MFYFCIVn1r MCHOVF7
ACORO CERTIFICATE OF LIABILITY INSURANCE
E ( MM/ D DIYYYY) DATE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy( ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to .the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement( s).
PRODUCERLicense # OD44424
INSURICA
8500 Stockdale Highway, Suite 200
Bakersfield, CA 93311
CONTACT
HOAIC, No, Ext): (661) 834-6222 ( A/C, No):(661) 281- 4992 EDDRES:
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Continental Casualty Company 20443
INSURED
Meyer Civil Engineering, Inc.
11200 River Run Blvd Ste 102
Bakersfield, CA 93311
INSURERB : National Fire Insurance Co. of Hartford 20478 INSURERC: Preferred Employers Insurance Coinpany 10900
INSURERD: Certain Underwriters at Lloyd' s, London NA
INSURER E
INSURER F :
CAVFRAr: FC CFRTIFICOTF NIIMRFR- REVISION NUMBER -
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR - CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH. RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTRLTR TYPE OF INSURANCE ASINSDSUBRWVD POLICY NUMBER
POLICY EFF
MM/DDIYYYYPOLICYEXPMM/ DDIYYYY LIMITS
A X COMMERCIALGENERALLIABILITY
CLAIMS -MADE X OCCUR X 6011257559 2/ 26/ 2025 2/ 26/ 2026 EACH OCCURRENCE 2, 000, 000
DAMAGE TO RENTED
PREMISES Ea occurrence
1, 000, 000
MED EXP ( Any oneperson) 10, 000
PERSONAL BADVINJURY
2, 000, 000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICYD JECOT E LOC
OTHER:
GENERAL AGGREGATE 4, 000, 000
PRODUCTS - COMPIOPAGG 4, 000, 000
B AUTOMOBILELIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON - OWNED
AUTOS ONLY AUTOS ONLY
BUA6011227624 2/ 26/ 2025 2/ 26/ 2026
EaaBINEDtSINGLELIMIT 1, 000, 000
BODILY INJURY Perperson)
BODILY INJURY Per accident
pe0ra.denDAMAGE
UMBRELLA LIAB
EXCESS LIAR
OCCUR
I I
EACH OCCURRENCE
HCLAIMS-MADE AGGREGATE
DEDI I RETENTION $
C WORKERSCOMPENSATION
AND EMPLOYERS' LIABILITY Y
ANY PROPRIETOR/ PARTNER/ EXECUTIVE
OFFICER/ MEMBER EXCLUDED?
Mandatory in, NH)
If yes, descr be under
DESCRIPTION OF OPERATIONS below
NIA
X PEG504602821 6/ 16/ 2024 6/ 16/ 2025
X STAH
STATUTE
ER E.
L. EACHACCIDENT1, 000,000 E.
L. DISEASE - EA EMPLOYEE1, 000,000 E.
L. DISEASE - POLICY LIMIT- 1,
000,000 D
ProfessionaLiabilityANE124605124 12/ 31/ 202412/ 31/ 2025Occurrence/Aggregate 2, 000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ( ACORD 101, AdditionalRemarks Schedule, may be attachedif morespace is required) The City of Bakersfield, it' s Mayor, Council, officers, agents, employeesand volunteersare an AdditionalInsured with respectto theGeneralLiability policy and a Waiverof Subrogationapplies with respectto theworkerscompensationpolicy if requiredor agreedto in a writtencontract subject to all provisionsand limitationsof thepolicy. 30 dayswrittennotice to thecertificateholder named to theleft. SHOULD ANY OF THE ABOVEDESCRIBEDPOLICIES BE CANCELLEDBEFORE City of BakersfieldTHE
EXPIRATIONDATE THEREOF, NOTICE WILL BE DELIVEREDIN tY
ACCORDANCE WITH THE POLICYPROVISIONS. 1600
Truxtun Avenue Bakersfield,
CA 93301AUTHORIZED
REPRESENTATIVE ' tr
ACORD
25 ( 2016103) ©1988- 2015 ACORDCORPORATION. All ri The
ACORDname and logo are registeredmarks of ACORD
CHA
SB146932G
Ed. 10- 19)
BLANKET ADDITIONAL INSURED AND LIABILITY EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following:
BUSINESSOWNERS LIABILITY COVERAGE FORM
BUSINESSOWNERS COMMON POLICY CONDITIONS'
TABLE OF CONTENTS
I. Blanket Additional Insured Provisions
A. Additional Insured — Blanket Vendors
B. Miscellaneous Additional Insureds
C. Additional Provisions Pertinent to Additional Insured Coverage
1. a. Primary — Noncontributory provision'
1: b. Definition of " written contract"
2. Additional Insured — Extended Coverage
II. Liability Extension Coverages
A. Bodily Injury — Expanded Definition
B. Broad Knowledge of Occurrence
C. Estates, Legal Representatives and Spouses
D. Fellow Employee First Aid
E. Legal Liability - Damage to Premises
F. Personal and Advertising Injury — Discrimination or Humiliation G. Personal and Advertising Injury — Broadened Eviction H. Waiver of Subrogation — Blanket
I. BLANKET ADDITIONAL INSURED PROVISIONS
A. ADDITIONAL INSURED — BLANKET VENDORS
Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed under a " written contract" to provide insurance, but only with respect to bodily injury" or "property damage" arisingout of "your products" which are distributedor sold in the regular course of the vendor's business, subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. " Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumptionof liabilityin a contractor agreement. This exclusiondoesnot applyto liabilityfor damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container;
e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with.the distribution or sale of the products;
f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or SB146932G ( 10- 19)
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h. " Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to:
1) The exceptions contained in Subparagraphs d. or f.; or 2) Such inspections, adjustments, tests or servicing. as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products.
2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products.
3. This provision2. doesnot applyto anyvendorincludedas an insuredby an endorsementissuedby us and made a part of this Policy.
4. This provision 2. does not apply if " bodily injury" or " property damage" included within the " products - completed operations hazard" is excludedeitherbythe provisionsof the Policyor by endorsement.
B. MISCELLANEOUS ADDITIONAL INSUREDS
1. Who Is An Insured is amended to include as an insured any person or organization ( called additional insured) described in paragraphs 3.a. through 3.j. below whom you are required to add as' an additional insuredonthis policyundera "written contract."
2. However, subject always to the terms and conditions of this policy, including the limits of insurance, we will not provide the additional insured with:
a. A higher limit of insurance than required by such " written contract;" b. Coverage broader than required by such "written contract" and in no event greater than that described bythe applicableparagrapha. throughk. below; or
c. Coverage for " bodily injury" or " property damage" included within the " products - completed operations hazard." But this paragraph c. does not apply to the extent coverage for such liability is provided by paragraph 3.j. below.
Any coverage granted by this endorsement shall apply only to the extent permitted by law.
3. Only the following persons or organizations can qualify as additional insureds under this endorsement:
a. Controlling Interest
Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of:
1) such person or organization's financial control of you; or 2) Premises such person or organization owns, maintains or controls while you lease or occupy these premises;
provided that the coverage granted to such additional insureds does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. b. Co- owner of Insured Premises
A co-owner of a premises co -owned by you and covered under this insurance but only with respect to the co -owners liability for "bodily injury," " property damage" or " personal and advertising injury" as co- owner of such premises.
c. Grantor of Franchise
Any person or organization that has granted a franchise to you, but only with respect to such person or organization's liability for "bodily injury," " property damage," or "personal and advertising injury" as grantor of a franchise to you.
SB146932G ( 10- 19) Page 2 of 7
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Ed. 10- 19)
d. Lessor of Equipment
Any personor organizationfromwhomyou leaseequipment, but onlywith respectto liabilityfor "bodily injury," " property damage" or " personal and advertising injury" caused in whole or in part by your maintenance, operation or use of such equipment, provided that the " occurrence" giving rise to such bodily injury" or " property damage" or the offense giving rise to such " personal and advertising injury" takes place prior to the termination of such lease. e. Lessor of Land
Any personororganizationfromwhomyou leaseland, butonlywith respectto, liabilityfor "bodily injury," property damage" or "personal and advertising injury" arising out of the ownership; maintenance or use of that specific part of the land leased to you, provided that the " occurrence" giving rise to such bodily injury' or "property damage" or the offense giving rise to such "personal and advertising injury," takes place prior to the termination of such lease. The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured.
f. Lessor of Premises
An owner or lessor of premises leased to you, or such owner or lessor's real estate manager, but only with respect to liability for " bodily injury," " property damage" or " personal and advertising injury" arising out of the ownership, maintenanceor use of such part of the premisesleased to you, and provided that the "occurrence" giving rise to such "bodily injury" or "property damage" or the offense givingriseto such "personal and advertising injury," takesplacepriorto the terminationof such lease.
The insurance hereby afforded to the additional insured does not apply to structural alterations, new construction or demolition operations performed by, on behalf of or for such additional insured. g. Mortgagee, Assignee or Receiver
A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee, or receiver's liability for " bodily injury," " property damage" or "personal and advertising injury" arising out of the ownership, maintenance, or use of a premises by you.
This insurancedoes not apply to structural alterations, new constructionor demolition operations performed by, on behalf of or for such additional insured. h. State or Political Subdivisions
A state or government agency or subdivision or political subdivision that has issued _a permit or authorization, but only with respect to such government agency or subdivision or political subdivision's liability for "bodily injury," " property damage" or "personal and advertising injury" arising out of:
N
1) The following hazards in connection with premises you own, rent, or control and to which this s
insurance applies:
a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or b) The construction, erection, or removal of elevators; or c) The ownership, maintenance or use of any elevators covered by this insurance; or 2) The permitted or authorized operations performed by you or on your behalf. But the coverage granted by this paragraph does not apply to:
a) " Bodily injury", " property damage" or " personal and advertising injury" arising out of operations performed for the state or government agency or subdivision or political subdivision; or
b) " Bodily injury" or " property damage" included within the " products - completed operations hazard."
With respect to this provision's requirement that additional insured status must be requested under a written contract," we will treat as a "written contract" any governmental permit that requires you to add the governmental entity as an additional insured.
SB146932G ( 10- 19) Page 3 of 7
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SB146932G
Ed. 10- 19)
i. Trade Show Event Lessor
With respect to your participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom you are required to include as an additional insured, but only with respect to such person or organization's liability for " bodily injury," " property damage," or ' personal and advertising injury" caused by:
a. Your acts or omissions; or
b. Acts or omissions of those acting on your behalf;
in the performance of your ongoing operations at the trade show premises during the trade show event. j. Other Person or Organization
Any person or organization who is not an additional insured under paragraphs a. through I. above. Such additional insured is an insured solely for " bodily injury'" " property damage" or " personal and advertising injury" for which such additional insured is liable because of your acts or omissions.
The coverage granted by this paragraph does not apply to any person or organization:
1) For " bodily injury," " property damage," or " personal and advertising injury" arising out of the rendering or failure to render any professional services; 2) For " bodily injury" or " property damage" included in the " products - completed operations hazard." Butthis provision (2) doesnotapplyto such "bodily injury" or "property damage" if:
a) It is entirely due to your negligence and specifically results from your workforthe additionalinsured which is thesubjectto the "writtencontract'; and b)
The "writtencontract" requires you to makethe personor organizationan additionalinsured for such " bodily injury" or " propertydamage'; or 3)
Whois affordedadditional insured coverageunder anotherendorsementattached to thispolicy. C.
ADDITIONALPROVISIONS PERTINENT TO ADDITIONALINSURED COVERAGE1.
With respectonly to additionalinsured coverageprovided under paragraphsA. andB. above: a.
The BUSINESSOWNERSCOMMON POLICY CONDITIONSare amendedto addthe followingto theCondition entitled Other Insurance: This
insuranceis excessof all otherinsuranceavailable to an additionalinsured whether primary, excess, contingentor onanyotherbasis. However, if a "writtencontract' requires that thisinsurancebe either primaryor primaryand noncontributing, then this insurancewill be primaryand non-contributoryrelative solely to insuranceon whichthe additionalinsured is a namedinsured. b.
UnderLiabilityand MedicalExpenseDefinitions, the followingdefinition is added: Written contract" means a writtencontract or agreementthat requiresyou to makea personor organization an additionalinsured on thispolicy, providedthe contractor agreement: 1) Is currentlyin effector becomeseffective -during the termof thispolicy; and 2) Wasexecutedprior to: a)
The "bodilyinjury" or " propertydamage;" or b)
Theoffensethat causedthe " personaland advertisinginjury"; for whichthe additionalinsured seeks coverage. 2.
With respectto anyadditionalinsured added by thisendorsementor by anyotherendorsementattached to this CoveragePart, the sectionentitled Who Is AnInsuredis amendedto makethe followingnatural persons insureds.
If
theadditionalinsured is: a.
An individual, then his or herspouseis an insured; SB146932G ( 10- 19) Page 4 of 7 v
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SB146932G
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b. A partnership or joint venture, then its partners, members and their spouses are insureds; c. A limited liability company, then its members and managers are insureds; d. An organization other than a partnership, joint venture or limited liability company, then its executive officers, directors and shareholders are insureds; or
e. Any type of entity, then its employees are insureds; but only with respect to locations and operations covered by the additional insured endorsement's provisions, and only with respect to their -respective roles within their organizations. Furthermore, employees of additional insureds are not insureds with respect to liability arising out of:
1) " Bodily injury" or "personal and advertising injury" to any fellow employee or to any natural person listedin paragraphsa. throughd. above;
2) " Property damage" to propertyowned, occupiedor usedby theiremployeror by anyfellowemployee; or 3) Providing or failing to provide professional health care services.
II. LIABILITY EXTENSION COVERAGES
It is understood and, agreed that this endorsement amends the Businessowners Liability Coverage Form. If any otherendorsementattachedto this policyamendsany provisionalso amendedby this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement to such provision do not apply.
A. Bodily injury— Expanded Definition
Under Liability and Medical Expenses Definitions, the definition of "Bodily injury" is deleted and replaced by the following:
Bodily injury" means physical injury, sickness or disease sustained by a person, including death, humiliation, shock, mentalanguishormentalinjurybythatpersonatanytimewhichresultsasa consequenceofthephysical injury, sickness or disease.
B. Broad Knowledge of Occurrence
Under Businessowners Liability Conditions, the Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended to add the following:
Paragraphs a. and b. above apply to you or to any additional insured only when such " occurrence," offense, r
claim or " suit" is known to:
m
1) You or any additional insured that is an individual; 2) Any partner, if youor an additionalinsuredis a partnership; 0 3) Any manager, if you or an additional insured is a limited liability company; 4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; 5) Any trustee, if you or an additional insured is a trust; or 6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity.
This paragraph applies separately to you and any additional insured.
C. Estates, Legal Representatives and Spouses
The estates, heirs, legal representatives and spouses of any natural person insured shall also be insured under thispolicy;, provided, however, coverageisaffordedtosuchestates, heirs, legalrepresentativesandspousesonly for claims arising solely out of their capacity as such and, in the case of a spouse, where such claim seeks damages from marital common property, jointly held property, or property transferred from such natural person insured to such, spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative or spouse outside the scope of such person' s capacity as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership Named Insureds are insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured' s business.
SB146932G ( 10- 19) Page 5 of
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ORIGINAL'
SB146932G
Ed. 10- 19)
D. Fellow Employee First Aid Coverage
In the section entitled Who Is An Insured, paragraph 2.a.1. is amended to add the following:
The limitations described in subparagraphs 2. a. 1.( a), ( b) and ( c) do not apply to your " employees" for " bodily injury" that results from providing cardiopulmonary resuscitation or other first aid services to a co -"employee" or volunteer worker" that becomes necessary while your "employee" is performing duties in the conduct of your business. Your " employees" are hereby insureds for such services. But the insured status conferred by this provisiondoes not applyto "employees" whose duties in your businessareto provideprofessionalhealthcare services or health examinations.
E. Legal Liability — Damage To Premises
1. Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. Damage To Property, is replaced by the following:
k. Damage To Property
Property damage" to:
1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organizationor entity, for repair, replacement, enhancement, restorationor maintenanceof such propertyfor any reason, includingpreventionof injury to a person or damageto another's property;
2. Premises you sell, give away or abandon, if the " property damage" arises out of any part of those premises;
3. Property loaned to you;
4. Personal property in the care, custody or control of the insured;
5. That particular part of any real property on which you or any contractors or subcontractors working directlyor indirectlyin your behalfare performingoperations, if the "property damage" arisesout of those operations; or
6. Thatparticularpartof anypropertythat mustbe restored, repairedor replacedbecause "your work" was incorrectly performed on it.
Paragraph 2 of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you.
Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" ( other than damage by fire or explosion) to premises:
1) rented to you:
2) temporarily occupied by you with the permission of the owner, or 3) to the contents of premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D — Liability and Medical Expenses Limits of Insurance.
Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement.
Paragraph 6 of this exclusion does not apply to " property damage" included in the " products - completed operations hazard."
2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the following paragraph is added, and replaces the similar paragraph, if any, beneath paragraph ( 14) of the exclusion entitled Personal and Advertising Injury:
Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you ortemporarilyoccupiedby youwith permissionofthe ownerorto thecontentsof premisesrentedto youfor a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance.
SB146932G ( 10- 19) Page 6 of 7
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SB146932G
Ed. 10- 19)
3. The first Paragraph under item 5. Damage To Premises Rented To You Limit of the section entitled Liability And Medical Expenses Limits Of Insurance is replaced by the following:
The most we will pay under Business Liability for damages because of " property damage" to any one premises, while rentedto you or temporarilyoccupiedby you with the permissionof the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You Limit. The Damage to Premises Rented to You Limit is the greater of:
a. $ 1, 000, 000; or
b. The Damage to Premises Rented to You Limit shown in the Declarations.
F. Personal and Advertising Injury — Discrimination or Humiliation
1. Under Liability and Medical Expenses Definitions, the definition of "personal and advertising injury" is amended to add the following:
h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is:
1) Not done intentionally by or at the direction of:
a) The insured; or
b) Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and
2) Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured.
2. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the exclusion entitled Personal and Advertising Injury is amended to add the following additional exclusions:
15) Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale; rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. 16) Employment Related Discrimination
Discrimination or humiliation directly or indirectly related to the employment, prospective employment, pastemploymentor terminationof employmentof anypersonby any insured. 17) Fines or Penalties
NW
Fines or penalties levied or imposed by a governmental entity because of discrimination.
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3. This provision ( Personal and Advertising Injury — Discrimination or Humiliation) does not apply if Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by 0 endorsement.
G. Personal and Advertising Injury - Broadened Eviction Under Liability and Medical Expenses Definitions, the definition of " Personal and advertising injury" is amended to delete Paragraph c. and replace it with the following:
c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwellingor premisesthata personor organizationoccupiescommittedby or on behalfof its owner, landlord or lessor.
H. Waiver of Subrogation — Blanket
We waive any right of recovery we may have against:
a. Any person or organization with whom you have a written contract that requires such a waiver.
All other terms and conditions of the Policy remain unchanged.
SB146932G ( 10- 19) Page7 of TpXc-y
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 07 00 A Ed. 04- 19)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — BLANKET
CALIFORNIA
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 for which you perform work under a written contract that requires you to obtain this agreement from us.
The premium charge for this endorsement shall be 3% of the Worker' s Compensation premium, subject to a minimum premium charge of $ 500.
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.) Endorsement Effective 06/ 16/ 2024 Policy No. PEG504602821 Insured Meyer Civil Engineering, Inc.
Insurance Company Preferred Employers Insurance Company Countersigned by
WC 99 07 00 A 1 of 1
Ed. 04- 19)
Endorsement No. 0
Premium $ 1, 584
Authorized Representative a
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POLICY NUMBER } INSURED NAb1E' AND ADDRESS
B 6011257559 MEYER CIVIL ENGINEERING , INC
11200 RIVER RUN BLVD STE 102
BAKERSFIELD, CA 93311- 3686
ADDITIONAL INTEREST SCHEDULE
LOCATION 1 BUILDING 1
The following has been added to your policy effective 01/ 06/ 2024 Type: Notice of Cancellation or Material Coverage Change Additional Interest Name and Address:
CITY OF BAKERSFIELD
1501 TRUXTUN AVENUE
BAKERSFIELD , CA 93301
K
INSURED Page 4 c € 5.
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