DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
4/3/2023
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 INSURERS), 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 endorsements).
PRODUCER Patriot Risk & Insurance Services Annette Romero 18952 MacArthur Blvd., Suite #300 949-486-7904 I FAC, No:
Irvine, CA 92612 [email protected]
INSURERS) AFFORDING COVERAGE NAIC #
www.patrisk.com 0K07568 INSURER A: Travelers Indemnity Company of CT 25682 INSURED INSURER B: Travelers Property Casualty Company of America 25674 Empire Pipe Cleaning & Equipment Inc.
INSURER C:
1788 North Neville
Orange CA 92865 INSURER D:
INSURER E:
INSURER F:
CERTIFICATE NUMBER: 73730685 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
ADDL SUBR LIMITS
TYPE OF INSURANCE INSD. MVD. POLICY NUMBER
COMMERCIAL GENERAL LIABILITY DT22C06K521249TCT23 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
CLAIMS-MADE / OCCUR PREMISES (Ea occurrence) $ 50,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY / PRO. LOC PRODUCTS - COMP/OP AGG
ECT $2,000,000
OTHER:
4/1/2023 OMBINED SINGLE LIMI
A AUTOMOBILE LIABILITY 8105P8053352326G 4/1/2024 Ea accident $ 1,000,000 / ANY AUTO BODILY INJURY (Per person)
OWNED | SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED VON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
UMBRELLA LIAB CUP6K4432472326 4/1/2023 4/1/2024 EACH OCCURRENCE $2,000,000 OCCUR
EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
DED RETENTION S
B WORKERS COMPENSATION [UB6K5209112326G 4/1/2023 4/1/2024 • STATUTE |
AND EMPLOYERS' LIABILITY
PROPRIETOR/PARTNER/EXECUT E.L. EACH ACCIDENT $1,000,000 "CER/MEMREREXCI UDR N/ A
Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 res, describe und
SCRIPTION OF OPFRATIONS beld E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Riy or Redondo Can, its
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ity of Redondo Beac THEREOF, NOTICE WILL BE DELIVERED IN Diamond Stree
Redondo Beach CA 90277
AUTHORIZED REPRESENTATIVE
Sie A. Jacker
Dave Jacobson
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 130695 certificate suncels •Annette Honest PM (PST 13
his supersedes ALL / previously issued certificates.
DT22CO6K521249TCT23 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Section II) is amended
to include any person or organization that you
agree in a "written contrac requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or "personal injury"; and to provide such coverage for that additional insured, and then the insurance provided to
b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts
or omissions of such person or organization.
3. The insurance provided to the additional insured
2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance" . whether primary. a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is (his Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the "written contract requiring insurance", , the in- "writen contract requiring insurance" specifically surance provided to the additional insured requires that this insurance apply on a primary shall be limited to the limits of liability re- basis or a primary and non-contributory basis, quired by that "written contract requiring in- this insurance is primary to "other insurance" surance". This endorsement shall not in- available to the additional insured which covers crease the limits of insurance described in that person or organization as a named insured Section Ill - Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to
b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erly damage" or "personal injury" arising out , whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services, including: an additional insured under such other insur- i. The preparing, approving, or failing to
prepare or approve, maps, shop draw- 4. As a condition of coverage provided lo the ings, opinions, reports, surveys, field or- additional insured by this endorsement:
ders or change orders, or the preparing.
approving, or failing to prepare or ap- a) The additional insured must give us written prove, drawings and specifications; and notice as soon as practicable of an "occur- rence" or an offense which may result in a
ii. Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities.
CG D2 46 08 05 © 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 Annere Honorn
This certificate cancers and supersedes ALl Previously issued certificates.
COMMERCIAL GENERAL LIABILITY
i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we cover under this endorsement. However, this
ii. The names and addresses of any injured
condition does not affect whether the insur-
persons and wilnesses, and
ance provided to the additional insured by
ili. The nature and location of any injury this endorsement is primary to "other insur- damage arising out of the "occurrence" or ance" available to the additional insured offense. which covers that person or organization as a
b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. the additional insured, the additional insured above.
5. The following definition is added to SECTION V.
i. Immediately record the specifics of the - DEFINITIONS:
claim or "suit" and the date received; and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement under which you are required lo include a
The additional insured must see to it that we
person or organization as an additional in-
receive written notice of the claim or "suit" as
sured on this Coverage Part, provided that
soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed:
connection with the claim or "suit", cooperate a. After the signing and execution of the with us in the investigation or settlement of contract or agreement by you; the claim or defense against the "suit", and
otherwise comply with all policy conditions. b. White that part of the contract or agreement is in effect; and
d) The additional insured must tender the de-
fense and indemnily of any claim or "suit" to c. Before the end of the policy period.
000858
1373068522124 GL/AULUMB/C/Annetto Ronoco4/3/20232041626 BMIR$B) | this certificate cancels and saue dedes bevi sta sues gees b DT22CO6K521249TCT23
Empire Pipe Cleaning & Equipment Inc.
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS XTEND ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Aircraft Chartered With Pilot H. Blanket Additional Insured - Lessors Of Leased Equipment
B. Damage To Premises Rented To You
I. Blanket Additional Insured - States Or Political
C. Increased Supplementary Payments
Subdivisions - Permits
D. Incidental Medical Malpractice
J. Knowledge And Notice Of Occurrence Or Offense
E. Who Is An Insured - Newly Acquired Or Formed
Organizations K. Unintentional Omission
F. Who Is An Insured - Broadened Named Insured L. Blanket Waiver Of Subrogation - Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured - Owners, Managers N. Contractual Liability - Railroads Or Lessors Of Premises
PROVISIONS INJURY AND PROPERTY DAMAGE LI-
A. AIRCRAFT CHARTERED WITH PILOT ABILITY:
The following is added to Exclusion g., Aircraft, Exclusions c. and g. through n. do not apply to "premises damage". Exclusion f.(1)(a)
Auto Or Watercraft, in Paragraph 2. of SECTION
I - COVERAGES - COVERAGE A BODILY IN- does not apply to "premises damage" caused JURY AND PROPERTY DAMAGE LIABILITY: by:
This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion;
(a) Chartered with a pilot to any insured; c. Lightning; (b) Not owned by any insured; and d. Smoke resulting from such fire, explosion, or lightning; or
(C) Not being used to carry any person or prop-
erty for a charge. e. Water;
B. DAMAGE TO PREMISES RENTED TO YOU unless Exclusion f. of Section I - Coverage A
1. The first paragraph of the exceptions in Ex- - Bodily Injury And Property Damage Liability clusion J., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION 1 - COVERAGES - Coverage Part that has Exclusion - All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- clusion in its title.
PROPERTY DAMAGE LIABILITY is deleted.
2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I - "premises damage" as described in Para- COVERAGES - COVERAGE A. BODILY graph 6. of SECTION III - LIMITS OF IN- SURANCE.
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved Page 1 of 6 73730685 | 23/24 GL/A0/UMB/NC| Annette Romero | 4/3/2023 2:41:26 PM (PST) | This certificate cancers and supersedes ALl/ 320v sly issued certificates 13
COMMERCIAL GENERAL LIABILITY
3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III - LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS - COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I - COVER- pay under Coverage A for damages because AGE:
of "premises damage" to any one premises b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You
required because of accidents or traffic
Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- fire; explosion; lightning; smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or
any combination of any of these causes. 2. The following replaces Paragraph 1.d. of
SUPPLEMENTARY PAYMENTS - COVER-
The Damage To Premises Rented To You AGES A AND B of SECTION I - COVER- Limit will be: AGES:
a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work.
Part. D. INCIDENTAL MEDICAL MALPRACTICE
4. The following replaces Paragraph a. of the 1. The following is added to the definition of "oc- definition of "insured contract" in the DEFINI- currence" in the DEFINITIONS Section:
TIONS Section:
"Occurrence" also means an act or omission
a. A contract for a lease of premises. How- committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services" to a person. person or organization for "premises
damage" is not an "insured contract"; 2. The following is added to Paragraph 2.a. (1) of SECTION II - WHO IS AN INSURED:
5. The following is added to the DEFINITIONS
Paragraph (1)(d) above does not apply to
Section:
"bodily injury" arising out of providing or fall-
"Premises damage" means "property dam- ing to provide:
age" to:
(1) "Incidental medical services" by any of
a. Any premises while rented to you or tem- your "employees" who is a nurse practi- porarily occupied by you with permission
tioner, registered nurse, licensed practical
of the owner; or nurse, nurse assistant, emergency medi- cal technician or paramedic; or
(il) First aid or "Good Samaritan services" by
consecutive days. any of your "employees" or "volunteer workers", other than an employed or vol-
6. The following replaces Paragraph 4.b. (1)(b) unteer doctor. Any such "employees" or of SECTION IV - COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or "Good Samaritan ser- (b) That is insurance for "premises damage"; vices" during their work hours for you will or be deemed to be acting within the scope
7. Paragraph 4.b.(1)(c) of SECTION IV - of their employment by you or performing
COMMERCIAL GENERAL LIABILITY CON-
DITIONS is deleted. ness.
i cereate 23/24 G7407045/NG 1 CAnnetta korato 17372023 2:41:26 PM (PS1) cancels and supersedes All previously ssued certificates
COMMERCIAL GENERAL LIABILITY
3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III - LIMITS OF INSURANCE: other than a partnership, joint venture or lim- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or "Good Samaritan services" to any one per- which provides similar coverage to that or- son will be deemed to be one "occurrence". ganization. However:
4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I - COV- only:
ERAGES - COVERAGE A BODILY INJURY (1) Until the 180th day after you acquire or AND PROPERTY DAMAGE LIABILITY: for the organization or the end of the Sale Of Pharmaceuticals policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or (2) Until the end of the policy period, when consent of, the insured. that date is later than 180 days after you
5. The following is added to the DEFINITIONS acquire or form such organization, if you Section: report such organization in writing to us
"Incidental medical services" means: within 180 days after you acquire or form it, and we agree in writing that it will con-
a. Medical, surgical, dental, laboratory, x-ray tinue to be a Named Insured until the end or nursing service or treatment, advice or
instruction, or the related fumishing of of the policy period; food or beverages; or b. Coverage A does not apply to "bodily injury" b. The furishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization; and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization.
6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED - BROADENED NAMED cess Insurance, of SECTION IV - COM- INSURED - UNNAMED SUBSIDIARIES
MERCIAL GENERAL LIABILITY CONDI-
TIONS: The following is added to SECTION II - WHO IS
AN INSURED:
The insurance is excess over any valid and
collectible other insurance available to the in- Any of your subsidiaries, other than a partnership, sured, whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. ", first aid or "Good Samaritan services" No such subsidiary is an insured for "bodily injury" to any person to the extent not subject to or "property damage", that occurred, or "personal Paragraph 2.a.(1) of Section II - Who Is An injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the
E. WHO IS AN INSURED - NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- The following replaces Paragraph 4. of SECTION sidiary.
I| - WHO IS AN INSURED:
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 pt/A0/0MB/WC 4/372023 2:41:26 PN TESTT
supersedes ALl previously saued certi fricates.
COMMERCIAL GENERAL LIABILITY
G. BLANKET ADDITIONAL INSURED - OWNERS, H. BLANKET ADDITIONAL INSURED - LESSORS
MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT
The following is added to SECTION II - WHO IS The following is added to SECTION II - WHO IS AN INSURED: AN INSURED:
Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for "bodily injury", "property dam- for "bodily injury", "property damage", "personal age", "personal injury" or "advertising injury" that:
injury" or "advertising injury" that:
a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising
occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement; and tract or agreement; and
b. Is caused, in whole or in part, by your acts or
b. Arises out of the ownership, maintenance or omissions in the maintenance, operation or use of that part of any premises leased to use of egulpment leased to you by such equipment lessor.
The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions:
visions:
a. The limits of insurance provided to such
a. The limits of insurance provided to such equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations, whichever are less. the limits shown on the Declarations, which-
b. The insurance provided to such equipment
ever are less.
lessor does not apply to any "bodily injury" or
b. The insurance provided to such premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury" or "advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or "personal injury" or "adver- lease expires. tising injury" caused by an offense that is The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises; or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or
c. The insurance provided to such premises non-contributory with, such other insurance, owner, manager or lessor Is excess over any in which case this insurance will be primary valid and collectible other Insurance available to, and non-contributory with, such other in- surance.
to such premises owner, manager or lessor,
whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED - STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS - PERMITS the written contract or agreement that this in-
The following is added to SECTION II - WHO IS
surance must be primary to, ornon.
contributory with, such other insurance, in AN INSURED:
which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required
73730685 23/24 GL/A0/UMB/NC I Annette Romaro I 4/3/2023 2:41:26 PM (PST) This certificate cancels and supersedes ALL 203 1y issued certificates 13 icates.
COMMERCIAL GENERAL LIABILITY
by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company; or an insured, but only with respect to liability for (ill) An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury" or "advertising injury" arising out of such op- that is your partner, joint venture erations.
member or manager; or
The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury" or "advertising injury" arising out to give notice of an "occurrence" or of operations performed for that state or po- offense.
litical subdivision; or (3) Notice to us of such "occurrence" or of an b. Any "bodily Injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work-
KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us of the "occurrence" or offense as soon as
The following is added to Paragraph 2., Dutles In practicable after any of the persons de- The Event of Occurrence, Offense, Claim or
Sult, of SECTION IV - COMMERCIAL GEN- scribed in Paragraphs e. (1) or (2) above discovers that the "occurrence" or offense
ERAL LIABILITY CONDITIONS:
may result in sums to which the insurance
e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply.
surance provided under this Coverage Part to
you or any insured listed in Paragraph 1. or 2. However, if this Coverage Part includes an en- dorsement that provides limited coverage for
of Section II - Who Is An Insured:
"bodily injury" or "property damage" or pollution
(1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of "pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment.
is an individual (if you are a limited liability K. UNINTENTIONAL OMISSION company, any of your "executive offi-
cers" or directors (if you are an organiza- The following is added to Paragraph 6., Repre- tion other than a partnership, joint venture sentations, of SECTION IV - COMMERCIAL or limited liability company or any "em- GENERAL LIABILITY CONDITIONS:
ployee" authorized by you to give notice The unintentional omission of, or unintentional of an "occurrence" or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company, and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence" or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence" or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (1) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV - COMMERCIAL GENERAL LI- ABILITY CONDITIONS:
CG D3 16 11 11 © 2011 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 2724 GLAMOUR W | Anrette Romero l 473/2023 2:41:26 PM PSTI Page 8 of 13 This certificate cancels and supersedes ALl previously issued certificates.
COMMERCIAL GENERAL LIABILITY
If the insured has agreed in a contract or agree- "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury, shock, fright, disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY - RAILROADS curs; or 1. The following replaces Paragraph c. of the
b. "Personal injury" or "advertising injury" definition of "insured contract" in the DEFINI- caused by an offense that is committed; TIONS Section:
subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- leted.
The following replaces the definition of "bodily
injury" in the DEFINITIONS Section:
icates.
8105P8053352326G
Empire Pipe Cleaning & Equipment Inc. COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered.
A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF
USE - INCREASED LIMIT
B. BLANKET ADDITIONAL INSURED
I. PHYSICAL DAMAGE - TRANSPORTATION
C. EMPLOYEE HIRED AUTO EXPENSES - INCREASED LIMIT
D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY
E. SUPPLEMENTARY PAYMENTS - INCREASED K. AIRBAGS
LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR
F. HIRED AUTO - LIMITED WORLDWIDE COV- LOSS
ERAGE - INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE - GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS
PROVISIONS
A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II - COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II.
Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II - COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE:
Coverage under this provision is afforded only un- An "employee" of vours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi-
B. BLANKET ADDITIONAL INSURED ness.
The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II - COVERED Other Insurance, of SECTION IV - BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS:
Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos" you own:
executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 23/21 GLAD/UMB/NC 10 01 13
This certificate cancels and supersedes ALL previously issued certificates.
COMMERCIAL AUTO
permission, while performing duties
related to the conduct of your busi-
ness.
However, any "auto" that is leased, hired,
rented or borrowed with a driver is not a
covered "auto".
D. EMPLOYEES AS INSURED Sie any such tain or sit are rea The following is added to Paragraph A.1., Who Is
LABILITY COVERIN I - COVERED AUTOS tions.
(il) Neither you nor any other involved
Any "employee" of yours is an "insured" while us- insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs.
(liü) We may, at our discretion, participate
E. SUPPLEMENTARY PAYMENTS - INCREASED in defending the "insured" against, or LIMITS in the settlement of, any claim or
1. The following replaces Paragraph A.2.a.(2), "suit".
of SECTION |I - COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must
(2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para-
graph C., Limits Of Insurance, of
2. The following replaces Paragraph A.2.a.(4), SECTION II - COVERED AUTOS of SECTION II - COVERED AUTOS LIABIL-
ITY COVERAGE: LIABILITY COVERAGE.
(v) We will reimburse the "insured" for
(4) All reasonable expenses incurred by the
the reasonable expenses incurred
"insured" at our request, including actual
with our consent for your investiga-
loss of eamings up to $500 a day be- tion of such claims and your defense cause of time off from work.
of the "insured" against any such
F. HIRED AUTO - LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE - INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory. SECTION II - COVERED AUTOS of SECTION IV - BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to
make such payments ends when we
(5) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanction, em-
bargo, or similar regulation imposed by the insurance in payments for damages, settlements or defense expenses.
United States of America applies to and pro-
hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada.
members of their households.
Includes copyrighted material of Insurance Services Office, Inc. with its permission. 73430685 23724 GL/AU/0MB7NC IT ANNELEE RomerO 77372023 2:01:20 PM (POT This certificate cancels and supersedes All previously issued certificates
COMMERCIAL AUTO
ou agree to maintain all required o (2) In or on your covered "auto". ompulsory insurance in any such cour
Thit of your evered only in the event of a total
No deductibles apply to this Personal Property
coverage.
K. AIRBAGS
The following is added to Paragraph B.3., Exclu
COVER SECTION I PHYSICAL DAMAGE
surance requirements.
(d) It is understood that we are not an admit-
ted or authorized insurer outside the
United States of America, its territories
and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only:
furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE - GLASS ranty; and
The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III - PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss".
No deductible for a covered "auto" will apply to L. • NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS
replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF SECTION IV - BUSINESS AUTO CONDITIONS:
USE - INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III - PHYSICAL DAMAGE COVERAGE: to:
However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner (if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- l. PHYSICAL DAMAGE - TRANSPORTATION
EXPENSES - INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses,' of ganization); or SECTION III - PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- tice of the "accident" or "loss".
We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto" of the private passenger type. of SECTION IV - BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS:
The following is added to Paragraph A.4., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III - PHYSICAL Others To Us
DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract
We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or "loss", provided that the "accident" or "loss" (1) Owned by an "insured"; and arises out of operations contemplated by CA T3 53 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission.
This certificate cancels and supersedes ALl previously issued certificates 13 23/24 GL/AU/UME/WC| Annette Pomero 4/3/2023 2:41:26 PM
COMMERCIAL AUTO
such contract. The waiver applies only to th The unintentional omission of, or unintentional erson or organization designated in suc error in, any information given by you shall not contract. prejudice your rights under this insurance. How- ever this provision does not affect our right to col-
lect additional premium or exercise our right of
cancellation or non-renewal.
Includes copyrighted materlal of Insurance Services Office, Inc. with its permission.
GETAU URE Annette konaro age 13 0i1
his certíficat cancels ertificates