ACCEPTED_ANY_AL_GL_AL_WC_01.14.25-12.02.25.pdf

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�057�8���70 <8 ���� �79 �3�25�3�0 03/12/2025

(PER POLICY FORM MEGL 1816 02 13).

Cindy Lewis Accepted

PRODUCTS INTERLINE

All other terms and conditions remain unchanged.

MEGL 1816 02 13 Page 1 of 1

EVANSTON INSURANCE COMPANY

XXXX

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT

This endorsement modifies insurance provided under the following:

GENERAL LIABILITY (INCLUDING PRODUCTS AND COMPLETED OPERATIONS LIABILITY) INSURANCE POLICY

In consideration of the premium paid, it is understood and agreed that the policy is amended as follows:

The Insured is amended to include any person or organization the Named Insured is required to include as an additional insured on this policy by a written contract or written agreement in effect during this Policy Period and executed prior to the Occurrence of the Bodily Injury or Property Damage, hereinafter referred to as Additional Insured.

Notwithstanding the foregoing, no contract manufacturer of the Named Insured and no ingredient or part supplier of the Named Insured shall be included as an Insured or Additional Insured pursuant to this endorsement.

The insurance provided to the Additional Insured is limited as follows:

1. The person or organization is only an Additional Insured with respect to liability arising solely out of the Products Hazard or Completed Operations Hazard as defined and as specified in the Declarations.

2. In the event that the limits of liability under this policy exceed the limits of insurance required by the written contract or written agreement, the insurance provided by this endorsement shall be limited to the limits of insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Liability stated in the Declarations.

3. This insurance does not apply to Bodily Injury or Property Damage arising out of the Products Hazard or Completed Operations Hazard as specified in the Declarations unless the Named Insured is required to provide such coverage by the written contract or written agreement but only for the period of time required by the written contract or written agreement and only for Bodily Injury or Property Damage, the entirety of which and the Occurrence causing such Bodily Injury and Property Damage happens during the Policy Period or on or after the Retroactive Date stated in the Declarations, arising out of the Products Hazard or Completed Operations Hazard as specified in the Declarations.

4. Any coverage provided by this endorsement to an Additional Insured shall be excess over any other valid and collectible insurance available to the Additional Insured whether primary, excess, contingent or on any other basis.

5. Where no coverage is afforded under this policy for the Named Insured, no coverage or defense shall be afforded to the Additional Insured.

6. This insurance does not apply to Bodily Injury or Property Damage arising out of the sole negligence of the Additional Insured.

All other provisions of the policy shall remain unchanged.

MEGL 1593 11 12 Page 1 of 1

EVANSTON INSURANCE COMPANY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

WAIVER OF SUBROGATION FOR ADDITIONAL INSUREDS

This endorsement modifies insurance provided under the following:

GENERAL LIABILITY (INCLUDING PRODUCTS AND COMPLETED OPERATIONS LIABILITY) INSURANCE POLICY

SPECIFIED PRODUCTS AND COMPLETED OPERATIONS INSURANCE POLICY

In consideration of the premium paid, it is hereby understood and agreed that the provision titled Subrogation is amended by the addition of the following:

Notwithstanding the foregoing, solely with respect to any Claim made against any Additional Insured covered hereunder, in the event of any payment under this policy, the Company waives all rights of subrogation against such Additional Insured provided the Named Insured has waived its rights of recovery against such Additional Insured in writing in a contract or agreement that was executed before the date such Claim was made.

All other provisions of the policy shall remain unchanged.

MEGL 1594 11 12 Page 1 of 1

EVANSTON INSURANCE COMPANY

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NON-CONTRIBUTORY FOR ADDITIONAL INSUREDS

This endorsement modifies insurance provided under the following:

GENERAL LIABILITY (INCLUDING PRODUCTS AND COMPLETED OPERATIONS LIABILITY) INSURANCE POLICY

SPECIFIED PRODUCTS AND COMPLETED OPERATIONS INSURANCE POLICY

In consideration of the premium paid, it is hereby understood and agreed that the policy is amended by the addition of the following:

Solely with respect to any Claim made against any Additional Insured covered hereunder, the Company agrees to provide primary insurance to such Additional Insured on a non-contributory basis relative to any other insurance carried by the Additional Insured, provided the Named Insured has agreed to provide primary insurance to such Additional Insured on a non-contributory basis, in writing in a contract or agreement that was executed before the date such Claim was made. If however, such Additional Insured has other insurance available as an Additional Insured, this provision shall not apply and this insurance shall apply on an excess basis relative to such other insurance.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06

(Ed. 4-84)

This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.

(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)

This endorsement, effective

Policy No.

Endorsement No.Issued to

Premium

By:

Carrier Code

(Ed. 4-84)

Authorized Representative Countersigned at on at 12:01 AM standard time, forms a part of Of the

WC 04 03 06

© 1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved.

Schedule

Person or Organization Job Description

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA

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.)

You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.

The additional premium for this endorsement shall be _____% of the California workers' compensation premium otherwise due on such remuneration.

With respect to all employees subject to the workers' compensation laws of the state of California, any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.

This policy is subject to a minimum charge of $250 for the issuance of waivers of subrogation

01/14/2025

EIG 5778980 00

APEX UNIVERSAL INC

$9,347

00920

EMPLOYERS PREFERRED INS. CO.