Document 25091709_44_37A�OR 1 6
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMMDNYYY)
09/06/2025
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 LIC #OC36861 1-415-403-1491
Alliant Insurance Services, Inc.
CONTACT NAME: Kimberly Leikam
PHONE 415-403-1491 AN: No : FAX 413-874-4818
Erro,kleikam@alliant.com
560 Mission Street, 6th Floor
E-MAIL
ADDRESS:
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA:TRANSPORTATION INS CO
20494
San Francisco, CA 94105 USA
INSURED
INSURERS: VALLEY FORGE INS CO
20508
Granite Construction Company
INSURERC:CONTINENTAL CAS CO
20443
INSURER D:
585 West Beach Street
INSURER E :
INSURERF:
Watsonville, CA 95076 USA
rnV90ArSF4 CFRTIFICATF WIIMRFR• 752270100 RFVISlf)N NIINIRFR-
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
LTR
OF INSURANCE
ADDLTYPE
INSO
WVDSUBRI
POLICY NUMBER
MIl POLICY EFF
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X
X
GL2074978689
10/01/23
10/01/26
EACH OCCURRENCE
$ 2,000,000
CLAIMS -MADE a OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 2,000,000
X
MED EXP (Anyone person)
$ Nil
Contractual Liability
XCU Hazards
PERSONAL & ADV INJURY
$ 2,000,000
X
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 10, 000, 000
GEN'L
POLICY a JECT � LOC
JEC
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
OTHER:
B
AUTOMOBILE LIABILITY
X
X
BUA2074978692
10/01/23
10/01/26
CEa OMaBINED SINGLE LIMIT
ccident
$ 2,000,000
BODILY INJURY (Per person)
$
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
X AUTOS ONLY X AUTOS ONLY
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
$
X Contractua
C
X
UMBRELLA LIAB
X
OCCUR
CUE2068209453
10/01/25
10/01/26
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
X
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
B
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANYPROPRIETOR/PARTNER/EXECU I
OFFICER/MEMBEREXCLUDED7IN I (Mandatory In NH)
NIA
X
X
WC274978630 (CA)
WC274978644 (AOS/Stop Gap)
10/01/25
10/01/25
10/01/26
10/01/26
X STATUTE I ERH
E.L. EACH ACCIDENT
$ 2,000,000
E.L. DISEASE - EA EMPLOYEE
$ 2,000,000
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Job #TBD / Project No. 2022-03 / Fred Waring Drive Pavement Rehabilitation
The City of La Quinta is included as Additional Insured where required by written and executed contract and per the
attached endorsements. Coverage is primary & non-contributory and waivers of subrogation apply. Umbrella coverage
follows form over underlying Liability coverages and forme. Thirty (30) day notice of cancellation or material change i
coverage provided.
GL PER ISO FORM CG0001 10/01; AL PER ISO FORM CA0001 03/10
I. tKI It -ILA I t MVLUtK VAPFI,CLLAIIVPI
2250
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Jon McMillen, City Manager
78-495 Calls Tampico AUTHORIZED REPRESENTATIVE
La Quints, CA 92253
USA
ACORD 25 (2016/03)
ttaganap
752270100
U T988-ZUIO AGUKU UUKYUKAI IL)N. Ali rlgnts reserve0.
The ACORD name and logo are registered marks of ACORD
El
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DATE
SUPPLEMENT TO CERTIFICATE OF INSURANCE 09/06/2025
NAME OF INSURED: Granite construction company
The named insured reserves its rights to provide any additional coverages under the policies above to only those
expressly negotiated for by contract.
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SUPP (10/00)
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G-140331-D
(Ed. 01/13)
BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -
WITH PRODUCTS -COMPLETED OPERATIONS COVERAGE
IN
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE w
PART as follows:
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SCHEDULE (OPTIONAL)
Name of Additional Insured Persons Or Organizations
(As required by "written contract" per Paragraph A. below.)
Locations of Covered Operations
(As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.)
A. Section II - Who Is An Insured is amended to include as an additional insured:
1. Any person or organization whom you are required by "written contract" to add as an additional insured on
this Coverage Part; and
2. The particular person or organization, if any, scheduled above.
B. The insurance provided to the additional insured is limited as follows:
1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property
damage," or "personal and advertising injury" caused in whole or in part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of
your ongoing operations specified in the "written contract"; or
b. "Your work" that is specified in the "written contract" but only for "bodily injury" or "property damage"
included in the "products -completed operations hazard," and only if:
(1) The "written contract" requires you to provide the additional insured such coverage; and
(2) This Coverage Part provides such coverage.
2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition
of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11 /85
edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part
by' are replaced by the words 'arising out of'.
3. We will not provide the additional insured any broader coverage or any higher limit of insurance than:
a. The maximum permitted bylaw;
b. That required by the "written contract";
c. That described in B.1. above; or
d. That afforded to you under this policy,
whichever is less.
4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is
excess of all other insurance available to the additional insured whether on a primary, excess, contingent or
G-140331-D (Ed.01/13) POLICY #: GL2074978689
Page 1 of 2 EFFECTIVE: 10/01/2023
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Copyright, CNA All Rights Reserved.
G-140331-D
(Ed. 01/13)
any other basis. But if required by the "written contract" to be primary and non-contributory, this insurance
will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured.
5. The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or
"personal and advertising injury" arising out of:
a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying
services, including:
(1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
(2) Supervisory, inspection, architectural or engineering activities; or
b. Any premises or work for which the additional insured is specifically listed as an additional insured on
another endorsement attached to this Coverage Part.
C. SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows:
1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following
additional conditions applicable to the additional insured:
An additional insured under this endorsement will as soon as practicable:
(1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this
insurance, and of any claim or "suit" that does result;
(2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance
the additional insured has for a loss we cover under this Coverage Part;
(3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation,
defense, or settlement of the claim or "suit"; and
(4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy
or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this
insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the
additional insured is a Named Insured.
We have no duty to defend or indemnify an additional insured under this endorsement until we receive from
the additional insured written notice of a claim or "suit."
D. Only for the purpose of the insurance provided by this endorsement, SECTION V - DEFINITIONS is amended to
add the following definition:
"Written contract" means a written contract or written agreement that requires you to make a person or
organization an additional insured on this Coverage Part, provided the contract or agreement:
1. Is currently in effect or becomes effective during the term of this policy; and
2. Was executed prior to:
a. The "bodily injury" or "property damage"; or
b. The offense that caused the "personal and advertising injury,"
for which the additional insured seeks coverage under this Coverage Part.
All other terms and conditions of the Policy remain unchanged.
G-140331-D (Ed.01/13)
Page 2 of 2
Material used with permission of ISO Properties, Inc.
Copyright, CNA All Rights Reserved.
POLICY #: GL2074978689
EFFECTIVE: 10/01 /2023
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POLICY NUMBER: GL2074978689
EFFECTIVE: 10/01 /2023
COMMERCIAL GENERAL LIABILITY
CG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Construction Project(s):
Any construction project as required by a written contract or agreement that was executed prior to the date of
loss.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. For all sums which the insured becomes legally
3. Any payments made under Coverage A for
obligated to pay as damages caused by
damages or under Coverage C for medical
"occurrences" under Section I - Coverage A, and
expenses shall reduce the Designated
for all medical expenses caused by accidents
Construction Project General Aggregate Limit
under Section I - Coverage C, which can be
for that designated construction project. Such
attributed only to ongoing operations at a single
payments shall not reduce the General
designated construction project shown in the
Aggregate Limit shown in the Declarations nor
Schedule above:
shall they reduce any other Designated
1. A separate Designated Construction Project
Construction Project General Aggregate Limit
General Aggregate Limit applies to each
for any other designated construction project
designated construction project, and that limit
shown in the Schedule above.
is equal to the amount of the General
4. The limits shown in the Declarations for Each
Aggregate Limit shown in the Declarations.
Occurrence, Damage To Premises Rented To
2. The Designated Construction Project General
You and Medical Expense continue to apply.
Aggregate Limit is the most we will pay for the
However, instead of being subject to the
sum of all damages under Coverage A,
General Aggregate Limit shown in the
except damages because of "bodily injury" or
Declarations, such limits will be subject to the
"property damage" included in the "products-
applicable Designated Construction Project
completed operations hazard," and for
General Aggregate Limit.
medical expenses under Coverage C
regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits."
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CG 25 03 05 09 Copyright, Insurance Services Office, Inc., 2008 Page 1 of 2
B. For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under Section I - Coverage A, and
for all medical expenses caused by accidents
under Section I - Coverage C, which cannot be
attributed only to ongoing operations at a single
designated construction project shown in the
Schedule above;
1. Any payments made under Coverage A for
damages or under Coverage C for medical
expenses shall reduce the amount available
under the General Aggregate Limit or the
Products -completed Operations Aggregate
Limit, whichever is applicable; and
2. Such payments shall not reduce any
Designated Construction Project General
Aggregate Limit.
C. When coverage for liability arising out of the
"products -completed operations hazard" is
provided, any payments for damages because of
"bodily injury" or "property damage" included in
the "products -completed operations hazard" will
reduce the Products -completed Operations
Aggregate Limit, and not reduce the General
Aggregate Limit nor the Designated Construction
Project General Aggregate Limit.
D. If the applicable designated construction project
has been abandoned, delayed, or abandoned
and then restarted, or if the authorized
contracting parties deviate from plans, blueprints,
designs, specifications or timetables, the project
will still be deemed to be the same construction
project.
E. The provisions of Section III - Limits Of
Insurance not otherwise modified by this
endorsement shall continue to apply as
stipulated.
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Page 2 of 2 Copyright, Insurance Services Office, Inc., 2008 CG 25 03 05 09
6
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Waiver of Transfer of Rights of Recovery Against Others to Us
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This endorsement modifies insurance provided under the following: o
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Commercial General Liability Coverage Form
00
Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, The Transfer Of Rights Of >
Recovery Against Others To Us Condition is amended by the addition of the following: w
We waive any right of recovery we may have against any person or organization because of payments we
make for injury or damage arising out of:
1. Your ongoing operations; or
2. "Your work" included in the "products completed operations hazard."
However, this waiver applies only when you have agreed in writing to waive such rights of recovery in a
contract or agreement, and only if the contract or agreement:
1. Is in effect or becomes effective during the term of this policy; and
2. Was executed prior to loss.
This endorsement is part of your policy and takes effect on the effective date of your policy, unless another effective
date is shown below.
Must Be Completed
ENDT. NO. POLICY NO.
26 GL 2074978689
Complete Only When This Endorsement Is Not Prepared
with the Policy Or Is Not to be Effective with the Policy
ISSUED TO: EFFECTIVE DATE OF THIS
ENDORSEMENT:
Granite Construction Incorporated 10/01/23
CNA
POLICY NUMBER: GL2074978689
EFFECTIVE: 10/01 /2023
G-15115-A
(Ed. 10/89)
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. o_
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CHANGES - NOTICE OF CANCELLATION
OR MATERIAL COVERAGE CHANGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part
(other than the reduction of aggregate limits through payment of claims), we agree to mail prior written notice of can-
cellation or material change to:
SCHEDULE
1. Name: Any person or organization you are required by written contract or agreement to mail prior written notice of
cancellation or material change.
2. Address: Per Certificates of Insurance on file with the broker.
3. Number of days advance notice:
For non-payment of premium, the greater of:
• the number of days required by state statute or
• the number of days required by written contract
For any other reason, the lesser of:
• 60 days or
• the number of days required in a written contract
G-15115-A Page 1 of 1
(Ed. 10/89)
CNA
CNA71527XX
(Ed. 10/12)
ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:
SCHEDULE
Name of Additional Insured Persons Or Organizations
Any person or organization whom the named insured is required by written contract to add as an additional insured
on this policy.
1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person
or organization scheduled above is an insured under this policy.
2. The insurance afforded to the additional insured under this policy will apply on a primary and non-contributory
basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the
"accident" for which the additional insured seeks coverage under this policy.
All other terms and conditions of the Policy remain unchanged.
CNA71527XX (10/12)
Page 1 of 1
Insured Name: Granite Construction Incorporated
Copyright CNA All Rights Reserved.
Policy No: BUA2074978692
Endorsement No:
Effective Date: 10/01 /2023
0
POLICY NUMBER: BUA2074978692 COMMERCIAL AUTO
CA04441013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
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This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
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MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: Granite Construction Incorporated
Endorsement Effective Date: 10/01/2023
SCHEDULE
Na
Any person or organization for whom or which you are required by written contract or agreement to obtain this
waiver from us.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against
Others To Us condition does not apply to the
person(s) or organization(s) shown in the Schedule,
but only to the extent that subrogation is waived prior
to the "accident" or the 'loss" under a contract with
that person or organization.
CA 04 4410 13 Copyright, Insurance Services Office, Inc., 2011
Page 1 of 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Notice of Cancellation or Material Change —
Designated Person or Organization
0
This endorsement modifies insurance provided under the following: N
Business Auto Coverage Form
In the event of cancellation or material change that reduces or restricts the insurance afforded by this w
Coverage Part, we agree to mail prior written notice of cancellation or material change to:
SCHEDULE
1. Name: Any person or organization you are required by written contract or agreement to mail prior
written notice of cancellation or material change.
2. Address: Per Certificates of Insurance on file with the broker.
3. Number of days advance notice:
For non-payment of premium, the greater of:
• the number of days required by state statute or
• the number of days required by written contract
For any other reason, the lesser of:
• 60 days or
• the number of days required in a written contract
This endorsement Is part of your policy and takes effect on the effective date of your policy, unless another effective
date is shown below.
Must Be Completed Complete Only When This Endorsement Is Not Prepared
With the Policy Or Is Not to be Effective with the Policy
ENDT. NO. POLICY NO. ISSUED TO: EFFECTIVE
DATE OF THIS
Granite Construction Incorporated ENDORSEMENT
19 BUA 2074978692 1 1 10/01 /2023
CNA ANNIM-__
EAIM19BB18 G-39543A
CNA
Workers Compensation And Employers Liability Insurance
This endorsement changes the policy to which it is attached.
It is agreed that Part One - Workers' Compensation Insurance G. Recovery From Others and Part Two -
Employers' Liability Insurance H. Recovery From Others are amended by adding the following:
We will not enforce our right to recover against persons or organizations. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
PREMIUM CHARGE - Refer to the Schedule of Operations
The charge will be an amount to which you and we agree that is a percentage of the total standard premium for
California exposure. The amount is 2%.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: G-19160-B 111-1997)
Endorsement Effective Date: Endorsement Expiration Date:
Endorsement No: 6; Page: 1 of 1
Underwriting Company: Valley Forge Insurance Company, 151 N Franklin St, Chicago, IL 60606
m Copyright CNA All Rights Reserved.
Policy No: WC 2 74978630
Policy Effective Date: 10/01/2025
Policy Page: 53 of 83
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We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not o
enforce our right against the person or organization named in the Schedule. This agreement applies only to the N
extent that you perform work under a written contract that requires you to obtain this agreement from us.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. 00
Any person or organization for which the employer has agreed by written contract, executed prior to loss, may z
execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this w
waiver of subrogation does not apply to any construction group of classifications as designated by the waiver
of right to recover from others (subrogation) rule in our manual.
Schedule
Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover
from under a written contract or agreement.
The premium charge for the endorsement is reflected in the Schedule of Operations.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another
effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy
unless another expiration date is shown below.
Form No: WC 00 03 13 (04-1984) Policy No: WC 2 74978644
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 10/01/2025
Endorsement No: 32; Page: 1 of 1 Policy Page: 296 of 442
Underwriting Company: Transportation Insurance Company, 151 N Franklin St, Chicago, IL 60606
Copyright 1983 National Council on Compensation Insurance.
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G-20472-A
s CM(Ed. 10/93)
WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY
NOTICE OF CANCELLATION OR MATERIAL CHANGE ENDORSEMENT
M
In the event of cancellation or other material change of the policy, we will mail advance notice to the person or o
organization named in the Schedule. The number of days advance notice is shown in the Schedule. N
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule z
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1, Number of days advance notice:
For non-payment of premium, the greater of:
a the number of days required by state statute or
• the number of days required by written contract
For any other reason, the lesser of:
• 60 days or
• the number of days required in a written contract
2. Notice will be mailed to:
Any person or organization you are required by written contract or agreement to mail prior written notice of
cancellation or material change.
Address: Per Certificates of Insurance on file with the broker
This endorsement changes the policy to which It Is attached and is effective on the date issued unless otherwise stated
(The information below is required only when the endorsement Is issued subsequent to preparation of the policy )
Endorsement Effective 10-1-25 Policy No, WC274978630 Valley Forge Insurance Company
WC274978644 Transportation insurance Company
G-20472-A Page 1 of 1
(Ed 10/93)
Alliant Insurance Services, Inc.
560 Mission Street, 6th Floor
San Francisco, CA 94105
Electronic Service Requested
Cityy of La Quinta
78495 CALLE TAMPICO
LA QUINTA, CA 92253-2839
EBIX BPO
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