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HomeMy WebLinkAbout2011-05 (Ortiz Enterprises) - InsuranceINSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Travelers Indemnity Company of CT Travelers Property Casualty Co of Amer Evanston Insurance Company 12/08/2022 Marsh & McLennan Agency LLC Marsh & McLennan Ins. Agency LLC 1 Polaris Way #300 Aliso Viejo, CA 92656 Brenda Marin 949-362-7214 OcCerts@MarshMMA.com Ortiz Enterprises, Inc. 6 Cushing, Suite 200 Irvine, CA 92618 25682 25674 35378 A X X X BI/PD Ded:5,000 X DT22CO2R806868TCT2 10/01/2022 10/01/2023 2,000,000 300,000 5,000 2,000,000 4,000,000 4,000,000 B X 8102R8093732226G 10/01/2022 10/01/2023 1,000,000 B X X X $10,000 CUP3R49533A2226 10/01/2022 10/01/2023 10,000,000 10,000,000 B N UB2R8182652226G 10/01/2022 10/01/2023 X 1,000,000 1,000,000 1,000,000 C Pollution Liab. / Professional Liab MMAENV003349 10/01/2022 10/01/2024 2,000,000 Each Cond. 2,000,000 Aggregate 25,000 Retention RE: City Project No. 2011-05; Federal Project No. BRNBIL (537), Dune Palms Road Improvements Project; Dune Palm Road Btwn. Hwy 111 and Westward Ho Dr. in La Quinta, CA. City of La Quinta, Coachella Valley Water District, its employees, directors, officers, agents, and volunteers are included as Additional Insured on General Liability and and Auto Liability per the attached. Insurance is Primary and Non-Contributory. Waiver of Subrogation applies on General Liability, and Workers Compensation, per the attached. CIty of La Quinta 78495 Calle Tampico La Quinta, CA 92253 1 of 1 #S12080965/M11807793 ORTIZENTERClient#: 492920 WXNQS 1 of 1 #S12080965/M11807793 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products-Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS (1)Any "bodily injury", "property damage" or "personal injury" arising out of the providing,The following is added to SECTION II – WHO IS AN or failure to provide, any professionalINSURED: architectural, engineering or surveyingAny person or organization that you agree in a services, including:written contract or agreement to include as an additional insured on this Coverage Part is an (a)The preparing, approving, or failing to insured, but only:prepare or approve, maps, shop drawings, opinions, reports, surveys,a.With respect to liability for "bodily injury" or field orders or change orders, or the"property damage" that occurs, or for "personal preparing, approving, or failing toinjury" caused by an offense that is committed, prepare or approve, drawings andsubsequent to the signing of that contract or agreement and while that part of the contract or specifications; and agreement is in effect; and (b)Supervisory, inspection, architectural or b.If, and only to the extent that, such injury or engineering activities.damage is caused by acts or omissions of you or (2)Any "bodily injury" or "property damage"your subcontractor in the performance of "your caused by "your work" and included in thework" to which the written contract or agreement "products-completed operations hazard"applies. Such person or organization does not unless the written contract or agreementqualify as an additional insured with respect to the independent acts or omissions of such specifically requires you to provide such person or organization.coverage for that additional insured during the policy period.The insurance provided to such additional insured is subject to the following provisions:c.The additional insured must comply with the a.If the Limits of Insurance of this Coverage Part following duties: shown in the Declarations exceed the minimum (1)Give us written notice as soon as practicablelimits required by the written contract or of an "occurrence" or an offense which mayagreement, the insurance provided to the result in a claim. To the extent possible, suchadditional insured will be limited to such notice should include:minimum required limits. For the purposes of determining whether this limitation applies, the (a)How, when and where the "occurrence"minimum limits required by the written contract or or offense took place;agreement will be considered to include the (b)The names and addresses of any injuredminimum limits of any Umbrella or Excess persons and witnesses; andliability coverage required for the additional insured by that written contract or agreement.(c)The nature and location of any injury orThis provision will not increase the limits of damage arising out of the "occurrence"insurance described in Section III – Limits Of or offense.Insurance. (2)If a claim is made or "suit" is brought againstb.The insurance provided to such additional the additional insured:insured does not apply to: CG D2 46 04 19 ú 2018 The Travelers Indemnity Company. All rights reserved.Page 1 of 2 INSURED: POLICY#:POLICY PERIOD: TO: Ortiz Enterprises, Inc. DT22CO2R806868TCT2 10/01/2022 10/01/2023 COMMERCIAL GENERAL LIABILITY (a)Immediately record the specifics of the (4)Tender the defense and indemnity of any claim or "suit" and the date received; and claim or "suit" to any provider of other insurance which would cover such additional(b)Notify us as soon as practicable and see insured for a loss we cover. However, thisto it that we receive written notice of the condition does not affect whether theclaim or "suit" as soon as practicable.insurance provided to such additional (3)Immediately send us copies of all legal insured is primary to other insurancepapers received in connection with the claim available to such additional insured whichor "suit", cooperate with us in the covers that person or organization as ainvestigation or settlement of the claim or named insured as described in Paragraph 4.,defense against the "suit", and otherwise Other Insurance, of Section IV – Commercialcomply with all policy conditions.General Liability Conditions. Page 2 of 2 ú 2018 The Travelers Indemnity Company. All rights reserved.CG D2 46 04 19 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE –This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A.Who Is An Insured – Unnamed Subsidiaries C.Incidental Medical Malpractice B.Blanket Additional Insured – Governmental D.Blanket Waiver Of Subrogation Entities – Permits Or Authorizations Relating To E.Contractual Liability – RailroadsOperationsF.Damage To Premises Rented To You PROVISIONS a.An organization other than a partnership, joint venture or limited liability company; orA. WHO IS AN INSURED – UNNAMED b.A trust;SUBSIDIARIES The following is added to SECTION II – WHO IS as indicated in its name or the documents that AN INSURED:govern its structure. Any of your subsidiaries, other than a partnership,B. BLANKET ADDITIONAL INSURED –joint venture or limited liability company, that is GOVERNMENTAL ENTITIES – PERMITS ORnot shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONSDeclarations is a Named Insured if: The following is added to SECTION II – WHO ISa.You are the sole owner of, or maintain an AN INSURED:ownership interest of more than 50% in, such Any governmental entity that has issued a permitsubsidiary on the first day of the policy period; or authorization with respect to operationsand performed by you or on your behalf and that youb.Such subsidiary is not an insured under are required by any ordinance, law, building codesimilar other insurance.or written contract or agreement to include as an No such subsidiary is an insured for "bodily injury"additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for "bodily injury", "property damage" or "personal andand advertising injury" caused by an offense advertising injury" arising out of such operations.committed: The insurance provided to such governmentala.Before you maintained an ownership interest entity does not apply to:of more than 50% in such subsidiary; or a.Any "bodily injury", "property damage" orb.After the date, if any, during the policy period "personal and advertising injury" arising out ofthat you no longer maintain an ownership operations performed for the governmentalinterest of more than 50% in such subsidiary.entity; orFor purposes of Paragraph 1.of Section II – Who b.Any "bodily injury" or "property damage"Is An Insured, each such subsidiary will be included in the "products-completeddeemed to be designated in the Declarations as:operations hazard". CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved.Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. INSURED: POLICY#:POLICY PERIOD: TO: Ortiz Enterprises, Inc. DT22CO2R806868TCT2 10/01/2022 10/01/2023 COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the knowledge or consent of, the insured.1.The following replaces Paragraph b.of the definition of "occurrence" in the 5.The following is added to the DEFINITIONS DEFINITIONS Section:Section: b.An act or omission committed in providing "Incidental medical services" means:or failing to provide "incidental medical a.Medical, surgical, dental, laboratory, x-rayservices", first aid or "Good Samaritan or nursing service or treatment, advice orservices" to a person, unless you are in instruction, or the related furnishing ofthe business or occupation of providing food or beverages; orprofessional health care services. b.The furnishing or dispensing of drugs or2.The following replaces the last paragraph of medical, dental, or surgical supplies orParagraph2.a.(1)of SECTION II – WHO IS appliances.AN INSURED: 6.The following is added to Paragraph 4.b.,Unless you are in the business or occupation Excess Insurance, of SECTION IV –of providing professional health care services, Paragraphs (1)(a),(b),(c)and (d)above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide:This insurance is excess over any valid and (a)"Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or failing to provide "incidental medical services"(b)First aid or "Good Samaritan services" by to any person to the extent not subject toany of your "employees" or "volunteer workers", other than an employed or Paragraph 2.a.(1)of Section II – Who Is An volunteer doctor. Any such "employees"Insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATIONto provide first aid or "Good Samaritan The following is added to Paragraph 8.,Transferservices" during their work hours for you Of Rights Of Recovery Against Others To Us,will be deemed to be acting within the of SECTION IV – COMMERCIAL GENERALscope of their employment by you or performing duties related to the conduct LIABILITY CONDITIONS: of your business.If the insured has agreed in a contract or 3.The following replaces the last sentence of agreement to waive that insured's right of Paragraph 5.of SECTION III – LIMITS OF recovery against any person or organization, we INSURANCE:waive our right of recovery against such person or organization, but only for payments we makeFor the purposes of determining the because of:applicable Each Occurrence Limit, all related acts or omissions committed in providing or a."Bodily injury" or "property damage" thatfailing to provide "incidental medical occurs; orservices", first aid or "Good Samaritan b."Personal and advertising injury" caused byservices" to any one person will be deemed to an offense that is committed;be one "occurrence". 4.The following exclusion is added to subsequent to the execution of the contract or Paragraph 2.,Exclusions, of SECTION I –agreement. COVERAGES – COVERAGE A – BODILY E. CONTRACTUAL LIABILITY – RAILROADSINJURY AND PROPERTY DAMAGE LIABILITY:1.The following replaces Paragraph c.of the definition of "insured contract" in theSale Of Pharmaceuticals DEFINITIONS Section:"Bodily injury" or "property damage" arising out of the violation of a penal statute or c.Any easement or license agreement; ordinance relating to the sale of Page 2 of 3 ú 2017 The Travelers Indemnity Company. All rights reserved.CG D3 16 02 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY 2.Paragraph f.(1)of the definition of "insured a.Any premises while rented to you or contract" in the DEFINITIONS Section is temporarily occupied by you with permission deleted.of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b.The contents of any premises while such premises is rented to you, if you rent suchThe following replaces the definition of "premises premises for a period of seven or fewerdamage" in the DEFINITIONS Section:consecutive days."Premises damage" means "property damage" to: CG D3 16 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved.Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. COMM RCIAL E ERAL IAB LITYEGNLI c. Meth d O h rin a.o f S a g The sta e e t in th a etmnser a cura ea d co peec t n m l t ;If a l o the o he i sura ce pe m t co t i ut ol f t r n n r is n r b i n by e u lsha e , w il fo l w t i m t o l oq a r s e w l l o h s eh da s .b.Tho e sta e e ts a e ba e upos t m n r s d n Und r th s e ch in ure co t i ut s re re e t ti n y ueiasrnrb e p s na o s o a e to us; nmd a d e ua a o n s unt l it ha pa d it a pl ca lqlmut i s i s p i be c.We ha e i sue th s po i y i re i n e up nv s d i lc n l a c o l m t o in ura ce o no e o th l ss re a ns,i i f s n r n f e o m i y ur e re e ta i ns.o r p s n t o The uni te ti n l o i sio o ,o uni t n i na e ron n o a m s n f r ne t o l r r If a y o th oh r i sura ce do s no pe m tnfete n n e t r i i ,a yi f rm ti n pro i e by y u whi h we re i dn n n o a o v d d o c l e co tr bu i n by e u l sha e , we wi l co t i utni t o q a r s l n r b e up n i issui g th s po i y wi l no pre u i e y uo n n i lc l t j d c o r by l m t . Und r th s m t o ,e ch i sure 'si is e i eh d a n r ri ht unde th s in ura ce Ho e e ,thi pro i i ngsri s n .w v r s vs o sha e is ba e o the ra i o is a p i a l i irsd n t o f t p lc be l m t do s no a f ct o r ri h to co l ct a di i n let f e u g t l e d t o a o in ura ce to th to a a pl ca l li is of s n e t l p i be m t f pre i m o to e e ci e o r rig t o ca ce l t o omurxrsu h s f n l a i n r i sura ce o l nsure s.n n f a li r no re e a i cco d nce w t pp i a l n ura cen n w l na r a i ha lc be i s n d P i a y And No -Co trib t ry In u an e If.r m r n n u o s r c l ws o e ul t o s.a r r g a i n Req i ed B Wri te o tracurytnC n t 7.Se arat o f n u edpinOIsrs If y u spe i i a l a re i a wri t n co t a t oocfc ly g e n t e n r c r Ex e t wi h re pe t to the Li i s o In ura ce a dcpt s c m t f s n ,n a re m nt tha the i sura ce a fo d d to ag e e t n n f r e n a y ri h s o du i s a sig e i th sn g t r t e s n d n i i sure un e hi Co e a e Pa t m st p l nn d d r t s v r g r u a p y o Co e a e Pa t to the fi st Na e Insure ,th svrgr r m d d i a pri a y ba i , o a pri a y a d no -m r ss r m r n n i sura ce a pl e :n n p i s co tr bu o y ba is, th s i sura ce is pri a y toni t r s i n n m r a.As i e ch Na e In ure we e the o lfamdsdrnyohrinuracetht i a a l bl otesn a s v i a e t Na e n ure ; ndmdI s d awhih o e s such n ure a an m d i sure ,c c v r i s d s a e n d b.Se a ae y to e ch in ure a an t who cl iprt l a s d g i s m a mad we wil no sha e wi h th t oh r in ura cenl t r t a t e s n , i m d o "sui "i b o g tsa e r t s r u h .pro i e ha :v d d t t 8.Tra sfe O i h s O e o ery Ag i s t ersnrfRgt f R c v a n t O h(1)The "bo iyi j ry o "pro e ty da a e fodlnu"r p r m g "r To Uswhihcoe a e i so gh o cur ; ndc v r g s u t c s a If the i sure ha ri h s to re o e a l o pa t o a yn d s g t c v r l r r f n(2)The "pe so a a d a v rt sin i j ry fornln d e i g nu "r pa m n we ha e m d unde thi Co e a e Pa tyet v a e r s v r g r ,whi h co e a e is so gh i ca se by ac v r g u t s u d n th seri ht a e tra sfe re t us. he i sure usto g s r n r d o T n d mofesetaicomte;f n h t s m it d dono h ng a te l ss to i p i th m At o r re u st,t i f r o m a r e .u q esubseunt to the si n ng o tha co tr ct oq e g i f t n a r th i sure wi l bri g "sui "o tra sfe tho e ri h se n d l n t r n r s g tarem nt by y ug e e o .to us a dh l s e f rce t e .n epu n o h m 5.P e i m Au irmu d t 9.Wh n We D N t en weo o R e a.We wi l co p t a l p e i m f r h s Co e a elmuelrmusot i v r g If we d ci en t o r n w h s Co e a e P rt e wi le d o t e e t i v r g a ,w lPaticcodncewtur ue a d ae .r na r a i ho r l s n r t s m i o de i e to th fi st Na e In ure sho n inalrlvrermdsdw b.Pre i m sho n in th s Co e a e Pa t amuwi v r g r s th De l ra i n wri te no i e o the no r n waecatos t n tc f n e e l a v nce pre i m i a de o i pr m um o l .Ad a m u s p st e i n y t no l ss th n 0 da s be o e t ee pi a i n da ete a 3 y f r h x r t o t . th clo e o e ch a d t pe i d we wi l co p tes f a u i r o l m ue If no i e is m i e ,pro f o m ii g wi l be suffi i ntcald o f a l n l c e tthernd pre i m fo th t pe i d a d se de a e m u r a r o n n pro f f o i eo o n tc .no i e t th fi st Na e I sure .The du da etco e r m d n d e t SE TI N V –D FNT O SCOEI I I Nfoadia d re ro pe ti ep e i m i t ed trutnt s c v r m u s s h ae 1."shown as the due date on the bill. If the sum of Ad e tse e t"m a s a no i e th t s br a ca t ovrimn e n tc a i o d s r pu lshe to the ge e a pub i o spe i i m rbid n r l lc r cfc athe advance and audit premiums paid for the k te po i y pe i d is gre te tha the e rn dlcro a r n a e se m nt a o t y ur go ds, pro u ts o ser i eg e s b u o o d c r vc s fo th purp se o a t a g custo e s ore o f t r m r rpremium,we will return the excess to the first Na e nsure .supp rt r . o h p r o e o hi de i ii nmdIdo e s F r t e u p s s f t s f n t o : c.The fi st Na e In ure m st k e re o d ormdsd u e p c r s f a.No i e th t a e publ she i cl de m t r atc s a r i d n u ae i l th in o m t o we ne d fo pre i m pl ce o the Int rn t o oefrain e r m u a d n e e r n sim l r i a co p t ti n a d se d us co i s a such t m smua o ,n n pe t i e m a s o co m ni a i n;a de n f m u c t o n a we m y re u st.s a q e b.Re a di g we sit s, o l tha pa t o a we si egrn b e n y t r f b t 6.Rep es n ati nretos th t is a o t y u go d , pro u ts o se v cea b u o r o s d c r r i s fo th pur o e o a t a custo e s ore p s s f t r m r rBytigt i p l cy o gre :p n h s o i ,y ua e supp rt r i co si e e a a v rt se e to e s s n d r d n d e i m n . Pa e 16 o 21gf CG 1 0 02 1T0 9© 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. approach specifically ctin cting electronic acce whichever comes first. Declarations such insured INSURED: POLICY#:POLICY PERIOD: TO: Ortiz Enterprises, Inc. DT22CO2R806868TCT2 10/01/2022 10/01/2023 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE – CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2.The following is added to Paragraph B.5.,Other Insurance of SECTION IV – BUSINESS AUTO1.The following is added to Paragraph c.in A.1.,CONDITIONS:Who Is An Insured, of SECTION Il – COVERED AUTOS LIABILITY COVERAGE:Regardless of the provisions of paragraph a. and paragraph d. of this part 5. Other Insurance, thisThis includes any person or organization who you insurance is primary to and non-contributory withare required under a written contract or applicable other insurance under which anagreement, that is signed by you before the additional insured person or organization is a"bodily injury" or "property damage" occurs and named insured when a written contract orthat is in effect during the policy period, to name agreement with you, that is signed by you beforeas an additional insured for Covered Autos the "bodily injury" or "property damage" occursLiability Coverage, but only for damages to which and that is in effect during the policy period,this insurance applies and only to the extent of requires this insurance to be primary and non-that person's or organization's liability for the contributory.conduct of another "insured". CA T4 99 02 16 ú 2016 The Travelers Indemnity Company. All rights reserved.Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. INSURED: POLICY#: POLICY PERIOD: TO: Ortiz Enterprises, Inc. 8102R8093732226G 10/01/2022 10/01/2023 INSURED: POLICY #: POLICY PERIOD: TO: Ortiz Enterprises, Inc. UB2R8182652226G 10/01/2022 10/01/2023