CTR062276.M22-0024_COI_Crushed_Asphalt___Southwest_Siteworks__07.16.23.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

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).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

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.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

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

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

9/21/2022

Crest Insurance Group, LLC 5285 E. Williams Circle Suite 4500 Tucson AZ 85711

Jynessa Shaffer 520-784-7617 520-618-3948 jshaffer@crestins.com

License#: 967026 Acuity 14184

SOUTSIT-01

Southwest Siteworks, LLC 6727 N. Silverbell Road Tucson AZ 85743

1413292349

A X 1,000,000 X 300,000

10,000

1,000,000

3,000,000 X

Y Y ZK4103 7/16/2022 7/16/2023

3,000,000

A 1,000,000

X

X X

Y Y ZK4103 7/16/2022 7/16/2023

A X 1,000,000 X

Y ZK4103 7/16/2022Y 7/16/2023

1,000,000

A XY ZN4991 7/27/2022 7/27/2023

1,000,000

1,000,000

1,000,000

Certificate holder and others when required in a written contract or agreement are Additional Insured (General Liability & Automobile Liability) including Products Completed. Coverage is Primary & Non-Contributory (General Liability). Waiver of Subrogation (General Liability & Automobile Liability) applies. This form is subject to all policy forms, terms, endorsements, conditions definitions & exclusions.

Project: BPM004630/M22-0024

STATE OF ARIZONA

DEPARTMENT OF EMERGENCY AND MILTARY

AFFAIRS

5636 East McDowell Road, Bldg M5800 Phoenix AZ 85008-3495

CB-7245B(7-13) Page 1 of 1

ADDITIONAL INSURED - COMPLETED OPERATIONS AUTOMATIC STATUS

WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU (OWNERS,

LESSEES OR CONTRACTORS)

This endorsement modifies insurance provided under the following:

BIS-PAK® BUSINESS LIABILITY AND MEDICAL EX-

PENSES COVERAGE FORM

1. Who Is An Insured is amended to include as an additional insured:

a. Any person(s) or organization(s) for whom you have performed operations if you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your poli-cy for completed operations; and

b. Any other person(s) or organization(s) you are required to add as an additional insured under the contract or agreement described in paragraph a above.

Such person or organization is an additional insured only with respect to liability included in the products-completed operations hazard for bodily injury or property damage caused, in whole or in part, by your work performed for that additional insured at the location designated and described in the contract or agreement.

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 in-sured is required by a contract or agree-ment, the insurance afforded to such addi-tional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

2. The insurance does not apply to:

a. Bodily injury or property damage which oc-curs prior to execution of the contract or agreement described in item 1; or

CB-7245B(7-13)

b. Bodily injury or property damage that occurs after the time period during which the contract or agreement described in item 1 requires you to add such person or or-ganization onto your policy as an additional insured for completed operations; or

c. Bodily injury or property damage arising out of the rendering of, or the failure to render, any professional, architectural, engineering or surveying services, including:

(1) The preparing, approving or failing to prepare or approve maps, shop draw-ings, opinions, reports, surveys, field or-ders, change orders or drawings and specifications; or

(2) Supervisory, inspection, architectural or engineering activities.

This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employ-ment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage involved the rendering of or the failure to render any profes-sional services by or for you.

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability And Medical Expenses Limits Of Insurance section:

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:

a. Required by the contract or agreement; or

b. Available under the applicable Limits of In-surance shown in the Declarations;

whichever is less.

This endorsement shall not increase the ap-plicable Limits of Insurance shown in the Dec-larations.

Includes copyrighted material of Insurance Services Office, Inc., with its permission.

CB-7433B(7-13) Page 1 of 1

ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -

AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION

AGREEMENT WITH YOU

CB-7433B(7-13)

This endorsement modifies insurance provided under the following:

BIS-PAK® BUSINESS LIABILITY AND MEDICAL EX-

PENSES COVERAGE FORM

1. Who Is An Insured is amended to include as an additional insured:

a. Any person(s) or organization(s) for whom you are performing operations when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and

b. Any other person(s) or organization(s) you are required to add as an additional insured under the contract or agreement described in paragraph a above.

Such person(s) or organization(s) is an addi-tional insured only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by:

a. Your acts or omissions; or

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

in the performance of your ongoing operations for the additional insured.

However, the insurance afforded to such addi-tional insured:

a. Only applies to the extent permitted by law;

and

b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

A person's or organization's status as an addi-tional insured under this endorsement ends on the earlier of the date:

a. When your operations for that insured are completed; or

b. The contract or agreement you have en-tered into with the additional insured is ter-minated.

2. With respect to the insurance afforded these additional insureds, the following additional ex-clusions apply:

This insurance does not apply to:

a. Bodily injury, property damage or personal and advertising injury arising out of the ren-dering of, or the failure to render, any pro-fessional architectural, engineering or sur-veying services, including:

(1) The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or

(2) Supervisory, inspection, architectural or engineering activities.

This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property dam-age, or the offense which caused the per-sonal and advertising injury, involved the rendering of or the failure to render any professional services.

b. 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 ser-vice, maintenance or repairs) to be per-formed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

(2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another con-tractor or subcontractor engaged in per-forming operations for a principal as a part of the same project.

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability And Medical Expenses Limits Of Insurance section:

The most we will pay on behalf of the addi-tional insured is the amount of insurance:

a. Required by the contract or agreement you have entered into with the additional in-sured; or

b. Available under the applicable Limits of In-surance shown in the Declarations;

whichever is less.

This endorsement shall not increase the ap-plicable Limits of Insurance shown in the Dec-larations.

CB-1488(7-13) Page 1 of 1

This endorsement modifies insurance provided under the following:

BIS-PAK® COMMON POLICY CONDITIONS

The following is added to paragraph H Other Insur-ance of the Bis-Pak® Common Policy Conditions and supersedes any provision to the contrary:

Primary And Noncontributory Insurance This insurance is primary to and will not seek con-

CB-1488(7-13)

tribution from any other insurance available to an additional insured under your policy provided that:

1. The additional insured is a Named Insured un-der such other insurance; and

2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured.

PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION

CB-7456(8-20) Page 1 of 11

CB-7456(8-20)ACUITY LIABILITY ENHANCEMENTS - GOLD

This endorsement modifies insurance provided under the following:

BIS-PAK ® BUSINESS LIABILITY AND MEDICAL EXPENSES COVERAGE FORM

BIS-PAK ® COMMON POLICY CONDITIONS

SCHEDULE

Coverage Limit of Insurance Page

Electronic Data Liability $10,000 9

Employee Benefits Liability $250,000 5

Increased Bail Bond Limit $2,500 2

Increased Limits of Insurance see below 9

Damage to Premises Rented to You $300,000 9

Generate Aggregate* 3 times current Liability and Medical Expenses Limit

Medical Expenses $10,000 9

Products - Completed Operations* 3 times current Liability and Medical Expenses Limit

Supplemental Reasonable Expenses $500 Per Day 2

Tenants Legal Liability $10,000 9

Voluntary Property Damage $2,500 Per Occurrence $5,000 Per Aggregate

Additional Included Coverages

Automatic Status Additional Insured - Lessors of Leased Equipment

Included 3

Automatic Status Additional Insured - Managers or Lessors of Premises

Included 3

Automatic Status Additional Insured - Mortgagee, Assignee, or Receiver

Included 4

Automatic Status Additional Insured - State or Government Agency or Subdivision

Included 4

Bodily Injury Expanded Definition Included 11

Damage to Premises Rented to You Broadening Included 10

First Aid/Good Samaritan Coverage Included 2

Knowledge by an Employee Included 10

Newly Acquired Organizations - up to180 days Included 10

Unintentional Failure to Disclose Included 11

Waiver of Subrogation Included 11

*If your current Liability and Medical Expenses limit is $500,000 or $1,000,000

CB-7456(8-20) Page 2 of 11Includes copyrighted material of Insurance Services Office, Inc., with its permission.

A. Increased Bail Bond Limit Paragraph 1f(1)(b) under Liability and Medical Expenses Coverages is replaced by the following:

(b) Up to the Increased Bail Bond Limit of Insurance shown in the Schedule for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for bodily injury applies. We do not have to furnish these bonds.

B. Supplemental Reasonable Expenses Incurred by Insured Paragraph 1f(1)(d) under Liability and Medical Expenses Coverages is replaced by the following:

(d) All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or suit, including actual loss of earnings up to the Supplemental Reasonable Expenses Limit of Insurance shown in the Schedule because of time off from work.

C. Voluntary Property Damage

1. With respect to the insurance provided under this coverage, the following apply:

a. Exclusion 1k(4) is replaced by the following:

(4) Personal property of others:

(a) Held by the insured for servicing, repair, storage or sale at premises owned, occupied or rented to the insured.

(b) Caused by the ownership, maintenance, use, loading or unloading of any auto, watercraft, or transportation of property by any means.

b. Exclusion 1k(5) is deleted.

2. The insurance provided by this coverage is subject to the following provisions:

a. We will pay for property damage at your request even if you are not legally liable, if it is otherwise subject to this coverage.

b. Property damage does not include loss of use if personal property of others is not physically injured.

c. Limits The most we will pay for an occurrence under this coverage is the Voluntary Property Damage, Per Occurrence Limit of Insurance shown in the Schedule.

The most we will pay for the sum of all amounts paid under this coverage is the Voluntary Property Damage, Aggregate Limit of Insurance shown in the

Schedule.

The Liability and Medical Expenses Limit and the Aggregate Limits do not apply to the insurance provided under this coverage.

d. Settlement If you make any repairs to damaged property, at our request, we will pay the larger of your actual cost or 75% of your usual charge for the necessary labor and materials. Any property paid for or replaced by us may become our property at our option. Any payment made under this coverage shall not be interpreted as an admission of liability by the insured or the company.

e. Deductible Our obligation to pay for a covered loss applies only to the amount of loss in excess of $100.

f. Other Insurance The insurance provided by this coverage is excess over any other insurance carried by the insured which applies to a loss covered by this coverage.

D. First Aid/Good Samaritan Coverage The Following is added to Liability and Medical Expenses Coverage:

1. For purposes of this coverage, the definition of occurrence in Definitions is replaced by the following:

"Occurrence" means an act or omission by your employee in providing or failing to provide first aid services provided:

a. Neither you nor the employee are employed to provide any type of first aid services or medical services.

b. The first aid services were provided while the employee was engaged in activities related to the scope and extent of their employment by you.

2. The following is added to paragraph 2 of Liability and Medical Expenses Limits of Insurance:

c. For the purposes of determining the applicable Each Occurrence Limit, all acts or omissions committed by one or more persons in providing or failing to provide first aid services to one person will be deemed to be one occurrence.

3. The following definitions are added to Definitions:

“First aid services” means medical services provided when no professional medical service provider (whether licensed or not) is present and without the immediate provision

CB-7456(8-20) Page 3 of 11Includes copyrighted material of Insurance Services Office, Inc., with its permission.

of which would have immediately resulted in death or significant adverse result from a serious injury or serious condition of the recipient of those services.

“Medical services” includes all medical and medically-related services.

“Professional medical services provider” means anyone who is employed to provide medical services or first aid services.

E. Automatic Status Additional Insured - Lessors of Leased Equipment

1. Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) which leases equipment to you, but only when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy provided that a certificate of insurance showing that person or organization as an additional insured has been issued.

However:

a. Such person(s) or organization(s) are additional insureds only with respect to bodily injury, property damage or personal and advertising injury caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s);

and

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

c. 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.

2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any occurrence that takes place after the equipment lease expires.

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability and Medical Expenses Limits of Insurance section:

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:

a. Required by the contract or agreement;

or

b. 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.

F. Automatic Status Additional Insured - Managers or Lessors of Premises

1. Who Is An Insured is amended to include any person(s) or organization(s) which manages or leases a premises rented to you which is covered under this policy, but only when you and such person or organization have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy provided that a certificate of insurance showing that person or organization as an additional insured has been issued.

However:

a. Such person(s) or organization(s) are additional insureds only with respect to bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of that part of the premises leased to you; and

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

c. 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.

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

This insurance does not apply to:

a. Any occurrence that takes place after you cease to be a tenant in the premises insured under this policy; and.

b. Structural alterations, new construction or demolition operations performed by or for the additional insured.

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability and Medical Expenses Limits of Insurance section:

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:

a. Required by the contract or agreement;

or

CB-7456(8-20) Page 4 of 11Includes copyrighted material of Insurance Services Office, Inc., with its permission.

b. 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.

G. Automatic Status Additional Insured - Mortgagee, Assignee, or Receiver

1. Who Is An Insured is amended to include any person(s) or organization(s) with respect to that person(s) or organization(s) liability as mortgagee, assignee or receiver, but only when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy provided that a certificate of insurance showing that person or organization as an additional insured has been issued.

However:

a. Such person(s) or organization(s) are additional insureds only with respect to liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance or use of premises by you and which is covered by this policy; and

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

c. 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.

2. With respect to the insurance afforded to these additional insureds this insurance does not apply to structural alterations, new construction or demolition operations performed by or for that person(s) or organization(s).

3. With respect to the insurance afforded to these additional insureds, the following is added to the Liability and Medical Expenses Limits of Insurance section:

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:

a. Required by the contract or agreement;

or

b. 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.

H. Automatic Status Additional Insured - State or Government Agency or Subdivision

1. Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision, but only when you and such state or governmental agency or subdivision or political subdivision have agreed in writing in a contract or agreement that such state or governmental agency or subdivision or political subdivision be added as an additional insured on your policy, subject to the following provisions, provided that a certificate of insurance showing that person or organization as an additional insured has been issued.

a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization.

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. This insurance does not apply to:

(1) Bodily injury, property damage, or personal and advertising injury arising out of operations performed for the federal government, state or municipality; or

(2) Bodily injury or property damage i n c l u d e d w i t h i n t h e products-completed operations hazard.

2. With respect to the insurance afforded to these additional insureds, the following is added to the Liability and Medical Expenses Limits of Insurance section:

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:

a. Required by the contract or agreement;

or

CB-7456(8-20) Page 5 of 11Includes copyrighted material of Insurance Services Office, Inc., with its permission.

b. 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.

I. Employee Benefits Liability Coverage

1. The following is added to Liability and

Medical Expenses Coverages:

Insuring Agreement

a. We will pay those sums that the inured becomes legally obligated to pay as damages because of any act, error or omission, of the insured, or of any other person for whose acts the insured is legally liable, to which this coverage applies. We will have the right and duty to defend the insured against any suit seeking those damages. However, we will have no duty to defend the insured against any suit seeking damages to which this coverage does not apply. We may, at our discretion, investigate any report of an act, error or omission and settle any claim or suit that may result.

But:

(1) The amount we will pay for damages is limited as described in paragraph 4 of this coverage; and

(2) Our right and duty to defend end when we have used up the applicable limit of insurance in the payment of judgments or settlements.

No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments.

b. This coverage applies to damages only if:

(1) The act, error or omission, is negligently committed in the administration of your employee benefit program;

(2) The act, error or omission, did not take place before the original inception date of this coverage nor after the end of the policy period; and

(3) A claim for damages, because of an act, error or omission, is first made against any insured, in accordance with paragraph c below, during the policy period or an Extended Reporting Period we provide under paragraph 6 of this coverage.

c. A claim seeking damages will be deemed to have been made at the earlier of the following times:

(1) When notice of such claim is received and recorded by any insured or by us, whichever comes first; or

(2) When we make settlement in accordance with paragraph a above.

A claim received and recorded by the insured within 60 days after the end of the policy period will be considered to have been received within the policy period, if no subsequent policy is available to cover the "claim".

d. All claims for damages made by an employee because of any act, error or omission, or a series of related acts, errors or omissions, including damages claimed by such employee's dependents and beneficiaries, will be deemed to have been made at the time the first of those claims is made against any insured.

Exclusions This coverage does not apply to:

a. Dishonest, Fraudulent, Criminal Or Malicious Act Damages arising out of any intentional, dishonest, fraudulent, criminal or malicious act, error or omission, committed by any insured, including the willful or reckless violation of any statute.

b. Bodily Injury, Property Damage, Or Personal And Advertising Injury Bodily injury, property damage or personal and advertising injury.

c. Failure To Perform A Contract Damages arising out of failure of performance of contract by any insurer.

d. Insufficiency Of Funds Damages arising out of an insufficiency of funds to meet any obligations under any plan included in the employee benefit program.

e. Inadequacy Of Performance Of Investment/Advice Given With Respect To Participation Any claim based upon:

(1) Failure of any investment to perform;

(2) Errors in providing information on past performance of investment vehicles; or

(3) Advice given to any person with respect to that person's decision to participate or not to participate in any plan included in the employee benefit program.

CB-7456(8-20) Page 6 of 11Includes copyrighted material of Insurance Services Office, Inc., with its permission.

f. Workers' Compensation And Similar Laws Any claim arising out of your failure to comply with the mandatory provisions of any workers' compensat ion, unemployment compensation insurance, social security or disability benefits law or any similar law.

g. ERISA Damages for which any insured is liable because of liability imposed on a fiduciary by the Employee Retirement Income Security Act of 1974, as now or hereafter amended, or by any similar federal, state or local laws.

h. Available Benefits Any claim for benefits to the extent that such benefits are available, with reasonable effort and cooperation of the insured, from the applicable funds accrued or other collectible insurance.

i. Taxes, Fines Or Penalties Taxes, fines or penalties, including those imposed under the Internal Revenue Code or any similar state or local law.

j. Employment-Related Practices Damages arising out of wrongful termination of employment, d isc r iminat ion , or o ther employment-related practices.

2. For the purposes of the coverage provided:

a. All references to Supplementary Payments are replaced by Supplementary Payments and Employee Benefits Liability.

b. Paragraphs f(1)(b), f(2) and f(3) Coverage Extension - Supplementary Payments do not apply.

3. For the purposes of the coverage provided, paragraphs 2 and 3 under Who Is An Insured are replaced by the following:

2. Each of the following is also an insured:

a. Each of your employees who is or was authorized to administer your employee benefit program.

b. Any persons, organizations or employees having proper temporary authorization to administer your employee benefit program if you die, but only until your legal representative is appointed.

c. Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this coverage.

3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no other similar insurance applies to that organization. However:

a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier.

b. Coverage under this provision does not apply to any act, error or omission that was committed before you acquired or formed the organization.

4. For the purposes of the coverage provided, the Liability and Medical Expenses Limits of Insurance Section is replaced by the following:

Limits Of Insurance

a. The rules below fix the most we will pay regardless of the number of:

(1) Insureds;

(2) Claims made or suits brought;

(3) Persons or organizations making claims or bringing suits;

(4) Acts, errors or omissions; or

(5) Benefits included in your employee benefits program.

b. The Employee Benefits Liability Limit of Insurance shown in the Schedule is the most we will pay for all damages because of acts, errors or omissions negligently committed in the administration of your employee benefit program.

c. Subject to paragraph b, the Employee Benefits Liability Limit of Insurance shown in the Schedule is the most we will pay for all damages sustained by any one employee, including damages sustained by such employee's dependents and beneficiaries, as a result of:

(1) An act, error or omission; or

(2) A series of related acts, errors or omissions negligently committed in the administration of your employee benefit program.

However, the amount paid under this coverage shall not exceed, and will be subject to, the limits and restrictions that apply to the payment of benefits in any plan included in the

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employee benefit program.

d. The Limits of Insurance of this coverage apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations of the policy to which this coverage is attached, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance.

Deductible

a. Our obligation to pay damages on behalf of the insured applies only to the amount of damages in excess of the deductible amount stated in e below as applicable to Each Employee. The Limits of Insurance shall not be reduced by the amount of this deductible.

b. The deductible amount stated in e below applies to all damages sustained by any one employee, including such employee's dependents and beneficiaries, because of all acts, errors or omissions to which this coverage applies.

c. The terms of this coverage, including those with respect to:

(1) Our right and duty to defend any suits seeking those damages;

and

(2) Your duties, and the duties of any other involved insured, in the event of an act, error or omission, or claim apply irrespective of the application of the deductible amount.

d. We may pay any part or all of the deductible amount to effect settlement of any claim or suit and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as we have paid.

e. Deductible

Each Employee Deductible: $1,000

5. For the purposes of the coverage provided, Duties In The Event Of Occurrence, Offense, Claim Or Suit Condition is replaced by the following:

2. Duties In The Event Of An Act, Error Or Omission, Or Claim Or Suit

a. You must see to it that we are notified as soon as practicable of an act, error or omission which may result in a claim. To the extent possible, notice should include:

(1) What the act, error or omission was and when it occurred; and

(2) The names and addresses of anyone who may suffer damages as a result of the act, error or omission.

b. If a claim is made or suit is brought against any insured, you must:

(1) Immediately record the specifics of the claim or suit and the date received; and

(2) Notify us as soon as practicable.

c. You and any other involved insured must:

(1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or suit;

(2) Authorize us to obtain records and other information;

(3) Cooperate with us in the investigation or settlement of the claim or defense against the suit; and

(4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of an act, error or omission to which this coverage may also apply.

d. No insured will, except at that insured’s own cost, voluntarily make a payment, assume any obligation or incur any expense without our consent.

e. The requirements to notify us can be satisfied by notifying our agent. Notice can be by any means of communication.

6. For the purposes of the coverage provided, the following Extended

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Reporting Period provisions are added:

EXTENDED REPORTING PERIOD

a. You will have the right to purchase an

Extended Reporting Period, as described below, if:

(1) This coverage is canceled or not renewed; or

(2) We renew or replace this coverage with insurance that:

(a) Has an inception date later than the original inception date of this coverage; or

(b) Does not apply to an act, error or omission on a claims-made basis.

b. The Extended Reporting Period does not extend the policy period or change the scope of coverage provided. It applies only to claims for acts, errors or omissions that were first committed before the end of the policy period but not before the original inception date of this coverage. Once in effect, the Extended Reporting Period may not be canceled.

c. An Extended Reporting Period of five years is available, but only by an endorsement and for an extra charge.

You must give us a written request for the endorsement within 60 days after the end of the policy period. The Extended Reporting Period will not go into effect unless you pay the additional premium promptly when due.

We will determine the additional premium in accordance with our rules and rates. In doing so, we may take into account the following:

(1) The employee benefit programs insured;

(2) Previous types and amounts of insurance;

(3) Limits of Insurance available under this coverage for future payment of damages; and

(4) Other related factors.

The additional premium will not exceed $100.

The Extended Reporting Period endorsement applicable to this coverage shall set forth the terms, not inconsistent with this Section, applicable to the Extended Reporting

Period, including a provision to the effect that the coverage afforded for claims first received during such period is excess over any other valid and collectible insurance available under policies in force after the Extended Reporting Period.

d. If the Extended Reporting Period is in effect, we will provide an extended reporting period aggregate limit of insurance described below, but only for claims first received and recorded during the Extended Reporting Period.

The extended reporting period aggregate limit of insurance will be equal to the Employee Benefits Liability Limit of Insurance shown in the Schedule.

Paragraph 4 of this coverage will be amended accordingly. The each employee limit will then continue to apply.

7. For the purposes of the coverage provided, the following definitions are added to Liability and Medical Expenses Definitions:

a. "Administration" means:

(1) Providing information to employees, including their dependents and beneficiaries, with respect to eligibility for or scope of employee benefit programs;

(2) Handling records in connection with the employee benefit program; or

(3) Effecting, continuing or terminating any employee's participation in any benefit included in the employee benefit program.

However, administration does not include handling payroll deductions.

b. "Cafeteria plans" means plans authorized by applicable law to allow employees to elect to pay for certain benefits with pre-tax dollars.

c. "Claim" means any demand, or suit, made by an employee or an employee's dependents and beneficiaries, for damages as the result of an act, error or omission.

d. "Employee benefit program" means a program providing some or all of the following benefits to employees, whether provided through a cafeteria

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plan or otherwise:

(1) Group life insurance; group accident or health insurance;

dental, vision and hearing plans;

and flexible spending accounts;

provided that no one other than an employee may subscribe to such benefits and such benefits are made generally available to those employees who satisfy the plan's eligibility requirements;

(2) Profit sharing plans, employee savings plans, employee stock ownership plans, pension plans and stock subscription plans, provided that no one other than an employee may subscribe to such benefits and such benefits are made generally available to all employees who are eligible under the plan for such benefits;

(3) Unemployment insurance, social security benefits, workers’ compensation and disability benefits;

(4) Vacation plans, including buy and sell programs; leave of absence programs, including military, maternity, family, and civil leave;

tuition assistance plans;

transportation and health club subsidies; and

(5) Any other similar benefits added thereto by endorsement.

8. For the purposes of the coverage provided, the following Definitions in the Liability and Medical Expenses Definitions Section are replaced by the following:

a. "Employee" means a person actively employed, formerly employed, on leave of absence or disabled, or retired. Employee includes a leased worker. Employee does not include a temporary worker.

b. "Suit" means a civil proceeding in which damages because of an act, error or omission to which this coverage applies are alleged. Suit includes:

(1) An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or

(2) Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent.

9. The Bis-Pak® Common Policy Conditions are amended as follows:

For the purposes of the coverage provided, paragraph H3 Other Insurance is replaced by the following:

3. This Employee Benefits Liability Coverage is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is effective prior to the beginning of the policy period shown in the Declarations and that applies to an act, error or omission on other than a claims-made basis, if the other insurance has a policy period which continues after the original inception date of this coverage.

J. Increased Limits of Insurance

1. The General Aggregate Limit is increased to equal the Liability and Medical Expenses Limit times the Increased Limits of Insurance

- General Aggregate number shown in the Schedule if your current Liability and Medical Expenses Limit is equal to $500,000 or $1,000,000.

2. The Products-Completed Operations Aggregate Limit is increased to equal the Liability and Medical Expenses Limit times the Increased Limits of Insurance - Products-Completed Operations Aggregate number shown in the Schedule if your current Liability and Medical Expenses Limit is equal to $500,000 or $1,000,000.

3. The Damage To Premises Rented To You Limit is increased to the Increased Limits of Insurance - Damage to Premises Rented to You Limit of Insurance shown in the Schedule.

4. The Medical Expense Limit is increased to the Increased Limits of Insurance - Medical Expenses Limit of Insurance shown in the Schedule.

The Limits of Insurance shown in the Schedule do not replace and are not in addition to the Limits of Insurance shown in the Declarations.

K. Tenants Legal Liability Paragraphs (1), (3) and (4) of exclusion k do not apply to property damage other than damage by fire, lightning, explosion, smoke, or water to premises, including the contents of such premises, rented to you for a period of 8 or more consecutive days.

The most we will pay under this coverage for damages because of property damage to any one premises is the Tenants Legal Liability Limit of Insurance shown in the Schedule. A $250

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deductible applies.

L. Electronic Data Liability

1. Exclusion 1s is replaced by the following:

This insurance does not apply to:

s. Access or Disclosure of Confidential or Personal Information and Data-related Liability

(1) Damages, other than damages because of personal and advertising injury, arising out of any access to or disclosure of any person's or organization's confidential or personal information, including patents, trade secrets, processing methods, customer lists, financial information, credit card information, health information or any other type of nonpublic information; or

(2) Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate electronic data that does not result from physical injury to tangible property.

This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses, forensic expenses, public relations expenses or any other loss, cost or expense incurred by you or others arising out of that which is described in paragraph (1) or (2) above.

However, unless paragraph (1) above applies, this exclusion does not apply to damages because of bodily injury.

2. The following paragraph is added to Liability and Medical Expenses Limits of Insurance:

Subject to 2 above, the most we will pay for property damage because of all loss of electronic data arising out of any one occurrence is the Electronic Data Liability Limit of Insurance shown in the Schedule.

3. The following definition is added to Liability and Medical Expenses Definitions:

"Electronic data" means information, facts or computer programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), on hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other repositories of computer software which are used with electronically controlled equipment. The term computer programs, referred to in the foregoing description of electronic data, means a set of related electronic instructions which direct the operations and functions of a computer or device connected to it, which enable the computer or device to receive, process, store, retrieve or send data.

4. For the purposes of this coverage, the definition of "property damage" is replaced by the following:

"Property damage" means:

a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it;

b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the occurrence that caused it; or

c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate electronic data, resulting from physical injury to tangible property. All such loss of electronic data shall be deemed to occur at the time of the occurrence that caused it.

For the purposes of this coverage, electronic data is not tangible property.

M. Newly Acquired Organizations Paragraph 3a under Who Is An Insured is replaced by the following:

a. Coverage under this provision is afforded only:

(1) For the number of days for the Newly Acquired Organizations as shown in the Schedule after you acquire or form the organization; or

(2) Until the end of the policy period, whichever is earlier;

N. Paragraph 3 of Liability and Medial Expenses Limits of Insurance is replaced by the following:

3. The most we will pay under Business Liability Coverage for damages because of property damage to a premises while rented to you or in the case of a fire, lightning, explosion, smoke or water while rented to you or temporarily occupied by you with permission of the owner is the applicable Damage To Premises Rented To You Limit shown for that premises in the Declarations.

For a premises temporarily occupied by you, the applicable limit will be the Damage To Premises Rented To You Limit shown in the Declarations.

O. Knowledge of Claim or Suit The following is added to the Duties in the Event of Occurrence, Offense, Claim or Suit Condition in Liability and Medical Expenses General Conditions:

Knowledge of an occurrence, offense, claim or

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suit by an agent or employee of any insured shall not in itself constitute knowledge of the insured unless your partners, executive officers, directors, managers, members or a person who has been designated by them to receive reports of occurrences, offenses, claims or suits shall have received such notice from the agent or employee.

P. Bodily Injury Definition Expanded The definition of bodily injury is amended to include mental distress and mental injury, including but not limited to mental anguish and emotional anguish.

Q. Waiver of Subrogation for Written Contracts The following is added to the Transfer of Rights of Recovery Against Others to Us Condition, Applicable to Liability Coverage in the Bis-Pak®

Common Policy Conditions:

We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard.

The waiver applies only to:

1. Any person or organization with whom you have a written contract or agreement in which you are required to waive rights of recovery under this policy.