JNS,URED : DBPipeline,lnc.
POLICY#: 1AC09217 4804 POLICY PERIOD: 1010112022
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TO: 10/01/2023
WC 04 03 06
(Ed. 04-84)
WAIVER Of OUR RIGHT To RECOVER FROM OTHERS ENDORSEMENT· 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 named In the Schedule. (This agreement app lies 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 endorsemen t shall be 2% Of the California workers' compensation premium otherwise due on such remune ration.
Schedule
Person or Organization Job Description
BLANKET WAIVER AS REQUIRED BY CONTRACT
This endorsemen t changes the policy to which ii is attache d and is effective on the date issued unles s otherw ise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy .) WC 04 03 06
(Ed. 04-84)
Countersigned by _____ ______ ________ _
INSURED: DB Pipeline , Inc.
POLICY# : GLO385404003 POLICY PERIOD: 1010112022 TO: 10/0112023 Additional Insured - Automatic - Owners, Lessees Or
Contractors
ZURICH
Policy No. EfT. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY .
Named Insured :
Address (including ZIP Code) :
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
.,
A. Section 11 - Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 or "your work" as included in the "products-completed operations hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities .
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" , or the offense which caused the "personal and advertising injury", involved the rende ring of or the failu re to render any profe ssion al architec tural , engineering or surveying services .
Includes copyrighted material of Insurance Services Office, Inc .• with its permission .
U-GL-1175 -F CW (04/13)
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV - Commercial General Liability Conditions :
The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV - Commercial General Liability Conditions :
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that:
a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV - Commercial General Liability Conditions :
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit" . This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section Ill - Limits Of Insurance :
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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.
Includes copyrighted material of Insurance SeNices Office, Inc., with its permissi on.
U-GL-1175-F CW (04/13)