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Contract - Elecnor Belco Electric, Inc. - 11/21/2024 BID COPY/ORIGINAL CITY OF ROUND ROCK TRANSPORTATION DEPARTMENT ROUND ROCK TEXAS Project Manual For: TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BLVD September 2024 Prepared By: APPROVED B — CITY ATTORNEY : GVV TIMOTFIY ORIIES � :.....100107.....:... f 1'PO <�CENSI!0'* ' 710 Hesters Crossing Rd #150 11�Z�ONAL 6�G� Round Rock, TX 78681 Date: X2024.09.09 09:03:15-05'00' TBPE Firm Registration No F-754 BID FORM PROJECT NAME: TRAFFIC SIGNAL AT SAM BASS ROAD&OLD SETTLERS BLVD PROJECT LOCATION: Round Rock,Texas OWNER: City of Round Rock, Texas DATE: October 17,2024 Gentlemen: Pursuant to the foregoing Notice to Bidders and Instructions to Bidders, the undersigned bidder hereby proposes to do all the Work, to furnish all necessary superintendence, labor, machinery, equipment, tools, materials, insurance and miscellaneous items,to complete all the Work on which he bids as provided by the attached Bid Documents, and as shown on the plans for the construction of Traffic Signal at Sam Bass Road&Old Settlers Blvd and binds himself on acceptance of this bid to execute the Agreement and bond for completing said Work within the time stated,for the following prices,to wit: Any addenda issued will be posted with the Project Manual and/or Contract Documents on the City's website at https://www.roundrocktexas.sov/businesses/solicitations/ by the end of day on Monday October 14th,2024 . Prior to submitting a bid, the bidder is responsible for determining if any addenda have been issued and for following any instructions in any addenda issued. Bidder acknowledges receipt of the following Addenda by listing Addendum "number" and "date". BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 1 1 LS MOBILIZATION � compl tom place p Ur �, ���h+ l�v►,�nL for dollars c and cents. I d ��•� �i ��U ' 2 9 MO BARRICADES, SIGNS,AND TRAFFIC HANDLING complete in place per I' V v 1A.���I Vz for ��V,rj� dollars and cents. 7104 ' r 1,5bo' 60 00300-9-2015 Page 1 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 3 21 CY EXCAV(ROADWAY) complete in place per for Qt4,,#f//1 f1a, dollars and �� cents. �b2 3�q oz, cA3 4 29 CY EMBANK(FNL)(OC)(TY B) ] complete in place per for Ute!7'n� 4 �j.��{,�,h/ dollars and ?Z*-& cents. 11-5• UO 3i 3�' w 5 510 SY FURN&PLACE TOP SOIL(4") complete in place per w for �� dollars and cents. 2� d..• to 6 510 SY BROADCAST SEED (PERM—URBAN—CLAY) complete in place per for V dollars and 1'1Z, 9OS• w cents. 00300-9-2015 Page 2 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 7 1 TGL VEGETATIVE WATERING complete in place per for V!`e, y dollars and 2z✓b cents. l G U6 . Lo ( l Gv 0. 0% 8 4 CY FLOWABLE BACKFILL complete in place pe��r,,�� for—Pio o 4VrJ,,4,,Fw q-Vjyldollars and cents. ZZ ib• W 1111 • Uv 9 39 LF DRILL SHAFT(TRF SIG POLE)(36 IN) complete in place per for f.tA*AY, %j l }% dollars and 2eA cents. 3 b 1 S' d 1-5- 10 s10 13 CY RIPRAP(CONC)(4 IN) complete in place per 1 ' for Vn and 1--eyb cents. 03 00300-9-2015 Page 3 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 11 71 LF RAIL(HANDRAIL)(TY B) complete in place per for ' '"n�Y'��1/ ,""I� �Vt dollars and cents. Z 5• Zd� Z 3 �'• w 12 32 LF RC PIPE(ARCH)(CL III)(DES 2) complete in place per for (/✓✓ ►y1Y�,� dollars and cents. y ?y� �0 V• 14 13 2 EA SET(TY II)(DES 2)(RCP)(6:1)(P) complete in place per for -V�fV.eo -Noys V4 dollars and -;Lew cents. 3, to d • W 4, 606 . 00 14 67 LF ROCK FILTER DAMS (INSTALL) (TY 1) complete in place per for dollars and cents. 3 3 • �° 00300-9-2015 Page 4 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 15 40 LF ROCK FILTER DAMS (INSTALL) (TY 3) complete in place per for �i`��'� 1��- dollars and Z� t* cents. �S ' 3, ttd 0' to 16 107 LF ROCK FILTER DAMES(REMOVE) complete in place per for TVV ft-t-y dollars and cents. 17 222 SY CONSTRUCTION EXITS (INSTALL)(TY 1) ,LL complete in place per for �n` �-( dollars and 3a• Go &,660 . w cents. 18 222 SY CONSTRUCTION EXITS (REMOVE) complete in place per for f N QA ye, dollars and 2x tb cents. 2' 2 1 4e 4 y. W 00300-9-2015 Page 5 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 19 134 LF TEMP SEDMT CONT FENCE (INSTALL) complete in place per for t-t dollars and -Z-'e Y cents. U Ob 20 134 LF TEMP SEDMT CONT FENCE (REMOVE) complete in place per for FU Vdollars and 2,ev u cents. `�• W 21 151 LF CONC CURB(MONO)(TY II) complete in place per 03w for �F YL ,✓�i dollars S GO G,,71,C.ef W and ✓ cents. 22 106 SY CONC SIDEWALK(4") complete in place per for �►� I "� J VZ- dollars and ° cents. v S' 60 00300-9-2015 Page 6 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 23 1 EA CURB RAMPS(TY 1) ��`` complete in place per fors W✓ 1)WVS,(4 ,Vt 4VA 4 dollars and !4 H cents. '41 5b If, SIG • (p 24 3 EA CURB RAMPS(TY 7) complete in place per for'��L�h��S A'y� ✓�Nv�/wa dollars 5 Sb G. and .l �. SU CA) cents. �w 25 290 LF COND(PVC)(SCH 80)(2") complete in place per for-fyq c,y»-,-%— dollars and 171M cents. 2 W ► g b P. �q 26 405 LF CONDT(PVC)(SCH 80)(3") complete in place per for �h f�j —9W dollars and Vre4i cents. 2`• Vo /G ► S3U. 00 00300-9-2015 Page 7 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 27 675 LF CONDT(PVC)(SCH 80)(3") (BORE)W/PRESSURE GROUT CONCRETE complete in place per for &L-R,, dollars and -z4-1y cents. y b • LA) 28 50 LF CONDT(PVC)(SCH 80)(4") complete in place per w for fg-3�1, f's�•� dollars and -7-4w cents. ta' 2, 2�b • W 29 1330 LF ELEC CONDR(NO. 8)BARE /, complete in place per for �tiC, dollars � , c� p 2, 527. E and ( 11 cents. 30 1500 LF ELEC CONDR(NO. 8) INSULATED ' complete in place per for U dollars N • . g� 2� �.b• W and � cents. 00300-9-2015 Page 8 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 31 80 LF ELEC CONDR(NO.6)BARE complete in place per for -Trje,n� dollars and :Fv, � cents. 32 160 LF ELEC CONDR(NO. 6) INSULATED complete in place per for ��� ''� dollars and � cents. 2 7J 3 4' 33 720 LF TRAY CABLE(3 CONDR)(12 AWG) � —y�!� complete in place per for 1 V� dollars and ?-&VV cents. fill 21 34 8 EA GROUND BOX TY D(162922)W/ APRON complete in place per /, for V` LL UV *4 1 S)� tW!4 dollars and G Ivo cents. i L U G /2 boo. (Jp 00300-9-2015 Page 9 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 35 1 EA ELC SRV TY D 120/240 100 (NS)AL(E)PS(U)PAINT GREEN � complete in place per � for c\' ''(I'V V�;' dollars and 74 r D cents. t 20 G• co -71 36 1 EA IN SM RD SUP&AM TY l OB WG(I)SA(P) complete in place per for U�� rthuy SIV dollars and Z eW cents. / G Gb. It D 37 1 EA IN SM RD SUP&AM TYIOBWG(1)SA(T) -�-�"complete in place per for Q/\.(� 4 r�13\1 sf,4 dollars and !�'�0 cents. 000. GO 38 1 EA REMOVE SM RD SN SUP&AM complete in place per for �w t 1rAye) dollars and �'-\a cents. 2 2 00300-9-2015 Page 10 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 39 215 LF REFL PAV MRK TY I (W)24"(SLD)(1 OOMIL) complete in place per for I W Gjy L dollars and 7-4YO cents. 40 215 LF RE PM TY II(V)24" (SLD) complete in place per for i �' dollars and cents. �J- �, 2�!U• U1 41 62 LF ELIM EXT PAV MRK&MRKS(4") complete in place per for S ' T" dollars and Zcents. Z" • o0 312. to 42 15 LF ELIM EXT PAV MRK&MRKS(8") complete in place per for � P/y� 1 I'1 lr•�i�i dollars and cents. Z 3• ����W 00300-9-2015 Page 11 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 43 26 LF ELIM EXT PAV MRK& MRKS(24") complete in place per for T"W' -TWO dollars and 7_4 n cents. 44 215 LF PAV SURF PREP FOR MRK(24") complete in place per for /.Y— dollars and l44,V cents. b �� 2.1 W 45 1 EA INSTALL HWY TRF SIG (SYSTEM)* complete in place per for I Viin 41 'N 11 k, _rk 9 0 J$-L-dollars and 2e ✓b cents. fi l,4va• to ?X7, 06P• l>+ * Cost of INSTALL HWY TRF SIG(SYSTEM)shall include the following subsidiary items: TRAFFIC CONTROLLER FOUNDATION EA 1 TRAFFIC SIGNAL CONTROLLER EA 1 TRAFFIC SIGNAL CONTROLLER CABINET EA 1 R10-17 (36"X42") EA 1 LED RDWY LUMINAIRE(.25 KW EQ) EA 3 WIND DAMPNERS EA 3 00300-9-2015 Page 12 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 46 9 EA VEH SIG SEC(12IN)LED(GRN) complete in place per for IVY, ! uA � d ollars and � cents. Z7 W 2 t ���• !lL 47 2 EA VEH SIG SEC(12IN)LED(GRN ARW) complete •in-place per fol tb P(�] k#t, .0 lLt dollars and �W cents. all. w 48 9 EA VEH SIG SEC(12IN)LED(YEL) complete in place per for-Tj\ll #Y ngd{t, SGVA -�U/u-dollars and -Z" cents. 2��• w 2 ► fel• to 49 3 EA VEH SIG SEC(121N)LED(YEL ARV) complete in place per for*'TOI "" Y � 54A,-1r1'-1 dollars; and cents. SSS, bo 00300-9-2015 Page 13 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 50 9 EA VEH SIG SEC(12M)LED(RED) complete in place per for ►yl 1�P*4Q,jeWA-N11-4ollars and oz' t✓b cents. 2 7 / • 2 S J d 51 1 EA VEH SIG SEC(12IN)LED(RED ARW) complete in place per forgN, 4,4V4041 Sc'Vp -,*,/,'�dollars and -ZAP-lb cents. 52 4 EA PED SIG SEC (LED)(COUNTDOWN) complete in place per for *if(����, 1 '64 dollars and Ozen cents. 53 8 EA BACKPLATE W/REF BRDR(3 SEC)(VENT)ALUM 'I complete in place per h forlye ^A VV Qy'1� ,Idollars and -zeW cents. 00300-9-2015 Page 14 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 54 1 EA BACKPLATE W/REF BRDR(4 SEC)(VENT)ALUM complete in place per foe flgy Aiyy V4t'A j:j7—TI/J dollars and 2Cr'+ cents. 4j s2" C2- 55 2 •55 1 EA BACKPLATE W/REF BRDR(5 SEC)(VENT)ALUM complete in place per for fy✓y #mA✓�S�c'f�/ dollars andcents. 6�' 4 6 G. !N 56 422 LF TRF SIG CBL(TY A)(14 AWG)(5 CONDR) complete in place per for dollars and ZG� cents. 3• �U r (4?7•(� 57 839 LF TRF SIG CBL(TY A)(14 AWG)(7 CONDR) complete in place per for Y''� dollars and cents. 00300-9-2015 Page 15 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 58 570 LF TRF SIG CBL(TY A)(14 AWG)(20 CONDR) complete in place per for V&*N dollars and ��+IU cents. Z• to q 7, 1"1.- TRF SIG CBL(TY C)(14 AWG)(2 59 660 LF CONDR) complete in place per for —P� dollars and Z-e✓v cents. 60 1 EA INS TRF SIG PL AM(S)1 ARM(48')LUM&ILSN complete in place per forY�1�'1'1 W t /I,.�i dollars and s.. cents. 27I 6 a`• to Z,7-16&. (� 61 2 EA INS TRF SIG PL AM(S)1 ARM(44')LUM&ILSN complete in place per fiw� -0,.t,-Th w� , for flyr14 CX dollars and -Zekv cents. Z�� 7 o d. co 3, 'j00• Go 00300-9-2015 Page 16 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 62 3 EA PED POLE ASSEMBLY* complete in place per fol-wol-hyyw,,5,x dollars and 1.60 cents. 71 b G.d' Gd l/ $GYM• Go * Cost of PED POLE ASSEMBLY shall include the following subsidiary items: DRILL SHAFT(TRF SIG POLE)(24 IN) LF 18 63 4 EA PED DETECT PUSH BUTTON(APS) complete inplace per ITh�vim, Tw� f>�iwC_ for dollars and cents. Z55, GO 5/ 0 32. Go 64 1 EA PED DETECTOR CONTROLLER UNIT � ""complete in place per for d > -l-ywl�, dollars and w�� cents. 2 �' (.4 2�• W 65 3 EA ILSN(8D) complete in place per -ry,Ir c.a-�►q 1 v C44C1 47 for EAV-4 dollars and 2t✓b cents. 3, �y•th Go 00300-9-2015 Page 17 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 66 766 LF ITS COM CBL (ETHERNET)DETECTION complete in place per for Tw dollars and cents. Z 'w 1 / . G>o 67 200 LF ITS COM CBL(ETHERNET)(CAT- 5E)(RADIO) complete in place per for Tw 0 dollars and eey cents. 2 y 0 ut4 68 200 LF ITS COM CBL(ETHERNET)(CAT 6)(PTZ CAMERA) complete in place per for 1N a dollars and -Z,,evy cents. 2 ' 140o. 40 69 1 EA VANTAGE NEXT PLATFORM (SHELF-MOUNT CCU WITH SHIP KIT) complete in plac-e-per for' /TWI dollars and cents. l 1741 d• O 00300-9-2015 Page 18 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 70 2 EA VANTAGE VECTOR HYBRID complete in place per diol L06&*<-7 for �/ (A�/(,i/ _ dollars C and Z,6W cents. J/ b 4 6. 1A 11I zo d • W 71 1 EA VANTAGE NEXT CAMERA complete in place per TNv44.4/ for ThY,(,(��-H,t � dollars and 12&4O cents. ZJ 300- 2/50(j' W 72 1 EA VANTAGE NEXT VIEWER AND SET UP TOOL cpm lete in place per -T{nrdw"fho for YA.4 f f:$ �VhJ a dollars and lz� cents. 73 1 EA AXIS NETWORK PTZ CAMERA co plete place per forftA V7#t - &T i oars ��dollars and 2&w2 cents. J 1 y 2q6'14 g q24 . w 00300-9-2015 Page 19 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 74 1 EA COMNET ETHERNET SWITCH �:ovr_ lrh-,Iv let�in�e per for �41r.4 9;4k141 - ^rlVw0-- dollars and '" cents. 75 1 EA PEGASUS TWIST PORT :5 300MG o in pldce per ru- for � V� dollars and cents. r U�• lA '•�, y 0 S. to 76 1 EA ANTENNA-ULTRA DISH TP400 24 DBL complete in place per for _^ r��� � dollars and er cents. 141 4/3' b�Q 77 1 EA OPTICOM DETECTOR-GTT MODEL 711 (SINGLE) co plete in place per ONOIThe vsem'/-r"O ;W✓Wvv' for rt�y!� dollars and L., ✓1 cents. // 79*. W Is-30. 60 00300-9-2015 Page 20 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 78 1 EA OPTICOM DETECTOR-GTT MODEL 722(DUAL) co�mpI to inplace er I�/��//�V / �j'V-C.. for �V 'NIS 'j+14—FI ✓,' dollars and 'Ze" cents. J/ 79 1 EA OPTICOM PHASE SELECTOR- GTT MODEL 764 lv✓'1 h I ver complj�ig�/.L' vpJ�l�r0 for "V1 �GVe+N dollars 11 and ! cents. 4 SL/7- Ga T/ SY 7 80 1 EA OPTICOM CARD RACK-GTT MODEL 760 complete in place per kik, 4vr�ov l .ry for / dollars and ` cents. b l Ca b �• /30 81 702 LF OPTICOM CABLE-GTT MODEL 138 complete in place per for dollars and WD cents. 00300-9-2015 Page 21 of 22 Bid Form BASE BID Approx. Item Description Bid Item Quantit Unit and Written Unit Price Unit Price Amount 82 1 EA BATTERY BACKUP UNIT compglZee lace per �i4V)T �1dV" X1,614*\ �Vrjw�dI for Oji -y-W 0 dollars and -zerb cents. �/ 6'1- Ld TOTAL BASE BID (Items 1 thru 82 ) $0.00 Materials: All Other Charges: Q, *Total: $ Q 1� $ 00 *Note:This total must be the same amount as shown above for"Total Base Bid" If this bid is accepted,the undersigned agrees to execute the Agreement and provide necessary bonds and Respectfully Submitted, SiXafe-6 Print Name Address John Wong 14320 Albers Way Chino,CA 91710 Title Telephone Vice President 909-993-5470 Name of Firm Elecnor Belco Electric,Inc. Date Secretary,if Bidder is a 10-10-2024 Corporation Roger Devito/Secretary 00300-9-2015 Page 22 of 22 Bid Form 00410 STATEMENT OF BIDDER'S SAFETY EXPERIENCE Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Solicitation Requirements, Contract Forms & Conditions of Contract Statement of Bidder's Safety Experience Section 00410 Bidder must submit a signed Statement of Bidder's Safety Experience form with his Bid; failure to do so will constitute an incomplete Bid that may be rejected. In order to make a responsive Bid, Bidder must provide evidence that it meets minimum OSHA construction safety program requirements, has not been fined by OSHA for any willful safety violations in the past three years, and has a lost time injury rate that doesn't exceed the limits established below. All questions must be answered and data given must be clear and comprehensive. If necessary, questions may be answered on separate attached sheets. Company Name: Elecnor Belco Electric, Inc. Address: 14320 Albers Way Chino, CA 91710 Phone: 909-993-5470 Completed by: John Wong/Vice President Date: 10-10-2024 1. Does the company have a written construction Safety program? DYes ❑No 2. Does the company conduct construction safety inspections? [aYes ❑No 3. Does the company have an active construction safety-training program? ❑/Yes ❑No 4. Has the company been fined by OSHA for any willful safety violations in the past ❑Yes ❑✓ No three years? 5. Does the company have a lost time injury rate of 7.8 for SIC 15,or 7.6 for SIC 16, ❑�Yes ❑No or less over the past three years? Attach the company's OSHA 200/300 logs for the past three years. 6. Does the company or affected subcontractors have competent persons in the following Areas? A. Scaffolding ❑Yes [:]No ❑� N/A B. Excavation ❑� Yes ❑No ❑N/A C. Cranes ❑� Yes ❑No ❑N/A D. Electrical ❑✓ Yes ❑No ❑N/A E. Fall Protection ,r❑Yes ❑No ❑N/A F. Confined Spaces ❑✓ Yes ❑No ❑N/A I hereby certify that the above information is true and correct. Signature .John Wong Title Vice President Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Attention: This form contains information relating � 10 employee health and must be used in a manner OSHA's Form 300 (Rev. 01/2004 hat protects the confidentiality of employees to the Year 2023 extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety and health purposes U.S. Department Labor Occupational Safety and Health Administration Yo u must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity or job transfer,days away from work,or medical treatment beyond first aid Form approved OMB no 1218-0178 You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional.You must also record work-related injuries and illnesses that meet any o1 the specific recording criteria listed in 29 CFR 1904.8 through 1904.12.Feel free to use two lines for a single case if you need to.You must complete an injury and illness incident report(OSHA Forth Establishment name Elecnor Belco Electric 301)or equivalent form for each injury or illness recorded on this form.If you're not sure whether a case is recordable,call your local OSHA office for help. City Chino State California Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the"injury"column or choose one type of Case Employee's Name Job Title (eg.,Welder) Date of Where the event occurred(e.g. Describe injury or illness,parts of body affected, the most serious outcome for that caseworker was. illness. Noinjury or Loading dock north end) and object/substance that directly injured or made onset of person ill(e.g.Second degree burns on right (M) N illness forearm from acetylene torch) Days awe Awa On job v (mo/day) Death from work Remained at work y transfer or o Z. From restrictiono rn Job transfer Other record- Work (days) Z. m a N ` o or restriction able cases (days) o 'o ar°i Q W ac co a x (G) (H) (p (J) (K) (L) (1) (2) (3) (4) (5) (6) Step from a side walk to location where sidewlak wase remove,stepped on a piece of debris 1 Gilberto Gonzalez Apprentice Electrician 9/27/23 5399 Orange Ave loosing balance This cause an ankle sprain. X X Page totals o 0 0 f 1 0 1 0 1 1 0 0 0 0 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. ; a o 0 o Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time to review the o rs 0 o = d� a Instruction,search and gather the data needed,and complete and review the collection o1 information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number If you have any comments about these m = o estimates or any aspects o1 this data collection,contact US Department of Labor,OSHA Office of Statistics,Room N-3644,200 Constitution Ave,NW,Washington,DC 20210.Do not send the completed forms to this office. Page i of 1 (1) (2) (3) (4) (5) (6) OSHA's Form 300A (Rev.01/2004) Year 2023 <<'� Summary of Work-Related Injuries and Illnesses occupational Lhty and edthU.S.DepaHealth of Labor Administrwtlon Form approved OMB no 1218-0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year Remember to review the Log to verify that the entries are complete Using the Log,count the individual entries you made for each category Then write the totals below Establishment information making sure you've added the entries from every page of the log If you had no cases write"0" Employees former employees,and their representatives have the right to review the OSHA Form 300m Your establishment name Elecnor Belco Electric,Inc. its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms Street 14320 Albers Way Number of Cases City Chino Slate California Zip 92647 Industry description(e.g.,Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of New Construction/TraKic Improvements deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 0 0 1 1 7 3 1 (G) (H) (1) (.1) OR North American Industrial Classification(NAICS),if known(e.g.,336212) 2 3 8 2 1 0 Number of Days Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 150 work Total hours worked by all employees last 0 0 year 283882 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 1 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing Loss 0 1certify that I have examined this document and that to the best of my knowledge the entries are true,accurate,and (3) Respiratory complete Condition 0 (6)All Other Illnesses 0 _ President&CEO �P-ny ex utive 909-993-5470 01/25/2024 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 58 minutes per response,including time to review the instruclion,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.If you nave any comments about these estimates or any aspects of this data collection,contact US Department of Labor,OSHA Office of Statistics,Room N-3644,200 ConsI tution Ave,NW,Washwgton,DC 20210.Do not send the completed forms to this office. Mention: This form contains information relating to employee health and must be used in a manner OSHAr s Form 300 (Rev. 0112004) that protects the confidentiality of employees to the Year 2022 ` extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety and health purposes. U.S. DepartmentHealth Labor Occupational Safety and Health Admmistratioi You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity or job transfer,days away from work,or medical treatment beyond first Form approved OMB no 1218-01 aid.You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional.You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to.You must complete an injury and illness incident report Establishment name Elecnor Belco Electric (OSHA Form 301)or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable,call your local OSHA office for help. City Chino State California Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the"injury"column or choose one Case Employee's Name Job Title (e.g.,Welder) Date of Where the event occurred(e.g. Describe injury or illness,parts of body affected, the most serious outcome for that case worker was. illness. No. injury or Loading dock north end) and object/substance that directly injured or made onset of person ill(e.g.Second degree burns on right (M) illness forearm from acetylene torch) On job w, D away (mc,/day) Death from work Remained at work Away transfer or p T o From restriction g J m 0 c m Jobtransfer Other record- Work (days) Z a c `m or restriction able cases (days) Y N o 5 N F rn of 0 a x (0) (H) (t) (J) (K) (L) (1) (2) (3) (4) (5) 11 in and Lake Street, Back Injury cause by strain when(Ming to stored 1 Antony Castro Eleclical Foreman 1/6/22 Huntington Beach jack hammer. x X 2 Page totals o 0 1 0 1 0 1 0 1 1 0 1 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it D o`o o c o m y 0 M Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time to review 0 5 m the inslruchon,search and gather the data needed,and complete and review the collection of information. Persons are not required rr m to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about m = these estimates or any aspects of this data collection,contact: US Department of Labor,OSHA Office of Statistics,Room N-3644, 200 Constitution Ave,NW,Washington,DC 20210.Do not send the completed forms to this office. Page 1 of 1 (1) (2) (3) (4) (5) OSHA's Form 300A (Rev.0112004) Year 2022 Summary of Work-Related Injuries and Illnesses U.S.Department of Labor Occupational Safety antl Health Administration Form approved OMB no 1218-0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year Remember to review the Log to verify that the entries are complete Using the Log,count the individual entries you made for each category. Then write the totals below. Establishment Information making sure you ve added the entries from every page of the log. If you had no cases write'0." Employees former employees,and their representatives have the right to review the OSHA Form 300m Your establishment name Eleanor Belco Electric,Inc its entirety. They also have limited access to the OSHA Form 301 or its equivalent. Sae 29 CFR 1904 35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms Street 14320 Albers Way Number of Cases City Chino State California Zip 92647 Industry description(e g Maufactuof motor truck trailers) Total number of Total number of Total number of cases Total number of New Construction/Trafnfic Improre vements deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(eg.,SIC 3715) 0 0 0 1 1 7 3 1 (Ci) (H) (I) (.1) OR North American Industrial Classification(NAICS),if known(eg.,336212) 2 3 8 2 1 0 Number of Days Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 145 work Total hours worked by all employees last 0 0 year 263928 83 (K) L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 1 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing Loss 0 I certify that I have eza �document and that to the best of my knowledge the entries are true,accurate,and (3) Respiratory complete. Condition 0 (6)All Other Illnesses 0 Director of Eastern[ Company executive Title (909)993-5470 1/26/1023 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 58 minutes per response,including time to review the instruction,search and gather the data needed,and wmplete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.If you have any comments about these estimates or any aspects of this data collection,contact US Department of Labor,OSHA Office of Stafisfics,Room N-3644,200 constitution Ave,NW,Washington,DC 20210.Do not send the cam plated forms to this office. Attention: This form contains Information relating � r to employee health and must be used in a manner e`C`*P OSHA's Form 300 (Rev. 0112004) that projects the confidentiality of employees to the Year 2021 extent possible while the Information is being used Log of Work-Related Injuries and Illnesses for occupational safety and health purposes. U.S. Department and aOt_abOr Occupational Safety and Health Administration You must record Information about every work-related injury or Illness that involves loss of consciousness,restricted work activity or lob transfer,days away from work,or medical treatment Form approved OMB no.1218-0176 beyond first aid You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional You must also record work-relaled injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12 Feel free to use two lines for a single case if you need to You must complete an Establishment name Elecnor Belco Electric.Inc. injury and illness incident report(OSHA Form 301)or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable,call your local OSHA office for help City Chino State California Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) tD) (E) (F) CHECK ONLY ONE box for each case based on days the Injured or III Check the"injury"column or choose one type Case Employee's Name Job Title (e.g.. Date of Where the event occurred(e.g. Describe injury or illness,parts of body affected, the most serious outcome for that caseworker was. of Illness No. Welder) injury or Loading dock north end) and object/substance that directly Injured or onset of made person ill(e.g.Second degree burns on (M) N illness right forearm from acetylene torch) On job o Days away Away d c (m /da 1 y Death from work Remained at work transfer or a Z o From restriction o m o o, d Job transfer Other record- Work (days) Z. oc m= N S or restriction able cases (days) c tj a r a (G) (H) (h JI tK) (11 (2) t3) (4) (5i (e 1 Manuel Montejano Jrnymn Labor 5/25/21 Work Site Lifting Object-Injured Back X 3 X 2 Noe Bermudez App Labor 8/9/21 Work Site Using Clayspade-Struck Top of Foot X 4 X 3 NA App Electrician 8/12/21 Work Site COVID r 4 Sam Villa Elec.Tech. 8/16/21 Work Site SIIp/Trlp X Page totals 0 3 0 1 42 0 3 0 1 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. L, a o o o N E Public reporting burden for this collection of Information is estimated to average 14 minutes per response,including time Ci uai � o to review the instruction,search and gather the data needed,and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control w = o number. If you have any comments about these estimates or any aspects of this data collection,contact. US Q Department of Labor,OSHA Office of Statistics,Room N-3644,200 Constitution Ave,NW,Washington,DC 20210. Do not send the completed forms to this office. Page 1 of 1 (1) (2) (3) (4) (5) (6) OSHA's Form 300A (Rev.01/2004) Year 2021 ``1� Summary of Work-Related Injuries and Illnesses U.S.Department of mI.--1Labor occ upanonal sarery-d H-111,Atlmmislranon All establishments covered by Part 1904 must complete this Summary pageeven d no injuries or illnesses occurred during the year Remember to review the Log to verify that the entries are complete _ Using the Log.count the individual entries you made for each category Then write the totals below, Establishment information making sure you've added the entries from every page of the log. Iryou had no cases write"0." Employees former employees.and their representatives have the right to review the OSHA Form 300 in Your establishment name Elecnor Belco Electric,Inc. its entirety. They also have limited access to the OSHA Form 301 or its equivalent See 29 CFR 1904 35.in OSHA's Recordkeeping rulefor further details on the access provisions for these forms Street 14320 Albers Way Number of Cases City Chino State California Zip 91710 Industry description(e.g..Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Traffic Signal Installation deaths cases with days with job transfer or other recordable away from work restriction oases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 3 0 1 1 7 3 1 (Co) (H) (I) (.1) OR North American Industrial Classification(NAILS).if known(e.g..336212) 2 3 7 3 Number of Days Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 165 work Total hours worked by all employees last 42 0 year 280439.8 (K) (L) Injury and Mness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 3 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing Loss 0 (3) Respiratory certify that I have examined ilii current and that to the best of my knowledge the entries are true accurate and Condition 1 (6)All Other Illnesses 0 complete. President&CEO pony executive Title 909 993 5470 02/03/2022 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Dale Public reporting burden for this collection of informaton is estimated to average 58 minutes per response,including time to review the instruction,search and gather thedata needed,and complete and review the collection of information Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.If you have any comments about these estimates or any aspects of this data collection,contact US Department of Labor,OSHA Office of Stabstics,Room N-3644,200 Consbtuhon Ave,NW,Washington,DC 20210 Do not send the completed forms to this office I m BID BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Elecnor Belco Electric,Inc. of the City of Cho County of San Bernardino State of California as Principal, and Liberty Mutual Insurance Company authorized under the laws of the State of Texas to act as surety on bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"), in the penal sum of Five Percent(5%)of the total amount of the Bid of the Principal submitted to the Owner, for the Work described below; for the payment whereof,well and truly to be made, and the said Principal and Surety do herby bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally,as follows: In no case shall the liability of the Surety hereunder exceed the sum of(Five Percent of Amount Bid Dollars($5% ). THE CONDITIONS OF THIS OBLIGATION ARE SUCH that,whereas,the Principal has submitted the above-referenced Bid to the Owner, for construction of the Work under the "Specifications for Construction of TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BLVD for which Bids are to be opened at the office of Owner on the 17th day of October ,2024 . NOW,THEREFORE,if the Principal is awarded the Contract,and within the time and manner required under the"Instructions to Bidders,"after the prescribed forms are presented to her/him for signature,enters into a written Agreement substantially in the form contained in the Bid Documents,in accordance with the Bid, and files the two (2) bonds with the Owner, one to guarantee faithful performance and the other to guarantee payment for labor and materials,then this obligation shall be null and void;otherwise,it shall be and remain in full force and effect. If, however, Principal fails to enter into a written Agreement with the Owner in accordance with the Bid or Principal and Surety fail to timely deliver to Owner the performance and payment bonds required by the Bid Documents, Surety within five(5)business days after receipt of a written demand from Owner shall pay to Owner the full penal sum of this Bid Bond,subject to the limitation described herein. In the event that suit is brought upon this Bond by the Owner and judgment is recovered, said Surety shall pay all costs incurred by the Owner in such suit, including a reasonable attorney's fee to be fixed by the Court. IN WITNESS WHEREOF, the said Principal and Surety have signed this instrument on this the 3rd day of the month of October 2024 . Elecnor Belco Electric,Inc. Liberty Mutual Insurance Company Principal Surety John Wong Sarah Murtha Printed me Printed Name By:_ By: Title: Vic P ident Title:Attomey-in- Address: 3 AlbM6 Way Address: 10 State House Square,Floor 1 t Hartford.CT 06103 002004-2020 Page I Bid Bond 00443638 Resident Agent of Surety: N/A Signature N/A Printed Name N/A Street Address N/A City,State,Zip Page 00200 42020 Bid Bond 00443638 This Power of Attorney limits the acts of those named herein.and they have no authority to l' bind the Company except in the manner and to the extent herein stated. Liberty l Ue� Liberty Mutual Insurance Company Mutual The Ohio Casualty Insurance Company Certificate No: 8210646-985949 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts.and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name.constitute and appoint Connor Wolpert,Doritza Mojica,Gerin SteHart.JenniferGodere.Jonathan Gleason.Joshua Sanford.Kathryn Pryor,Kyle Williams.Michelle Anne McMahon.Nicholas Miller.Richard Hackney Roblin Salley.Sarah Murtha all of the city of I Iarttlord state of CT each individually if there be more than one named,its true and lawful attomey-in-fact to make. execute.seal,acknowledge and deliver.for and on its behalf as surety and as its act and deed,any and all undertakings.bonds.recognizances and other surety obligations.in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 22nd day of August 20'3 . Liberty Mutual Insurance Company PV INS11 P1SV INSUR 1NSURq The Ohio Casualty Insurance Company `oavoRq �Ln yJ `oaPoay 9y c,P Boa°OR. � West American Insurance Company J 2 rFo F U + �Fo r`�o on a 191 00 1919 f 1991 �� Q d� 6'ACHUS�.aD SNA M7`'�,dD� YS NOIAHP ,dD By- David M.Carey,Assistant Secretary cc State of PENNSYLVANIA ss V ami County of MONTGOMERY On this 222nd dayof Al 2023 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance m Company,The Ohio Casualty Company.and West American Insurance Company.and that he,as such.being authorized so to do.execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. — IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting.Pennsylvania.on the day and year first above written.to p PAST X 5 O Q� pRW F CommoTeresa a Pennsylvania-Notan Seal 6 O o Fk's`v Teresa Pastelia.Notary Pubilc Montgomery County O (L) OF My wmmission expires March 28 2025 C f6 P Commissar number 1126044 By. LVPW E' Member PennsyNanla Assooabon of Notanes Teresa Pastella.Notary Public CD co Q) dr 6 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company.Liberty Mutual Insurance N o S� Company.and West American Insurance Company which resolutions are now in full force and effect reading as follows: oQ —6 ARTICLE IV-OFFICERS:Section 12.Power of Attomey. o Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President.and subject to such limitation as the Chairman or the President b U may prescribe.shall appoint such attomeys-in-fact.as may be necessary to act in behalf of the Corporation to make,execute.seal,acknowledge and deliver as surety any and all >MC aa) undertakings,bonds.recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall have full o t: power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such instruments shall Z 0 be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under the provisions of this article may be revoked at any time by the Board.the Chairman.the President or by the officer or officers granting such power or authority. LL (5 ARTICLE XIII-Execution of Contracts:Section 5.Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president.and subject to such limitations as the chairman or the president may prescribe. shall appoint such attorneys-in-fact.as may be necessary to act in behalf of the Company to make.execute,seal,acknowledge and deliver as surety any and all undertakings. bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company.authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in- fact as may be necessary to act on behalf of the Company to make.execute,seal.acknowledge and deliver as surety any and all undertakings.bonds,recognizances and other surety obligations Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I.Renee C.Llewellyn,the undersigned.Assistant Secretary,The Ohio Casualty Insurance Company.Liberty Mutual Insurance Company.and West American Insurance Company do hereby certify that the original power of attomey of which the foregoing is a full,Eve ago Correct copy of the Power of Attorney executed by said Companies.is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF.I have hereunto set my hart,and affixed the sfi of said Comipanies this 3rd day of October 2024. tl Zvi INS& �"� \NSU/, 0 OP-41 1 lq P,OaPORgT•9.l, LPRPOR4t9�C1 f 19120 1919 1991 - Y 9 Z,3 ,i sF z`',jo 3 By: HuSNAMP's f{- S`SAC `'�•dD /Dr Y' �NDIANP D � /a s a Renee C.Llewellyn,Assistant Secretary LMS-12873 LMIC OCIC WAIC Multi Co 02!21 Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste.400 2200 Renaissance Blvd., Ste.400 King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages, rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection(111-1 A) de Texas Consumer Protection(111-1 A) P. O. Box 149091 P. O. Box 149091 Austin,TX 78714-9091 Austin,TX 78714-9091 FAX: (512)490-1007 FAX#(512)490-1007 Web: http://www.tdi.texas.gov Web: htti)://www.tdi.texas.,ov E-mail: ConsumerProtection(atdi.texas.gov E-mail: ConsumerProtection(c�,tdi.texas.-ov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concemiente a su prima o a premium or about a claim you should first contact un reclamo, debe comunicarse con el agente o the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved,you may contact the entonces comunicarse con el departamento(TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POI.17.A: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-16M 10/15 IF CALIFORNIA ALL PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A nota public or other officer notary p ecompleting this certificate verifies only the Identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. I State of California } County of�5�0 J5e_yAAtzOtr-rJ } ' Onc'Xzog<� before me, ` kx' tt'AC\4'Vz '000 aq� Lic' ere insert name and title of the officer) personally appeared \Aotkg who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m had n o ial seal. pOUGMCWHORTER Y Notary public-California ss San Bernardino County S Commission M 2426775 16.y Comm.Expires Nav 15,2026 Ota u li S gn tur (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notary to violate California notary law. (Title or description of attached document) a State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. a The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/they,is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer s The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. ❑ Partner(s) • Signature of the notary public must match the signature on file with the office of the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). "fi 1 r Version wk,,rw NotarfCiasses.corr <;,;_,73_ygg3 • Securely attach this document to the signed document with a staple. • ' •;c,� ! i ♦ j'A � � ,',t � e i 00500 AGREEMENT City of Round Rock, Texas Contract Forms Standard Form of Agreement: Section 00500 City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor AGREEMENT made as of the 30 l-` day oE in the year 207--Y BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") 221 East Main Street Round Rock,Texas 78664 and the Contractor Elecnor Belco Electric,Inc. ("Contractor") 14320 Albers Way Chino,CA 91710 The Project is described as: TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BOULEVARD The Engineer is: HDR Engineering, Inc. 710 Hesters Crossing#150 Round Rock,Texas,78681 For and in consideration of the mutual terms, conditions and covenants of this Agreement and all accompanying documents between Owner and Contractor, the receipt and sufficiency of which are hereby acknowledged,Owner and Contractor agree as follows: ARTICLE I THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement,Conditions of the Contract(General,Supplementary and other Conditions), Drawings, Specifications,Addenda issued prior to execution of this Agreement,other documents listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements, either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 7. ARTICLE 2 THE WORK OF THIS CONTRACT Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically indicated in the Contract Documents to be the responsibility of others. 00500 4-2020 Pagel of 5 Standard Form of Agreement 00443647 ARTICLE 3 DATE OF COMMENCEMENT; DATE OF SUBSTANTIAL COMPLETION; DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 3.3 Contractor shall commence Work within ten ( 10 ) calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this Agreement no later than N/A ( N/A )calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than two hundred and seventy 270 )calendar days from issuance by Owner of Notice to Proceed,subject to adjustments of this Contract Time as provided in the Contract Documents. 3.5 If Contractor fails to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages, the sum of six hundred and No/100 Dollars($ 600.00 ) for each calendar day that Substantial Completion is delayed after the date(s) specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is entitled hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement and is not a penalty. It is agreed that the harm that would be caused by such failure, which includes loss of expected use of the Project areas,provision of alternative storage facilities and rescheduling of moving and occupancy dates, is one that is incapable or very difficult of accurate estimation. It is hereby agreed that if Substantial Completion of the Work(or any portion thereof) is not achieved on or before thirty (30)days after the date(s) specified for Substantial Completion in the Agreement, the Owner shall have the option to either collect liquidated damages as set forth herein or to thereafter rely on its remedies under the Contract Documents and at law and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial Completion of the Work(or any portion thereof) in the Agreement shall be subject to adjustment as provided in the Contract Documents. 3.6 Contractor shall achieve Final Completion of the entire Work no later than two hundred and seventy (270 )calendar days from issuance by Owner of Notice to Proceed. ARTICLE 4 CONTRACT SUM 4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's full and complete performance of the Work and all of Contractor's obligations under this Agreement. The Contract Sum shall be Four hundred ninety-nine thousand eight hundred eighty-eight dollars and zero cents ($499,888.00 ),subject to additions and deductions as provided in the Contract Documents. 4.2 Does the Contract Sum include alternates which are described in the Bid Form? No X Yes .If yes,please provide details below: N/A 00500 4-2020 Page 2 of 5 Standard Form of Agreement 00443647 ARTICLE 5 PAYMENTS 5.1 PROGRESS PAYMENTS 5.1.1 Based upon Applications for Payment submitted to Engineer and Owner by Contractor,and Certificates for Payment issued by Engineer and not disputed by Owner and/or Owner's lender,Owner shall make progress payments on account of the Contract Sum to Contractor as provided below, in Article 14 of the General Conditions, and elsewhere in the Contract Documents. 5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month. 5.1.3 Provided that an Application for Payment is received by Engineer and Owner, and Engineer issues a Certificate of Payment not later than the tenth (10th) day of a month, Owner shall make payment to Contractor of amounts approved by the Owner not later than the tenth(10th)day of the next month. If an Application for Payment is received by Engineer and Owner after the application date fixed above,payment shall be made by Owner not later than one month after the Engineer issues a Certificate for Payment. The Owner shall not have any obligation to pay any amount covered by the Engineer's Certificate for Payment that is disputed by the Owner. 5.1.4 Each Application for Payment shall be based on the most recent schedule of values submitted by Contractor in accordance with the Contract Documents.The schedule of values shall allocate the entire Contract Sum among the various portions of the Work. The schedule of values shall be prepared in such form and supported by such data to substantiate its accuracy as Engineer and Owner may require.This schedule,unless objected to by Engineer or Owner, shall be used as a basis for reviewing Contractor's Applications for Payment. 5.1.5 Applications for Payment shall warrant the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 5.1.6 Subject to other provisions of the Contract Documents, the amount of each progress payment shall be computed as provided in Article 14 of the General Conditions. 5.1.7 Except with Owner's prior written approval, Contractor shall not make advance payments to suppliers for materials or equipment which have not been delivered and stored at the site. 5.2 FINAL PAYMENT 5.2.1 Final payment, constituting the entire unpaid balance of the Contract Sum, shall be made by Owner to Contractor when: .1 Contractor has fully performed the Contract except for Contractor's responsibility to correct Work, and to satisfy other requirements,if any,which extend beyond final payment;and .2 a final Certificate for Payment has been issued by Engineer and approved by the Owner. 5.2.2 Owner's final payment to Contractor shall be made no later than thirty (30) days after the issuance of Engineer's final Certificate for Payment. In no event shall final payment be required to be made prior to thirty(30) days after all Work on the Contract has been fully performed. Defects in the Work discovered prior to final payment shall be treated as non-conforming Work and shall be corrected by Contractor prior to final payment,and shall not be treated as warranty items. ARTICLE 6 TERMINATION OR SUSPENSION 6.1 The Contract may be terminated by Owner or Contractor as provided in Article 15 of the General Conditions. 00500 4-2020 Page 3 of 5 Standard Form of Agreement 00443647 6.2 The Work may be suspended by Owner as provided in Article 15 of the General Conditions. ARTICLE 7 ENUMERATION OF CONTRACT DOCUMENTS 7.1 The Contract Documents,except for Modifications issued after execution of this Agreement,are enumerated as follows: 7.1.1 The Agreement is this executed version of the City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor,as modified. 7.1.2 The General Conditions are the "City of Round Rock Contract Forms 00700," General Conditions, as modified. 7.1.3 The Supplementary,Special,and other Conditions of the Contract are those contained in the Project Manual dated September 2024 . 7.1.4 The Specifications are those contained in the Project Manual dated September 2024 7.1.5 The Drawings,if any,are those contained in the Project Manual dated September 2024 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated September 2024 7.1.7 The Notice to Bidders,Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the Project Manual dated September 2024 7.1.8 If this Agreement covers construction involving federal funds, thereby requiring inclusion of mandated contract clauses, such federally required clauses are those contained in the "City of Round Rock Contract Forms 03000,"Federally Required Contract Clauses,as modified. 7.1.9 Other documents,if any,forming part of the Contract Documents are as follows: - t(1A ARTICLE 8 MISCELLANEOUS PROVISIONS 8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. 8.2 Owner's representative is: Reuben Ramirez City of Round Rock 3400 Sunrise Road Round Rock,TX 78665 8.3 Contractor's representative is: Pau Pardo Elecnor Belco Electric,Inc. 4766 SH-123 Bldg 4 San Marcos,TX 78666 8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the other party. 00500 4-2020 Page 4 of 5 Standard Form of Agreement 00443647 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. 8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in accordance with the bid or proposal submitted therefor,subject to proper additions and deductions,all as provided in the General Conditions, Supplemental Conditions,and Special Conditions of this Agreement,and Owner agrees to make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only. 8.7 Although this Agreement is drawn by Owner,both parties hereto expressly agree and assert that,in the event of any dispute over its meaning or application,this Agreement shall be interpreted reasonably and fairly,and neither more strongly for nor against either party. 8.8 This Agreement shall be enforceable in Round Rock,Texas,and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein,exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by an arbitration proceeding,including without limitation,any proceeding under the Federal Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute. 8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal representatives for the full and faithful performance of the terms and provisions hereof. This Agreement is entered into as of the day and year first written above and is executed in at least two(2) original copies,of which one is to be delivered to Owner. OWNER CONTRACTOR CITY 10 C ERAS EL DR BELCO ELECTRIC,INC. Printed N e: Craig M gan )4d :Title Mayor V. Q /lYSf`I'. �(►.. Date Signed: 2�3a �2'7 Date Signed: �J A ATTES City Clerk FOR CITY,APPROVED AS TO FORM: City Aft ey 00500 4-2020 Page 5 of 5 Standard Form of Agreement 00443647 O CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On 12/13/24 before me, Rebecca Wilks, Notary Public ere rnsert name and e of the o icer) personally appeared Roger DeVito who proved to me on the basis of satisfactory evidence to be the person(s� whose name() Is re subscribed to the within instrument and acknowledged to me that he/they executed the same in 41Fs er/their authorized capacity(ies), and that by Is er/their signature( on the instrument the person(s), or the entity upon behalf of which the person(-s-) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. REBECCA VVILKS commission#2462475 Commis WITNESS my hand and official seal. y., \� Notary PutAic sion#2�If�nia c:: ! �� San Bernardino County My Comm.Expires Sep.9,2027 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT if needed.should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long as the wording does not require the California notan,to violate California notao, Round Rock contract law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/they-is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection ofdocument recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). wwna.NotaryClasses.corn 800-873-9865 Securely attach this document to the signed document with a staple. PERFORMANCE BOND Bond No.015226272 THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Elecnor Belco Electric,Inc. , of the City of Chino , County of San Bernardino , and State of California , as Principal, and Liberty Mutual Insurance Company authorized under the law of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS (Owner),in the penal sum of Four hundred ninety-nine thousand eight hundred eighty-eight dollars Dollars ($499,888.00 ) for the payment whereof, well and truly to be made the said Principal and Surety bind themselves, and their heirs, administrators, executors, successors and assigns,jointly and severally,by these presents: WHEREAS, the Prix`pipal has entered into/a,certain written Agreement with the Owner dated the Z d y day o� 20 to which the Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BLVD NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said Principal shall faithfully perform said Agreement and shall, in all respects, duly and faithfully observe and perform all and singular the covenants, conditions and agreements in and by said Agreement, agreed and covenanted by the Principal to be observed and performed, including but not limited to, the repair of any and all defects in said work occasioned by and resulting from defects in materials furnished by or workmanship of,the Principal in performing the Work covered by said Agreement and occurring within a period of twelve (12) months from the date of Final Completion and all other covenants and conditions, according to the true intent and meaning of said Agreement and the Plans and Specifications hereto annexed,then this obligation shall be void; otherwise to remain in full force and effect; PROVIDED, HOWEVER,that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government Code, as amended; and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00610 4-2020 Performance Bond 00443639 PERFORMANCE BOND(continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement, or to the Work performed thereunder, or the Plans, Specifications, or drawings accompanying the same, shall in anywise affect its obligation on this bond,and it does hereby waive notice of any such change,extension of time,alteration or addition to the terms of the Agreement, or to the work to be performed thereunder. If Principal fails to faithfully perform said Agreement, Surety, after receipt of written notice of Principal's default,shall perform all of Principal's duties and obligations under the Agreement. If, within ten (10) days after receipt of such notice from Owner, Surety does not commence to complete the obligations of Principal with a contractor acceptable to Owner and diligently complete the performance of the Principal's duties and obligations,Owner shall have the right but not the obligation to have the duties and obligations of Principal performed. In such event, Surety shall pay to Owner,upon demand, all costs,expenses and damages sustained by Owner as a result of Principal's failure to perform its duties and obligations under the Agreement up to the $499,888.00 sum of this Performance Bond, plus all costs and expenses, including attorney's fees and expert and consultant fees incurred by Owner to enforce its rights under this Performance Bond. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this 5th day of December ,20 24 . Etecnor Belco Electr' Inc.,050 Liberty Mutual Insurance Company Pral Surety yr ev' 0., Michelle Anne McMahon Printed Name Printed Name By: By: Title: Title: Attorney-In-Fact Address: Address: 10 State House Square,Floor 11 Smi va j CA Hartford,CT 06103 TX License No.2098182 Resident Agent of Surety: 1NSU Signature JJP� vkp0 "o'tt� a F Printed Name 1912 Street Addresss�+CH �Ab City, State& Zip Code Page 2 00610 4-2020 Performance Bond 00443639 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On 12/13/24 before me, Rebecca Wilks, Notary Public ere insertna— m�"ule of personally appeared Jeroni Gervilla who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s-) Is re subscribed to the within instrument and acknowledged to me that Kie_she/they executed the same in Is er/their authorized capacity(ie-s), and that by Is er/their signature(&) on the instrument the person(s), or the entity upon behalf of which the person() acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. REBECCA WITNESS my hand and official seal. Commission#24on#24 2 62475 � r Notary Public-California San Bernardino County My Comm.Expires Sep.9.2027 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM Thisform complies with current California statutes regarding notary wording and, DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long Round Rock bond as the wording does not rewire the California notary to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/they-is/afe)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection of document recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other Indicate title or type of attached document,number of pages and date. E] Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). v".t.Notar'yClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. PAYMENT BOND Bond No.015226272 THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Elecnor Belco Electric,Inc. , of the City of Chino , County of San Bernardino , and State of California , as Principal,and authorized under the laws of the State of Texas to act as Surety on Bonds for Principals,are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Four hundred ninety-nine thousand eight hundred and eighty-eight dollars and zero cents Dollars($ 499,888.00 )for the payment whereof,well and truly be made the said Principal and Surety bind themselves and their heirs, administrators, executors, successors, and assigns,jointly and severally,by these presents: WHEREAS,thePrj gcipal has entered into a certain written Agreement with the Owner,dated the Z o 20 to which Agreement is hereby referred to day ofn&,g L-b&', and made a part hereof as fully and to the same extent as if copied at length herein consisting of: TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BLVD NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall well and truly pay all subcontractors, workers, laborers,mechanics, and suppliers, all monies to them owing by said Principals for subcontracts,work,labor,equipment,supplies and materials done and furnished for the construction of the improvements of said Agreement, then this obligation shall be and become null and void;otherwise to remain in full force and effect. PROVIDED,HOWEVER,that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government Code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00620 04-2020 Payment Bond 00437699 PAYMENT BOND(continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement, or to the Work performed thereunder, or the plans, specifications or drawings accompanying the same shall in anywise affect its obligation on this bond,and it does hereby waive notice of any such change,extension of time,alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this Instrument this 5th day of December , 2024 . Elecnor Belco Electr' ,Inc.(TX) Liberty Mutual Insurance Company Princ al Surety - L Michelle Anne McMahon PrintedName Printed Name By: By: Title: MV Title: Attorney-In-Fact Address: 1`k 33,0 M16k.r$ Wq,v Address: 10 State House Square,Floor 11 o m Hartford,CT 06103 TX License No.2098182 Resident Agent of SuretN: Signature \1 �N S UR j �0OaPOR,�T�-1 Printed Name 1912 0 Street Address d�9as s�fiy a City, State&Zip Code Page 2 006201-2020 Pacment Bond 00090656 CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California } County of San Bernardino } On 12/13/24 before me, Rebecca Wilks, Notary Public ere insert name and title of the o icer personally appeared Jeroni Gervilla who proved to me on the basis of satisfactory evidence to be the person(a) whose name(s-) Is re subscribed to the within instrument and acknowledged to me that r Ze he/they executed the same in Is er/their authorized capacity(ies), and that by Is er/their signature(&) on the instrument the person(s), or the entity upon behalf of which the person(&) acted, executed the instrument. certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. REBECCA WILKS WI Commission NESS m hand and official seal. ;.� c y Notary Public California San Bemardino County My Comm.Expires Sep.9,2027 Notary Public Signature (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRUCTIONS FOR COMPLETING THIS FORM This form complies with current California stakries regarding notary wording and. DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded.should be completed and attached to the document.Acknowledgments from other states may be completed for documents being sent to that state so long Round Rock bond as the wording does not require the California notan,to violate California notary law. (Title or description of attached document) • State and County information must be the State and County where the document signer(s)personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s)personally appeared which (Title or description of attached document continued) must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her Number of Pages Document Date commission followed by a comma and then your title(notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e. he/she/they,-is/are)or circling the correct forms.Failure to correctly indicate this ❑ Individual (s) information may lead to rejection ofdocument recording. ❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges,re-seal if a (Title) sufficient area permits,otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of ❑ Partner(s) the county clerk. ❑ Attorney-in-Fact . Additional information is not required but could help to ensure this ❑ Trustee(s) acknowledgment is not misused or attached to a different document. Other ee Indicate title or type of attached document,number of pages and date. ❑ Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer,indicate the title(i.e.CEO,CFO,Secretary). vN,nv.NotaryClasses.com 800-873-9865 • Securely attach this document to the signed document with a staple. This Power of Attorney limits the acts of those named herein,and they have no authority to Liberty bind the Company except in the manner and to the extent herein stated. Ll Uerty Liberty Mutual Insurance Company Mutual: The Ohio Casualty Insurance Company Certificate No: 8210646-985949 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts.and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies'),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Connor %k olpert.Doritza Mojica,Genal Stewart,Jennitcr GtwJerc.Jonathan Gleason.Joshua Sanford.Kathryn Pryor,KvIc Williams,Michelle Anne McMahon,Nicholas Miller.Richard Hackner,Robyn Salley,Sarah Murtha all of the city of Hartford state of CT each individually if there be more than one named.its true and lawful attomey-in-fact to make. execute.seal.acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings.bonds,recognizances and other surety obligations.in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this "nd day of August 1 2023 Liberty Mutual Insurance Company %NSU,* 01 INS& tNsuRq The Ohio Casualty Insurance Company �JP4°RPOR.4r1't'Ci yJPPOP 4l R'17y ClP LOµPOR9tF yC West American Insurance Company J 3 Fo F Q 3 Fo n a: 3 o m 1912 N 0 0 1919 g 1991 0 d 3 / l �9sS4CHU`��ti dD3" yQ ZFN.h4MPS��,aD� (s �HDIANP ya r c By: � David M.Carey.Assistant Secretary co State of PENNSYLVANIA ss A ami R County of MONTGOMERY On this 22nd day of August 2023 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance co Company..The Ohio Casualty Company,and West American Insurance Company.and that he,as such.being authorized so to do.execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. co —D IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting..Pennsylvania,on the day and year first above written. — C U) IF Qti�koN WE TF( Commonwealth of Pennsylvania-Notary Seal y7 ° 4a ! Teresa Pastelia,Montgomery Notary Public f Q� � 0 t` � .-. 7 Montgomery County Q 9� OF My commission expires March 28.2025 By: C: CU �P Commission number 1126044 }� Member.Pennsylvania Association of Notanes Teresa Paste la.Notary PUBIC EO C Q) 0 4Ry t! This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company.Liberty Mutual InsuranceCNJ o Company.and West American Insurance Company which resolutions are now in full force and effect reading as follows: w Gi ARTICLE IV-OFFICERS:Section 12.Power of Attorney. � o 76 Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the President b co may prescribe,shall appoint such attomeys-in-fact.as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety any and all undertakings.bonds.recognizances and other surety obligations.Such attomeys-in-fact.subject to the limitations set forth in their respective powers of attorney.shall have full — power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed.such instruments shall o Z U be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fad under the provisions of this co article may be revoked at any time by the Board.the Chairman,the President or by the officer or officers granting such power or authority. LL C. — ARTICLE XIII-Execution of Contracts:Section 5,Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president.and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make.execute,seal,acknowledge and deliver as surety any and all undertakings. bonds.recognizances and other surety obligations.Such attomeys-in-fact subject to the limitations set forth in their respective powers of attomey,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company.authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal.acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization-By unanimous consent of the Company's Board of Directors.the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company.wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I.Renee C.Llewellyn,the undersigned.Assistant Secretary.The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies.is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF.I have hereunto set my hand and affixed the seals of said Companies this 5th day of December r 2024 INSUR �tY INS& to \NSUR �JPc°avoR4r4'LCi �iJPc.°RvoRyr�y2 �Pc°ReOR'9�4yC' J 3 Fo m Q 1912 "Q 1919 2 1991 'x.11' ey. i al p Q d�'SS4CMU`'�,dD� SQ Fh NA MPSI,da3 �s HDIANP aa3 Renee C.Llewellyn.Assistant Secretary LMS-12873 LMIC CLIC WAIC Multi Co 02121 _ Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call toll-free for information or to Usted puede llamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste.400 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages,rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection(111-1 A) de Texas Consumer Protection(111-1 A) P. O. Box 149091 P. O. Box 149091 Austin,TX 78714-9091 Austin,TX 78714-9091 FAX: (512)490-1007 FAX#(512)490-1007 Web: htty://www.tdi.texas.gov Web: htty://www.tdi.texas.gov E-mail: ConsumerProtection(a,tdi.texas.gov E-mail: ConsumerProtection(atdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first contact un reclamo, debe comunicarse con el agente o the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved, you may contact the entonces comunicarse con el departamento(TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15M 10/15 Page 1 of 3 A ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/18/2024 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. 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). PRODUCER CONTACT NAME: Nancy Kwong Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd PHOUVC.NNo,EExfi1-877-945-7376 aC No: 1-888-467-2378 P.O. Box 305191 A DRIESS: certificates@willis.com Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hartford Insurance Company of the Midwest 37478 INSURED INSURER B: Hartford Fire Insurance Company 19682 Elecnor Belco Electric, Inc. 14320 Albers Way INSURER C: Navigators Insurance Company 42307 Chino, CA 91710 INSURER D: Sentinel Insurance Company Ltd 11000 INSURERE: Markel American Insurance Company 28932 INSURER F: Axis Specialty Insurance Company 15610 COVERAGES CERTIFICATE NUMBER:W36751496 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. INSR ADDTYPE OF INSURANCE IVSD WVDSUBR POLICY NUMBER MMIDDIYYYY MPOLICY EFF M LICY EXP LTR IDDfYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREM SE,(E.occurrence) ccurrrence) $ 300,000 A MED EXP(Any one person) $ 10,000 y y 10 UEA BH6 U3E 11/01/2024 11/01/2025-PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PROF—] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED y y 10 UEA HF1837 11/01/2024 11/01/2025 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 C X EXCESS LIAB CLAIMS-MADE MR24EXC918906IV 11/01/2024 11/01/2025 AGGREGATE $ 3,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUE No NIA y 10 WEA AU9T8V 11/01/2024 11/01/2025 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Excess Liability MKLI-nEUE100962 11/01/2024 11/01/2025 Each Occurrence $5,000,000 Aggregate $5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: TRAFFIC SIGNAL AT SAM BASS ROAD AND OLD SETTLERS BLVD Certificate Holder is included as an Additional Insured as respects to General Liability and Auto Liability. General Liability and Auto Liability shall be Primary and Non-contributory with any other insurance in force for or SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Manager AUTHORIZED REPRESENTATIVE City of Round Rock 221 E. Main Street (��•. ' y, Round Rock, TX 78664 YRVV(��• ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 26943902 BATCH: 3747432 AGENCY CUSTOMER ID: LOC#: ACC o® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Elecnor Belco Electric, Inc. 14320 Albers Way POLICY NUMBER Chino, CA 91710 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance which may be purchased by Additional Insured. Waiver of Subrogation applies in favor of Additional Insured with respects to General Liability, Auto Liability and Workers Compensation, as permitted by law. Excess policy(ies) is excess over the General Liability, Automobile and Employers Liability. Additional Insureds: The City of Round Rock. INSURER AFFORDING COVERAGE: Axis Specialty Insurance Company NAIC#: 15610 POLICY NUMBER: P-001-001026810-03 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occurrence $2,000,000 Aggregate $2,000,000 INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: QT-630-7Y941398-TIL-24 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Property Personal Property $4,332,300 Business Income & $1,000,000 Extra Expense INSURER AFFORDING COVERAGE: Travelers Property Casualty Company of America NAIC#: 25674 POLICY NUMBER: QT-630-7Y941398-TIL-24 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Installation Coverage Each Job Site $5,000,000 Each Temp Storage $1,000,000 All Covered Combined $6,000,000 ADDITIONAL REMARKS: In Transit - $1,000,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 26943902 BATCB: 3747432 CERT: W36751496 AGENCY CUSTOMER ID: LOC#: A� ADDITIONAL REMARKS SCHEDULE Page 3 of 3 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. Elecnor Belco Electric, Inc. 14320 Albers Way POLICY NUMBER Chino, CA 91710 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance INSURER AFFORDING COVERAGE: Specialty Builders Insurance Company NAIC#: 16826 POLICY NUMBER: ZCO-16P95415 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Professional Liability Per Claim $5,000,000 Aggregate $5,000,000 SIR Per Claim $250,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 26943902 BATCH: 3747432 CERT: w36751496 Policy Number: 10UEABH6U3E Policy Term: 11/1/2024- 11/1/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Designated Project(s) Or Location(s) Or Organization(s): Of Covered Operations: As required by written contract As specified in written contract Information required to complete this Schedule if not shown above will be shown in the Declarations. A. With respect to those person(s) or organization(s) (3) In connection with "your work" for the shown in the Schedule above when you have additional insured at the project(s) or agreed in a written contract or written agreement location(s) designated in the Schedule to provide insurance such as is afforded under this and included within the "products- policy to them, Subparagraph f., Any Other completed operations hazard", but only if: Party, under the Additional Insureds When (a) The written contract or written Required By Written Contract, Written agreement requires you to provide Paragraph of such coverage to such additional Who Is An Insured is replaced with the following: insured at the project(s) or location(s) f. Any Other Party designated in the Schedule; and Any other person or organization who is not (b) This Coverage Part provides an insured under Paragraphs a. through e. coverage for "bodily injury" or above, but only with respect to liability for "property damage" included within the "bodily injury", "property damage" or"personal "products-completed operations and advertising injury" caused, in whole or in hazard". part, by your acts or omissions or the acts or The insurance afforded to the additional omissions of those acting on your behalf: insured shown in the Schedule applies: (1) In the performance of your ongoing (1) Only if the "bodily injury" or "property operations for such additional insured at damage" occurs, or the "personal and the project(s) or location(s) designated in advertising injury"offense is committed: the Schedule; (a) During the policy period; and (2) In connection with your premises owned (b) Subsequent to the execution of such by or rented to you and shown in the written contract or written agreement; Schedule; or and Form HS 24 80 07 13 Page 1 of 2 © 2013,The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) (c) Prior to the expiration of the period of When You Add Others As An Additional time that the written contract or written Insured To This Insurance agreement requires such insurance (a) Primary Insurance When Required By be provided to the additional insured. Contract (2) Only to the extent permitted by law; and This insurance is primary if you have agreed (3) Will not be broader than that which you in a written contract or written agreement that are required by the written contract or this insurance be primary. If other insurance written agreement to provide for such is also primary, we will share with all that additional insured. other insurance by the method described in With respect to the insurance afforded to the Paragraph (c) below. This insurance does not person(s)or organization(s)that are additional apply to other insurance to which the insureds under this endorsement, the additional insured in the Schedule has been following additional exclusion applies: added as an additional insured. This insurance does not apply to "bodily (b) Primary And Non-Contributory To Other injury", "property damage" or "personal and Insurance When Required By Contract advertising injury" arising out of the rendering This insurance is primary to and will not seek of, or the failure to render, any professional contribution from any other insurance architectural, engineering or surveying available to an additional insured under your services, including: policy provided that: (1) The preparing, approving, or failing to (i) The additional insured in the Schedule is prepare or approve maps, shop drawings, a Named Insured under such other opinions, reports, surveys, field orders, insurance; and change orders, designs or specifications; (ii) You have agreed in a written contract or or written agreement that this insurance (2) Supervisory, inspection, architectural or would be primary and would not seek engineering activities. contribution from any other insurance The limits of insurance that apply to the additional available to the additional insured in the insured shown in the Schedule are described in the Schedule. Limits Of Insurance section. (c) h Iethod Of Sharing How this insurance applies when other insurance is If all of the other insurance permits available to the additional insured is described in the contribution by equal shares, we will follow Other Insurance Condition in this method also. Under this approach, each Commercial General Liability Conditions, except as insurer contributes equal amounts until it has otherwise amended below. paid its applicable limit of insurance or none of B. With respect to insurance provided to the the loss remains, whichever comes first. person(s) or organization(s) that are additional If any of the other insurance does not permit insureds under this endorsement, the When You contribution by equal shares, we will Add Others As An Additional Insured To This contribute by limits. Under this method, each Insurance subparagraph, under the Other insurer's share is based on the ratio of its Condition of applicable limit of insurance to the total General Liability Conditions is replaced with the applicable limits of insurance of all insurers. following: All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 07 13 Policy Number: 10UEABH6U3E Policy Term: 11/1/2024 - 11/1/2025 it COMMERCIAL GENERAL LIABILITY COVERAGE FORM Various provisions in this policy restrict coverage. (1) The "bodily injury" or"property damage" is Read the entire policy carefully to determine rights, caused by an "occurrence" that takes duties and what is and is not covered. place in the"coverage territory"; Throughout this policy the words "you" and "your" (2) The "bodily injury" or "property damage" refer to the Named Insured shown in the occurs during the policy period; and Declarations, and any other person or organization (3) Prior to the policy period, no insured listed qualifying as a Named Insured under this policy. The under Paragraph 1. of Section II —Who Is words "we", "us' and "our" refer to the stock An Insured and no "employee" authorized insurance company member of The Hartford by you to give or receive notice of an providing this insurance. "occurrence" or claim, knew that the The word "insured" means any person or "bodily injury" or "property damage" had organization qualifying as such under Section II — occurred, in whole or in part. If such a Who Is An Insured. listed insured or authorized "employee" Other words and phrases that appear in quotation knew, prior to the policy period, that the marks have special meaning. Refer to Section V — "bodily injury" or "property damage" Definitions. occurred, then any continuation, change SECTION I—COVERAGES or resumption of such "bodily injury" or "property damage" during or after the COVERAGE A BODILY INJURY AND PROPERTY policy period will be deemed to have been DAMAGE LIABILITY known prior to the policy period. 1. Insuring Agreement c. "Bodily injury" or "property damage" will be a. We will pay those sums that the insured deemed to have been known to have becomes legally obligated to pay as damages occurred at the earliest time when any because of "bodily injury" or "property insured listed under Paragraph 1. of Section II damage" to which this insurance applies. We — Who Is An Insured or any "employee" will have the right and duty to defend the authorized by you to give or receive notice of insured against any "suit" seeking those an "occurrence" or claim: damages. However, we will have no duty to (1) Reports all, or any part, of the "bodily defend the insured against any "suit" seeking injury" or "property damage" to us or any damages for "bodily injury" or "property other insurer; damage" to which this insurance does not (2) Receives a written or verbal demand or apply. We may, at our discretion, investigate claim for damages because of the "bodily any"occurrence" and settle any claim or"suit" injury" or"property damage"; or that may result. But: (3) Becomes aware by any other means that (1) The amount we will pay for damages is "bodily injury" or "property damage" has limited as described in Section III — Limits occurred or has begun to occur. Of Insurance; and (2) Our right and duty to defend ends when d. Damages because of "bodily injury" include damages claimed by any person or we have used up the applicable limit of organization for care, loss of services or insurance in the payment of judgments or death resulting at any time from the "bodily settlements under Coverages A or B or injury". medical expenses under Coverage C. e. Incidental Medical Malpractice And Good No other obligation or liability to pay sums or Samaritan Coverage perform acts or services is covered unless explicitly provided for under Supplementary "Bodily injury" arising out of the rendering of Payments—Coverages A and B. or failure to render the following health care services by any "employee" or "volunteer b. This insurance applies to "bodily injury" and worker" shall be deemed to be caused by an "property damage" only if: "occurrence"for: HG 00 01 09 16 Page 1 of 21 ©2016 The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission.) (1) Professional health care services such as: (a) Liability to such party for, or for the (a) Medical, surgical, dental, laboratory, x- cost of, that party's defense has also ray or nursing services or treatment, been assumed in the same "insured advice or instruction, or the related contract'; and furnishing of food or beverages; (b) Such attorney fees and litigation (b) Any health or therapeutic service, expenses are for defense of that party treatment, advice or instruction; or against a civil or alternative dispute (c) The furnishing or dispensing of drugs resolution proceeding in which or medical, dental, or surgical supplies damages to which this insurance or appliances; or applies are alleged. (2) First aid services, which include: c. Liquor Liability "Bodily injury" or "property damage" for which (a) Cardiopulmonary resuscitation, any insured may be held liable by reason of: whether performed manually or with a defibrillator; or (1) Causing or contributing to the intoxication (b) Services performed as a Good of any person; Samaritan. (2) The furnishing of alcoholic beverages to a For the purpose of determining the limits of person under the legal drinking age or insurance, any act or omission together with under the influence of alcohol; or all related acts or omissions in the furnishing (3) Any statute, ordinance or regulation of these services to any one person will be relating to the sale, gift, distribution or use considered one "occurrence". of alcoholic beverages. However, this Incidental Medical Malpractice This exclusion applies even if the claims And Good Samaritan Coverage provision against any insured allege negligence or applies only if you are not engaged in the other wrongdoing in: business or occupation of providing any of the (a) The supervision, hiring, employment, services described in this provision. training or monitoring of others by that 2. Exclusions insured; or This insurance does not apply to: (b) Providing or failing to provide transportation with respect to any a. Expected Or Intended Injury person that may be under the influence "Bodily injury" or "property damage" expected of alcohol; or intended from the standpoint of the if the "occurrence" which caused the "bodily insured. This exclusion does not apply to injury" or "property damage", involved that "bodily injury" or "property damage" resulting which is described in Paragraph (1), (2) or (3) from the use of reasonable force to protect above. persons or property. b. Contractual Liability However, this exclusion applies only if you are in the business of manufacturing, "Bodily injury" or "property damage" for which distributing, selling, serving or furnishing the insured is obligated to pay damages by alcoholic beverages. For the purposes of this reason of the assumption of liability in a exclusion, permitting a person to bring contract or agreement. This exclusion does alcoholic beverages on your premises, for not apply to liability for damages: consumption on your premises, whether or (1) That the insured would have in the not a fee is charged or a license is required absence of the contract or agreement; or for such activity, is not by itself considered the (2) Assumed in a contract or agreement that business of selling, serving or furnishing is an "insured contract", provided the alcoholic beverages. "bodily injury" or "property damage" d. Workers' Compensation And Similar Laws occurs subsequent to the execution of the Any obligation of the insured under a workers' contract or agreement. Solely for the compensation, disability benefits or purposes of liability assumed in an unemployment compensation law or any "insured contract", reasonable attorney similar law. fees and necessary litigation expenses e. Employer's Liability incurred by or for a party other than an insured are deemed to be damages "Bodily injury"to: because of "bodily injury" or "property (1) An "employee" of the insured arising out of damage", provided: and in the course of: Page 2 of 21 HG 00 01 09 16 (a) Employment by the insured; or the handling, storage, disposal, (b) Performing duties related to the processing or treatment of waste; conduct of the insured's business; or (c) Which are or were at any time (2) The spouse, child, parent, brother or sister transported, handled, stored, treated, of that "employee" as a consequence of disposed of, or processed as waste by Paragraph (1) above. or for: This exclusion applies: (i) Any insured; or (1) Whether the insured may be liable as an (ii) Any person or organization for employer or in any other capacity; and whom you may be legally (2) To any obligation to share damages with responsible; or repay someone else who must pay (d) At or from any premises, site or damages because of the injury. location on which any insured or any contractors or subcontractors working This exclusion does not apply to liability directly or indirectly on any insured's assumed by the insured under an "insured behalf are performing operations if the contract". "pollutants" are brought on or to the f. Pollution premises, site or location in connection (1) "Bodily injury" or "property damage" with such operations by such insured, arising out of the actual, alleged or contractor or subcontractor. However, threatened discharge, dispersal, seepage, this subparagraph does not apply to: migration, release or escape of (i) "Bodily injury"or"property damage" "pollutants": arising out of the escape of fuels, (a) At or from any premises, site or lubricants or other operating fluids location which is or was at any time which are needed to perform the owned or occupied by, or rented or normal electrical, hydraulic or loaned to, any insured. However, this mechanical functions necessary for subparagraph does not apply to: the operation of"mobile equipment" (i) "Bodily injury" if sustained within a or its parts, if such fuels, lubricants building and caused by smoke, or other operating fluids escape fumes, vapor or soot produced by from a vehicle part designed to or originating from equipment that hold, store or receive them. This is used to heat, cool or dehumidify exception does not apply if the the building, or equipment that is "bodily injury" or"property damage" used to heat water for personal arises out of the intentional use, by the building's occupants or discharge, dispersal or release of their guests; the fuels, lubricants or other operating fluids, or if such fuels, (ii) "Bodily injury" or"property damage" lubricants or other operating fluids for which you may be held liable, if are brought on or to the premises, you are a contractor and the owner site or location with the intent that or lessee of such premises, site or they be discharged, dispersed or location has been added to your released as part of the operations policy as an additional insured with being performed by such insured, respect to your ongoing operations contractor or subcontractor; performed for that additional (ii) "Bodilyinjury" "property or" ro damage" insured at that premises, site or m y p p il g sustained within a building and location and such premises, site or caused by the release of gases, location is not and never was owned or occupied by, or rented or fumes or vapors from materials loaned to, any insured, other than brought into that building in that additional insured; connection with operations being performed by you or on your behalf (iii) "Bodily injury" or"property damage" by a contractor or subcontractor;or arising out of heat, smoke or fumes (iii) "Bodily injury"or"property damage" from a "hostile fire"; arising out of heat, smoke or fumes (b) At or from any premises, site or from a "hostile fire"; or location which is or was at any time (e) At or from any premises, site or used by or for any insured or others for location on which any insured or any contractors or subcontractors working HG 00 01 09 16 Page 3 of 21 directly or indirectly on any insured's to, premises you own or rent, provided the behalf are performing operations if the "auto" is not owned by or rented or loaned operations are to test for, monitor, to you or the insured; clean up, remove, contain, treat, (4) Liability assumed under any "insured detoxify or neutralize, or in any way contract" for the ownership, maintenance respond to, or assess the effects of, or use of aircraft or watercraft; "pollutants". (5) "Bodily injury" or "property damage" (2) Any loss, cost or expense arising out of arising out of: any: (a) The operation of machinery or (a) Request, demand, order or statutory or equipment that is attached to, or part regulatory requirement that any of, a land vehicle that would qualify insured or others test for, monitor, under the definition of "mobile clean up, remove, contain, treat, equipment" if it were not subject to a detoxify or neutralize, or in any way compulsory or financial responsibility respond to, or assess the effects of, law or other motor vehicle insurance "pollutants'; or law where it is licensed or principally (b) Claim or suit by or on behalf of a garaged; or governmental authority for damages (b) The operation of any of the machinery because of testing for, monitoring, or equipment listed in Paragraph f.(2) cleaning up, removing, containing, or f.(3) of the definition of "mobile treating, detoxifying or neutralizing, or equipment"; or in any way responding to, or assessing the effects of, "pollutants". (6) An aircraft that is not owned by any insured and is hired, chartered or loaned However, this paragraph does not apply to with a paid crew. However, this exception liability for damages because of "property does not apply if the insured has any other damage" that the insured would have in insurance for such "bodily injury" or the absence of such request, demand, "property damage", whether the other order or statutory or regulatory insurance is primary, excess, contingent requirement, or such claim or "suit" by or or on any other basis. on behalf of a governmental authority. h. Mobile Equipment g. Aircraft, Auto Or Watercraft "Bodily injury" or "property damage" arising "Bodily injury" or "property damage" arising out of: out of the ownership, maintenance, use or entrustment to others of any aircraft, "auto" or (1) The transportation of "mobile equipment" watercraft owned or operated by or rented or by an "auto" owned or operated by or loaned to any insured. Use includes operation rented or loaned to any insured; or and "loading or unloading". (2) The use of"mobile equipment" in, or while This exclusion applies even if the claims in practice for, or while being prepared for, against any insured allege negligence or any prearranged racing, speed, other wrongdoing in the supervision, hiring, demolition, or stunting activity. employment, training or monitoring of others i. War by that insured, if the "occurrence" which "Bodily injury" or "property damage", however caused the "bodily injury" or "property caused, arising, directly or indirectly, out of: damage" involved the ownership, (1) War, including undeclared or civil war; maintenance, use or entrustment to others of any aircraft, "auto" or watercraft that is owned (2) Warlike action by a military force, including or operated by or rented or loaned to any action in hindering or defending against an insured. actual or expected attack, by any This exclusion does not apply to: government, sovereign or other authority using military personnel or other agents; (1) A watercraft while ashore on premises you or own or rent; (3) Insurrection, rebellion, revolution, usurped (2) A watercraft you do not own that is: power, or action taken by governmental (a) Less than 51 feet long; and authority in hindering or defending against (b) Not being used to carry persons for a any of these. charge; j. Damage To Property (3) Parking an "auto" on, or on the ways next "Property damage"to: Page 4 of 21 HG 00 01 09 16 (1) Property you own, rent, or occupy, This exclusion does not apply if the damaged including any costs or expenses incurred work or the work out of which the damage by you, or any other person, organization arises was performed on your behalf by a or entity, for repair, replacement, subcontractor. enhancement, restoration or maintenance m. Damage To Impaired Property Or Property of such property for any reason, including Not Physically Injured prevention of injury to a person or damage to another's property; "Property damage" to "impaired property" or property that has not been physically injured, (2) Premises you sell, give away or abandon, arising out of: if the "property damage" arises out of any part of those premises; (1) A defect, deficiency, inadequacy or 3 Property loaned to you- dangerous condition in "your product" or ( ) p Y Y "your work"; or (4) Personal property in the care, custody or (2) A delay or failure by you or anyone acting control of the insured; on your behalf to perform a contract or (5) That particular part of real property on agreement in accordance with its terms. which you or any contractors or This exclusion does not apply to the loss of subcontractors use of other property arising out of sudden working directly or indirectly on your behalf and accidental physical injury to "your are performing operations, if the "property product" or "your work" after it has been put damage" arises out of those operations; or to its intended use. (6) That particular part of any property that n. Recall Of Products,Work Or Impaired must be restored, repaired or replaced Property because "your work" was incorrectly performed on it. Damages claimed for any loss, cost or expense incurred by you or others for the loss Paragraphs (1), (3) and (4) of this exclusion of use, withdrawal, recall, inspection, repair, do not apply to "property damage" (other than replacement, adjustment, removal or disposal damage by fire) to premises, including the of: contents of such premises, rented to you for a period of seven or fewer consecutive days. A (1) "Your product"; separate limit of insurance applies to Damage (2) "Your work"; or To Premises Rented To You as described in (3) "Impaired property"; Section III—Limits Of Insurance. if such product, work, or property is withdrawn Paragraph (2) of this exclusion does not apply or recalled from the market or from use by if the premises are "your work" and were any person or organization because of a never occupied, rented or held for rental by known or suspected defect, deficiency, You. inadequacy or dangerous condition in it. Paragraphs (3) and (4) of this exclusion do o. Personal And Advertising Injury not apply to "property damage" arising from "Bodily injury' arising out of "personal and the use of elevators. advertising injury". Paragraphs (3), (4), (5) and (6) of this exclusion do not apply to liability assumed p• Access or Disclosure Of Confidential Or under a sidetrack agreement. Personal Information And Data-related Liability Paragraphs (3) and (4) of this exclusion do not apply to "property damage" to borrowed Damages arising out of: equipment while not being used to perform (1) Any access to or disclosure of any operations at the job site. person's or organization's confidential or Paragraph (6) of this exclusion does not apply personal information, including patents, to "property damage" included in the trade secrets, processing methods, "products-completed operations hazard". customer lists, financial information, credit card information, health information or any k. Damage To Your Product other type of nonpublic information; or "Property damage" to "your product" arising (2) The loss of, loss of use of, damage to, out of it or any part of it. corruption of, inability to access, or I. Damage To Your Work inability to manipulate electronic data. "Property damage" to "your work" arising out This exclusion applies even if damages are of it or any part of it and included in the claimed for notification costs, credit "products-completed operations hazard". monitoring expenses, forensic expenses, HG 00 01 09 16 Page 5 of 21 public relations expenses or any other loss, assess the effects of an "asbestos cost or expense incurred by you or others hazard"; or arising out of that which is described in (c) Arise out of any claim or suit for Paragraph (1) or(2) above. damages because of testing for, However, unless Paragraph (1) above monitoring, cleaning up, removing, applies, this exclusion does not apply to encapsulating, containing, treating, damages because of"bodily injury". detoxifying or neutralizing or in any As used in this exclusion, electronic data way responding to or assessing the means information, facts or programs stored effects of an "asbestos hazard". as or on, created or used on, or transmitted to s. Recording And Distribution Of Material Or or from computer software, including systems Information In Violation Of Law and applications software, hard or floppy "Bodily injury" or "property damage" arising disks, CD-ROMS, tapes, drives, cells, data directly or indirectly out of any action or processing devices or any other media which omission that violates or is alleged to violate: are used with electronically controlled equipment. (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or q. Employment-Related Practices addition to such law; "Bodily injury"to: (2) The CAN-SPAM Act of 2003, including (1) A person arising out of any "employment— any amendment of or addition to such law; related practices"; or (3) The Fair Credit Reporting Act(FCRA), and (2) The spouse, child, parent, brother or sister any amendment of or addition to such law, of that person as a consequence of"bodily including the Fair and Accurate Credit injury" to that person at whom any Transaction Act(FACTA); or "employment-related practices" are (4) Any federal, state or local statute, directed. ordinance or regulation, other than the This exclusion applies: TCPA or CAN-SPAM Act of 2003 or FCRA (1) Whether the injury-causing event and their amendments and additions, that described in the definition of"employment- addresses, prohibits or limits the printing, related practices" occurs before dissemination, disposal, collecting, employment, during employment or after recording, sending, transmitting, employment of that person; communicating or distribution of material or information. (2) Whether the insured may be liable as an employer or in any other capacity; and Damage To Premises Rented To You — Exception For Damage By Fire, Lightning Or (3) To any obligation to share damages with Explosion or repay someone else who must pay damages because of the injury. Exclusions c. through h. and j. through n. do not r. Asbestos apply to damage by fire, lightning or explosion to premises while rented to you or temporarily (1) "Bodily injury" or "property damage" occupied by you with permission of the owner. A arising out of the "asbestos hazard". separate limit of insurance applies to this (2) Any damages, judgments, settlements, coverage as described in Section III — Limits Of loss, costs or expenses that: Insurance. (a) May be awarded or incurred by reason COVERAGE B PERSONAL AND ADVERTISING of any claim or suit alleging actual or INJURY LIABILITY threatened injury or damage of any 1. Insuring Agreement nature or kind to persons or property a. We will pay those sums that the insured which would not have occurred in becomes legally obligated to pay as damages whole or in part but for the "asbestos because of "personal and advertising injury" hazard"; to which this insurance applies. We will have (b) Arise out of any request, demand, the right and duty to defend the insured order or statutory or regulatory against any "suit" seeking those damages. requirement that any insured or others However, we will have no duty to defend the test for, monitor, clean up, remove, insured against any "suit" seeking damages encapsulate, contain, treat, detoxify or for "personal and advertising injury" to which neutralize or in any way respond to or this insurance does not apply. We may, at our Page 6 of 21 HG 00 01 09 16 discretion, investigate any offense and settle use another's "advertising idea" in your any claim or"suit"that may result. But: "advertisement". (1) The amount we will pay for damages is g. Quality Or Performance Of Goods — limited as described in Section III — Limits Failure To Conform To Statements Of Insurance; and "Personal and advertising injury" arising out of (2) Our right and duty to defend end when we the failure of goods, products or services to have used up the applicable limit of conform with any statement of quality or insurance in the payment of judgments or performance made in your"advertisement". settlements under Coverages A or B or h. Wrong Description Of Prices medical expenses under Coverage C. "Personal and advertising injury" arising out of No other obligation or liability to pay sums or the wrong description of the price of goods, perform acts or services is covered unless products or services. explicitly provided for under Supplementary Payments—Coverages A and B. I. Infringement Of Intellectual Property Rights b. This insurance applies to "personal and advertising injury" caused by an offense (1) "Personal and advertising injury" arising arising out of your business but only if the out of any actual or alleged infringement offense was committed in the "coverage or violation of any intellectual property territory" during the policy period. rights such as copyright, patent, trademark, trade name, trade secret, trade 2. Exclusions dress, service mark or other designation This insurance does not apply to: of origin or authenticity; or a. Knowing Violation Of Rights Of Another (2) Any injury or damage alleged in any clam "Personal and advertising injury" arising out of or "suit" that also alleges an infringement an offense committed by, at the direction or or violation of any intellectual property with the consent or acquiescence of the right, whether such allegation of insured with the expectation of inflicting infringement or violation is made by you or "personal and advertising injury". by any other party involved in the claim or "suit", regardless of whether this b. Material Published With Knowledge Of insurance would otherwise apply. Falsity However, this exclusion does not apply if the "Personal and advertising injury" arising out of only allegation in the claim or "suit" involving oral, written or electronic publication, in any any intellectual property right is limited to: manner, of material, if done by or at the direction of the insured with knowledge of its (1) Infringement, in your"advertisement", of: falsity. (a) Copyright; c. Material Published Prior To Policy Period (b) Slogan; or "Personal and advertising injury" arising out of (c) Title of any literary or artistic work; or oral, written or electronic publication, in any (2) Copying, in your "advertisement", a manner, of material whose first publication person's or organization's "advertising took place before the beginning of the policy idea"or style of"advertisement". period. j. Insureds In Media And Internet Type d. Criminal Acts Businesses "Personal and advertising injury" arising out of "Personal and advertising injury" committed a criminal act committed by or at the direction by an insured whose business is: of the insured. (1) Advertising, broadcasting, publishing or e. Contractual Liability telecasting; "Personal and advertising injury"for which the (2) Designing or determining content of web insured has assumed liability in a contract or sites for others; or agreement. This exclusion does not apply to liability for damages that the insured would (3) Internet search, access, content or se have in the absence of the contract or service provider. agreement. However, this exclusion does not apply to f. Breach Of Contract Paragraphs a., b. and c. of the definition of "personal and advertising injury" under the "Personal and advertising injury"arising out of a Definitions Section. breach of contract, except an implied contract to HG 00 01 09 16 Page 7 of 21 For the purposes of this exclusion, the placing "Personal and advertising injury" arising out of frames, borders or links, or advertising, for of: you or others anywhere on the Internet, is not (1) An "advertisement" for others on your web by itself, considered the business of site; advertising, broadcasting, publishing or telecasting. (2) Placing a link to a web site of others on your web site; k. Electronic Chatrooms Or Bulletin Boards (3) Content, including information, sounds, "Personal and advertising injury" arising out of text, graphics, or images from a web site an electronic chatroom or bulletin board the of others displayed within a frame or insured hosts, owns, or over which the border on your web site; or insured exercises control. (4) Computer code, software or programming I. Unauthorized Use Of Another's Name Or used to enable: Product (a) Your web site; or "Personal and advertising injury" arising out of the unauthorized use of another's name or (b) The presentation or functionality of an "advertisement" or other content on product in your e-mail address, domain name your web site. or metatags, or any other similar tactics to mislead another's potential customers. q. Right Of Privacy Created By Statute m. Pollution "Personal and advertising injury" arising out of "Personal and advertising injury" arising out of the violation of a person's right of privacy the actual, alleged or threatened discharge, created by any state or federal act. dispersal, seepage, migration, release or However, this exclusion does not apply to escape of"pollutants" at any time. liability for damages that the insured would n. Pollution-Related have in the absence of such state or federal act. Any loss, cost or expense arising out of any: r. Violation Of Anti-Trust law (1) Request, demand, order or statutory or regulatory requirement that any insured or "Personal and advertising injury" arising out of others test for, monitor, clean up, remove, a violation of any anti-trust law. contain, treat, detoxify or neutralize, or in s. Securities any way respond to, or assess the effects "Personal and advertising injury" arising out of of, "pollutants", or the fluctuation in price or value of any stocks, (2) Claim or suit by or on behalf of a bonds or other securities. governmental authority for damages t. Recording And Distribution Of Material Or because of testing for, monitoring, Information In Violation Of Law cleaning up, removing, containing, treating, detoxifying or neutralizing, or in "Personal and advertising injury" arising any way responding to, or assessing the directly or indirectly out of any action or effects of, "pollutants". omission that violates or is alleged to violate: o. War (1) The Telephone Consumer Protection Act (TCPA), including any amendment of or "Personal and advertising injury", however addition to such law; caused, arising, directly or indirectly, out of: (2) The CAN-SPAM Act of 2003, including (1) War, including undeclared or civil war; any amendment of or addition to such law; (2) Warlike action by a military force, including (3) The Fair Credit Reporting Act(FCRA), and action in hindering or defending against an any amendment of or addition to such law, actual or expected attack, by any including the Fair and Accurate Credit government, sovereign or other authority Transaction Act(FACTA); or using military personnel or other agents; (4) Any federal, state or local statute, or ordinance or regulation, other than the (3) Insurrection, rebellion, revolution, usurped TCPA or CAN-SPAM Act of 2003 or FCRA power, or action taken by governmental and their amendments and additions, that authority in hindering or defending against addresses, prohibits or limits the printing, any of these. dissemination, disposal, collecting, p. Internet Advertisements And Content Of recording, sending, transmitting, Others communicating or distribution of material or information. Page 8 of 21 HG 00 01 09 16 u. Employment-Related Practices information or any other type of nonpublic "Personal and advertising injury"to: information. (1) A person arising out of any "employment— This exclusion applies even if damages are related practices"; or claimed for notification costs, credit monitoring expenses, forensic expenses, (2) The spouse, child, parent, brother or sister public relations expenses or any other loss, of that person as a consequence of cost or expense incurred by you or others "personal and advertising injury" to that arising out of any access to or disclosure of person at whom any "employment-related any person's or organization's confidential or practices" are directed. personal information. This exclusion applies: COVERAGE C MEDICAL PAYMENTS (1) Whether the injury-causing event 1. Insuring Agreement described in the definition of"employment- a. We will pay medical expenses as described related practices" occurs before below for "bodily injury" caused by an employment, during employment or after accident: employment of that person; (1) On premises you own or rent; (2) Whether the insured may be liable as an e (2) On ways next to premises you own or employer or in any other capacity; and rent; or (3) To any obligation to share damages with or repay someone else who must pay (3) Because of your operations; damages because of the injury. provided that: v. Asbestos (1) The accident takes place in the "coverage (1) "Personal and advertising injury" arising territory" and during the policy period; out of the"asbestos hazard". (2) The expenses are incurred and reported (2) Any damages, judgments, settlements, to us within three years of the date of the loss, costs or expenses that: accident; and (a) May be awarded or incurred by reason (3) The injured person submits to of any claim or suit alleging actual or examination, at our expense, by threatened injury or damage of any physicians of our choice as often as we nature or kind to persons or property reasonably require. which would not have occurred in b. We will make these payments regardless of whole or in part but for the "asbestos fault. These payments will not exceed the hazard"; applicable limit of insurance. We will pay (b) Arise out of any request, demand, reasonable expenses for.- order or:order or statutory or regulatory (1) First aid administered at the time of an requirement that any insured or others accident; test for, monitor, clean up, remove, (2) Necessary medical, surgical, X-ray and encapsulate, contain, treat, detoxify or dental services, including prosthetic neutralize or in any way respond to or devices; and assess the effects of an "asbestos (3) Necessary ambulance, hospital, hazard"; or professional nursing and funeral services. (c) Arise out of any claim or suit for 2. Exclusions damages because of testing for, monitoring, cleaning up, removing, We will not pay expenses for"bodily injury": encapsulating, containing, treating, a. Any Insured detoxifying or neutralizing or in any To any insured, except"volunteer workers". way responding to or assessing the effects of an "asbestos hazard". b. Hired Person w. Access Or Disclosure Of Confidential Or To a person hired to do work for or on behalf Personal Information of any insured or a tenant of any insured. "Personal and advertising injury" arising out of c. Injury On Normally Occupied Premises any access to or disclosure of any person's or To a person injured on that part of premises organization's confidential or personal you own or rent that the person normally information, including patents, trade secrets, occupies. processing methods, customer lists, financial d. Workers Compensation And Similar Laws information, credit card information, health To a person, whether or not an "employee" of HG 00 01 09 16 Page 9 of 21 any insured, if benefits for the "bodily injury" are party to the "suit", we will defend that indemnitee payable or must be provided under a workers' if all of the following conditions are met: compensation or disability benefits law or a a. The "suit" against the indemnitee seeks similar law. damages for which the insured has assumed e. Athletics Activities the liability of the indemnitee in a contract or To a person injured while practicing, agreement that is an "insured contract"; instructing or participating in any physical b. This insurance applies to such liability exercises or games, sports, or athletic assumed by the insured; contests. c. The obligation to defend, or the cost of the f. Products-Completed Operations Hazard defense of, that indemnitee, has also been Included within the "products-completed assumed by the insured in the same "insured operations hazard". contract'; g. Coverage A Exclusions d. The allegations in the "suit" and the information we know about the "occurrence" Excluded under Coverage A. are such that no conflict appears to exist SUPPLEMENTARY PAYMENTS — COVERAGES between the interests of the insured and the A AND B interests of the indemnitee; 1. We will pay, with respect to any claim we e. The indemnitee and the insured ask us to investigate or settle, or any "suit" against an conduct and control the defense of that insured we defend: indemnitee against such "suit" and agree that a. All expenses we incur. we can assign the same counsel to defend b. Up to $1,000 for cost of bail bonds required the insured and the indemnitee; and because of accidents or traffic law violations f. The indemnitee: arising out of the use of any vehicle to which (1) Agrees in writing to: the Bodily Injury Liability Coverage applies. (a) Cooperate with us in the investigation, We do not have to furnish these bonds. settlement or defense of the"suit"; c. The cost of appeal bonds or bonds to release (b) Immediately send us copies of any attachments, but only for bond amounts demands, notices, summonses or legal within the applicable limit of insurance. We do papers received in connection with the not have to furnish these bonds. "suit"; d. All reasonable expenses incurred by the (c) Notify any other insurer whose insured at our request to assist us in the coverage is available to the investigation or defense of the claim or"suit", indemnitee; and including actual loss of earnings up to $500 a day because of time off from work. (d) Cooperate with us with respect to coordinating other applicable e. All court costs taxed against the insured in insurance available to the indemnitee; the "suit". However, such costs do not and include attorneys' fees, attorneys' expenses, witness or expert fees, or any other expenses (2) Provides us with written authorization to: of a party taxed to the insured. (a) Obtain records and other information f. Prejudgment interest awarded against the related to the "suit"; and insured on that part of the judgment we pay. If (b) Conduct and control the defense of the we make an offer to pay the applicable limit of indemnitee in such "suit". insurance, we will not pay any prejudgment So long as the above conditions are met, interest based on that period of time after the attorneys' fees incurred by us in the defense of offer. that indemnitee, g. All interest on the full amount of any judgment necessary litigation expenses incurred by us and that accrues after entry of the judgment and necessary litigation expenses incurred by the before we have paid, offered to pay, or indemnitee at our request will be paid as deposited in court the part of the judgment Supplementary Payments. Notwithstanding the that is within the applicable limit of insurance. provisions of Paragraph 2.b.(2) of Section I — These payments will not reduce the limits of Coverage A — Bodily Injury And Property insurance. Damage Liability, such payments will not be deemed to be damages for "bodily injury" and 2. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a "property damage" and will not reduce the limits of insurance. Page 10 of 21 HG 00 01 09 16 Our obligation to defend an insured's indemnitee liability company), to a co-"employee" and to pay for attorneys' fees and necessary while in the course of his or her litigation expenses as Supplementary Payments employment or performing duties ends when: related to the conduct of your a. We have used up the applicable limit of business, or to your other "volunteer insurance in the payment of judgments or workers" while performing duties settlements; or related to the conduct of your b. The conditions set forth above, or the terms of business; the agreement described in Paragraph f. (b) To the spouse, child, parent, brother or above, are no longer met. sister of that co-"employee" or that SECTION II—WHO IS AN INSURED "volunteer worker" as a consequence of Paragraph (1)(a) above; 1. If you are designated in the Declarations as: (c) For which there is any obligation to a. An individual, you and your spouse are share damages with or repay someone insureds, but only with respect to the conduct else who must pay damages because of a business of which you are the sole of the injury described in Paragraphs owner. (1)(a) or(1)(b) above; or b. A partnership or joint venture, you are an (d) Arising out of his or her providing or insured. Your members, your partners, and failing to provide professional health their spouses are also insureds, but only with care services. respect to the conduct of your business. If you are not in the business of providing c. A limited liability company, you are an professional health care services: insured. Your members are also insureds, but (a) Subparagraphs (1)(a), (1)(b) and (1)(c) only with respect to the conduct of your above do not apply to any "employee" business. Your managers are insureds, but or "volunteer worker" providing first aid only with respect to their duties as your services; and managers. (b) Subparagraph (1)(d) above does not d. An organization other than a partnership, joint apply to any nurse, emergency medical venture or limited liability company, you are technician or paramedic employed by an insured. Your "executive officers" and you to provide such services. directors are insureds, but only with respect to their duties as your officers or directors. Your (2) "Property damage"to property.- stockholders roperty:stockholders are also insureds, but only with (a) Owned, occupied or used by, respect to their liability as stockholders. (b) Rented to, in the care, custody or e. A trust, you are an insured. Your trustees are control of, or over which physical also insureds, but only with respect to their control is being exercised for any duties as trustees. purpose by 2. Each of the following is also an insured: you, any of your "employees", "volunteer a. Employees And Volunteer Workers workers", any partner or member (if you are a partnership or joint venture), or any Your volunteer workers" only while member (if you are a limited liability performing duties related to the conduct of company). your business, or your "employees", other than either your"executive officers"(if you are b. Real Estate Manager an organization other than a partnership, joint Any person (other than your "employee" or venture or limited liability company) or your "volunteer worker"), or any organization while managers (if you are a limited liability acting as your real estate manager. company), but only for acts within the scope c. Temporary Custodians Of Your Property of their employment by you or while performing duties related to the conduct of Any person or organization having proper your business. temporary custody of your property if you die, but only: However, none of these "employees" or "volunteer workers"are insureds for: (1) With respect to liability arising out of the (1) "Bodily injury" or"personal and advertising maintenance or use of that property; and injury": (2) Until your legal representative has been (a) To you, to your partners or members (if appointed. you are a partnership or joint venture), d. Legal Representative If You Die to your members (if you are a limited Your legal representative if you die, but only HG 00 01 09 16 Pagel 1 of 21 with respect to duties as such. That 5. Additional Insureds When Required By representative will have all your rights and Written Contract, Written Agreement Or duties under this Coverage Part. Permit e. Unnamed Subsidiary The following person(s) or organization(s) are an Any subsidiary, and subsidiary thereof, of additional insured when you have agreed, in a yours which is a legally incorporated entity of written contract, written agreement or because of which you own a financial interest of more a permit issued by a state or political subdivision, than 50% of the voting stock on the effective that such person or organization be added as an date of the Coverage Part. additional insured on your policy, provided the injury or damage occurs subsequent to the The insurance afforded herein for any execution of the contract or agreement. subsidiary not named in this Coverage Part as a named insured does not apply to injury A person or organization is an additional insured or damage with respect to which such insured under this provision only for that period of time is also a named insured under another policy required by the contract or agreement. or would be a named insured under such However, no such person or organization is an policy but for its termination or the exhaustion insured under this provision if such person or of its limits of insurance. organization is included as an insured by an 3. Newly Acquired Or Formed Organization endorsement issued by us and made a part of Any organization you newly acquire or form, this Coverage Part. other than a partnership, joint venture or limited a. Vendors liability company, and over which you maintain Any person(s) or organization(s) (referred to financial interest of more than 50% of the voting below as vendor), but only with respect to stock, will qualify as a Named Insured if there is "bodily injury" or "property damage" arising no other similar insurance available to that out of"your products"which are distributed or organization. However: sold in the regular course of the vendor's a. Coverage under this provision is afforded only business and only if this Coverage Part until the 180th day after you acquire or form provides coverage for "bodily injury" or the organization or the end of the policy "property damage" included within the period, whichever is earlier; "products-completed operations hazard". b. Coverage A does not apply to "bodily injury" (1) The insurance afforded the vendor is or "property damage" that occurred before subject to the following additional you acquired or formed the organization; and exclusions: c. Coverage B does not apply to "personal and This insurance does not apply to: advertising injury" arising out of an offense (a) "Bodily injury" or "property damage" for committed before you acquired or formed the which the vendor is obligated to pay organization. damages by reason of the assumption 4. Nonowned Watercraft of liability in a contract or agreement. With respect to watercraft you do not own that is This exclusion does not apply toliability for damages that the vendor less than 51 feet long and is not being used to would have in the absence of the carry persons for a charge, any person is an contract or agreement; insured while operating such watercraft with your permission. Any other person or organization (b) Any express warranty unauthorized by responsible for the conduct of such person is you; also an insured, but only with respect to liability (c) Any physical or chemical change in the arising out of the operation of the watercraft, and product made intentionally by the only if no other insurance of any kind is available vendor; to that person or organization for this liability. (d) Repackaging, except when unpacked However, no person or organization is an insured solely for the purpose of inspection, with respect to: demonstration, testing, or the a. "Bodily injury" to a co-"employee" of the substitution of parts under instructions person operating the watercraft; or from the manufacturer, and then b. "Property damage" to property owned by, repackaged in the original container; rented to, in the charge of or occupied by you (e) Any failure to make such inspections, or the employer of any person who is an adjustments, tests or servicing as the insured under this provision. vendor has agreed to make or normally Page 12 of 21 HG 00 01 09 16 undertakes to make in the usual This insurance does not apply to: course of business, in connection with 1. Any "occurrence" which takes place after the distribution or sale of the products; you cease to lease that land; or (f) Demonstration, installation, servicing 2. Structural alterations, new construction or or repair operations, except such demolition operations performed by or on operations performed at the vendor's behalf of such person or organization. premises in connection with the sale of the product; d. Architects, Engineers Or Surveyors (g) Products which, after distribution or Any architect, engineer, or surveyor, but only sale by you, have been labeled or with respect to liability for "bodily injury", relabeled or used as a container, part "property damage" or "personal and or ingredient of any other thing or advertising injury" caused, in whole or in part, substance by or for the vendor; or by your acts or omissions or the acts or omissions of those acting on your behalf: (h) "Bodily injury" or "property damage" arising out of the sole negligence of the (1) In connection with your premises; or vendor for its own acts or omissions or (2) In the performance of your ongoing those of its employees or anyone else operations performed by you or on your acting on its behalf. However, this behalf. exclusion does not apply to: With respect to the insurance afforded these (i) The exceptions contained in Sub- additional insureds, the following additional paragraphs (d) or (f); or exclusion applies: (ii) Such inspections, adjustments, This insurance does not apply to "bodily tests or servicing as the vendor has injury", "property damage" or "personal and agreed to make or normally advertising injury" arising out of the rendering undertakes to make in the usual of or the failure to render any professional course of business, in connection services by or for you, including: with the distribution or sale of the 1. The preparing, approving, or failing to products. prepare or approve, maps, shop drawings, (2) This insurance does not apply to any opinions, reports, surveys, field orders, insured person or organization, from change orders or drawings and whom you have acquired such products, specifications; or or any ingredient, part or container, 2. Supervisory, inspection, architectural or entering into, accompanying or containing engineering activities. such products. This exclusion applies even if the claims b. Lessors Of Equipment against any insured allege negligence or (1) Any person(s) or organization(s) from other wrongdoing in the supervision, hiring, whom you lease equipment; but only with employment, training or monitoring of others respect to their liability for "bodily injury", by that insured, if the "occurrence" which "property damage" or "personal and caused the "bodily injury" or "property advertising injury" caused, in whole or in damage", or the offense which caused the part, by your maintenance, operation or "personal and advertising injury", involved the use of equipment leased to you by such rendering of or the failure to render any person(s) or organization(s). professional services by or for you. (2) With respect to the insurance afforded to e. Permits Issued By State Or Political these additional insureds this insurance Subdivisions does not apply to any "occurrence" which Any state or political subdivision, but only with takes place after the equipment lease respect to operations performed by you or on expires. your behalf for which the state or political c. Lessors Of Land Or Premises subdivision has issued a permit. Any person or organization from whom you With respect to the insurance afforded these lease land or premises, but only with respect additional insureds, this insurance does not to liability arising out of the ownership, apply to: maintenance or use of that part of the land or (1) "Bodily injury", "property damage" or premises leased to you. "personal and advertising injury" arising With respect to the insurance afforded these out of operations performed for the state additional insureds the following additional or municipality; or exclusions apply: HG 00 01 09 16 Page 13 of 21 (2) "Bodily injury" or "property damage" by that insured, if the "occurrence" which included within the "products-completed caused the "bodily injury" or "property operations hazard". damage", or the offense which caused the f. Any Other Party "personal and advertising injury", involved the rendering of or the failure to render any Any other person or organization who is not professional services by or for you. an additional insured under Paragraphs a. through e. above, but only with respect to The limits of insurance that apply to additional liability for "bodily injury", "property damage" insureds is described in Section III — Limits Of or"personal and advertising injury" caused, in Insurance. whole or in part, by your acts or omissions or How this insurance applies when other insurance the acts or omissions of those acting on your is available to the additional insured is described behalf: in the Other Insurance Condition in Section IV — (1) In the performance of your ongoing Commercial General Liability Conditions. operations; No person or organization is an insured with respect (2) In connection with your premises owned to the conduct of any current or past partnership, by or rented to you; or joint venture or limited liability company that is not shown as a Named Insured in the Declarations. (3) In connection with "your work" and included within the "products-completed SECTION III—LIMITS OF INSURANCE operations hazard", but only if 1. The Most We Will Pay (a) The written contract or agreement The Limits of Insurance shown in the requires you to provide such coverage Declarations and the rules below fix the most we to such additional insured; and will pay regardless of the number of: (b) This Coverage Part provides coverage a. Insureds; for"bodily injury" or'property damage" b. Claims made or"suits" brought; or included within the "products- completed operations hazard". c. Persons or organizations making claims or bringing "suits". However: 2. General Aggregate Limit (1) The insurance afforded to such additional insured only applies to the extent The General Aggregate Limit is the most we will permitted by law; and pay for the sum of: (2) If coverage provided to the additional a. Medical expenses under Coverage C; insured is required by a contract or b. Damages under Coverage A, except agreement, the insurance afforded to such damages because of "bodily injury" or additional insured will not be broader than "property damage" included in the "products- that which you are required by the contract completed operations hazard"; and or agreement to provide for such c. Damages under Coverage B. additional insured. 3. Products-Completed Operations Aggregate With respect to the insurance afforded to Limit these additional insureds, this insurance does The Products-Completed Operations Aggregate not apply to: Limit is the most we will pay under Coverage A "Bodily injury", "property damage" or for damages because of "bodily injury" and "personal and advertising injury" arising out of "property damage" included in the "products- the rendering of, or the failure to render, any completed operations hazard". professional architectural, engineering or surveying services, including: 4. Personal And Advertising Injury Limit (1) The preparing, approving, or failing to Subject to 2. above, the Personal and prepare or approve, maps, shop drawings, Advertising Injury Limit is the most we will pay opinions, reports, surveys, field orders, under Coverage B for the sum of all damages change orders or drawings and because of all "personal and advertising injury" specifications; or sustained by any one person or organization. (2) Supervisory, inspection, architectural or 5. Each Occurrence Limit engineering activities. Subject to 2. or 3. above, whichever applies, the This exclusion applies even if the claims Each Occurrence Limit is the most we will pay for against any insured allege negligence or the sum of: other wrongdoing in the supervision, hiring, a. Damages under Coverage A; and employment, training or monitoring of others Page 14 of 21 HG 00 01 09 16 b. Medical expenses under Coverage C a. Notice Of Occurrence Or Offense because of all "bodily injury" and "property You or any additional insured must see to it damage" arising out of any one "occurrence". that we are notified as soon as practicable of 6. Damage To Premises Rented To You Limit an "occurrence" or an offense which may result in a claim. To the extent possible, Subject to 5. above, the Damage To Premises notice should include: Rented To You Limit is the most we will pay under Coverage A for damages because of (1) How, when and where the "occurrence" or "property damage" to any one premises, while offense took place; rented to you, or in the case of damage by fire, (2) The names and addresses of any injured lightning or explosion, while rented to you or persons and witnesses; and temporarily occupied by you with permission of (3) The nature and location of any injury or the owner. damage arising out of the "occurrence" or In the case of damage by fire, lightning or offense. explosion, the Damage to Premises Rented To b. Notice Of Claim You Limit applies to all damage proximately caused by the same event, whether such If a claim is made or "suit" is brought against damage results from fire, lightning or explosion any insured, you or any additional insured or any combination of these. must: 7. Medical Expense Limit (1) Immediately record the specifics of the claim or"suit" and the date received; and Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage C for all (2) Notify us as soon as practicable. medical expenses because of "bodily injury" You or any additional insured must see to it sustained by any one person. that we receive written notice of the claim or 8. How Limits Apply To Additional Insureds "suit" as soon as practicable. If you have agreed in a written contract or written c. Assistance And Cooperation Of The agreement that another person or organization Insured be You and any other involved insured must: added as an additional insured on your policy, (1) Immediately send us copies of any the most we will pay on behalf of such additional demands, notices, summonses or legal insured is the lesser of: papers received in connection with the a. The limits of insurance specified in the written claim or"suit"; contract or written agreement; or (2) Authorize us to obtain records and other b. The Limits of Insurance shown in the information; Declarations. (3) Cooperate with us in the investigation or Such amount shall be a part of and not in settlement of the claim or defense against addition to Limits of Insurance shown in the the "suit'; and Declarations and described in this Section. (4) Assist us, upon our request, in the The Limits of Insurance of this Coverage Part apply enforcement of any right against any person separately to each consecutive annual period and to or organization which may be liable to the any remaining period of less than 12 months, insured because of injury or damage to starting with the beginning of the policy period which this insurance may also apply. shown in the Declarations, unless the policy period d. Obligations At The Insureds Own Cost is extended after issuance for an additional period of less than 12 months. In that case, the additional No insured will, except at that insured's own cost, voluntarily make a payment, assume period will be deemed part of the last preceding period for purposes of determining the Limits of any obligation, or incur any expense, other than for first aid, without our consent. Insurance. SECTION IV — COMMERCIAL GENERAL e. Additional Insureds Other Insurance LIABILITY CONDITIONS If we cover a claim or "suit" under this 1. Bankruptcy Coverage Part that may also be covered by other insurance available to an additional Bankruptcy or insolvency of the insured or of the insured, such additional insured must submit insured's estate will not relieve us of our such claim or "suit" to the other insurer for obligations under this Coverage Part. defense and indemnity. 2. Duties In The Event Of Occurrence, Offense, However, this provision does not apply to the Claim Or Suit extent that you have agreed in a written HG 00 01 09 16 Page 15 of 21 contract or written agreement that this b. Excess Insurance insurance is primary and non-contributory This insurance is excess over any of the other with the additional insured's own insurance. insurance, whether primary, excess, f. Knowledge Of An Occurrence, Offense, contingent or on any other basis: Claim Or Suit (1) Your Work Paragraphs a. and b. apply to you or to any That is Fire, Extended Coverage, Builder's additional insured only when such Risk, Installation Risk or similar coverage "occurrence", offense, claim or"suit" is known for"your work"; to: (2) Premises Rented To You (1) You or any additional insured that is an individual; That is fire, lightning or explosion insurance for premises rented to you or (2) Any partner, if you or the additional temporarily occupied by you with insured is a partnership; permission of the owner; (3) Any manager, if you or the additional (3) Tenant Liability insured is a limited liability company; That is insurance purchased by you to (4) Any "executive officer" or insurance cover your liability as a tenant for manager, if you or the additional insured is "property damage" to premises rented to a corporation; you or temporarily occupied by you with (5) Any trustee, if you or the additional permission of the owner; insured is a trust; or (4) Aircraft, Auto Or Watercraft (6) Any elected or appointed official, if you or If the loss arises out of the maintenance or the additional insured is a political use of aircraft, "autos" or watercraft to the subdivision or public entity. extent not subject to Exclusion g. of This duty applies separately to you and any Section I — Coverage A — Bodily Injury additional insured. And Property Damage Liability; 3. Legal Action Against Us (5) Property Damage To Borrowed No person or organization has a right under this Equipment Or Use Of Elevators Coverage Part: If the loss arises out of"property damage" a. To join us as a party or otherwise bring us to borrowed equipment or the use of into a "suit" asking for damages from an elevators to the extent not subject to insured; or Exclusion j. of Section I - Coverage A - Bodily Injury And Property Damage b. To sue us on this Coverage Part unless all of Liability; its terms have been fully complied with. A person or organization may sue us to recover (6) When You Are Added As An Additional Insured To Other Insurance on an agreed settlement or on a final judgment against an insured; but we will not be liable for Any other insurance available to you damages that are not payable under the terms of covering liability for damages arising out this Coverage Part or of the premises or operations, or products that are in excess of the applicable limit of and completed operations, for which you insurance. An agreed settlement means a have been added as an additional insured settlement and release of liability signed by us, by that insurance; or the insured and the claimant or the claimant's (7) When You Add Others As An legal representative. Additional Insured To This Insurance 4. Other Insurance Any other insurance available to an If other valid and collectible insurance is additional insured. available to the insured for a loss we cover under However, the following provisions apply to Coverages A or B of this Coverage Part, our other insurance available to any person or obligations are limited as follows: organization who is an additional insured a. Primary Insurance under this coverage part. This insurance is primary except when b. (a) Primary Insurance When Required below applies. If other insurance is also By Contract primary, we will share with all that other This insurance is primary if you have insurance by the method described in c. agreed in a written contract or written below. agreement that this insurance be primary. If other insurance is also Page 16 of 21 HG 00 01 09 16 primary, we will share with all that 5. Premium Audit other insurance by the method a. We will compute all premiums for this described in c. below. Coverage Part in accordance with our rules (b) Primary And Non-Contributory To and rates. Other Insurance When Required By b. Premium shown in this Coverage Part as Contract advance premium is a deposit premium only. If you have agreed in a written At the close of each audit period we will contract, written agreement, or permit compute the earned premium for that period that this insurance is primary and non- and send notice to the first Named Insured. contributory with the additional The due date for audit and retrospective insured's own insurance, this insurance premiums is the date shown as the due date is primary and we will not seek on the bill. If the sum of the advance and contribution from that other insurance. audit premiums paid for the policy period is Paragraphs (a) and (b) do not apply to greater than the earned premium, we will other insurance to which the additional return the excess to the first Named Insured. insured has been added as an additional c. The first Named Insured must keep records of insured. the information we need for premium When this insurance is excess, we will have computation, and send us copies at such no duty under Coverages A or B to defend times as we may request. the insured against any "suit" if any other 6. Representations insurer has a duty to defend the insured a. When You Accept This Policy against that"suit". If no other insurer defends, we will undertake to do so, but we will be By accepting this policy, you agree: entitled to the insured's rights against all (1) The statements in the Declarations are those other insurers. accurate and complete; When this insurance is excess over other (2) Those statements are based upon insurance, we will pay only our share of the representations you made to us; and amount of the loss, if any, that exceeds the (3) We have issued this policy in reliance sum of: upon your representations. (1) The total amount that all such other b. Unintentional Failure To Disclose Hazards insurance would pay for the loss in the If unintentionally you should fail to disclose all absence of this insurance; and hazards relating to the conduct of your (2) The total of all deductible and self-insured business that exist at the inception date of amounts under all that other insurance. this Coverage Part, we shall not deny We will share the remaining loss, if any, with coverage under this Coverage Part because any other insurance that is not described in of such failure. this Excess Insurance provision and was not 7. Separation Of Insureds bought specifically to apply in excess of the Except with respect to the Limits of Insurance, Limits of Insurance shown in the Declarations of this Coverage Part. and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, c. Method Of Sharing this insurance applies: If all of the other insurance permits a. As if each Named Insured were the only contribution by equal shares, we will follow Named Insured; and this method also. Under this approach each b. Separately to each insured against whom insurer contributes equal amounts until it has paid its applicable limit of insurance or none claim is made or"suit"is brought. of the loss remains, whichever comes first. 8. Transfer Of Rights Of Recovery Against If any of the other insurance does not permit Others To Us contribution by equal shares, we will a. Transfer Of Rights Of Recovery contribute by limits. Under this method, each If the insured has rights to recover all or part insurer's share is based on the ratio of its of any payment, including Supplementary applicable limit of insurance to the total Payments, we have made under this applicable limits of insurance of all insurers. Coverage Part, those rights are transferred to us. The insured must do nothing after loss to HG 00 01 09 16 Page 17 of 21 impair them. At our request, the insured will other motor vehicle insurance law where it is bring "suit" or transfer those rights to us and licensed or principally garaged. help us enforce them. However, "auto" does not include "mobile b. Waiver Of Rights Of Recovery (Waiver Of equipment". Subrogation) 5. "Bodily injury" means physical: If the insured has waived any rights of a. Injury; recovery against any person or organization for all or part of any payment, including b. Sickness; or Supplementary Payments, we have made c. Disease under this Coverage Part, we also waive that sustained by a person and, if arising out of the right, provided the insured waived their rights above, mental anguish or death at any time. of recovery against such person or organization in a contract, agreement or 6. "Coverage territory" means: permit that was executed prior to the injury or a. The United States of America (including its damage. territories and possessions), Puerto Rico and 9. When We Do Not Renew Canada; If we decide not to renew this Coverage Part, we b. International waters or airspace, but only if will mail or deliver to the first Named Insured the injury or damage occurs in the course of shown in the Declarations written notice of the travel or transportation between any places nonrenewal not less than 30 days before the included in a. above; or expiration date. c. All other parts of the world if the injury or If notice is mailed, proof of mailing will be damage arises out of: sufficient proof of notice. (1) Goods or products made or sold by you in SECTION V—DEFINITIONS the territory described in a. above; 1. "Advertisement" means the widespread public (2) The activities of a person whose home is dissemination of information or images that has in the territory described in a. above, but is the purpose of inducing the sale of goods, away for a short time on your business; or products or services through: (3) "Personal and advertising injury" offenses a. (1) Radio; that take place through the Internet or similar electronic means of communication (2) Television; provided the insured's responsibility to pay (3) Billboard; damages is determined in the United States of (4) Magazine; America (including its territories and possessions), (5) Newspaper; or Puerto Rico or Canada, in a "suit" on the merits according to the substantive law in such territory or b. Any other publication that is given widespread in a settlement we agree to. public distribution. 7. "Employee" includes a "leased worker". However, "advertisement" does not include: "Employee" does not include a "temporary a. The design, printed material, information or worker". images contained in, on or upon the 8. "Employment-Related Practices" means: packaging or labeling of any goods or products; or a. Refusal to employ that person; b. An interactive conversation between or b. Termination of that person's employment; or among persons through a computer network. c. Employment-related practices, policies, acts 2. "Advertising idea" means any idea for an or omissions, such as coercion, demotion, "advertisement". evaluation, reassignment, discipline, defamation, harassment, humiliation, 3. "Asbestos hazard" means an exposure or discrimination or malicious prosecution threat of exposure to the actual or alleged directed at that person. properties of asbestos and includes the mere presence of asbestos in any form. 9. "Executive officer" means a person holding any of the officer positions created by your charter, 4. "Auto" means: constitution, by-laws or any other similar a. A land motor vehicle, trailer or semitrailer governing document. designed for travel on public roads, including 10."Hostile fire" means one which becomes any attached machinery or equipment; or uncontrollable or breaks out from where it was b. Any other land vehicle that is subject to a intended to be. compulsory or financial responsibility law or Page 18 of 21 HG 00 01 09 16 11."Impaired property" means tangible property, (a) Preparing, approving, or failing to other than "your product" or "your work", that prepare or approve, maps, shop cannot be used or is less useful because: drawings, opinions, reports, surveys, a. It incorporates "your product" or "your work" field orders, change orders or drawings that is known or thought to be defective, and specifications; or deficient, inadequate or dangerous; or (b) Giving directions or instructions, or b. You have failed to fulfill the terms of a failing to give them, if that is the contract or agreement; primary cause of the injury or damage; or if such property can be restored to use by the repair, replacement, adjustment or removal of (2) Under which the insured, if an architect, "your product" or "your work", or your fulfilling the engineer or surveyor, assumes liability for terms of the contract or agreement. an injury or damage arising out of the insured's rendering or failure to render 12."Insured contract" means: professional services, including those listed a. A contract for a lease of premises. However, in (1) above and supervisory, inspection, that portion of the contract for a lease of architectural or engineering activities. premises that indemnifies any person or 13."Leased worker" means a person leased to you organization for damage by fire, lightning or by a labor leasing firm under an agreement explosion to premises while rented to you or between you and the labor leasing firm, to temporarily occupied by you with permission perform duties related to the conduct of your of the owner is subject to the Damage to business. "Leased worker" does not include a Premises Rented To You Limit described in "temporary worker". Section III—Limits of Insurance; 14."Loading or unloading" means the handling of b. A sidetrack agreement; property: c. Any easement or license agreement, a. After it is moved from the place where it is including an easement or license agreement accepted for movement into or onto an in connection with construction or demolition aircraft, watercraft or"auto"; operations on or within 50 feet of a railroad; b. While it is in or on an aircraft, watercraft or d. An obligation, as required by ordinance, to "auto"; or indemnify a municipality, except in connection with work for a municipality; c. While it is being moved from an aircraft, e. An elevator maintenance agreement; watercraft or "auto" to the place where it is finally delivered; f. That part of any other contract or agreement but "loading or unloading" does not include the pertaining to your business (including an movement of property by means of a mechanical indemnification of a municipality in connection device, other than a hand truck, that is not with work performed for a municipality) under attached to the aircraft,watercraft or"auto". which you assume the tort liability of another party to pay for "bodily injury" or "property 15."Mobile equipment" means any of the following damage" to a third person or organization, types of land vehicles, including any attached provided the "bodily injury" or "property machinery or equipment: damage" is caused, in whole or in part, by a. Bulldozers, farm machinery, forklifts and other you or by those acting on your behalf. Tort vehicles designed for use principally off public liability means a liability that would be roads; imposed by law in the absence of any b. Vehicles maintained for use solely on or next contract or agreement. to premises you own or rent; Paragraph f. includes that part of any contract c. Vehicles that travel on crawler treads; or agreement that indemnifies a railroad for "bodily injury" or "property damage" arising d. Vehicles, whether self-propelled or not, out of construction or demolition operations, maintained primarily to provide mobility to within 50 feet of any railroad property and permanently mounted: affecting any railroad bridge or trestle, tracks, (1) Power cranes, shovels, loaders, diggers or road-beds, tunnel, underpass or crossing. drills; or However, Paragraph f. does not include that (2) Road construction or resurfacing part of any contract or agreement: equipment such as graders, scrapers or (1) That indemnifies an architect, engineer or rollers; surveyor for injury or damage arising out e. Vehicles not described in a., b., c. or d. above of: that are not self-propelled and are maintained HG 00 01 09 16 Page 19 of 21 primarily to provide mobility to permanently e. Oral, written or electronic publication, in any attached equipment of the following types: manner, of material that violates a person's (1) Air compressors, pumps and generators, right of privacy; including spraying, welding, building f. Copying, in your "advertisement", a person's cleaning, geophysical exploration, lighting or organization's "advertising idea" or style of and well servicing equipment; or "advertisement"; or (2) Cherry pickers and similar devices used to g. Infringement of copyright, slogan, or title of raise or lower workers; any literary or artistic work, in your f. Vehicles not described in a., b., c. or d. above "advertisement". maintained primarily for purposes other than 18."Pollutants" mean any solid, liquid, gaseous or the transportation of persons or cargo. thermal irritant or contaminant, including smoke, However, self-propelled vehicles with the vapor, soot, fumes, acids, alkalis, chemicals and following types of permanently attached waste. Waste includes materials to be recycled, equipment are not"mobile equipment" but will reconditioned or reclaimed. be considered"autos": 19."Prod ucts-completed operations hazard": (1) Equipment designed primarily for: a. Includes all "bodily injury" and "property (a) Snow removal; damage" occurring away from premises you (b) Road maintenance, but not own or rent and arising out of "your product" construction or resurfacing; or or"your work"except: (c) Street cleaning; (1) Products that are still in your physical possession; or (2) Cherry pickers and similar devices (2) Work that has not yet been completed or mounted on automobile or truck chassis abandoned. However, "your work" will be and used to raise or lower workers; and deemed completed at the earliest of the (3) Air compressors, pumps and generators, following times: including spraying, welding, building (a) When all of the work called for in your cleaning, geophysical exploration, lighting contract has been completed. and well servicing equipment. (b) When all of the work to be done at the However, "mobile equipment" does not include job site has been completed if your any land vehicle that is subject to a compulsory contract calls for work at more than or financial responsibility law or other motor one job site. vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a (c) When that part of the work done at a compulsory or financial responsibility law or other job site has been put to its intended motor vehicle insurance law are considered use by any person or organization "autos". other than another contractor or 16."Occurrence" means an accident, including subcontractor working on the same project. continuous or repeated exposure to substantially the same general harmful conditions. Work that may need service, maintenance, correction, repair or 17."Personal and advertising injury" means replacement, but which is otherwise injury, including consequential "bodily injury", complete,will be treated as completed. arising out of one or more of the following offenses: b. Does not include "bodily injury" or "property a. False arrest, detention or imprisonment; damage" arising out of: b. Malicious prosecution; (1) The transportation of property, unless the p injury or damage arises out of a condition c. The wrongful eviction from, wrongful entry in or on a vehicle not owned or operated into, or invasion of the right of private by you, and that condition was created by occupancy of a room, dwelling or premises the "loading or unloading" of that vehicle that a person or organization occupies, by any insured; committed by or on behalf of its owner, (2) The existence of tools, uninstalled landlord or lessor; equipment or abandoned or unused d. Oral, written or electronic publication, in any materials; or manner, of material that slanders or libels a (3) Products or operations for which the person or organization or disparages a classification, listed in the Declarations or person's or organization's goods, products or in a policy Schedule, states that products- services; Page 20 of 21 HG 00 01 09 16 completed operations are subject to the 24."Your product": General Aggregate Limit. a. Means: 20."Property damage" means: (1) Any goods or products, other than real a. Physical injury to tangible property, including property, manufactured, sold, handled, all resulting loss of use of that property. All distributed or disposed of by: such loss of use shall be deemed to occur at (a) You; the time of the physical injury that caused it; (b) Others trading under your name; or or b. Loss of use of tangible property that is not (c) A person or organization whose physically injured. All such loss of use shall business or assets you have acquired; be deemed to occur at the time of the and "occurrence"that caused it. (2) Containers (other than vehicles), As used in this definition, computerized or materials, parts or equipment furnished in electronically stored data, programs or software connection with such goods or products. are not tangible property. Electronic data means b. Includes information, facts or programs: (1) Warranties or representations made at a. Stored as or on; any time with respect to the fitness, b. Created or used on; or quality, durability, performance or use of c. Transmitted to or from; "your product"; and (2) The providing of or failure to provide computer software, including systems and warnings or instructions. applications software, hard or floppy disks, CD- Does not include vending machines or other ROMS, tapes, drives, cells, data processing c. devices or any other media which are used with property rented to or located for the use of others but not sold. electronically controlled equipment. 21."Suit" means a civil proceeding in which 25."Your work": damages because of "bodily injury", "property a. Means: damage" or "personal and advertising injury" to (1) Work or operations performed by you or which this insurance applies are alleged. "Suit" on your behalf; and includes: (2) Materials, parts or equipment furnished in a. An arbitration proceeding in which such connection with such work or operations. damages are claimed and to which the b. Includes insured must submit or does submit with our consent; or (1) Warranties or representations made at b. Any other alternative dispute resolution any time with respect to the fitness, proceeding in which such damages are quality, durability, performance or use of claimed and to which the insured submits with "your work", and our consent. (2) The providing of or failure to provide 22."Temporary worker" means a person who is warnings or instructions. furnished to you to substitute for a permanent "employee" on leave or to meet seasonal or short-term workload conditions. 23."Volunteer worker" means a person who a. Is not your"employee"; b. Donates his or her work; c. Acts at the direction of and within the scope of duties determined by you; and d. Is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. HG 00 01 09 16 Page 21 of 21 Policy Number: 10 UEA HF1837 Policy Term: 11/1/2024 - 11/1/2025 COMMERCIAL AUTOMOBILE HA 99 16 03 12 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 To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED d. Any "employee" of yours while using a A. Subsidiaries and Newly Acquired or covered "auto" you don't own, hire or Formed Organizations borrow in your business or your The Named Insured shown in the personal affairs. Declarations is amended to include: C. Lessors as Insureds (1) Any legal business entity other than a Paragraph A.1. -WHO IS AN INSURED -of partnership or joint venture, formed as a Section II - Liability Coverage is amended to subsidiary in which you have an add: ownership interest of more than 50% on e. The lessor of a covered "auto" while the the effective date of the Coverage Form. "auto" is leased to you under a written However, the Named Insured does not agreement if: include any subsidiary that is an "insured" under any other automobile (1) The agreement requires you to policy or would be an "insured" under provide direct primary insurance for the lessor and such a policy but for its termination or the exhaustion of its Limit of Insurance. (2) The"auto" is leased without a driver. (2) Any organization that is acquired or Such a leased "auto" will be considered a formed by you and over which you covered "auto" you own and not a covered maintain majority ownership. However, "auto"you hire. the Named Insured does not include any D. Additional Insured if Required by Contract newly formed or acquired organization: (1) Paragraph A.1. -WHO IS AN INSURED (a) That is a partnership or joint - of Section II - Liability Coverage is venture, amended to add: (b) That is an "insured" under any other f. When you have agreed, in a written policy, contract or written agreement, that a (c) That has exhausted its Limit of person or organization be added as Insurance under any other policy, or an additional insured on your (d) 180 days or more after its business auto policy, such person or acquisition or formation by you, organization is an "insured", but only unless you have given us notice of to the extent such person or the acquisition or formation. organization is liable for "bodily Coverage does not apply to "bodily injury" or "property damage" caused injury" or "property damage" that results by the conduct of an "insured" under from an "accident" that occurred before paragraphs a. or b. of Who Is An you formed or acquired the organization. Insured with regard to the B. Employees as Insureds ownership, maintenance or use of a covered"auto." Paragraph A.1. -WHO IS AN INSURED - of SECTION II - LIABILITY COVERAGE is amended to add: ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 1 of 5 POLICY NUMBER: 10 UEA HF 1837 The insurance afforded to any such E. Primary and Non-Contributory if additional insured applies only if the Required by Contract "bodily injury" or "property damage" Only with respect to insurance provided to occurs: an additional insured in 1.D. - Additional (1) During the policy period, and Insured If Required by Contract, the (2) Subsequent to the execution of such following provisions apply: written contract, and (3) Primary Insurance When Required By (3) Prior to the expiration of the period Contract of time that the written contract This insurance is primary if you have requires such insurance be provided agreed in a written contract or written to the additional insured. agreement that this insurance be (2) How Limits Apply primary. If other insurance is also primary, we will share with all that other If you have agreed in a written contract insurance by the method described in or written agreement that another Other Insurance 5.d. person or organization be added as an additional insured on your policy, the (4) Primary And Non-Contributory To Other most we will pay on behalf of such Insurance When Required By Contract additional insured is the lesser of: If you have agreed in a written contract (a) The limits of insurance specified in or written agreement that this insurance the written contract or written is primary and non-contributory with the agreement; or additional insured's own insurance, this insurance is primary and we will not (b) The Limits of Insurance shown in seek contribution from that other the Declarations. insurance. Such amount shall be a part of and not Paragraphs (3) and (4) do not apply to other in addition to Limits of Insurance shown insurance to which the additional insured in the Declarations and described in this has been added as an additional insured. Section. When this insurance is excess, we will have no (3) Additional Insureds Other Insurance duty to defend the insured against any "suit" if If we cover a claim or "suit" under this any other insurer has a duty to defend the Coverage Part that may also be covered insured against that "suit". If no other insurer by other insurance available to an defends, we will undertake to do so, but we will additional insured, such additional be entitled to the insured's rights against all insured must submit such claim or"suit" those other insurers. to the other insurer for defense and When this insurance is excess over other indemnity. insurance, we will pay only our share of the However, this provision does not apply amount of the loss, if any, that exceeds the sum to the extent that you have agreed in a of: written contract or written agreement (1) The total amount that all such other that this insurance is primary and non- insurance would pay for the loss in the contributory with the additional insured's absence of this insurance; and own insurance. (2) The total of all deductible and self-insured (4) Duties in The Event Of Accident, Claim, amounts under all that other insurance. Suit or Loss If you have agreed in a written contract We will share the remaining loss, if any, by the method described in Other Insurance 5.d. or written agreement that another person or organization be added as an 2. AUTOS RENTED BY EMPLOYEES additional insured on your policy, the Any "auto" hired or rented by your "employee" additional insured shall be required to on your behalf and at your direction will be comply with the provisions in LOSS considered an"auto"you hire. CONDITIONS 2. - DUTIES IN THE The OTHER INSURANCE Condition is amended EVENT OF ACCIDENT, CLAIM , SUIT by adding the following: OR LOSS — OF SECTION IV — BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. C 2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 2 of 5 POLICY NUMBER: 10 UEA HF 1837 If an "employee's" personal insurance also 5. PHYSICAL DAMAGE - ADDITIONAL applies on an excess basis to a covered "auto" TEMPORARY TRANSPORTATION EXPENSE hired or rented by your "employee" on your COVERAGE behalf and at your direction, this insurance will Paragraph A.4.a. of SECTION III - PHYSICAL be primary to the "employee's" personal DAMAGE COVERAGE is amended to provide a insurance. limit of $50 per day and a maximum limit of 3. AMENDED FELLOW EMPLOYEE EXCLUSION $1,000. EXCLUSION 5. - FELLOW EMPLOYEE - of 6. LOAN/LEASE GAP COVERAGE SECTION II - LIABILITY COVERAGE does not Under SECTION III - PHYSICAL DAMAGE apply if you have workers' compensation COVERAGE, in the event of a total "loss" to a insurance in-force covering all of your covered "auto", we will pay your additional legal "employees". obligation for any difference between the actual Coverage is excess over any other collectible cash value of the "auto" at the time of the "loss" insurance. and the"outstanding balance"of the loan/lease. 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE "Outstanding balance" means the amount you If hired "autos" are covered "autos" for Liability owe on the loan/lease at the time of "loss" less Coverage and if Comprehensive, Specified any amounts representing taxes; overdue Causes of Loss, or Collision coverages are payments; penalties, interest or charges provided under this Coverage Form for any resulting from overdue payments; additional "auto" you own, then the Physical Damage mileage charges; excess wear and tear charges; Coverages provided are extended to "autos"you lease termination fees; security deposits not hire or borrow, subject to the following limit. returned by the lessor; costs for extended warranties, credit life Insurance, health, accident The most we will pay for "loss" to any hired or disability insurance purchased with the loan or "auto" is: lease; and carry-over balances from previous (1) $100,000; loans or leases. (2) The actual cash value of the damaged or 7. AIRBAG COVERAGE stolen property at the time of the"loss"; or Under Paragraph B. EXCLUSIONS - of (3) The cost of repairing or replacing the SECTION III - PHYSICAL DAMAGE damaged or stolen property, COVERAGE, the following is added: whichever is smallest, minus a deductible. The The exclusion relating to mechanical breakdown deductible will be equal to the largest deductible does not apply to the accidental discharge of an applicable to any owned "auto" for that airbag. coverage. No deductible applies to"loss"caused g, ELECTRONIC EQUIPMENT - BROADENED by fire or lightning. Hired Auto Physical Damage COVERAGE coverage is excess over any other collectible insurance. Subject to the above limit, deductible a. The exceptions to Paragraphs 6.4 - and excess provisions, we will provide coverage EXCLUSIONS - of SECTION III - PHYSICAL equal to the broadest coverage applicable to any DAMAGE COVERAGE are replaced by the covered "auto"you own. following: We will also cover loss of use of the hired "auto" Exclusions 4.c. and 4.d. do not apply to if it results from an "accident", you are legally equipment designed to be operated solely liable and the lessor incurs an actual financial by use of the power from the "auto's" loss, subject to a maximum of $1000 per electrical system that, at the time of"loss", "accident". is: This extension of coverage does not apply to (1) Permanently installed in or upon any "auto" you hire or borrow from any of your the covered"auto"; "employees", partners (if you are a partnership), (2) Removable from a housing unit members (if you are a limited liability company), which is permanently installed in or members of their households. or upon the covered "auto" (3) An integral part of the same unit housing any electronic equipment described in Paragraphs (1)and (2) above; or ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 3 of 5 POLICY NUMBER: 10 UEA HF 1837 (4) Necessary for the normal If another Hartford Financial Services Group, operation of the covered "auto"or Inc. company policy or coverage form that is not the monitoring of the covered an automobile policy or coverage form applies to "auto's"operating system. the same"accident", the following applies: b.Section III — Version CA 00 01 03 10 of the (1) If the deductible under this Business Auto Business Auto Coverage Form, Physical Coverage Form is the smaller (or smallest) Damage Coverage, Limit of Insurance, deductible, it will be waived; Paragraph C.2 and Version CA 00 01 10 01 of (2) If the deductible under this Business Auto the Business Auto Coverage Form, Physical Coverage Form is not the smaller (or Damage Coverage, Limit of Insurance, smallest) deductible, it will be reduced by Paragraph C are each amended to add the the amount of the smaller (or smallest) following: deductible. $1,500 is the most we will pay for"loss" in 12. AMENDED DUTIES IN THE EVENT OF any one "accident" to all electronic ACCIDENT, CLAIM, SUIT OR LOSS equipment(other than equipment designed solely for the reproduction of sound, and The requirement in LOSS CONDITIONS 2.a. - accessories used with such equipment) DUTIES IN THE EVENT OF ACCIDENT,CLAIM, that reproduces, receives or transmits SUIT OR LOSS - of SECTION IV - BUSINESS AUTO CONDITIONS that you must notify us of audio, visual or data signals which, at the time of"loss", is: an "accident" applies only when the"accident"is known to: (1) Permanently installed in or upon the covered "auto" in a housing, (1) You, if you are an individual; opening or other location that is not (2) A partner, if you are a partnership; normally used by the "auto" (3) A member, if you are a limited liability manufacturer for the installation of company; or such equipment; (4) An executive officer or insurance manager, if (2) Removable from a permanently you are a corporation. installed housing unit as described 13. UNINTENTIONAL FAILURE TO DISCLOSE in Paragraph 2.a. above or is an HAZARDS integral part of that equipment; or (3)An integral part of such equipment. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we c.For each covered "auto", should loss be limited will not deny coverage under this Coverage to electronic equipment only, our obligation to Form because of such failure. pay for, repair, return or replace damaged or 14. HIRED AUTO -COVERAGE TERRITORY stolen electronic equipment will be reduced by the applicable deductible shown in the Paragraph e. of GENERAL CONDITIONS 7. - Declarations, or $250, whichever deductible is POLICY PERIOD, COVERAGE TERRITORY - less. of SECTION IV - BUSINESS AUTO 9. EXTRA EXPENSE - BROADENED CONDITIONS is replaced by the following: COVERAGE e. For short-term hired "autos", the coverage Under Paragraph A. -COVERAGE -of SECTION territory with respect to Liability Coverage is III - PHYSICAL DAMAGE COVERAGE, we will anywhere in the world provided that if the pay for the expense of returning a stolen covered "insured's" responsibility to pay damages for "auto"to you. "bodily injury" or "property damage" is determined in a"suit,"the"suit"is brought in 10. GLASS REPAIR-WAIVER OF DEDUCTIBLE the United States of America, the territories Under Paragraph D.-DEDUCTIBLE-of SECTION and possessions of the United States of III - PHYSICAL DAMAGE COVERAGE, the America, Puerto Rico or Canada or in a following is added: settlement we agree to. No deductible applies to glass damage if the 15. WAIVER OF SUBROGATION glass is repaired rather than replaced. TRANSFER OF RIGHTS OF RECOVERY 11. TWO OR MORE DEDUCTIBLES AGAINST OTHERS TO US - of SECTION IV - Under Paragraph D.-DEDUCTIBLE-of SECTION BUSINESS AUTO CONDITIONS is amended by III - PHYSICAL DAMAGE COVERAGE, the adding the following: following is added: 02011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 4 of 5 POLICY NUMBER: 10 UEA HF 1837 We waive any right of recovery we may have c.Regardless of the number of autos deemed a against any person or organization with whom total loss, the most we will pay under this you have a written contract that requires such Hybrid, Electric, or Natural Gas Vehicle waiver because of payments we make for Payment Coverage provision for any one damages under this Coverage Form. "loss" is $10,000. 16. RESULTANT MENTAL ANGUISH COVERAGE For the purposes of the coverage provision, The definition of "bodily injury" in SECTION V- a.A "non-hybrid" auto is defined as an auto that DEFINITIONS is replaced by the following: uses only an internal combustion engine to "Bodily injury" means bodily injury, sickness or move the auto but does not include autos disease sustained by any person, including powered solely by electricity or natural gas. mental anguish or death resulting from any of b.A "hybrid" auto is defined as an auto with an these. internal combustion engine and one or more 17. EXTENDED CANCELLATION CONDITION electric motors; and that uses the internal Paragraph 2. of the COMMON POLICY combustion engine and one or more electric CONDITIONS - CANCELLATION - applies motors to move the auto, or the internal except as follows: combustion engine to charge one or more electric motors, which move the auto. If we cancel for any reason other than 19. VEHICLE WRAP COVERAGE nonpayment of premium, we will mail or deliver to the first Named Insured written notice of In the event of a total loss to an "auto" for which cancellation at least 60 days before the effective Comprehensive, Specified Causes of Loss, or date of cancellation. Collision coverages are provided under this 18. HYBRID, ELECTRIC, OR NATURAL GAS Coverage Form, then such Physical Damage VEHICLE PAYMENT COVERAGE Coverages are amended to add the following: In addition to the actual cash value of the "auto", In the event of a total loss to a "non-hybrid" auto we will pay up to $1,000 for vinyl vehicle wraps for which Comprehensive, Specified Causes of which are displayed on the covered "auto" at the Loss, or Collision coverages are provided under time of total loss. Regardless of the number of this Coverage Form, then such Physical autos deemed a total loss, the most we will pay Damage Coverages are amended as follows: under this Vehicle Wrap Coverage provision for a.If the auto is replaced with a "hybrid" auto or any one "loss" is $5,000. For purposes of this an auto powered solely by electricity or natural coverage provision, signs or other graphics gas, we will pay an additional 10%, to a painted or magnetically affixed to the vehicle are maximum of$2,500, of the "non-hybrid" auto's not considered vehicle wraps. actual cash value or replacement cost, whichever is less, b.The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of"loss," ©2011, The Hartford (Includes copyrighted material Form HA 99 16 03 12 of ISO Properties, Inc., with its permission.) Page 5 of 5 Policy Number: 10WEAU9T8V Policy Term: 11/1/2024 - 11/1/2025 it THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description As required by written contract Project notated in contract Countersigned by Authorized Representative Policy No. 10 WEA AU9T8V Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: