Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Exhibit 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F
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
6/5/2025
Woodruff-Sawyer & Co.
50 California Street, Floor 12
San Francisco CA 94111
Rose Amoroso
415-391-2141
[email protected]
Zurich American Insurance Company
16535
ARMERNORMA
Westchester Surplus Lines Insurance Company
10172
Armer/Norman and Assoc., Inc.
2600 Williams St.
San Leandro, CA 94577
Acceptance Casualty Insurance Company
10349
Upland Specialty Insurance Company
16988
1657749233
B
X
1,000,000
X
100,000
10,000
1,000,000
2,000,000
X
Y
G71803119006
4/29/2025
4/29/2026
2,000,000
A
1,000,000
X
X
X
Y
BAP747636105
4/29/2025
4/29/2026
B
X
8,000,000
X
G71803120006
4/29/2025
4/29/2026
8,000,000
A
X
Y
WC809156805
4/29/2025
4/29/2026
1,000,000
1,000,000
1,000,000
B
C
D
Pollution Liability
Excess Liability - 1st layer
Excess Liability - 2nd Layer
Y
G71803119006
EMM0002466
USXTL0949225
4/29/2025
4/29/2025
4/29/2025
4/29/2026
4/29/2026
4/29/2026
Per Occ/Agg
Per Occ/Agg
Per Occ/Agg
$1M/$2M
$3,000,000
$2,000,000
Excess Liability Policy #G71803120006 goes over policies: G71803119006 and WC809156805.
Excess Liability Policy #EMM0002466 goes over policy: BAP747636105 (Auto Liability only).
Excess Liability Policy #USXTL0949225 is excess of policy #EMM0002466.
Re: Underground Fuel Storage Tank (UST) Replacement Project.
See Attached...
City of Alameda
2263 Santa Clara Ave.
Alameda, CA 94501
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F 6/9/2025
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
ARMERNORMA
1 1
Woodruff-Sawyer & Co.
Armer/Norman and Assoc., Inc.
2600 Williams St.
San Leandro, CA 94577
25 CERTIFICATE OF LIABILITY INSURANCE
City of Alameda, its City Council, boards, commissions, officials, employees, agents and volunteers are included as additional insured as respects General Liability, Auto Liability and Pollution Liability to the extent provided in the attached forms.
Waiver of Subrogation applies as respects Workers Compensation to the extent provided in the attached form and as permitted by law.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F g
Coverage Extension Endorsement ZURICH
Policy No. Eff. Date of Exp. Date of Eff. Date of End. Producer No. Add'I. Prem Return Prem.
BAP747636105 Pol. 04/29/2025 Pol. 04/29/2026
-~-~
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form
A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II - Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any "employee" of yours is also an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don't own, hire or borrow to transport your clients or other persons in activities necessary to your business. c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract or written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you, provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance - Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond the terms and conditions of the Coverage Form.
B. Amendment - Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II - Covered Autos Liability Coverage are replaced by the following:
(2) Up to $5,000 for the cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
U-CA-424-F CW (04/14)
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F U. Expected Or Intended Injury
The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II -Covered Auto Liability Coverage is replaced by the following:
Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property.
V. Physical Damage -Additional Temporary Transportation Expense Coverage Paragraph A.4.a. of Section 111- Physical Damage Coverage is replaced by the following:
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $50 per day to a maximum of $1,000 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss".
W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section:
In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost of the replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel source within 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease agreement.
To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source of propulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas, either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must be powered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled by biofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source.
X. Return of Stolen Automobile
The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section:
If a covered "auto" is stolen and recovered, we will pay the cost of transport to return the "auto" to you. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage.
All other terms, conditions, provisions and exclusions of this policy remain the same.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
U-CA-424-F CW (04/14)
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F G71803119 006
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F G71803119 006
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Westchester
A Chubb Company
ADDITIONAL INSURED ENDORSEMENT - ONGOING WORK OR OPERATIONS Named Insured
Armer Norman & Associates, Inc
Policy Symbol
I
Policy Number
I
Policy Period
GLW G71803119006 04/29/2025 TO 04/29/2026
Endorsement Number
Effective Date of Endorsement
04/29/2025
Issued By (Name oflnsurance Company)
Westchester Surplus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
CONTRACTORS POLLUTION LIABILITY COVERAGE PART
SCHEDULE:
Name of Person(s) or Organization(s):
As required by written contract, prior to a loss to which this insurance applies (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the persons or organizations shown in the Schedule, but only with respect to liability for injury or damage, to which this insurance applies, caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insureds.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
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.
B. With respect to the insurance afforded to these additional insureds, the following exclusion is added:
Exclusions
This insurance does not apply to injury or damage occurring after:
a. All work or operations, including materials, parts or equipment furnished in connection with such work or operations, on the project (other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed; or ENV-3250 (12/18)
(221012.1)
Includes copyrighted material of Insurance Services Office, Inc . with its permission Page 1of2 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Westchester
A Chubb Company
b. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the additional insured as a part of the same project.
C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III - LIMITS OF INSURANCE:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged.
ENV-3250 (12/18)
(221012.1)
Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of2 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84)
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 dause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) at 12:01 A.M. standard time, forms a part of
(DATE)
Endorsement No.
This endorsement, effective on 04/29/2025
Policy No. WC809156805
of the
issued to Armer/Norman & Associates, Inc.
Premium (if any) $
Zurich American Insurance Company
(NAME OF INSURANCE COMPANY)
Authorized Representative
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be
mium otherwise due on such remuneration.
Schedule
Person or Organization
ALL PERSONS AND/OR ORGANIZATIONS THAT ARE
REQUIRED BY WRITTEN CONTRACT OR AGREEMENT
WITH THE INSURED, EXECUTED PRIOR TO THE
ACCIDENT OR LOSS, THAT WAIVER OF
SUBROGATION BE PROVIDED UNDER THIS POLICY
FOR WORK PERFORMED BY YOU FOR THAT PERSON
AND/OR ORGANIZATION ALL CA OPERATIONS
WC 252 (4-84)
WC 04 03 06 (Ed. 4-84)
% of the California workers' compensation pre-
Job Description
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F General Endorsement
General Policy
Information
Named Insured: Armer Norman & Associates, Inc
Policy Symbol: EXW
Endorsement Number: 001
Policy Number: G71803120 006
Effective date of Endorsement: 04/29/2025
Policy Period: 04/29/2025 to 04/29/2026
Issued by: Westchester Surplus Lines Insurance Company (Name of Insurance Company)
This Endorsement changes the policy – Please read it carefully This endorsement modifies insurance provided under the following:
Environmental Follow-Form Excess Liability COVERAGE FORM Endorsement
Information
In consideration of an additional premium of it is agreed that form ENV-1503 (06/10) Environmental Follow-Form Excess Policy Declarations Item 6, Limits of Insurance is amended to read:
$8,000,000 Each Occurrence; Each Claim; Each Pollution Condition $8,000,000 General Aggregate (other than Products Completed Operations and Automobile Liability) $8,000,000 Products/Completed Operations Aggregate excess of the limits indicated in Item 5 of the Declarations
It is also agreed that the following form is amended as per the attached:
ENVM-272 Multiple Retroactive Date Limits Endorsement-Excess All other terms and conditions remain the same.
Form CC-3R19 (7/97) Authorized Agent
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENVM-272 Page 1 of 1
MULTIPLE RETROACTIVE DATE LIMITS ENDORSEMENT – EXCESSTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: EXCESS FOLLOW-FORM Solely with respect to Commercial General Liability coverage, the following items: a.Item 6. Limits of Insurance as shown on the Declarations, andb. The retroactive date in the Schedule of Underlying Insurance are amended as stated below: The Limits of Insurance shall not exceed $2,000,000 Each Occurrence Limit; $2,000,000 General Aggregate Limit and $2,000,000 Products/Completed Operations Aggregate Limit for “bodily injury” or “property damage” caused by an “occurrence” that takes place after SEE ENV-8101 (09/04) Claims-Made Endorsement and before 04/29/2024; and The Limits of Insurance shall not exceed $5,000,000 Each Occurrence Limit; $5,000,000 General Aggregate Limit and $5,000,000 Products/Completed Operations Aggregate Limit for “bodily injury” or “property damage” caused by an “occurrence” that takes place after 04/29/2024 and before 04/29/2025; and The Limits of Insurance shall not exceed $8,000,000 Each Occurrence Limit; $8,000,000 General Aggregate Limit and $8,000,000Products/Completed Operations Aggregate Limit for “bodily injury” or “property damage” caused by an “occurrence” that takes place after 04/29/2025 and before the end of the policy period. All other terms and conditions remain the same.
Named Insured Armer Norman & Associates, IncEndorsement Number001Policy Symbol EXWPolicy Number G71803120 006Policy Period 04/29/2025 to 04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F WSG-084 (05/11) Page 1 of 1
11575 Great Oaks WaySuite 200Alpharetta , GA 30022NOTICEPOLICY NO.G71803120 006NAME OF INSURED:Armer Norman & Associates, IncADDRESS:2600 Williams StreetSan Leandro , California 94577-3153We are pleased to enclose your policy for this account.Please be advised that by binding this risk with the above referenced Surplus Lines Insurance Company,you agree that as the Surplus Lines Broker responsible for the placement of this insurance policy, it isyour obligation to comply with all States Surplus Lines Laws including completion of anydeclarations/affidavits that must be filed as well as payment of any and all Surplus Lines taxes that mustbe remitted to the State(s). We will look to you for indemnification if controlling Surplus Lines Laws areviolated by you as the Surplus Lines broker responsible for the placement.You further confirm that any applicable state requirement concerning a diligent search for coverage byadmitted carriers has been fulfilled in accordance with state law.Thank you for this placement and your regulatory compliance.Date: 05/05/2025 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F X
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Westchester Surplus Lines Insurance Company
Westchester Surplus Lines Insurance Company
Environmental Follow-Form Excess
Policy Declarations
ENV- 1503 (06-10) Page 1 of 2
THE DECLARATIONS, TOGETHER WITH THE COMPLETED AND SIGNED APPLICATION, THIS POLICY AND ANY ENDORSEMENTS OR SCHEDULES ATTACHED HERETO, CONSTITUTE THE INSURANCE POLICY.
Policy Number: G71803120 006 Renewal of: G71803120 005
Item 1. Named Insured: Armer Norman & Associates, Inc
2600 Williams Street
San Leandro, California 94577-3153
The Named Insured is a: Individual Partnership Limited Liability Company X Corporation Other:
Item 2. Producer: Amwins Brokerage Insurance Services
221 Main Street Suite 580
San Francisco, California 94105
Item 3. Policy Period: Inception Date: 04/29/2025 Item 4. Expiration date: 04/29/2026
1. If “NOT INCLUDED” appears, then no such Coverage is provided under this policy.
Item 5. Schedule of Underlying Coverage
Commercial General Liability
Westchester Surplus Lines
Insurance Company
G71803119 006
04/29/2025 to 04/29/2026
$1,000,000 Each Occurrence Limit
$2,000,000 General Aggregate Limit (Other than
Products/Completed Operations)
$2,000,000 Products/Completed Operations Aggregate Limit $1,000,000 Personal & Advertising Injury Limit
$100,000 Damage to Premises Rented to You
$10,000 Medical Payments
$1,000,000 Contractors Pollution Liability Coverage Part $1,000,000 Professional Liability Coverage Part
Employer’s Liability
Zurich American Insurance
Company
WC809156805
04/29/2025 to 04/29/2026
$1,000,000 Each Accident
$1,000,000 Each Employee for Disease
$1,000,000 Policy Limit
Automobile Liability
NOT INCLUDED Not Applicable Bodily Injury Liability
Not Applicable Property Damage Liability
Not Applicable Combined Bodily Injury and Property Damage Liability
NO FLAT CANCELLATION
California Premium:
ees:
Surplus Lines Tax:
Stamping Fee:
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Westchester Surplus Lines Insurance Company
Westchester Surplus Lines Insurance Company
Environmental Follow-Form Excess
Policy Declarations
ENV- 1503 (06-10) Page 2 of 2
Item 6. Limits of Insurance: $5,000,000 Each Occurrence; Each Claim; Each Pollution Condition $5,000,000 General Aggregate (Other than Products/Completed Operations and Automobile Liability)
$5,000,000 Products/Completed Operations Aggregate
excess of the limits indicated in Item 5 of the Declarations Item 7. Advance Premium: (25% minimum earned)
Item 8. Rate:
Item 9. Estimated Basis:
Flat / Non Auditable
Estimated Revenue
Item 10. Forms and Endorsements:
Endorsements as listed on Forms Schedule CPFS2
Item 11.
Date: 05/05/2025
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Forms ScheduleCompany: Westchester Surplus Lines Insurance CompanySYM: EXW Policy ID: G71803120 006Policy PeriodWhen Coverage Begins: 04/29/202512:01 A.M. Local Time At Named Insured’s AddressWhen Coverage Ends: 04/29/202612:01 A.M. Local Time At Named Insured’s AddressForm Number Form Title CPfs2 (01/11) ©Chubb. 2016. All rights reserved. Page 1 of 1 LD-5S23l (10/24) SignaturesFM101.0.302 (04-13) Excess Insurance PolicyALL-21101 (11/06) Trade or Economic Sanctions EndorsementENV-5100 (06/11) Asbestos Amendatory EndorsementENV-5102 (10/04) Nuclear Hazard Liability ExclusionENV-5519 (09/04) Earned Premium Endorsement - 25% Minimum EarnedENV-8101 (09/04) Claims-Made EndorsementENV-8102 (09/04) Contractors Limitation EndorsementENV-8103 (09/04) Discrimination ExclusionENV-8104 (09/04) Drop-Down Exclusion ClauseENV-8105 (09/04) Employment Discrimination and Employment-Related PracticesExclusionENV-8106 (09/04) Property Damage Exclusion - Real and Personal PropertyENV-8110 (12/08) Amendment - Pay On Behalf OfENV-8111 (12-08) Defense Expense Amendatory Endorsement - Follow-Form ExcessENV-8112 (06-09) Bankruptcy or Insolvency of Any Underlying InsurerENV-8116 (06/16) Uninsured/Underinsured Motorist Exclusionary EndorsementENV-9950 (01/15) Exclusion of Certified Acts of TerrorismENVM-484 (03/22) Designated Country Limitation EndorsementSL-34255b (04/23) Service of Suit EndorsementENV-3126 (08/04) Notice of Cancellation to Specific Parties EndorsementENV-3126 (08/04) Notice of Cancellation to Specific Parties EndorsementENVM-272 Multiple Retroactive Date Limits Endorsement - ExcessMA-608255e (04/15) Claims Directory - Umbrella/Excess Casualty/EnvironmentalTRIA24a (08/20) Policyholder Disclosure - Notice of Terrorism Insurance Coverage Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F FM 101.0.302 (04-13) Page 1 of 2
EXCESS INSURANCE POLICYIn consideration of the payment of premium and in reliance upon the statements in the Declarations and subject to all theterms of this policy, the Company named in the Declarations (a capital stock company, herein called the company) agreeswith the insured, also named in the Declarations, to provide coverage as follows:INSURING AGREEMENTTo indemnify the insured for that amount of loss which exceeds the amount of loss payable by underlying policiesdescribed in the Declarations, but the Company’s obligation hereunder shall not exceed the limit of liability stated inDeclarations 6.CONDITIONSA. Application of Underlying Insurance. Except as otherwise stated herein, and except with respect to (1) anyobligation to investigate or defend any claim or suit, or (2) any obligation to renew, the insurance afforded by this policyshall apply in like manner as the underlying insurance described in the Declarations.B. Maintenance of Underlying Insurance. It is warranted by the insured that the underlying policies listed in item 5 ofthe declarations, or renewals or replacements thereof not more restricted, shall be maintained in force as valid andcollectible during the currency of this policy, except for any reduction of the aggregate limits contained therein solely bypayment of claims in respect of occurrences happening during this policy period. In the event of failure by the insured toso maintain such policies in force or to meet all conditions and warranties subsequent to loss under such policies, theinsurance afforded by this policy shall apply in the same manner it would have applied had such policies been somaintained in force. Notice of exhaustion of underlying insurance shall be given the company within thirty (30) days ofsuch exhaustion.C. Loss Payable. Liability of the company with respect to any one occurrence shall not attach unless and until theinsured, or the insured’s underlying insurer, has paid the amount of underlying insurance stated in Declaration 5. Theinsured shall make a definite claim for loss, for which the company may be liable within twelve (12) months after theinsured has paid any amount of excess loss, as stated in Declaration 6; or after the insured’s liability shall have beenmade certain by final judgment after actual trial; or by written agreement of the insured, the claimant, and the company.Any subsequent payments made by the insured on account of the same occurrence shall be payable by the companywithin thirty (30) days after additional claim is made by the insured, and after the insured has shown proof in conformitywith this policy.D. Premium Computation. The premium for this policy shall be based upon the rating basis set forth in the declarationsand shall be computed by applying the rate set forth in the declarations to each unit of exposure generated by the insuredduring the policy period. The advance premium is based upon the estimated exposures for the policy period as stated inthe declarations. Upon expiration of this policy or its termination during the policy period, the earned premium shall becomputed as thus defined. If the computed earned premium is more than the advance premium paid, the named insuredshall immediately pay the excess to the company; if less, the company shall return the difference to the named insured;but the company shall receive and retain the annual minimum premium for each twelve (12) months of the policy period.E. Assistance and Co-Operation. The company shall not be called upon to assume charge of the settlement ordefense of any claim made or proceeding instituted against the insured; but the company shall have the right andopportunity to associate with the insured in the defense and control of any claim or proceeding reasonably likely to involvethe company. In such event the insured and the company shall cooperate fully.F. Expenses. Loss and legal expenses incurred by the insured with the consent of the company in the investigation ordefense of claims, including court costs and interest, shall be borne by both the company and the insured in the proportionthat each party’s share of loss bears to the total amount of such loss. Salaries and expenses of the insured’s employeesshall not be considered as part of the above expenses. Expenses thus paid by the company shall be paid in addition tothe limit of liability stated in Declaration 6.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F FM 101.0.302 (04-13) Page 2 of 2
G. Notice of Occurrence. Upon the happening of an occurrence reasonably likely to involve the company hereunder,written notice shall be given as soon as practicable to the company or any of its authorized agents. Such notice shallcontain particulars sufficient to identify the insured and the fullest information obtainable at the time.The insured shall give like notice of any claim made on account of such occurrence. If legal proceedings are begun, theinsured, when requested by the company, shall forward to it each paper thereon, or a copy thereof, received by theinsured or the insured’s representatives, together with copies of reports of investigations made by the insured with respectto such claim proceedings.H. Appeals. In the event the insured or the insured’s underlying insurer elects not to appeal a judgment which exceedsthe underlying insurance, the company may elect to do so at its own expense, and shall be liable for the taxable costs,disbursements and interest incidental thereto, but in no event shall the liability of the company for excess loss exceed theamount set forth in Declaration 6.I. Subrogation. In the event of payment under this policy, the company will participate with the insured and anyunderlying insurer in the exercise of all the insured’s rights of recovery against any person or organization liable therefore.Recoveries shall be applied first to reimburse any interest (including the insured) that may have paid any amount, withrespect to liability in excess of the limit of the company’s liability hereunder, then to reimburse the company up to theamount paid hereunder, and lastly to reimburse such interests (including the insured), to whom this insurance is excessas are entitled to claim the residue, if any. Such expenses incurred in the exercise of rights of recovery shall beapportioned among all interests in the ratio of their respective losses for which recovery is sought.J. Cancellation. This policy may be cancelled by the named insured by surrender thereof to the company or any of itsauthorized agents, or by mailing to the company written notice stating when thereafter such cancellation shall be effective.This policy may be cancelled by the company by mailing to the named insured at the address shown in this policy writtennotice stating when, not less than thirty (30) days thereafter, such cancellation shall be effective. The mailing of notice asaforesaid shall be sufficient notice and the effective date of cancellation stated in the notice shall become the end of thepolicy period. Delivery of such written notice either by the named insured or by the company shall be equivalent tomailing.Premium adjustment shall be made by the company either at the time cancellation is effected or as soon as practicablethereafter. The check of the company or its representative, mailed or delivered, shall be sufficient tender of any refunddue the named insured.If this policy insures more than one named insured, cancellation may be effected by the first of such named insureds forthe account of all insureds; and notice of cancellation by the company to such first named insured shall be notice to allinsureds. Payment of any unearned premium to such first named insured shall be for the account of all interests therein.K. Other Insurance. If other valid and collectible insurance is available to the insured which covers a loss also coveredby this policy, other than insurance that is specifically purchased as being in excess of this policy, this policy shall operatein excess of, and not contribute with, such other insurance.INWITNESS WHEREOF, the company has caused this policy to be signed by its chairman of the board and secretary butthis policy shall not be valid unless completed by the attachment hereto of a Declarations page countersigned by a dulyauthorized representative of the company.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ALL-21101 (11-06) Ptd. In U.S.A. Page 1 of 1
TRADE OR ECONOMIC SANCTIONS ENDORSEMENTNamed InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit usfrom providing insurance, including but not limited to, the payment of claims. All other terms and conditions of policyremain unchanged. ____________________________Authorized Agent
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-5100 (06/11)©Chubb. 2016. All rights reserved.Page 1 of 1 ASBESTOS AMENDATORY ENDORSEMENTNamed InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:This insurance does not apply tobodily injuryorproperty damageat any time arising out of the manufacture of, miningof, sale or distribution of, or installation of asbestos products, asbestos fibers or asbestos dust, or to any obligation of theinsured to indemnify any party because of damages arising out of suchbodily injuryorproperty damageat any time asa result of the manufacture of, mining of, sale or distribution of, or installation of asbestos products, asbestos fibers orasbestos dust.Furthermore, the Company shall not be obligated to defend anyclaimorsuitagainst any insured allegingbodily injuryorproperty damageresulting from or contributed to, by any and all manufacture of, mining of, sale or distribution of, orinstallation of asbestos products, asbestos fibers or asbestos dust.For the purpose of this endorsement,bodily injuryshall include disability, disease, occupational disease, sickness, andshock.All other terms and conditions of thisPolicy remain unchanged.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.NUCLEAR HAZARD L IABILITY EXCLUSIONTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.NUCLEAR HAZARD LIABILITY EXCLUSIONThis insurance does not apply to:A.Bodily injury orproperty damage:1. With respect to which the Insured under the policy is also an Insured under a nuclear energyliability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic EnergyLiability Underwriters, or Nuclear Insurance Association of Canada, or would be an Insured underany such policy but for its termination upon exhaustion of its limits of insurance;2. Resulting from thehazardous properties ofnuclear material and with respect to which:(a) Any person or organization is required to maintain financial protection pursuant to theAtomic Energy Act of 1954, or any law amendatory thereof; or(b) The Insured is, or had this policy not been issued would be, entitled to indemnity from theUnited States of America, or any agency thereof, under any agreement entered into bythe United States of America, or any agency thereof, with any person or organization.B. Resulting from the hazardous properties ofnuclear material, if:1. Thenuclear material(a) Is at anynuclear facility owned by, or operated by or on behalf of the Insured; or(b) Has been discharged or dispersed therefrom;2. Thenuclear materialis contained inspent fuelorwasteat any time possessed, handled, used,processed, stored, transported or disposed of by or on behalf of the Insured; or3. Thebodily injuryorproperty damagearises out of the furnishing by the Insured of services,materials, parts or equipment in connection with the planning, construction, maintenance,operation or use of anynuclear facility, located within the United States of America, its territoriesor possessions or Canada.C. As used in this exclusion:1.Hazardous properties include radioactive, toxic, or explosive properties.2.Nuclear material meanssource material,special nuclear material, orbyproduct material.ENV-5102 (10-04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 2 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F
3.Source material, special nuclear material,andbyproduct materialhave the meanings given them in the Atomic Energy Act of 1954 or inany law amendatory thereof.4.Spent fuelmeans any fuel element or fuel component, solid or liquid,which has been used or exposed to radiation in anuclear reactor.5.Wastemeans anywaste material:(a) Containingbyproduct materialother than the tailings orwastes produced by the extraction or concentration of uraniumor thorium from any ore processed primarily for itssourcematerial content;(b) Resulting from the operation by any person or organization ofany nuclear facility included under the first two paragraphs ofthe definition ofnuclear facility;6.Nuclear facility means:(a) Anynuclear reactor;(b) Any equipment or device designed or used for:i. Separating the isotopes of uranium or plutonium;ii. Processing or utilizingspent fuel; oriii. Handling, processing or packagingwaste;(c) Any equipment or device used for the processing, fabricatingor alloying ofspecial nuclear materialif at any time the totalamount of such material in the custody of the Insured at thepremises where such equipment or device is located consistsof or contains more than 25 grams of plutonium or uranium233 or any combination thereof, or more than 250 grams ofuranium 235;(d) Any structure, basin, excavation, premises, or place preparedor used for the storage or disposal ofwaste;(e) The site on which any of the foregoing is located, alloperations conducted on such site and all premises used forsuch operations.7.Nuclear reactormeans any apparatus designed or used to sustainnuclear fission in a self-supporting chain reaction or to contain a criticalmass of fissionable material.8.Property damageincludes all forms of radioactive contamination ofproperty.ENV-5102 (10-04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 2 of 2 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-5519 (09-04) Page 1 of 1
Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.EARNED PREMIUM ENDORSEMENT – 25% MINIMUM EARNEDEARNED PREMIUM ENDORSEMENT – 25% MINIMUM EARNEDThe Minimum Earned Premium due for this policy shall be calculated in accordance with the following:1. In the event of cancellation of this policy by the firstNamed Insuredthe minimum earned premium due if thispolicy remains in effect for ninety (90) days or less shall be twenty-five percent (25%) of the amount enteredas advance premium on the Declarations of this policy; and2. In the event of cancellation of this policy by the firstNamed Insuredafter this policy has been in effect formore than ninety (90) days, the return premium due, if any, shall be computed at a rate equal to ninetypercent (90%) of the pro-rata unearned policy premium, subject, however, to final premium adjustment inaccordance with our rules, rates and the Premium Audit provisions of this policy; and3. In the event of cancellation of this policy by the Company for reasons other than non-payment of premium,the earned premium for this policy shall be computed on a pro-rata basis, subject, however, to final premiumadjustment in accordance with our rules, rates and Premium Audit provisions of this policy; and4. The following supersedes any provision to the contrary contained in the policy to which this endorsement isattached:The premium entered in the Declarations of this policy as advance premium is a provisional premium onlyand is subject to adjustment in accordance with our rules, rates and the Premium Audit provisions of thispolicy. Premium adjustments effected as a result of premium audits will be done after the policy is no longerin effect but may be done by the Company while the policy is in effect. Premium audit adjustment calculationswill be made to determine additional premiums only. The firstNamed Insuredagrees that there will be nodownward adjustment of the advance premium resulting from the Premium Audit provisions of this policy. Youagree that we may examine and audit your books and records as they relate to this policy at any time duringthe policy period and up to three (3) years afterward.All other terms and conditions remain the same.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-8101 (09-04) Page 1 of 1
Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.CLAIMS-MADE ENDORSEMENTTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.CLAIMS-MADE ENDORSEMENTSCHEDULE OF UNDERLYING INSURANCECarrier:Coverage:Retroactive Date:Westchester Surplus Lines InsuranceCompanyProfessional Liability See ENV-3179 NamedInsured RetroactiveDate on underlyingPolicy # G71803119006This policy shall follow the insuring agreement, exclusions, definitions and any limitations of the underlying insurancelisted in the above Schedule of Underlying Insurance, provided that:This insurance applies only if a claim is first made in writing during the policy period.This insurance does not apply to any liability covered by those underlying policies shown in the Schedule above whichoccurs prior to any retroactive date listed in the Schedule of Underlying Insurance for that respective policy, hereinafterreferred to as the "retroactive date". No coverage exists forclaimsfirst made against the insured after the end of thepolicy period unless an Extended Reporting Period endorsement is added to this policy and an additional premium is paidwithin thirty (30) days after the end of the policy period and provided that:1. Aclaimfirst made during the Extended Reporting Period shall be deemed to have been made on the lastday of the policy period provided that theclaim(s)is for operations that occurred before the end of thepolicy period but not before the retroactive date.The length of the Extended Reporting Period will be for a period of thirty-four (34) months or the time period provided bythe underlying policies coverage whichever is less and provided the Company issues an Extended Reporting Periodendorsement if the first named insured:1. Makes a written request for it which is received by the Company with thirty (30) days after the end of thepolicy period; and2. Pays the additional premium within thirty (30) days after the end of the policy period; and3. Purchases the available Extended Reporting Period endorsement afforded by the primary policies.The additional premium for such Extended Reporting Period shall not exceed 200% of the premium for this policy.The Extended Reporting Period endorsement shall not reinstate or increase the Company's Limit of Liability or extend thepolicy period.The Extended Reporting Period endorsement will amend the policy condition pertaining to "Other Insurance" to the extentthat such coverage provided will be excess over any valid and collectible insurance available to the insured, whetherprimary, excess, contingent or on any other basis, whose policy begins or continues after the endorsement takes effect.All other terms and conditions remain the same.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.CONTRACTOR'S LIMITATION ENDORSEMENTCON TRACTOR'S LIMITATION ENDORSEMENTThis insurance does not apply tobodily injury,property damage,personal injury oradvertising injury thatarises out of:1. Any project insured under a wrap-up or any similar program; or2. Operations performed by or on behalf of any joint venture of which the insured is a member.All other terms and conditions remain the same.
ENV-8102 (09-04) Page 1 of 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.DISCRIMINATION EXCLUSIONDISCRIMINAT ION EXCLUSIONThis insurance does not apply to any liability, defense costs, fines, or damages which arise out of thediscrimination of any person or persons based upon, but not limited to color, creed, gender, race, national origin,age, disability, illness, religion, or sexual orientation.All other terms and conditions remain the same.
ENV-8103 (09-04) Page 1 of 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.DROP-DOWN EXCLUSION CLAUSEDROP-DOWN EXCLUSION CLAU SEIt is agreed that this insurance shall not become excess of any reduced or exhausted underlying limit(s) to theextent that such reduction or exhaustion is the result of claim, damage, loss or expense not covered hereunder.All other terms and conditions remain the same.
ENV-8104 (09-04) Page 1 of 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.EMPLOYMENT DISCRIMINATION AND EMPLOYMENT-RELATED PRACTICES EXCLUSIONEMPLOYMENT DISCRIMINATION AND EMPLOYMENT-RELATED PRACTICES EXCLUSIONThis insurance does not apply to any liability, defense costs, fines or damages which arise out of any:1. Refusal to employ;2. Termination of employment;3. Coercion, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation,discrimination, or other employment-related practices, policies, acts or omissions;4. Consequentialbodily injury orpersonal injury as a result of items1.through 3.above.This exclusion applies whether the insured may be held liable as an employer or in other capacity and to anyobligation of the insured to share damages with or to repay someone else who must pay damages because of theinjury.All other terms and conditions remain the same.
ENV-8105 (09-04) Page 1 of 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.PROPERTY DAMAGE EXCLUSION - REAL AND PERSONAL PROPERTYPROPERTY DAMAGE EXCLUSION - REAL AND PERSONAL PROPERT YThis insurance does not apply to any liability forproperty damage to real and personal property:1. Owned, rented or occupied by the insured;2. Used by the insured;3. Loaned to the insured;4. In the care, custody or control of the insured or as to which the insured is for any purposeexercising physical control.All other terms and conditions remain the same.
ENV-8106 (09-04) Page 1 of 1
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-8110 (12-08) Includes copyrighted material of Insurance Services Office, Inc., with its permission ©Chubb. 2016. All rights reserved.
Named Insured
Armer Norman & Associates, Inc
Endorsement Number
Policy Symbol
EXW
Policy Number
G71803120 006
Policy Period
04/29/2025 to 04/29/2026
Effective Date of Endorsement
04/29/2025
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT – PAY ON BEHALF OF
AMENDMENT – PAY ON BEHALF OF
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
EXCESS INSURANCE POLICY
I. The INSURING AGREEMENT is replaced by the following:
INSURING AGREEMENT
To pay on behalf of the insured, the amount of loss the insured is legally obligated to pay, which is excess of the amount of loss payable by the underlying policies listed in Item.5 of the declarations.
II. Condition C., Loss Payable, is replaced by the following:
Loss Payable. Liability of the company with respect to any one occurrence shall not attach unless and until the insured, or the insured's underlying insurer, has paid the amount of underlying insurance stated in Item.5 of the declarations.
III. The following condition is added to CONDITIONS:
L. Legal Action Against Us.
No person or organization has a right under this policy:
- To join us as a party or otherwise bring us into a “suit” asking for damages from an insured; or - To sue us on this policy unless all of its terms have been fully complied with.
A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this policy or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative.
All other terms and conditions remain the same.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-8111 (12-08)©Chubb. 2016. All rights reserved.Page 1 of 1 Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.DEFENSE EXPENSE AMENDATORY – FOLLOW-FORM EXPENSESDEFENSE EXPENSE AMENDATORY – FOLLOW-FORM EXPENSESTHIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:EXCESS INSURANCE POLICYCondition F. Expenses is deleted in its entirety and replaced with the following:F. Expenses. Loss and legal expenses incurred by the company or by the insured with the consent of thecompany in the investigation or defense of claims, including court costs and interest, shall be paid in addition tothe limits of insurance, except when such expenses reduce the limits of liability of any underlying insurancelisted inSchedule Aof this policy, in which case expenses will reduce the company’sLimits of Liabilitystated in Item Sixof the Declarations.All other terms and conditions remain the same.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Named InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.BANKRUPTCY OR INSOLVENCY OF ANY UNDERLYING INSURERBANKRUPTCY OR INSOLVENCY OF ANY UNDERLYING INSURERTHIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:EXCESS INSURANCE POLICYThe following Condition is added to CONDITIONS:L. Bankruptcy or Insolvency of Any Underlying Insurer.Bankruptcy or insolvency of any underlying insurer willnot relieve us of our obligations under this policy.However, insurance provided under this policy will not replace any underlying insurance in the event of bankruptcyor insolvency of any underlying insurer. The insurance provided under this policy will apply as if the underlyinginsurance were in full effect and recoverable.All other terms and conditions remain the same.
ENV-8112 (06-09)©Chubb. 2016. All rights reserved.Includes copyrighted material of Insurance Services Office, Inc with its permission PolicyPage 1 of 1 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-8116 (06/16) Page 1 of 1
UNINSURED/UNDERINSURED MOTORIST EXCLUSIONARY ENDORSEMENTNamed InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:EXCESS INSURANCE POLICY (FM.101.0.302 (04-13))This policy is hereby amended by addition of the following:EXCLUSIONSNotwithstanding anything in the underlying policies described in the Declarations that might be construed to thecontrary, this insurance does not apply to:Uninsured/Underinsured Motorist ExposuresAny loss otherwise payable pursuant to the underlying policies that results from any claim or claimsmade by or against the insured with respect to uninsured motorists, underinsured motorists, personalinjury protection, first party benefits or similar no-fault coverage.All other terms and conditions of this policy remain unchanged.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-9950 (01/15)©Chubb. 2016. All rights reserved.Includes copyrighted material of Insurance Services Office, Inc., with its permissionPage 1 of 1 EXCLUSION OF CERTIFIED ACTS OF TERRORISMNamed InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.A. The following exclusion is added to all coverage parts:This insurance does not apply to:TERRORISMAny injury or damagearising, directly or indirectly,out of acertified act of terrorism.B. The following definitions are added:1.For the purposes of this endorsement, "any injuryordamagemeans any injury or damage coveredunderthisPolicyoranyCoverageParttowhichthis endorsement is applicable, and includes but isnot limited tobodilyinjury,propertydamage,personalandadvertisinginjury,correctiveactioncostsorcleanupcostsas may be definedin any applicable Coverage Part.2. Certified act of terrorismmeans an actthat is certified by the Secretary of theTreasury, in consultation with the SecretaryofHomelandSecurityandtheAttorneyGeneral of the United States, to be an act ofterrorism pursuant to the federal TerrorismRiskInsuranceAct.Thecriteriacontainedinthe Terrorism Risk Insurance Act for acertifiedactofterrorisminclude thefollowing:a.The act resulted in insured losses inexcess of $5 million in the aggregate,attributable to all types of insurancesubjecttotheTerrorismRiskInsuranceAct; andb.The act is a violent act or an act that isdangerous to human life, property orinfrastructureandiscommittedbyanindividual or individuals as part of aneffort to coerce the civilian population oftheUnitedStatesortoinfluencethepolicy or affect the conduct of the UnitedStates Government by coercion.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F SL-34255b (04/23)
SERVICE OF SUIT ENDORSEMENTNamed InsuredArmer Norman & Associates, IncEndorsement NumberPolicy SymbolEXWPolicy NumberG71803120 006Policy Period04/29/2025 to 04/29/2026Effective Date of Endorsement04/29/2025Issued By (Name of Insurance Company)Westchester Surplus Lines Insurance CompanyInsert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.Information about service of suits upon the company is given below. Service of process of suits against thecompany may be made upon the following person, or another person the company may designate:Natalie D'Amora, Esq., Managing CounselChubb436 Walnut StreetPhiladelphia, PA 19106-3703The person named above is authorized and directed to accept service of process on the company's behalf in anyaction, suit or proceeding instituted against the company. If the insured requests, the company will give theinsured a written promise that a general appearance will be entered on the company's behalf if a suit is brought.If the insured requests, the company will submit to the jurisdiction of any court of competent jurisdiction. Thecompany will accept the final decision of that court or any Appellate Court in the event of an appeal. However,nothing in this endorsement constitutes a waiver of the company’s right to: remove an action to a United StatesDistrict Court, seek a transfer of a case to another court, or to enforce policy provisions governing choice of law orvenue selection, as may be permitted by the laws of the United States, or of any state in the United States.The law of some jurisdictions of the United States of America requires that the Superintendent, Commissioner orDirector of Insurance (or their successor in office) be designated as the company's agent for service of process. Inthese jurisdictions, the company designates the Director of Insurance as the company's true and lawful attorneyupon whom service of process on the company's behalf may be made. The company also authorizes the Directorof Insurance to mail process received on the company's behalf to the company person named above.If the insured is a resident of Canada, the insured may also serve suit upon the company by serving thegovernment official designated by the law of the insured's province.NOTHING HEREIN CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THETERMS, CONDITIONS, OR LIMITATIONS OF THE POLICY TO WHICH THIS ENDORSEMENT IS ATTACHEDOTHER THAN AS ABOVE STATED.Authorized Representative Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-3126 (08-04) Page 1 of 1
N O TI C E O F C A NC E LL A TI O N T O S P E C I F I C P A R TI E S E N DO RS E ME N Named Insured
Armer Norman & Associates, Inc
Endorsement Number
Policy Symbol
EXW
Policy Number
G71803120 006
Policy Period
04/29/2025 to 04/29/2026
Effective Date of Endorsement
04/29/2025
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO SPECIFIC PARTIES ENDORSEMENT
SCHEDULE
Dempsey Construction, Inc.
1835 Aston Ave.
Carlsbad, CA 92008
If we decide to cancel this policy on or before the expiration date shown on the Declarations Page, we will mail to the person(s) or organization(s) shown in the Schedule above, written notice of cancellation not less than 30 days prior to cancellation or 10 days for non-payment of premium.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ENV-3126 (08-04) Page 1 of 1
N O TI C E O F C A NC E LL A TI O N T O S P E C I F I C P A R TI E S E N DO RS E ME N Named Insured
Armer Norman & Associates, Inc
Endorsement Number
Policy Symbol
EXW
Policy Number
G71803120 006
Policy Period
04/29/2025 to 04/29/2026
Effective Date of Endorsement
04/29/2025
Issued By (Name of Insurance Company)
Westchester Surplus Lines Insurance Company
Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NOTICE OF CANCELLATION TO SPECIFIC PARTIES ENDORSEMENT
SCHEDULE
Dempsey Construction, Inc.
C/O: myCOI
1075 Broad Ripple Ave, Suite 313
Indianapolis, IN 46220
If we decide to cancel this policy on or before the expiration date shown on the Declarations Page, we will mail to the person(s) or organization(s) shown in the Schedule above, written notice of cancellation not less than 30 days prior to cancellation or 10 days for non-payment of premium.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F MA-608255e (04/15)©Chubb. 2016. All rights reserved.Page 1 of 1 Claims Directory Environmental Business AutoClaims DirectoryUmbrella/Excess Casualty/EnvironmentalClaims or Loss Notices related to this policy should be reported to the following:Claim Office Email and Fax LocationChubb NorthAmericanClaimsFirst Notices Email:[email protected] Notices Fax:(877)-395-0131 (Toll Free)(302)-476-7254 (Local)Phone:(800)-433-0385 - Business Hours(800)-523-9254 – After HoursP.O. Box 5122Scranton, PA18505-0554 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F TRIA24a (08/20) Page 1 of 1
Westchester Surplus Lines Insurance CompanyInsurance CompanyArmer Norman & Associates, IncPolicyholderG71803120 006Policy NumberAmwins Brokerage Insurance ServicesBroker/ProducerPOLICYHOLDER DISCLOSURENOTICE OF TERRORISM INSURANCE COVERAGEYou were notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurancecoverage for losses resulting from acts of terrorism.: The term "act of terrorism"means any act or acts that are certified by the Secretary of the Treasury---in consultation with the Secretary of HomelandSecurity, and the Attorney General of the United States---to be an act of terrorism; to be a violent act or an act that isdangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside theUnited States in the case of certain air carriers or vessels or the premises of a United States mission; and to have beencommitted by an individual or individuals as part of an effort to coerce the civilian population of the United States or toinfluence the policy or affect the conduct of the United States Government by coercion.YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY YOUR POLICY FOR LOSSES RESULTINGFROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITEDSTATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAYCONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FORNUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES80% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BYTHE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PREMIUM THAT WOULD BE CHARGED FORTHIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSSTHAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT.YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS’ LIABILITY FORLOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANYONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERSEXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED.You electedNOTto purchase terrorism coverage under the Act at the price indicated. ACCORDINGLY, WE WILLNOTPROVIDE THIS COVERAGE AND YOU DO NOT OWE THE ADDITIONAL PREMIUM FOR THAT COVERAGEINDICATED BELOW.Terrorism coverage described by the Act under your policy was made available to you foradditional premium in the amount of $1,313, however you elected to decline such coverage.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F ALL-20887 (10/06) Page 1 of 1
Chubb Pro ducer Compensation Practices & PoliciesChubb Producer CompensationPractices & PoliciesChubb believes that policyholders should have access to information about Chubb's practices and policies related to thepayment of compensation to brokers and independent agents. You can obtain that information by accessing our websiteat http://www.chubbproducercompensation.com or by calling the following toll-free telephone number: 1-866-512-2862.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F IL P 001 01 04© ISO Properties, Inc., 2004Page1 of1
IL P 001 01 04U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGNASSETS CONTROL ("OFAC")ADVISORY NOTICE TO POLICYHOLDERSNo coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of yourpolicy. You should read your policy and review your Declarations page for complete information on thecoverages you are provided.This Notice provides information concerning possible impact on your insurance coverage due to directivesissued by OFAC.Please read this Notice carefully.The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidentialdeclarations of "national emergency". OFAC has identified and listed numerous:Foreign agents;Front organizations;Terrorists;Terrorist organizations; andNarcotics traffickers;as "Specially Designated Nationals and Blocked Persons". This list can be located on the United StatesTreasury's web site – http//www.treas.gov/ofac.In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entityclaiming the benefits of this insurance has violated U.S. sanctions law or is a Specially Designated National andBlocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and allprovisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to besuch a blocked or frozen contract, no payments nor premium refunds may be made without authorization fromOFAC. Other limitations on the premiums and payments also apply.
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F
NO FLAT CANCELLATION
California Premium:
ees:
Surplus Lines Tax :
Stamping Fee:
Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F POLICY NUMBER: EMM0002466 00
PXU 85 00 0619
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MINIMUM EARNED PREMIUM ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
COMMERCIAL EXCESS LIABILITY COVERAGE PART
It is hereby agreed and understood that in the event of cancellation or endorsement of this policy, the minimum earned premium shall not be less than$ or %, whichever is greater.
PXU 85 00 06 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F Docusign Envelope ID: 274E3BC6-9F78-4076-834B-36C2C981051F