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CORRESPONDENCE - RFP - 8818 ENCAMPMENT SITE ABATEMENT ON-CALL SERVICES
November 14, 2019 Custom Environmental Services Inc. Attn: Gerald J. Marks 8041 N I-70 Frontage Road #11 Arvada, CO 80002 RE: Contract Renewal, 8818 - Encampment Site Abatement On-Call Services Dear Mr. Marks: The City of Fort Collins wishes to extend the agreement term for the above captioned proposal per the existing terms and conditions and the following: 1) The term will be extended for one (1) additional year, February 1, 2020 through January 31, 2021. If the renewal is acceptable to your firm, please sign this letter in the space provided and include a current copy of insurance certificate naming the City as an additional insured for General and Automotive Liability within the next fifteen (15) days. If this extension is not agreeable with your firm, we ask that you send us a written notice stating that you do not wish to renew the contract and state the reason for non-renewal. Please contact Beth Diven, Buyer at (970) 221-6216 if you have any questions regarding this matter. Sincerely, Gerry S. Paul Director of Purchasing __________________________________________ ________________ Signature Date (Please indicate your desire to renew 8818 by signing this letter and returning it to Purchasing Division within the next fifteen days.) GSP:kr Financial Services Purchasing Division 215 N. Mason St. 2nd Floor PO Box 580 Fort Collins, CO 80522 970.221.6775 970.221.6707- fax fcgov.com/purchasing DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD 11/16/2019 03/28/2019 LAKESIDE INSURANCE CENTER, LLC 7728 Vance Drive ARVADA CO 80003 Judy Graham (303)421-8590 (303)531-5433 certs@lakeside-insurance.com Custom Environmental Services, Inc. 8041 West I-70 Frontage Road Arvada CO 80002 Homeland Ins. Co. of NY 34452 Atlantic Specialty Insurance Company 27154 Pinnacol Assurance Company 41190 19-20 gl,ba,xs,wc pol A X X X Per Project Aggregate X Fungi/Mold/Aggregate X X X X 7930032150004 5,000,000 Req by Contract 04/01/2019 04/01/2020 1,000,000 Professional 1,000,000 Each Wrongful Act 1,000,000 300,000 25,000 1,000,000 1,000,000 1,000,000 Employee Benefit Liability Each Employee 1,000,000 B X X X X 7930032160004 04/01/2019 04/01/2020 1,000,000 Comprehensive-Large truck A X X X 0 7930032170004 04/01/2019 04/01/2020 10,000,000 10,000,000 C 4018550 04/01/2019 04/01/2020 X 1,000,000 1,000,000 1,000,000 A Contractors Pollution 7930032150004 04/01/2019 04/01/2020 Limit 1,000,000 Transportation Pollution 7930032150004 04/01/2019 04/01/2020 Limit 1,000,000 City of Fort Collins, its officers, agents and employees are Additional Insured for General Liability and Auto Liability as required by written contract subject to the forms, terms and conditions of the policy. Michael McCarron/JUDY City of Fort Collins P O Box 580 Fort Collins, CO 80522 ahines@customsvcs.com The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. Policy Number: OBENV XS 301 (04 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies coverage provided under the following: FOLLOW-FORM EXCESS COVERAGE PART SECTION III - CONDITIONS, 9. Other Insurance, is amended by adding the following paragraph: This insurance will be considered primary to, and non-contributory with, any other insurance issued directly to a person or organization added as an additional insured under the underlying insurance, only if you specifically agree, in a written contract or agreement, that this insurance must be primary to, and non-contributory with, such other insurance. All other terms and conditions remain the same. OneBeacon Insurance Group LLC 793-00-32-17-0004 E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GE 320 (04 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement only modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: SECTION IV – CONDITIONS, 13. Transfer of Rights of Recovery Against Others To Us is deleted and replaced with the following: 13. Transfer of Rights of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured must do nothing to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. Any recovery will be paid first to us until all amounts we have spent on a claim or suit have been reimbursed. The insured expressly waives the right to be made whole by any such recovery. We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the SCHEDULE above. All other terms and conditions remain the same. OneBeacon Insurance Group LLC 793-00-32-15-0004 Any person or organization who requires such a waiver by written contract or written agreement between the "Named Insured" and such person or organization that was fully executed prior to the performance of the "Named Insured's" work that is the subject of such written contract or written agreement. E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". B. The following is added to the Other Insurance Condition in the Auto Dealers Coverage Form and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage and General Liability Coverages are primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". E-INSURED Policy Numer: 793-00-32-16-0004 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV XS 300 (04 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement only modifies coverage provided under the following: FOLLOW-FORM EXCESS COVERAGE PART SCHEDULE Name Of Person Or Organization: 1. SECTION III – CONDITIONS, 13. Transfer of Rights of Recovery Against Others To Us is deleted and replaced with the following: 13. Transfer of Rights of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this policy, those rights are transferred to us. The insured must do nothing to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. Any recovery will be paid first to us until all amounts we have spent on a claim or suit have been reimbursed. The insured expressly waives the right to be made whole by any such recovery. We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard. This waiver applies only to the person or organization shown in the SCHEDULE above. 2. The following is added to SECTION VI - DEFINITIONS: Your work and products-completed operations hazard shall have the same meanings as such terms or equivalent terms in the underlying insurance. All other terms and conditions remain the same. OneBeacon Insurance Group LLC 793-00-32-17-0004 Any person or organization for which the Named Insured has agreed to provide insurance prior to loss as provided by this policy but only to the scope of insurance agreed to by the Named Insured. E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GE 304 (02 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement only modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE above, but only with respect to liability for bodily injury, property damage or environmental damage caused, in whole or in part, by your work at the location designated and described in the SCHEDULE above performed for that additional insured and included in the products- completed operations hazard. All other terms and conditions remain the same. OneBeacon Insurance Group LLC 793-00-32-15-0004 Any person or organization that the "Named Insured" agreed to add as an additional insured in a written contract or written agreement between the "Named Insured" and such person or organization that was fully executed prior to the performance of the "Named Insured's" work that is the subject of such written contract or written agreement. Coverage afforded to such person or organization will not be broader than the scope of insurance agreed to by the "Named Insured" in such written contract or written agreement. Any location, and completed operations at such location, where required by the written contract or written agreement between the “Named Insured” and the person or organization qualifying as an additional insured under this endorsement. E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD ONEBEACON5: Sharon Levesque Successfully Filed MCS-90 (Liability) on 04/02/2019 02:12 PM with PUC Motor Carrier Inusrance Public Burden Statement OMB NO.: 2126-0008 A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590. ENDORSEMENT FOR MOTOR CARRIER POLICIES OF INSURANCE FOR PUBLIC LIABILITY UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980 Issued to CUSTOM ENVIRONMENTAL SERVICES, INC. of 8041 North I-70 Frontage Road # 11 Arvada, CO 80002 Dated at 605 Highway 169 North, Suite 800, Plymouth, MN 55441 this 2nd day of April , 2019 Amending Policy No. 793-00-32-17 Effective Date April 2, 2019 Name of Insurance Company Homeland Insurance Company of New York Telephone Number (952) 852-2431 Countersigned by Patty Hylton Authorized Company Representative The policy to which this endorsement is attached provides primary or excess insurance, as indicated by ¿[X],¿ for the limits shown: [ ] This insurance is primary and the company shall not be liable for amounts in excess of $ for each accident. [X] This insurance is excess and the company shall not be liable for amounts in excess of $4,000,000 for each accident in excess of the underlying limit of $1,000,000 for each accident. Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA , to verify that the policy is in force as of a particular date. The telephone number to call is: (952) 852- 2431 . Cancellation of this endorsement may be effected by the company of the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA's registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, D.C.). DEFINITIONS AS USED IN THIS ENDORSEMENT Accident includes continuous or repeated exposure to conditions which results in bodily Property Damage means damage to or loss of use of tangible property. Environmental Restoration Page 1 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/2/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD injury, property damage, or environmental damage which the insured neither expected nor intended. Motor Carrier means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof. Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these. means restitution for the loss, damage, or destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife. Public Liability means liability for bodily injury, property damage, and environmental restoration. The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA). In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured's employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon, or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured (2) For-hire and Private (In interstate, foreign, or intrastate commerce, with a gross vehicle weight rating of 10,000 or more pounds). Hazardous substances, as defined in 49 CFR 171.8, transported in cargo tanks, portable tanks, or hopper-type vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403 $5,000,000 (3) For-hire and Private (In interstate or foreign commerce, in any quantity; or in intrastate commerce, in bulk only; with a gross vehicle weight rating of 10,000 or more pounds). Oil listed in 49 CFR 172.101; hazardous waste, hazardous materials, and hazardous substances defined in 49 CFR 171.8 and listed in 49 CFR 172.101, but not mentioned in (2) above or (4) below. $1,000,000 (4) For-hire and Private (In interstate or foreign commerce, with a gross vehicle weight rating of less than 10,000 pounds). Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of a Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403. $5,000,000 Page 3 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/2/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GE 301 (02 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION – FORM I This endorsement only modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II – WHO IS AN INSURED is amended to include as an insured the person or organization shown in the SCHEDULE above, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury, property damage or environmental damage occurring after: (a) 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 site of the covered operations has been completed; or (b) 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. All other terms and conditions remain the same. OneBeacon Insurance Group LLC 793-00-32-15-0004 Any person or organization that the "Named Insured" agreed to add as an additional insured in a written contract or written agreement between the "Named Insured" and such person or organization that was fully executed prior to the performance of the "Named Insured's" work that is the subject of such written contract or written agreement. Coverage afforded to such person or organization will not be broader than the scope of insurance agreed to by the "Named Insured" in such written contract or written agreement. E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD ONEBEACON1: Sharon Levesque Successfully Filed MCS-90 (Liability) on 04/01/2019 02:33 PM with PUC Motor Carrier Inusrance Public Burden Statement OMB NO.: 2126-0008 A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590. ENDORSEMENT FOR MOTOR CARRIER POLICIES OF INSURANCE FOR PUBLIC LIABILITY UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980 Issued to CUSTOM ENVIRONMENTAL SERVICES, INC. of 8041 North I-70 Frontage Road # 11 Arvada, CO 80002 Dated at 605 Highway 169 North, Suite 800, PLYMOUTH, MN 55441 this 1st day of April , 2019 Amending Policy No. 793-00-32-16 Effective Date April 1, 2019 Name of Insurance Company Atlantic Specialty Insurance Company Telephone Number (952) 852-2431 Countersigned by Sharon Levesque Authorized Company Representative The policy to which this endorsement is attached provides primary or excess insurance, as indicated by ¿[X],¿ for the limits shown: [X] This insurance is primary and the company shall not be liable for amounts in excess of $1,000,000 for each accident. [ ] This insurance is excess and the company shall not be liable for amounts in excess of $ for each accident in excess of the underlying limit of $ for each accident. Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA , to verify that the policy is in force as of a particular date. The telephone number to call is: (952) 852- 2431 . Cancellation of this endorsement may be effected by the company of the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA's registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, D.C.). DEFINITIONS AS USED IN THIS ENDORSEMENT Accident includes continuous or repeated exposure to conditions which results in bodily injury, property damage, or environmental damage Property Damage means damage to or loss of use of tangible property. Environmental Restoration means restitution for the loss, damage, or Page 1 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/1/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD which the insured neither expected nor intended. Motor Carrier means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof. Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these. destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife. Public Liability means liability for bodily injury, property damage, and environmental restoration. The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA). In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured's employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon, or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, (2) For-hire and Private (In interstate, foreign, or intrastate commerce, with a gross vehicle weight rating of 10,000 or more pounds). Hazardous substances, as defined in 49 CFR 171.8, transported in cargo tanks, portable tanks, or hopper-type vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403 $5,000,000 (3) For-hire and Private (In interstate or foreign commerce, in any quantity; or in intrastate commerce, in bulk only; with a gross vehicle weight rating of 10,000 or more pounds). Oil listed in 49 CFR 172.101; hazardous waste, hazardous materials, and hazardous substances defined in 49 CFR 171.8 and listed in 49 CFR 172.101, but not mentioned in (2) above or (4) below. $1,000,000 (4) For-hire and Private (In interstate or foreign commerce, with a gross vehicle weight rating of less than 10,000 pounds). Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of a Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR 173.403. $5,000,000 Page 3 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/1/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GL 001 02 11 LIABILITY DECLARATIONS Policy Number: LIABILITY COVERAGE PART DECLARATIONS This policy consists of the following coverages for which a limit of insurance is indicated. Where "NOT COVERED" is shown, there is no coverage. 793-00-32-15-0004 Limits of Insurance Policy Aggregate Limit $1,000,000 Commercial General Liability Coverage Part Each Occurrence Limit $1,000,000 General Aggregate Limit $1,000,000 (other than Products/Completed Operations) Products/Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 Any One Person or Organization Damage to Premises Rented to You Limit $300,000 Any One Premise Medical Expenses Limit $25,000 Any One Person Contractors Environmental Liability Coverage Part Contractors Pollution Liability $1,000,000 Each Pollution Condition Transportation Pollution Liability $1,000,000 Each Pollution Condition Non-Owned Disposal Site Liability $1,000,000 Each Pollution Condition Short-Term Environmental Premises Liability $1,000,000 Each Pollution Condition Professional Services Liability Coverage Part Professional Services Liability $1,000,000 Each Professional Services Wrongful Act Deductibles Commercial General Liability Coverage Part $2,500 Each Occurrence Contractors Environmental Liability Coverage Part Contractors Pollution Liability $2,500 Each Pollution Condition Transportation Pollution Liability $2,500 Each Pollution Condition Non-Owned Disposal Site Liability $25,000 Each Pollution Condition Short-Term Environmental Premises Liability $25,000 Each Pollution Condition Professional Services Liability Coverage Part Professional Services Liability $25,000 Each Claim Coverage Retroactive Date(s) This policy consists of the following coverages for which a Retroactive Date may be applicable. If Not Covered is shown, no Retroactive Date applies. Contractors Environmental Liability Coverage Part Non-Owned Disposal Site Liability April 01, 2015 Professional Services Liability Coverage Part Professional Services Liability February 23, 1999 Page 1 of 1 E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GE 319 (02 11) Includes copyrighted material of Insurance Services Office, Inc. 1 of 1 Copyright 2011, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS ENVIRONMENTAL LIABILITY COVERAGE PART SECTION IV - CONDITIONS, 8. Other Insurance, is amended by adding the following paragraph: This insurance will be considered primary to, and non-contributory with any other insurance issued directly to a person or organization added as an additional insured under this policy, only if you specifically agree, in a written contract or agreement, that this insurance must be primary to, and non-contributory with, such other insurance. All other terms and conditions remain the same. OneBeacon Insurance Group LLC E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GL 324 (07 13) Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2 Copyright 2013, Policy Number: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) AGGREGATE LIMIT This endorsement modifies coverage provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Designated Construction Project(s): Total Designated Construction Project(s) Aggregate Limit: $ A. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above: 1. A separate Designated Construction Project General Aggregate Limit applies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Section I - Coverage A, except damages because of bodily injury or property damage included in the products-completed operations hazard, and for medical expenses under Section I - Coverage C regardless of the number of: a. Insureds; b. Claims made or suits brought; or c. Persons or organizations making claims or bringing suits. 3. The Total Designated Construction Project(s) Aggregate Limit shown in the SCHEDULE above is the most we will pay for the sum of all damages caused by occurrences under Section I – Coverage A, except damages because of bodily injury or property damage included in the products-completed operations hazard, and for all medical expenses caused by accidents under Section I – Coverage C, which can be attributed only to ongoing operations at designated construction projects. OneBeacon Insurance Group LLC 793-00-32-15-0004 5,000,000 Where required by contract E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD OBENV GL 324 (07 13) Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 Copyright 2013, 4. Any payments made under Coverage A for damages or under Coverage C for medical expenses will reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments will also reduce the Total Designated Construction Project(s) Aggregate Limit shown in the SCHEDULE above. However, such payments will not reduce: a. The General Aggregate Limit or Policy Aggregate Limit shown in the Declarations; or b. Any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the SCHEDULE above. 5. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit or Policy Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the SCHEDULE above, any payments made under Section I – Coverage A, and for all medical expenses caused by accidents under Section I – Coverage C will: 1. Reduce the amount available under the General Aggregate Limit and Policy Aggregate Limit shown in the Declarations; and 2. Not reduce any Designated Construction Projects Aggregate Limit or the Total Designated Construction Project(s) Aggregate Limit. C. If the applicable designated construction project has been abandoned, delayed or abandoned and restarted, or if the authorized contracting parties deviate from plans, blueprints, specifications or timetables, we will deem the project to be the same construction project as it was originally listed in the SCHEDULE above. All other terms and conditions remain the same. OneBeacon Insurance Group LLC DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD COMMERCIAL AUTO CA 99 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLLUTION LIABILITY – BROADENED COVERAGE FOR COVERED AUTOS – BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. Covered Autos Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Paragraph A.1. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or 2. Any claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto"; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a ! ! " VCA 201 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 5 Copyright 2018, Policy Number: COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM AUTOMOBILE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM This endorsement extends certain coverages. The following listing and the headers in this endorsement are only for convenience. Provisions in this endorsement might be modified by other endorsements. Read the entire policy carefully to determine rights, duties and what is and is not covered. AA.. Drive Other Car Coverage – Executive Officers and Certain Individuals BB.. Section II – Covered Autos Liability Coverage 1. Additional Insured – Written Contract, Agreement, Permit or Authorization 2. Broadened Named Insured 3. Employees as Insureds (Including Employee Hired Autos and Fellow Employee Coverage) 4. Newly Acquired or Formed Organizations 5. Supplementary Payments – Bail Bonds and Loss of Earnings CC.. Section III – Physical Damage Coverage 1. Hired Auto Physical Damage Coverage 2. Towing – Any Covered Autos 3. Transportation Expenses Increased 4. Loss of Use Expenses Increased 5. Other Coverage Extensions a. Airbag Discharge b. Auto Theft Reward c. Loan/Lease Gap Coverage d. Rental Reimbursement 6. Diminution in Value 7. Communications Equipment 8. Deductible Waived For Glass Repair DD.. Section IV – Business Auto Conditions 1. Duties in Event of Accident, Claim, Suit or Loss 2. Waiver of Subrogation When Required by Written Contract or Agreement EE.. Section V – Definitions 1. Bodily Injury – Includes Mental Anguish 2. Executive Officer AA.. Drive Other Car Coverage – Executive Officers and Certain Individuals 1. The following is added to Section I – Covered Autos: Drive Other Car Coverage a. For Covered Autos Liability Coverage and Physical Damage Coverage, “autos” in the care, custody or control of an “insured” described in Paragraph 2. below, which you do not own, hire, lease or borrow, are covered “autos”. But this does not include any “auto”: (1) Owned by any “insured” described in Paragraph 2. below, or any member of their household, including any “auto” that is owned but not insured; (2) Used by an “insured” described in Paragraph 2. below while working in the business of selling, servicing, repairing or parking autos; or (3) Insured or covered under another policy. b. If Medical Payments, Uninsured/Underinsured Motorist, Personal Injury Protection or other compulsory coverages required by the governing jurisdiction are provided by this policy, then an “insured” described in Paragraph 2. below, and their family members residing in the same household, are “insureds” while: (1) Occupying as a passenger; or (2) A pedestrian when struck by; any “auto” you do not own, hire, lease or borrow, except an “auto” owned by an “insured” described VCA 201 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 5 Copyright 2018, 2. With respect to Drive Other Car Coverage only, Paragraph A.1. Who is an Insured of Section II – Liability Coverage is amended to include as an “insured” the following: If you are designated in the Declarations as: a. An individual, you and your spouse. b. A partnership, your partners and their spouses. c. An organization other than an individual or a partnership, your “executive officers” and their spouses. 3. Limit of Insurance and Deductible The most we will pay for Drive Other Car Coverage is the single highest Limit of Insurance for the applicable coverage for an “auto” you own. The Deductible for Drive Other Car Coverage is the largest Deductible for the applicable coverage for an “auto” you own. 4. Other Insurance Regardless of the existence of other insurance or Paragraph B.5. Other Insurance of Section IV – Business Auto Conditions, Drive Other Car Coverage is primary. BB.. Section II – Covered Autos Liability Coverage 1. Additional Insured – Written Contract, Agreement, Permit or Authorization Paragraph A.1. Who is an Insured of Section II – Covered Autos Liability Coverage is amended to include as an additional “insured” any person or organization with whom you have agreed in a written contract, agreement, permit or authorization to provide insurance such as is afforded under this Coverage Form but only with respect to liability for “bodily injury” or “property damage” caused in whole or in part by your maintenance, operation or use of a covered “auto”. But this insurance does not apply: a. Unless the written contract or agreement has been executed or the permit or authorization has been issued prior to the “accident” that caused the “bodily injury” or “property damage”; b. To any person or organization included as an “insured” under any other provisions of this policy, including this or any other endorsement; c. To the independent acts or omissions of such person or organization; or d. To any lessor of “autos” when their contract or agreement with you for such leased “auto” ends or the lessor or its agent takes possession of the “auto”. 2. Broadened Named Insured Paragraph A.1. Who is an Insured of Section II – Covered Autos Liability Coverage is amended to include as a Named Insured any legally incorporated entity in which you maintain ownership of more than 50 percent of the voting stock on or after the effective date of this endorsement, but only if there is no other similar insurance available to that organization. This insurance does not apply to any organization that is an insured under another policy or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. 3. Employees as Insureds (Including Employee Hired Autos and Fellow Employee Coverage) a. Paragraph A.1. Who is an Insured of Section II – Covered Autos Liability Coverage is amended to include as an “insured” your “employee” while: (1) Using a covered “auto” you do not own, hire or borrow in your business or your personal affairs. (2) 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. b. Exclusion B.5. Fellow Employee of Section II – Covered Autos Liability is deleted. c. The following is added to B.5.b of Section IV – Business Auto Conditions: Any covered “auto” hired or rented without a driver 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 is also deemed to be a covered “auto” you own. OneBeacon Insurance Group LLC DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD VCA 201 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 5 Copyright 2018, 4. Newly Acquired or Formed Organizations Paragraph A.1. Who is an Insured of Section II – Covered Autos Liability Coverage is amended to include as an “insured” any organization you newly acquire or form, other than a partnership or joint venture, and over which you maintain ownership or majority interest, if there is no other similar insurance available to that organization. But: (1) Coverage under this provision is afforded only until the end of the policy period; and (2) Coverage does not apply to “bodily injury” or “property damage” caused by an “accident” that occurred before you acquired or formed the organization. 5. Supplementary Payments – Bail Bonds and Loss of Earnings In Paragraph A.2.a. Supplementary Payments of Section II – Covered Autos Liability, the following replaces Paragraphs (2) and (4): (2) Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. CC.. Section III – Physical Damage Coverage 1. Hired Auto Physical Damage Coverage a. If hired “autos” are covered “autos” under Section II – Covered Autos Liability Coverage and this policy provides Comprehensive, Specified Causes of Loss Coverage or Collison Coverage for any “auto” you own, a hired “auto” will be deemed a covered “auto” for Physical Damage Coverage subject to the provisions in Paragraph b. below. b. For Hired Physical Damage Coverage provided by paragraph a. above: (1) The most we will pay for “loss” to any hired “auto” is the lesser of: (a) $75,000 for “autos” of the private passenger type and $50,000 for all other “autos”; (b) The actual cash value of the damaged or stolen property as of the time of the “loss”; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) The Deductible is the largest Deductible for the applicable coverage for an “auto” you own. (3) This insurance is excess over any other valid and collectible insurance, whether such insurance is primary, excess, contingent or on any other basis. 2. Towing – Any Covered Autos The following replaces Paragraph A.2. Towing of Section III – Physical Damage Coverage: We will pay up to $100 for towing and, if labor is performed at the place of disablement, labor costs incurred each time a covered “auto” is disabled if a premium charge for towing and labor is shown in the Schedule or the Declarations. 3. Transportation Expenses Increased In Paragraph A.4.a. Transportation Expenses of Section III – Physical Damage Coverage, the amounts we will pay amounts we will pay for temporary transportation expenses incurred by you because of the total theft of a covered “auto” of the private passenger type are increased to $75 per day, to a maximum of $2,250. 4. Loss of Use Expenses Increased The following replaces the last paragraph in Paragraph A.4.b. Loss Of Use Expenses of Section III – Physical Damage Coverage: However, the most we will pay for any expenses for loss of use is $1,000. 5. Other Coverage Extensions If you have Physical Damage Coverage, the following are added to Paragraph A.4. Coverage Extensions of Section III – Physical Damage Coverage: OneBeacon Insurance Group LLC DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD VCA 201 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 5 Copyright 2018, a. Airbag Discharge We will pay to reset or replace a covered “auto’s” airbag that accidentally discharges without the “auto” being involved in an “accident” if the airbag is not covered under a manufacturer’s warranty and you did not intentionally cause the discharge. No Deductible applies to this Coverage Extension. b. Auto Theft Reward If you have Comprehensive or Specified Cause of Loss Coverage, we will pay a reward up to $2,000 for information leading to the arrest and conviction of anyone stealing a covered “auto”. But we will not pay a reward to you, any family members or “employees” or any public officials while performing their duties. c. Loan/Lease Gap Coverage If a covered “auto” is subject to a long-term loan or lease that requires, in writing, that the lender or lessor be an additional “insured”, and you are legally obligated for the remaining balance on the loan or lease, we will pay the difference between the actual cash value of the “auto” at the time of “loss” and the remaining balance on your loan or lease. But we will not pay for: (1) Any amount paid under the policy’s Physical Damage Coverage; or (2) Any amounts for abnormal or excess wear and tear, additional or high mileage charges, carry-over balances from previous loans or leases, extended warranties or insurance purchased with the loan or lease, lease termination fees, taxes, overdue payments, unreturned security deposits or any penalties, interest or charges resulting from overdue payments. d. Rental Reimbursement We will pay for expenses to rent an “auto” of the private passenger type because of “loss” to a covered “auto” of the private passenger type. But: (1) We will only pay expenses incurred during the policy period at the time of the “loss” and ending, regardless of the policy period, six days after the “loss”. (2) The most we will pay is the lesser of: (a) Reasonable and necessary expenses actually incurred; or (b) $50 per day. (3) This coverage does not apply if a spare or reserve “auto” is available to you. (4) If “loss” is because of the total theft of a covered “auto”, we will pay only those amounts that are not already covered under Transportation Expenses. No Deductible applies to this Coverage Extension. 6. Diminution in Value The following is added to Exclusion B.6. of Section III – Physical Damage Coverage: This exclusion does not apply to “diminution in value” of a covered “auto” of the private passenger type used in the conduct of the “insured’s” business that is leased, rented, hired or borrowed without a driver for a period of 30 days or less. But the most we will pay for such “diminution in value” is the lesser of: a. 20 percent of the actual cash value of the “auto” as of the time of the “loss”; or b. $7,500. 7. Communications Equipment The following is added to Paragraph B. Exclusions of Section III – Physical Damage Coverage: Exclusions 4.c. and 4.d. do not apply to communications equipment, including its antenna and other accessories, that is permanently installed in, and not removable from, a covered “auto” and designed for use as a: a. Citizen’s band radio; b. Two-way mobile radio or telephone; OneBeacon Insurance Group LLC DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD VCA 201 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 5 Copyright 2018, c. Scanning monitor receiver; or d. GPS navigation system. No Deductible applies to “loss” to such communications equipment. But the most we will pay for all such communications equipment is $5,000 for any one “loss”. 8. Deductible Waived For Glass Repair The following is added to Paragraph D. Deductible of Section III – Physical Damage Coverage: No Deductible applies if glass that is damaged is repaired rather than replaced. DD.. Section IV – Business Auto Conditions 1. Duties in the Event of Accident, Claim, Suit or Loss The following is added to Paragraph A.2. Duties in the Event of Accident, Claim, Suit or Loss of Section IV – Business Auto Conditions: The requirements that you must notify us of an “accident”, claim, “suit” or “loss”, or send us documents concerning a claim or “suit”, apply only if 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 or risk manager, if you are a corporation; or (4) A manager, if you are a limited liability company. The requirement that you must notify us as soon as practicable of an “accident”, claim, “suit” or “loss” does not apply if you report the “accident”, claim, “suit” or “loss” to your workers’ compensation insurer and the “accident”, claim, “suit” or “loss” later develops into a liability claim for which coverage is provided by this policy. But as soon as you become aware that an “accident”, claim, “suit” or “loss” is a liability claim rather than a workers’ compensation claim, you must comply with all parts of Paragraph A.2. Duties in the Event of Accident, Claim, Suit or Loss of Section IV – Business Auto Conditions. 2. Waiver of Subrogation When Required by Written Contract or Agreement The following is added to Paragraph A.5. Transfer of Rights of Recovery Against Others to Us of Section IV – Business Auto Conditions: We will waive any right of recovery against any person or organization because of payments we make for “bodily injury” or “property damage” arising out of the ownership, maintenance or use of a covered “auto” when you have assumed liability for such “bodily injury” or “property damage” under an “insured contract”, but only if the “insured contract” is executed before the “accident” or “loss” occurs. EE.. Section V – Definitions 1. Bodily Injury – Includes Mental Anguish The following is added to Paragraph C. of Section V – Definitions: “Bodily injury” includes mental anguish resulting from bodily injury, sickness, or disease sustained by a person at any time. 2. Executive Officer The following is added to Section V – Definitions: “Executive officer” means a person holding any of the officer positions created by your charter, constitution, bylaws or any other similar governing document. OneBeacon Insurance Group LLC DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD ASC 00 11 01 98 POLICY SCHEDULE SCHEDULE Effective , this schedule forms a part of Policy No. (At the time stated in the policy) issued to by Common Policy Declarations, 4 VIL 100 NA 10 98, Continued: Forms applicable to this Policy: 4 VIL 100 NA 10 98 COMMON POLICY DECLARATIONS OBENV GE 001 02 11 COMMON POLICY DECLARATIONS PREMIUM STATEMENT OBENV GE 402 04 14 ENVIRONMENTAL CLAIMS REPORTING NOTICE OBENV GE 408 08 16 SERVICE OF SUIT OBENV TR 420 01 15 EXCL CERTIFIED ACTS OF TERRORISM & EXCL OF OTHER ACTS OF TERRORISM OBENV XS 001 02 11 LIABILITY COVERAGE PART DECLARATIONS OBENV XS 100 02 11 FOLLOW-FORM EXCESS COVERAGE FORM OBENV XS 300 04 11 WAIVER TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US OBENV XS 301 04 11 PRIMARY & NON-CONTRIBUTORY ENDORSEMENT OBENV XS 304 10 11 EXCLUSION OF UNDERLYING COVERAGE ASC 00 11 01 98 Schedule 1 - LIST OF COMMON DEC FORMS Page 1 of 1 1 3 0-00-0000 04/03/2019 CXD CPW PR 1.000 CUSTOM ENVIRONMENTAL SERVICES INC. Producer: WESTERN PACIFIC INSURANCE NETWORK 04/01/2019 Homeland Insurance Company of New York 793-00-32-17-0004 E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD in Paragraph 2. below or members of their household, or an “auto” insured or covered under any other policy. OneBeacon Insurance Group LLC 793-00-32-16-0004 E-INSURED DocuSign Envelope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ocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD covered "auto" if: (1) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. E-INSURED DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement. It is further understood and agreed that, upon failure of the company to pay any final judgment recovered again the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment. The limits of the company's liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of any one accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident. Form MCS-90 SCHEDULE OF LIMITS¿PUBLIC LIABILITY Type of carriage Commodity transported Jan. 1, 1985 (1) For-hire (In interstate or foreign commerce, with a gross vehicle weight rating of 10,000 or more pounds). Property (nonhazardous)........................................ $ 750,000 Page 2 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/1/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement. It is further understood and agreed that, upon failure of the company to pay any final judgment recovered again the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment. The limits of the company's liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of any one accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident. Form MCS-90 SCHEDULE OF LIMITS¿PUBLIC LIABILITY Type of carriage Commodity transported Jan. 1, 1985 (1) For-hire (In interstate or foreign commerce, with a gross vehicle weight rating of 10,000 or more pounds). Property (nonhazardous)........................................ $ 750,000 Page 2 of 3 https://www.dora.state.co.us/pls/real/PUC_INS_CERTIFICATE_GUI.Save_form_mcs90 4/2/2019 DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) JECT LOC PRO- POLICY GEN'L AGGREGATE LIMIT APPLIES PER: CLAIMS-MADE OCCUR COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ DED RETENTION $ CLAIMS-MADE OCCUR $ AGGREGATE $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS PER STATUTE OTH- ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNED AUTOS AUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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 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: INSURED PHONE (A/C, No, Ext): PRODUCER ADDRESS: E-MAIL FAX (A/C, No): CONTACT NAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INS025 (201401) DocuSign Envelope ID: 2EF7F8CC-9F89-48B1-9082-84D54D4EE7BD