20220430 COI.pdf

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER CONTACT

NAME:

PHONE

(A/C, No, Ext):

FAX

(A/C, No):

E-MAIL

ADDRESS:

INSURER(S) AFFORDING COVERAGE NAIC #

INSURED

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: XXXXXXX

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR

LTR TYPE OF INSURANCE

ADDL

INSD

SUBR

WVD POLICY NUMBER

POLICY EFF

(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY) LIMITS

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY PRO-

JECT LOC

OTHER:

EACH OCCURRENCE

DAMAGE TO RENTED

PREMISES (Ea occurrence)

MED EXP (Any one person)

PERSONAL & ADV INJURY

GENERAL AGGREGATE

PRODUCTS - COMP/OP AGG

AUTOMOBILE LIABILITY

ANY AUTO

OWNED

AUTOS ONLY

HIRED

AUTOS ONLY

SCHEDULED

AUTOS

NON-OWNED

AUTOS ONLY

COMBINED SINGLE LIMIT

(Ea accident)

BODILY INJURY (Per person)

BODILY INJURY (Per accident)

PROPERTY DAMAGE

(Per accident)

UMBRELLA LIAB OCCUR

EXCESS LIAB CLAIMS-MADE

DED RETENTION $

EACH OCCURRENCE

AGGREGATE

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY Y / N

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

If yes, describe under DESCRIPTION OF OPERATIONS below

N / A

PER

STATUTE

OTH-

ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved

The ACORD name and logo are registered marks of ACORD

LOCKTON COMPANIES

3657 BRIARPARK DRIVE, SUITE 700

HOUSTON TX 77042

866-260-3538

Crafco, Inc.

2829 Lakeland Drive Flowood MS 39232

4/30/2022

1407257

X 3,000,000

XXXXXXX

XXXXXXX

XXXXXXX

XXXXXXX

X X 10,000,000 10,000,000

XXXXXXX

X X

1,000,000 1,000,000

XXXXXXX

1,000,000 6,000,000 6,000,000

N

X 1,000,000 1,000,000 1,000,000

ACE American Insurance Company 22667 National Fire and Marine Insurance Co 20079

A ISA H25550213 4/30/2021 4/30/2022

A XSL G72487461 4/30/2021 4/30/2022

B 42-UMO-302493-06 4/30/2021 4/30/2022

A WLR C67807467 4/30/2021 4/30/2022

See Attachments

State of Arizona Arizona Department of Transportation 1739 W. Jackson St., Ste. A Phoenix AZ 85007

17784275

17784275

10/20/2021

THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED.

RE: Asphalt equipment, heaters. Contract no.: CTR057691.

X

Y Y

Y Y

Y Y

Y a8812 Accepted

Additional insured in favor of the State of Arizona and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees on all policies (except Workers' Compensation/EL) where and to the extent required by written contract. All policies include a blanket notice of cancellation to certificate holders endorsement, providing for 30 days' advance notice if the policy is cancelled by the company other than for nonpayment of premium, 10 days' notice if the policy is cancelled for nonpayment of premium. Notice is sent to certificate holders with mailing addresses on file with the agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation.

CONTINUATION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS (Use only if more space is required)

ACORD 25 (2016/03) Certificate Holder ID: 17784275

All policies (except Workers' Compensation/EL) include a blanket automatic Additional Insured endorsement [provision] that confers Additional Insured status to the certificate holder only if there is a written contract between the named insured and the certificate holder that requires the named insured to name the certificate holder as an Additional Insured. In the absence of such a contractual obligation on the part of the named insured, the certificate holder is not an Additional Insured under the policy. 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.

All policies include a blanket automatic Waiver of Subrogation endorsement [provision] that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. In the absence of such a contractual obligation on the part of the named insured, the Waiver of Subrogation feature does not apply.

Attachment Code : D547512 Master ID: 1407257, Certificate ID: 17784275

Named Insured Schedule

Ergon, Inc.

Ergon - West Virginia, Inc.

Ergon Refining, Inc.

Ergon BioFuels, LLC

Ergon BioSciences, Inc.

Ergon Asphalt & Emulsions, Inc.

Ergon Asphalt Holdings, LLC

Crafco, Inc.

Tricor Refining, LLC

Paragon Technical Services, Inc.

Paving Maintenance Supply, Inc.

Ergon Terminaling, Inc.

Ergon Oil Purchasing, Inc.

Ergon - Baton Rouge, Inc.

Ergon - Ironton, LLC

Ergon - Knoxville, Inc.

Ergon - St. James, Inc.

Ergon Moda St. James, LLC

Ergon - Texas Pipeline, Inc.

Ergon Acquisition Corp.

Ergon Foundation, Inc.

Ergon Securities, Inc.

Big Valley, LLC

Ergon Properties, Inc.

ISO Panels, Inc.

Magnolia Marine Transport Company

Ergon Marine & Industrial Supply, Inc.

Ergon Trucking, Inc.

LLWR, LLC

M & L Properties, LLC

Mirror Lake Building, LLC

Mirror Lake Land Company

Pearl Street Parking LLC

PruGON Properties LLC

Crafco (Wuxi) Pavement Preservation Equipment Co., Ltd.

Ergon - Latin America, LLC

Ergon - Asia, Inc.

Ergon Asia (Hong Kong) Limited

Ergon Mexico S de R.L. de C.V.

Attachment Code : D547513 Master ID: 1407257, Certificate ID: 17784275

Ergon Oil (Singapore) Pte. Ltd

Ergon Oil (Indonesia)

Ergon International, Inc. (Formerly Ergon Europe, MEA, Inc.)

Bay Harbour Development, LLC

Grand Harbour Development, LLC

Specialty Process Fabricators, Inc.

Ergon Energy Associates, LLC

Ergon Energy Partners, LP

Flowood Oil, LLC

Ergon Exploration, Inc.

Ergon Production, Inc.

MSLATX Pipeline Company

Kearney Park Farms, Inc.

Lampton-Love, Inc.

Lacox Propane Gas Company

Blossman L. P. Gas Service, Inc.

Harrell Gas, Inc.

Lacox, Inc.

Lampton-Love Gas Company

Lampton-Love of Magee, Inc.

Lampton-Love of Pelahatchie, Inc.

Liquefied Petroleum Gas Management, Inc.

Allgas, Inc.

Allgas, Inc., of Montgomery

Allgas, Inc., of TN

Magnolia Gas, Inc.

Natchez Butane, Inc.

Petroleum Distributor of Jackson, Inc.

Progas Inc.

Southern Propane, Inc.

Starkville L.P. Gas, Inc.

Process Oils, Inc.

Chemical Marketing Associates DBA Process Oils, Inc.

Ergon Construction Group, Inc.

Ergon Construction Group, Inc. dba Alliant Construction

Ergon Construction Group, Inc. dba Ergon Maintenance Services

Bryan & Bryan Asphalt, LLC

TABB Management Services, LLC

Trinity Asphalts, Ltd.

BMR Transport, Inc.

Ergon Construction Group, Inc. dba ISO Panels, Inc.

Bryan & Bryan Trucking, LLC

Ergon Asfaltos México HC, LLC

Ergon México HC, LLC

Ergon Chemicals, LLC

Resinall Corporation

Industrial Transport, Inc.

Ergon-Frazier Development I, LLC

Diversified Technology, Inc.

Bunge-Ergon Renewable Energy, LLC

Ergon Asphalt Products - Coolidge, Inc. (Dissolved 10/8/2010)

Ergon Asphalt Products, Inc.

Lampton-Love Trucking, Inc.

Mainstreet Builders, Inc. (Dissolved 6/30/10)

Pearl Street Properties, Inc. (Dissolved 08/11/2010)

Solquim, C.A. (Sold March 2007)

Flowood Properties LLC (Dissolved 01/23/2007)

Georgia Emulsions, LLC (Dissolved 10/21/2010)

Bunge-Ergon Vicksburg, LLC

Ergon Ethanol, Inc.

Telfer Pavement Technologies (Southeast), LLC (Dissolved 2019)

Telfer Pavement Technologies, LLC (Dissolved 2019)

Telfer Geosynthetics (Dissolved 2019)

Telfer Highway Technologies, LLC (Dissolved 2019)

Telfer Oil Company (Dissolved 2019)

Continental Western Transportation Co., Inc. (Dissolved)

Western States Asphalt of Montana, LLC

Western States Group, LLC

DA-13115a (06/14) Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H25550213 Policy Period

04/30/2021 TO 04/30/2022

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIERS COVERAGE FORM

AUTO DEALERS COVERAGE FORM

We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make for injury or damage arising out of the use of a covered auto. The waiver applies only to the person or organization shown in the SCHEDULE.

SCHEDULE

Any person or organization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss.

Authorized Representative

DA-9U74c (03/16) Page 1 of 1

ADDITIONAL INSURED – DESIGNATED PERSONS OR ORGAN IZAT IONS

ADDITIONAL INSURED –

DESIGNATED PERSONS OR ORGANIZATIONS

Named Insured Ergon, Inc. Endorsement Number

Policy Symbol

ISA

Policy Number

H25550213 Policy Period

04/30/2021 TO 04/30/2022

Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

AUTO DEALERS COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

EXCESS BUSINESS AUTO COVERAGE FORM

Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

A. For a covered “auto,” Who Is Insured is amended to include as an “insured,” the persons or organizations named in this endorsement. However, these persons or organizations are an “insured” only for “bodily injury” or “property damage” resulting from acts or omissions of:

1. You.

2. Any of your “employees” or agents.

3. Any person operating a covered “auto” with permission from you, any of your “employees” or agents.

B. The persons or organizations named in this endorsement are not liable for payment of your premium.

Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number

Policy Number Symbol: Number:

Policy Period

TO

Effective Date of Endorsement

Issued By (Name of Insurance Company)

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.

This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.

Schedule

For the states of CA, UT, TX, refer to state specific endorsements.

This endorsement is not applicable in KY, NH, and NJ.

The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications.

For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A..

16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program.

Authorized Representative

WC 00 03 13 (11/05) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation

ERGON, INC.

2829 LAKELAND DRIVE

FLOWOOD MS 39232-7611 WLR C67807467

04-30-2021 04-30-2022 04-30-2021

ACE AMERICAN INSURANCE COMPANY

ANY PERSON OR ORGANIZATION AGAINST WHOM YOU HAVE AGREED TO WAIVE YOUR RIGHT OF RECOVERY IN A WRITTEN CONTRACT, PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO THE DATE OF LOSS.

XS-20288a (05/14) ©Chubb. 2016. All rights reserved. Page 1 of 1

NON-CONTRIBUTORY END ORSEMENT FOR ADDITIONAL INSUREDS

NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72487461 Policy Period

04/30/2021 to 04/30/2022 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

Schedule

Organization Additional Insured Endorsement

Any additional insured with whom you have agreed to provide such non-contributory insurance, pursuant to and as required under a written contract executed prior to the date of loss

(If no information is filled in, the schedule shall read: “All persons or entities added as additional insureds through an endorsement with the term “Additional Insured” in the title)

For organizations that are listed in the Schedule above that are also an Additional Insured under an endorsement attached to this policy, the following is added to Section IV.4:

If other insurance is available to an insured we cover under any of the endorsements listed or described above (the “Additional Insured”) for a loss we cover under this policy, this insurance will apply to such loss and is primary (subject to satisfaction of the “retained limit”), meaning that we will not seek contribution from the other insurance available to the Additional Insured. Your “retained limit” still applies to such loss, and we will only pay the Additional Insured for the “ultimate net loss” in excess of the “retained limit” shown in the Declarations of this policy.

XS-21168a (04/13) Copyright, Insurance Services Office, Inc., 2012 Page 1 of 2

A DDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72487461 Policy Period

04/30/2021 to 04/30/2022 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations

Any Owner, Lessee or Contractor whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

All locations where you are performing operations for such additional insured pursuant to any such written contract.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza-tion(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your behalf;

in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above.

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. 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.

B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:

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 additional insured(s) at the location of the covered operations has been completed; or

XS-21168a (04/13) Copyright, Insurance Services Office, Inc., 2012 Page 2 of 2

2. 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.

C. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance And Retained Limit:

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 the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

WC 99 03 70A (08/12) Page 1 of 1

Workers' Compensation and Employers' Liability Policy

Named Insured Endorsement Number

Policy Number

Symbol: Number:

Policy Period

TO

Effective Date of Endorsement

Issued By (Name of Insurance Company)

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

NOTICE TO OTHERS ENDORSEMENT – SCHEDULE

A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic or other form of notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the “Schedule”). You or your representative must provide us with the physical and/or e-mail address of such persons or organizations, and we will utilize such e-mail address or physical address that you or your representative provided to us on such Schedule.

B. The Schedule must be initially provided to us within 15 days after:

i. The beginning of the Policy period, if this endorsement is effective as of such date; or

ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences.

C. This endorsement must be in an electronic format that is acceptable to us; and must be accurate.

D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured.

E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy.

F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy.

G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail and physical address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement.

H. We may arrange with your representative to send such notice in the event of any such cancellation.

I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule.

J. This endorsement does not apply in the event that you cancel the Policy.

All other terms and conditions of this Policy remain unchanged.

Authorized Representative

ERGON, INC.

2829 LAKELAND DRIVE

FLOWOOD MS 39232-7611 WLR C67807467

04-30-2021 04-30-2022 04-30-2021

ACE AMERICAN INSURANCE COMPANY

XS-21164a (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1

ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – COMPLETED OPERATIONS

Named Insured

Ergon, Inc.

Endorsement Number

Policy Symbol

XSL

Policy Number

G72487461 Policy Period

04/30/2021 to 04/30/2022 Effective Date of Endorsement

Issued By (Name of Insurance Company)

ACE American Insurance Company

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This Endorsement modifies insurance provided under the following:

EXCESS COMMERCIAL GENERAL LIABILITY POLICY

SCHEDULE

Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations

Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss.

All locations where you perform work for such additional insured pursuant to any such written contract.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organiza-tion(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorse-ment performed for that additional insured and included in the "products-completed operations hazard".

However:

1. The insurance afforded to such additional insured only applies to the extent permitted by law; and

2. 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.

B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance And Retained Limit:

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 the contract or agreement; or

2. Available under the applicable Limits of Insurance shown in the Declarations;

whichever is less.

This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.