CTR074821-COI_Exp_2025-5-1.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

12/12/2024

AssuredPartners Design Professionals Insurance Services, LLC 3697 Mt. Diablo Blvd., Suite 230 Lafayette CA 94549

Stefanie Fuller

DesignProCerts@AssuredPartners.com

License#: 6003745 Travelers Property Casualty Company of America 25674 NINY&MO-01 Pacific Insurance Company, Limited 10046

Ninyo & Moore Geotechnical & Environmental Sciences Consultants 3202 E. Harbour Drive Phoenix AZ 85034

917806160

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

X Contractual Liab 10,000

X OCP / XCU 1,000,000

2,000,000 X

Y Y 6308986R247 10/3/2024 10/3/2025

2,000,000

A 1,000,000

X

X X

Y Y 8107N033091 10/3/2024 10/3/2025

A X X 10,000,000Y CUP9J428527 10/3/2024Y 10/3/2025

10,000,000

A X

N

Y UB6P428399 5/1/2024 5/1/2025

1,000,000

1,000,000

1,000,000 B Professional Liab. &

Contractor's Pollution Liab.

Claims - Made

Y Y Y 72OH068190524 10/3/2024 10/3/2025 Per Claim

Annual Aggregate 5,000,000 5,000,000

Umbrella Liability policy is a follow-form to underlying General Liability/Auto Liability/Employers Liability.

Contract No. CTR074821 / Brownfields Site Assessment Services --

State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees are named as Additional Insured on General Liability and Auto Liability, per policy forms, with respect to the operations of the Named Insured as required by written contract. General Liability and Auto Liability are Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per attached.

CANCELLATION: 30 day notice per policy forms attached

30 Day Notice of Cancellation

Arizona Department of Environmental Quality 1110 W. Washington Street Phoenix AZ 85007

ÐÑÔ×ÝÇÒËÓÞÛÎæ

COMMERCIAL GENERAL LIABILITY

ISSUED DATE:

ÌØ×ÍÛÒÜÑÎÍÛÓÛÒÌÝØßÒÙÛÍÌØÛÐÑÔ×ÝÇòÐÔÛßÍÛÎÛßÜ×ÌÝßÎÛÚËÔÔÇò

Ì̧·»²¼±®»³»²¬³±¼·º·»·²«®¿²½»°®±ª·¼»¼«²¼»®¬̧»º±́́±©·²¹æ

ÝÑÓÓÛÎÝ×ßÔÙÛÒÛÎßÔÔ×ßÞ×Ô×ÌÇÝÑÊÛÎßÙÛÐßÎÌ

ײº±®³¿¬·±²®»̄«·®»¼¬±½±³°́»¬»¬̧·Í½̧»¼«́»ô·º²±¬̧±©²¿¾±ª»ô©·́́¾»̧±©²·²¬̧»Ü»½́¿®¿¬·±²ò

·¿³»²¼»¼¬±·²ó ±́½¿¬·±²¼»·¹²¿¬»¼¿²¼¼»½®·¾»¼·²¬̧»½̧»¼«́»±º ½́«¼»¿¿²¿¼¼·¬·±²¿́ ·²«®»¼¬̧»°»®±²ø÷±®±®ó ¬̧·»²¼±®»³»²¬°»®º±®³»¼º±®¬̧¿¬¿¼¼·¬·±²¿́ ·²ó ¹¿²·¦¿¬·±²ø÷̧±©²·²¬̧»Í½̧»¼«́»ô¾«¬±²́§©·¬̧ «®»¼¿²¼·²½́«¼»¼·²¬̧»þ°®±¼«½¬ó½±³°́»¬»¼±°»®¿ó ®»°»½¬¬±·́¿¾·́·¬§º±®þ¾±¼·́§·²¶«®§þ±®þ°®±°»®¬§¼¿³ó ¬·±²̧ ¿¦¿®¼þò ¿¹»þ½¿«»¼ô·²©̧ ±́»±®·²°¿®¬ô¾§þ§±«®©±®µþ¿¬¬̧»

×ÍÑЮ±°»®¬·»ôײ½òôîððì п¹»ï±ºï

Any person or organization that you agree in a written contract to include as an additional insured on this Coverage Part for "bodily injury" or "property damage" included in the "products-completed operations hazard", provided that such contract was signed and executed by you before, and is in effect when, the bodily injury or property damage occurs.

Any project to which an applicable contract described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies.

12/12/20246308986R247

ÐÑÔ×ÝÇÒËÓÞÛÎ

ISSUED DATE:

ÌØ×ÍÛÒÜÑÎÍÛÓÛÒÌÝØßÒÙÛÍÌØÛÐÑÔ×ÝÇòÐÔÛßÍÛÎÛßÜ×ÌÝßÎÛÚËÔÔÇò

Ì̧·»²¼±®»³»²¬³±¼·º·»·²«®¿²½»°®±ª·¼»¼«²¼»®¬̧»º±́́±©·²¹æ

ÝÑÓÓÛÎÝ×ßÔÙÛÒÛÎßÔÔ×ßÞ×Ô×ÌÇÝÑÊÛÎßÙÛÐßÎÌ øײº±®³¿¬·±²®»̄«·®»¼¬±½±³°́»¬»¬̧·Í½̧»¼«́»ô·º²±¬̧±©²¿¾±ª»ô©·́́¾»̧±©²·²¬̧»Ü»½́¿®¿¬·±²ò÷

Í»½¬·±²×× É ±̧×߲ײ«®»¼·¿³»²¼»¼¬±·²ó Ì̧··²«®¿²½»¼±»²±¬¿°°́§¬±þ¾±¼·́§·²¶«®§þ±® ½́«¼»¿¿²¿¼¼·¬·±²¿́ ·²«®»¼¬̧»°»®±²ø÷±® þ°®±°»®¬§¼¿³¿¹»þ±½½«®®·²¹ô±®�°»®±²¿́·²¶«®§Œ ±®¹¿²·¦¿¬·±²ø÷̧±©²·²¬̧»Í½̧»¼«́»ô¾«¬±²́§ ±®�¿¼ª»®¬··²¹·²¶«®§Œ¿®··²¹±«¬±º¿²±ºº»²» ©·¬̧®»°»½¬¬±·́¿¾·́·¬§º±®þ¾±¼·́§·²¶«®§þôþ°®±°»®¬§ ½±³³·¬¬»¼ô¿º¬»®æ ¼¿³¿¹»þôþ°»®±²¿́·²¶«®§Œ±®�¿¼ª»®¬··²¹·²¶«®§þ ß́ ©́±®µô·²½́«¼·²¹³¿¬»®·¿́ô°¿®¬±®»̄«·°ó ½¿«»¼ô·²©̧ ±́»±®·²°¿®¬ô¾§æ ³»²¬º«®²·̧»¼·²½±²²»½¬·±²©·¬̧«½̧ ©±®µô DZ«®¿½¬±®±³··±²å±® ±²¬̧»°®±¶»½¬ø±¬̧»®¬̧¿²»®ª·½»ô³¿·²¬»ó

²¿²½»±®®»°¿·®÷¬±¾»°»®º±®³»¼¾§±®±² Ì̧»¿½¬±®±³··±²±º¬̧±»¿½¬·²¹±²§±«® ¾»̧¿́º±º¬̧»¿¼¼·¬·±²¿́·²«®»¼ø÷¿¬¬̧»±́½¿ó¾»̧¿́ºå ¬·±²±º¬̧»½±ª»®»¼±°»®¿¬·±²̧ ¿¾»»²½±³ó

·²¬̧»°»®º±®³¿²½»±º§±«®±²¹±·²¹±°»®¿¬·±²º±® °́»¬»¼å±® ¬̧»¿¼¼·¬·±²¿́·²«®»¼ø÷¿¬¬̧»±́½¿¬·±²ø÷¼»·¹ó

Ì̧¿¬°±®¬·±²±ºþ§±«®©±®µþ±«¬±º©̧·½̧ ¬̧»²¿¬»¼¿¾±ª»ò ·²¶«®§±®¼¿³¿¹»¿®·»̧ ¿¾»»²°«¬¬±·¬·²ó

É·¬̧ ®»°»½¬¬±¬̧»·²«®¿²½»¿ºº±®¼»¼¬±¬̧»» ¬»²¼»¼«»¾§¿²§°»®±²±®±®¹¿²·¦¿¬·±² ¿¼¼·¬·±²¿́·²«®»¼ô¬̧»º±́́±©·²¹¿¼¼·¬·±²¿́»̈½́«ó ±¬̧»®¬̧¿²¿²±¬̧»®½±²¬®¿½¬±®±®«¾½±²¬®¿½ó ·±²¿°°́§æ ¬±®»²¹¿¹»¼·²°»®º±®³·²¹±°»®¿¬·±²º±®¿

°®·²½·°¿́¿¿°¿®¬±º¬̧»¿³»°®±¶»½¬ò

ݱ°§®·¹̧¬îððëÌ̧»Í¬òп«́Ì®¿ª»́»®Ý±³°¿²·»ôײ½òß́ ®́·¹̧¬®»»®ª»¼ò п¹»ï±ºï ײ½́«¼»½±°§®·¹̧¬»¼³¿¬»®·¿́±º×²«®¿²½»Í»®ª·½»Ñºº·½»ôײ½ò©·¬̧·¬°»®³··±²ò

Any person or organization that you agree in a written contract, on this Coverage Part, provided that such written contract was signed and executed by you before, and is in effect when the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed.

Any project to which an applicable written contract with the described in the Name of Additional Insured Person(s) or Organization(s) section of this Schedule applies.

6308986R247 12/12/2024

c. Method Of Sharing

If all of the other insurance permits contribution by equal shares, we will follow this method also.

Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first.

If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this methoo, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers.

d. Primary And Non-Contributory Insurance If Required By Written Contract

If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non contributory basis. this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we will not share with that other insurance, provided that:

(1) The "bodily injury'' or "property damage" for which coverage is sought occurs; and

(2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed;

subsequent to the signing of that contract or agreement by you.

5. Premium Audit

a. We will compute all premiums for this Coverage Part in accordance with our rules and rates.

b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit perioo we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured.

c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request.

6. Representations

By accepting this policy, you agree:

a. The statements in the Declarations are accurate and complete;

b. Those statements are based upon representations you made to us; and

c. We have issued this policy in reliance upon your representations.

The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations.

7. Separation Of Insureds

Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies:

a. As if each Named Insured were the only Named Insured; and

b. Separately to each insured against whom claim is made or "suit" is brought.

8. Transfer Of Rights Of Recovery Against Others To Us

If the insured has rights to recover all or part of any payment we have made under this Coverage Part, 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.

9. When We Do Not Renew

If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date.

If notice is mailed, proof of mailing will be sufficient proof of notice.

SECTION V - DEFINITIONS

1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition:

a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and

b. Regarding websites, only that part of a website that is about your goods, prooucts or services for the purposes of attracting customers or supporters is considered an advertisement.

Page 16 of 21 © 2017 The Travelers Indemnity Company. All rights reserved. CG T1000219 Includes copyrighted material of Insurance Services Office, Inc. with its permiss ion.

Policy # 6308986R247 that is available to any of your "employees"occupational therapist or occupational for "bodily injury" that arises out of providingtherapy assistant, physical therapist or or failing to provide "incidental medicalspeech-language pathologist; or services" to any person to the extent not

(b) First aid or "Good Samaritan services" subject to Paragraph 2.a.(1) of Section II –by any of your "employees" or "volunteer Who Is An Insured.workers", other than an employed or volunteer doctor. Any such "employees" K. MEDICAL PAYMENTS – INCREASED LIMIT or "volunteer workers" providing or failing

The following replaces Paragraph 7. of to provide first aid or "Good Samaritan

SECTION III – LIMITS OF INSURANCE:

services" during their work hours for you

7. Subject to Paragraph 5. above, the Medicalwill be deemed to be acting within the scope of their employment by you or Expense Limit is the most we will pay under performing duties related to the conduct Coverage C for all medical expenses of your business. because of "bodily injury" sustained by any one person, and will be the higher of:3. The following replaces the last sentence of Paragraph 5. of SECTION III – LIMITS OF a. $10,000; or

INSURANCE:

b. The amount shown in the Declarations of For the purposes of determining the this Coverage Part for Medical Expenseapplicable Each Occurrence Limit, all related Limit.acts or omissions committed in providing or failing to provide "incidental medical L. AMENDMENT OF EXCESS INSURANCE services", first aid or "Good Samaritan CONDITION – PROFESSIONAL LIABILITY services" to any one person will be deemed

The following is added to Paragraph 4.b.,to be one "occurrence".

Excess Insurance, of SECTION IV –

4. The following exclusion is added to COMMERCIAL GENERAL LIABILITY Paragraph 2., Exclusions, of SECTION I – CONDITIONS:

COVERAGES – COVERAGE A – BODILY

This insurance is excess over any of the otherINJURY AND PROPERTY DAMAGE insurance, whether primary, excess, contingentLIABILITY:

or on any other basis, that is Professional

Sale Of Pharmaceuticals Liability or similar coverage, to the extent the

"Bodily injury" or "property damage" arising loss is not subject to the professional services out of the violation of a penal statute or exclusion of Coverage A or Coverage B.

ordinance relating to the sale of

M. BLANKET WAIVER OF SUBROGATION –pharmaceuticals committed by, or with the WHEN REQUIRED BY WRITTEN CONTRACTknowledge or consent of the insured.

OR AGREEMENT

5. The following is added to the DEFINITIONS The following is added to Paragraph 8., TransferSection:

Of Rights Of Recovery Against Others To Us, "Incidental medical services" means:

of SECTION IV – COMMERCIAL GENERAL

a. Medical, surgical, dental, laboratory, x- LIABILITY CONDITIONS:

ray or nursing service or treatment, If the insured has agreed in a written contract or advice or instruction, or the related agreement to waive that insured's right offurnishing of food or beverages; or recovery against any person or organization, we

b. The furnishing or dispensing of drugs or waive our right of recovery against such person medical, dental, or surgical supplies or or organization, but only for payments we make appliances. because of:

6. The following is added to Paragraph 4.b.,

a. "Bodily injury" or "property damage" that

Excess Insurance, of SECTION IV – occurs; or

COMMERCIAL GENERAL LIABILITY

b. "Personal and advertising injury" caused byCONDITIONS:

an offense that is committed;This insurance is excess over any valid and subsequent to the signing of that contract orcollectible other insurance, whether primary, excess, contingent or on any other basis, agreement.

CG D3 79 02 19 ú 2017 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 Includes copyrighted material of Insurance Services Office, Inc. with its permission.

Policy # 6308986R247

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ÐÑÔ×ÝÇ ÒËÓÞÛÎæ

ÛÓÐÔÑÇÛÎÍ Ô×ßÞ×Ô×ÌÇ ÐÑÔ×ÝÇ ßÒÜ

ÉÑÎÕÛÎÍ ÝÑÓÐÛÒÍßÌ×ÑÒ

Éß×ÊÛÎ ÑÚ ÑËÎ Î×ÙØÌ ÌÑ ÎÛÝÑÊÛÎ ÚÎÑÓ ÑÌØÛÎÍ ÛÒÜÑÎÍÛÓÛÒÌ ððï

ÑÒÛ ÌÑÉÛÎ ÍÏËßÎÛ ØßÎÌÚÑÎÜ ÝÌ ðêïèí

É» ¸¿ª» ¬¸» ®·¹¸¬ ¬± ®»½±ª»® ±«® °¿§³»²¬ º®±³ ¿²§±²» ´·¿¾´» º±® ¿² ·²¶«®§ ½±ª»®»¼ ¾§ ¬¸· °±´·½§ò É» ©·´´ ²±¬ »²º±®½» ±«® ®·¹¸¬ ¿¹¿·²¬ ¬¸» °»®±² ±® ±®¹¿²·¦¿¬·±² ²¿³»¼ ·² ¬¸» ͽ¸»¼«´»ò ø̸· ¿¹®»»³»²¬ ¿°°´·» ±²´§ ¬± ¬¸» »¨¬»²¬ ¬¸¿¬ §±« °»®º±®³ ©±®µ «²¼»® ¿ ©®·¬¬»² ½±²¬®¿½¬ ¬¸¿¬ ®»¯«·®» §±« ¬± ±¾¬¿·² ¬¸· ¿¹®»»³»²¬ º®±³ «ò÷

̸· ¿¹®»»³»²¬ ¸¿´´ ²±¬ ±°»®¿¬» ¼·®»½¬´§ ±® ·²¼·®»½¬´§ ¬± ¾»²»º·¬ ¿²§ ±²» ²±¬ ²¿³»¼ ·² ¬¸» ͽ¸»¼«´»ò

ÍÝØÛÜËÔÛ

ÜÛÍ×ÙÒßÌÛÜ ÑÎÙßÒ×ÆßÌ×ÑÒæ

ÜÛÍ×ÙÒßÌÛÜ ÐÛÎÍÑÒæ

ÐßÙÛÍÌ ßÍÍ×ÙÒæ ÑÚÜßÌÛ ÑÚ ×ÍÍËÛæ ï ï

Any Person or organization for which the insured has agreed by written contract executed prior to loss to furnish this waiver.

UB6P428399

12/12/2024 Travelers Property Casualty Company of America

AE 00 H015 00 0321 © 2021, The Hartford Page 1 of 1

ENDORSEMENT NO:4

This endorsement, effective 12:01 am, 10/03/2024 forms part of policy number 72 OH 0681905-24 issued to: NINYO & MOORE GEOTECHNICAL & ENVIRONMENTAL SCIENCES CONSULTANTS by: PACIFIC INSURANCE COMPANY, LTD

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

BLANKET NOTICE ENDORSEMENT

This endorsement modifies insurance provided under:

THE HARTFORD PREMIER CHOICE PROFESSIONAL LIABILITY INSURANCE POLICYSM

DESIGN PROFESSIONALS LIABILITY COVERAGE PART

It is agreed that:

The Insurer will provide 30 day’s written notice prior to the effective date of:

30 Cancellation of the policy.

30 Cancellation of the policy for any reason other than nonpayment of premium.

30 Nonrenewal of the policy.

30 Reduction of policy limits by endorsement.

30 Material change in coverage by endorsement.

The Insurer will provide this written notice using:

Certified mail

US

MAIL

U. S. mail

Other

The Insurer will provide this written notice to the persons or entities specified by the Named Entity provided that the Insurer receives a written request from the Named Entity listing the name and address of each of the entities designated to receive such notice. Should the policy be cancelled due to nonpayment of premium, the Insurer will provide 10 days written notice to the specified persons or entities.

The Named Entity’s failure to provide the Insurer such list, and/or the Insurer’s failure to send notice will not amend the cancellation date of the policy.

All other terms and conditions remain unchanged.

Ross Fisher, President

POLICY NUMBER:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

DESIGNATED PERSON OR ORGANIZATION – NOTICE OF

CANCELLATION PROVIDED BY US

This endorsement modifies insurance provided under the following:

ALL COVERAGE PARTS INCLUDED IN THIS POLICY

CANCELLATION:

SCHEDULE

Number of Days Notice:

PERSON OR

ORGANIZATION:

ADDRESS:

PROVISIONS

IL T4 05 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1

SEE CA T8 01

If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation.

8107N033091

SEE CA T8 01

SAN DIEGO CA 92123

POLICY NUMBER:

COMMERCIAL AUTO POLICY

IT IS AGREED THAT:

** THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. **

ENDORSEMENT -

8107N033091

IL T4 05 - DESIGNATED ENTITY

CA T8 01 10 23

PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE

AGREED IN A WRITTEN CONTRACT THATNOTICE OF CANCELLATION OF THIS POLICY

WILL BE GIVEN, BUT ONLY IF:

1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE

NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST

NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS

POLICY; AND

2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE

BEGINNING OFTHE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE.

ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH

WRITTEN REQUESTFROM YOU TO US.

Page of1 1

POLICY NUMBER: 6308986R247 GENERAL PURPOSE ENDORSEMENT

DESIGNATED ENTITY - NOTICE OF

CANCELLATION PROVIDED BY US

(IL T4 05 03 11)

THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:

ALL COVERAGE PARTS INCLUDED IN THIS POLICY:

CONTINUATION OF FORM IL T4 05 PERSON OR ORGANIZATION

SCHEDULE

CANCELLATION: NUMBER OF DAYS NOTICE: 30

"ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT

THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF:

1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING

THE NAMED AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER

THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE

CANCELLATION OF THIS POLICY, AND

2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE

BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS

SCHEDULE."

ADDRESS:

"THE ADDRESS FOR THE PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST

FROM YOU TO US."

IL TB 03 Page 1

POLICY NUMBER: 6308986R247 GENERAL PURPOSE ENDORSEMENT

DESIGNATED ENTITY - NOTICE OF

CANCELLATION PROVIDED BY US

(IL T4 00)

THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:

ALL COVERAGE PARTS INCLUDED IN THIS POLICY:

CONTINUATION OF FORM IL T4 05 PERSON OR ORGANIZATION

SCHEDULE

CANCELLATION: NUMBER OF DAYS NOTICE: 30

"ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT

THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF:

1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING

THE NAMED AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER

THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE

CANCELLATION OF THIS POLICY, AND

2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE

BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS

SCHEDULE."

ADDRESS:

"THE ADDRESS FOR THE PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST

FROM YOU TO US."

IL TB 03 Page 2

All other terms and conditions of this policy remain unchanged.

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.)

Endorsement Effective Policy No. Endorsement No.

Insured Premium $

Countersigned by

WORKERS COMPENSATION

AND

EMPLOYERS LIABILITY POLICY

ENDORSEMENT WC 99 06 R4 (00) -

POLICY NUMBER:

NOTICE OF CANCELLATION OR NONRENEWAL

TO DESIGNATED PERSONS OR ORGANIZATIONS

SCHEDULE

Name and Address of Designated Persons or Organizations: Number of Days Notice:

The following is added to PART SIX – CONDITIONS :

Notice Of Cancellation Or Nonrenewal To Designated Persons Or Organizations

If we cancel or non-renew this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation or non-renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect.

You are responsible for providing us with the information necessary to accurately complete the Schedule below.

If we cannot mail or deliver a notice of cancellation or nonrenewal to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation or nonrenewal.

ONE TOWER SQUARE

HARTFORD CT 06183

UB6P428399

ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A

WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF

THIS POLICY WILL BE GIVEN, BUT ONLY IF:

1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE

SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR

ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM

US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND

2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE

BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS

ENDORSEMENT.

ADDRESS:

THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN

SUCH WRITTEN REQUEST FROM YOU TO US.

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Insurance Company

ST ASSIGN:

© 2013 The Travelers Indemnity Company. All rights reserved.