Loading...
HomeMy WebLinkAboutQuantum Water Consulting LLC - Insurance Certificate 2025-2026ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 8/5/2025 (720) 212-2057 17370 Quantum Water Consulting LLC dba Quantum Water & Environment, 1746 Cole Boulevard, Suite 340 Lakewood, CO 80401 39926 41190 A 2,000,000 X ECP2017418-19 3/1/2025 3/1/2026 100,000 5,000 2,000,000 4,000,000 4,000,000 1,000,000B S2303050 3/1/2025 3/1/2026 2,000,000A FFX201741919 3/1/2025 3/1/2026 2,000,000 0 C 4150439 9/1/2025 9/1/2026 1,000,000 1,000,000 1,000,000 A Professional Liab.ECP2017418-19 3/1/2025 Each Claim Limit 2,000,000 A Pollution Liab ECP2017418-19 3/1/2025 3/1/2026 Ea Condition Limit 2,000,000 As required by written contract or written agreement, the City of Fort Collins is included as Additional Insured for ongoing operations under General Liability. City of Fort Collins Purchasing Division PO Box 580 Fort Collins, CO 80522 QUANWAT-01 MARGARETM CCIG 155 Inverness Drive West Englewood, CO 80112 Margaret Mulloy Margaret.Mulloy@thinkccig.com Nautilus Insurance Company Selective Insurance Company of the Southeast Pinnacol Assurance X 3/1/2026 X X X X X X X ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – ONGOING OPERATIONS – COVERAGE A, B, D.1 & D.4 ECP2017418-19 3/1/2025 3/1/2026 3/1/2025 This endorsement modifies insurance provided under the following: is amended to include as an additional insured: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, or personal injury or advertising injury under SECTION I - COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY directly caused by: Your acts or omissions; or The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above. However, the insurance afforded to such additional insured described above: Only applies to the extent permitted by law; and Will not be broader than that which you are required by the contract or agreement to provide for such additional insured, and Will not extend beyond that which is provided to you in this policy. A person’s or organization’s status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: , property damage or personal and advertising injury arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage, or the offense which caused the personal and advertising injury, involved the rendering of, or the failure to render any professional architectural, engineering or surveying services. or property damage occurring after: All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or ECP 1246 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.Page 2 of 2 (2)That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. III.With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement described in Paragraph I.1.; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. IV.With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1.Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence or offense which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V.SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS AUTOMATIC STATUS – COMPLETED OPERATIONS – COVERAGE A, D.1 & D.4 ECP2017418-19 3/1/2025 3/1/2026 3/1/2025 This endorsement modifies insurance provided under the following: is amended to include as an additional insured: Any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I – COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Coverage D.1 – Contractors Pollution Legal Liability and Coverage D.4 – Microbial Substance Contractors Pollution Liability, directly caused by your work performed for the additional insured described in Paragraph 1. or 2. above, and included in the products-completed operations hazard. However, the insurance afforded to such additional insured described above: Only applies to the extent permitted by law; and Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and Will not extend beyond that which is provided to you in this policy. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: or property damage arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage involved the rendering of, or the failure to render any professional architectural, engineering or surveying services. With respect to the insurance afforded to these additional insureds, the following is added to SECTION V – LIMITS OF INSURANCE: The most we will pay on behalf of the additional insured is the amount of insurance: Required by the contract or agreement described in Paragraph I.1.; or Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. With respect to the insurance afforded to these additional insureds, the following is added to SECTION VI – ECP 1248 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.Page 2 of 2 REPORTING, DEFENSE, SETTLEMENT & COOPERATION: 1.Duties -- Additional Insured An additional insured must see to it that: a.We are notified in writing as soon as practicable of an occurrence which may result in a claim or suit; b.We receive written notice of a claim or suit as soon as practicable; and c.A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory. V.SECTION VII – CONDITION 10. – Other Insurance is amended by the addition of the following which supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that: 1.The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and 2.You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement. However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project- specific, primary insurance. VI.This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ECP 1260 01 21 Includes copyrighted material of Insurance Services Office, Inc., used with its permission.Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION (TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US) AUTOMATIC STATUS – COVERAGE A, B & D ECP2017418-19 3/1/2025 3/1/2026 3/1/2025 This endorsement modifies insurance provided under the following: The following is added to Paragraph 17. Subrogation of SECTION VII – CONDITIONS: We waive any right of recovery against any person(s) or organization(s) because of payments we make under COVERAGE A – BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B – PERSONAL AND ADVERTISING INJURY LIABILITY, and COVERAGE D – CONTRACTORS POLLUTION LIABILITY under this policy. Such waiver by us applies only if: The insured has agreed in writing in a contract or agreement with such person(s) or organization(s) to waive its right of recovery; and The insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This waiver does not apply in any jurisdiction where such waiver is held to be illegal or against public policy or in any situation where the person(s) or organization(s) against whom subrogation is to be waived is found to be solely negligent. This endorsement does not apply to any person(s) or organization(s) designated in a SCHEDULE of person(s) or organization(s) against whom rights of recovery have been waived. INSURED'S COPY CA 78 09CO 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. S 2 3 0 3 0 5 0 20000F Page 1 of 7 13 8 ElitePac® Commercial Automobile Extension COMMERCIAL AUTO CA 78 09CO 04 24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. AMENDMENT TO SECTION I -COVERED AUTOS COVERAGES AND SECTION II -COVERED AUTOS LIABILITY COVERAGE If this policy provides Auto Liability coverage for Owned Autos, the following extension is applicable: EMPLOYEE OWNED AUTOS - BUSINESS USE Solely for purposes of the coverage extended by this endorsement: A.The following is added to SECTION I,A. Description of Covered Auto Designation Symbols: Coverage symbols 1,2,3,4,5,6 and 7 are amended to include the following: Any “auto”owned by an “employee”specifically described on the Declarations page or on file with us when issued on a non-specified “auto”basis is considered an “auto”you own and not a covered “auto” you hire, borrow or lease; and B.The following is added to SECTION II,A.1.Who Is An Insured: An “employee”who is the owner of a specifically described “auto”on the Declarations page or on file with us when issued on a non-specified “auto”basis is an “insured”. If the “employee” owned “auto” is used: 1.Without your permission; 2.Outside the scope of any policies and procedures your business has for acceptable vehicle usage; 3.For any purpose other than the conduct of your business; or 4.By anyone other than the “employee”who owns the “auto”, except another “employee”, the limits of liability available to the “employee”or anyone other than a named “insured”under all coverages shall be limited to the higher of: 1.$250,000; or 2.The compulsory or financial responsibility law limits where the “auto”is licensed and principally garaged. AMENDMENTS TO SECTION II -LIABILITY COVERAGE A.If this policy provides Auto Liability coverage for Owned Autos,the following extensions are applicable accordingly: N E W L Y A C Q U I R E D O R F O R M E D ORGANIZATIONS The following is added to SECTION II,A.1.-Who Is An Insured: Any organization you newly acquire or form,other than a partnership,joint venture or limited liability company over which you maintain ownership or majority interest,will qualify as a Named Insured if there is no similar insurance available to that organization. However: 1.Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; 2.Coverage does not apply to “bodily injury”or “property damage”resulting from an “accident” that occurred before you acquired or formed the organization. No person or organization is an “insured”with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations. INSURED'S COPY CA 78 09CO 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 2 of 7 EXPENSES FOR BAIL BONDS AND LOSS OF EARNINGS Paragraphs (2)and (4)of SECTION II,A.2.a.- Supplementary Payments are deleted in their entirety and replaced with the following: (2)Up to the Limit of Insurance shown on the ElitePac Schedule for the cost of bail bonds (including bonds for related traffic law violations)required because of an “accident” covered under this policy.We do not have to furnish these bonds. (4)All reasonable expenses incurred by the “insured”at our request.This includes actual loss of earnings because of time off from work, which we will pay up to the Limit of Insurance shown on the ElitePac Schedule. E M P L O Y E E I N DE M NI F I C AT I O N A ND EMPLOYER’S LIABILITY AMENDMENT The following is added to SECTION II,B.4.- Exclusions: This exclusion does not apply to a “volunteer worker”who is not entitled to workers compensation, disability or unemployment compensation benefits. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion,SECTION II,B.5. - is deleted in its entirety. CARE, CUSTODY OR CONTROL AMENDMENT The following is added to SECTION II,B.6.- Exclusions: This exclusion does not apply to property owned by anyone other than an “insured”,subject to the following: 1.The most we will pay under this exception for any one “accident”is the Limit of Insurance stated in the ElitePac Schedule; and 2.A per “accident”deductible as stated in the ElitePac Schedule applies to this exception. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. B.If this policy provides Auto Liability coverage for Owned Autos,Non-Owned Autos or Hired Autos,the following extensions are applicable accordingly: LIMITED LIABILITY COMPANIES The following is added to SECTION II,A.1.-Who Is An Insured: If you are a limited liability company,your members and managers are “insureds”while using a covered “auto”you don’t own,hire or borrow during the course of their duties for you. BLANKET ADDITIONAL INSUREDS -As Required By Contract The following is added to SECTION II,A.1.-Who Is An Insured: Any person or organization whom you have agreed in a written contract,written agreement or written permit that such person or organization be added as an additional “insured”on the Business Auto Coverage Part on your policy is an additional “insured”,but only with respect to liability for “bodily injury”or “property damage”caused,in whole or in part,by your ownership,maintenance or use of a covered “auto”.This coverage shall be primary and non-contributory with respect to the additional “insured”. This provision only applies if: 1.It is required in the written contract,written agreement or written permit identified in this section; 2.It is permitted by law; and 3.The written contract or written agreement has been executed (executed means signed by a named insured)or written permit issued prior to the “bodily injury” or “property damage”. C.If this policy provides Auto Liability coverage for Non-Owned Autos,the following extension is applicable accordingly: EMPLOYEES AS INSUREDS If this policy provides Auto Liability coverage for Non-Owned Autos,the following is added to SECTION II, A.1. - Who Is An Insured: Any “employee”of yours is an “insured”while using a covered “auto”you don’t own,hire or borrow in your business or your personal affairs. An “employee”of yours is an “insured”while operating an “auto”hired or rented under a contract or agreement in that “employee’s”name with your permission,while performing duties related to the conduct of your business. AMENDMENTS TO SECTION III -PHYSICAL DAMAGE COVERAGE For those covered “autos”for which Comprehensive, Specified Causes of Loss or Collision coverage is shown in the Declarations,the following extensions of coverage are applicable: Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 78 09CO 04 24 INSURED'S COPY S 2 3 0 3 0 5 0 20000F Page 3 of 7 14 0 TOWING AND LABOR SECTION III,A.2.-Towing is deleted in its entirety and replaced with the following: We will pay all reasonable towing and labor costs up to the applicable Limit of Insurance shown on the ElitePac Schedule per tow each time a covered “Private Passenger Auto”,“Social Service Van or Bus”,“Light Truck”or any commercial “auto”with a gross vehicle weight rating or gross combination weight greater than 10,000 pounds is disabled. For labor charges to be eligible for reimbursement the labor must be performed at the place of disablement. Coverage for towing and labor costs afforded by any other endorsement added to the commercial auto policy shall apply in excess of the coverage afforded by this ElitePac. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. GLASS BREAKAGE DEDUCTIBLE The following is added to SECTION III,A.3.-Glass Breakage -Hitting A Bird Or Animal -Falling Objects or Missiles: If damaged glass is repaired rather than replaced,no deductible will apply for such repair.This extension does not apply to Emergency Services Organizations and Governmental Entities. ADDITIONAL TRANSPORTATION EXPENSES SECTION III,A.4.a.-Transportation Expenses is deleted in its entirety and replaced with the following: We will pay up to the Limit of Insurance shown on the ElitePac Schedule for temporary transportation expenses that you incur because of any “loss”to a covered “auto”,but only if the covered “auto”carries the coverages and meets the requirements described in Paragraphs 1. or 2. below: 1.We will pay temporary transportation expenses for total theft of a covered “auto”.We will only pay for such expenses incurred during the period beginning 24 hours after the theft and ending,regardless of the policy’s expiration,when the covered “auto”is returned to use or we pay for its “loss”. 2.For “loss”other than total theft of a covered “auto” under Comprehensive or Specified Causes of Loss Coverage,or for any “loss”under Collision Coverage to a covered “auto”,we will only pay for those temporary transportation expenses incurred during a period of time reasonably required to repair or replace the covered “auto”,even if that time period extends beyond the policy expiration date. Paragraph 2.of this extension does not apply while there are spare or reserve “autos”available to you for your operations. The 24 hour waiting period found on any other form endorsed onto the Auto Coverage part does not apply for any covered Rental Reimbursement “loss”. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO PHYSICAL DAMAGE COVERAGE If Comprehensive,Specified Causes of Loss or Collision coverage applies to a covered “auto”,the following is added to SECTION III, A.4. - Coverage Extensions: Physical Damage coverage is hereby extended to apply to Physical Damage “loss”to “autos”leased,hired, rented or borrowed without a driver.We will provide coverage equal to the broadest coverage available to any covered “auto”shown on the Declarations;however, the most we will pay for “loss”to each “auto”under this coverage extension is the lesser of: 1.The Limit of Insurance stated in the ElitePac Schedule; or 2.The actual cash value of the damaged or stolen property as of the time of the “loss”; or 3.The actual cost of repairing or replacing the damaged or stolen property with other property of like kind and quality.A part is of like kind and quality when it is of equal or better condition than the pre-accident part.We will use the original equipment from the manufacturer when: (a)The operational safety of the vehicle might otherwise be impaired; (b)Reasonable and diligent efforts to locate the appropriate rebuilt,aftermarket or used part have been unsuccessful; or (c)A new original equipment part of like kind and quality is available and will result in the lowest overall repair cost. For each leased,hired,rented or borrowed covered “auto”our obligation to pay each applicable “loss”will be reduced by the hired “auto”deductible on this policy.If there is no hired “auto”coverage symbol 8 for physical damage coverage on the policy,our obligation to pay for each “loss”will be reduced by the deductible equal to the highest deductible applicable to any owned “auto” for that coverage. No deductible will be applied to any “loss” caused by fire or lightning. Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 78 09CO 04 24 INSURED'S COPY S 2 3 0 3 0 5 0 20000F Page 4 of 7 14 1 SECTION IV,B.5.Other Insurance Condition, Paragraph 5.b.is deleted in its entirety and replaced by the following: For Hired Auto Physical Damage Coverage,the following are deemed to be covered “autos’” you own: 1.Any covered “auto”you lease,hire,rent,or borrow; and 2.Any covered “auto”hired or rented by your “employee”under a contract or agreement in that “employee’s”name,with your permission,while performing duties related to the conduct of your business. However,any “auto”that is leased,hired,rented or borrowed with a driver is not a covered “auto”. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. HIRED AUTO LOSS OF USE COVERAGE If Comprehensive,Specified Causes of Loss or Collision coverage applies to a covered “auto”,the following is added to SECTION III, A.4. - Coverage Extensions: We will pay expenses for which you are legally responsible to pay for loss of use of a leased,hired, rented or borrowed “auto”if it results from an “accident”. The per day limit in the Business Auto Coverage form does not apply and the most we will pay per “accident”is the Limit of Insurance shown on the ElitePac Schedule. Loss of Use Expense limits afforded by any endorsement added to the commercial auto policy shall apply in excess of the coverage afforded by this ElitePac form. This coverage extension does not apply to Emergency Services Organizations,Governmental Entities,and Schools. AUTO LOAN/LEASE GAP COVERAGE (Not Applicable in New York) If Comprehensive,Specified Causes of Loss or Collision coverage applies to a covered “auto”,the following is added to SECTION III, A.4. - Coverage Extensions: In the event of a total “loss”to a covered “auto”we will pay any unpaid amount due on the lease or loan for a covered “auto”, less: 1.The amount paid under the Physical Damage Coverage Section of the policy; and 2.Any: a.Overdue or any deferred lease/loan payments at the time of “loss”; b.Financial penalties imposed under a lease for excessive use,abnormal wear and tear,high mileage or similar charges; c.Security deposits not refunded by the lessor or financial institution; d.Costs for extended warranties,credit life,health, accident,or disability insurance purchased with the loan or lease; and e.Carry-over balances from previous leases or loans. You are responsible for the deductible applicable to the “loss” for the covered “auto”. The insurance provided by this coverage provision is excess over any other collectible insurance including but not limited to any coverage provided by or purchased from the lessor or any financial institution. PERSONAL EFFECTS The following is added to SECTION III,A.4.-Coverage Extensions: If this policy provides Comprehensive Coverage for a covered “auto”you own and that covered “auto”is stolen,we will pay up to the Limit of Insurance shown on the ElitePac Schedule,without application of a deductible,for lost personal effects that were in the covered “auto”at the time of theft.Personal effects do not include jewelry,tools,money,or securities.This coverage is excess over any other collectible insurance. AIRBAG COVERAGE The following is added to SECTION III,B.3.a.- Exclusions: Mechanical breakdown does not include the accidental discharge of an airbag. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. EXPANDED AUDIO,VISUAL,AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III, B.4. - Exclusions This exclusion does not apply to the following: 1.Global positioning systems; 2.“Telematic devices”; or 3.Electronic equipment that reproduces,receives or transmits visual or data signals and accessories used with such equipment, provided such equipment is: a.Permanently installed in or upon the covered “auto” at the time of the “loss”; Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 78 09CO 04 24 INSURED'S COPY S 2 3 0 3 0 5 0 20000F Page 5 of 7 14 2 b.Removable from a housing unit that is permanently installed in the covered “auto”at the time of the “loss”; c.Designed to be solely operated by use of power from the “auto’s” electrical system; or d.Designed to be used solely in or upon the covered “auto”. For each covered “loss”to such equipment,a deductible of $50 shall apply,unless the deductible otherwise applicable to such equipment is less than $50,at which point the lower deductible, if any, will apply. COMPREHENSIVE DEDUCTIBLE -LOCATION TRACKING DEVICE The following is added to SECTION III, D. - Deductible: Any Comprehensive Coverage Deductible shown in the Declarations will be reduced by 50%for any “loss” caused by theft if the covered “auto”is equipped with a location tracking device and that device was the sole method used to recover the “auto”. PHYSICAL DAMAGE LIMIT OF INSURANCE SECTION III,C.-Limit Of Insurance is deleted in its entirety and replaced with the following: The most we will pay for a “loss”in any one “accident”is the lesser of: 1.The actual cash value of the damaged or stolen property as of the time of the “loss”; or 2.The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. This coverage extension does not apply to Emergency Services Organizations and Governmental Entities. GREEN AUTOMOBILE REPLACEMENT COVERAGE In the event of a total “loss”to an owned “auto”that is a “gasoline powered auto”for which Comprehensive, Specified Causes of Loss,or Collision coverage applies, Physical Damage coverage will be amended as follows: If the owned “gasoline powered auto”is replaced by you with a “green auto”,we will pay an additional 10%of the “gasoline powered auto’s”actual cash value up to a maximum of $3,000,provided the “auto”is replaced and a copy of a bill of sale or new lease agreement is received by us within 60 calendar days of the date of the “loss”. Regardless of the number of “autos”deemed a total loss,the most we will pay under this coverage extension for any one “loss” is $10,000. AMENDMENTS TO SECTION IV -BUSINESS AUTO CONDITIONS DUTIES IN THE EVENT OF ACCIDENT,CLAIM,SUIT OR LOSS The following is added to SECTION IV,A.2.a.-Duties In The Event Of Accident, Claim, Suit Or Loss: The notice requirements for reporting “accident”claim, “suit”or “loss”information to us,including provisions related to the subsequent investigation of such “accident”,claim,“suit”or “loss”do not apply until the “accident”, claim, “suit” or “loss” is known to: 1.You, if you are an individual; 2.A partner, if you are a partnership; 3.An executive officer or insurance manager,if you are a corporation; 4.Your members,managers or insurance manager,if you are a limited liability company; 5.Your elected or appointed officials,trustees,board members or your insurance manager,if you are an organization other than a partnership,joint venture or limited liability company. However,this section does not amend the provisions relating to notification of police or protection or examination of the property that was subject to the “loss”. WAIVER OF SUBROGATION SECTION IV,A.5.-Transfer Of Rights Of Recovery Against Others To Us is deleted in its entirety and replaced with the following: We waive any right of recovery we may have against any person or organization because of payments we make for “bodily injury”or “property damage”resulting from the ownership,maintenance or use of a covered “auto”but only when you have assumed liability for such “bodily injury”or “property damage”in an “insured contract”.In all other circumstances,if a person or organization to or for whom we make payment under this Coverage Form has rights to recover damages from another, those rights are transferred to us. MULTIPLE DEDUCTIBLES The following is added to SECTION IV,A.-Loss Conditions: If a “loss”from one event or "accident"involves two or more covered “autos”and Collision Coverage applies, only the highest applicable deductible will be applied. Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 78 09CO 04 24 INSURED'S COPY S 2 3 0 3 0 5 0 20000F Page 6 of 7 14 3 CONCEALMENT, MISREPRESENTATION OR FRAUD The following is added to SECTION IV,B.2.- Concealment, Misrepresentation Or Fraud: If you should unintentionally fail to disclose any existing hazards in your representations to us prior to the inception date of the policy or during the policy period in connection with any newly discovered hazards,we will not deny coverage under this Coverage Form based upon such failure. POLICY PERIOD, COVERAGE TERRITORY SECTION IV,B.7.-Policy Period,Coverage Territory is deleted in its entirety and replaced with the following: Under this Coverage Form,we cover “accidents”and “losses” occurring: a.During the policy period shown in the Declarations; and b.Within the “Coverage Territory”. We also cover “loss”to or “accidents”involving a covered “auto”while being transported between any of these places. TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US - DEDUCTIBLES The following is added to SECTION IV,B.8.-Two Or More Coverage Forms Or Policies Issued By Us: If a “loss”covered under this Coverage Form also involves a “loss”to other property resulting from the same “accident”that is covered under this policy or another policy issued by us or any member company of ours,only the highest applicable deductible will be applied. AMENDMENTS TO SECTION V - DEFINITIONS BODILY INJURY INCLUDING MENTAL ANGUISH (Not Applicable in New York) The definition of bodily injury is deleted in its entirety and replaced by the following: “Bodily injury”means bodily injury,sickness,or disease sustained by a person,including death resulting from any of these.“Bodily injury”includes mental anguish resulting from bodily injury,sickness or disease sustained by a person. ADDITIONS TO SECTION V - DEFINITIONS COVERAGE TERRITORY “Coverage Territory” means: 1.The United States of America (including its territories and possessions), Canada and Puerto Rico; and 2.Anywhere in the world,except for any country or jurisdiction that is subject to trade or other economic sanction or embargo by the United States of America,if a covered “auto”is leased,hired,rented, or borrowed without a driver for a period of 30 days or less,and the insured’s responsibility to pay “damages”is determined in a “suit”on the merits in and under the substantive law of the United States of America (including its territories and possessions), Puerto Rico,or Canada,or in a settlement we agree to. If we are prevented by law,or otherwise,from defending the “insured”in a “suit”brought in a location described in Paragraph 2.above,the insured will conduct a defense of that “suit”.We will reimburse the “insured”for the reasonable and necessary expenses incurred for the defense of any such “suit”seeking damages to which this insurance applies,and that we would have paid had we been able to exercise our right and duty to defend. GASOLINE POWERED AUTO An “auto”that is designed to be solely powered by petroleum-based fuel. GREEN AUTO An “auto”that is designed to be powered by both petroleum-based fuel and electric power;or solely by electricity or any other renewable energy source. LIGHT TRUCK “Light Truck”means a truck with a gross vehicle weight rating of 10,000 pounds or less. PRIVATE PASSENGER AUTO “Private Passenger Auto”means a four-wheel “auto”of the private passenger or station wagon type.A pickup, panel truck or van not used for business is included within the definition of a “private passenger auto”. Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 78 09CO 04 24 INSURED'S COPY S 2 3 0 3 0 5 0 20000F Page 7 of 7 14 4 SOCIAL SERVICE VAN OR BUS “Social Service Van or Bus”means a van or bus used by a government entity,civic,charitable or social service organization to provide transportation to clients incidental to the social services sponsored by the organization, including special trips and outings. TELEMATIC DEVICE “Telematic Device”includes devices designed for the collection and dissemination of data for the purpose of monitoring vehicle and/or driver performance.This includes Global Positioning System technology,wireless safety communications and automatic driving assistance systems,all integrated with computers and mobile communications technology in automotive navigation systems. VOLUNTEER WORKER “Volunteer worker”means a person who is not your “employee”and who donates their work and acts at the direction of you and within the scope of duties determined by you,and is not paid a fee,salary or other compensation by you or anyone else for their work performed for you. INSURED'S COPY CA 78 16 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. S 2 3 0 3 0 5 0 20000F Page 1 of 2 14 5 ElitePac® Commercial Automobile Extension COMMERCIAL AUTO CA 78 16 04 24 SCHEDULE OF COVERAGE EXTENSIONS AND LIMITS OF INSURANCE This ElitePac Schedule is a summary of additional coverages,coverage modifications and corresponding Limits of Insurance that supplements the Business Auto Coverage Form.No coverage is provided by this summary.Refer to the actual endorsement for changes affecting your insurance protection. DESCRIPTION AMENDMENT TO SECTION I — COVERED AUTOS COVERAGES AND SECTION II — COVERED AUTOS LIABILITY COVERAGE Employee Owned Autos - Business Use Coverage Extension AMENDMENTS TO SECTION II — LIABILITY COVERAGE Newly Acquired Or Formed Organizations Coverage Extension Expenses For Bail Bonds And Loss Of Earnings Bail Bonds $3,000 Per "Accident" Loss Of Earnings $1,000 Per Day Employee Indemnification and Employer's Liability Amendment Coverage Extension Fellow Employee Coverage Coverage Extension Care, Custody Or Control Amendment $1,000 Per Accident $500 Deductible Per "Accident" Limited Liability Companies Coverage Extension Blanket Additional Insureds Coverage Extension Employees As Insureds Coverage Extension AMENDMENTS TO SECTION III — PHYSICAL DAMAGE COVERAGE Towing And Labor Coverage Extension Private Passenger Auto, Social Service Van or Bus, Light Truck Commercial Auto With GVWR or GCW Greater Than 10,000 Pounds $75 Per Tow $150 Per Tow Glass Breakage Deductible Coverage Extension Additional Transportation Expenses $60 per day up to a maximum of $1,800 Hired Auto Physical Damage Coverage $75,000 per "loss" Hired Auto Loss of Use Coverage $750 Per "Accident" Auto Loan/Lease Gap Coverage (Not Available in New York)Coverage Extension INSURED'S COPY CA 78 16 04 24Copyright, 2023 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 2 of 2 DESCRIPTION AMENDMENTS TO SECTION III — PHYSICAL DAMAGE COVERAGE - Continued Personal Effects $500 Per "Accident" Airbag Coverage Coverage Extension Expanded Audio, Visual, And Data Electronic Equipment Coverage Coverage Extension Comprehensive Deductible - Location Tracking Device Coverage Extension Physical Damage Limit Of Insurance Coverage Extension Green Automobile Replacement Coverage Coverage Extension AMENDMENTS TO SECTION IV — BUSINESS AUTO CONDITIONS Duties In The Event Of Accident, Claim, Suit Or Loss Coverage Extension Waiver of Subrogation Coverage Extension Multiple Deductibles Coverage Extension Concealment, Misrepresentation Or Fraud Coverage Extension Policy Period, Coverage Territory Coverage Extension Two Or More Coverage Forms Or Policies Issued By Us - Deductibles Coverage Extension AMENDMENTS TO SECTION V — DEFINITIONS Bodily Injury Including Mental Anguish (Not Applicable in New York)Broadened Definition Coverage Territory Broadened Definition 7501 E. Lowry Blvd. Denver, CO 80230-7006 303.361.4000 / 800.873.7242 Pinnacol.com Quantum Water Consulting LLC 1746 Cole Blvd. Suite 340 Lakewood, CO 80401 CCIG 155 Inverness Drive West Englewood, CO 80112 (303) 799-0110 7501 E. Lowry Blvd Denver, CO 80230-7006 Page 1 of 1 P BULLARDN - Underwriter 08/05/2025 12:05:39 4150439 85600330 359-B NCCI #: WC000313B Policy #: 4150439 ENDORSEMENT:Blanket Waiver of Subrogation Effective Date:September 1, 2025 Expires on: September 1, 2026 Pinnacol Assurance has issued this endorsement August 5, 2025 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE To any person or organization when agreed to under a written contract or agreement, as defined above and with the insured, which is in effect and executed prior to any loss.