FIRST AMENDMENT
ORD
ER FORM
Order Date: Date of the last signature below
Trimble Entity Name (“Trimble”)
and Address:
Azteca Systems, LLC, a Trimble company
11075 South State, Suite 24, Sandy, Utah 84070
Customer Entity Name
(“Customer”) and Address:
Cupertino, CA
10300 Torre Avenue
Cupertino, CA 95014
Billing Contact Name and E-Mail
Address:
Teri Gerhardt
(408) 777-3311
[email protected]
Initial Term: 12/31/2022 - 12/30/2028
Validity: This Order Form shall expire on 11/25/2024. If this Order Form is not executed by the Customer by the Validity Date, Trimble reserves the right to not offer the pricing found in the Order Form.
Miscellaneous: Purchase orders issued by Customer are issued for administrative purposes only; terms and conditions contained in any such purchase order shall be null and void.
The purpose of this Order Form is to downgrade the Customer’s Licensed Software from a Standard AMS ELA to a Custom AMS ELA.
Post-Termination Customer Data Access. For 30 days from the expiration or termination of the Agreement, Trimble will make Customer Data available to Customer upon request for export or download as provided in the Agreement for the applicable Product. Additional fees may apply.
Licens
ed Software:
Description Number of Authorized
Users
Annual Term Total
Server AMS Standard Cityworks Enterprise License
Agreement (ELA), Includes Unlimited Quantities of
the Identified Products:
Office
Respond
Mobile Native Apps (for iOS/Android)
--Includes the following Add-ons:
Storeroom
Equipment Checkout
Contracts
Cityworks for Excel
Cityworks Analytics for AMS
eURL (Enterprise URL)
Workload
Web Hooks
OpX Projects
Citizen Engagement API
Metrics API
N/A Year 1 12/31/2022 – 12/30/2023 $71,070.00
Year 2 12/31/2023 – 12/30/2024 $72,491.40
ATTACHMENT A
Use of Cityworks AMS Application Programming
Interfaces (APIs) with commercially available
Cityworks-centric applications that are licensed and
maintained by authorized Cityworks partners
Server AMS Custom Cityworks Enterprise License
Agreement (ELA), Includes the Identified Products for up to 37 Named Logins:
Office
Respond
Mobile Native Apps (for iOS/Android)
--Includes the following Add-ons:
Storeroom
Web Hooks
Service Request API
Metrics API
37 - Named Users Year 3: 12/31/2024 - 12/30/2025 $53,941.23 Year 4: 12/31/2025 - 12/30/2026 $53,941.23
Year 5: 12/31/2026 - 12/30/2027 $55,020.05
Year 6: 12/31/2027 - 12/30/2028 $56,120.46
All Licensed Software is for the indicated term and not perpetual. Annual fee herein is based on 50,001 - 100,000 population range. Trimble reserves the right to adjust the annual fee accordingly to align with the Customer’s actual population range.
TERMS AND CONDITIONS
1. Terms and Conditions. This Order is subject to the agreement executed by the Parties on March 15, 2023 (the “Agreement”).
2. Payment Terms. All fees are due net 30 from the date of the Trimble invoice. ● Annual Licensed Software: Trimble will invoice 1) Year 3 in the amount of $53,941.23 upon execution of this Order Form, 2) each subsequent Year and any renewals 30 days in advance of each successive anniversary date.
3. Due Authority. By signing below, the signatory represents that he/she (i) is an authorized representative of Customer and (ii) has the authority to legally and functionally commit the Customer.
[Signature Page to Follow]
3 ACCEPTANCE
Accepted and agreed:
CUSTOMER: CITY OF CUPERTINO
B y
Title
D a t e
APPROVED AS TO FORM
City Attorney
ATTEST:
City Clerk
D a t e
TRIMBLE:
Signature:
__________________
Print Name: George Mastakas____
Title: Vice President__________
Date: __________________
Contract No. ________
Exhibit B: Insurance Requirements and Proof of Insurance Proof of insurance coverage described below is attached to this Exhibit, with City named as additional insured.
1. MINIMUM SCOPE AND LIMITS OF REQUIRED INSURANCE POLICIES Additional Insureds:
The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers (“Additional Insureds”) are to be covered as additional insureds on Consultant’s Commercial General Liability and Cyber Liability policies. General Liability coverage can be provided in the form of an endorsement to Consultant’s insurance (at least as broad as ISO Form CG 20 10 (11/ 85) or both CG 20 10 and CG 20 37 forms, if later editions are used).
Primary Coverage:
Coverage afforded to City/Additional Insureds shall be primary insurance. Any insurance or self- insurance maintained by City, its officers, officials, employees, or volunteers shall be excess of Software Provider’s insurance and shall not contribute to it.
Notice of Cancellation:
Each insurance policy shall state that coverage shall not be canceled or allowed to expire, except with written notice to City 30 days in advance or 10 days in advance if due to non- payment of premiums.
Workers' Compensation:
As required by the State of California, with Statutory Limits and Employer’s Liability Insurance of no less than $1,000,000 per occurrence for bodily injury or disease.
T
he Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of City for all work performed by Software Provider, its employees, agents, and subconsultants.
General Liability:
For bodily injury, property damage, personal injury liability for premises operations, products and completed operations, contractual liability, and personal and advertising injury with limits no less than $2,000,000 per occurrence (ISO Form CG 00 01). If a ge neral aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO Form CG 25 03 or 25 04) or it shall be twice the required occurrence limit. a. It shall be a requirement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (i) the minimum coverage/limits specified in this agreement; or (ii) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater.
b. Additional Insured coverage under Software Provider’s policy shall be "primary and non-contributory," will not seek contribution from City’s insurance/self-insurance, and shall be at least as broad as ISO Form CG 20 01 (04/13).
Contract No. ________
c
. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Agreement. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary basis for the benefit of City before the City’s own insurance or self-insurance shall be called u pon to protect City as a named insured.
Automobile Liability
ISO CA 00 01 covering any auto (including owned, hired, and non-owned autos) with limits no less than $1,000,000 per accident for bodily injury and property damage.
Cyber Liability:
Insurance, with limits not less than:
$2,000,000 each occurrence
$2,000,000 aggregate - all other
Coverage shall be sufficiently broad to respond to the duties and obligations as is undertaken by Software Provider in this Agreement and shall include, but not be limited to, claims involving infringement of intellectual property, includi ng but not limited to infringement of copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electronic information, release of private information, alteration of electronic information, extortion, and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations.
If the Software Provider maintains broa der coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or higher limits maintained by the Software Provider . Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City.
2. ABSENCE OF INSURANCE COVERAGE.
City may direct Software Provider to immediately cease a ll activit ies with respect to thi s Agreement if it determines that Software Provider fails to carry, in full force and effect , all insurance policies with coverages at or above the limits specified in thi s Agreement. At the City’s discretion, under conditions of lapse, City may purchase appropriate insurance and charge all costs related to such policy to Software Provider.
3. PROOF OF INSURANCE COVERAGE AND COVERAGE VERIFICATION.
A Ce rtificate of Insurance, on an Accord for m, and comple ted coverage ve rification shall be provided to City by each o f Software Provider's insuranc e companies as evidence of the stipulated coverages prior to the Commencement Date of thi s Agreement , and annuall y thereafter for the term of this Agreement. All of the insurance companies providing insurance for Software Provider shall be licensed to do insurance business in the State of California and shall have, and provide evidence of, a Bes t Rating Service rate of A:VII or above.
Contract No. ________
4. SUBCONTRACTORS
S
oftware Provider shall require and verify that all subconsultants maintain insurance that meet the requirements of this Contract, including naming the City as an additional insured on subconsultant’s insurance policies.
5. H
IGHER INSURANCE LIMITS
If
Software Provider maintains broader coverage and/or higher limits than the minimums shown above, City shall be entitled to coverage for the higher insurance limits maintained by Software Provider .
6. ADE
QUACY OF COVERAGE
C
ity reserves the right to modify these insurance requirements/coverage based on the nature of the risk, prior experience, insurer or other special circumstances, with not less than ninety (90) days prior written notice.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE 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):FAXE-MAILADDRESS: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 onthis 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. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)(Ea accident)$
$
N / A
SUBRWVDADDLINSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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. $$$$PROPERTY DAMAGEBODILY INJURY (Per accident)BODILY INJURY (Per person)COMBINED SINGLE LIMIT
AUTOS ONLYAUTOSAUTOS ONLYNON-OWNEDSCHEDULEDOWNEDANY AUTOAUTOMOBILE LIABILITY Y / NWORKERS COMPENSATIONAND EMPLOYERS' LIABILITYOFFICER/MEMBER EXCLUDED?(Mandatory in NH)DESCRIPTION OF OPERATIONS belowIf yes, describe underANY PROPRIETOR/PARTNER/EXECUTIVE$$$E.L. DISEASE - POLICY LIMITE.L. DISEASE - EA EMPLOYEEE.L. EACH ACCIDENTEROTH-STATUTEPER
LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIABUMBRELLA LIAB $EACH OCCURRENCE$AGGREGATE$OCCURCLAIMS-MADEDEDRETENTION$ $PRODUCTS - COMP/OP AGG$GENERAL AGGREGATE$PERSONAL & ADV INJURY$MED EXP (Any one person)$EACH OCCURRENCEDAMAGE TO RENTED$PREMISES (Ea occurrence)COMMERCIAL GENERAL LIABILITYCLAIMS-MADEOCCURGEN'L AGGREGATE LIMIT APPLIES PER:POLICYPRO-JECTLOC
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIREDAUTOS ONLY
E
A
408 467 5699
1,000,000
12/01/2024
1,000,000
35323540
X
WC7 11892854 (RETRO)
SEA-003879365-05
1,000,000
2,000,000
WC7 11636763 (CA)
X
20427
2,000,000
Retention
N
X
COMP/COLL DED
12/01/2023
Transportation Insurance Co
4 12/01/2024
12/01/2023
35289
1,000,000
12/01/2024
1,000,000
12/01/2024
[email protected]
73257020
Technology Errors & Omissions
B
2,000,000
1,000,000
X
GAP7011892868 (STOP GAP)
American Casualty Company of Reading, PA
1,000,000
X
C
X
1,000
12/06/2023
2,500,000
12/01/2023
10,000,000
12/01/2023
X
12/01/2023
Cupertino, CA 95014
City of Cupertino
Continental Insurance Company
A
E
Syndicate 2623/623 at Lloyd's
CN102488216-STND-GAWUE-23-
Limit
10,000
12/01/2024
1,000,000
79724719
D
2,000,000
20281
1,000,000
1,000,000
12/01/2024
WC7 11636746 (AOS); Ded: $250k
1735 Technology Drive, Suite 790
Marsh Risk & Insurance Services
X
San Jose, CA 95110
Azteca Systems LLC (dba Cityworks)
Trimble Inc.
Sandy, UT 84070
11075 South State #24
X
W101C7231801
12/01/2023
10300 torre Ave
12/01/2023
12/01/2023
A
Petronella Massey
12/01/2024
20494
12/01/2024
408 467 5614
Federal Insurance Company
Form: 16-02-0292 (Rev. 11-16) Page 1 of 3
"Includes copyrighted material of Insurance Services Office, Inc. with its permission"
COMMERCIAL AUTOMOBILE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
This endorsement modifies the Business Auto Coverage Form.
1. EXTENDED CANCELLATION CONDITION
Paragraph A.2.b. – CANCELLATION - of the
COMMON POLICY CONDITIONS form IL 00 17 is
deleted and replaced with the following:
b. 60 days before the effective date of cancellation if we cancel for any other reason.
2. BROAD FORM INSURED
A. Subsidiaries and Newly Acquired or Formed
Organizations As Insureds
The Named Insured shown in the Declarations is
amended to include:
1. Any legally incorporated subsidiary in which
you own more than 50% of the voting stock on
the effective date of the Coverage Form.
However, the Named Insured does not include
any subsidiary that is an “insured” under any
other automobile policy or would be an
“insured” under such a policy but for its
termination or the exhaustion of its Limit of
Insurance.
2. Any organization that is acquired or formed by
you and over which you maintain majority
ownership. However, the Named Insured
does not include any newly formed or acquired
organization:
(a) That is an “insured” under any other
automobile policy;
(b) That has exhausted its Limit of Insurance
under any other policy; or
(c) 180 days or more after its acquisition or
formation by you, unless you have given
us written notice of the acquisition or
formation.
Coverage does not apply to “bodily injury” or
“property damage” that results from an “accident”
that occurred before you formed or acquired the
organization.
B. Employees as Insureds
Paragraph A.1. – WHO IS AN INSURED – of
SECTION II – LIABILITY COVERAGE is amended to
add the following:
d. Any “employee” of yours while using a
covered “auto” you don’t own, hire or
borrow in your business or your personal
affairs.
C. Lessors as Insureds
Paragraph A.1. – WHO IS AN INSURED – of
SECTION II – LIABILITY COVERAGE is
amended to add the following:
e. The lessor of a covered “auto” while the
“auto” is leased to you under a written
agreement if:
(1) The agreement requires you to
provide direct primary insurance for
the lessor; and
(2) The “auto” is leased without a driver.
Such leased “auto” will be considered a
covered “auto” you own and not a covered
“auto” you hire.
However, the lessor is an “insured” only
for “bodily injury” or “property damage”
resulting from the acts or omissions by:
1. You;
2. Any of your “employees” or agents;
or
3. Any person, except the lessor or
any “employee” or agent of the
lessor, operating an “auto” with the
permission of any of 1. and/or 2.
above.
D. Persons And Organizations As Insureds
Under A Written Insured Contract
Paragraph A.1 – WHO IS AN INSURED – of
SECTION II – LIABILITY COVERAGE is
amended to add the following:
f. Any person or organization with respect to
the operation, maintenance or use of a
covered “auto”, provided that you and
such person or organization have agreed
under an express provision in a written
“insured contract”, written agreement or a
written permit issued to you by a
governmental or public authority to add
such person or organization to this policy
as an “insured”.
However, such person or organization is
an “insured” only:
Form: 16-02-0292 (Rev. 11-16) Page 2 of 3
"Includes copyrighted material of Insurance Services Office, Inc. with its permission" (1) with respect to the operation,
maintenance or use of a covered
“auto”; and
(2) for “bodily injury” or “property damage”
caused by an “accident” which takes
place after:
(a) You executed the “insured
contract” or written agreement; or
(b) The permit has been issued to
you.
3. FELLOW EMPLOYEE COVERAGE
EXCLUSION B.5. - FELLOW EMPLOYEE – of
SECTION II – LIABILITY COVERAGE does not apply.
4. PHYSICAL DAMAGE – ADDITIONAL TEMPORARY
TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. – TRANSPORTATION EXPENSES
– of SECTION III – PHYSICAL DAMAGE
COVERAGE is amended to provide a limit of $50 per
day for temporary transportation expense, subject to a
maximum limit of $1,000.
5. AUTO LOAN/LEASE GAP COVERAGE
Paragraph A. 4. – COVERAGE EXTENSIONS - of
SECTION III – PHYSICAL DAMAGE COVERAGE is
amended to add the following:
c. Unpaid Loan or Lease Amounts
In the event of a total “loss” to a covered “auto”, we will pay any unpaid amount due on the loan or lease for a
covered “auto” minus:
1. The amount paid under the Physical Damage
Coverage Section of the policy; and
2. Any:
a. Overdue loan/lease payments at the time of
the “loss”;
b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage;
c. Security deposits not returned by the lessor:
d. Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease;
and
e. Carry-over balances from previous loans or
leases.
We will pay for any unpaid amount due on the loan or
lease if caused by:
1. Other than Collision Coverage only if the
Declarations indicate that Comprehensive
Coverage is provided for any covered “auto”;
2. Specified Causes of Loss Coverage only if the
Declarations indicate that Specified Causes of
Loss Coverage is provided for any covered “auto”;
or
3. Collision Coverage only if the Declarations indicate that Collision Coverage is provided for any
covered “auto.
6. RENTAL AGENCY EXPENSE
Paragraph A. 4. – COVERAGE EXTENSIONS – of
SECTION III – PHYSICAL DAMAGE COVERAGE
is amended to add the following:
d. Rental Expense
We will pay the following expenses that you or
any of your “employees” are legally obligated
to pay because of a written contract or
agreement entered into for use of a rental
vehicle in the conduct of your business:
MAXIMUM WE WILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:
1. $2,500 for loss of income incurred by the
rental agency during the period of time that
vehicle is out of use because of actual
damage to, or “loss” of, that vehicle, including
income lost due to absence of that vehicle for
use as a replacement;
2. $2,500 for decrease in trade-in value of the
rental vehicle because of actual damage to
that vehicle arising out of a covered “loss”; and
3. $2,500 for administrative expenses incurred
by the rental agency, as stated in the contract
or agreement.
4. $7,500 maximum total amount for paragraphs
1., 2. and 3. combined.
7. EXTRA EXPENSE – BROADENED COVERAGE
Paragraph A.4. – COVERAGE EXTENSIONS – of
SECTION III – PHYSICAL DAMAGE COVERAGE
is amended to add the following:
e. Recovery Expense
We will pay for the expense of returning a
stolen covered “auto” to you.
8. AIRBAG COVERAGE
Paragraph B.3.a. - EXCLUSIONS – of SECTION
III – PHYSICAL DAMAGE COVERAGE does not
apply to the accidental or unintended discharge of
an airbag. Coverage is excess over any other
collectible insurance or warranty specifically
designed to provide this coverage.
9. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT - BROADENED COVERAGE
Paragraph C.1.b. – LIMIT OF INSURANCE - of
SECTION III - PHYSICAL DAMAGE is deleted
and replaced with the following:
b. $2,000 is the most we will pay for "loss" in any
one "accident" to all electronic equipment that
reproduces, receives or transmits audio, visual
or data signals which, at the time of "loss", is:
(1) Permanently installed in or upon the
covered "auto" in a housing, opening or
other location that is not normally used by
the "auto" manufacturer for the installation
of such equipment;
(2) Removable from a permanently installed
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipment; or
(3) An integral part of such equipment.
10. GLASS REPAIR – WAIVER OF DEDUCTIBLE
Form: 16-02-0292 (Rev. 11-16) Page 3 of 3
"Includes copyrighted material of Insurance Services Office, Inc. with its permission" Under Paragraph D. - DEDUCTIBLE – of
SECTION III – PHYSICAL DAMAGE COVERAGE
the following is added:
No deductible applies to glass damage if the glass
is repaired rather than replaced.
11. TWO OR MORE DEDUCTIBLES
Paragraph D.- DEDUCTIBLE – of SECTION III –
PHYSICAL DAMAGE COVERAGE is amended to
add the following:
If this Coverage Form and any other Coverage
Form or policy issued to you by us that is not an
automobile policy or Coverage Form applies to the
same “accident”, the following applies:
1. If the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it will be waived; or
2. If the deductible under this Business Auto
Coverage Form is not the smaller (or smallest)
deductible, it will be reduced by the amount of
the smaller (or smallest) deductible.
12. AMENDED DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
Paragraph A.2.a. - DUTIES IN THE EVENT OF
AN ACCIDENT, CLAIM, SUIT OR LOSS of
SECTION IV - BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:
a. In the event of “accident”, claim, “suit” or
“loss”, you must promptly notify us when the
“accident” is known to:
(1) You or your authorized representative, if
you are an individual;
(2) A partner, or any authorized
representative, if you are a partnership;
(3) A member, if you are a limited liability
company; or
(4) An executive officer, insurance manager,
or authorized representative, if you are an
organization other than a partnership or
limited liability company.
Knowledge of an “accident”, claim, “suit” or
“loss” by other persons does not imply that the
persons listed above have such knowledge.
Notice to us should include:
(1) How, when and where the “accident” or
“loss” occurred;
(2) The “insured’s” name and address; and
(3) To the extent possible, the names and
addresses of any injured persons or
witnesses.
13. WAIVER OF SUBROGATION
Paragraph A.5. - TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US of
SECTION IV – BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:
5. We will waive the right of recovery we would
otherwise have against another person or
organization for “loss” to which this insurance
applies, provided the “insured” has waived
their rights of recovery against such person or
organization under a contract or agreement
that is entered into before such “loss”.
To the extent that the “insured’s” rights to
recover damages for all or part of any
payment made under this insurance has not
been waived, those rights are transferred to
us. That person or organization must do
everything necessary to secure our rights and
must do nothing after “accident” or “loss” to
impair them. At our request, the insured will
bring suit or transfer those rights to us and
help us enforce them.
14. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
Paragraph B.2. – CONCEALMENT,
MISREPRESENTATION or FRAUD of SECTION
IV – BUSINESS AUTO CONDITIONS - is deleted
and replaced with the following:
If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we will
not void coverage under this Coverage Form
because of such failure.
15. AUTOS RENTED BY EMPLOYEES
Paragraph B.5. - OTHER INSURANCE of
SECTION IV – BUSINESS AUTO CONDITIONS -
is amended to add the following:
e. Any “auto” hired or rented by your “employee”
on your behalf and at your direction will be
considered an “auto” you hire. If an
“employee’s” personal insurance also applies
on an excess basis to a covered “auto” hired
or rented by your “employee” on your behalf
and at your direction, this insurance will be
primary to the “employee’s” personal
insurance.
16. HIRED AUTO – COVERAGE TERRITORY
Paragraph B.7.b.(5). - POLICY PERIOD,
COVERAGE TERRITORY of SECTION IV –
BUSINESS AUTO CONDITIONS is deleted and
replaced with the following:
(5) A covered “auto” of the private passenger
type is leased, hired, rented or borrowed
without a driver for a period of 45 days or
less; and
17. RESULTANT MENTAL ANGUISH COVERAGE
Paragraph C. of - SECTION V – DEFINITIONS is
deleted and replaced by the following:
“Bodily injury” means bodily injury, sickness or
disease sustained by any person, including
mental anguish or death as a result of the “bodily
injury” sustained by that person.
Workers Compensation And Employers Liability Insurance
Policy Endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
WC 7 11636746
Endorsement No: 38; Page: 1 of 1 Policy Page: 265 of 396 Underwriting Company: American Casualty Company of Reading, Pennsylvania, 151 N Franklin St, Chicago, IL 60606
Form No: WC 00 03 13 (04-1984)
Endorsement Effective Date:
Policy No:
Policy Effective Date: 12/01/2023Endorsement Expiration Date:
Copyright 1983 National Council on Compensation Insurance.
Workers Compensation And Employers Liability Insurance
Policy Endorsement
BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers’ Compensation Insurance G. Recovery From Others and Part Two - Employers’ Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
WC 7 11636763
Endorsement No: 7; Page: 1 of 1 Policy Page: 42 of 66
Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 Form No: G-19160-B (11-1997)
Endorsement Effective Date:
Policy No:
Policy Effective Date: 12/01/2023Endorsement Expiration Date:
© Copyright CNA All Rights Reserved.
Workers Compensation And Employers Liability Insurance
Policy Endorsement
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
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.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.
WC 7 11892854
Endorsement No: 17; Page: 1 of 1 Policy Page: 62 of 86
Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606 Form No: WC 00 03 13 (04-1984)
Endorsement Effective Date:
Policy No:
Policy Effective Date: 12/01/2023Endorsement Expiration Date:
Copyright 1983 National Council on Compensation Insurance.