SECTION II - COVERED AUTOS LIABILITY COVERAGE
B. Designated (Additional) Insured Coverage
SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add the following:
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 by a written contract, agreement or permit issued to you by governmental or public authority to add such person or organization, or governmental or public authority, to this policy as an “insured”.
However, such person or organization is an “insured”:
(1) Only with respect to the operation, maintenance or use of a covered “auto”; and (2) Only for “bodily injury” or “property damage” caused by an “accident” which takes place after you executed the written contract or agreement or after the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit provided the “bodily injury” or “property damage” is caused, in whole or in part, by you or by those acting on your behalf.
C. Newly Acquired Organization
SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add the following:
Any organization you own on the inception of this policy, or newly acquire or form during the policy period, and over which you maintain during the policy period, majority ownership or majority interest, will qualify as a Named Insured if:
(1) There is no other similar insurance available to that organization; and (2) The first Named Insured shown in the Declarations of this policy has the responsibility of placing insurance for that organization; and
(3) The organization is incorporated or organized under the laws of the United States of America.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
C. Newly Acquired Organization - continued
However:
a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and b. Coverage under this provision does not apply to “bodily injury” or “property damage” that results from an “accident” that occurred before you acquired or formed the organization; and
c. No person or organization is an “insured” with respect to any current or past partnership, or joint venture that is not shown as a Named Insured in the Declarations; and d. Coverage under C. (1), (2) and (3) above does not apply to any organization that is covered as an insured under any other automobile liability insurance policy whose limits of insurance have been exhausted or whose insurer has become insolvent.
D. Employees As Insureds
SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add the following:
Any “employee” of yours while using a covered “auto” you do not own, hire or borrow in your business or your personal affairs.
E. Employee Hired Autos
SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured is amended to add the following:
An “employee” of yours is 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.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
F. Supplementary Payments – Higher Limits
SECTION II – COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 2. Coverage Extensions, a. Supplementary Payments, paragraphs (2) and (4) are deleted in their entirety and replaced by the following:
(2) Up to $2,500 for cost of bail bonds (including bonds for related traffic violations) required because of an “accident” we cover. We do not have to furnish these bonds. (3) 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.
G. Expected Or Intended Injury
SECTION II – COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 1.
Expected or Intended Injury is deleted in its entirety and replaced by the following:
“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.
H. Fellow Employee Coverage
The Fellow Employee Exclusion contained under SECTION II – COVERED AUTOS LIABILITY COVERAGE, B. Exclusions, 5. Fellow Employee does not apply.
Coverage afforded by this provision is excess over any other collectible insurance.
SECTION III – PHYSICAL DAMAGE COVERAGE
I. Towing And Labor
SECTION III – PHYSICAL DAMAGE COVERAGE, Paragraph A. Coverage, 2. Towing is replaced by the following:
If Physical Damage Coverage is provided under the Business Auto Coverage Form for an “auto” you own, with the symbol 2, 3, 4 or 7, we will pay towing and labor costs incurred, up to the limits shown below, each time a covered “auto” classified and rated as a private passenger type, light truck or medium truck is disabled:
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
I. Towing And Labor - continued
a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For light trucks that have a gross vehicle weight (GVW) of 10,000 pounds or less as defined by the manufacturer as the maximum loaded weight the “auto” is designed to carry, we will pay up to $50 per disablement.
c. For medium trucks that have a gross vehicle weight (GVW) of 10,001-20,000 pounds as defined by the manufacturer as the maximum loaded weight the “auto” is designed to carry, we will pay up to $150 per disablement.
However, the labor must be performed at the place of disablement.
J. Expense To Recover A Stolen Auto
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, is amended to add the following:
We will pay up to $1,000 for the expense of recovering a stolen covered “auto” to you. This Expense To Recover A Stolen Auto Coverage applies only to those owned “autos”:
1. That are four-wheel passenger-type vehicles or pick-up trucks designed for use on public roadways; and
2. For which the auto symbol 2, 3, 4 or 7 is indicated for Comprehensive coverage on the Declarations.
K. Transportation Expenses Increased
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, a. Transportation Expenses is amended to provide a limit of $100 per day, to a maximum of $3,000.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
L. Rental Reimbursement
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, is amended to add the following:
If a “loss” occurs to a covered “auto” described or designated in the Declarations with symbols 2, 3, 4 or 7 for Physical Damage Coverage, we will pay up to $100 per day for rental reimbursement expenses incurred by you for the rental of an “auto” because of an “accident” or “loss” to a covered “auto”. We will pay only for those expenses incurred after the first 24 hours following the “accident” or “loss” to the covered “auto”.
Rental Reimbursement will be on the rental of a comparable vehicle, which may be substantially less than $100 per day and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum period of 30 days.
We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered “auto”.
This coverage does not apply while there are spare or reserve “autos” available to you for your use and operation.
If the “loss” results from the total theft of a covered “auto” of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage,
4. Coverage Extensions of the Business Auto Coverage Form.
No deductible applies to this coverage. For the purposes of this endorsement, tools and equipment does not include “personal effects”.
M. “Personal Effects”
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions is amended to add the following:
If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that “auto” is stolen, we will pay, without application of deductible, up to $600 for “personal effects” stolen with the “auto”. The insurance provided under this provision is excess over any other collectible insurance available to you or your “employees”.
No deductible applies to this “Personal Effects” coverage extension. For the purposes of this endorsement, “personal effects” means tangible property that is worn or carried by an “insured”. “Personal effects” does not include tools, jewelry, money or securities.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
N. Hired Auto Physical Damage Coverage
This Hired Auto Physical Damage Coverage does not apply to Physical Damage Coverage to any hired “autos” unless symbol 1 or 8 is shown for Liability on the Declarations.
SECTION III – PHYSICAL DAMAGE COVERAGE, A. Coverage, 4. Coverage Extensions, b. Loss Of Use Expenses is replaced with the following:
a. Loss Of Use Expenses
For Hired Auto Physical Damage, we will pay expenses for which an “insured” becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by:
1. Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered “auto”;
2. Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for a covered “auto”; or
3. Collision only if the Declarations indicate that Collision Coverage is provided for any covered “auto.”
However, any expenses for loss of use will be subject to the Limit Of Insurance.
SECTION III – PHYSICAL DAMAGE COVERAGE, C. Limits Of Insurance, 1., is replaced with the following:
1. For Hired Autos Only, the most we will pay for “loss” in any one “accident” is the lesser of:
a. The actual cash value of the damaged or stolen property as of the time of the “loss”; b. The cost of repairs and loss of use charges imposed by the rental company while the property is being repaired; or
c. The cost of replacing the damaged or stolen property with other property of like kind and quality.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
O. Airbag Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE, B. Exclusions, 3.a., is amended to add the following:
However, the mechanical and electrical breakdown portion of this exclusion does not apply to the accidental discharge of an airbag.
This Airbag Coverage is applicable only if comprehensive coverage applies to the covered “auto” with symbol 2, 3, 4 or 7.
This coverage for airbags is excess over any other collectible insurance or warranty.
P. Audio, Visual And Electronic Equipment Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE, B. Exclusions, 5., is deleted and replaced by the following:
Exclusions 4.c. and 4.d. do not apply to electronic equipment that is permanently installed in the covered “auto” at the time of the “loss”, or such equipment which is removable from a housing unit which is permanently installed in the covered “auto” at the time of “loss”, and such equipment is designed to be solely operated by use of power from the “auto's” electrical system, in or upon the covered “auto”. This coverage also applies to antennas and other accessories necessary for the use of the electronic equipment.
SECTION III – PHYSICAL DAMAGE COVERAGE, C. Limits Of Insurance, 1.b is amended by replacing the most we will pay from $1,000 to $1,500.
This Audio, Visual And Data Electronic Equipment Coverage is applicable to covered “autos” with symbols 2, 3, 4 or 7 for Physical Damage Coverage.
Q. Original Equipment Manufacturer Parts Replacement
SECTION III – PHYSICAL DAMAGE COVERAGE, C. Limits of Insurance, 1. is amended to add the following:
However, if the covered “auto” has less than 25,000 miles on its odometer at the time of the loss and was purchased new by the insured within the last 24 months, we will pay the cost to replace the damaged parts (excluding glass and mechanical parts) with new original equipment manufacturer replacement parts. This applies only if the damaged parts cannot be repaired.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
R. Loan/Lease Gap Coverage
SECTION III – PHYSICAL DAMAGE COVERAGE, C. Limits of Insurance is amended to add the following:
If a covered “auto” owned by you is:
a. Shown in the Declarations with symbols 2, 3, 4 or 7 and designated as covered for Physical Damage Coverage; and
b. Shown in this policy as having a loss payee or additional insured-lessor; and c. Incurs a covered total “loss”;
we will pay the greater of:
(1) The “outstanding indebtedness” under the initial finance agreement for the covered “auto” and its equipment; or.
(2) The actual cash value, as determined by us, of the damaged or stolen property as of the time of the total “loss”. An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the “loss”.
As used here, “outstanding indebtedness” means the amount you owe on the finance agreement at the time of total “loss”:
i. Less any amounts representing taxes, overdue payments, penalties, interest, or charges resulting from overdue payments, additional mileage, excess wear and tear, or lease termination fees; and
ii. Less any administrative costs or overhead fees assessed by the finance company who has leased the covered “auto” to you; and
iii. Less security deposits not returned by the lessor; and iv. Less costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and
v. Less carry-over balances from previous loans or leases; and. vi. Less final payments due under a “balloon loan”; and vii. Less the dollar amount of any unrepaired damage which occurred prior to the “total loss” of a covered “auto”
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
R. Loan/Lease Gap Coverage - continued
Additional Condition
This coverage applies only to the:
(1) Original loan for which the covered “auto” serves as collateral; or (2) Lease written on a covered “auto”.
Additional Definitions
For the purposes of this endorsement:
(1) “Balloon loan” means a loan with periodic payments that are not enough to fully repay the entire amount of the balance, resulting in a large final payment. (2) “Total loss” means a loss in which the cost of repairs plus the salvage value exceeds the actual cash value.
S. Waiver Of Depreciation – Private Passenger Vehicle
SECTION III – PHYSICAL DAMAGE COVERAGE, C. Limits of Insurance is amended to add the following:
If we deem a covered “auto” of the private passenger type to be a total “loss” within 90 days of your purchase of the “auto”, and it has not been previously titled under the motor vehicle laws of any state, at our option we may:
a. Replace the covered “auto” with a new “auto” of like make, model and year; or b. Pay you an amount equal to the cost of the covered “auto” as purchased new, including taxes. This coverage does not apply to a leased “auto”.
T. Glass Repair – Waiver Of Deductible
SECTION III – PHYSICAL DAMAGE COVERAGE, D. Deductible is amended to add the following:
No deductible applies to glass damage if the glass is repaired in a manner acceptable to us rather than replaced.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
U. Common Deductible
SECTION III – PHYSICAL DAMAGE COVERAGE, D. Deductible is amended to add the following:
If a “loss” covered under this Coverage Form also involves a covered “loss”, under another Commercial Property Coverage Form that we are providing coverage for the named insured, only one Deductible, the largest, will be applied. The deductible under the other coverage form will be waived.
SECTION IV – BUSINESS AUTO CONDITIONS
V. Duties In The Event Of Accident, Claim, Suit Or Loss SECTION IV – BUSINESS AUTO CONDITIONS, A. Loss Conditions, 2. Duties In The Event Of Accident, Claim, Suit Or Loss, a. is deleted in its entirety and replaced by the following:
Your obligation to notify us promptly of an “accident”, claim, “suit” or “loss” is satisfied if you send us the required notice as soon as practicable after your insurance administrator or anyone else designated by you to be responsible for insurance matters is notified, or in any manner made aware, of an “accident”, claim, “suit” or “loss”.
Notice should include:
(1) How, when and where the “accident” or “loss” occurred; and (2) The “insured’s” name and address; and
(3) To the extent possible, the names and address of any injured persons and witnesses.
Written notice by or on behalf of the injured person or any other claimant to our authorized representative shall be deemed notice to us.
W. Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) SECTION IV – BUSINESS AUTO CONDITIONS, A. Loss Conditions, is amended to add the following:
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) named in an “insured contract” or written agreement, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under a contract with that person or organization.
COMMERCIAL AUTO ENHANCEMENT ENDORSEMENT
COMMERCIAL AUTO POLICY
CAL 01 01 06 19 CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
X. Unintentional Failure To Disclose Hazards
SECTION IV – BUSINESS AUTO CONDITIONS, B. General Conditions, 2.
Concealment, Misrepresentation Or Fraud is amended to add the following:
However, if you unintentionally fail to disclose any hazards existing at the inception date of this policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal.
Y. Cancellation – 60 Days Notice
SECTION IV – BUSINESS AUTO CONDITIONS, B. General Conditions, is amended to add the following:
If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the First Named Insured, at the last mailing address known to us, written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancellation.
SECTION V – DEFINITIONS
Z. “Mental Anguish” Resulting From “Bodily Injury”
SECTION V – DEFINITIONS, C. “Bodily injury” is deleted in its entirety and replaced by the following:
“Bodily injury” means bodily injury, sickness or disease sustained by a person including death or “mental anguish” resulting from any of these at any time.
SECTION V – DEFINITIONS, is amended to add the following:
“Mental anguish” means any type of mental or emotional illness or disease.
COMMERCIAL AUTO
CA 04 49 11 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. The following is added to the Other Insurance
Condition in the Business Auto Coverage Form
and the Other Insurance – Primary And Excess
Insurance Provisions in the Motor Carrier
Coverage Form and supersedes any provision to
the contrary:
This Coverage Form's Covered Autos Liability
Coverage is primary to and will not seek
contribution from any other insurance available to
an "insured" under your policy provided that:
1. Such "insured" is a Named Insured under such
other insurance; and
2. You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution from
any other insurance available to such
"insured".
B. The following is added to the Other Insurance
Condition in the Auto Dealers Coverage Form and
supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability
Coverage and General Liability Coverages are
primary to and will not seek contribution from any
other insurance available to an "insured" under
your policy provided that:
1. Such "insured" is a Named Insured under such
other insurance; and
2. You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution from
any other insurance available to such
"insured".
CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 Policy Number: 325699
FOLLOWING FORM ENDORSEMENT
COMMERCIAL LIABILITY UMBRELLA POLICY
CU 62 07 09 21 NY CUMIS Insurance Society, Inc.
Includes copyrighted material of Insurance Services Office, Inc., with its permission
This endorsement changes the Policy. Please read it carefully. This endorsement modifies insurance provided under the following:
Commercial Liability Umbrella Coverage Part
The insurance provided under this Policy will follow the same provisions, exclusions and limitations that are contained in the applicable “underlying insurance”, unless otherwise directed by this Policy. To the extent provisions of “underlying insurance” conflict with the provisions of this Policy, the provisions of this Policy will apply. However, the coverage provided under this Policy will not be broader than that provided by the applicable “underlying insurance.”
There may be more than one “underlying insurance” listed in the Declarations. When provisions in those policies conflict, and are not superseded by the provisions of this Policy, the provisions, exclusions and limitations of the “underlying insurance” applicable to the particular “occurrence” or offense which results in a claim or “suit” will apply.
Notwithstanding anything to the contrary in this Policy, the insurance coverage afforded by this Policy as respects operations in New York State shall conform to the requirements of the applicable New York State Insurance Laws and the applicable New York State Department of Financial Services Regulation; provided, however, that the limits of liability as stated in this Policy shall be excess of the limits of liability of any “underlying insurance” as stated in the Declarations or in any endorsement attached hereto.
This provision still applies when the “underlying insurance” is issued by an unlicensed company.
Policy Number: 325700
POLICY NUMBER: COMMERCIAL LIABILITY UMBRELLA
CU 24 03 09 00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CU 24 03 09 00 Copyright, Insurance Services Office, Inc., 2000 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
BLANKET AS REQUIRED BY WRITTEN CONTRACT
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
The Transfer Of Rights Of Recovery Against Others To Us Condition under Section IV – Conditions is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard".
This waiver applies only to the person or organization shown in the Schedule above. 325700
POLICY #325700
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WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
WC 00 0313
(Ed. 04-84)
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 as required by written contract 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 7/1/2026
Insured
Policy No. MWC1042097
Insurance Company
C & S Engineers Inc
Milford Casualty Insurance Company
Endorsement No. 0
Countersigned by _________________ _
WC 00 0313
(Ed. 04-84)
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
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 WVDADDL
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
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
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 EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER 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
10/1/2026
Edgewood Partners Ins Center
3780 Mansell Rd. Suite 370
Alpharetta GA 30022
EPIC Construction & Design COI Team 770-552-4225 770.756.6599 [email protected] Berkley Assurance Company 39462 C&SWORL C&S Engineers, Inc.
499 Col. Eileen Collins Blvd
Syracuse, NY 13212-0000
368423737
A Professional Liability
incl. Pollution Liability
PCAB50317430726 7/1/2026 7/1/2027 Per Claim
Aggregate
$5,000,000
$5,000,000
Waiver of Subrogation is applicable where required by written contract & allowed by law. Should any of the above described policies be cancelled by the issuing insurer before the expiration date thereof, we will endeavor to provide 30 days' written notice (except 10 days for nonpayment of premium) to the Certificate Holder. Professional liability retroactive date 1/1/1968.
City of Fullerton
303 W. Commonwealth Ave.
Fullerton CA 92832