Vernon City Council
June 3, 2025

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DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E

INSURANCE
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E

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
4/11/2023
Orr & Associates Insurance Services
28780 Single Oak Dr
Ste 255
Temecula CA 92590
Certificates 800-311-3081 800-474-3003 [email protected] License#: 0E63493 Associated Industries Ins. Co. 23140 RAMCGEN-01 Mt. Hawley Insurance Company 37974 Ramco General Engineering Contractor
PO Box 920878
Sylmar CA 91392
State Compensation Ins Fund 35076 AmGuard Insurance Company 42390 139958973 A X 1,000,000 X 100,000 5,000 1,000,000 2,000,000 X
AES102897410 4/11/2023 4/11/2024
2,000,000
D 1,000,000 X
X X
EMAU343335 7/13/2022 7/13/2023
B X 2,000,000 X
GXS0011633 4/11/2023 4/11/2024
2,000,000
C 9226904-2023 3/1/2023 3/1/2024
1,000,000 1,000,000 1,000,000
Certificate is subject to policy limits, conditions and exclusions.

City of Vernon is named as Certificate Holder.

City of Vernon
4305 Santa Fe Ave
Vernon, CA 90058
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E AES102897410
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E AES102897410
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E AES102897410
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E AES102897410
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E AES102897410
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E

COMMERCIAL AUTO
BA 99 04 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT
This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This provision does not apply in regard to any ownership, maintenance or use of the additional insured’s “autos.” Additional Insured When Required by Contract
(1) Paragraph A.1. – WHO IS AN INSURED –
of Section II – Liability Coverage is
amended to add:
d. When you have agreed, in a written
contract or written agreement, that a
person or organization be added as an
additional insured on your business auto
policy, such person or organization is an
“insured”, but only to the extent such
person or organization is liable for
“bodily injury” or “property damage”
caused by the conduct of an “insured”
under paragraphs a. or b. of Who Is An
Insured with regard to the ownership,
maintenance or use of a covered “auto.”
The insurance afforded to any such
additional insured applies only if the
“bodily injury” or “property damage”
occurs:
(1) During the policy period, and
(2) Subsequent to the execution of such
written contract, and
(3) Prior to the expiration of the period
of time that the written contract
requires such insurance be provided
to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
most we will pay on behalf of such
additional insured is the lesser of:
(a) The limits of insurance specified in
the written contract or written
agreement; or
(b) The Limits of Insurance shown in
the Declarations.

Such amount shall be a part of and not
in addition to Limits of Insurance shown
in the Declarations and described in this
Section.
(3) Additional Insureds Other Insurance
If we cover a claim or “suit” under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional
insured must submit such claim or “suit”
to the other insurer for defense and
indemnity.

However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that the insurance is primary and noncontributory with the additional insured’s own insurance.
(4) Duties in The Event Of Accident, Claim,
Suit or Loss
If another person or organization is
added as an additional insured on your
policy, the additional insured shall be
required to comply with the provisions in
A. Loss Conditions 2. – Duties In The
Event Of Accident, Claim, Suit Or
Loss – of SECTION IV – BUSINESS
AUTO CONDITIONS, in the same
manner as the Named Insured.

DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E

COMMERCIAL AUTO
BA 99 02 09 08
BA 99 02 09 08 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

BLANKET WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is amended by adding the following:

We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form.

DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E

RAMCO GENERAL ENGINEERING CONTRACT
PO BOX 920878
SYLMAR, CA 91392

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.

THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM.

SCHEDULE
EFFECTIVE March 1, 2023 AT 12:01 AM.

AND EXPIRING March 1, 2024 AT 12:01 AM
9226904-23

RENEWAL
Southern
5446627

HOME OFFICE

SAN FRANCISCO

ALL EFFECTIVE DATES
AT 12:01 AM PACIFIC

STANDARD TIME OR THE

TIME INDICATED AT

PACIFIC STANDARD TIME

PERSON OR ORGANIZATION

ANY PERSON OR ORGANIZATION

FOR WHOM THE NAMED INSURED

HAS AGREED BY WRITTEN

CONTRACT TO FURNISH THIS
WAIVER

JOB DESCRIPTION

BLANKET WAIVER OF SUBROGATION

NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL

BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: February 28, 2023

AUTHORIZED REPRESENTATIVE
2572
SCIF FORM 10217 (REV. 4 - 2018)

PRESIDENT AND CEO
OLD DP 217

ENDORSEMENT AGREEMENT

WAIVER OF SUBROGATION
BLANKET BASIS Page 1
DocuSign Envelope ID: C6A68051-A386-458F-B90D-40D0E5D5650E