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HomeMy WebLinkAbout2019-714-E AMS - Xybix Systems Inc. ES furniture DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 [Departmental Use Only] TITLE ES Comm Furn FY 2019-20 NORTH CAROLINA CONSTRUCTION AGREEMENT UNDER$250,000.00 ORANGE COUNTY THIS CONSTRUCTION AGREEMENT (hereinafter called "Agreement"), made as of the 30th day of September, 2019, by and between Xybix Systems, Inc., (hereinafter called the "Contractor"), and Orange County, a body politic and a political subdivision of the State of North Carolina, (hereinafter called the "County," "Orange County," and/or"Owner"). WITNESSETH: That the Contractor and the Owner, for the consideration herein named, agree as follows: 1. CONTRACT DOCUMENTS; PRIORITY The Contract Documents consist of this Agreement, the Request for Proposals, Proposal, Construction Drawings, and Written Specifications. The Contract Documents form the Contract. In the event of any inconsistency between or among the Contract Documents the Contract Documents shall be interpreted in the following order of priority: a. This Agreement. b. Designer Approved Bulletins and/or Field Orders. c. Request for Proposals and addenda thereto. d. Proposal. 2. SCOPE OF WORK The Contractor shall furnish and deliver all of the materials, and perform all of the work required by this Agreement within the time period stipulated in a written Notice-to-Proceed to be executed by the Contractor and Owner and in accordance with the following enumerated documents, which are made a part hereof as if fully contained herein: a. Construction Drawings prepared by N/A (Sheet dated ) b. Written specifications prepared by the project engineer. c. Xybix Systems, Inc., #24880 proposal dated September 12, 2019 which fully describes the work to be performed. Such work will hereafter be called the "Work". d. Related documents listed under Section 1 above. 3. TERM AND SCHEDULING Revised 12/18 1 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 a. The Contractor agrees to commence work pursuant to the written Notice to Proceed. b. The Contractor agrees to complete substantially all Work by December 22, 2019. c. Time is of the essence with respect to all dates specified in the Contract Documents as Completion Dates. d. The Contractor shall perform the Work in the time, manner, and form required by the Contract Documents and as stipulated in a written Notice-to-Proceed to be executed by the Contractor and Owner. e. It is expressly understood that the Owner will employ other contractors to perform work as a part of the Project whose work will be performed simultaneously and sequentially with the performance of the Work by the Contractor. It shall be necessary for the Contractor to coordinate its activities with such other contractors, particularly with respect to access to work areas, storage of materials and other common facilities. f. Should the Owner determine that the Contractor is behind schedule Owner may require, at no additional cost to the Owner, the Contractor to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform the Work in accordance with the approved project schedule. 4. STANDARD OF CARE a. The Contractor shall exercise reasonable care and diligence in performing the Work in accordance with the highest generally accepted standards of this type of Contractor practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. Contractor is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work. b. The Contractor shall not load or permit any part of the Work to be loaded with a weight that will endanger its safety, intended performance or configuration. c. Contractor shall be responsible for all errors or omissions caused by its employees, agents, contractors, or assigns in the performance of the Agreement. Contractor shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the Owner. d. Contractor is an independent contractor of Owner. Any and all employees of the Contractor engaged by the Contractor in the performance of any work or services required of the Contractor under this Agreement, shall be considered employees or agents of the Contractor only and not of the Owner, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Contractor. e. If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Contractor represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, Revised 12/18 2 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. f. The Contractor is responsible for all physical damage to owned or rented machinery, tools, equipment, forms, and other items owned, rented or used by the Contractor and/or Subcontractor(s) in the performance of the Work including all of Owner's property in Contractor's care, custody, or control, and all such property while it is in transit. g. The Contractor is solely responsible for obtaining all permits necessary to complete the Work in compliance with all local, state, and federal laws. 5. PAYMENT & TAXES a. The Owner hereby agrees to pay to the Contractor for the faithful performance of this Agreement, and the Contractor hereby agrees to perform all of the Work for a sum not-to- exceed One Hundred Seventy One Thousand Four Hundred Twenty Three Dollars ($171,423.00). Not later than the fifth (5th) day of each calendar month the Contractor shall submit to the Owner's Representative, generally the architect if an architect is retained on the Work, a Request for Payment for work done during the previous calendar month. i. The Request for Payment shall be in form of a standardized invoice or AIA Document G702-703 appropriately addressed to Owner's Representative at Orange County, Asset Management Services, C/O Angel Barnes PO Box 8181, Hillsborough, NC 27278 and shall show substantially the value of work done during the previous calendar month. ii. The amount due for payment shall be ninety-five percent (95%) of the value of work completed since the last Request for Payment and this amount shall be paid by the Owner on or before the last business day of the month. Owner shall retain five percent(5%). 1. Upon Owner's Representative's certification that ninety percent (90%) of the Work has been satisfactorily completed retainage may be discontinued. Retainage may be discontinued, at Owner's Discretion, so long as work continues to be completed satisfactorily and on schedule. iii. Final payment shall not be due to the Contractor until thirty (30) days after one hundred percent (100%) of the Work, including punch list work, has been satisfactorily completed and an appropriate affidavit as required in Section 7(c) below has been received by Owner. b. Should Owner reasonably determine that Contractor has failed to perform the Work related to a Request for Payment, Owner, at its discretion may provide the Contractor ten (10) days to cure the breach. Owner may withhold the accompanying payment without penalty until such time as Contractor cures the breach. i. Should Contractor or its representatives fail to cure the breach within ten (10) days, or fail to reasonably agree to such modified schedule, Owner may immediately terminate this Agreement in writing, without penalty or incurring further obligation to Contractor. ii. This section shall not be interpreted to limit the definition of breach to the failure to perform the Work related to a Request for Payment. Revised 12/18 3 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 c. The Contractor has included in the Contract Price and shall pay all taxes assessed by any authority on the Work or the labor and materials used therein. It shall be the Contractor's responsibility to furnish the Owner documentary evidence showing the materials used and sales and use tax paid by the Contractor and each of its subcontractors. 6. INSURANCE AND BONDS a. Minimum requirements — Contractor shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by Owner's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http://www.oran eg countyLac. ova/departments/purchasing_division/contracts.php). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall be designated here N/A (if no additional insurance required mark N/A as being not applicable). Contractor shall not commence construction work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. b. Performance Bonds — Contractor shall furnish bonds covering the faithful performance of the Contract and payment of all obligations arising under any of the Contract Documents or related in any way to the Work. Contractor shall immediately furnish a copy of such bonds to any requesting person who appears to be a potential beneficiary of bonds covering payment obligations arising under any of the Contract Documents. This subsection 6(b) applies only to Contracts of fifty thousand dollars ($50,000.00) or more where the total cost for the project is three hundred thousand dollars ($300,000.00) or more. 7. INDEMNITY a. The Contractor shall indemnify, without limitation, and hold harmless to the maximum extent permitted by law the Owner and its agents and employees from and against any and all claims, damages, losses and expenses, including attorney's fees, arising out of or resulting from the performance or nonperformance of the Work, provided that any such claim, damages, loss or expense (A) is attributable to bodily injury, sickness, disease or death or injury to, or destruction of, property, including the loss of use resulting therefrom; and (B) is caused in whole or in part by any breach of any provision of the Agreement or by any negligent or wrongful act or omission of the Contractor, any Subcontractor, or supplier of the Contractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The indemnification obligation under this paragraph shall not be limited in any way by any limitation of the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' compensation acts, disability benefits acts or other employee benefit acts. b. The Contractor shall indemnify and hold harmless Owner from any lien of whatever type through the purchase of appropriate bonds and insurance as designated in Section 6 above. In the event any such lien is filed against Owner's property Contractor shall, through such bonds and insurance or at Contractors expense, defend Owner against all such claims of lien. Revised 12/18 4 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 c. Upon completion of the Work the Contractor shall execute an affidavit stating there are no unpaid debts for any work that has been done or materials that have been furnished to the project prior to and as of the date of substantial completion and further stating that Contractor shall indemnify, save and protect Owner and Owner's lender, if any, harmless from and against any and all claims, liabilities, losses, damages, causes of action, and expenses (including court costs and reasonable attorney's fees related thereto) arising out of, in connection with, or resulting from any such debts and liens. Such indemnification shall be in a form and substance acceptable to Owner. d. By executing this Agreement Contractor agrees to abide by and be bound by the indemnification provisions herein and of Section 7(c) specifically. 8. DISPUTE RESOLUTION AND GOVERNING LAW a. Any dispute with respect to any provision of, or the performance or non-performance of, this Agreement shall be subject to the Dispute Resolution Rules and Procedures for Orange County Design, Building Construction, Renovation, and Repair Projects. The policy is incorporated herein by reference and may be viewed at http://www.oran e�ync. o�partments/purchasing division/contracts.php). b. The laws of the State of North Carolina shall apply to the interpretation and enforcement of this Agreement. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or nonperformance of, this Agreement or the Contract shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina and it is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. c. Notice of any claim by Owner or Contractor must be initiated by written notice to the other Party within thirty (30) days of the occurrence of the event giving rise to the claim or within thirty (30) days of the discovery of the event or condition giving rise to the claim, whichever is later. i. Should any claim be made, regardless of whether such claim is made by Owner or Contractor, Contractor shall continue to faithfully and diligently perform the Work in such a manner as to meet all scheduled timelines. Any failure to faithfully and diligently perform the Work may be deemed, by the Owner, a breach of the Contract. ii. If a claim is made such claim shall be made to the initial decision maker, if applicable, who may request more supporting data, reject the claim in whole or in part, approve the claim in whole or in part or advise the parties the claim is unable to be resolved. iii. If a claim is made by the Owner the Owner may, but is not obligated to, notify the surety. 9. NON—APPROPRIATION a. Contractor acknowledges that Owner is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. b. In the event that public funds are unavailable and not appropriated for the performance of Owner's obligations under this Agreement, then this Agreement shall automatically expire Revised 12/18 5 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 without penalty to Owner immediately upon written notice to Contractor of the unavailability and non-appropriation of public funds. It is expressly agreed that Owner shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. c. In the event of a change in the Owner's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects Owner's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to Owner upon written notice to Contractor of such limitation or change in Owner's legal authority. 10. NOTICES Any notice required by this Agreement shall be in writing and delivered by certified or registered mail,return receipt requested to the following: Owner: Contractor: Orange County Xybix Systems, Inc. Attn: Angel Barnes Attn: Ken Carson P.O. Box 8181 8207 South Park Circle Hillsborough,NC 27278 Littleton, CO 80120 11. MISCELLANEOUS a. Duties and Obligations imposed by the Contract Documents shall be in addition to any Duties and Obligations imposed by state, federal or local law, rules, regulations and ordinances. b. No act or failure to act by the Owner or Contractor shall constitute a waiver of any right or duty granted them under the Contract Documents, nor shall any act or failure to act constitute any approval except as specifically agreed in writing. c. The Work shall be tested and inspected as required by the Contract Documents and as required by law. Unless prohibited by law the costs of all such tests and inspections related to state and federal codes such as ADA, Administrative, Electrical, Plumbing, Mechanical and Building Codes shall be borne by the Contractor. The costs for material and structural testing shall be conducted by an independent third party at the expense of the Owner. Delays related to any of the aforementioned tests and inspections shall not be grounds for delaying the completion of the work. If any such tests and inspections reveal deficiencies in the Work such that the Work does not comply with terms or requirements of the Contract Documents and/or the requirements of any code or law the Contractor is solely responsible for the cost of bringing such deficiencies into compliance with the terms of the Contract Documents and/or any code or law. d. Should the Architect, if an architect is retained for the project involving the Work, or Owner reject any portion of the Work for failing to comply with the Contract Documents Contractor shall immediately, at Contractor's expense, correct the Work. Any such rejection may be made before or after substantial completion. If applicable, any additional expense borne by the Architect under this section shall be paid at Contractor's expense. Revised 12/18 6 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 e. The Contractor shall not assign any portion of this Agreement nor subcontract the Work in its entirety without the prior written consent of the Owner. f. By executing this Agreement Contractor affirms that Contractor and any subcontractors of Contractor are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. g. By executing this Agreement Contractor certifies that Contractor has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.58. h. By executing this Agreement Contractor certifies that Contractor has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. i. The County has designated(Angel Barnes)to act as the County's representative with respect to the Work and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. j. Contractor shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal non- discrimination laws, policies, rules, and regulations and the Orange County Non- Discrimination Policy and Orange County Living Wage Policy(each policy is incorporated herein by reference and may be viewed at http://www.oran eg countync. ov�/departments/purchasing division/contracts.php). Any violation of the Orange County Non-Discrimination Policy is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. k. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and intent of the Parties to comply with Article I I A and Article 40 of North Carolina General Statute Chapter 66. 12. CONSEQUENTIAL AND LIQUIDATED DAMAGES a. Owner and Contractor mutually waive any claim against each other for consequential damages. Consequential Damages include: i. Damages incurred by Owner for loss of use, income, financing, or business. ii. Damages incurred by Contractor for office expenses, including personnel, loss of financing, profit, income, business, damage to reputation, or any other non-direct damages. b. Liquidated damages shall be in accord with the Contract Documents. If the Contract Documents do not otherwise address liquidated damages, such damages shall be in the Revised 12/18 7 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 amount of five hundred dollars ($500.00) per day. 13. TERMINATION OR SUSPENSION a. The Owner may, without cause, order the Contractor to terminate, suspend, delay or interrupt the Work in whole or in part for such period of time as the Owner may determine. i. If Owner issues a written order to delay, suspend, or interrupt the Work, and such order is not due to or as a result of any fault on the part of the Contractor or any subcontractor, the Contractor may recover a per diem amount of five hundred dollars ($500.00) per day with a not-to-exceed limit of ten thousand dollars ($10,000.00). ii. In the event of termination by the Owner under this Agreement, the Contractor shall be entitled to receive its reasonable and documented direct costs prior to termination, including the cost of materials purchased for the Work which purchases cannot be canceled or which material cannot reasonably be used by the Contractor on other work, and the cost of closing down the work in a safe and efficient manner. iii. If Owner elects to suspend or terminate the contract pursuant to subparagraphs 13.a.i. or 13 a.ii. the sole remedy available to the Contractor are those listed in the subparagraphs and Contractor is not entitled to any right to further claims for any amount owed or disputed or for payment of damages alleged to have been sustained as a result of Owner's order to delay, suspend, or interrupt the Work. b. The Owner may, with cause, order the Contractor to suspend, delay or interrupt the Work in whole or in part for such period of time as the cause remains. i. If Owner issues a written order to delay, suspend, or interrupt the Work, and such order is due to or as a result of any fault on the part of the Contractor or any subcontractor, the Owner may reduce payment at a per diem amount of five hundred dollars ($500.00)per day. c. Contractor may terminate the Contract if, at the Owner's written direction, the Work is stopped for twenty one (21) consecutive days through no act or fault of the Contractor, their agents or employees, or a subcontractor or their agents or employees or any other person performing work pursuant to the Contract Documents. Contractor may terminate the Contract if a Court or other Public authority having jurisdiction enters a lawful order that requires all work to be stopped and such stoppage lasts for twenty one (21) consecutive days. 14. ENTIRE AGREEMENT All of the documents listed, referenced or described in this Agreement, the written Notice-to- Proceed, together with Modifications made or issued in accordance herewith are the Contract Documents, and the work, labor, materials and completed construction required by the Contract Documents and all parts thereof is the Work. The Contract Documents constitute the entire agreement between Owner and Contractor. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. If any provision of the Agreement shall be declared invalid or unenforceable, the remainder of the Agreement shall continue in full force and effect. Revised 12/18 8 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 [SIGNATURE PAGE TO FOLLOW] Revised 12/18 9 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the day and date first above written wholly or in a number of counterparts each of which shall, without proof or accounting for other counterparts, be deemed an original contract. ORANGE COUNTY CONTRACTOR f�akuit.�a+uwtv'� 10/8/2019 9/30/2019 Signature Signature County Manager Ken Carson Executive vice President Printed Name and Title Revised 12/18 10 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 ORANGE COUNTY-DEPARTMENT USE ONLY Party/Vendor Name: Xybix Systems, Inc Party/Vendor Contact Person: Cher Stepanov(cherIkNybix.com) Contact Phone: 303.683.5656 Party/Vendor Address: 8207 South Park Circle City Littleton State: Colorado Zip: 80120 Department: AMS/ES Amount: $171,423.00 Purpose: Provide and install furniture for the Orange County 9-1-1 Communication Center Budget Code(s): 61370035-880000-10068 Vendor# 63767 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 9/30/19 Approved by Board Yes Sd ❑No® Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: Department Director's Signature CimIXL ,is Date:10/1/2019 s Q, Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: N/A Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: Office of the Risk Management Officer , S,bn1t f° Date:10/4/2019 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officers Date:10/7/2019 Legal Services This agreement is approved as to legal form and sufficiency: Office of the Count Attorne '�'�'" Date: 10/8/2019 y y��4..,,,��wa,P Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 12/18 11 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Xybix Systems, Inc. 8207 SouthPark Circle � Quote Number: 24880 Littleton, CO 80120 g XYb1X P Quote Date: 9/12/2019 hone:303-683-5656 Fax:303-683-5454 Revision: C kristiner Orig Create Date: 4/23/2019 'Quote Expires: 12/11/2019 Opp#: 0020487 Terms: 1% 20 Days, NET 30 Days Page: 1 of 3 Quote To: Ship To: Orange County Emergency Services Acct: ORACOUHINC 510 Meadowland Drive Kevin Medlin Orange County Emergency Services Hillsborough PO Box 8181 NC 27278 Hillsborough NC 27278-8181 Sales Person: CHER ICE Rep Phone: 919.904.3487 Phone: 919-245-6139 Email: cheri@xybix.com HGAC-EC07-18 Eagle Line 09.12.2019-Drawing R3—kmr 08.20.2019-Drawing R2—kmr 04.23.19-Drawing R1. KNC Line Part Number Description Qty U/M List Ea Disc% DiscPrice Net Price 1.00 12343. Panel System Priced by the Linear Foot: 21 1.0 EA $42,151.50 50$21,075.75 $21,075.75 Grade 3Fabric 12343-1-SS-42-48in-58.5 LF @ 199 12343-1-DS-42-48in- 113 LF @ 270 12344-1-SS-65in-0 LF @ 267 12344-1-DS-65in-0 LF @ 372 Upper Tiles Fabric Color:TBD Grade 3 G3 Lower Tiles Fabric Color:TBD Grade 3 G3 Panel Trim Color: Black 1.01 14145-BLK Cable Pole 96"-Alum Black 20 12.0 EA $92.00 50 $46.00 $552.00 2.00 14377-3D. Adj.Table Worksurface-Corner Dual Surface-90L 1 11.0 EA $2,292.00 50 $1,146.00 $12,606.00 x 90R 10 RV- Cable Management Included 3.00 15702 L5 Table Base 2 11.0 EA $7,174.00 50 $3,587.00 $39,457.00 4.00 12757-3D. Monitor Mount 2 -Rollervision- -1 HI - 22 11.0 EA $3,498.00 50 $1,749.00 $19,239.00 Corner Dual Surface-90L x 90R 10 RV- 12076-Std VESA Mount Qty=4 Total: $1056 16127-Std VESA Mount 2 HI 2 Knuckle Qty= 1 Total: $675 5.00 14349 Display Port Cable 25 FT Male/Male 4 22.0 EA $82.00 50 $41.00 $902.00 5.01 12616 Ext. Monitor Cable 20'VGA High Quality 30 11.0 EA $82.00 50 $41.00 $451.00 Male/Female QuotForm:001:00 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Xybix Systems, Inc. 8207 SouthPark Circle • Quote Number: 24880 Littleton, CO 80120 Quote Date: 9/12/2019 XYb1X Phone:303-683-5656 Fax:303-683-5454 -Ow Revision: C kristiner Orig Create Date: 4/23/2019 Quote Expires: 12/11/2019 Opp#: 0020487 Terms: 1% 20 Days, NET 30 Days Page: 2 of 3 5.02 15532 Ext. Monitor Replacement Cable DVI-D Male/Male 31 33.0 EA $82.00 50 $41.00 $1,353.00 8M (25') 5.03 16130-8 Datadock2-Keyboard Snap-In Cable Organizer 5 11.0 EA $567.00 50 $283.50 $3,118.50 Includes: 8-USB Ports 1 -RJ45 Port 6.00 11792-BLK Power Bar- 10 Outlet With Black Sticker 6 11.0 EA $146.00 50 $73.00 $803.00 6.01 11792-OR Power Bar- 10 Outlet With Orange Sticker 7 11.0 EA $146.00 50 $73.00 $803.00 7.00 12605MCC Light-LED Status Indicator 56MM 2 HI 8 11.0 EA $1,013.00 50 $506.50 $5,571.50 Red-Green-24VAC/DC For MyClimate 7.01 15618MCC Task Light Pair LUX2 LED My Climate 9 11.0 EA $539.00 50 $269.50 $2,964.50 8.00 15463 Shelf Under Surface 19W x 9D-Metal 10 11.0 EA $137.00 50 $68.50 $753.50 8.01 15476 Shelf Under Surface USB Charging Upgrade 11 11.0 EA $114.00 50 $57.00 $627.00 Assembly 9.00 15620MCC MyClimate Personal Climate Control With Forced Ait2 11.0 EA $2,142.00 50 $1,071.00 $11,781.00 Heat 250W X2 =50OW 10.00 12033-3D. Return Worksurface- 18Wx36D 23 5.0 EA $485.00 50 $242.50 $1,212.50 10.01 12033-3D. Return Worksurface-36Wx33D 24 1.0 EA $485.00 50 $242.50 $242.50 11.00 16209 Cable Bridge Corner Angled Left Side 13 6.0 EA $215.00 50 $107.50 $645.00 11.01 16210 Cable Bridge Corner Angled Right Side 14 7.0 EA $215.00 50 $107.50 $752.50 11.02 15220-3D. CPU Cabinet-ERGO ACCESS Tech Tower 15 2.0 EA $1,757.00 50 $878.50 $1,757.00 18Wx48H Single Left Access 11.03 15220-3D. CPU Cabinet-ERGO ACCESS Tech Tower 16 3.0 EA $1,757.00 50 $878.50 $2,635.50 18Wx48H Single Right Access 11.04 15220-3D. CPU Cabinet-ERGO ACCESS Tech Tower 28 1.0 EA $1,757.00 50 $878.50 $878.50 18Wx48H Single Back Access 11.05 13629-3D. CPU Cabinet-Tech Tower 18Wx48H No Back 29 5.0 EA $2,069.00 50 $1,034.50 $5,172.50 Access with Sliding Shelf QuotForm:001:00 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Xybix Systems, Inc. 8207 SouthPark Circle • Quote Number: 24880 Littleton, CO 80120 Quote Date: 9/12/2019 XYb1X Phone:303-683-5656 Fax:303-683-5454 ~ "' Revision: C kristiner Orig Create Date: 4/23/2019 Quote Expires: 12/11/2019 Opp#: 0020487 Terms: 1% 20 Days, NET 30 Days Page: 3 of 3 15.00 11765-3D. Bookcase-18W-28H-22D-Under WS With Toekic4'5 5.0 EA $649.00 50 $324.50 $1,622.50 15.01 11766-3D. Bookcase-36W-28H-22D-Under WS With Toekic4?6 1.0 EA $663.00 50 $331.50 $331.50 19.00 10176EXT Cup Holder-Extended for Eagle 17 11.0 EA $97.00 50 $48.50 $533.50 90.00 16139 Installers Kit Eagle Line 18 11.0 EA $- $0.00 $0.00 99.00 OTHER Other Charges&Services 19 1.0 EA $- $0.00 $0.00 Line(19) - Miscellaneous Charge - Freight- FullTruck Taxable $4,947.00 Installation - Non-Taxable $18,296.25 Estimated Sales Tax 7.5% $10,338.09 List Price Total $275,682.50 Lines Total: $137,841.25 Line Miscellaneous Charges Total: $33,581.34 Quote Total: $171,422.59 Note 1: All quoted taxes are estimated.Any applicable taxes,fees,permits,etc. must be added to this quote. Note 2: Where installation is listed on quote it is based in non-union labor and on one trip for installation only. Client is responsible for coordination of Technicians and other Vendors/Contractors.Waiting time will be charged at the rate of$75 per man hour straight time and$115 per man hour for OT plus subsistence expenses. Additionally, this quote is based upon a remodel in an existing space and/or new building - completely finished with a Certificate of Occupancy. Any project where the General Contractor is still on the job is subject to additional charges. We appreciate this opportunity to provide this quote. Our goal is to substantially improve working conditions for your valuable staff.We look forward to meeting with you to review this proposal in detail. In the meantime please don't hesitate to call us with any questions. QuotForm:001:00 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 ERGOSYS-02 KDERRILL '4�aRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/11/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Jennifer Wilke NAME: HUB International Insurance Services(COL) PHONE FAX, 720 207-2367 FAX 866 243-0727 2000 S.Colorado Blvd., ) ( (A/C,No):( ) Tower 2,Suite 150 E-MAIL SS:jennifer.wilke@hubinternational.com Denver,CO 80222 INSURERS AFFORDING COVERAGE NAIC# INSURER A:The Travelers Indemnity Company of America 25666 INSURED Ergoflex Systems,Inc. INSURER B:Travelers Casualty Insurance Company of Americ 19046 dba Xybix Systems,Inc. INSURERC:The Phoenix Insurance Company 25623 CQCR LLC INSURER D: 8207 Southpark Circle Littleton,CO 80120 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 680009A16819518 10/1/2018 10/1/2019 DAMAGE TO RENTED 300,000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X X BA9A17253A18 10/1/2018 10/1/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PerOaccitlenDAMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUP9A18097118 10/1/2018 10/1/2019 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER UB5J67568818 10/1/2018 10/1/2019 1,000,000 OFFICERO/MEMBER EXCLUDEDXECUTIVE ❑ N/A X E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Purchase Workstation Consoles Orange County is included as additional insured under General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 9181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE w ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies 'insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this Insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- and Contractors Protective policy. tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- t. With respect to the insurance afforded to Addi- sonal injury." or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cludirg: liability apply: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising 'mjury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs, and CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured J. Bodily Injury To Cc-Employees And Co-Volunteer B. Blanket Additional Insured—Broad Form Vendors Workers C. Damage To Premises Rented To You K. Aircraft Chartered With Crew • Perils of fire, explosion, lightning, smoke, L. Non-Owned Watercraft— Increased From 25 Feet water To 50 Feet • Limit increased to$300,000 M. Increased Supplementary Payments D. Blanket Waiver Of Subrogation 0 Cost of bail bonds increased to $2,500 E. Blanket Additional Insured — Owners, Managers 0 Loss of earnings increased to$500 per day Or Lessors Of Premises N. Medical Payments- Increased Limit F. Blanket Additional Insured — Lessors Of Leased O. Knowledge And Notice Of Occurrence Or Offense Equipment G. Incidental Medical Malpractice P. Unintentional Omission H. Personal Injury—Assumed By Contract Q. Reasonable Force — Bodily Injury Or Property I. Amended Bodily Injury Definition Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS 1. The following is added to SECTION II —WHO The following is added to SECTION II —WHO IS IS AN INSURED: AN INSURED: Any organization, other than a partnership or Any person or organization that is a vendor and joint venture, over which you maintain owner- that you have agreed in a written contract or ship or majority interest on the effective date agreement to include as an additional insured on of the policy qualifies as a Named Insured. this Coverage Part is an insured, but only with re- However, coverage for any such organization spect to liability for "bodily injury" or "property will cease as of the date during the policy pe- damage"that: riod that you no longer maintain ownership of, a. Is caused by an "occurrence"that takes place or majority interest in, such organization. after you have signed and executed that can- t. The following replaces Paragraph 4.a. of tract or agreement; and SECTION II —WHO IS AN INSURED: b. Arises out of "your products" which are dis- a. Coverage under this provision is afforded tributed or sold in the regular course of such only until the 180th day after you acquire vendor's business. or form the organization or the end of the policy period, whichever is earlier, unless The insurance provided to such vendor is subject reported in writing to us within 180 days. to the following provisions: CG D4 58 07 13 ©2013 The Travelers Indemnity Company All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- COVERAGES — COVERAGE A BODILY IN- dor will be the limits which you agreed to pro- JURY AND PROPERTY DAMAGE LIABIL- vide in the written contract or agreement, or ITY: the limits shown in the Declarations of this Exclusions c. through n. do not apply to dam- Coverage Part, whichever are less. age to premises while rented to you, or tem- b. The insurance provided to such vendor does porarily occupied by you with permission of not apply to: the owner, caused by: (1) "Bodily injury" or "property damage" for a. Fire; which the vendor is obligated to pay dam- b. Explosion; ages by reason of the assumption of li- ability in a contract or agreement. This c. Lightning; exclusion does not apply to liability for d. Smoke resulting from such fire, explo- damages that the vendor would have in sion, or lightning; or the absence of the contract or agree- e. Water. ment; (2) Any express warranty unauthorized by A separate limit of insurance applies to such damage to premises as described in Para- you; graph 6. of Section III—Limits Of Insurance. (3) Any physical or chemical change in "your p This insurance does not apply to damage to products"made intentionally by such ven- dor; premises while rented to you, or temporarily occupied by you with permission of the own- (4) Repackaging, unless unpacked solely for er, caused by: the purpose of inspection, demonstration, a. Rupture, bursting, or operation of pres- testing, or the substitution of parts under instructions from the manufacturer, and sure relief devices; then repackaged in the original container; b. Rupture or bursting due to expansion or (5) Any failure to make such inspections, ad- swelling of the contents of any building or justments, tests or servicing as vendors structure, caused by or resulting from agree to perform or normally undertake to water; perform in the regular course of business, c. Explosion of steam boilers, steam pipes, in connection with the distribution or sale steam engines, or steam turbines. of"your products"; 2. The following replaces Paragraph 6. of SEC- (6) Demonstration, installation, servicing or TION III—LIMITS OF INSURANCE: repair operations, except such operations Subject to 5. above, the Damage To Prem- performed at such vendor's premises in ises Rented To You Limit is the most we will connection with the sale of "your prod- pay under Coverage A for damages because ucts"; or products" which, after distribution of "property damage" to any one premises (7) "Your p while rented to you, or temporarily occupied or sale by you, have been labeled or rela- by you with permission of the owner, caused beled or used as a container, part or in- by fire; explosion; lightning smoke resulting gredient of any other thing or substance from such fire, explosion, or lightning; or by or for such vendor. water. The Damage To Premises Rented To Coverage under this provision does not apply to: You Limit will apply to all damage proximately a. Any person or organization from whom you caused by the same "occurrence", whether have acquired "your products", or any ingre- such damage results from fire; explosion; dient, part or container entering into, accom- lightning; smoke resulting from such fire, ex- panying or containing such products; or plosion, or lightning; water; or any combina- b. Any vendor for which coverage as an addi- tion of any of these. tional insured specifically is scheduled by en- The Damage To Premises Rented To You dorsement. Limit will be the higher of: C. DAMAGE TO PREMISES RENTED TO YOU a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- Page 2 of 7 ©2013 The Travelers Indemnity Company All rights reserved. CG D4 5$07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY ises Rented To You Limit. for "bodily injury", "property damage", "personal 3. The following replaces Paragraph a. of the injury"or"advertising injury"that: definition of"insured contract" in the DEFINI- a. Is"bodily injury"or"property damage" caused TIONS Section: by an "occurrence" that takes place, or "per- a. A contract for a lease of premises. How- sonal injury" or "advertising injury" caused by ever, that portion of the contract for a an offense that is committed, after you have lease of premises that indemnifies any signed and executed that contract or agree- person or organization for damage to ment; and premises while rented to you, or tempora- b. Arises out of the ownership, maintenance or rily occupied by you with permission of use of that part of any premises leased to the owner, caused by: you. (1) Fire; The insurance provided to such premises owner, manager or lessor is subject to the following pro- (2) Explosion; visions: (3) Lightning; a. The limits of insurance provided to such (4) Smoke resulting from such fire, ex- premises owner, manager or lessor will be plosion, or lightning; or the limits which you agreed to provide in the written contract or agreement, or the limits (5) Water. shown on the Declarations of this Coverage is not an"insured contract; Part, whichever are less. 4. The following replaces Paragraph 4.b.(1)(b) b. The insurance provided to such premises of SECTION IV— COMMERCIAL GENERAL owner, manager or lessor does not apply to: LIABILITY CONDITIONS: (1) "Bodily injury" or "property damage" (b) That is insurance for premises rented to caused by an "occurrence" that takes you, or temporarily occupied by you with place, or "personal injury" or "advertising the permission of the owner; injury" caused by an offense that is com- mitted, after you cease to be a tenant in D. BLANKET WAIVER OF SUBROGATION that premises; or The following is added to Paragraph 8., Transfer (2) Structural alterations, new construction or Of Rights Of Recovery Against Others To Us, demolition operations performed by or on of SECTION IV — COMMERCIAL GENERAL LI- behalf of such premises owner, manager ABILITY CONDITIONS: or lessor. We waive any right of recovery we may have c. The insurance provided to such premises against any person or organization because of owner, manager or lessor is excess over any payments we make for injury or damage arising valid and collectible other insurance available out of premises owned or occupied by or rented to such premises owner, manager or lessor, or loaned to you; ongoing operations performed unless you have agreed in a written contract by you or on your behalf, done under a contract for this insurance to apply on a primary or with that person or organization; "your work"; or contributory basis. "your products". We waive this right where you F. BLANKET ADDITIONAL INSURED — LESSORS have agreed to do so as part of a written contract, OF LEASED EQUIPMENT executed by you prior to loss. The following is added to SECTION II —WHO IS E. BLANKET ADDITIONAL INSURED — OWNERS, AN INSURED: MANAGERS OR LESSORS OF PREMISES Any person or organization that is an equipment The following is added to SECTION II —WHO IS lessor and that you have agreed in a written con- AN INSURED: tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but on- Any person or organization that is a premises ly with respect to liability for"bodily injury", "prop- owner, manager or lessor and that you have erty damage", "personal injury" or "advertising in- agreed in a written contract or agreement to jury"that: name as an additional insured on this Coverage a. Is"bodily injury"or"property damage" caused Part is an insured, but only with respect to liability by an "occurrence" that takes place, or "per- CG D4 58 07 13 ©2013 The Travelers Indemnity Company All rights reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY sonal injury" or "advertising injury" caused by sation is demanded or received. an offense that is committed, after you have 3. The following is added to Paragraph 2.a.(1) of signed and executed that contract or agree- SECTION II—WHO IS AN INSURED: ment; and Unless you are in the business or occupation b. Is caused, in whole or in part, by your acts or of providing professional health care services, omissions in the maintenance, operation or Paragraphs (1)(a), (b), (c) and (d) above do use by you of equipment leased to you by not apply to any "bodily injury" arising out of such equipment lessor. any providing or failing to provide "incidental The insurance provided to such equipment lessor medical services" by any of your is subject to the following provisions: "employees", other than an employed doctor. Any such "employees" providing or failing to a. The limits of insurance provided to such provide "incidental medical services" during equipment lessor will be the limits which you their work hours for you will be deemed to be agreed to provide in the written contract or acting within the scope of their employment agreement, or the limits shown on the Decla- by you or performing duties related to the rations of this Coverage Part, whichever are conduct of your business. less. 4. The following exclusion is added to Para- b. The insurance provided to such equipment graph 2., Exclusions, of SECTION I — COV- lessor does not apply to any"bodily injury" or ERAGES —COVERAGE A BODILY INJURY "property damage" caused by an "occur- AND PROPERTY DAMAGE LIABILITY: rence"that takes place, or"personal injury" or Sale Of Pharmaceuticals "advertising injury" caused by an offense that is committed, after the equipment lease ex- "Bodily injury" or "property damage" arising Aires. out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- c. The insurance provided to such equipment cals committed by, or with the knowledge or lessor is excess over any valid and collectible consent of, the insured. other insurance available to such equipment 5. The following is added to Paragraph 5. of lessor, unless you have agreed in a written SECTION III —LIMITS OF INSURANCE: contract for this insurance to apply on a pri- mary or contributory basis. For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or G. INCIDENTAL MEDICAL MALPRACTICE omissions committed in the providing or fail- 1. The following is added to the definition of"oc- ing to provide "incidental medical services"to currence"in the DEFINITIONS Section: any one person will be considered one "oc- currence". Unless you are in the business or occupation of providing professional health care services, 6. The following is added to Paragraph 4.b., Ex- "occurrence" also means an act or omission cess Insurance, of SECTION IV — COM- committed in providing or failing to provide MERCIAL GENERAL LIABILITY CONDI- "incidental medical services"to a person. TIONS: 2. The following is added to the DEFINITIONS This insurance is excess over any valid and Section: collectible other insurance, whether primary, excess, contingent or on any other basis,that "Incidental medical services" means: is available to any of your "employees" for a. Medical, surgical, dental, laboratory, x-ray "bodily injury" that arises out of providing or or nursing service or treatment, advice or failing to provide "incidental medical services" instruction, or the related furnishing of to any person to the extent not subject to food or beverages; Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED. b. The furnishing or dispensing of drugs or H. PERSONAL INJURY — ASSUMED BY CON- medical, dental, or surgical supplies or TRACT appliances; c. First aid; or 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION I d. "Good Samaritan services". —COVERAGES — COVERAGE B PERSON- "Good Samaritan services" means any emer- AL AND ADVERTISING INJURY LIABILITY: gency medical services for which no compen- e. Contractual Liability Page 4 of 7 ©2013 The Travelers Indemnity Company All rights reserved. CG D4 5$07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY "Personal injury"or "advertising injury" for 4. The following replaces the first subparagraph which the insured is obligated to pay of Paragraph f. of the definition of "insured damages by reason of the assumption of contract" in the DEFINITIONS Section: liability in a contract or agreement. This exclusion does not apply to: f. That part of any other contract or agree- ment pertaining to your business (includ- (1) Liability for damages that the insured ing an indemnification of a municipality in would have in the absence of the connection with work performed for a mu- contract or agreement; or nicipality) under which you assume the (2) Liability for damages because of"per- tort liability of another party to pay for sonal injury"assumed in a contract or "bodily injury,""property damage" or "per- agreement that is an "insured con- sonal injury"to a third person or organiza- tract", provided that the "personal in- tion. Tort liability means a liability that jury" is caused by an offense commit- would be imposed by law in the absence ted subsequent to the execution of of any contract or agreement. the contract or agreement. Solely for I. AMENDED BODILY INJURY DEFINITION the purposes of liability assumed in The following replaces the definition of "bodily in- an "insured contract", reasonable at- jury"in the DEFINITIONS Section: torneys fees and necessary litigation "Bodily injury" means bodily injury, mental an- expenses incurred by or for a party guish, mental injury, shock, fright, disability, hu- other than an insured will be deemed miliation, sickness or disease sustained by a per- to be damages because of "personal son, including death resulting from any of these at injury", provided that: any time. (a) Liability to such party for, or for J. BODILY INJURY TO CO-EMPLOYEES AND the cost of, that party's defense CO-VOLUNTEER WORKERS has also been assumed in the The following is added to Paragraph 2.a.(1) of same"insured contract"; and SECTION II —WHO IS AN INSURED: (b) Such attorney fees and litigation Paragraph (1)(a) above does not apply to "bodily expenses are for defense of that injury" to a co-"employee" in the course of the party against a civil or alternative co-"employee's" employment by you or perform- dispute resolution proceeding in ing duties related to the conduct of your business, which damages to which this in- or to "bodily injury" to your other "volunteer work- surance applies are alleged. ers" while performing duties related to the con- 2. The following replaces the third sentence of duct of your business. Paragraph 2. of SUPPLEMENTARY PAY- K. AIRCRAFT CHARTERED WITH CREW MENTS—COVERAGES A AND B: The following is added to Exclusion g., Aircraft, Notwithstanding the provisions of Paragraph Auto Or Watercraft, in Paragraph 2. of SEC- 2.b.(2) of Section I —Coverage A— Bodily In- TION I — COVERAGES — COVERAGE A BOD- jury And Property Damage Liability or Para- ILY INJURY AND PROPERTY DAMAGE LI- graph 2.e. of Section I — Coverage B — Per- ABILITY: sonal and Advertising Injury Liability, such This exclusion does not apply to an aircraft that payments will not be deemed to be damages is: because of"bodily injury", "property damage" (a) Chartered with crew to any insured; or "personal injury", and will not reduce the (b) Not awned by any insured; and limits of insurance. 3. The following replaces Paragraph 2.d. of (c) Not being used to carry any person or prop- g p g p erty for a charge. SUPPLEMENTARY PAYMENTS — COVER- L. NON-OWNED WATERCRAFT AGES A AND B: d. The allegations in the "suit"and the infor- 1. The following replaces Paragraph (2) of Ex- mation we know about the "occurrence" clusion g., Aircraft, Auto Or Watercraft, in or offense are such that no conflict ap- Paragraph 2. of SECTION I — COVERAGES pears to exist between the interests of — COVERAGE A BODILY INJURY AND the insured and the interests of the in- PROPERTY DAMAGE LIABILITY: demnitee; (2) A watercraft you do not own that is: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY (a) Fifty feet long or less; and e. The following provisions apply to Paragraph (b) Not being used to carry any person a. above, but only for the purposes of the in- or property for a charge. surance provided under this Coverage Part to 2. The following is added to Paragraph 2. of you or any insured listed in Paragraph 1. or 2. SECTION II —WHO IS AN INSURED: of Section II —Who Is An Insured: Any person or organization that, with your ex- (1) Notice to us of such "occurrence" or of- press or implied consent, either uses or is re- fense must be given as soon as practica- sponsible for the use of a watercraft that you ble only after the "occurrence" or offense do not own that is: is known to you (if you are an individual), (1) Fifty feet long or less; and any of your partners or members who is an individual (if you are a partnership or (2) Not being used to carry any person or joint venture), any of your managers who property for a charge. is an individual (if you are a limited liability M. INCREASED SUPPLEMENTARY PAYMENTS company), any of your trustees who is an 1. The following replaces Paragraph 1.b. of individual (if you are a trust), any of your SUPPLEMENTARY PAYMENTS — COVER- "executive officers"or directors (if you are AGES A AND B of SECTION I — COVER- an organization other than a partnership, AGES: joint venture, limited liability company or trust) or any "employee" authorized by b. Up to $2,500 for cost of bail bonds re- you to give notice of an "occurrence" or quired because of accidents or traffic law offense. violations arising out of the use of any ve- hicle to which the Bodily Injury Liability (2) If you are a partnership,joint venture, lim- Coverage applies. We do not have to fur- ited liability company or trust, and none of nish these bonds. your partners, joint venture members, 2. The following replaces Paragraph 1.d. of managers or trustees are individuals, no- SUPPLEMENTARY PAYMENTS — COVER- tice to us of such "occurrence"or offense AGES A AND B of SECTION I — COVER- must be given as soon as practicable on- ly after the "occurrence" or offense is AGES: known by: d. All reasonable expenses incurred by the (a) Any individual who is: insured at our request to assist us in the investigation or defense of the claim or (i) A partner or member of any part- "suit", including actual loss of earnings up nership or joint venture; to $500 a day because of time off from (ii) A manager of any limited liability work. company; N. MEDICAL PAYMENTS— INCREASED LIMIT (iii)A trustee of any trust; or The following replaces Paragraph 7. of SECTION III —LIMITS OF INSURANCE: (iv)An executive officer or director of any other organization; 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage that is your partner, joint venture C. for all medical expenses because of "bod— ily injury" sustained by any one person, and (b) Any "employee" authorized by such will be the higher of: partnership, joint venture, limited li- (a) $10,000; or ability company, trust or other organi- (b) The amount shown on the Declarations of zation to give notice of an "occur- this Coverage Part for Medical Expense rence" or offense. Limit. (3) Notice to us of such "occurrence" or of- O. KNOWLEDGE AND NOTICE OF OCCUR- fense will be deemed to be given as soon RENCE OR OFFENSE as practicable if it is given in good faith as soon as practicable to your workers' com- The following is added to Paragraph 2., Duties In pensation insurer. This applies only if you The Event of Occurrence, Offense, Claim or subsequently give notice to us of the "oc- Suit, of SECTION IV — COMMERCIAL GENER- currence" or offense as soon as practica- AL LIABILITY CONDITIONS: ble after any of the persons described in Paragraphs e.(1) or (2) above discovers Page 6 of 7 ©2013 The Travelers Indemnity Company All rights reserved. CG D4 5$07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY that the "occurrence" or offense may re- your rights under this insurance. However, this sult in sums to which the insurance pro- provision does not affect our right to collect addi- vided under this Coverage Part may ap- tional premium or to exercise our rights of cancel- ply- lation or nonrenewal in accordance with applica- However, if this policy includes an endorse- ble insurance laws or regulations. ment that provides limited coverage for "bod Q. REASONABLE FORCE — BODILY INJURY OR fly injury" or "property damage" or pollution PROPERTY DAMAGE costs arising out of a discharge, release or escape of "pollutants" which contains a re- The following replaces Exclusion a., Expected Or quirement that the discharge, release or es- Intended Injury, in Paragraph 2. of SECTION I — cape of "pollutants" must be reported to us COVERAGES — COVERAGE A BODILY IN- within a specific number of days after its JURY AND PROPERTY DAMAGE LIABILITY: abrupt commencement, this Paragraph e. does not affect that requirement. a. Expected or Intended Injury or Damage P. UNINTENTIONAL OMISSION "Bodily injury" or"property damage" expected The following is added to Paragraph 6., Repre- or intended from the standpoint of the in- sentations, of SECTION IV — COMMERCIAL sured. This exclusion does not apply to"bod- GENERAL LIABILITY CONDITIONS: ily injury" or "property damage" resulting from The unintentional omission of, or unintentional er- the use of reasonable force to protect any rcr in, any information provided by you which we person or property. relied upon in issuing this policy will not prejudice CG D4 5$ 07 13 ©2013 The Travelers Indemnity Company All rights reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL.GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY TOTAL GENERAL AGGREGATE LIMIT DESIGNATED PROJECT(S) -- GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL.GENERAL LIABILITY COVERAGE PART SCHEDULE Total General Aggregate Limit: $ 10,000,000 Designated Project(s): Each "project" for which you have agreed, in a written contract which is in effect during this policy period, to provide a separate General Aggregate Limit; provided that, the contract is signed and executed prior to any loss for which coverage is sought. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. The Total General Aggregate Limit stated in the for all medical expenses caused by accidents Schedule above is the most we will pay for the under COVERAGE C (SECTION 1), which can be sum of all: attributed only to operations at a single desig- 1. Medical Expenses under COVERAGE C nated"project" shown in the Schedule above: (SECTION 1); 1. A separate Designated Project General Ag- 2. Damages under COVERAGE A (SECTION 1), gregate Limit applies to each designated g "project", and that limit is equal to the amount except damages because of"bodily injury" or of the General Aggregate Limit shown in the "property damage" included in the "products- Declarations. completed operations hazard'; and 2. Subject to the Total General Aggregate Limit 3. Damages under COVERAGE B (SECTION 1) stated in the Schedule above, the Designated regardless of the number of: Project General Aggregate Limit is the most a. Insureds; we will pay for the sum of all damages under COVERAGE A, except damages because of b. Claims made or"suits" brought; "bodily injury" or "property damage" included c. Persons or organizations making claims in the "products-completed operations haz- or bringing "suits'; or and", and for medical expenses under d. Designated "projects" in the SCHEDULE COVERAGE C regardless of the number of: above. a. Insureds; 13. For all sums which the insured becomes legally b. Claims made or"suits" brought; or obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION 1), and CG M1 06 06 06 ©2005 The Travelers Companies,Inc. Page 1 of 2 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY c. Persons or organizations making claims To Premises Rented To You and Medical Ex- or bringing"suits". pense continue to apply. 3. Any payments made under COVERAGE A D. Part 2. of SECTION 111 — LIMITS OF for damages or under COVERAGE C for INSURANCE is deleted and replaced by the fol- medical expenses shall reduce both the Total lowing: General Aggregate Limit stated in the Sched- 2. The General Aggregate Limit is the most we ule above, and the Designated Project Gen- will pay for the sum of: eral Aggregate Limit for that designated "pro- ject". Such payments shall not reduce the a. Damages under COVERAGE B; and General Aggregate Limit shown in the Decla- b, Damages from "occurrences" under rations nor shall they reduce any other Des- COVERAGE A (SECTION 1) and for all ignated Project General Aggregate Limit for medical expenses caused by accidents any other designated "project" shown in the under COVERAGE C (SECTION 1) which Schedule above. cannot be attributed only to operations at 4. The limits shown in the Declarations for Each a single designated "project" shown in the Occurrence, Damage To Premises Rented SCHEDULE above. To You and Medical Expense continue to ap- E. When coverage for liability arising out of the ply. However, instead of being subject to the "products-completed operations hazard" is pro- General Aggregate Limit shown in the Decla- vided, any payments for damages because of rations, such limits will be subject to both the "bodily injury" or "property damage" included in Total General Aggregate Limit stated in the the "products-completed operations hazard" will Schedule above, and the applicable Desig- reduce the Products-Completed Operations Ag- nated Project General Aggregate Limit, gregate Limit, and not reduce the Total General C. For all sums which the insured becomes legally Aggregate Limit stated in the Schedule above, obligated to pay as damages caused by "occur- the General Aggregate Limit, or the Designated rences" under COVERAGE A (SECTION 1), and Project General Aggregate Limit. for all medical expenses caused by accidents F. For the purposes of this endorsement the under COVERAGE C (SECTION 1), which cannot Definitions Section is amended by the addition of be attributed only to operations at a single desig- the following definition: nated "project" shown in the Schedule above: "Project" means an area away from premises 1. Any payments made under COVERAGE A owned by or rented to you at which you are per- for damages or under COVERAGE C for forming operations pursuant to a contract or medical expenses shall reduce the amount agreement. For the purposes of determining the available under the Total General Aggregate applicable aggregate limit of insurance, each Limit stated in the Schedule above and the °'project" that includes premises involving the General Aggregate Limit, or the Products- same or connecting lots, or premises whose con- Completed Operations Aggregate Limit, nection is interrupted only by a street, roadway, whichever is applicable; and waterway or right-of-way of a railroad shall be 2. Such payments shall not reduce any Desig- considered a single "project" nated Project General Aggregate Limit, G. The provisions of LIMITS OF INSURANCE As respects this Provision C., the limits shown in (SECTION III) not otherwise modified by this en- the Declarations for Each Occurrence, Damage dorsement shall continue to apply as stipulated. Page 2 of 2 ©2005 The Travelers Companies,Inc. CG M1 06 06 06 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1., Who Is your business. An Insured, of SECTION II —COVERED AUTOS 2. The following replaces Paragraph b. in B.5., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization, that is signed and age, the following are deemed to be cov- executed by you before the "bodily injury" or ered"autos"you own: "property damage" occurs and that is in effect during the policy period, to be named as an addi- (1) Any covered "auto" you lease, hire, tional insured is an "insured" for Covered Autos rent or borrow; and Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this insurance applies and only to the extent that your "employee" under a contract in person or organization qualifies as an "insured" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section II. related to the conduct of your busi- B. EMPLOYEE HIRED AUTO ness. 1. The following is added to Paragraph A.1., However, any"auto" that is leased, hired, Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE: covered "auto". An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in an "em- An Insured, of SECTION II—COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL AUTO Any"employee" of yours is an "insured"while us- (2) An adjustment for depreciation and physical ing a covered "auto"you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value in the event of a total "loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality, we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION II —COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of bail bonds (in- covered "auto". cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: tions) required because of an "accident" (a) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds. 2. The following replaces Paragraph A.2.a.(4) of (b) Any "auto" that is hired, rented or bor- SECTION II —COVERED AUTOS LIABILITY rowed from your"employee". COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT (4) All reasonable expenses incurred by the "insured" at our request, including actual The following replaces the first sentence in Para- loss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses, of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- AGE: E. TRAILERS—INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- We will pay up to $50 per day to a maximum of TION I—COVERED AUTOS: $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3,000 ered"auto"of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III — PHYSICAL I. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following is added to Paragraph D., Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto", then the Physical Damage Cover- J. PERSONAL PROPERTY age is extended to "autos" that you hire, rent or The following is added to Paragraph A.4., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,000; parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an"insured"; and stolen property as of the time of the (2) In or on your covered "auto". "loss"; or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered "auto'. damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page 2 of 3 ©2015 The Travelers Indemnity Company. All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the 'loss"; COVERAGE: (b) Financial penalties imposed under a Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear more airbags in a covered "auto'you own that in- and tear or high mileage; flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto' is a covered "auto' for Compre- (d) Costs for extended warranties, Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability b. The airbags are not covered under any war- Insurance purchased with the loan or ranty; and lease; and c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans or leases. We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION one'loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph AA., Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total 'loss"to a covered "auto'of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person or organization to the ex- or Declarations for which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted prior to any "accident" or 'loss", pro- due on the lease or loan for such covered "auto' vided that the "accident" or"loss"arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract. The waiver applies only to the person or Coverage Section of the policy for that "auto'; organization designated in such contract. and CA T4 20 02 15 ©2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00)- 001 POLICY NUMBER: UB-5J675688-18-42-G 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 09-29-17 ST ASSIGN: PAGE 1 OF1 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 ERGOSYS-02 M H O F F CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/26/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0757776 CONTACT Jennifer Wilke NAME: HUB International Insurance Services(COL) PHONNo, x 207-2367 FAX 866 243-0727 2000 S.Colorado Blvd., Et):(720 (A/C,No):( Tower 2,Suite 150 ADD RIESS:Jennifer.wilke@hubinternational.com Denver,CO 80222 INSURERS AFFORDING COVERAGE NAIC# INSURER A:The Travelers Indemnity Company of America 25666 INSURED Ergoflex Systems,Inc. INSURER B:Travelers Casualty Insurance Company of Americ 19046 dba Xybix Systems,Inc. INSURERC:The Phoenix Insurance Company 25623 CQCR LLC INSURER D: 8207 Southpark Circle Littleton,CO 80120 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 680009A16819519 10/1/2019 10/1/2020 DAMAGE TO RENTED 300,000 X X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO X X BA9A17253A19 10/1/2019 10/1/2020 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PerOaccitlenDAMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CUP9A18097119 10/1/2019 10/1/2020 AGGREGATE $ 5,000,000 DED X RETENTION$ 5,000 C WORKERS COMPENSATION XPER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN X UB5J67568819 10/1/2019 10/1/2020 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:Purchase Workstation Consoles Orange County is included as additional insured under General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 9181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE w ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Policy: 680009A16819519 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies 'insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this Insurance to to include as an Insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for wham you have purchased an Owners work" or your ongoing operations for that addi- and Contractors Protective policy. tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- t. With respect to the insurance afforded to Addi- sonal injury." or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in- a. Limits of Insurance — The following limits of cluding: liability apply: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever Is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible Insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Policy: 680009A 16819519 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The"personal injury"or"advertising 'injury"for COMMERCIAL GENERAL LIABILITY CONDITIONS which coverage is sought arises out of an of- (Section IV), Paragraph 4. (Other Insurance), is fense committed amended as follows: subsequent to the signing and execution of that 1. The following is added to Paragraph a. Primary contract or agreement by you. Insurance: 2. The first Subparagraph (2) of Paragraph b. Ex- However, if you specifically agree in a written con- cess Insurance regarding any other primary in- tract or written agreement that the insurance pro- surance available to you is deleted. vided to an additional insured under this 3. The following is added to Paragraph b. Excess Coverage Part must apply on a primary basis, or Insurance, as an additional subparagraph under a primary and non-contributory basis, this insur- Subparagraph (1): ance is primary to other insurance that is avail- That is available to the insured when the insured able to such additional insured which covers such is added as an additional insured under any other additional insured as a named insured, and we policy, including any umbrella or excess policy. will not share with that other insurance, provided that. a. The "bodily injury" or "property damage" for which coverage is sought occurs, and CG Do 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc.All rights reserved. Page 1 of 1 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Policy: 680009A16819519 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY TOTAL GENERAL AGGREGATE LIMIT DESIGNATED PROJECT(S) -- GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL.GENERAL LIABILITY COVERAGE PART SCHEDULE Total General Aggregate Limit: $ 10,000,000 Designated Project(s): Each "project" for which you have agreed, in a written contract which is in effect during this policy period, to provide a separate General Aggregate Limit; provided that, the contract is signed and executed prior to any loss for which coverage is sought. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. The Total General Aggregate Limit stated in the for all medical expenses caused by accidents Schedule above is the most we will pay for the under COVERAGE C (SECTION 1), which can be sum of all: attributed only to operations at a single desig- 1. Medical Expenses under COVERAGE C nated"project" shown in the Schedule above: (SECTION 1); 1. A separate Designated Project General Ag- gregate Limit applies to each designated 2. Damages project", and that limit is equal to the amount except damages because of"bodily injury" or of the General Aggregate Limit shown in the "property damage" included in the "products- Declarations. completed operations hazard"; and 2. Subject to the Total General Aggregate Limit 3. Damages under COVERAGE B (SECTION 1) stated in the Schedule above, the Designated regardless of the number of: Project General Aggregate Limit is the most a. Insureds; we will pay for the sum of all damages under COVERAGE A, except damages because of b. Claims made or"suits" brought; "bodily injury" or "property damage" included c. Persons or organizations making claims in the "products-completed operations haz- or bringing "suits"; or and", and for medical expenses under d. Designated "projects" in the SCHEDULE COVERAGE C regardless of the number of: above. a. Insureds; B. For all sums which the insured becomes legally b. Claims made or"suits" brought; or obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION 1), and CG M1 06 06 06 0 2005 The Travelers Companies,Inc. Page 1 of 2 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY c. Persons or organizations making claims To Premises Rented To You and Medical Ex- or bringing"suits". pense continue to apply. 3. Any payments made under COVERAGE A D. Part 2. of SECTION 111 — LIMITS OF for damages or under COVERAGE C for INSURANCE is deleted and replaced by the fol- medical expenses shall reduce both the Total lowing: General Aggregate Limit stated in the Sched- 2. The General Aggregate Limit is the most we ule above, and the Designated Project Gen- will pay for the sum of: eral Aggregate Limit for that designated "pro- ject". Such payments shall not reduce the a. Damages under COVERAGE B; and General Aggregate Limit shown in the Decla- b, Damages from "occurrences" under rations nor shall they reduce any other Des- COVERAGE A (SECTION 1) and for all ignated Project General Aggregate Limit for medical expenses caused by accidents any other designated "project" shown in the under COVERAGE C (SECTION 1) which Schedule above. cannot be attributed only to operations at 4. The limits shown in the Declarations for Each a single designated "project" shown in the Occurrence, Damage To Premises Rented SCHEDULE above. To You and Medical Expense continue to ap- E. When coverage for liability arising out of the ply. However, instead of being subject to the "products-completed operations hazard" is pro- General Aggregate Limit shown in the Decla- vided, any payments for damages because of rations, such limits will be subject to both the "bodily injury" or "property damage" included in Total General Aggregate Limit stated in the the "products-completed operations hazard" will Schedule above, and the applicable Desig- reduce the Products-Completed Operations Ag- nated Project General Aggregate Limit, gregate Limit, and not reduce the Total General C. For all sums which the insured becomes legally Aggregate Limit stated in the Schedule above, obligated to pay as damages caused by "occur- the General Aggregate Limit, or the Designated rences" under COVERAGE A (SECTION 1), and Project General Aggregate Limit. for all medical expenses caused by accidents F. For the purposes of this endorsement the under COVERAGE C (SECTION 1), which cannot Definitions Section is amended by the addition of be attributed only to operations at a single desig- the following definition: nated "project" shown in the Schedule above: "Project" means an area away from premises 1. Any payments made under COVERAGE A owned by or rented to you at which you are per- for damages or under COVERAGE C for forming operations pursuant to a contract or medical expenses shall reduce the amount agreement. For the purposes of determining the available under the Total General Aggregate applicable aggregate limit of insurance, each Limit stated in the Schedule above and the °'project" that includes premises involving the General Aggregate Limit, or the Products- same or connecting lots, or premises whose con- Completed Operations Aggregate Limit, nection is interrupted only by a street, roadway, whichever is applicable; and waterway or right-of-way of a railroad shall be 2. Such payments shall not reduce any Desig- considered a single "project" nated Project General Aggregate Limit, G. The provisions of LIMITS OF INSURANCE As respects this Provision C., the limits shown in (SECTION III) not otherwise modified by this en- the Declarations for Each Occurrence, Damage dorsement shall continue to apply as stipulated. Page 2 of 2 0 2005 The Travelers Companies,Inc. CG M1 06 06 06 DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Policy: 680009A16819519 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR COMMERCIAL INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured J. Bodily Injury To Co-Employees And Cc-Volunteer B. Blanket Additional Insured—Broad Form Vendors Workers C. Damage To Premises Rented To You K. Aircraft Chartered With Crew • Perils of fire, explosion, lightning, smoke, L. Non-Owned Watercraft— Increased From 25 Feet water To 50 Feet • Limit increased to$300,000 M. Increased Supplementary Payments D. Blanket Waiver Of Subrogation 0 Cost of bail bonds increased to $2,500 E. Blanket Additional Insured — Owners, Managers 0 Loss of earnings increased to$500 per day Or Lessors Of Premises N. Medical Payments- Increased Limit F. Blanket Additional Insured — Lessors Of Leased O. Knowledge And Notice Of Occurrence Or Offense Equipment G. Incidental Medical Malpractice P. Unintentional Omission H. PersonalInjury—AssumedByContract Q. Reasonable Force — Bodily Injury Or Property I. Amended Bodily Injury Definition Damage PROVISIONS B. BLANKET ADDITIONAL INSURED — BROAD A. BROADENED NAMED INSURED FORM VENDORS 1. The following is added to SECTION II —WHO The following is added to SECTION II —WHO IS IS AN INSURED: AN INSURED: Any organization, other than a partnership or Any person or organization that is a vendor and joint venture, over which you maintain owner- that you have agreed in a written contract or ship or majority interest on the effective date agreement to include as an additional insured on of the policy qualifies as a Named Insured. this Coverage Part is an insured, but only with re- However, coverage for any such organization spect to liability for "bodily injury" or "property will cease as of the date during the policy pe- damage"that: riod that you no longer maintain ownership of, a. Is caused by an "occurrence"that takes place or majority interest in, such organization. after you have signed and executed that con- 2. The following replaces Paragraph 4.a. of tract or agreement; and SECTION II —WHO IS AN INSURED: b. Arises out of "your products" which are dis- a. Coverage under this provision is afforded tributed or sold in the regular course of such only until the 180th day after you acquire vendor's business. or form the organization or the end of the policy period, whichever is earlier, unless The insurance provided to such vendor is subject reported in writing to us within 180 days. to the following provisions: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY a. The limits of insurance provided to such ven- COVERAGES — COVERAGE A BODILY IN- dor will be the limits which you agreed to pro- JURY AND PROPERTY DAMAGE LIABIL- vide in the written contract or agreement, or ITY: the limits shown in the Declarations of this Exclusions c. through n. do not apply to dam- Coverage Part, whichever are less. age to premises while rented to you, or tem- b. The insurance provided to such vendor does porarily occupied by you with permission of not apply to: the owner, caused by: (1) "Bodily injury" or "property damage" for a. Fire; which the vendor is obligated to pay dam- b. Explosion; ages by reason of the assumption of li- ability in a contract or agreement. This c. Lightning; exclusion does not apply to liability for d. Smoke resulting from such fire, explo- damages that the vendor would have in sicn, or lightning; or the absence of the contract or agree- e. Water. ment; (2) Any express warranty unauthorized by A separate limit of insurance applies to such damage to premises as described in Para- you; graph 6. of Section III—Limits Of Insurance. (3) Any physical or chemical change in "your p This insurance does not apply to damage to products"made intentionally by such ven- dor; premises while rented to you, or temporarily occupied by you with permission of the own- (4) Repackaging, unless unpacked solely for er, caused by: the purpose of inspection, demonstration, a. Rupture, bursting, or operation of pres- testing, or the substitution of parts under instructions from the manufacturer, and sure relief devices; then repackaged in the original container; b. Rupture or bursting due to expansion or (5) Any failure to make such inspections, ad- swelling of the contents of any building or justments, tests or servicing as vendors structure, caused by or resulting from agree to perform or normally undertake to water; perform in the regular course of business, c. Explosion of steam boilers, steam pipes, in connection with the distribution or sale steam engines, or steam turbines. of"your products"; 2. The following replaces Paragraph 6. of SEC- (6) Demonstration, installation, servicing or TION III—LIMITS OF INSURANCE: repair operations, except such operations Subject to 5. above, the Damage To Prem- performed at such vendor's premises in ises Rented To You Limit is the most we will connection with the sale of "your prod- pay under Coverage A for damages because ucts"; or of "property damage" to any one premises (7) "Your products" which, after distribution while rented to you, or temporarily occupied or sale by you, have been labeled or rela- by you with permission of the owner, caused beled or used as a container, part or in- by fire; explosion; lightning smoke resulting gredient of any other thing or substance from such fire, explosion, or lightning; or by or for such vendor. water. The Damage To Premises Rented To Coverage under this provision does not apply to: You Limit will apply to all damage proximately a. Any person or organization from whom you caused by the same "occurrence", whether have acquired "your products", or any ingre- such damage results from fire; explosion; dient, part or container entering into, accom- lightning; smoke resulting from such fire, ex- panying or containing such products; or plosion, or lightning; water; or any combina- b. Any vendor for which coverage as an addi- tion of any of these. tional insured specifically is scheduled by en- The Damage To Premises Rented To You dorsement. Limit will be the higher of: C. DAMAGE TO PREMISES RENTED TO YOU a. $300,000; or 1. The following replaces the last paragraph of b. The amount shown on the Declarations of Paragraph 2., Exclusions, of SECTION I — this Coverage Part for Damage To Prem- Page 2 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY ises Rented To You Limit. for "bodily injury", "property damage", "personal 3. The following replaces Paragraph a. of the injury"or"advertising injury"that: definition of"insured contract" in the DEFINI- a. Is"bodily injury" or"property damage" caused TIONS Section: by an "occurrence" that takes place, or "per- a. A contract for a lease of premises. How- sonal injury" or "advertising injury" caused by ever, that portion of the contract for a an offense that is committed, after you have lease of premises that indemnifies any signed and executed that contract or agree- person or organization for damage to ment; and premises while rented to you, or tempora- b. Arises out of the ownership, maintenance or rily occupied by you with permission of use of that part of any premises leased to the owner, caused by: you. (1) Fire; The insurance provided to such premises owner, manager or lessor is subject to the following pro- (2) Explosion; visions: (3) Lightning; a. The limits of insurance provided to such (4) Smoke resulting from such fire, ex- premises owner, manager or lessor will be plosion, or lightning; or the limits which you agreed to provide in the written contract or agreement, or the limits (5) Water. shown on the Declarations of this Coverage is not an"insured contract"; Part, whichever are less. 4. The following replaces Paragraph 4.b.(1)(b) b. The insurance provided to such premises of SECTION IV— COMMERCIAL GENERAL owner, manager or lessor does not apply to: LIABILITY CONDITIONS: (1) "Bodily injury" or "property damage" (b) That is insurance for premises rented to caused by an "occurrence" that takes you, or temporarily occupied by you with place, or "personal injury" or "advertising the permission of the owner; injury" caused by an offense that is com- mitted, after you cease to be a tenant in D. BLANKET WAIVER OF SUBROGATION that premises; or The following is added to Paragraph 8., Transfer (2) Structural alterations, new construction or Of Rights Of Recovery Against Others To Us, demolition operations performed by or on of SECTION IV — COMMERCIAL GENERAL LI- behalf of such premises owner, manager ABILITY CONDITIONS: or lessor. We waive any right of recovery we may have c. The insurance provided to such premises against any person or organization because of owner, manager or lessor is excess over any payments we make for injury or damage arising valid and collectible other insurance available out of premises owned or occupied by or rented to such premises owner, manager or lessor, or loaned to you; ongoing operations performed unless you have agreed in a written contract by you or on your behalf, done under a contract for this insurance to apply on a primary or with that person or organization; "your work"; or contributory basis. "your products". We waive this right where you F. BLANKET ADDITIONAL INSURED — LESSORS have agreed to do so as part of a written contract, OF LEASED EQUIPMENT executed by you prior to loss. The following is added to SECTION II —WHO IS E. BLANKET ADDITIONAL INSURED — OWNERS, AN INSURED: MANAGERS OR LESSORS OF PREMISES Any person or organization that is an equipment The following is added to SECTION II —WHO IS lessor and that you have agreed in a written con- AN INSURED: tract or agreement to include as an additional in- sured on this Coverage Part is an insured, but on- Any person or organization that is a premises ly with respect to liability for"bodily injury", "prop- owner, manager or lessor and that you have erty damage", "personal injury" or "advertising in- agreed in a written contract or agreement to jury"that: name as an additional insured on this Coverage a. Is"bodily injury" or"property damage" caused Part is an insured, but only with respect to liability by an "occurrence" that takes place, or "per- CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 3 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY sonal injury" or "advertising injury" caused by sation is demanded or received. an offense that is committed, after you have 3. The following is added to Paragraph 2.a.(1) of signed and executed that contract or agree- SECTION II—WHO IS AN INSURED: ment; and Unless you are in the business or occupation b. Is caused, in whole or in part, by your acts or of providing professional health care services, omissions in the maintenance, operation or Paragraphs (1)(a), (b), (c) and (d) above do use by you of equipment leased to you by not apply to any "bodily injury" arising out of such equipment lessor. any providing or failing to provide "incidental The insurance provided to such equipment lessor medical services" by any of your is subject to the following provisions: "employees", other than an employed doctor. Any such "employees" providing or failing to a. The limits of insurance provided to such provide "incidental medical services" during equipment lessor will be the limits which you their work hours for you will be deemed to be agreed to provide in the written contract or acting within the scope of their employment agreement, or the limits shown on the Decla- by you or performing duties related to the rations of this Coverage Part, whichever are conduct of your business. less. 4. The following exclusion is added to Para- b. The insurance provided to such equipment graph 2., Exclusions, of SECTION I — COV- lessor does not apply to any"bodily injury" or ERAGES —COVERAGE A BODILY INJURY "property damage" caused by an "occur- AND PROPERTY DAMAGE LIABILITY: rence"that takes place, or"personal injury" or Sale Of Pharmaceuticals "advertising injury" caused by an offense that is committed, after the equipment lease ex- "Bodily injury" or "property damage" arising Aires. out of the willful violation of a penal statute or ordinance relating to the sale of pharmaceuti- c. The insurance provided to such equipment cals committed by, or with the knowledge or lessor is excess over any valid and collectible consent of, the insured. other insurance available to such equipment 5. The following is added to Paragraph 5. of lessor, unless you have agreed in a written SECTION III —LIMITS OF INSURANCE: contract for this insurance to apply on a pri- mary or contributory basis. For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or G. INCIDENTAL MEDICAL MALPRACTICE omissions committed in the providing or fail- 1. The following is added to the definition of"oc- ing to provide "incidental medical services"to currence"in the DEFINITIONS Section: any one person will be considered one "oc- currence". Unless you are in the business or occupation of providing professional health care services, 6. The following is added to Paragraph 4.b., Ex- "occurrence" also means an act or omission cess Insurance, of SECTION IV — COM- committed in providing or failing to provide MERCIAL GENERAL LIABILITY CONDI- "incidental medical services"to a person. TIONS: 2. The following is added to the DEFINITIONS This insurance is excess over any valid and Section: collectible other insurance, whether primary, excess, contingent or on any other basis, that "Incidental medical services" means: is available to any of your "employees" for a. Medical, surgical, dental, laboratory, x-ray "bodily injury" that arises out of providing or or nursing service or treatment, advice or failing to provide "incidental medical services" instruction, or the related furnishing of to any person to the extent not subject to food or beverages; Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED. b. The furnishing or dispensing of drugs or H. PERSONAL INJURY — ASSUMED BY CON- medical, dental, or surgical supplies or TRACT appliances; c. First aid; or 1. The following replaces Exclusion e., Contrac- tual Liability, in Paragraph 2. of SECTION I d. "Good Samaritan services". — COVERAGES — COVERAGE B PERSON- "Good Samaritan services" means any emer- AL AND ADVERTISING INJURY LIABILITY: gency medical services for which no compen- e. Contractual Liability Page 4 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY "Personal injury"or "advertising injury" for 4. The following replaces the first subparagraph which the insured is obligated to pay of Paragraph f. of the definition of "insured damages by reason of the assumption of contract" in the DEFINITIONS Section: liability in a contract or agreement. This exclusion does not apply to: f. That part of any other contract or agree- ment pertaining to your business (includ- (1) Liability for damages that the insured ing an indemnification of a municipality in would have in the absence of the connection with work performed for a mu- contract or agreement; or nicipality) under which you assume the (2) Liability for damages because of"per- tort liability of another party to pay for sonal injury"assumed in a contract or "bodily injury,""property damage" or "per- agreement that is an "insured con- sonal injury"to a third person or organiza- tract", provided that the "personal in- tion. Tort liability means a liability that jury" is caused by an offense commit- would be imposed by law in the absence ted subsequent to the execution of of any contract or agreement. the contract or agreement. Solely for I. AMENDED BODILY INJURY DEFINITION the purposes of liability assumed in The following replaces the definition of"bodily in- an "insured contract", reasonable at- jury"in the DEFINITIONS Section: torneys fees and necessary litigation "Bodily injury" means bodily injury, mental an- expenses incurred by or for a party guish, mental injury, shock, fright, disability, hu- other than an insured will be deemed miliation, sickness or disease sustained by a per- to be damages because of "personal son, including death resulting from any of these at injury", provided that: any time. (a) Liability to such party for, or for J. BODILY INJURY TO CO-EMPLOYEES AND the cost of, that party's defense CO-VOLUNTEER WORKERS has also been assumed in the The following is added to Paragraph 2.a.(1) of same"insured contract"; and SECTION II —WHO IS AN INSURED: (b) Such attorney fees and litigation Paragraph (1)(a) above does not apply to "bodily expenses are for defense of that injury" to a co-"employee" in the course of the party against a civil or alternative co-"employee's" employment by you or perform- dispute resolution proceeding in ing duties related to the conduct of your business, which damages to which this in- or to "bodily injury" to your other "volunteer work- surance applies are alleged. ers" while performing duties related to the con- s. The following replaces the third sentence of duct of your business. Paragraph 2. of SUPPLEMENTARY PAY- K. AIRCRAFT CHARTERED WITH CREW MENTS—COVERAGES A AND B: The following is added to Exclusion g., Aircraft, Notwithstanding the provisions of Paragraph Auto Or Watercraft, in Paragraph 2. of SEC- 2.b.(2) of Section I —Coverage A— Bodily In- TION I — COVERAGES — COVERAGE A BOD- jury And Property Damage Liability or Para- ILY INJURY AND PROPERTY DAMAGE LI- graph 2.e. of Section I — Coverage B — Per- ABILITY: sonal and Advertising Injury Liability, such This exclusion does not apply to an aircraft that payments will not be deemed to be damages is: because of"bodily injury", "property damage" (a) Chartered with crew to any insured; or "personal injury", and will not reduce the (b) Not awned by any insured; and limits of insurance. 3. The following replaces Paragraph 2.d. of (c) Not being used to carry any person or prop- g p g p erty for a charge. SUPPLEMENTARY PAYMENTS — COVER- L. NON-OWNED WATERCRAFT AGES A AND B: d. The allegations in the "suit" and the infor- 1. The following replaces Paragraph (2) of Ex- mation we know about the "occurrence" clusion g., Aircraft, Auto Or Watercraft, in or offense are such that no conflict ap- Paragraph 2. of SECTION I — COVERAGES pears to exist between the interests of — COVERAGE A BODILY INJURY AND the insured and the interests of the in- PROPERTY DAMAGE LIABILITY: demnitee; (2) A watercraft you do not own that is: CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 5 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY (a) Fifty feet long or less; and e. The following provisions apply to Paragraph (b) Not being used to carry any person a. above, but only for the purposes of the in- or property for a charge. surance provided under this Coverage Part to 2. The following is added to Paragraph 2. of you or any insured listed in Paragraph 1. or 2. SECTION II —WHO IS AN INSURED: of Section II —Who Is An Insured: Any person or organization that, with your ex- (1) Notice to us of such "occurrence" or of- press or implied consent, either uses or is re- fense must be given as soon as practica- sponsible for the use of a watercraft that you ble only after the "occurrence" or offense do not own that is: is known to you (if you are an individual), (1) Fifty feet long or less; and any of your partners or members who is an individual (if you are a partnership or (2) Not being used to carry any person or joint venture), any of your managers who property for a charge. is an individual (if you are a limited liability M. INCREASED SUPPLEMENTARY PAYMENTS company), any of your trustees who is an 1. The following replaces Paragraph 1.b. of individual (if you are a trust), any of your SUPPLEMENTARY PAYMENTS — COVER- "executive officers"or directors (if you are AGES A AND B of SECTION I — COVER- an organization other than a partnership, AGES: joint venture, limited liability company or trust) or any "employee" authorized by b. Up to $2,500 for cost of bail bonds re- you to give notice of an "occurrence" or quired because of accidents or traffic law offense. violations arising out of the use of any ve- hicle to which the Bodily Injury Liability (2) If you are a partnership,joint venture, lim- Coverage applies. We do not have to fur- ited liability company or trust, and none of nish these bonds. your partners, joint venture members, 2. The following replaces Paragraph 1.d. of managers or trustees are individuals, no- SUPPLEMENTARY PAYMENTS — COVER- tice to us of such "occurrence"or offense AGES A AND B of SECTION I — COVER- must be given as soon as practicable on- ly after the "occurrence" or offense is AGES: known by: d. All reasonable expenses incurred by the (a) Any individual who is: insured at our request to assist us in the investigation or defense of the claim or (i) A partner or member of any part- "suit", including actual loss of earnings up nership or joint venture; to $500 a day because of time off from (ii) A manager of any limited liability work. com pany; N. MEDICAL PAYMENTS— INCREASED LIMIT (iii)A trustee of any trust; or The following replaces Paragraph 7. of SECTION III—LIMITS OF INSURANCE: (iv)An executive officer or director of any other organization; 7. Subject to 5. above, the Medical Expense Limit is the most we will pay under Coverage that is your partner, joint venture C. for all medical expenses because of "bod— ily injury" sustained by any one person, and (b) Any "employee" authorized by such will be the higher of: partnership, joint venture, limited li- (a) $10,000; or ability company, trust or other organi- (b) The amount shown on the Declarations of zation to give notice of an "occur- this Coverage Part for Medical Expense rence"or offense. Limit. (3) Notice to us of such "occurrence" or of- O. KNOWLEDGE AND NOTICE OF OCCUR- fense will be deemed to be given as soon RENCE OR OFFENSE as practicable if it is given in good faith as soon as practicable to your workers' com- The following is added to Paragraph 2., Duties In pensation insurer. This applies only if you The Event of Occurrence, Offense, Claim or subsequently give notice to us of the "oc- Suit, of SECTION IV — COMMERCIAL GENER- currence" or offense as soon as practica- AL LIABILITY CONDITIONS: ble after any of the persons described in Paragraphs e.(1) or (2) above discovers Page 6 of 7 ©2013 The Travelers Indemnity Company.All rights reserved. CG D4 58 07 13 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL GENERAL LIABILITY that the "occurrence" or offense may re- your rights under this insurance. However, this sult in sums to which the insurance pro- provision does not affect our right to collect addi- vided under this Coverage Part may ap- tional premium or to exercise our rights of cancel- ply. laticn or nonrenewal in accordance with applica- However, if this policy includes an endorse- ble insurance laws or regulations. ment that provides limited coverage for "bod- REASONABLE FORCE — BODILY INJURY OR ily injury" or "property damage" or pollution Q PROPERTY DAMAGE costs arising out of a discharge, release or escape of "pollutants" which contains a re- The following replaces Exclusion a., Expected Or quirement that the discharge, release or es- Intended Injury, in Paragraph 2. of SECTION I — cape of "pollutants" must be reported to us COVERAGES — COVERAGE A BODILY IN- within a specific number of days after its JURY AND PROPERTY DAMAGE LIABILITY: abrupt commencement, this Paragraph e. does not affect that requirement. a. Expected or Intended Injury or Damage P. UNINTENTIONAL OMISSION "Bodily injury" or"property damage" expected The following is added to Paragraph 6., Repre- or intended from the standpoint of the in- sentations, of SECTION IV — COMMERCIAL sured. This exclusion does not apply to "bod- GENERAL LIABILITY CONDITIONS: ily injury" or "property damage" resulting from The unintentional omission of, or unintentional er- the use of reasonable force to protect any ror in, any information provided by you which we person or property. relied upon in issuing this policy will not prejudice CG D4 58 07 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 7 of 7 Includes copyrighted material of Insurance Services Office, Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 Policy: BA9A17253A19 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT—INCREASED LIMIT C. EMPLOYEES AS INSURED I. WAIVER OF DEDUCTIBLE—GLASS D. SUPPLEMENTARY PAYMENTS — INCREASED J. PERSONAL PROPERTY LIMITS K. AIRBAGS E. TRAILERS—INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT A. BLANKET ADDITIONAL INSURED performing duties related to the conduct of The following is added to Paragraph A.1., Who Is your business. An Insured, of SECTION II —COVERED AUTOS 2. The following replaces Paragraph b. in B.5., LIABILITY COVERAGE: Other Insurance, of SECTION IV — BUSI- Any person or organization who is required under NESS AUTO CONDITIONS: a written contract or agreement between you and b. For Hired Auto Physical Damage Cover- that person or organization, that is signed and age, the following are deemed to be cov- executed by you before the "bodily injury" or ered"autos"you own: "property damage" occurs and that is in effect during the policy period, to be named as an addi- (1) Any covered "auto" you lease, hire, tional insured is an "insured" for Covered Autos rent or borrow; and Liability Coverage, but only for damages to which (2) Any covered "auto" hired or rented by this insurance applies and only to the extent that your "employee" under a contract in person or organization qualifies as an "insured" an "employee's" name, with your under the Who Is An Insured provision contained permission, while performing duties in Section II. related to the conduct of your busi- B. EMPLOYEE HIRED AUTO ness. 1. The following is added to Paragraph A.1., However, any"auto" that is leased, hired, Who Is An Insured, of SECTION II — COV- rented or borrowed with a driver is not a ERED AUTOS LIABILITY COVERAGE: covered "auto". An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in an "ern- An Insured, of SECTION II—COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 ©2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL AUTO Any"employee" of yours is an "insured"while us- (2) An adjustment for depreciation and physical ing a covered "auto"you don't own, hire or borrow condition will be made in determining actual in your business or your personal affairs. cash value in the event of a total "loss". D. SUPPLEMENTARY PAYMENTS — INCREASED (3) If a repair or replacement results in better LIMITS than like kind or quality, we will not pay for the 1. The following replaces Paragraph A.2.a.(2) of amount of betterment. SECTION II—COVERED AUTOS LIABILITY (4) A deductible equal to the highest Physical COVERAGE: Damage deductible applicable to any owned (2) Up to $3,000 for cost of bail bonds (in- covered "auto". cluding bonds for related traffic law viola- (5) This Coverage Extension does not apply to: tions) required because of an "accident" (a) Any "auto" that is hired, rented or bor- we cover. We do not have to furnish rowed with a driver; or these bonds. 2. The following replaces Paragraph A.2.a.(4) of (b) Any "auto" that is hired, rented or bor- SECTION II—COVERED AUTOS LIABILITY rowed from your"employee". COVERAGE: G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT (4) All reasonable expenses incurred by the "insured" at our request, including actual The following replaces the first sentence in Para- loss of earnings up to $500 a day be- graph A.4.a., Transportation Expenses, of cause of time off from work. SECTION III — PHYSICAL DAMAGE COVER- AGE: E. TRAILERS—INCREASED LOAD CAPACITY We will pay up to $50 per day to a maximum of The following replaces Paragraph C.1. of SEC- The I—COVERED AUTOS: $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- 1. "Trailers" with a load capacity of 3,000 ered"auto"of the private passenger type. pounds or less designed primarily for travel H. AUDIO, VISUAL AND DATA ELECTRONIC on public roads. EQUIPMENT—INCREASED LIMIT F. HIRED AUTO PHYSICAL DAMAGE Paragraph C.1.b. of SECTION III — PHYSICAL The following is added to Paragraph A.4., Cover- DAMAGE COVERAGE is deleted. age Extensions, of SECTION III — PHYSICAL I. WAIVER OF DEDUCTIBLE—GLASS DAMAGE COVERAGE: The following is added to Paragraph D., Deducti- Hired Auto Physical Damage Coverage ble, of SECTION III — PHYSICAL DAMAGE If hired "autos" are covered "autos" for Covered COVERAGE: Autos Liability Coverage but not covered "autos" No deductible for a covered "auto" will apply to for Physical Damage Coverage, and this policy glass damage if the glass is repaired rather than also provides Physical Damage Coverage for an replaced. owned "auto', then the Physical Damage Cover- J. PERSONAL PROPERTY age is extended to "autos" that you hire, rent or The following is added to Paragraph A.4., Cover- borrow subject to the following: age Extensions, of SECTION III — PHYSICAL (1) The most we will pay for "loss" to any one DAMAGE COVERAGE: "auto" that you hire, rent or borrow is the Personal Property Coverage lesser of: We will pay up to $400 for "loss" to wearing ap- (a) $50,000; parel and other personal property which is: (b) The actual cash value of the damaged or (1) Owned by an"insured"; and stolen property as of the time of the (2) In or on your covered "auto". "loss"; or This coverage only applies in the event of a total (c) The cost of repairing or replacing the theft of your covered "auto". damaged or stolen property with other No deductibles apply to Personal Property cover- property of like kind and quality. age. Page 2 of 3 ©2015 The Travelers Indemnity Company. All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 COMMERCIAL AUTO K. AIRBAGS (2) Any: The following is added to Paragraph B.3., Exclu- (a) Overdue lease or loan payments at the sions, of SECTION III — PHYSICAL DAMAGE time of the "loss"; COVERAGE: (b) Financial penalties imposed under a Exclusion 3.a. does not apply to "loss" to one or lease for excessive use, abnormal wear more airbags in a covered "auto"you own that in- and tear or high mileage; flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but (c) Security deposits not returned by the les- only: sor; a. If that "auto" is a covered "auto" for Compre- (d) Costs for extended warranties, Credit Life hensive Coverage under this policy; Insurance, Health, Accident or Disability b. The airbags are not covered under any war- Insurance purchased with the loan or ranty; and lease; and c. The airbags were not intentionally inflated. (e) Carry-over balances from previous loans or leases. We will pay up to a maximum of $1,000 for any M. BLANKET WAIVER OF SUBROGATION one "loss". L. AUTO LOAN LEASE GAP The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, The following is added to Paragraph AA., Cover- of SECTION IV — BUSINESS AUTO CONDI- age Extensions, of SECTION III — PHYSICAL TIONS: DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private 5. Transfer Of Rights Of Recovery Against Passenger Type Vehicles Others To Us In the event of a total 'loss"to a covered "auto'of We waive any right of recovery we may have the private passenger type shown in the Schedule against any person or organization to the ex- or Declarations for which Physical Damage Cov- tent required of you by a written contract exe- erage is provided, we will pay any unpaid amount cuted prior to any "accident" or "loss", pro- due on the lease or loan for such covered "auto' vided that the "accident" or"loss"arises out of less the following: the operations contemplated by such con- (1) The amount paid under the Physical Damage tract. The waiver applies only to the person or Coverage Section of the policy for that "auto'; organization designated in such contract. and CA T4 20 02 15 ©2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.with its permission. DocuSign Envelope ID:95ED4E50-2135-4421-9D73-64AF3CA1B6D8 TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00)- 001 POLICY NUMBER: UB-5J675688-19-42-G 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR 'WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 09-29-1.7 ST ASSIGN: PAGE 1 OF1.