TEP_Certificate_of_Insurance_Valid_Thru_6-1-21.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

12/10/2020

NFP Corporate Services (SE), Inc.

1901 Roxborough Rd, Ste 300 Charlotte NC 28211

Maria Wilson 704-973-2351 704-523-0024 maria.wilson@nfp.com

Allied World Specialty Insurance Company 16624 TOWENGP Indian Harbor Insurance Company 36940

TEP OpCo LLC, Tower Engineering Professionals Inc.

TEP Holdings, LLC 326 Tryon Road Raleigh NC 27603-3530

Allied World Surplus Lines Insurance Co 24319 Starr Indemnity & Liability Company 38318 Redwood Fire and Casualty Insurance Company 11673

376559140

C X 2,000,000 X 100,000

X BI/PD Ded 50,000 5,000

2,000,000

4,000,000 X

Y Y 6004-0343 6/1/2020 6/1/2021

4,000,000

A 2,000,000

X

X X

Y Y 6000-0619 6/1/2020 6/1/2021

D X 5,000,000 X

1000586344201 6/1/2020 6/1/2021

5,000,000

E X

N

Y TEWC120628 (AOS) 6/1/2020 6/1/2021

1,000,000

1,000,000

1,000,000 E B B

Workers Compensation Pollution Liability Professional Liability

TEWC120815 (FL & OR)

CEO744614601

CEO744614601

6/1/2020 6/1/2020 6/1/2020

6/1/2021 6/1/2021 6/1/2021

Employers Liability 25,000 Retention 250,000 Retention

1,000,000 5,000,000 5,000,000

Excess Liability - Endurance American Specialty Insurance Company #ELD30001725100 Eff 06/01/2020 to 06/01/2021 - $5,000,000 Limit - Each Occurrence/Aggregate (This policy is Excess Limit to Starr Policy #1000586344201)

RE: Solicitation BPM002972 Arizona Department of Public Safety, the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents and employees are named as Additional Insured with respect to General Liability and Auto Liability coverage. Coverage is primary and non-contributory. Waiver of subrogation in favor of Additional Insureds with regards to General Liability, Auto Liability and Workers' Compensation coverage.

Arizona Department of Public Safety 2102 W. Encanto Blvd.

Phoenix AZ 85009

COMMERCIAL AUTO

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 00033 00 (11/15)

PRIMARY AND NON-CONTRIBUTORY - SCHEDULE

This endorsement modifies insurance provided under the following:

BUSINESS AUTO COVERAGE FORM

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Where required by written contract

(Effective: May 22, 2020)

Notwithstanding any other provision of this policy to the contrary, the insurance afforded to the person(s) or organization(s) shown in the Schedule above will be primary to, and non-contributory with, any other insurance available to such person or organization in the event a written contract or written agreement you enter into requires you to furnish insurance to such person or organization of the type provided by this policy.

POLICY NUMBER: 6000-0619 COMMERCIAL AUTO

CA 04 44 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US (WAIVER OF SUBROGATION)

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: TEP Holdings, LLC

Endorsement Effective Date: 05/22/2020

SCHEDULE

Name(s) Of Person(s) Or Organization(s):

Where required under written contract provided such contract was entered into prior to the occurrence.

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

The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization.

POLICY NUMBER: 6000-0619 COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: TEP Holdings, LLC

Endorsement Effective Date: 05/22/2020

SCHEDULE

Name Of Person(s) Or Organization(s):

Where required by written contract

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

Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form.

POLICY NUMBER: 6004-0343 COMMERCIAL GENERAL LIABILITY

CG 20 10 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2

ADDITIONAL INSURED – OWNERS, LESSEES OR

CONTRACTORS – SCHEDULED PERSON OR

ORGANIZATION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE

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

Any owner, lessee, or contractor whom you have agreed to include as an additional insured under a fully executed written contract or written agreement, provided that such was executed prior to an "occurrence", loss, injury or damage.

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

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

1. Your acts or omissions; or

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

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

However:

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

2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured.

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

This insurance does not apply to "bodily injury" or "property damage" occurring after:

1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or

2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.

Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13

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

If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance:

1. Required by the contract or agreement; or

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

whichever is less.

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

COMMERCIAL GENERAL LIABILITY

CG 20 01 04 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1

PRIMARY AND NONCONTRIBUTORY –

OTHER INSURANCE CONDITION

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

The following is added to the Other Insurance Condition and supersedes any provision to the contrary:

Primary And Noncontributory Insurance

This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that:

(1) The additional insured is a Named Insured under 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.

POLICY NUMBER: 6004-0343 COMMERCIAL GENERAL LIABILITY

CG 24 04 05 09

CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE

Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a fully executed written contract or written agreement, provided such contract or agreement was executed prior to the date of the "occurrence", loss, injury or damage.

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

The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions:

We waive any right of recovery we may have against the person or organization shown in the Schedule above 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". This waiver applies only to the person or organization shown in the Schedule above.

WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13

(Ed. 4-84)

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All AZ Operations 558.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

Premium $

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All CO Operations 762.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All GA Operations 10.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All ID Operations 6.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All IN Operations 161.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All MT Operations 0.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All NC Operations 8,348.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All NY Operations 0.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All SC Operations 0.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All TN Operations 0.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All VA Operations 0.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Redwood Fire and Casualty Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120628Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All FL Operations 485.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Continental Divide Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120815Endorsement Effective: 06/01/2020

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

WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT

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

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

Schedule

Blanket Waiver

Person/Organization: Blanket Waiver - Any person or organization for whom the Named

Insured has agreed by written contract to furnish this waiver.

Waiver PremiumJob Description

All OR Operations 15.00

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

© 1983 National Council on Compensation Insurance

(Ed. 4-84)

Countersigned by ____________________________________WC 00 03 13

Insurance Company: Continental Divide Ins Co

Insured:

Endorsement No.: Policy No.: TEWC120815Endorsement Effective: 06/01/2020

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