e d ee m ed t o b e a c ti ng within th e s co pe o f thei r em ploy m ent b y y ou o r Ex pens e L im i t i s the mo s t w e wil l pay und e r pe rfo rm in g dutie s r elated to t he c o ndu ct C ov erage C fo r al l me di c al ex pens e s o f yo ur bus ine s s . be c aus e o f " bodily inj ury " s us tained b y any one pers on, and w ill be th e highe r o f:3. The fo llowing r epla c e s the la st s e nt en c e o f Pa r ag r aph 5. o f SE CTIO N I II – L IMIT S O F a. $10, 00 0; orINSU R A N CE :
b . The am o unt s how n i n th e D e clarat ion s o fFo r t he p urpo s es o f d eterm i ni ng th e th i s C ov erage P art fo r Medica l E x pens eappl i cable E a c h Occurrenc e L im i t , all r e la ted Lim i t.a ct s or om i s s ions c om m i tted i n prov iding o r fa il in g t o pr ov ide "inci dent al me dical L . AM END MEN T OF EXCES S INS URA NCE s e rv i ce s ", fi r s t a id or "Good Sama ri tan COND I T ION – P ROF ES SI ONAL L IA BIL I TY s e rv i ce s " to any one p er s on wil l b e deemed The f ol lo wing i s added t o P ar ag r aph 4.b . ,to b e one " o cc urrence ". Ex ces s Insu r ance , o f SE CTI O N IV –4. The fol lowing ex clu s ion is ad ded t o CO MM ERCIAL GENE R AL L IA BI LIT Y Pa r a graph 2. , Ex clus ion s , o f SE CTION I – COND I T ION S :
CO V ER AGE S – C O VER AGE A – BODI L Y Thi s in s uranc e is ex c e s s ov er any o f the oth e rINJU RY A ND P ROP ERT Y DAM AGE i nsur an c e, wh eth e r prim ary, ex ces s , c o nti ng entL IA BI LI TY : or on a ny other b a s i s , that i s Pr o fe ss ionalSa le O f Ph armac eu ticals Lia bil ity or s im i la r c ov e rag e, t o th e ex tent t h e "Bo dily inj ury " o r "pr op e rty d am age " ari s ing lo ss i s n o t s ub ject to th e pro fe s s ional s e rv i c e s ou t o f t h e v iola t ion o f a p enal s ta tute o r ex clusion o f C o v erage A or Co v e r age B . ordi nanc e r elatin g t o the s a le of M . B LA NKET W AIVER OF SUBRO GATION –pharma c eut i c al s c om m i tt ed b y, o r w i th t he W H EN R E QUI RED BY WRI TT E N C ON T RACTk now ledg e o r c o n s ent o f t he in s ur ed. O R AG R EEMEN T5. The f ol lo wing i s a dd ed t o th e D EFIN I TION S The f ol lo w ing is add ed to P a ragraph 8. , Tra nsfe rSe ctio n:
O f Ri g h t s O f Re co very Again st O the r s T o U s ,"In ci dent al m ed i c al s e rv i ce s " m ea ns : o f SE CTION IV – C O MMERCIAL GEN ERAL a . Med i c al , s urgic a l, d en tal , lab orato ry, x - L IA BI LI TY CO ND I T ION S :
r ay o r n ursing s erv i ce or tr eatm en t, If the i nsur ed h a s agreed in a wri tten c o n tr a ct o radv i c e o r ins tru ction, o r the r ela ted ag r ee ment to w aiv e that i nsur ed ' s right o ffu rni s hing o f food or be v e rag es; or r e cov e ry against any p ers on o r o rg anizat io n, w e b . The fur nishin g o r di s pens i ng o f drug s o r w aiv e our r ight o f r e c ov e ry agai nst s uch p ers o nm ed i c al , d en tal, or s ur gi cal s u pplie s o r or o r ganizatio n, but only f o r p ay men ts w e m akeappl ia nc e s . be c aus e o f:
6. The f ol lo w i ng is added t o Par agraph 4.b . , a. "Bo dily injury " o r "property d am age " thatE xces s Ins u r ance , o f SE CTI O N IV – o ccurs ; o rCO M M ERCI AL GENE R AL LI A B ILI T Y b . "Pe rs o nal and a dv e rti s ing injury " c aus ed b yCOND I TION S :
an o ffe n s e th at i s c om m it ted ;Thi s i nsur an c e i s ex c e s s ov e r any v al id an d s ubs equent to th e s igni ng o f that c o ntra ct o rcol le c ti ble oth e r i ns ur ance , w h ether p rim a ry, ex c e ss , c o nti ng ent o r on any other b a sis, ag r ee ment.
CG D3 79 02 19 ú 20 17 T he Tra v e le rs In d e mn ity C o mp a ny . All righ ts re se rv e d . Pa ge 5 o f 6 I nc lud es co py rig ht e d ma te ria l o f I nsur a nce Se rv ice s O f f ice , Inc. w it h its p e rm is sio n.
Policy #
6802J195036
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Policy #: BA8R565397
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
ENDORSEMENT WC 99 03 76 ( A)
POLICY NUMBER:
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT
CALIFORNIA
(BLANKET WAIVER)
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 this endorsement shall be % of the California workers' compensation pre- mium.
Schedule
Person or Organization Job Description
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Insurance Company Countersigned by
DATE OF ISSUE: Page 1 of 1
Any Person or organization for which the insured has agreed by written contract executed prior to loss to furnish this waiver.
UB3J886238
Travelers Property Casualty Company of America
5/5/2025
Docusign Envelope ID: E89BE28E-85E2-4468-80EA-B9ACCF39C34B