Loading...
Insurance Certificates 2019/20 PWLC II, IncPWLCIII-01 AU5 INA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 2/25/2020 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 License # GE67768 200CT Laurie Lloyd IOA Insurance Services PHI2 H Extl; (619) 788-5798 50212 {FAr�`xC, ,e,Not. 619) 674-6288 4370 La Jolla Village Drive Suite 600 Laurle.Lloyd@ioausa.com San Diego, CA 92122 INSURERiSiAFFORDING COVERAGE NAll:11 INSURED PWLC II, Inc. PO Box 986 Vista, CA 92085 INSURER D : F: Florists' R1r111CInKI MI.IMRFR LrV Y CCV14]l-J vwa�f ,a vry � e�Yr.-,.+� •- 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 MIAD LTRTYPE OF INSURANCE +JNSD 41 D POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 seENTED cs MEDEXP An one person)$ g 1,000,000 CLAIMS -MADE OCCUR X X IBP15867 3/10/2019 3/10/2020E 10,000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEWAGGREGATE LIMIT APPLIES PER: I. POLICY PEA LOC PRODUCTS - COMP/OP AGG $ 2,000,000 L7TMER. EB Aggregate s 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _(gdenl 1,000,000 8 BODILY INJURY (Par person)$ X ANY AUTO IFMA011477 3/10/2019 3/10/2020 BODILY 1NJUR Per acciden $ OWNED SCHEDULED AUTOS ONLY AA�UUpTTpOppSWyyNry�� AUTOS ONLY AlTT�059NL� PROPERTYDAMAGE$ $ X Cram.: $1k Per X Coll.: $1 k Per Claim CCii A X UMBRELLA LIAB X EXCESS LIAB OCCUR CLAIMS -MADE IEX11308 3/10/2019 3/10/2020 EACH OCCURRENCE 3 4,000,000 AGGREGATE S 4,000,000 DED I X I RETENTION $ 10,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE RFICERWMEMBER EXCLUDED? [Mandatory in NH) N I A X SD502946304 3/10/2019 3/10/2020 TH- X STR OER E.L. EACH ACCIDENT 1,000,000 $ I- L. DISEASE - EA EMPLOYE $ 1,000,000 E:L. DISEASE -PDLJ Y L IT 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations City of La Quinta is Additional Insured with respect to General Liability per the attached endorsement as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to General Liability and Workers' Compensation. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. City of La Quinta 78-495 Calle Tampico SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �.�o.l. bis� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BP-15867 COMMERCIAL GENERAL LIABILITY LCA20310712 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CONTRACTORS BLANKET ADDITIONAL INSURED - WHEN REQUIRED BY WRITTEN CONTRACT ONGOING & COMPLETED OPERATIONS -- BLANKET WAIVER OF SUBROGATION — PRIMARY & NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (optional - see Paragraph A.) Name Of Person(s) Or Organization(s) I Location(s) And Description of Covered Operations as required by "written contract": 1 per the "written contract": A. ADDITIONAL INSURED - CONTRACTORS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person(s) or or- ganizations) you are required by a "written contract" to add as an additional insured on this Coverage Part. The "written contract" requirement for additional in- sured status is automatically fulfilled for any addi- tional insured shown in the Schedule above. However: 1. If an additional insured(s) is a builder, general contractor or contractor not affiliated with the builder; and 2. You have entered into a residential construction contract subject to the requirements of California Civil Code Section 2782(c) with such builder or contractor; then such builder or contractor is an additional in- sured under this endorsement but only to the extent of the liability for "bodily injury", "property damage" or "personal and advertising injury" that you have assumed in the residential construction contract with that party. B. Coverage provided to such additional insured(s) is limited as follows: L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1. ONGOING OPERATIONS: Such person(s) or organization(s) is an addi- tional 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 (b) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations as specified in the "written contract". 2. COMPLETED OPERATIONS: (a) Such person(s) or organization(s) is an addi- tional insured with respect to liability includ- ed in the "products -completed operations hazard" for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" only if: I. The "written contract" requires you to pro- vide the additional insured such cover- age; and ii. "Your work" included in the "products - completed operations hazard" is limited to the location designated and described in the "written contract". (b) Such coverage for the additional insured ends at the earliest of the following: The date specified in the "written con- tract"; or Five years from the completion of "your work" included in the "products - completed operations hazard" as desig- nated and described in the "written con- tract". 3. Coverage provided to such additional insured(s) described in Paragraph A is limited as follows: (a) The insurance afforded to such additional insured only applies to the extent permitted by law; and (b) Will not be broader than the lesser of what is afforded to you under this Coverage Part or that which you are required by the "writ- ten contract" to provide for the additional insured, (c) Does not apply to any person(s) or organi- zations) covered as an additional insured on any other endorsement attached to this Coverage Part. C. ADDITIONAL INSURED - EXCLUSIONS With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: This insurance does not apply to: 1. The sole negligence of the additional insured. 2. The rendering of, or the failure to render, any professional architectural, engineering or sur- veying services, including: (a) The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or (b) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitor- ing of others by that insured, if the "occurrence" which caused the "bodily injury" or "property dam- age", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, en- gineering or surveying services. D. ADDITIONAL INSURED - LIMITS With respect to the insurance afforded to these addi- tional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: The most we will pay on behalf of the additional in- sured is the amount of insurance: 1. Required by the "written contract"; or 2. Available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. ADDITIONAL INSURED —PRIMARY AND NONCONTRIBUTORY SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. OTHER INSURANCE is amended for the additional insured by the addition of the following, superseding any provision to the contrary: If required by "written contract", this insurance is primary to and will not seek contribution from any other insurance maintained by an additional insured under your policy if the additional insured is a Named Insured under such other insurance. F. ADDITIONAL INSURED - DUTIES: SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 2. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT are amended to add the following conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practical: 1. Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance. L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Provide us any written documentation which triggered additional insured status or waiver of recovery rights. 3. Provide us copies of all legal papers received and otherwise cooperate with us in the investi- gation, defense or settlement of the claim or suit". We have no duty to defend or indemnify an addi- tional insured under this endorsement until we re- ceive written notice of a claim or "suit" from the ad- ditional insured. G. ADDITIONAL INSURED — DEFINITIONS: SECTION V — DEFINITIONS is amended for this endorsement by the addition of the following: 1. "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 written contract or written agreement: (a) Is effective during the term of this Cover- age Part; and (b) Was signed by you prior to the "bodily inju- ry", "property damage" or "personal and advertising injury" offense applicable to this Coverage Part; and (c) Pertains to your ongoing operations or "your work" included in the "products - completed operations hazard" for the addi- tional insured. 2. The definition of "insured contract" is modified for the additional insured as follows: Paragraph f. of the "insured contract" definition does not apply to "bodily injury" or "property damage" included within the "products - com- pleted operations hazard" unless required by the "written contract". W. BLANKET WAIVER OF SUBROGATION SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: We waive any right of subrogation we may have against any person(s) or organization(s) with whom you have signed a written contract or written agree- ment that requires such a waiver. This waiver applies only if the written contract or written agreement is: 1. Signed by you prior to the "bodily injury", "prop- erty damage" or "personal and advertising inju- ry" offense applicable to this Coverage Part and; 2. Effective during the term of this Coverage Part and is an "insured contract" and; 3. Applicable to your ongoing operations or "your work" included in the "products -completed op- erations hazard". L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. { WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • BLANKET i I 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 tothe extent that you perform work under a written contract that requires you to obtain this agreement from us). i The additional prernium for this endorsement shall be 3 % of the total California Workers' Compensation premium otherwise due, Schedule Person or Organization Job Description ANY PERSON OR ALL CALIFORNIA t ORGANIZATION FOR OPERATIONS. WHICH THIS WAIVER r IS REQUIRED. 1 Ee€` E •. f �k f F' I F e i 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 this endorsement is issued subsequent to preparation of the policy.) Policy Number: WSD502946304 Endorsement No. Insured PWLC II INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) N4UAF;n PWLCIII-01 LYNI CERTIFICATE OF LIABILITY INSURANCE DAT6 6/2 DIYYYY) /6/2019 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 License # OES7768 CONTACT Laurie Lloyd IOA Insurance Services PHONE FAX 4370 La Jolla Village Drive (A/C, No, Est): (619) 788-5798 50212 (A/C, N_o):(619) 574-6288 Suite 600 Laurie.Lioyd@ioausa.com San Diego, CA 92122 INSURER151 AFFDRpING COVERAGE NAIC # INSURED Y- INSURERB:InsuranceComPan of the West 127847 -- PWLC II, Inc. PO Box 986 Vista, CA 92085 INSURER E : INSURER F : r—nVFRAf.FS r:FRTIFIrATF MI. IMRFR• RFV1Cir]AI All IMR;=pI 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 _ TYPE OF INSURANCE ,ADDL INSD •SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP MID YYYYY LIMITS . EACH OCCURRENCE A X COMMERCIAL GENERAL LIABILITY S 1,000,000 CLAIMS -MADE X OCCUR X X IBP15867 3/10/2019 3/10/2020 PRAMAGETO RENTED S 1,000,000 S 10,000 MED EXP (Any one person) PERSONAL & AOV INJURY GENERAL AGGREGATE PRODUCTS-COMP/OPAGG S 1,000,000 GEN'L AGGREC�,4T'r LIMIT APPLIES PER: POLICY X� JEeT F LOC S 2,000,00 S_ 2,000,000 OTHER EB Aggregate 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acciden 1000,360 S S _ 5 X ANY AUTO IFMA011477 OWNED ISCHEDULED AURTEO�S ONLY AUTO��77Sy��E❑ 3/10/2019 3/10/2020 BODILY_ INJURY_ (Per person) BODILY INJURY Per acciden 5 AUTOS ONLY -- A!°TOS CNLY �( ClaX:SlkPer X Coll S1kPerClalni CC mm PP�'PE AMAGE S. A X UMBRELLA LIAB X I OCCUR EACH OCCURRENCE 4,000,000 EXCESS LIAB CLAIMS -MADE! IEX11308 7/01/2019 3/10/2020 AGGREGATE 4,000,000 S. )(� PER rS.TH- - - S DED X I RETENTIONS 10,000 3/1012019 3/1012020 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N WMFFICER/MEMBER EXCLUDED? J andatory in NH) If yes, describe under i DESCRIPTION OF OPERATION below X 'WSD502946304 N / A E. L_ EACH ACCIDENT 1,000,000 S E_-L- DISEASE - EA EMPLOYE E L DISEASE - POLICY LIMIT S 1'000'000 S 1,000,0�0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All Operations City of La Quinta is Additional Insured with respect to General Liability perthe attached endorsement as required by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to General Liability and Workers' Compensation. 30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions. TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of La Quinta 78-495 Calle Tampico r r ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BP-15867 COMMERCIAL GENERAL LIABILITY LCA20310712 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CONTRACTORS BLANKET ADDITIONAL INSURED - WHEN REQUIRED BY WRITTEN CONTRACT ONGOING & COMPLETED OPERATIONS - BLANKET WAIVER OF SUBROGATION - PRIMARY & NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (optional - see Paragraph A.) Name Of Person(s) Or Organization(s) Location(s) And Description of Covered Operations as required by "written contract': per the "written contract": A. ADDITIONAL INSURED - CONTRACTORS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person(s) or or- ganization(s) you are required by a "written contract" to add as an additional insured on this Coverage Part. The "written contract" requirement for additional in- sured status is automatically fulfilled for any addi- tional insured shown in the Schedule above. However: 1. If an additional insured(s) is a builder, general contractor or contractor not affiliated with the builder; and 2. You have entered into a residential construction contract subject to the requirements of California Civil Code Section 2782(c) with such builder or contractor; then such builder or contractor is an additional in- sured under this endorsement but only to the extent of the liability for "bodily injury", "property damage" or "personal and advertising injury" that you have assumed in the residential construction contract with that party. B. Coverage provided to such additional insured(s) is limited as follows: L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1. ONGOING OPERATIONS: Such person(s) or organization(s) is an addi- tional 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 (b) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations as specified in the "written contract". 2. COMPLETED OPERATIONS: (a) Such person(s) or organization(s) is an addi- tional insured with respect to liability includ- ed in the "products -completed operations hazard" for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" only if: i. The "written contract" requires you to pro- vide the additional insured such cover- age-, and ii. "Your work" included in the "products - completed operations hazard" is limited to the location designated and described in the "written contract". (b) Such coverage for the additional insured ends at the earliest of the following: i. The date specified in the "written con- tract'; or ii. Five years from the completion of "your work" included in the "products - completed operations hazard" as desig- nated and described in the "written con- tract". 3. Coverage provided to such additional insured(s) described in Paragraph A is limited as follows: (a) The insurance afforded to such additional insured only applies to the extent permitted by law; and (b) Will not be broader than the lesser of what is afforded to you under this Coverage Part or that which you are required by the "writ- ten contract" to provide for the additional insured. (c) Does not apply to any person(s) or organi- zations) covered as an additional insured on any other endorsement attached to this Coverage Part. C. ADDITIONAL INSURED - EXCLUSIONS With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions apply: This insurance does not apply to: 1. The sole negligence of the additional insured. 2. The rendering of, or the failure to render, any professional architectural, engineering or sur- veying services, including: (a) The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or (b) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitor- ing of others by that insured, if the "occurrence" which caused the "bodily injury" or "property dam- age", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, en- gineering or surveying services. D., ADDITIONAL INSURED - LIMITS With respect to the insurance afforded to these addi- tional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: The most we will pay on behalf of the additional in- sured is the amount of insurance: 1. Required by the "written contract"; or 2. Available under the applicable Limits of Insur- ance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. ADDITIONAL INSURED — PRIMARY AND NONCONTRIBUTORY SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. OTHER INSURANCE is amended for the additional insured by the addition of the following, superseding any provision to the contrary: If required by "written contract", this insurance is primary to and will not seek contribution from any other insurance maintained by an additional insured under your policy if the additional insured is a Named Insured under such other insurance. F. ADDITIONAL INSURED - DUTIES: SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS 2. DUTIES IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT are amended to add the following conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practical: 1. Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance. L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. Provide us any written documentation which triggered additional insured status or waiver of recovery rights. 3. Provide us copies of all legal papers received and otherwise cooperate with us in the investi- gation, defense or settlement of the claim or suit". We have no duty to defend or indemnify an addi- tional insured under this endorsement until we re- ceive written notice of a claim or "suit" from the ad- ditional insured. G. ADDITIONAL INSURED — DEFINITIONS: SECTION V — DEFINITIONS is amended for this endorsement by the addition of the following: 1. "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 written contract or written agreement: (a) Is effective during the term of this Cover- age Part; and (b) Was signed by you prior to the "bodily inju- ry", "property damage" or "personal and advertising injury" offense applicable to this Coverage Part; and (c) Pertains to your ongoing operations or "your work" included in the "products - completed operations hazard" for the addi- tional insured. 2. The definition of "insured contract" is modified for the additional insured as follows: Paragraph f. of the "insured contract" definition does not apply to "bodily injury" or "property damage" included within the "products - com- pleted operations hazard" unless required by the "written contract". H. BLANKET WAIVER OF SUBROGATION SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: We waive any right of subrogation we may have against any person(s) or organization(s) with whom you have signed a written contract or written agree- ment that requires such a waiver. This waiver applies only if the written contract or written agreement is: 1. Signed by you prior to the "bodily injury", "prop- erty damage" or "personal and advertising inju- ry" offense applicable to this Coverage Part and; 2. Effective during the term of this Coverage Part and is an "insured contract" and, 3. Applicable to your ongoing operations or "your work" included in the "products -completed op- erations hazard". L CA 20 31 07 12 Florists' Mutual Insurance Company - Edwardsville, Illinois Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. r WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT • BLANKET 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 tothe extent that you porform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 3 %of the total California Workers' Compensation premium otherwise due. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THIS WAIVER IS REQUIRED. Job Description ALL CALIFORNIA OPERATIONS. 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 this endorsement is issued subsequent to preparation of the policy.) Policy Number: WSD502946304 Endorsement No. Insured PWLC II INC Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned Fay WC 99 06 34 (Ed. 8.00) NSl1H F;n