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2 Communication Supply Services meaning property supplying communication services including telephone radio microwave or television services to the described premises such as a Communication transmission lines including optic fiber transmission lines b Coaxial cables and c Microwave radio relays except satellites. It does not include above ground communication lines. 3 Power Supply Services meaning the following types of property supplying electricity steam or gas to the described premises a Utility generating plants b Switching stations c Substations d Transformers and e Transmission lines. It does not include above ground transmission or distribution lines. Coverage under this Extension does not apply to Business Income loss related to interruption in utility service which causes loss or damage to electronic data including destruction or corruption of electronic data. The term electronic data has the meaning described in the BUILDING AND PERSONAL PROPERTY COVERAGE FORM under Property Not Covered Elec tronic Data. 4 Business Income means the a Net Income net profit or loss before income taxes that would have been earned or incurred including Rental Value and b Continuing normal operating expenses incurred including payroll. For manufacturing risks Net Income includes the net sales value of production. 5 Rental Value means Business Income that consists of a. Net Income Net Profit or Loss before income taxes that would have been earned or incurred as rental income from tenant occupancy of the premises described in the Declarations as furnished and equipped by you including fair rental value of any portion of the described premises which is occupied by you and b. Continuing normal operating expenses incurred in connection with that premises including 1 Payroll and 2 The amount of charges which are the legal obligation of the tenants but would otherwise be your obligations. Refer to the Extra Expense Coverage Extension for the following definitions 1 Operations 2 Period of Restoration 3 Suspension Loss Adjustment Expenses You may extend the insurance provided by the BUILDING AND PERSONAL PROPERTY COV ERAGE FORM to apply to your expenses for preparation of loss data including inventories and appraisals in connection with any claim covered under this policy. We will not pay for ex penses incurred in using the services of a public adjuster or an attorney. The most we will pay at any one location under this Extension is 2500. 2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc. with its Permission. CP 88 00 07 10 Page 9 of 11
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61506798 002842 2n0 o 162 r. Salespersons Samples You may extend the insurance that applies to Your Business Personal Property to apply to Salespersons Samples of your stock in trade including their containers while they are in the care custody or control of your sales representatives agents or yourself while acting as a sales representative. The most we will pay for loss to Salespersons Samples in any one occurrence is 1000 for property in the custody of any one salesperson. s. Appurtenant Structures If not otherwise covered by this policy you may extend the insurance that applies to Building to apply to your storage buildings your garages and your other appurtenant structures except outdoor fixtures at the premises described in the Declarations. The most we will pay at any one location for such loss or damage under this Extension in 50000. If not otherwise covered by this policy you may extend the insurance that applies to Business Personal Property to apply to such property in your storage buildings your garages and your other appurtenant structures at the premises described in the Declarations. The most we will pay for such loss or damage under this Extension is 5000. The second paragraph of Section C. LIMITS OF INSURANCE of the BUILDING AND PERSONAL PROP ERTY COVERAGE FORM is deleted and replaced by the following Signs Outdoor The most we will pay for loss or damage to outdoor signs whether or not the sign is attached to a building is 5000 per sign in any one occurrence. The following changes are applicable to Section E. Loss Conditions of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM. Special Valuation Provision The limit of insurance in Paragraph 7.b. Valuation is increased from 2500 to 5000. Property In Transit The 100 foot limitation in Paragraph 1.a. Property In Transit of Section F. Additional Coverage Exten sions of the CAUSES OF LOSS SPECIAL FORM is changed to 1000 feet. The limit of insurance in Paragraph 1.c. Property In Transit of Section F. Additional Coverage Exten sions of the CAUSES OF LOSS SPECIAL FORM is increased from 5000 to 10000 in any one occurrence. The following is added to Paragraph 1. Property In Transit of Section F. Additional Coverage Exten sions of the CAUSES OF LOSS SPECIAL FORM d. This Coverage Extension does not apply to fine arts in transit as provided in item h. Fine Arts of Paragraph B.11. Coverage Extensions of endorsement CP 88 00. Back Up of Sewers or Drains Paragraph B.3. WATER of the WATER EXCLUSION ENDORSEMENT is deleted and replaced by the following 3 Except as provided under the Back Up of Sewers or Drains Additional Coverage Extension water that backs up or overflows or is otherwise discharged from a sewer drain sump sump pump or related equipment The following is added to Section F. Additional Coverage Extensions of the CAUSES OF LOSS SPECIAL FORM 2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc. with its Permission. CP 88 00 07 10 Page 10 of 11
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4. Back Up of Sewers or Drains We cover direct physical loss or damage caused by water a. Which backs up into a building or structure through sewers or drains which are directly connected to asanitary sewer or septic system or b. Which enters into and overflows from within a sump pump sump pump well or other type of system designed to remove subsurface water which is drained from the foundation area. This coverage does not apply if the loss or damage is caused by your negligence. We will not pay for water or other materials that back up overflow or are discharged from a sewer drain sump sump pump or related equipment when it is caused by any flood whether the flood is caused by an act of nature or is otherwise caused. The most we will pay for loss or damage at any one location under this Coverage Extension is 10000. All other terms and conditions remain unchanged. 2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc. with its Permission. CP 88 00 07 10 Page 11 of 11
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COMMERCIAL PROPERTY CP 880403 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. REMOVAL PERMIT This endorsement modifies insurance provided under the following COMMERCIAL PROPERTY COVERAGE PART 61506798 002842 If Covered Property is removed to a new location that is added by endorsement to the policy subsequent to its original issue you may extend this insurance to include that Covered Property at each location during the removal. Coverage at each location will apply in the proportion that the value at each location bears to the value of all Covered Property being removed. This permit applies up to 10 days after the effective date of the endorsement adding the new location after that this insurance does not apply at the previous location. 2010 Liberty Mutual Insurance Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc. with its permission. CP 88 04 03 10 Page 1 of 1
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COMMERCIAL PROPERTY CP 905512 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS INCOME AND EXTRA EXPENSE CHANGES ACTUAL LOSS SUSTAINED IN A TWELVE MONTH PERIOD This endorsement modifies insurance provided under the following A. BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FORM The following changes apply to Section A. Coverage 1. 3. Broadened Premises The wi a. Section A.1. Business Income and in 100 feet of the described premises stated in b. Paragraph A.5.b. Alterations and New Buildings is deleted and replaced by within 1000 feet. The following is added to paragraph A.5. Additional Coverages e. Business Income from Dependent Properties We will pay up to 10000 for the actual loss of Business Income you sustain and necessary Extra Expense you incur due to the necessary suspension of your operations during the period of restoration. The suspension must be caused by direct physical loss of or dam age to a dependent property caused by or resulting from a Covered Cause of Loss. Dependent Property as used in this Additional Coverage means property operated by others whom you depend on to 1 Deliver materials or services to you or to others for your account Contributing Loca tions. With respect to Contributing Locations services does not mean water fuel com munication or power supply services 2 Accept your products or services Recipient Locations 3 Manufacture products for delivery to your customers under contract of sale Manufactur ing Locations or 4 Attract customers to your business Leader Locations. The following paragraph 3 is added to Additional Coverage 5.c. Extended Business Income 3 The Extended Business Income Additional Coverage applies only to such loss that occurs within 12 consecutive months after the date of direct physical loss or damage subject to all provisions and limitations of that Additional Coverage including the 30 day limitation or 180 day limitation if your policy includes the PROPERTY EXTENSION OPTIMUM en dorsement. The Limits of Insurance clause in the Coverage Form modified by this endorsement does not apply. However specific dollar limitations on payment under any applicable Coverage Extension or Addi tional Coverage continue to apply. For purposes of this endorsement only Section D. Additional Condition Coinsurance is deleted. Paragraph b. of definition F.3. Period of Restoration is deleted and replaced by the following b. Ends on the earlier of 1 The date when the property at the described premises should be repaired rebuilt or replaced with reasonable speed and similar quality 2 The date when business is resumed at a new permanent location or 3 Twelve consecutive months after the suspension of your operations. All other terms and conditions remain unchanged. 2012Liberty Mutual Insurance CP 90 55 12 12 Includes copyrighted material of Insurance Services Office Inc. with its permission. Page 1 of 1 CP 90551212 Page 1 of 1
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61506798 002842 2n0 COMMERCIAL PROPERTY CP9059 12 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IDENTITY THEFT ADMINISTRATIVE SERVICES AND EXPENSE COVERAGE This endorsement modifies insurance provided under the following BUILDING AND PERSONAL PROPERTY COVERAGE FORM The following is added to paragraph A.4. Additional Coverages IDENTITY THEFT ADMINISTRATIVE SERVICES AND EXPENSE COVERAGE We will provide Ildentity Theft Administrative Services and will reimburse up to 25000 for Identity Theft Expenses incurred by an identity theft insured as a direct result of any one identity theft in the coverage territory if all of the following requirements are met 1. The personal identity of an identity theft insured under this policy was the subject of an identity theft and 2. Such identity theft is first discovered by the identity theft insured during the policy period for which this Identity Theft Expense Coverage is applicable and 3. Such identity theft is reported to us as soon as practicable but in no event later than 60 days after it is first discovered by the identity theft insured and 4. The identity theft insured reports the identity theft in writing to the appropriat e law enforce ment agency. Any act or series of acts committed by one or more persons or in which such person or persons are aiding or abetting others against an identity theft insured is considered to be one identity theft even if a series of acts continues into a subsequent policy period. LIMITS Regardless of the number of claims or Identity Theft Insureds the most we will pay in the aggregate for all identity theft expenses resulting from identity theft discovered during the policy period is 25000. 1. The 25000 Identity Theft Expense Limit shall be reduced by the amount of any payment made by us under the terms of this insurance. If the Identity Theft Expense Limit of Insurance is exhausted we will have no further liability to pay for loss which may be discovered during the remainder of the policy period. 2. Any recovery made by us after settlement of aloss covered by this insurance shall not be used to increase or reinstate the Limit of Insurance. 3. ldentity Theft Incident Administrative Services is provided up to 12 consecutive months after service begins. 4. ldentity Theft Administrative Services do not reduce the Identity Theft limit. This Identity Theft Administrative Service and Identity Theft Expense Coverage is additional insurance. EXCLUSIONS The following exclusions are added to the applicable Cause of Loss Form shown on the Declarations. We do not provide ldentity Theft Administrative Services or cover identity theft expenses 1. Incurred as the result of identity theft due to any fraudulent dishonest or criminal act by you your partners employees members executive officers managers directors or trustees or by any authorized representative of yours whether acting alone or in collusion with others. In the event of any such act no identity theft insured is entitled to identity theft expenses even an identity theft insured who did not commit or conspire to commit the act causing the identity theft. 2012Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CP9059 1212 Page 1 of 3
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2. Arising out of identity theft committed by or with knowledge of any relative or former relative of the identity theft insured. 3. Arising out of an identity theft first discovered by the identity theft insured prior to the policy period or after the policy period even if the identity theft began or continued during the policy period. 4. Arising out of an identity theft that is not reported to us within 60 days after it is first discovered by the identity theft insured. DEDUCTIBLE 1. There is no deductible applicable to the Identity Theft Administrative Services. 2. We will not pay for identity theft expenses resulting from an identity theft unless the amount exceeds 250. We will then pay the amount of identity theft expense in excess of the Deductible Amount up to the Limit of Insurance. Each identity theft insured shall be subject to only one deductible during any one policy period. CONDITIONS The following additional conditions are added for Identity Theft Administrative Services and Expense Coverage 1. The coverage provided under this endorsement will be excess over any other insurance covering the same loss or damage whether you can collect on it or not. But we will not pay any more than the Identity Theft Expense Limits of Insurance applicable to this coverage. 2. Reimbursement for Identity Theft Expense will be made to the Identity Theft Insured. 3. ldentity Theft Administrative Services will provide instructions on a. How to respond to apotential ldentity Theft b. How to submit arequest for ldentity Theft Administrative Services and c. Information needed for reimbursement of Identity Theft Expenses. We may provide ldentity Theft Administrative Services prior to afinal determination of Identity Theft. However if we determine there was not an Identity Theft these services will end and we will not have a right or duty to continue these services. Offering ldentity Theft Administrative Service does not indicate an admission of liability under this policy. 4. ldentify Theft Administrative Services. The following apply with respect to ldentity Theft Admin istrative Services a. Services will depend on the cooperation permissions and assistance provided by the Identity Theft Insured b. There is no warranty or guarantee that ldentity Theft issues will end and it will not prevent future ldentity Theft incidences and c. All services may not be offered or applicable to all Identity Theft Insureds. For example minors may not have credit reports available to be monitored. DEFINITIONS 1. Coverage Territory means a. The United States of America including its territories and possessions b. Puerto Rico and c. Canada. 2. Executive officers means a person holding any of the officer positions created by your charter constitution by laws or any other similar governing document. 3. Identity theft means the act of knowingly transferring or using without lawful authority a means of identification of an identity theft insured with the intent to commit or to aid or abet another to commit any unlawful activity that constitutes a violation of federal law or a felony under any applicable state or local law. Identity theft does not include the fraudulent use of a business name d b a or any other method of identifying a business activity. 2012Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CP9059 1212 Page 2 of 3
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4. Identity Theft Expenses means the following reasonable and necessary items incurred as a result of identity theft a. Costs for notarizing affidavits or similar documents attesting to fraud required by financial institutions or similar credit grantors or credit agencies. b. Costs for certified mail to law enforcement agencies credit agencies financial institutions or similar credit grantors. c. Costs for obtaining credit reports. Charges incurred for long distance telephone calls to merchants vendors suppliers cus tomers law enforcement agencies financial institutions or similar credit grantors or credit agencies to report or discuss an actual identity theft. e. Application fees for re applying for a loan or loans when the original application is re jected solely because the lender received incorrect credit information as a result of a covered identity theft. f. Lost income resulting from time taken off from work to complete fraud affidavits meet with or talk to law enforcement agencies credit agencies andor legal counsel up to a maximum of 250 per day. Total payment for loss of income is not to exceed 5000 per identity theft insured and is included within the identity theft expense and aggregate limits. g. Attorney fees to i. Defend lawsuits brought against an identity theft insured by merchants ven dors suppliers financial institutions or their collection agencies. Remove any criminal or civil judgments wrongly entered against an identity theft insured and Challenge the accuracy or completeness of any information in a consumer credit report. h. Advertising expenses to restore the reputation of your business after an identity theft insured has been the victim of identity theft. Total payment for advertising expenses is not to exceed 5000 per identity theft insured and is included within the identity theft expense and aggregate limits. ldentity Theft Administrative Services means one or more individuals assigned by us to the identity theft insured to assist with the communication needed to re establish the integrity of the identity theft insured s identity including with the identity s theft insured s permission and cooperation written and telephone communication with law enforcement authorities government agencies credit agencies and individual creditors and businesses. Identity Theft Insured means the following if you are designated in the Declarations as a. Anindividual or sole proprietorship you and your spouse are insureds. b. A partnership or joint venture your members your partners and their spouses are in sured s. c. Alimited liability company your members are insured s. An organization other than a partnership joint venture or limited liability company your executive officers and directors are insureds. Your stockholders are not identity theft insureds. a6L96519 2012Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CP9059 1212 Page 3 of 3
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COMMERCIAL PROPERTY CP92010517 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PROPERTY ANTI STACKING ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL PROPERTY COVERAGE PART This policy may contain multiple editions of one or more property forms andor endorsements. Where coverage for specific loss or damage is provided by more than one edition of the same form andor endorse ment payment under only one such edition shall apply in any given occurrence. When coverage andor limits differ among the various editions of the same form or endorsemen t the claim will be settled using the edition that provides the most favorable outcome to you. 2017 Liberty Mutual Insurance CP 92010517 Page 1 of 1
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IL00 17 11 98 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. CANCELLATION D. INSPECTIONS AND SURVEYS 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance writ ten notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least a. 10 days before the effective date of cancellation if we cancel for nonpay ment of premium or b. 30 days before the effective date of cancellation if we cancel for any oth er reason. 3. We will mail or deliver our notice to the first Named Insured s last mailing ad dress known to us. 4. Notice of cancellation will state the effec tive date of cancellation. The policy pe riod will end on that date. 5. If this policy is cancelled we will send the first Named Insured any premium re fund due. If we cancel the refund will be pro rata. If the first Named Insured can cels the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed proof of mailing will be sufficient proof of notice. CHANGES 1. We have the right to a. Make inspections and surveys at any time b. Give you reports on the conditions we find and c. Recommend changes. 2. We are not obligated to make any inspec tions surveys reports or recommenda tions and any such actions we do under take relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not un dertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions a. Are safe or healthful or b. Comply with laws codes or standards. 3. Paragraphs 1. and 2. of this condition ap ply not only to us but also to any rating advisory rate service or similar organiza tion which makes insurance inspections surveys reports or recommendations. regulations 4. Paragraph 2. of this condition does not apply to any inspections surveys reports or recommendations we may make rela tive to certification under state or mu nicipal statutes ordinances or regula tions of boilers pressure vessels or elevators. This policy contains all the agreements be tween you and us concerning the insurance E. PREMIUMS afforded. The first Named Insured shown in The first Named Insured shown in the Dec the Declarations is authorized to make larations changes in.Ihs m ls of this policy with our 1. s responsible for the payment of all pre consent. This policy s terms can be amended miums and or waived only by endorsement issued by us and made a part of this policy. 2. Wil be the payee for any return premi ums we pay. EXAMINATION OF YOUR BOOKS AND RECORDS F. TRANSFER OF YOUR RIGHTS AND DUTIES We may examine and audit your books and records as they relate to this policy at any time during the policy period and up to three years afterward. UNDER THIS POLICY Your rights and duties under this policy may not be transferred without our written con sent except in the case of death of an individ ual named insured. a6L96519 IL00 17 11 98 Page 1 of 2 Copyright Insurance Services Office Inc. 1998
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If you die your rights and duties under this policy will be transferred to your legal repre sentative but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL00 17 11 98 Page 2 of 2 Copyright Insurance Services Office Inc. 1998
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IL 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT Broad Form This endorsement modifies insurance provided under the following COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL 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 UNDERGROUND STORAGE TANK POLICY COMMERCIAL GENERAL LIABILITY COVERAGE FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAG OWNERS AND CONTRACTORS PROTECTIVELI. POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILIT RAILROAD PROTECTIVELIABILITY COVERAGE UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply A. Under any Liability Coverage to bodily injury or property damage 1 With respect to which an insured under the policy is also an insured under a nuclear energy liability poli cy issued by Nuclear Energy Liabil ity Insurance Association Mutual Atomic Energy Liability Underwrit ers Nuclear Insurance Association of Canada or any of their succes sors or would be an insured under any such policy but for its termina tion upon exhaustion of its limit of liability or 2n0 2 Resulting from the hazardous properties of nuclear material and with respect to which a any person or organization is required to maintain financial protection pur suant to the Atomic Energy Act of 1954 or any law amendatory there of or b the insured s or had this policy not been issued would be entitted to indemnity from the United States of America or any agency thereof under any agree ment entered into by the United States of America or any agency thereof with any person or organi zation. B. Under any Medical Payments coverage to expenses incurred with respect to bodily injury resulting from the haz ardous properties of nuclear materi al and arising out of the operation of a nuclear facility by any person or or ganization. C. Under any Liability Coverage to bodily injury or property damage resulting from hazardous properties of nuclear material if 1 The nuclear material a is at any nuclear facility owned by or op erated by or on behalf of an in sured or b has been discharged or dispersed therefrom 2 The nuclear material is contained in spent fuel or waste at any time possessed handled used pro cessed stored transported or disposed of by or on behalf of an insured or SO Properties Inc. 2007 IL 00 21 09 08 Page 1 of 2
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3 The bodily injury or property damage arises out of the furnish ing by an insured of services materials parts or equipment in connection with the planning con struction maintenance operation or use of any nuclear facility but if such facility is located within the United States of America its ter ritories or possessions or Canada this exclusion 3 applies only to property damage to such nucle ar facility and any property thereat. As used in this endorsement Hazardous properties includes radioactive toxic or explosive properties. Nuclear material means source materi al special nuclear material or by prod uct material. Source material special nuclear mate rial and by product material have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory there of. Spent fuel means any fuel element or fuel component solid or liquid which has been used or exposed to radiation in a nuclear reactor. Waste means any waste material a con taining by product material other than the tailings or wastes produced by the extrac tion or concentration of uranium or thorium from any ore processed primarily for its source material content and b resulting from the operation by any person or or ganization of any nuclear facility included under the first two paragraphs of the defini tion of nuclear facility. Nuclear facility means a Any nuclear reactor b Any equipment or device designed or used for 1 separating the iso topes of uranium or plutonium 2 processing or utilizing spent fuel or 3 handling processing or pack aging waste c Any equipment or device used for the processing fabricating or alloying of special nuclear mate rial if at any time the total amount of such material in the custody of the insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof or more than 250 grams of uranium 235 d Any structure basin excavation premises or place prepared or used for the storage or disposal of waste and includes the site on which any of the foregoing is located all operations conduct ed on such site and all premises used for such operations. Nuclear reactor means any apparatus de signed or used to sustain nuclear fission in a self supporting chain reaction or to con tain a critical mass of fissionable material. Property damage includes all forms of ra dioactive contamination of property. SO Properties Inc. 2007 IL 00 21 09 08 Page 2 of 2
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61506798 002842 2n0 This endorsement IL 01 02 02 20 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES ACTUAL CASH VALUE modifies insurance provided under the following CAPITAL ASSETS PROGRAM OUTPUT POLICY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY With respect to an open policy the following are added to any provision which uses the term actual cash value A. In the event of a partial or total loss to a building or structure actual cash value is calculated as the lesser of the following 1. The amount it would cost to repair re build or replace the property less a fair and reasonable deduction for physical depreciation of the components of the building or structure that are normally subject to repair or replacement during its useful life. Physical depreciation is based upon the condition of the prop erty at the time of the loss or 2. The Limit of Insurance applicable to the property. In the event of a partial or total loss to Covered Property other than a building or structure actual cash value is calculated as the lesser of the following 1. The amount it would cost to repair or replace the property less a fair and rea sonable deduction for physical depreci ation based on the condition of the property at the time of loss or 2. The Limit of Insurance applicable to the property. An open policy is a policy under which the value of Covered Property is not fixed at policy inception but is determined at the time of loss in accordance with policy provi sions on valuation. The term open policy does not apply to Covered Property that is subject to an Agreed Value clause or similar In the event of a partial or total loss to Covered Property other than a building or structure actual cash value is calculated as the lesser of the following 1. The amount it would cost to repair or replace the property less a fair and rea sonable deduction for physical depreci ation based on the condition of the property at the time of loss or 2. The Limit of Insurance applicable to the property. An open policy is a policy under which the value of Covered Property is not fixed at policy inception but is determined at the time of loss in accordance with policy provi sions on valuation. The term open policy does not apply to Covered Property that is subject to an Agreed Value clause or similar clause that establishes an agreed value pri or to loss unless such clause has expired. Insurance Services Office Inc. 2019 IL 010202 20 Page 1 of 1
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IL 01 04 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES This endorsement modifies insurance provided under the following COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART FARM PROPERTY OTHER FARM PROVISIONS FORM ADDITIONAL COVERAGES CONDITIONS DEFINITIONS FARM COVERAGE PART LIVESTOCK COVERAGE FORM FARM COVERAGE PART MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM STANDARD PROPERTY POLICY When this endorsement is attached to the Standard Property Policy CP 00 99 the term Coverage Part in this endorsement is re placed by the term Policy. The Concealment Misrepresentation Or Fraud Condition is replaced by the following with respect to loss loss or damage caused by fire We do not provide coverage to the insured insured who whether before or after a loss loss has committed fraud or inten tionally concealed or misrepresented any material fact or circumstance concerning 1. This Coverage Part 2. The Covered Property 3. That insured s insured s interest in the Covered Property or 4. A claim under this Coverage Part or Coverage Form. The Concealment Misrepresentation Or Fraud Condition is replaced by the following with respect to loss loss or damage caused by a Covered Cause of Loss other than fire This Coverage Part is void if any insured insured whether before or after a loss loss has committed fraud or intention ally concealed or misrepresented any ma terial fact or circumstance concerning 1. This Coverage Part 2. The Covered Property 3. An insured s insured s interest in the Covered Property or 4. A claim under this Coverage Part or Coverage Form. Except as provided in E. the Appraisal Con dition is replaced by the following If we and you disagree on the value of the property or the amount of loss loss ei ther may make written request for an ap praisal of the loss loss. If the request is accepted each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two ap praisers will select an umpire. If they can not agree within 15 days either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss loss. If they fail to agree they will submit their differences to the um pire. A decision agreed to by any two will be binding. Each party will 1. Pay its chosen appraiser and 2. Bear the other expenses of the apprais al and umpire equally. If there is an appraisal we will still retain our right to deny the claim. The Appraisal Condition in 1. Business Income And Extra Expense Coverage Form CP 00 30 and 2. Business Income Without Extra Ex pense Coverage Form CP 00 32 4. A claim under this Coverage Part or Coverage Form. Except as provided in E. the Appraisal Con dition is replaced by the following If we and you disagree on the value of the property or the amount of loss loss ei ther may make written request for an ap praisal of the loss loss. If the request is accepted each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two ap praisers will select an umpire. If they can not agree within 15 days either may request that selection be made by a judge of a court having jurisdiction. The appraisers will state separately the value of the property and amount of loss loss. If they fail to agree they will submit their differences to the um pire. A decision agreed to by any two will be binding. Each party will 1. Pay its chosen appraiser and 2. Bear the other expenses of the apprais al and umpire equally. If there is an appraisal we will still retain our right to deny the claim. The Appraisal Condition in 1. Business Income And Extra Expense Coverage Form CP 00 30 and 2. Business Income Without Extra Ex pense Coverage Form CP 00 32 SO Properties Inc. 2006 IL 01 04 09 07 Page 1 of 2
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is replaced by the following If we and you disagree on the amount of Net Income and operating expense or the amount of loss either may make written request for an appraisal of the loss. If the request is accepted each party will select a competent and impartial appraiser. Each party shall notify the other of the appraiser selected within 20 days of the request. The two appraisers will select an umpire. If they can not agree within 15 days either may request that selection be made by a judge of a court having jurisdiction. The apprais ers will state separately the amount of Net Income and operating expense or amount of loss. If they fail to agree they will submit their differences to the umpire. A decision agreed to by any two will be binding. Each party will a. Pay its chosen appraiser and b. Bear the other expenses of the apprais al and umpire equally. If there is an appraisal we will still retain our right to deny the claim. a6L96519 SO Properties Inc. 2006 IL 01 04 09 07 Page 2 of 2
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IL0270 1219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following CAPITAL ASSETS PROGRAM OUTPUT POLICY COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART 3. Al Policies In Effect For More Than 60 Paragraphs 2. and 3. of the Cancellation Days Common Policy Condition are replaced by a. If this policy has been in effect for the following more than 60 days or is a renewal 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less and is not a renewal of a policy we have previously issued we may cancel this policy by mailing or delivering to the first Named Insured at the mailing address shown in the poli cy and to the producer of record ad vance written notice of cancellation stating the reason for cancellation at least a. 10 days before the effective date of cancellation if we cancel for 1 Nonpayment of premium or 2 Discovery of fraud by a Any insured or his or her representative in obtaining this insurance or b You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. of a policy we issued we may can cel this policy only upon the occur rence after the effective date of the policy of one or more of the fol lowing 1 Nonpayment of premium in cluding payment due on a prior policy we issued and due dur ing the current policy term cov ering the same risks. 2 Discovery of fraud or material misrepresentation by a Any insured or his or her representative in obtaining this insurance or b You or your representative in pursuing a claim under this policy. 3 A judgment by a court or an administrative tribunal that you have violated a California or Federal law having as one of its necessary elements an act which materially increases any of the risks insured against. Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less and is not a renewal of a policy we have previously issued we may cancel this policy by mailing or delivering to the first Named Insured at the mailing address shown in the poli cy and to the producer of record ad vance written notice of cancellation stating the reason for cancellation at least a. 10 days before the effective date of cancellation if we cancel for 1 Nonpayment of premium or 2 Discovery of fraud by a Any insured or his or her representative in obtaining this insurance or b You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. Insurance Services Office Inc. 2019 IL02701219 Page 1 of 4
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4 Discovery of willful or grossly negligent acts or omissions or of any violations of state laws or regulations establishing safe ty standards by you or your representative which materially increase any of the risks in sured against. 5 Failure by you or your repre sentative to implement reason able loss control requirements agreed to by you as a condition of policy issuance or which were conditions precedent to our use of a particular rate or rating plan if that failure ma terially increases any of the risks insured against. 6 A determination by the Com missioner of Insurance that the a Loss of or changes in our reinsurance covering all or part of the risk would threaten our financial integ rity or solvency or b Continuation of the policy coverage would i Place us in violation of California law or the laws of the state where we are domiciled or ii Threaten our solvency. 7 A change by you or your repre sentative in the activities or property of the commercial or industrial enterprise which re sults in a materially added in creased or changed risk unless the added increased or changed risk is included in the policy. We will mail or deliver advance written notice of cancellation stat ing the reason for cancellation to the first Named Insured at the mailing address shown in the poli cy and to the producer of record at least 1 10 days before the effective date of cancellation if we can cel for nonpayment of premium or discovery of fraud or 2 30 days before the effective date of cancellation if we can cel for any other reason listed in Paragraph 3.a. B. The following provision is added to the Cancellation Common Policy Condition 7. Residential Property This provision applies to coverage on real property which is used predomi nantly for residential purposes and con sisting of not more than four dwelling units and to coverage on tenants household personal property in a resi dential unit if such coverage is written under one of the following Commercial Property Coverage Part Farm Coverage Part Farm Property Farm Dwellings Appurtenant Structures And Household Personal Property Cov erage Form a. If such coverage has been in effect for 60 days or less and is not a renewal of coverage we previously issued we may cancel this cover age for any reason except as pro vided in b. and c. below. b. We may not cancel this policy sole ly because the first Named Insured has 1 Accepted an offer of earthquake coverage or 2 Cancelled or did not renew a policy issued by the California Earthquake Authority CEA that included an earthquake policy premium surcharge. However we shall cancel this poli cy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium sur charge but fails to pay the earth quake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil condi tions exist on the premises. This restriction c. applies only if cov erage is subject to one of the fol lowing which exclude loss or dam age caused by or resulting from corrosive soil conditions 1 Commercial Property Coverage Part Causes Of Loss Special Form or 2 Farm Coverage Part Causes Of Loss Form Farm Property Paragraph D. Covered Causes Of Loss Special. a6L96519 Insurance Services Office Inc. 2019 Page 2 of 4 IL0270 1219
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Commercial Property Coverage Part Farm Coverage Part Farm Property Farm Dwellings Appurtenant Structures And Household Personal Property Cov erage Form a. We may elect not to renew such coverage for any reason except as provided in b. c. and d. below. We will not refuse to renew such coverage solely because the first Named Insured has accepted an of fer of earthquake coverage. However the following applies only to insurers who are associate par ticipating insurers as established by Cal. Ins. Code Section 10089.16. We may elect not to renew such cov erage after the first Named Insured has accepted an offer of earthquake coverage if one or more of the fol lowing reasons applies 1 The nonrenewal is based on sound underwriting principles that relate to the coverages provided by this policy and that are consistent with the ap proved rating plan and related documents filed with the De partment of Insurance as re quired by existing law 2 The Commissioner of Insurance finds that the exposure to po tential losses will threaten our solvency or place us in a haz ardous condition. A hazardous condition includes but is not limited to a condition in which we make claims payments for losses resulting from an earth quake that occurred within the preceding two years and that required a reduction in policyholder surplus of at least 25 for payment of those claims or 3 We have a Lost or experienced a sub stantial reduction in the availability or scope of re insurance coverage or b Experienced a substantial increase in the premium charged for reinsurance coverage of our residential property insurance policies and d. If a state of emergency under Cali fornia Law is declared and the resi dential property is located in any ZIP Code within or adjacent to the fire perimeter as determined by California Law we may not cancel this policy for one year beginning from the date the state of emer gency is declared solely because the dwelling or other structure is located in an area in which a wildfire has occurred. However we may cancel 1 When you have not paid the premium at any time by letting you know at least 10 days be fore the date cancellation takes effect 2 If willful or grossly negligent acts or omissions by the Named Insured or his or her representatives are discovered that materially increase any of the risks insured against or 3 If there are physical changes in the property insured against beyond the catastrophe damaged condition of the struc tures and surface landscape which result in the property be coming uninsurable. C. The following is added and supersedes any provisions to the contrary Nonrenewal 1. Subject to the provisions of Paragraphs C.2. and C.3. below if we elect not to renew this policy we will mail or de liver written notice stating the reason for nonrenewal to the first Named In sured shown in the Declarations and to the producer of record at least 60 days but not more than 120 days before the expiration or anniversary date. We will mail or deliver our notice to the first Named Insured and to the pro ducer of record at the mailing address shown in the policy. Residential Property This provision applies to coverage on real property used predominantly for residential purposes and consisting of not more than four dwelling units and to coverage on tenants household property contained in a residential unit if such coverage is written under one of the following Insurance Services Office Inc. 2019 IL02701219 Page 3 of 4
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the Commissioner has ap proved a plan for the nonrenewals that is fair and equitable and that is respon sive to the changes in our re insurance position. We will not refuse to renew such coverage solely because the first Named Insured has cancelled or did not renew a policy issued by the Callifornia Earthquake Authority that included an earthquake policy premium surcharge. We will not refuse to renew such coverage solely because corrosive soil conditions exist on the prem ises. This restriction d. applies only if coverage is subject to one of the following which exclude loss or damage caused by or resulting from corrosive soil conditions 1 Commercial Property Coverage Part Causes Of Loss Special Form or 2 Farm Coverage Part Causes Of Loss Form Farm Property Paragraph D. Covered Causes Of Loss Special. If a state of emergency under Cali fornia Law is declared and the resi dential property is located in any ZIP Code within or adjacent to the fire perimeter as determined by California Law we may not nonrenew this policy for one year beginning from the date the state of emergency is declared solely be cause the dwelling or other struc ture is located in an area in which a wildfire has occurred. However we may nonrenew 1 If willful or grossly negligent acts or omissions by the Named Insured or his or her representatives are discovered that materially increase any of the risks insured against 2 If losses unrelated to the postdisaster loss condition of the property have occurred that would collectively render the risk ineligible for renewal or 3 If there are physical changes in the property insured against beyond the catastrophe damaged condition of the struc tures and surface landscape which result in the property be coming uninsurable. We are not required to send notice of nonrenewal in the following situations a. If the transfer or renewal of a poli cy without any changes in terms conditions or rates is between us and a member of our insurance group. If the policy has been extended for 90 days or less provided that no tice has been given in accordance with Paragraph C.1. If you have obtained replacement coverage or if the first Named In sured has agreed in writing within 60 days of the termination of the policy to obtain that coverage. If the policy is for a period of no more than 60 days and you are no tified at the time of issuance that it will not be renewed. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy with in 60 days of the end of the policy period. If we have made a written offer to the first Named Insured in accor dance with the timeframes shown in Paragraph C.1. to renew the policy under changed terms or con ditions or at an increased premium rate when the increase exceeds 25. a6L96519 Insurance Services Office Inc. 2019 Page 4 of 4 IL0270 1219
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IL 09 35 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION OF CERTAIN COMPUTER RELATED LOSSES This endorsement modifies insurance provided under the following COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART STANDARD PROPERTYPOLICY A. We will not pay for loss loss or damage caused directly or indirectly by the following. Such loss loss or damage is excluded re gardless of any other cause or event that con tributes concurrently or in any sequence to the loss loss or damage. 1. The failure malfunction or inadequacy of a. Any of the following whether be longing to any insured or to others 1 Computer hardware including miCroprocessors 2 Computer application software 3 Computer operating systems and related software 4 Computer networks 5 Microprocessors computer chips not part of any computer system or 6 Any other computerized or elec tronic equipment or compo nents or Any other products and any ser vices data or functions that directly or indirectly use or rely upon in any manner any of the items listed in Paragraph A.1.a. of this endorse ment due to the inability to correctly recognize process distinguish interpret or accept one or more dates or times. An example is the inability of computer software to recognize the year 2000. 2. An ati an pre de tial gre If an e Paragre 1. In we will age c Loss Loss. We wil modific Ala. rect an 2. Any device consultation design evalu ation inspection installation mainten ance repair replacement or supervision provided or done by you or for you to determine rectify or test for any poten tial or actual problems described in Para graph A.1. of this endorsement. If an excluded Cause of Loss as described in Paragraph A. of this endorsement results 1. In a Covered Cause of Loss under the Crime and Fidelity Coverage Part the Commercial Inland Marine Coverage Part or the Standard Property Policy or 2. Under the Commercial Property Cover age Part a. In aSpecified Cause of Loss or in elevator collision resulting from me chanical breakdown under the Causes of Loss Special Form or b. InaCovered Cause of Loss under the Causes of Loss Basic Form or the Causes of Loss Broad Form we will pay only for the loss loss or dam age caused by such Specified Cause of Loss elevator collision or Covered Cause of Loss. We will not pay for repair replacement or modification of any items in Paragraphs A.la. and A.1.b. of this endorsement to cor rect any deficiencies or change any features. SO Properties Inc. 2001 IL 09 35 07 02 Page 1 of 1
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61506798 002842 2n0 IL09 52 01 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART STANDARD PROPERTY POLICY Cap On Certified Terrorism Losses Certified act of terrorism means an act that is certified by the Secretary of the Treasury in accordance with the provisions of the fed eral Terrorism Risk Insurance Act to be an act of terrorism pursuant to such Act. The criteria contained in the Terrorism Risk Insurance Act for a certified act of terrorism include the following 1. The act resulted in insured losses in ex cess of 5 million in the aggregate attrib utable to all types of insurance subject to the Terrorism Risk Insurance Act and 2. The act is a violent act or an act that is dangerous to human life property or in frastructure and is committed by an in dividual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. This endorsement modifies insurance provided under the following If aggregate insured losses attributable to ter rorist acts certified under the Terrorism Risk Insurance Act exceed 100 billion in a calen dar year and we have met our insurer deduct ible under the Terrorism Risk Insurance Act we shall not be liable for the payment of any portion of the amount of such losses that ex ceeds 100 billion and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. Application Of Exclusions The terms and limitations of any terrorism ex clusion or the inapplicability or omission of a terrorism exclusion do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Part or Poli cy such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Ac tion Exclusion. If aggregate insured losses attributable to ter rorist acts certified under the Terrorism Risk Insurance Act exceed 100 billion in a calen dar year and we have met our insurer deduct ible under the Terrorism Risk Insurance Act we shall not be liable for the payment of any portion of the amount of such losses that ex ceeds 100 billion and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury. Application Of Exclusions The terms and limitations of any terrorism ex clusion or the inapplicability or omission of a terrorism exclusion do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Part or Poli cy such as losses excluded by the Nuclear Hazard Exclusion or the War And Military Ac tion Exclusion. Insurance Services Office Inc. 2015 IL09 520115 Page 1 of 1
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IL 09 96 01 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONDITIONAL EXCLUSION OF TERRORISM INVOLVING NUCLEAR BIOLOGICAL OR CHEMICAL TERRORISM RELATING TO DISPOSITION OF FEDERAL TERRORISM RISK INSURANCE ACT This endorsement modifies insurance provided under the following BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART EQUIPMENT BREAKDOWN PROTECTION COVERAGE FORM FARM COVERAGE PART STANDARD PROPERTY POLICY SCHEDULE The Exception Covering Certain Fire Losses Paragraph D applies to property located in the following states if covered under the indicated Coverage Form Coverage Part or Policy States Coverage Form Coverage Part or Policy California Connecticut Georgia lllinois Commercial Property Coverage Part lowa Maine Massachusetts Missouri New Jersey New York North Carolina Oregon Rhode Island Virginia Washington West Virginia Wisconsin California Connecticut Georgia lllinois Commercial Inland Marine Coverage Part lowa Maine Massachusetts Missouri New Jersey New York North Carolina Oregon Rhode Island Virginia Washington West Virginia Wisconsin Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Applicability Of The Provisions Of This En b. A renewal extension or replace dorsement ment of the Program has become effective without a requirement to make terrorism coverage available to you and with revisions that 1. The provisions of this endorsement be come applicable commencing on the date when any one or more of the fol lowing first occurs. But if your policy 1 Increase our statutory percent meaning the policy period in which age deductible under the Pro this endorsement applies begins after gram for terrorism losses. such date then the provisions of this That deductible determines endorsement become applicable on the the amount of all certified ter date your policy begins. rorism losses we must pay in a a. The federal Terrorism Risk Insur calendar year before the fed ance Program Program estab eral government shares in sub lished by the Terrorism Risk Insur sequent payment of certified ance Act has terminated with terrorism losses. or respect to the type of insurance 2 Decrease the federal govern provided under this Coverage ment s statutory percentage Form Coverage Part or Policy or share in potential terrorism losses above such deductible or Commercial Inland Marine Coverage Part ISO Properties Inc. 2005 IL 09 96 01 07 Page 1 of 3
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3 Redefine terrorism or make in surance coverage for terrorism subject to provisions or re quirements that differ from those that apply to other types of events or occurrences under this policy. 2. If the provisions of this endorsement become applicable such provisions a. Supersede any terrorism endorse ment already endorsed to this poli cy that addresses certified acts of terrorism andor other acts of terrorism but only with respect to loss or damage from an inci dents of terrorism however de fined that occurs on or after the date when the provisions of this endorsement become applicable and b. Remain applicable unless we notify you of changes in these provisions in response to federal law. 3. If the provisions of this endorsement do NOT become applicable any terror ism endorsement already endorsed to this policy that addresses certified acts of terrorism andor other acts of terrorism will continue in effect un less we notify you of changes to that endorsement in response to federal law. The following definition is added and ap plies under this endorsement wherever the term terrorism is enclosed in quotation marks. Terrorism means activites against per sons organizations or property of any na ture 1. That involve the following or prepara tion for the following a. Use or threat of force or violence or b. Commission or threat of a danger ous act or c. Commission or threat of an act that interferes with or disrupts an elec tronic communication information or mechanical system and 2. When one or both of the following ap plies a. The effect is to intimidate or coerce a government or the civilian popu lation or any segment thereof or to disrupt any segment of the econo my or b. It appears that the intent is to in timidate or coerce a government or to further political ideological reli gious social or economic objectives or to express or express opposition to a philosophy or ideology. The following exclusion is added EXCLUSION OF TERRORISM We will not pay for loss or damage caused directly or indirectly by terrorism includ ing action in hindering or defending against an actual or expected incident of terror ism. Such loss or damage is excluded re gardless of any other cause or event that contributes concurrently or in any sequence to the loss. But this exclusion applies only when one or more of the following are attributed to an incident of terrorism 1. The terrorism is carried out by means of the dispersal or application of radio active material or through the use of a nuclear weapon or device that involves or produces a nuclear reaction nuclear radiation or radioactive contamination or 2. Radioactive material is released and it appears that one purpose of the terror ism was to release such material or 3. The terrorism is carried out by means of the dispersal or application of patho genic or poisonous biological or chemi cal materials or 4. Pathogenic or poisonous biological or chemical materials are released and it appears that one purpose of the terror ism was to release such materials. Exception Covering Certain Fire Losses The following exception to the Exclusion Of Terrorism applies only if indicated and as indicated in the Schedule of this endorse ment. a6L96519 ISO Properties Inc. 2005 IL 09 96 01 07 Page 2 of 3
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If terrorism results in fire we will pay for the loss or damage caused by that fire subject to all applicable policy provisions including the Limit of Insurance on the af fected property. Such coverage for fire ap plies only to direct loss or damage by fire to Covered Property. Therefore for exam ple the coverage does not apply to insur ance provided under Business Income andor Extra Expense coverage forms or en dorsements that apply to those coverage forms or to the Legal Liability Coverage Form or the Leasehold Interest Coverage Form. E. Application Of Other Exclusions 1. When the Exclusion Of Terrorism ap plies in accordance with the terms of C.1. or C.2 such exclusion applies without regard to the Nuclear Hazard Exclusion in this Coverage Form Cov erage Part or Policy. The terms and limitations of any terror ism exclusion or the inapplicability or omission of a terrorism exclusion do not serve to create coverage for any loss or damage which would otherwise be excluded under this Coverage Form Coverage Part or Policy such as losses excluded by the Nuclear Hazard Exclu sion or the War And Military Action Exclusion. ISO Properties Inc. 2005 IL 09 96 01 07 Page 3 of 3
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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LC 87 10 05 00 PUNITIVE OR EXEMPLARY DAMAGES EXCLUSION 61506798 002842 2n0 BUSINESSOWNERS POLICY COMMERCIAL AUTOMOBILE COVERAGE PART This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART EMPLOYEE BENEFITS COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS CONTRACTORS PROTECTIVE COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART RAILROAD PROFESSIONAL COVERAGE PART LIABILITY COVERAGE is changed by adding the following exclusion Regardless of any other provision of this poli cy this policy does not apply to punitive or exemplary damages awarded against an insured. However if a suit is brought against an insured arising out of a claim which alleges both compensatory and puni tive or exemplary damages we will defend the entire suit with the understanding that we pay only the compensatory damages. ADDITIONAL DEFINITION Punitive or exemplary damages include damages which are awarded to punish or de ter wrongful conduct to set an example to fine penalize or impose a statutory penalty and damages which are awarded for any pur pose other than as compensatory damages for bodily injury or property damage. LC 87 10 05 00 Page 1 of 1
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Libe Mut gi. INSURANCE 002607 2n0 Coverage Is Provided In. Policy Number leerty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 07192020 to 07192021 Policy Change Endorsement 1201 am Standard Time at Insured Mailing Location Named Insured Mailing Address Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 916 846 9555 1309 TRADEWINDS CIR PACIFIC UNITY INSURANCE WEST SACRAMENTO CA 95691 SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 CHANGES TO POLICY TRANSACTION 2 This Policy Change Endorsement Results In A Change In The Charges As Follows Additional Premium 497.00 Total Additional Charges 497.00 Certified Acts of Terrorism Additional Charges 5.00 Included Note This is not a bill Description of Changes Form CG8583 Blanket Contractors Products Completed Operations now applies to the policy. See The Revised Declarations and Declarations Schedule Policy Change Endorsement 497.00 497.00 5.00 Included Note This is not a bill Issue Date 072320 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 1 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 1 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07192020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS Thi section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 2426 04 13 CG 25 03 05 09 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disps sition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Amendment of Insured Contract Definition Designated Construction Projects General Aggregate Limit Issue Date 072320 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 2 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 2 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07192020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002607 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED Thi ction lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 84 94 1208 Exclusion Consolidated Insurance Programs Wrap Up CG 84 99 01 12 Non Cumulation Of Liability Limits Same Occurrence CG 85 83 04 13 Blanket Additional Insured Contractors Products Completed Operations CG 88 10 04 13 Commercial General Liability Extension CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 90 41 01 13 CG 919205 15 CP 00 10 04 02 CP 00 30 04 02 CP 00 90 07 88 CP 01 40 07 06 Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement Exclusion Asbestos Liability Exclusion Lead Liability Amendment Of Coverage B Personal And Advertising Injury Exclusion New Residential Construction Operations Building and Personal Property Coverage Form Business Income and Extra Expense Coverage Form Commercial Property Conditions Exclusion of Loss Due to Virus or Bacteria PRO WEST WALL PRODUCTS INC. Issue Date 072320 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 3 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 3 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07192020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement IL 00 17 11 98 Common Policy Conditions IL 00 21 09 08 Nuclear Energy Liability Exclusion Endorsement Broad Form IL 01 02 02 20 California Changes Actual Cash Value IL 01 04 09 07 California Changes IL 0270 12 19 California Changes Cancellation and NonRenewal IL 09 35 07 02 Exclusion of Certain Computer Related Losses Issue Date 072320 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 4 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 4 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07192020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002607 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 09 5201 15 Cap On Losses From Certified Acts Of Terrorism IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 072320 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 5 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 5 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised 798 6 002607 Commercial Property Declarations Revised Named Insured 1201 am Standard Time at Insured Mailing Location Agent PRO WEST WALL PRODUCTS INC. SUMMARY OF CHARGES 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 7 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 7 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Commercial Property Declarations Schedule Named Insured 1201 am Standard Time at Insured Mailing Location Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown. Optional coverages apply only when entries are made in this schedule. 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Property Characteristics Description Construction Frame Your Business Personal Property Occupancy Dry Wall or Wallboard Installation Office Coverage Description Limit of Insurance Replacement Cost 150000 Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 333.00 Personal Property Description of Others Limit of Insurance Replacement Cost 50 000 Coverage Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 112.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 8 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 8 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised 61506798 002607 2n0. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Continuation of 1309 Tradewinds Cir West Sacramento CA 95691 3516 Business Income Description and Extra EXpense imit of Insurance Including Rental Value See Endorsement Coverage Actual Loss Sustained 12 Months Covered Causes of Loss Special Form Including Theft Premium 978.00 Equipment This Equipment Breakdown insurance applies to the coverages shown for this Breakdown location. The Equipment Breakdown limits of insurance and deductible are Coverage included in and not in addition to the limits and deductible shown for the Building Your Business Personal Property Your Business Personal Property of Others Tenants Improvements and Betterments Business Income and Extra Expense Business Income Without Extra Expense and Extra Expense coverages. Premium 39.00 SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Description Administrative Limit of Insurance See Endorsement CP9059 Services And Expense Coverage Premium 12.00 Property Description Extension Property Extension Endorsement.00 Endorsement Premium Included Commercial Property Schedule Total 1474.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072320 61596798 NO114621 210 NCXHPPNO INSURED COPY 002607 PAGE 9 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 9 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stock company BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time lity at Insured Mailing Location Commercial General Lial Declarations Revised Commercial General Liability Declarations Revised Occurrence 61506798 002607 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION umIT General Each Occurrence Limit 1000000 lsf Damage To Premises Rented To You Limit Any One Premises 500 000 Insurance Medical Expense Limit Any One Person 15000 Personal and Advertising Injury Limit 1000000 General Aggregate Limit Other than Products Completed Operations 2000000 Products Completed Operations Aggregate Limit 2000000 Explanation of Charges DESCRIPTION PREMIUM General Liability Schedule Totals 14013.00 Certified Acts of Terrorism Coverage 140.00 Total Advance Charges 14153.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 072320 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE n OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CLASSIFICATIONS BY LOCATION 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Insured PRO WEST WALL PRODUCTS INC. CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Executive Officers 1000 PREMIUM Premise Operations 33600 Dollars Of Payroll 18.886 635.00 Total 635.00 Products Completed Operations 5927 199.00 Total 199.00 CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Employees Payroll 1000 PREMIUM Premise Operations 506595 Dollars Of Payroll 18.886 9568.00 Total 9568.00 Products Completed Operations 5927 3003.00 Total 3003.00 To report a claim call your Agent or 1 844 325 2467 072320 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 12 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 61506798 002607. o 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF OTHER COVERAGE COVERAGE DESCRIPTION PREMIUM CG8870 Construction Projects General Aggregate Limit 116.00 Per Project CG85830413 Blanket Additional Insured Contractors Products 492.00 Completed Operations CG85830413 492.00 Commercial General Liability Schedule Total 14013.00 To report a claim call your Agent or 1 844 325 2467 072320 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2607.0 PAGE 13 OF 18
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COMMERCIAL GENERAL LIABILITY CG 85830413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED CONTRACTORS PRODUCTS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under Section Il Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract or written agreement. Such person or organization is an additional insured but only with respect to liability for bodily injury or property damage 61506798 1. Caused by your work performed for that additional insured that is the subject of the written contract or written agreement and 002607 2. Included in the products completed operations hazard. However a The insurance afforded to such additional insured only applies to the extent permitted by law and b If coverage provided to the additional insured is required by a contract or agreement the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the bodily injury or property damage. We have no duty to defend an additional insured under this endorsement until we receive written notice of asuit by the additional insured as required in Paragraph b. of Condition 2. Duties In The Event Of Occurrence Offense Claim Or Suit under Section IV Commercial General Liability Conditions. B. With respect to the insurance provided by this endorsement the following are added to Paragraph 2. Exclusions under Section Coverage A Bodily Injury And Property Damage Lial H This insurance does not apply to 1. Bodily injury or property damage that occurs prior to you commencing operations at the location where such bodily injury or property damage occurs. 2. Bodily injury or property damage arising out of the rendering of or the failure to render any professional architectural engineering or surveying services including a. The preparing approving or failure to prepare or approve maps shop drawings opinions reports surveys field orders change orders or drawing and specifications and b. Supervisory inspection architectural or engineering activities. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 85830413 Page 1 of 2
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With respect to the insurance afforded by this endorsement exclusion I. Damage To Your Work of Paragraph 2. Exclusions under Section Coverage A Bodily Injury And Property Damage Liability is replaced by the following I. Damage To Your Work Property damage to your work arising out of it or any part of it and included in the products completed operations hazard. With respect to the insurance afforded to these additional insureds the following is added to Section Il Limits of Insurance If coverage provided to the additional insured is required by a contract or agreement the most we will pay on behalf of the additional insured is the amount of insurance 1. Required by contract or agreement or 2. Available under the applicable Limits of Insurance shown in the Declaration. whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declaratio ns. With respect to the insurance afforded by this endorsement Section IV Commercial General Liability Conditions is amended as follows 1. The following is added to Paragraph 2. Duties In The Event Of Occurrence Offense Claims Or Suit An additional insured under this endorsement will as soon as practicable a. Give written notice of an occurrence or an offense that may result in a claim or suit under this insurance to us b. Tender the defense and indemnity of any claim or suit to all insurers whom also have insurance available to the additional insured and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a suit by the additional insured. 2. Paragraph 4. of Section IV Commercial General Liability Conditions is amended as follows a. The following is added to Paragraph a. Primary Insurance If an additional insured s policy has an Other Insurance provision making its policy excess and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis this policy shall be primary and we will not seek contribution from the additional insured s policy for damages we cover. b. The following is added to Paragraph b. Excess Insurance When a written contract or written agreement other than a premises lease facilities rental contract or agreement an equipment rental or lease contract or agreement or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non contributory this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured this insur ance is excess over any other insurance whether primary excess contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 85830413 Page 2 of 2
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NP 74 26 04 13 61506798 002607 IMPORTANT NOTICE NOTICE TO POLICYHOLDERS This explanation is not a part of your insurance policy and it does not alter any of its provisions or conditions. No coverage is provided by this notice nor can it be construed to replace any provision in your policy or policies with us or any forms attached to your policy or policies. The following information only gives a general explanation which may have occurred from your prior or old policy. Read your policy carefully to determine rights duties and what is and is not covered. Only the provisions of your policy determine the scope of your insurance protection. This notice has been prepared to provide you with information since one of the forms listed below maybe attached to your policy. Fully Earned and Minimum Premium Endorsements CG 04 37 Electronic Data Liability CG 20 03 Additional Insured Concessionaires Trading Under Your Name CG 20 10 Ad nal Insured Owners Lessees Or Contractors Scheduled Person Or Organization CG 89 79 Additional Insured Owners Lessees Or Contractors Completed Operations Scheduled Person Or Organization Arising Out Of Your Ongoing Operations CG 90 47 Additional Insured Owners Lessees or Contractors Scheduled Person Or Organization Caused In Whole Or In Part CG 90 43 Additional Insured Owners Lessees Or Organizations Scheduled Person Or Organization Including Primary Non Contributory And Waiver Of Subrogation CG 90 44 Additional Insured Owners Lessees Or Contractors Completed Operations Including Primary And Non Contributory And Waiver Of Subrogation CG 20 11 Additional Insured Managers Or Lessors Of Premises CG 20 15 Adi nal Insured Vendors CG 20 26 Additional Insured Designated Person Or Organization Insured Lessor Of Leased Equipment Insured Grantor Of Franchise Insured Engineers Architects Or Surveyors Not Engaged By The Named Insured Insured Lessor Of Leased Equipment Automatic Status When Required In Lease Agreement With You CG 20 37 Additional Insured Owners Lessees Or Contractors Completed Operations CG 89 80 Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out Of Your Work CG 84 56 Additional Insured Boat Shows CG 85 83 Blanket Additional Insured Contractors Products Completed Operations CG 85 84 Additional Insured Contractors Products Completed Operations CG 86 11 Additional Insured Automatic Status When Required In Construction Agreement With You Contractors Completed Operations CG 89 95 Additional Insured Automatic Status When Required In Construction Agreement With You Products Completed Operations CG 88 83 Amendment of Other Insurance Condition Designated Persons or Organizations CG 89 98 Amendment of Other Insurance Condition One of the above endorsements may be attached to your policy. With the attachment of the endorsement a premium charge has been made along with a fully earned or minimum premium amount which will be retained if the policy is cancelled or issued for less than a one year period. Please refer any questions you may have to your insurance agent. Not applicable in Ohio. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. NP 74 26 04 13 Page 1 of 1
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Libe Mut gi. INSURANCE 61506798 002419 Coverage Is Provided In. Policy Number leerty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 Policy Change Endorsement 1201 am Standard Time at Insured Mailing Location Named Insured Mailing Address Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 916 846 9555 1309 TRADEWINDS CIR PACIFIC UNITY INSURANCE WEST SACRAMENTO CA 95691 SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 CHANGES TO POLICY TRANSACTION 4 This Policy Change Endorsement Results In A Change In The Charges As Follows Additional Premium 498.00 Total Additional Charges 498.00 Certified Acts of Terrorism Additional Charges 5.00 Included Note This is not a bill Description of Changes Forms CG8980 CG8979 now applies to the following additional insured DPR Construction A General Partnership its their officers owners partners agents employees affiliates parents and subsidiaries Owner AbbVie Inc. a Delaware Corporation AbbVie Stemcentrx LLC a Delaware LLC AbbVie Biotherapeutics Inc. a Delaware Corporation Pharmacyclics LLC a Delaware LLC BioMed Realty LLC BioMed Realty L.P. BRE Edison L.P. BRE Edison LLC BRE Edison Parent L.P. and their respective officers employees general partners members subsidiaries affiliates and any lender mortgage ground lessor Landlord or beneficiary of the Landlord. RE DPR Job DO0 A18020 00 See The Revised Declarations and Declarations Schedule Policy Change Endorsement 498.00 498.00 5.00 Included Note This is not a bill Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 1 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 1 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 24 04 05 09 CG 2426 04 13 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disposition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 2 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 2 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002419 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 25 03 05 09 Designated Construction Projects General Aggregate Limit CG 70 02 01 01 General Endorsement CG 84 94 12 08 Exclusion Consolidated Insurance Programs Wrap Up CG 8499 01 12 Non Cumulation Of Liability Limits Same Occurrence CG 858304 13 Blanket Additional Insured Contractors Products Completed Operations CG 8310 04 13 Commercial General Liability Extension CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 8979 04 13 CG 89 80 04 13 Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement Exclusion Asbestos Liability Exclusion Lead Liability Additional Insured Owners Lessees Or Contractors Scheduled Person or Organization Arising Out of Your Ongoing Operations Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out of Your Work PRO WEST WALL PRODUCTS INC. Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 3 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 3 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 90 41 01 13 Amendment Of Coverage B Personal And Advertising Injury CG 91920515 Exclusion New Residential Construction Operations CP 00 10 04 02 Building and Personal Property Coverage Form CP 00 30 04 02 Business Income and Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 4 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 4 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002419 2n0 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 00 17 11 98 IL 00 21 09 08 IL 01 02 02 20 IL 01 04 09 07 IL 0270 12 19 IL 09 35 07 02 IL 09 5201 15 IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement Broad Form California Changes Actual Cash Value California Changes California Changes Cancellation and NonRenewal Exclusion of Certain Computer Related Losses Cap On Losses From Certified Acts Of Terrorism Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 5 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 5 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CHARGES Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 7 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 7 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Commercial Property Declarations Schedule Named Insured 1201 am Standard Time at Insured Mailing Location Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown. Optional coverages apply only when entries are made in this schedule. 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Property Characteristics Description Construction Frame Your Business Personal Property Occupancy Dry Wall or Wallboard Installation Office Coverage Description Limit of Insurance Replacement Cost 150000 Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 333.00 Personal Property Description of Others Limit of Insurance Replacement Cost 50 000 Coverage Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 112.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 8 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 8 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised 61506798 002419 2n0. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Continuation of 1309 Tradewinds Cir West Sacramento CA 95691 3516 Business Income Description and Extra EXpense imit of Insurance Including Rental Value See Endorsement Coverage Actual Loss Sustained 12 Months Covered Causes of Loss Special Form Including Theft Premium 978.00 Equipment This Equipment Breakdown insurance applies to the coverages shown for this Breakdown location. The Equipment Breakdown limits of insurance and deductible are Coverage included in and not in addition to the limits and deductible shown for the Building Your Business Personal Property Your Business Personal Property of Others Tenants Improvements and Betterments Business Income and Extra Expense Business Income Without Extra Expense and Extra Expense coverages. Premium 39.00 SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Description Administrative Limit of Insurance See Endorsement CP9059 Services And Expense Coverage Premium 12.00 Property Description Extension Property Extension Endorsement.00 Endorsement Premium Included Commercial Property Schedule Total 1474.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002419 PAGE 9 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 9 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stock company BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time lity at Insured Mailing Location Commercial General Lial Declarations Revised Commercial General Liability Declarations Revised Occurrence 61506798 002419 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION umIT General Each Occurrence Limit 1000000 lsf Damage To Premises Rented To You Limit Any One Premises 500 000 Insurance Medical Expense Limit Any One Person 15000 Personal and Advertising Injury Limit 1000000 General Aggregate Limit Other than Products Completed Operations 2000000 Products Completed Operations Aggregate Limit 2000000 Explanation of Charges DESCRIPTION PREMIUM General Liability Schedule Totals 14874.00 Certified Acts of Terrorism Coverage 149.00 Total Advance Charges 15023.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE n OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CLASSIFICATIONS BY LOCATION 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Insured PRO WEST WALL PRODUCTS INC. CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Executive Officers 1000 PREMIUM Premise Operations 33600 Dollars Of Payroll 18.886 635.00 Total 635.00 Products Completed Operations 5927 199.00 Total 199.00 CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Employees Payroll 1000 PREMIUM Premise Operations 506595 Dollars Of Payroll 18.886 9568.00 Total 9568.00 Products Completed Operations 5927 3003.00 Total 3003.00 To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 12 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 61506798 002419 2n0 Named Insured Commercial General Liability 1201 am Standard Time Declarations Schedule Revised Agent at Insured Mailing Location PRO WEST WALL PRODUCTS INC. SUMMARY OF OTHER COVERAGE 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC COVERAGE DESCRIPTION PREMIUM CG8870 Construction Projects General Aggregate Limit 116.00 Per Project CG2404 Waiver of Transfer of Rights of Recovery Against Us 39.00 to Others CG85830413 Blanket Additional Insured Contractors Products 492.00 Completed Operations CG89790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 205.00 Completed Operations CG89790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 369.00 Completed Operations 39.00 CG85830413 492.00 CG89790413 124.00 CG89800413 205.00 CG89790413 124.00 CG89800413 369.00 Commercial General Liability Schedule Total 14874.00 To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2419.0 PAGE 13 OF 18
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POLICY NUMBER BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location General Endorsement This Endorsement Changes The Policy. Please Read it Carefully. Complete name od additional insured with respects form CG8980 and CG8979. 61506798 DPR Construction A General Partnership its their officers owners partners agents employees affiliates parents and subsidiaries Owner AbbVie Inc. a Delaware 002419 Corporation AbbVie Stemcentrx LLC a Delaware LLC AbbVie Biotherapeutics Inc. a Delaware Corporation Pharmacyclics LLC a Delaware LLC BioMed Realty LLC BioMed Realty L.P. BRE Edison L.P. BRE Edison LLC BRE Edison Parent L.P. and their respective officers employees general partners members subsidiaries affiliates and any lender mortgage ground lessor Landlord or beneficiary of the Landlord. 1450 Veterans Blvd Redwood City CA 94063 Project reference DPR Job D0 A18020 00 AbbVie West Coast Oncology Hub aka Project Lighthouse FRP Paneling Wall Coverings 1000 Gateway Blvd South San Francisco CA 94080 To report a claim call your Agent or CG70 02 01 01 Page 1 of 2
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POLICY NUMBER BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location General Endorsement To report a claim call your Agent or CG70 02 01 01 Page 2 of 2
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COMMERCIAL GENERAL LIABILITY CG 89790413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION ARISING OUT OF YOUR ONGOING OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Person Or Organization DPR Construction A General See form CG7002 for complete name. 1450 Veterans Blvd REDWOOD CITY CA 94063 Locations Of Covered Operations 1000 Gateway Blvd South San Francisco CA 94080 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of your ongoing operations performed for that insured With respect to the insurance afforded to these additional insureds the following exclusion is added This insurance does not apply to bodily injury or property damage occurring after 1. All work including materials parts or equipment furnished in connection with such work on the project other than service maintenance or repairs to be performed by or on behalf of the addi tional insureds at the site of the covered operations has been completed or That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89790413 Page 1 of 1
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COMMERCIAL GENERAL LIABILITY CG 89800413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS COMPLETED OPERATIONS ARISING OUT OF YOUR WORK This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Persons or Organizations DPR Construction A General See form CG7002 for complete name. Address 1450 Veterans Blvd City State Zip REDWOOD CITY CA 94063 Location And Description of Completed Operations Description of Completed Operations DPR Job D0 A18020 00 FRP Paneling Wall Coverings Location Including Duration of Job 1000 Gateway Blvd South San Francisco CA 94080 6 months Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an additional insured the persons or organiza tions shown in the Schedule but only with respect to liability arising out of your work at the location designated and described in the schedule of this endorsement performed for that insured and included in the products completed operations hazard. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89800413 Page 1 of 1
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Libe Mut gi. INSURANCE Coverage Is Provided In. Policy Number leerty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 07212020 to 07192021 Policy Change Endorsement 1201 am Standard Time at Insured Mailing Location Named Insured Mailing Address Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 916 846 9555 1309 TRADEWINDS CIR PACIFIC UNITY INSURANCE WEST SACRAMENTO CA 95691 SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 CHANGES TO POLICY TRANSACTION 3 This Policy Change Endorsement Results In A Change In The Charges As Follows Additional Premium 372.00 Total Additional Charges 372.00 Certified Acts of Terrorism Additional Charges 4.00 Included Note This is not a bill Description of Changes Forms CG8979 CG8980 and CG2404 now applies to the following additional insured ROEBBELEN CONTRACTING INC. 1241 HAWKS FLIGHT COURT EL DORADO HILLS CA 95762 RE JATC Woodland Training Facility FRP Paneling Santa Anita Dr Woodland CA 95776 See The Revised Declarations and Declarations Schedule Policy Change Endorsement 372.00 372.00 4.00 Included Note This is not a bill Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 1 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 1 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07212020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 24 04 05 09 CG 2426 04 13 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disposition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 2 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 2 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07212020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002418 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED Thi ction lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 25 03 05 09 CG 84 94 12 08 CG 84 99 01 12 CG 8583 04 13 CG 88 10 04 13 CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 89 79 04 13 CG 89 80 04 13 CG 90 41 01 13 Designated Construction Projects General Aggregate Limit Exclusion Consolidated Insurance Programs Wrap Up Non Cumulation Of Liability Limits Same Occurrence Blanket Additional Insured Contractors Products Completed Operations Commercial General Liability Extension Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement s Liability Exclusion Lead Liability Exclusion Asbes Additional Insured Owners Lessees Or Contractors Scheduled Person or Organization Arising Out of Your Ongoing Operations Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out of Your Work Amendment Of Coverage B Personal And Advertising Injury PRO WEST WALL PRODUCTS INC. Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 3 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 3 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07212020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 91920515 Exclusion New Residential Construction Operations CP 00 10 04 02 Building and Personal Property Coverage Form CP 00 30 04 02 Business Income and Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement IL 00 17 11 98 Common Policy Conditions Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 4 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 4 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07212020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002418 2n0 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED s the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 00 21 09 08 IL 01 02 02 20 IL 01 04 09 07 IL 0270 12 19 IL 09 35 07 02 IL 09 5201 15 IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Nuclear Energy Liability Exclusion Endorsement Broad Form California Changes Actual Cash Value California Changes California Changes Cancellation and NonRenewal Exclusion of Certain Computer Related Losses Cap On Losses From Certified Acts Of Terrorism Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 072420 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 5 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 5 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CHARGES Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 7 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 7 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Commercial Property Declarations Schedule Named Insured 1201 am Standard Time at Insured Mailing Location Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown. Optional coverages apply only when entries are made in this schedule. 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Property Characteristics Description Construction Frame Your Business Personal Property Occupancy Dry Wall or Wallboard Installation Office Coverage Description Limit of Insurance Replacement Cost 150000 Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 333.00 Personal Property Description of Others Limit of Insurance Replacement Cost 50 000 Coverage Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 112.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 8 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 8 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised 61506798 002418 2n0. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Continuation of 1309 Tradewinds Cir West Sacramento CA 95691 3516 Business Income Description and Extra EXpense imit of Insurance Including Rental Value See Endorsement Coverage Actual Loss Sustained 12 Months Covered Causes of Loss Special Form Including Theft Premium 978.00 Equipment This Equipment Breakdown insurance applies to the coverages shown for this Breakdown location. The Equipment Breakdown limits of insurance and deductible are Coverage included in and not in addition to the limits and deductible shown for the Building Your Business Personal Property Your Business Personal Property of Others Tenants Improvements and Betterments Business Income and Extra Expense Business Income Without Extra Expense and Extra Expense coverages. Premium 39.00 SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Description Administrative Limit of Insurance See Endorsement CP9059 Services And Expense Coverage Premium 12.00 Property Description Extension Property Extension Endorsement.00 Endorsement Premium Included Commercial Property Schedule Total 1474.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072420 61596798 NO114621 210 NCXHPPNO INSURED COPY 002418 PAGE 9 OF 18 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 9 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stock company BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time lity at Insured Mailing Location Commercial General Lial Declarations Revised Commercial General Liability Declarations Revised Occurrence 61506798 002418 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION umIT General Each Occurrence Limit 1000000 lsf Damage To Premises Rented To You Limit Any One Premises 500 000 Insurance Medical Expense Limit Any One Person 15000 Personal and Advertising Injury Limit 1000000 General Aggregate Limit Other than Products Completed Operations 2000000 Products Completed Operations Aggregate Limit 2000000 Explanation of Charges DESCRIPTION PREMIUM General Liability Schedule Totals 14381.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 14525.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE n OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CLASSIFICATIONS BY LOCATION 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Insured PRO WEST WALL PRODUCTS INC. CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Executive Officers 1000 PREMIUM Premise Operations 33600 Dollars Of Payroll 18.886 635.00 Total 635.00 Products Completed Operations 5927 199.00 Total 199.00 CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Employees Payroll 1000 PREMIUM Premise Operations 506595 Dollars Of Payroll 18.886 9568.00 Total 9568.00 Products Completed Operations 5927 3003.00 Total 3003.00 To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 12 OF 18
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liabili at Insured Mailing Location 61506798 002418 2n0 Named Insured Declarations Schedule Revised Agent PRO WEST WALL PRODUCTS INC. SUMMARY OF OTHER COVERAGE 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC COVERAGE DESCRIPTION PREMIUM CG8870 Construction Projects General Aggregate Limit 116.00 Per Project CG2404 Waiver of Transfer of Rights of Recovery Against Us 39.00 to Others CG85830413 Blanket Additional Insured Contractors Products 492.00 Completed Operations CG89790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 205.00 Completed Operations 39.00 CG85830413 492.00 CG89790413 124.00 CG89800413 205.00 Commercial General Liability Schedule Total 14381.00 To report a claim call your Agent or 1 844 325 2467 072420 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2418.0 PAGE 13 OF 18
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POLICY NUMBER COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US 61506798 002418 This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization ROEBBELEN CONTRACTING INC. 1241 HAWKS FLIGHT COURT EL DORADO HILLS CA 95762 Information required to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV Conditions 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 hazar This waiver applies only to the person or organi zation shown in the Schedule above. SCHEDULE nsurance Services Office Inc. 2008 CG 24 04 05 09 Page 1 of 1
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COMMERCIAL GENERAL LIABILITY CG 89790413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION ARISING OUT OF YOUR ONGOING OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Person Or Organization ROEBBELEN CONTRACTING INC. 1241 HAWKS FLIGHT COURT EL DORADO HILLS CA 95762 Locations Of Covered Operations Santa Anita Dr Woodland CA 95776 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of your ongoing operations performed for that insured With respect to the insurance afforded to these additional insureds the following exclusion is added This insurance does not apply to bodily injury or property damage occurring after 1. All work including materials parts or equipment furnished in connection with such work on the project other than service maintenance or repairs to be performed by or on behalf of the addi tional insureds at the site of the covered operations has been completed or That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89790413 Page 1 of 1
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COMMERCIAL GENERAL LIABILITY CG 89800413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS COMPLETED OPERATIONS ARISING OUT OF YOUR WORK This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Persons or Organizations ROEBBELEN CONTRACTING INC. Address 1241 HAWKS FLIGHT COURT City State Zip EL DORADO HILLS CA 95762 Location And Description of Completed Operations Description of Completed Operations JATC Woodland Training Facility FRP Paneling Location Including Duration of Job Santa Anita Dr Woodland CA 95776 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an additional insured the persons or organiza tions shown in the Schedule but only with respect to liability arising out of your work at the location designated and described in the schedule of this endorsement performed for that insured and included in the products completed operations hazard. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89800413 Page 1 of 1
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Libe Mut gi. INSURANCE 002149 Coverage Is Provided In. Policy Number Liberty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 Policy Change Endorsement 1201 am Standard Time Named Insured Mailing Address at Insured Mailing Location Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 1309 TRADEWINDS CIR WEST SACRAMENTO CA 95691 CHANGES TO POLICY TRANSACTION 5 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 This Policy Change Endorsement Results In A Change In The Charges As Follows No Change in Premium Description of Changes Job duration with respects to DPR Job DO0 A18020 00 is amended to 12 months. See The Revised Declarations and Declarations Schedule Policy Change Endorsement Issue Date 072820 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 1 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 1 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 24 04 05 09 CG 2426 04 13 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disposition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition Issue Date 072820 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 2 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 2 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002149 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 25 03 05 09 Designated Construction Projects General Aggregate Limit CG 70 02 01 01 General Endorsement CG 84 94 12 08 Exclusion Consolidated Insurance Programs Wrap Up CG 8499 01 12 Non Cumulation Of Liability Limits Same Occurrence CG 858304 13 Blanket Additional Insured Contractors Products Completed Operations CG 8310 04 13 Commercial General Liability Extension CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 8979 04 13 CG 89 80 04 13 Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement Exclusion Asbestos Liability Exclusion Lead Liability Additional Insured Owners Lessees Or Contractors Scheduled Person or Organization Arising Out of Your Ongoing Operations Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out of Your Work PRO WEST WALL PRODUCTS INC. Issue Date 072820 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 3 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 3 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 90 41 01 13 Amendment Of Coverage B Personal And Advertising Injury CG 91920515 Exclusion New Residential Construction Operations CP 00 10 04 02 Building and Personal Property Coverage Form CP 00 30 04 02 Business Income and Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement Issue Date 072820 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 4 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 4 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07232020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002149 2n0 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 00 17 11 98 IL 00 21 09 08 IL 01 02 02 20 IL 01 04 09 07 IL 0270 12 19 IL 09 35 07 02 IL 09 5201 15 IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement Broad Form California Changes Actual Cash Value California Changes California Changes Cancellation and NonRenewal Exclusion of Certain Computer Related Losses Cap On Losses From Certified Acts Of Terrorism Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 072820 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 5 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 5 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CHARGES Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 7 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 7 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Commercial Property Declarations Schedule Named Insured 1201 am Standard Time at Insured Mailing Location Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown. Optional coverages apply only when entries are made in this schedule. 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Property Characteristics Description Construction Frame Your Business Personal Property Occupancy Dry Wall or Wallboard Installation Office Coverage Description Limit of Insurance Replacement Cost 150000 Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 333.00 Personal Property Description of Others Limit of Insurance Replacement Cost 50 000 Coverage Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 112.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 8 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 8 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised 61506798 002149 2n0. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Continuation of 1309 Tradewinds Cir West Sacramento CA 95691 3516 Business Income Description and Extra EXpense imit of Insurance Including Rental Value See Endorsement Coverage Actual Loss Sustained 12 Months Covered Causes of Loss Special Form Including Theft Premium 978.00 Equipment This Equipment Breakdown insurance applies to the coverages shown for this Breakdown location. The Equipment Breakdown limits of insurance and deductible are Coverage included in and not in addition to the limits and deductible shown for the Building Your Business Personal Property Your Business Personal Property of Others Tenants Improvements and Betterments Business Income and Extra Expense Business Income Without Extra Expense and Extra Expense coverages. Premium 39.00 SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Description Administrative Limit of Insurance See Endorsement CP9059 Services And Expense Coverage Premium 12.00 Property Description Extension Property Extension Endorsement.00 Endorsement Premium Included Commercial Property Schedule Total 1474.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 072820 61596798 NO114621 210 NCXHPPNO INSURED COPY 002149 PAGE 9 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 9 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stock company BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time lity at Insured Mailing Location Commercial General Lial Declarations Revised Commercial General Liability Declarations Revised Occurrence 61506798 002149 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION umIT General Each Occurrence Limit 1000000 lsf Damage To Premises Rented To You Limit Any One Premises 500 000 Insurance Medical Expense Limit Any One Person 15000 Personal and Advertising Injury Limit 1000000 General Aggregate Limit Other than Products Completed Operations 2000000 Products Completed Operations Aggregate Limit 2000000 Explanation of Charges DESCRIPTION PREMIUM General Liability Schedule Totals 14874.00 Certified Acts of Terrorism Coverage 149.00 Total Advance Charges 15023.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 072820 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE n OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CLASSIFICATIONS BY LOCATION 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Insured PRO WEST WALL PRODUCTS INC. CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Executive Officers 1000 PREMIUM Premise Operations 33600 Dollars Of Payroll 18.886 635.00 Total 635.00 Products Completed Operations 5927 199.00 Total 199.00 CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Employees Payroll 1000 PREMIUM Premise Operations 506595 Dollars Of Payroll 18.886 9568.00 Total 9568.00 Products Completed Operations 5927 3003.00 Total 3003.00 To report a claim call your Agent or 1 844 325 2467 072820 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 12 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 61506798 002149 2n0 Named Insured Commercial General Liability 1201 am Standard Time Declarations Schedule Revised Agent at Insured Mailing Location PRO WEST WALL PRODUCTS INC. SUMMARY OF OTHER COVERAGE 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC COVERAGE DESCRIPTION PREMIUM CG8870 Construction Projects General Aggregate Limit 116.00 Per Project CG2404 Waiver of Transfer of Rights of Recovery Against Us 39.00 to Others CG85830413 Blanket Additional Insured Contractors Products 492.00 Completed Operations CG89790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 205.00 Completed Operations CG89790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 369.00 Completed Operations 39.00 CG85830413 492.00 CG89790413 124.00 CG89800413 205.00 CG89790413 124.00 CG89800413 369.00 Commercial General Liability Schedule Total 14874.00 To report a claim call your Agent or 1 844 325 2467 072820 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2149.0 PAGE 13 OF 16
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798 002149 2n0 COMMERCIAL GENERAL LIABILITY CG 89800413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS COMPLETED OPERATIONS ARISING OUT OF YOUR WORK This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Persons or Organizations DPR Construction A General See form CG7002 for complete name. Address 1450 Veterans Blvd City State Zip REDWOOD CITY CA 94063 Location And Description of Completed Operations Description of Completed Operations DPR Job D0 A18020 00 FRP Paneling Wall Coverings Location Including Duration of Job 1000 Gateway Blvd South San Francisco CA 94080 12 months Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an additional insured the persons or organiza tions shown in the Schedule but only with respect to liability arising out of your work at the location designated and described in the schedule of this endorsement performed for that insured and included in the products completed operations hazard. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89800413 Page 1 of 1
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Libe Mut gi. INSURANCE Coverage Is Provided In. Policy Number leerty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 07302020 to 07192021 Policy Change Endorsement 1201 am Standard Time at Insured Mailing Location Named Insured Mailing Address Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 916 846 9555 1309 TRADEWINDS CIR PACIFIC UNITY INSURANCE WEST SACRAMENTO CA 95691 SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 CHANGES TO POLICY TRANSACTION 6 This Policy Change Endorsement Results In A Change In The Charges As Follows Additional Premium 331.00 Total Additional Charges 331.00 Certified Acts of Terrorism Additional Charges 2.00 Included Note This is not a bill Description of Changes ROEBBELEN CONTRACTING INC. are named as additional insured per form CG8979 and CG8980 with respects to FRP Paneling 145 N Lincoln Way Galt CA 95632 Job 19 19 063 Galt High School Biomedical CTE Science Building Construction Upgrade and 3051 Redding Ave 7050 San Juan St Sacramento CA 95820 Transportation Facility Warehouse Renovation Warehouse Renovation. See The Revised Declarations and Declarations Schedule Policy Change Endorsement 331.00 331.00 2.00 Included Note This is not a bill Issue Date 081020 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 1 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 1 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07302020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 24 04 05 09 CG 2426 04 13 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disposition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition Issue Date 081020 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 2 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 2 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07302020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002380 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 25 03 05 09 Designated Construction Projects General Aggregate Limit CG 70 02 01 01 General Endorsement CG 84 94 12 08 Exclusion Consolidated Insurance Programs Wrap Up CG 8499 01 12 Non Cumulation Of Liability Limits Same Occurrence CG 858304 13 Blanket Additional Insured Contractors Products Completed Operations CG 8310 04 13 Commercial General Liability Extension CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 8979 04 13 CG 89 80 04 13 Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement Exclusion Asbestos Liability Exclusion Lead Liability Additional Insured Owners Lessees Or Contractors Scheduled Person or Organization Arising Out of Your Ongoing Operations Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out of Your Work PRO WEST WALL PRODUCTS INC. Issue Date 081020 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 3 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 3 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07302020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 90 41 01 13 Amendment Of Coverage B Personal And Advertising Injury CG 91920515 Exclusion New Residential Construction Operations CP 00 10 04 02 Building and Personal Property Coverage Form CP 00 30 04 02 Business Income and Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement Issue Date 081020 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 4 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 4 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 07302020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 002380 2n0 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 00 17 11 98 IL 00 21 09 08 IL 01 02 02 20 IL 01 04 09 07 IL 0270 12 19 IL 09 35 07 02 IL 09 5201 15 IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement Broad Form California Changes Actual Cash Value California Changes California Changes Cancellation and NonRenewal Exclusion of Certain Computer Related Losses Cap On Losses From Certified Acts Of Terrorism Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 081020 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 5 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 5 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised 798 6 002380 Commercial Property Declarations Revised Named Insured 1201 am Standard Time at Insured Mailing Location Agent PRO WEST WALL PRODUCTS INC. SUMMARY OF CHARGES 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 7 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 7 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Commercial Property Declarations Schedule Named Insured 1201 am Standard Time at Insured Mailing Location Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Insurance at the described premises applies only for coverages for which a limit of insurance is shown. Optional coverages apply only when entries are made in this schedule. 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Property Characteristics Description Construction Frame Your Business Personal Property Occupancy Dry Wall or Wallboard Installation Office Coverage Description Limit of Insurance Replacement Cost 150000 Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 333.00 Personal Property Description of Others Limit of Insurance Replacement Cost 50 000 Coverage Coinsurance 100 Covered Causes of Loss Special Form Including Theft Deductible All Covered Causes of Loss Unless Otherwise Stated 1000 Premium 112.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 8 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 8 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised 61506798 002380 2n0. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF PROPERTY COVERAGES BY LOCATION Continuation of 1309 Tradewinds Cir West Sacramento CA 95691 3516 Business Income Description and Extra EXpense imit of Insurance Including Rental Value See Endorsement Coverage Actual Loss Sustained 12 Months Covered Causes of Loss Special Form Including Theft Premium 978.00 Equipment This Equipment Breakdown insurance applies to the coverages shown for this Breakdown location. The Equipment Breakdown limits of insurance and deductible are Coverage included in and not in addition to the limits and deductible shown for the Building Your Business Personal Property Your Business Personal Property of Others Tenants Improvements and Betterments Business Income and Extra Expense Business Income Without Extra Expense and Extra Expense coverages. Premium 39.00 SUMMARY OF OTHER PROPERTY COVERAGES Identity Theft Description Administrative Limit of Insurance See Endorsement CP9059 Services And Expense Coverage Premium 12.00 Property Description Extension Property Extension Endorsement.00 Endorsement Premium Included Commercial Property Schedule Total 1474.00 To report a claim call your Agent or 1 844 325 2467 DS 70 23 01 08 081020 61596798 NO114621 210 NCXHPPNO INSURED COPY 002389 PAGE 9 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 9 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stock company BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time lity at Insured Mailing Location Commercial General Lial Declarations Revised Commercial General Liability Declarations Revised Occurrence 61506798 002380 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LIMITS AND CHARGES Commercial DESCRIPTION umIT General Each Occurrence Limit 1000000 lsf Damage To Premises Rented To You Limit Any One Premises 500 000 Insurance Medical Expense Limit Any One Person 15000 Personal and Advertising Injury Limit 1000000 General Aggregate Limit Other than Products Completed Operations 2000000 Products Completed Operations Aggregate Limit 2000000 Explanation of Charges DESCRIPTION PREMIUM General Liability Schedule Totals 15203.00 Certified Acts of Terrorism Coverage 152.00 Total Advance Charges 15355.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 081020 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE n OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Named Insured Revised Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF CLASSIFICATIONS BY LOCATION 0001 1309 Tradewinds Cir West Sacramento CA95691 3516 Insured PRO WEST WALL PRODUCTS INC. CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Executive Officers 1000 PREMIUM Premise Operations 33600 Dollars Of Payroll 18.886 635.00 Total 635.00 Products Completed Operations 5927 199.00 Total 199.00 CLASSIFICATION 92338 Dry Wall Or Wallboard Installation RATED PER COVERAGE DESCRIPTION PREMIUM BASED ON Employees Payroll 1000 PREMIUM Premise Operations 506595 Dollars Of Payroll 18.886 9568.00 Total 9568.00 Products Completed Operations 5927 3003.00 Total 3003.00 To report a claim call your Agent or 1 844 325 2467 081020 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 12 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stockcompany Commercial General Liability Declarations Schedule Revised Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 1201 am Standard Time at Insured Mailing Location. o 1201 am Standard Time Commercial General Liability at Insured Mailing Location Declarations Schedule Revised Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF OTHER COVERAGE COVERAGE DESCRIPTION PREMIUM 61506798 CG8870 Construction Projects General Aggregate Limit 116.00 Per Project 002380 CG2404 Waiver of Transfer of Rights of Recovery Against Us 39.00 to Others CG85830413 Blanket Additional Insured Contractors Products 492.00 Completed Operations CGBIT790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 205.00 Completed Operations CGBIT790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 369.00 Completed Operations CGBIT790413 Additional Insured Owners Lessees or Contractors 124.00 Scheduled Person or Organization CG89800413 Additional Insured Owners Lessees Or Contractors 205.00 Completed Operations 39.00 CG85830413 492.00 CG89790413 124.00 CG89800413 205.00 CG89790413 124.00 CG89800413 369.00 CG89790413 124.00 CG89800413 205.00 Commercial General Liability Schedule Total 15203.00 To report a claim call your Agent or 1 844 325 2467 081020 nan nan nan nan 61596798.0 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 2389.0 PAGE 13 OF 16
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COMMERCIAL GENERAL LIABILITY CG 89790413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION ARISING OUT OF YOUR ONGOING OPERATIONS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Person Or Organization ROEBBELEN CONTRACTING INC. 1241 HAWKS FLIGHT COURT EL DORADO HILLS CA 95762 Locations Of Covered Operations 145 N Lincoln Way Galt CA 95632 3051 Redding Ave 7050 San Juan St Sacramento CA 95820 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of your ongoing operations performed for that insured With respect to the insurance afforded to these additional insureds the following exclusion is added This insurance does not apply to bodily injury or property damage occurring after 1. All work including materials parts or equipment furnished in connection with such work on the project other than service maintenance or repairs to be performed by or on behalf of the addi tional insureds at the site of the covered operations has been completed or That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89790413 Page 1 of 1
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COMMERCIAL GENERAL LIABILITY CG 89800413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS LESSEES OR CONTRACTORS COMPLETED OPERATIONS ARISING OUT OF YOUR WORK This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Persons or Organizations ROEBBELEN CONTRACTING INC. Address 1241 HAWKS FLIGHT COURT City State Zip EL DORADO HILLS CA 95762 Location And Description of Completed Operations Description of Completed Operations FRP Paneling Location Including Duration of Job 145 N Lincoln Way Galt CA 95632 3051 Redding Ave 7050 San Juan St Sacramento CA 95820 Information required to complete this Schedule if not shown above will be shown in the Declarations. Section Il Who Is An Insured is amended to include as an additional insured the persons or organiza tions shown in the Schedule but only with respect to liability arising out of your work at the location designated and described in the schedule of this endorsement performed for that insured and included in the products completed operations hazard. 2013 Liberty Mutual Insurance Includes copyrighted material of Insurance Services Office Inc. with its permission. CG 89800413 Page 1 of 1
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Libe Mut gi. INSURANCE 798 6 004680 2n0 Coverage Is Provided In Policy Number Liberty Ohio Security Insurance Company a stock company BKS 21 61596798 Mutual. Policy Period INSURANCE From 07192020 To 07192021 Endorsement Period From 08202020 to 07192021 Policy Change Endorsement 1201 am Standard Time at Insured Mailing Location Named Insured Mailing Address Agent Mailing Address Phone No. PRO WEST WALL PRODUCTS INC. 916 846 9555 1309 TRADEWINDS CIR PACIFIC UNITY INSURANCE WEST SACRAMENTO CA 95691 SOLUTIONS INC 2241 DOUGLAS BLVD STE 200 ROSEVILLE CA 95661 4261 CHANGES TO POLICY TRANSACTION 7 This Policy Change Endorsement Results In A Change In The Charges As Follows Additional Premium 331.00 Total Additional Charges 331.00 Certified Acts of Terrorism Additional Charges 2.00 Included Note This is not a bill Description of Changes Forms CG8979 and CG8980 now applies to the following additional insured Overaa Co. 200 Parr Blvd Richmond CA 94801 RE Job Details Corner Guards Accent Railing Door Guards Location 850 marina Bay Pkwy Richmond CA 94804 See The Revised Declarations and Declarations Schedule Policy Change Endorsement 331.00 331.00 2.00 Included Note This is not a bill Issue Date 090220 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 1 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 1 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 08202020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC SUMMARY OF LOCATIONS 0001 1309 Tradewinds Cir West Sacramento CA 95691 3516 POLICY FORMS AND ENDORSEMENTS This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 00 01 04 13 CG 21 06 05 14 CG 21 47 12 07 CG 21 67 12 04 CG 217001 15 CG 217601 15 CG 21 86 12 04 CG 21 8301 15 CG 21 96 03 05 CG 22790413 CG 24 04 05 09 CG 2426 04 13 Commercial General Liability Coverage Form Occurrence Exclusion Access Or Disclosure Of Confidential Or Personal Information And Data Related Liability With Limited Bodily Injury Exception Employment Related Practices Exclusion Fungi or Bacteria Exclusion Cap on Losses from Certified Acts of Terrorism Exclusion of Punitive Damages Related to a Certified Act of Terrorism Exclusion Exterior Insulation and Finish Systems Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Disposition of Federal Terrorism Risk Insurance Act Silica or Silica Related Dust Exclusion Exclusion Contractors Professional Liability Waiver of Transfer of Rights of Recovery Against Others to Us Amendment of Insured Contract Definition Issue Date 090220 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 2 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 2 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 08202020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 004680 2n0 Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 25 03 05 09 Designated Construction Projects General Aggregate Limit CG 70 02 01 01 General Endorsement CG 84 94 12 08 Exclusion Consolidated Insurance Programs Wrap Up CG 8499 01 12 Non Cumulation Of Liability Limits Same Occurrence CG 858304 13 Blanket Additional Insured Contractors Products Completed Operations CG 8310 04 13 Commercial General Liability Extension CG 88 60 12 08 CG 88 70 12 08 CG 88 75 12 08 CG 88 77 12 08 CG 88 86 12 08 CG 88 87 12 08 CG 8979 04 13 CG 89 80 04 13 Each Location General Aggregate Limit Construction ProjectsGeneral Aggregate Limit Per Project Exclusion Earth Movement Medical Expense At Your Request Endorsement Exclusion Asbestos Liability Exclusion Lead Liability Additional Insured Owners Lessees Or Contractors Scheduled Person or Organization Arising Out of Your Ongoing Operations Additional Insured Owners Lessees Or Contractors Completed Operations Arising Out of Your Work PRO WEST WALL PRODUCTS INC. Issue Date 090220 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 3 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 3 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 08202020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE CG 90 41 01 13 Amendment Of Coverage B Personal And Advertising Injury CG 91920515 Exclusion New Residential Construction Operations CP 00 10 04 02 Building and Personal Property Coverage Form CP 00 30 04 02 Business Income and Extra Expense Coverage Form CP 00 90 07 88 Commercial Property Conditions CP 01 40 07 06 Exclusion of Loss Due to Virus or Bacteria CP 04 49 12 05 California Changes Replacement Cost CP 10 30 04 02 Causes of Loss Special Form CP 10 32 08 08 Water Exclusion Endorsement CP 72 97 04 02 Equipment Breakdown Enhancement Endorsement Special Form CP 88 00 07 10 Property Extension Endorsement CP 88 04 03 10 Removal Permit CP 905512 12 Business Income And Extra Expense Changes Actual Loss Sustained In A Twelve Month Period CP 90 59 12 12 Identity Theft Administrative Services and Expense Coverage CP 920105 17 Property Anti Stacking Endorsement Issue Date 090220 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 4 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 4 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Ohio Security Insurance Company a stock company Policy Change Endorsement Policy Number BKS 21 61596798 Policy Period From 07192020 To 07192021 Endorsement Period From 08202020 to 07192021 1201 am Standard Time at Insured Mailing Location Policy Change Endorsement 61506798 004680 2n0 Named Insured Agent PRO WEST WALL PRODUCTS INC. 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC POLICY FORMS AND ENDORSEMENTS CONTINUED This section lists the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage. FORM NUMBER TITLE IL 00 17 11 98 IL 00 21 09 08 IL 01 02 02 20 IL 01 04 09 07 IL 0270 12 19 IL 09 35 07 02 IL 09 5201 15 IL 09 96 01 07 LC 87 10 05 00 NP 74 26 04 13 Common Policy Conditions Nuclear Energy Liability Exclusion Endorsement Broad Form California Changes Actual Cash Value California Changes California Changes Cancellation and NonRenewal Exclusion of Certain Computer Related Losses Cap On Losses From Certified Acts Of Terrorism Conditional Exclusion of Terrorism Involving Nuclear Biological or Chemical Terrorism Relating to Dispostion of Federal Terrorism Risk Insurance Act Punitive or Exemplary Damages Exclusion Notice to Policyholder Fully Earned Minimum Premium Endorsements PRO WEST WALL PRODUCTS INC. Issue Date 090220 Authorized Representative To report a claim call your Agent or 1 844 325 2467 DS 70 27 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 5 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 5 OF 16
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Libe Mut gi. INSURANCE Coverage Is Provided In Policy Number Ohio Security Insurance Company a stockcompany BKS 21 61596798 Policy Period From 07192020 To 07192021. 1201 am Standard Time Commercial Property at Insured Mailing Location Declarations Revised 798 6 004680 Commercial Property Declarations Revised Named Insured 1201 am Standard Time at Insured Mailing Location Agent PRO WEST WALL PRODUCTS INC. SUMMARY OF CHARGES 916 846 9555 PACIFIC UNITY INSURANCE SOLUTIONS INC Explanation of DESCRIPTION PREMIUM Charges Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill DESCRIPTION PREMIUM Property Schedule Totals 1474.00 Certified Acts of Terrorism Coverage 144.00 Total Advance Charges 1618.00 Note This is not a bill To report a claim call your Agent or 1 844 325 2467 DS 70 22 01 08 090220 61596798 NO114621 210 NCXHPPNO INSURED COPY 004680 PAGE 7 OF 16 NO114621 270 NCXHPPNO INSURED COPY nan nan nan nan 4680.0 PAGE 7 OF 16
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