Loading...
Insurance Certificates 2020/21 World Triathlon Corporation dba IronmanPage 1 of 2 AC � I j' DATE (MM/DDNYYY) �. CERTIFICATE OF LIABILITY INSURANCE 07/21/2021 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 endorsements . PRODUCER CONTACT NAME: Willie Towers Watson Certificate Center Willie Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd . ArC Np : P.O. Box 305191 ADDRESS; certificates @Willis.Com Nashville, TN 372305191 USA INSUR ER AFF RDING COVERA E INSURED World Triathlon Corporation 3407 W. Dr. Martin Luther King Jr. Blvd Tampa, FL 336076226 (S) 0 G NAIC k INSURERA: Philadelphia Indemnity Insurance Company 18058 INSURERS: AIU Insurance Company 19399 INSURERC: BDI Global Specialty BE B0783 INSURERD: Endurance American Specialty Insurance Cost 41718 INSURERE: Factory Mutual Insurance Company 21482 COVERAGES CERTIFICATE NIIMRFR- W21661519 RRVIGInN NIIMRFR- 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. INTR TYPEOFINSURANCE tADDLSUBR• POLICYEFF POLICYEXP I POLICY NUMBER MMIDDrYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE LJ OCCUR A 1,000,000 P A�4iSE$_{Ea gcrArrrgr�cgj; $ A MED EXP (Any one person) $ 5,000 Y Y PHPK2222108 12/31/2020 12/31/2021 PERSONAL & ADV INJURY $ 1,000,000 GENT_ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 3,000,000 X POLICY JECOT- LOC PRODUCTS - COMP/OP AGG $ 3,000,00a OTHER- $ AUTOMOBILE LIABILITY COM8INED SINGLE LIMIT �Ee 9cfident] $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED y Y PHPK2222108 12/31/2020 12/31/2021' BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED ONLY AUTOS ONLY rPR-AMAGEOPERTt'DAUTOS er accident},_-_ _ _____ - .$ - ------ - - A X UMBRELLA LIAB X OCCUR I EACH OCCURRENCE $ 5, 000, 000. AGGREGATE — — $ 5,000,000 EXCESSLIAB -CLAIMS -MADE PHOB751698 12/31/2020 12/31/2021 DED %� RETENTIONS 10, 000 $ WORKERS COMPENSATION X P OTH- TAT TE ' ER AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 1, 000, 00C B ANYPROPRIETORIPARTNER/EXECUTIVE Y —_ OFFICER/MEMBEREXCLUDED? N/A WC 058240232 O1/O1/2021 O1/O7/2022 (Mandetory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 II yes, describe under E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS below C Excess Liability 18HX1337 12/31/2020 12/31/2021 Each Occ/ Agg $10,000,000 I Excess of $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED Uth I RADA I I; HVLL)LK CANCELLATION City of La Quinta 78495 Calla Tampico La Quints, CA 92253 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 1 � 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sit ID: 21376198 BATCH: 2173390 2 of 5 6093 ACURE) AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED World Triathlon Corporation Willis Towers Watson Northeast, Inc. 3407 W. Dr. Martin Luther Ring Jr. Blvd Tampa, FL 336076226 POLICY NUMBER See Page 1 CARRIER NAIC CODE EFFECTIVE DATE: See Page 1 See Page 1 See Page 1 lDDITIONAI RFMARK.% THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Certificate Holder is included as an Additional Insured as respects to General Liability and Auto Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured. Waiver of Subrogation applies in favor of Certificate Holder with respects to General Liability, Auto Liability and Workers Compensation as permitted by law. INSURER AFFORDING COVERAGE: Endurance American Specialty Insurance Company NAIC#: 41718 POLICY NUMBER: ELD30002742000 EFF DATE: 12/31/2020 EXP DATE: 12/31/2021 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occ/ Agg $5,000,000 Excess of $15,000,000 INSURER AFFORDING COVERAGE: Factory Mutual Insurance Company NAIC#: 21482 POLICY NUMBER: 1084667 EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Rented / Leased Equipment Limit: $ 1,750,000 Replacement Cost, Special Form ACORD 101 (2008/01) © 2008 ACOHD CORPUHA I IUN. All rlgnts reservea. The ACORD name and logo are registered marks of ACORD SR ID: 21376198 BATCH: 2173390 CERT: W21661519 POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): I Location(s) Of Covered Operations Where required by Written Contract Information required to complete this Schedule, If not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work' out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ 3 of 5 6093 POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) Where required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization where required by a written contract that was executed prior to the occurrence of a loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your world' done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 13 4 of 5 6093 PI-CANXAICH-002 (05/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR CERTIFICATE HOLDER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART COMMERCIAL CRIME COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS All or CH Additional Insured or Certificate Holder Address AI As required by written contract executed by the named insured prior to an occurrence resulting in a loss or claim The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part: A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives. 1. 30 days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium. As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage. Page 1 of 2 BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 1/1/2021 Issued to ADVANCE PUBLICATIONS, INC. By Al INSURANCE COMPANY forms a part of Policy No, WC 058240232 We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization, The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 Countersigned by - _ - - - - - (Ed. 11/90) Authorized Representative 5 of 5 6093 Page 1 of 2 A�R�O �J CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ 2021Y) o7/02/2021 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 Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-995-7378 FAX 1-888-467-2378 A/C No Ext : A X No ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC # Nashville, TN 372305191 USA INSURERA: Philadelphia Indemnity Insurance Company 18058 INSURED World Triathlon Corporation 3407 W. Dr. Martin Luther King Jr. Blvd INSURERB: Continental Casualty Company 20443 INSURERC: HDI Global Specialty SE B0783 INSURERD: Endurance American Specialty Insurance Com 41718 Tampa, FL 336076226 INSURERE: Factory Mutual Insurance Company 21482 INSURER F : COVERAGES CERTIFICATE NUMBER: W21575290 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR a RDAMAGE TO ENTED PREMISES('a )$ 1,000,000 MED EXP (Any one person) $ 5,000 A Y Y PHPK2222108 12/31/2020 12/31/2021 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑ PRO- JECT ❑ LOC X PRODUCTS - COMP/OPAGG $ 3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS Y Y PHPK2222108 12/31/2020 12/31/2021 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE PHUB751698 12/31/2020 12/31/2021 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA Y WC6081247400 07/17/2020 07/17/2021 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ C Excess Liability 18HX1337 12/31/2020 12/31/2021 Each Occ/ Agg $10,000,000 Excess of $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21308103 BATCH: 2153801 AGENCY CUSTOMER ID: LOC #: 'ORE) ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED World Triathlon Corporation Willis Towers Watson Northeast, Inc. 3407 W. Dr. Martin Luther King Jr. Blvd POLICY NUMBER Tampa, FL 336076226 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 Certificate Holder is included as an Additional Insured as respects to General Liability and Auto Liability. General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured. Waiver of Subrogation applies in favor of Certificate Holder with respects to General Liability, Auto Liability and Workers Compensation as permitted by law. INSURER AFFORDING COVERAGE: Endurance American Specialty Insurance Company POLICY NUMBER: ELD30002742000 EFF DATE: 12/31/2020 EXP DATE: 12/31/2021 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occ/ Agg $5,000,000 Excess of $15,000,000 INSURER AFFORDING COVERAGE: Factory Mutual Insurance Company POLICY NUMBER: 1084667 EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Rented / Leased Equipment Limit: $ lf750,000 Replacement Cost NAIC#: 41718 NAIC#: 21482 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 21308103 BATCH: 2153801 CERT: W21575290 POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s : Locations Of Covered Operations Where required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) Where required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: PHPK2222108 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization where required by a written contract that was executed prior to the occurrence of a loss. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ❑ PI-CANXAICH-002 (05/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTICE TO SCHEDULED ADDITIONAL INSURED OR CERTIFICATE HOLDER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART COMMERCIAL CRIME COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE OF ADDITIONAL INSUREDS OR CERTIFICATE HOLDERS Al or CH Additional Insured or Certificate Holder Address AI As required by written contract executed by the named insured prior to an occurrence resulting in a loss or claim The following is added to A. CANCELLATION of the Common Policy Conditions of the above applicable coverage part: A. In the event we cancel the policy in accordance with the policy's terms and conditions, we will endeavor to mail written notice of cancellation to Additional Insureds or Certificate Holders, shown in the above SCHEDULE within the time frame listed below. However, failure to mail such notice shall impose no obligation of any kind upon us, our agents or representatives. 1. 30 days before the effective date of cancellation if we cancel for any reason other than for non - payment of premium. As respects Additional Insureds, the above cancellation provision applies only when the Additional Insured shown in the above SCHEDULE is added to the policy by a separate additional insured endorsement as the CANCELLATION NOTICE TO ADDITIONAL INSURED OR CERTIFICATE HOLDER does not provide additional insured coverage. Page 1 of 2 Workers, Compensation And Employerr, Liability Insurance CMAPglicy Endursgment This endorsement changes the policy to which it is attached. It is agreed that fart Cne - Woirkars' Compensation Insuranpce G. Rrmwery From Others and Part Two - Employers' UaWlilty Insurarw;oe H. Recovery From OIhers are amended by adding the fallowing-. We will not enforce our right to recover against persons or orgenixatione. (This agreement applies only to the extent that you perform work under a written contract that requirer. you to- obtain this agreement from us.) PREMIUM CHARGE - Refer to the Schedule of Operations The Charge will be on amount 10 which you and we agree that 1$ a percentage of the total standard premium for California exposure, The arnount is 3%. All other terms and oandltlons of the policy rernaln unchanged. This endorsement, which farms a part of and is for attachment to the policy issued try the designated Insurers, takes eflect on the Policy Effective bate of said policy at the hour stated in said policy, unless another effective pate Ithe Endorsement IVIKOve Uatel is shown below, and expires concurrently wlth said policy unless another expiration date is shown below. Fo-rn N6: & 1916CLE1 1`11-19971 Policy No: WC 6 912e7414 Emlormrneot Errao7iw Dow: Eeidoreemam ExOrMoo Data: Polley ErreeUve'Dm: 0711 7�2024 Entlormms+n5 No: 2: PM6: 7 or 1 Policy tea: SS vF 46 lJndarwrrfing Camparry: Continarvial Casualty Corrwany. 151 N Franklin St.. Chicago, IL 60606 e Coluyd aht CNA All MOW Fleawwod. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this 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) Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 8; Page: 1 of 1 Underwriting Company: Continental Casualty Company, 151 N Franklin St, Chicago, IL 60606 Policy No: WC 6081247400 Policy Effective Date: 07/17/2020 Policy Page: 243 of 367 Copyright 1983 National Council on Compensation Insurance.