Cox_Castle_COI-2_for_CGL-Auto-WC_to_10-1-2024.pdf

ANY PROPRIETOR/PARTNER/EXECUTIVE

OFFICER/MEMBER EXCLUDED?

INSR ADDL SUBR

LTR INSD WVD

DATE (MM/DD/YYYY)

PRODUCER CONTACT

NAME:

FAXPHONE

(A/C, No):(A/C, No, Ext):

E-MAIL

ADDRESS:

INSURER A :

INSURED INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

POLICY NUMBER

POLICY EFF POLICY EXP

TYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY)

AUTOMOBILE LIABILITY

UMBRELLA LIAB

EXCESS LIAB

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

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

AUTHORIZED REPRESENTATIVE

EACH OCCURRENCE $

DAMAGE TO RENTED

CLAIMS-MADE OCCUR $PREMISES (Ea occurrence)

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $

PRO-

POLICY LOC PRODUCTS - COMP/OP AGG $JECT

OTHER: $

COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $

OWNED SCHEDULED BODILY INJURY (Per accident) $

AUTOS ONLY AUTOS

HIRED NON-OWNED PROPERTY DAMAGE $

AUTOS ONLY AUTOS ONLY (Per accident)

OCCUR EACH OCCURRENCE $

CLAIMS-MADE AGGREGATE $

DED RETENTION $ $

PER OTH-

STATUTE ER

E.L. EACH ACCIDENT $

E.L. DISEASE - EA EMPLOYEE $

If yes, describe under

E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below

INSURER(S) AFFORDING COVERAGE NAIC #

COMMERCIAL GENERAL LIABILITY

Y / N

N / A (Mandatory in NH)

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

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.

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).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

CERTIFICATE HOLDER CANCELLATION

© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03)

CERTIFICATE OF LIABILITY INSURANCE

Lockton Insurance Brokers, LLC 777 S. Figueroa Street, 52nd Fl.

CA License #0F15767 Los Angeles CA 90017

(213) 689-0065

Cox, Castle & Nicholson, LLP 2029 Century Park East, Suite 2100 Los Angeles CA 90067

COXCA01

Federal Insurance Company 20281 Vigilant Insurance Company 20397

X X

1,000,000 1,000,000 10,000 1,000,000 2,000,000 Included

X X

1,000,000

XXXXXXX

XXXXXXX

XXXXXXX

Comp/Coll Ded. 1,000

XXXXXXX

XXXXXXX

XXXXXXX

N

X

1,000,000 1,000,000 1,000,000

B 73266243 10/1/2023 10/1/2024

A 35752754 10/1/2023 10/1/2024

B 71732889 10/1/2023 10/1/2024

NOT APPLICABLE

10/1/2024

1072001

Y Y

Y Y

Y

9/27/2023

13172257

13172257 XXXXXXX

State of Arizona Arizona State Retirement System ITS Account Number: AZS8 c/o Insurance Tracking Services, Inc. (ITS) P.O. Box 20270 Long Beach CA 90801

The State of Arizona, its departments, agencies, boards, commissions, universities and its officers, officials, agents and employees are named as Additional Insured to the extent provided by the policy language or endorsement issued or approved by the insurance carrier. This insurance is primary and non-contributory as per the attached Endorsement. Waiver of Subrogation applies per the attached Endorsement. Notice of Cancellation applies per attached endorsement(s).

X X

See Attachments

State of Arizona Arizona State Retirement System ITS Account Number: AZS8 c/o Insurance Tracking Services, Inc. (ITS) P.O. Box 20270 Long Beach, CA 90801

To whom it may concern:

In our continuing effort to provide timely certificate delivery, Lockton Companies is transitioning to paperless delivery of Certificates of Insurance, thus, this is your final hard-copy delivery.

To ensure electronic delivery for future renewals of this certificate, we need your email address.

Please contact us via one of the methods below, referencing Certificate ID 13172257.

Email: PacificeDelivery@lockton.com Phone: (213) 689-2300

If you received this certificate through an internet link where the current certificate is viewable, we have your email and no further action is needed.

In the event your mailing address has changed, will change in the future, or you no longer require this certificate, please let us know using one of the methods above.

The above inbox and phone number below are for automating electronic delivery of certificates only. Please do NOT send future certificate requests to the above inbox or call into the number below.

Thank you for your cooperation and willingness in reducing our environmental footprint.

Lockton Insurance Brokers, LLC - Pacific Series

Lockton Insurance Brokers, LLC License #0F15767

777 S Figueroa Street, 52nd Fl / Los Angeles, CA 90017-5524

213-689-0065 / FAX: 213-689-0550

lockton.com

Attachment Code: D567517 Master ID: 1072001, Certificate ID: 13172257 mailto:PacificeDelivery@lockton.com

Policy Number: 35752754

Conditions (continued)

Transfer Or Waiver Of Rights Of Recovery Against others

We Will waive the right of recovery we would otherwise have had against another person or organizations, for loss to which this insurance applies, provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss.

To the extent that the insured's rights into recover all or part of any payment made under this insurance have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them.

This condition does not apply to medical expenses

Liability Insurance Form 80-02-2000 (Rev.4-01) Contract Page 24 of 32

Attachment Code: D486562 Certificate ID: 13172257

WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY

WC 99 03 04 (Ed. 7-08)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -

CALIFORNIA

This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below.

(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)

This endorsement, effective on 10/1/2023 AT 12:01 A.M. standard time, forms a part of

Policy No. 71732889 of the Federal Insurance Company issued to Cox, Castle & Nicholson,LLP

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. The additional premium for this endorsement shall be 1.00 % of the total California premium.

Schedule

Person or Organization Job Description

BLANKET WAIVER - ANY PERSON OR

ORGANIZATION FOR WHOM THE NAMED

INSURED HAS AGREED BY WRITTEN

CONTRACT PRIOR TO AN OCCURRENCE TO

FURNISH THIS WAIVER.

ALL CALIFORNIA OPERATIONS.

WC 99 03 04 (Ed. 7-08)

Attachment Code: D486563

Policy Conditions Endorsement

Policy Period 10/1/2023 TO 10/1/2024 Effective Date 10/1/2023 Policy Number 35752754 Insured Vigilant Insurance Company

Name of Company

Cox, Castle & Nicholson,LLP

This Endorsement applies to the following forms:

COMMON POLICY CONDITIONS

Under Conditions, the following condition is added:

Conditions

Notice of Cancellation to Scheduled Persons Or Organizations When We Cancel

When we cancel this policy for any reason, other than non-payment of premium, we will notify person(s) or organization(s) shown in the Schedule at least 30 days in advance of the cancellation date.

Any failure by us to notify such person(s) or organization(s) will not:

impose any liability or obligation of any kind upon us; or invalidate such cancellation.

Schedule

Person(s) or Organization(s):

All other terms and conditions remain unchanged.

Liability Insurance Notice of Cancellation to Scheduled Persons or Organizations (Except for Non-Payment of Premium)

Form 80-02-9779 (Ed.

4-01)

Endorsement

Attachment Code: D486564

Liability Insurance Endorsement

Policy Period 10/1/2023 TO 10/1/2024

Effective Date 10/1/2023

Policy Number 35752754

Insured Cox, Castle & Nicholson, LLP

Name of Company Vigilant Insurance Company

Date Issued 10/1/2023

This Endorsement applies to the following forms: GENERAL LIABILITY Under Who An Insured, the following provision is added.

Who Is An Insured Additional Insured-Schedu led Person Or Organization

Persons or organizations shown in the Schedule are insureds; but they are insured you are obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by this policy.

However, the person or organization is an insured only:

if and then only to the extent the person or organization is described in the

Schedule:

to the extent such contract or agreement requires the person or organization to be afforded status as an insured:

for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and with respect to damage, loss, cost or expense for injury or damage to which this insurance applies.

No person or organization is an insured under this provision:

that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto).

With respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement.

Under Conditions, the following provision is added to the condition titled Other Insurance.

Other Insurance

- Primary, Noncontributory Insurance - Scheduled Person Or Organization

If you are obligated, pursuant to a contract or agreement, to provide the person or organization shown in the Schedule with primary insurance such as is afforded by this policy, then in such case this insurance is primary and we will not seek contribution from insurance available to such person or organization.

Attachment Code: D525386 Certificate ID: 13172257

Liability Endorsement (continued)

Schedule

Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy.

All other terms and conditions remain unchanged.

Additional Insured - Scheduled Person Or Organization

Form 80-02-2367 (rev. 5-07) Page 2

Attachment Code: D525386 Certificate ID: 13172257