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Certificates of Insurance 710/22/2020 E(M MID DIYYYY) AC+af� .... CERTIFICATE OF LIABILITY INSURANCE 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). PRODUCER CONTACT NAME: Michelle Rushing Bowen, Miclette& Britt of Florida, LLC AICO"N Ext: (407)647-1616 FAX No:(407)628-1635 1020 N. Orlando Avenue, Suite 200 E-MAIL Maitland FL 32751 ADDRESS: mrushing@bmbinc.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Company 19488 INSURED PEDROFALCO INSURER B:Amerisure Mutual Insurance Company 23396 Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C INSURER C Big Pine Key FL 33043-4516 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 70370249 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBRTYPE OF INSURANCE INSp WVp POLICY NUMBER POLICY EFF POLICY EXP LTR MM DDIYYYY D MM DIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 61-209294106 11/2/2020 11/2/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $100,000 Approved Risk Management MED EXP(Any one person) $5,0c0 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY Ln PRO JECT LOC 4-9-2021 PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y CA209293905 11/2/2020 11/2/2021 COMBINED SINGLE LIMIT $ Ea accident 1,000 000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident B X UMBRELLA LIAB X OCCUR Y Y CU209294206 11/2/2020 11/2/2021 EACH OCCURRENCE $4,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION$ $ B WORKERS COMPENSATION Y WC209452606 11/2/2020 11/2/2021 X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract,those parties listed in said contract, including the Certificate Holder, are added as additional insureds with respect to the General Liability including ongoing and completed operations,Auto Liability,and Umbrella Liability as afforded by the policy and/or endorsements. When required by written contract,waiver of Subrogation is granted with respect to the General Liability,Auto Liability,Workers Compensation,and Umbrella See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners 500 Whitehead Street Key West FL 33040 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEDROFALCO LOC#: AC 401?LT ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Bowen,Miclette&Britt of Florida, LLC Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C POLICY NUMBER Big Pine Key FL 33043-4516 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Liability to those parties listed in said contract, including the Certificate Holder. The General Liability and Umbrella Liability certified herein are primary and non-contributory to other insurance available, but only to the extent required by written contract. Certificate Holder includes:The Monroe County Board of County Commissioners, its employees and officials RE: Big Pine Key Community Park Phase II Repairs ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT _ FORM A This endorsement modifies insurance provided under the foUowing� COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number Agency Number Policy Effective Date Policy Expiration Date Date Account Number Named Insured Agency Issuing Company CONTRACTORS INC FLORIDA, LLC CDMIPANY 1. a. SECTION 11 -WHO IS AN INSURED is amended to add as an additional insured any person or organization: (1) Whom you are required io add as an additional insured on this policy under a written contract or written agreement relating tu your business; or (2) Who is named as an additional insured under this policy on a certificate of insurance. b. The written contract.written agreement, or certificate of insurance must: (1) Require additional insured status for atime period during the term of this policy; and (2) Be executed prior to the "bodily injury","property damage", or"personal and advertising injury" leading toa claim under this policy. c |thowever (7) "Your work" began under a letter of intent or work order; and (Z) The letter of intent or work order led to a written contract or written agreement within 30 days of beginning such work; and (3) Your customer's customary contracts require persons or organizations to be named as additional insureds; we will provide additional insured status as specified in this endorsement. Z The insurance provided under this enclo/sementis limited asfnUovvs; a. That person or organization is an additional insured only with respect to liability caused, in whole or in part, by: (1) Premises you: (a)Own; (b) R�� (c) Lease: or (d) Oocupy: (2) Ongoing operations performed by you orom your behalf, Ongoing operations does not apply uu "bodily iniury'ur"property damage"occurring after: includes copyrighted material cd insurance Services Office, Inc. CG7o481n 15 Pages of Polky#GL2093Q41OO Effective Dates: 11/2/2O2[-11/2/2O21 (a) All work to be performed by you or on your behailf for the additional insured(s) at the site of the covered operations is complete, including related materials, parts or equipment (other than sen/ice, maintenance or repairs),- or (6) That Portion of"your work"out of which the injury or damage arises is put to its intended use by any person or organization other than another contractor working for a principal as a part of the same project. (3) Completed operations coverage, but only if (a) The written contract, written agreement, orcertificate of insurance requires completed operations coverage or"your work"coverage; and (b) Thiscoverpgepartprovidescove,agefor''budi|yinjury''ur^Propertydamage~inc|udcdwithin the"prod ucts-cump|etcd operations hazard" However, the irsurance afforded to such additional insured only applies to the extent permitted by law. b. |f the written contract,written agreement. or certificate ofinsurance: (1) Requires"arising out of'language;or (2) Requires you to provide additional insured coverage to that person or organization by the use of either orboth uf the foWmwing� (a) Additional Insured—Owners, Lessees or Contractors— Scheduled Person Or Organization endorsement CG2O101OD1;or (b) Additional |nsuned—Owners. Lessees or Conrrac<ors—Cnmp|eted Operations endorsementCG 203/ lOQ1� then the phrase"caused, in whole or in part, by" in paragraph 2.a. above is replaced by"arising out of'. C. If the written contract, written agreement, or certificate of insurance requires you to provide additional insured coverage vo that person ur organization by the use of: (1) Additional Insured—Owners, Lessees or Contractors—Scheduled Person Or organization endorsement[GZ010Q7O4orCG2O1AU413� ur (2) Additional Insured—Owners, Lessees or Contractors—Completed Operations endorsement CG 20 370704orCG20370413; or (3) Both those endorsements with either of those edition dates; or (4) Either or both of the following: (a) Additional Insured—Owners, Lessees or Contractors—Scheduled Person Or Organization endorsement CG20 1O without anedition date specifind� or (b) Addibona| Insured —Ovvnem. LesseesorContractoru—Cnrnp|etedOpemdons endorsement CG 2U37 without an edition date specified: then paragraph 2.a. above applies, d. Premises, as respects paragraph 2.a.(1)above, include common or public areas about such premises if co required in the written contract nr written agreement, e. Additional insured status provided uvder paragraphs 2.a.(1)(b)or2.a.(1)(c)above does not extend beyond the end ofa premises lease or rental agreement, [ The limits vf insurance that apply to the additional insured are the least of those specified imthe� (1) Written contract-, (2) Written agreement: (3) Certificate. uf insurance; or (4) Declarations of this policy. The limits of insurance are inclusive ot and not in addition to the limits of insurance shown in the Declarations. includes copyrighted material of Insurance Services Office, Inc, Page of CG 7048 10 15 Poioy#GL20@3841OO EffouUva Dates: 11/2/2U2U'11/2/2U21 g. The insurance provided to the additional insured does not apply to "bodily injury", "property damage".or ''persona/andudvertisinginju?y' erisingoutcfaoanchiteci's. emBinee/s'nrsumeyor'snenderingotor failure io render, any professional services, including but not limited to: (1) The preparing, approving, or failing to prepare orapprove.- (a) Maps; (b) Drawings; (c) Opninns; *URcpnrts; (e) Surveys; (0Ohange ordens� (g) Design specifications; and (2) Supervisory, inspection, or engineering services. h. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4.Other Insurance is deleted and replaced with thefoUovjng� 4. Other Insurance. Coverage provided by this endorsement is excess over any other valid and collectible insurance available to the additional insured whether: a.Primary: b.Exceys, c. Contingent: nr d.On any other basis.- but if the written contract, written agreement, or ce6ficate of insurance requires primary and non- contributory coverage. this insurance will be primary and non-contributory relative to other insurance available to the additional insured which covers that person or organization as a Named Insured, and we will not share with that other insurance. i If the written contract,written agreement, or certificate of insurance as outlined above requires additional insured status by use of CG 20 10 11 85. then the coverage provided under this CG 70 48 endorsement does riot apply except for paragraph 2.h.Other Insurance. Additional insured status b limited tothat provided by CG 20 10 11 85 shown below and paragraph 2.11h. Other insurance shown above. ADDITIONAL INSURED-OWNERS,LESSEES OR CONTRACTORS(FORM 8) This endorsement modifies insurance provided under the followrig,. COMMERCIAL GENERAL LIABILITY COVERAGE PART, SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract,Agreement,or Certificate of insurance that the terms of CG 20 10 11 85 apply (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of"your work"for that insured by or for you. CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Includes copyrighted matcrialof insurance Services Office, Inc. CG78481O15 Pages 3 *f4 Policy#GL2092Q 106 EffmnUvm Dates: 11/3/2030'11/3/3021 j. The insurance provided by this endorsement does not apply to any premises or work for which the person or organization is specifically listed as an additional insured on another endorsernent attached to this policy, Includes copyrighted material of Insurance Services Office, Inc. Page 4of4 CG 70481015 Policy#GL209294106 Effective Dates: 11/2/2020-11/2/2021 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SECTION 1—COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, paragraph 2. EXCLUSIONS, provisions 1.through 6. of this endorsement are excess over any valid and collectible insurance (including any deductible)available to the insured, whether primary, excess or contingent(SECTION IV— 'COMMERCIAL GENERAL LIABILITY CONDITIONS,paragraph 4.Other Insurance is changed accordingly). Provisions 1.through 6.of this endorsement amend the policy as follows: 1. PROPERTY DAMAGE LIABILITY—ALIENATED PREMISES A. Exclusion j. Damage to Property, paragraph (2)is deleted. B. The following paragraph is also deleted from Exclusion j. Damage to Property: Paragraph(2)of this exclusion does not apply if the premises are"your work"and were never occupied, rented or held for rental by you. 2. PROPERTY DAMAGE LIABILITY—ELEVATORS AND SIDETRACK AGREEMENTS A. Exclusion j. Damage to Property, paragraphs(3),(4), and (6) do not apply to the use of elevators. B. Exclusion k. Damage to Your Product does not apply to: 1. The use of elevators; or 2. Liability assumed under a sidetrack agreement, 3. PROPERTY DAMAGE LIABILITY—PROPERTY LOANED TO THE INSURED OR PERSONAL PROPERTY IN THE CARE,CUSTODY AND CONTROL OF THE INSURED A. Exclusion j.Damage to Property,paragraphs(3)and(4) are deleted. B. Coverage under this provision 3.does not apply to "property damage"that exceeds$25,000 per Occurrence or$25,000 annual aggregate. 4. PRODUCT RECALL EXPENSE A. Exclusion n. Recall Of Products,Work Or Impaired Property does not apply to"product recall expenses"that you incur for the"covered recall"of "your product". This exception to the exclusion does not apply to"product recall expenses"resulting from: 1. Failure of any products to accomplish their intended purpose; 2. Breach of warranties of fitness, quality, durability or performance; 3. Loss of customer approval or any cost incurred to regain customer approval; 4. Redistribution or replacement of"your product", which has been recalled, by like products or substitutes; 5. Caprice or whim of the insured; 6. A condition likely to cause loss, about which any insured knew or had reason to know at the inception of this insurance; 7. Asbestos, including loss, damage or clean up resulting from asbestos or asbestos containing materials; 8. Recall of"your product(s)"that have no known or suspected defect solely because a known or suspected defect in another of"your product(s)" has been found. B. Under SECTION III—LIMITS OF INSURANCE, paragraph 3. is replaced in its entirety as follows and paragraph 8. is added: 3. The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of: Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 11 CG 72 89 0417 Policy#GL209294106 Effective Dates: 11/2/2020-11/2/2021 We will not deny coverage under this Coverage Form if you unintentionally fail to disclose all hazards existing as of the inception date of this policy. You must report to us any knowledge of an error or omission in the description of any premises or operations intended to be covered by this Coverage Form as soon as practicable after its discovery. However,this provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. 18. TRANSFER OF RIGHTS(BLANKET WAIVER OF SUBROGATION) Paragraph 8.Transfer of Rights Of Recovery Against Others To Us is deleted and replaced with the following: 8. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring"suit"or transfer those rights to us and help us enforce them. However, if the insured has waived rights to recover through a written contract, or if"your work"was commenced under a letter of intent or work order,subject to a subsequent reduction to writing with customers whose customary contracts require a waiver,we waive any right of recovery we may have under this Coverage Form. 19. MOBILE EQUIPMENT REDEFINED Under SECTION V—DEFINITIONS, paragraph 12. "Mobile equipment", paragraph f. (1)does not apply to self-propelled vehicles of less than 1,000 pounds gross,vehicle weight. 20. ADDITIONAL DEFINITIONS 1. SECTION V—DEFINITIONS, paragraph 4. "Coverage territory"is replaced by the following definition: "Coverage territory"means anywhere in the world with respect to liability arising out of"bodily injury," ",property damage,"or"personal and advertising injury,"including "personal and advertising injury" offenses that take place through the Internet or similar electronic means of communication provided the insured's responsibility to pay damages is determined in a settlement to which we agree or in a"suit"on the merits, in the United States of America(including its territories and possessions), Puerto Rico and Canada. 2. SECTION V—DEFINITIONS is amended by the addition of the following definitions: "Covered recall" means a recall made necessary because you or a government body has determined that a known or suspected defect, deficiency, inadequacy, or dangerous condition in "your product"has resulted or will result in"bodily injury"or"property damage". "Product Recall expenses" mean only reasonable and necessary extra costs, which result from or are related to the recall or withdrawal of"your product"for: a. Telephone and telegraphic communication, radio or television announcements,computer time and newspaper advertising; b. Stationery, envelopes, production of announcements and postage or facsimiles; c. Remuneration paid to regular employees for necessary overtime or authorized travel expense; d. Temporary hiring by you or by agents designated by you of persons,other than your regular employees, to perform necessary tasks; e. Rental of necessary additional warehouse or storage space; f. Packaging of or transportation or shipping of defective products to the location you designate; and g. Disposal of"your products"that cannot be reused. Disposal expenses do not include: (1) Expenses that exceed the original cost of the materials incurred to manufacture or process such product; and (2) Expenses that exceed the cost of normal trash discarding or disposal, except as are necessary to avoid "bodily injury"or"property damage", Includes copyrighted material of Insurance Services Office, Inc. CC 72 89 0417 Page 9 of 11 Policy EffauUvo Dates: 11/3/2030'11/3/3021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. FLORIDA ADVANTAGE COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The premium for this endorsement is� l. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS-CANCELLATION, Paragraph A.2.is replaced by the following: 2. VVe may cancel this policy by mailing or delivering Wthe first Named Insured written notice ofcancellation at least: a. 1U days before theeffecdvedatewfcunce|labonifwecamcc|fornonpaymmntofpremium; o/ b. 60 days before the effective date of cancellation if we cancel for any other reason. 2- BROAD FORM INSURED SECTION 11-LIABILITY COVERAGE A.1.WHO IS AN INSURED is amended by the addition of the following: d^ Any organization you newly acquire or form, other than a partnership,joint venture or limited liability company, and over which you maintain ownership or a majority interest, will qualify as a Named Insured, However. (1) Coverage under this provision is afforded only until the end of the policy period: (2) Coverage does not apply to"accidents" or"loss"that occurred before you acquired or formed the organization:and (3) Cnveoageduesnotapp|ymanorgamizatinnthatisan^insured~underaoy*therpo|icyormmu|dbean "insured"but for its termination or the exhausting of its limit of insurance. e' Any~emp|oyee~uf yours using: (1) A covered"auto"you do not own, hire or borrow,or a covered"auto"not owned by the"employee"or a member of his or her household,while performing duties reIated to the conduct of your business or your personal affairs; o, (2) An `auUo"hired or rented under contract or agreement in that~emp|oyee's''name,with your permission, while performing duties related to the conduct of your business. However,your "employee"does not qualify as an insured under this paragraph (2)while using a covered"auto" rented from You or from any member of the'emp|oyee,s'household. [ Yourmembers. ifyouanea |imhedUabi|hycumpany.whi|eusingacoveped'`aukz''youdonotmwn. hire.or borrovv. whi|epmMbnningduhesve|atedtotheconductofyourbusincasoryourpersona|affairs. g. Any person or organization with whom you agree in a written contract, written agreement or permit,to provide insurance such asis afforded under this policy,but only with respect tu your covered^autms~. This provision does not apply: (1) Unless the written contract oragreement is executed or the permit is issued prior to the"bodily injury" or"property damage~; Includes copyrighted material of insurance Services Cdficc. Inc. [A717105 08 Page 1mf6 Policy# Effective Dates: 11/2/2020'11/2/2021 S. AIRBAG COVERAGE SECTION|U~PHYSICAL DAMAGE, B.EXCLUSIONS, Panagnaph3. is deleted and replaced by the following: We will not pay for^|oss"caused by or resulting from any of the following unless caused by other^|oys"that is covered by this insurance: a. Wear and tear, freezing,mechanical or electrical breakdown, However,this exclusion does not include the discharge ofanairbag. 6. Blowouts,punctures or other road damage»o hres- 9. GLASS REPAIR'WAIVER OFDEDUCTIBLE SECTION III'PHYSICAL DAMAGE COVERAGE,D.DEDUCTIBLE iu amended*o add the following: Nu deductible applies k, glass damage. 10. COLLISION COVERAGE—WAIVER OFDEDUCTIBLE SECTION U|-PHYS|CAL DAMAGE COVERAGE,D. DEDUCTIBLE bamended to add the following.- When there is a "loss"to your covered"auto"insured for Collision Coverage, no deductible wi] apply if the ^|oss''was caused bya collision with another~autu-insured byus. 11. KNOWLEDGE OF ACCIDENT SECTION |V' BUSINESS AUTO CONDITIONS,A.LOSS CONDITIONS,2. DUTIES|NTHE EVENT OF ACCIDENT,CLAIM,SUIT OR LOSS, paragraph a. is deleted and replaced by the following: a You must see to it that we are notified as soon as practicable of an"accident",claim, "suit"or"loss", Knowledge of an"accident", claim. 'suit'or"loss"by your~cmployees^shall not,in itsclf,constitute knowledge to you unless one of your partners, executive officers, directors, managers, of members (if you are a limited liability company) has knowledge of the "accident",claim, "suit"or'1uss^ Notice should include: (1) How,when and where the~accident"orloas^occurred. (2) The ^inyurmd',''name and address; and (3) To the extent possib|e, the names and addresses of any injured persons and witnesses. 12. TRANSFER oF RIGHTS(BLANKET WAIVER OFSUBROGATION) SECTION IV-BUSINESS AUTO CONDITIONS A.5.TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO USis deleted and replaced by the following: If any person or mrgamizadon to or for whom we make payment under this[overage Form has rights to recover damages from another,those rights are transferred to us. That person or organization must do everything necessary to secure our rights and must do nothing after"accident"or'1ous''uo impair them, Hmvevar,if the insured has waived rights to recover through a written contract, or if your work was commenced under a letter of intent or work order, subject to a subsequent reduction in writing with customers whose customary contracts require a waiver,we waive any right of recovery we may have under this Coverage Form. 13. UNINTENTIONAL FAILURE T0 DISCLOSE HAZARDS SECTION IV-BUSINESS AUTO CONDITIONS, B.GENERAL CONDITIONS,2. CONCEALMENT, MISREPRESENTATION C)R FRAUD is amended by the addition of the following: VVe will not deny coverage under this Coverage Form if you unintentionally fail m disclose all hazards existing as of the inception date of this policy, You must report to us any knowledge of an error or omission in your representations as soon as practicable after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. Includes copyrighted material uf Insurance Services Office, Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 ;Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. {This agreement applies only to the extent that you perform work Linder 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 "Any person or organization required by written contract or certificate of insurance." "This endorsement is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas and Utah." "This andorsernerit does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287,150 61 of the Missouri Statues, a contractual provision purporting to waive subrogation rights is against public policy and void where one party to the contract is an employer in the construction group of code classifications." This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/212020 Policy No WC209452606 Endorsement No. Insured Pedro Falcon Electrical Contractors, Inc. Premium Insurance Company Amerisure Insurance Co. Countersigned by WC 00 03 13 H-1 7--6 3--., (Ed. 4-84) Copyright 1583 National Council on Corvperisation Insurance. corder Na 14-43HB Po|icyNCU20@3@420O Effective Dates: 11/2/2U2[-11/3/2O21 COMMERCIAL LIABILITY UMBRELLA CUDOO1n413 �~�����������~U��U LIABILITY UMBRELLA ���������»J����� ���n���� COMMERCIAL��� � � ���� � ��� �� ~���� ^ ~�� �^~^ Various provisions in this restrict coverage. No other obligation or liability to pay sums or Read the entire policy carefully to determine hghts, perform acts or services is covered unless duties and what is and is not covered. explicitly provided for under Supplementary Throughout this policy the wmnb "you" and "your" Payments-Coverages/\and B' refer oo the Named Insured shown in the Declarations, b. This insurance applies to "bodily injury" or and any other person or organization qualifying as a "property damage" that is subject to an Named Insured under this poUcy� The words "we", applicable "retained limit", If any other limit, ^us" and ''our" refer to the company providing this such as a sub|imit' is specified in the insurance. "underlying inyunance^, this insurance does not The word"insured" means any person ororganization apply t "bodily injury" or "property damage" qualifying as such under Section U - Who Is An arising out of that exposure unless that limit is Insured. specified in the Declarations under the Other words and phrases that appear in quotationSchodu|euf^undor�inginsuranoe^on . marks have special meaning. Refer to Section V - c. This insurance applies to "bodily injury" and Definitions. "property damage"only if: SECTION |-CgVER&GES (1) The "bodily injury" or "property damage" is caused by an "occurrence" that takes p|oma COVERAGEA-BOD!LYlNJURYANDpROpERTY in the"coverage oeni,ory^: DAMAGE LIABILITY (2) The "bodily injury" or "property dam�gdamage"�. Insuring Agreement occurs during the policyperiod; and a. We will pay on behalf of the insured the (3) Prior to the policy period no insured listedmm ''u|tia«e net |*ss'' in excess of the ''r��ain�d ' under Paragraph 1 a of Section |l-VVhu Is limit" because of "bodily iniory^ or "property �n Insured and n- � Sectionemp|oyee^ authorized damage" to which this insurance applies. We by you to give or receive notice of an will have the right and duty to defend the .occurrence" or claim, knew that the "bodily"suit"insuned against any "suit" seekingd forinjury" or "property damage" had occurred, such "bodily "n"'y or"property damage" when in whole or in part If such a listed insured the "underlying insurance" does not provide aut authorized --|-'-- knew, prior to the coverage — � policy period, that the "bodily injury" or have been exhausted. When wehave ' -r` damage" occurred, - any to we will have the right to defend, or ��nu�� �� � � m� th �c�n�o ot Uhe insured ~hndi� i ' =- - ---� — - | si oher sut seeking damages to nrafter-^�' - ---r~ dmg g the wmchmemsu� However, we have beenpolicy ' «,�emPcvp peill be rioed d. will have no duty to defend the insured against known-- prior " - -� any "suit" seeking damage for "bodily �injury" d. "Bodily injury" or "property damage" to which this insurance occurs vu/me the policy prnvu and was not, does not apply. At our discnehon, we may prior to the policy period, known to have investigate any "occurrence" that may involve occurred by any insured listed under this insurance and settle any |t ntc|aimor Paragraph 1.s. of Section U - Who Is An "suit" for which we have the duty to defend. Insured u/any'emp!oyee''authorized by you to But: give or receive notice of an "occurrence" or (1) The amount we will pay for the "ultimate net gaim, includes any continuation, change or k/resumption oy that ^bodiinjury" or "property loss" is limited as described in Section U[ - damage"after the end of the policy period.Umhs[f|nsu/ nce;and (2) Our right and duty to defend ends when wr have used up the applicable limit of insurance in the payment of judgments o/ settlements under Coverages Ao,B. CU0881p413 (C�Insurance Services Office, |nc.2012 Page 1mf18 (3) Any person m organization having proper (4) Anyone other than temporary custody cf your property if you partners (if you are a partnc,ship), die, but only: members (if you are a limited liability (a) With respect to liability arising out ofthe com[any)' ora lessee ur borrower or any of maintenance or use of that property: their "employees", while moving property to and or from a "covered auto' (b) Until your legal representative has been (5) A partner (if you are a partnership), or a appointed. member (if you are a limited liability PQ Your legal representative if you die, but only company) fora "covered auto" owned by him or her or a member of his or her with respect to dudes as such. That representative will have all you, rights and . duties under this Coverage Part. (6) ^Ennp|oyecs'` with respect Lo "bodily injury" c Any organization you newly acquire or form, to: other than a partnership,joint venture orlimited (a) Any fellow "employee" of the insured liability company, and over which you maintain arising out of and in the course of the ownership or najority interest, will qualify as a feUowemployment or Named Insured if there is no other similar while performing duties related to the insurance available to that organization. conduct nf your business, ur However: (b) The spouye, child, pamnt, brother or (1) Coverage under this provision is afforded sister of that fellow "employee" as a only until the g0t day after you acquire ur consequence of Paragraph (a)above. form the organization o/ the end of the c. Anyone liable for the conduct of an insured policy period, whichever ieearlier; described above is also an insured, but only to (2) Coverage/\does not apply V*"bodily inju/y" the extent of that liability. nr "property damage" that occurred before 3. Any additional insured under any policy of you acquired or formed the organization; ..underlying insurance" will automatically be an and insured under this insurance. (3) [overage B does not apply to "personal Subject to Section U| — Limits Of |msurance, if and advertising hnjury" arising out of an coverage id d to the additional insured is offense committed before you acquired or required b, a contract or agreement, the most we formed the organization. will pay on behalf of the additional insured is the 2. Only with respect to liability arising out of the amount ofinsurance: ownership, maintenance o, use of "covered a. Required by the contract or agreement, less autos": any amounts payable by any "underlying a. You are aninsured, insurance''; or b. Anyone else while using with your permission a 6^ Available under the applicable Limits of "covercd auto" you own, hire or borrow is also Insurance shown in the Declarations; an insured except: whichever isless. (1) The owner or anyone else from whom you Additional insured coverage provided by this hire or borrow o "covered auto". This insurance will not be broader than coverage exception does not apply if the "covered provided by the"underlying insuencc^. auto" is a trailer or semitrailer connected to a "covered auto you No Person or organization is an insured with respect partnership,to the conduct of any current or past (2) You, "employee" if the "covered auto" is venture or limited liabilitycompany cn that is not shown owned by that "employee" or a member of as a Named Insured in the Declarations. his ur her household. (3) Someone using "covered auto" while he o/ she is working ioa business ofselling, servicing, repui,ing, parking or storing "autos^unless that business isyours. CW00 01 04 13 C)Insurance Services Office, |nc-Z012 Pagel 1nf18 (2) Authorize us to obtain records and other (%) The total of all deductible and self-insured information; amounts under all that other insurance. (%) Cooperate with us in the investigation or 6. Premium Audit settlement of the claim or defense against a. We will compute all premiums for this the "suit";' Coverage Part in accordance with our rules (4) Assist us, upon our equest, in the and rates, enforcement of any right against any b. Premium shown in this Coverage Part as person or organization which maybe liable advance premium is a deposit premium only, to the insured because of injury or damage At the close of each audit period we will to which this insurance may also apply. compute the earned premium for that period ^ d. No insured will, except at that insured's own and send notice to the first Named insured. cost, voluntarily payment assume any The due date for audit and retmspectiva obligation, o, incur any expense, other than for premiums is the data shown as the due date first aid, without our consent. on the bill. If the sum of the advance and audit 4' Legal Action Against Us Premiums paid for the policy period is greater than the earned pemium, we will return the No person or organization has a right under this excess to the first Named Insured. Coverage Pau: c. The first Named Insured must keep records of a' To join us as a party o,otherwise bring us into the information we need for premium a^suit^ asking for damages from an insured; or c*mputadon, and send us copies at such times b. To sue us on this [overage Part unless all of as we may request. its terms have been fully complied with. 7. Representations Or Fraud A person or organization may sue usoo recover nn 8y accepting this policy,you agree: an agreed settlement o, on a final judgment against an insured; but we will not be liable for a. The statements in the Declarations are damages that are not payable under the terms of accurate and complete; this Coverage Part or that are in excess of the b. Those statements are based upon applicable limit of insurance,Ao agreed seU|emen\ representations you made touc means settlement and release of liability signed c' We have issued this policy in reliance uponby us' the insured and the claimant or the your representations: and claimant's legal representative. d. This policy is void in any case of fraud by you S. Other ' as it relates to this policy or any claim under a. This insurance is excess over, and shall riot this policy. contribute with any of the other insurance, 8' Separation OfInsureds whether primary, excess, contingent oronany other basis. This condition will not apply to Except with respect hothe Limits of|nsurance, and insurance specifically written as excess over any rights or dudes specifically assigned in this this Coverage Part. Coverage Part to the first Named Insured, this � VVhenthis insurance is excess, we will have no insurance app|ies� duty under Coverages A or B to defend the a, As if each Named Insured were the only insured against any "suit" if any other insurer Named Insured; and has m duty to defend the insured against that h. Separately to each insured against whom claim ~svit^ If no other insurer defends. we will is made p,^suirisbrought. undertake to du so but �� will b� entitled \o' 9. TransferOf Rights Of Recovery Against Others the insurad's rights against all those other To Us insurers. b. When this insurance is excess over other If the insured has rights to recover all or part of insurance we vviU pay only our share of the any payment we have made under this Coverage ' ^u/Umote net loss"that exceeds the sum of: Part' those rights are transferred to us. The insured must do nothing after loss to impair them. (1) The total amount that all such other At our request, the insured will bring "suit" or insurance would pay for the loss in the transfer those rights to us and help us enforce absence of the insurance provided under them. this Coverage Part: and Policy#CU209294206 Effective Dates: 11/2/2020-11/2/2021 COMMERCIAL LIABILITY UMBRELLA CU 74 67 08 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARYNON-CONTRIBUTORY COVERAGE WHEN REQUIRED BY WRITTEN CONTRACT, WRITTEN AGREEMENT, OR CERTIFICATE OF INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL LIABILITY UMBRELLA COVERAGE FORM All policy terms apply except as stated below. Under SECTION 11—WHO IS AN INSURED, the following is added to paragraph 3: If coverage provided to any additional insured is required by a written contract,written agreement, or certificate of insurance, we will provide coverage to the additional insured on a primary basis without contribution from any other valid and collectible insurance available to the additional insured. Under SECTION IV—CONDITIONS, paragraph 5. Other Insurance does not apply to coverage provided by this endorsement, Includes copyrighted material of Insurance Services Office, Inc. CU 74 67 08 10 Policy#GL209294106 Effective Dates: 1 112/2020-1 1/21202 1 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION, NONREN'EWAL OR MATERIAL CHANGE - THIRD PARTY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM TRUCKERS COVERAGE FORM Subject to the cancellation and/or nonrenewal provisions of the Coverage Form to which this endorsement is attached,we will not: 1. Cancel; 2. Nonrenew;or, 3. Materially change (reduce or restrict) this Coverage Form, except for nonpayment of premium, until we provide at least 3 0 days written notice of such cancellation, nonrenewal or material change.Written notice will be to the person or organization named in the Schedule. This notification of cancellation, nonrenewal or material change to the person or organization named in the Schedule is intended as a courtesy only. If the person or organization named in the Schedule does not receive such notification within the time frame stated in this endorsement,this will not: 1. Extend any Coverage Form cancellation date; 2. Negate the cancellation as to any insured or any certificate holder; 3. Provide any additional insurance that would not have been provided in the absence of this endorsement; or 4, Impose liability of any Find upon us. This endorsement does not entitle the person or organization named in the Schedule to any benefits, rights or protection under this Coverage Form. SCHEDULE Name Of Person Or Organization Mailing Address Any person or organization holding a certificate of insurance issued The address shown for that person or organization in for you, provided the certificate: that certificate of insurance 1. Refers to this policy; 2. States that notice of: a. Cancellation; b. Nonrenewal; or c. Material change reducing or restricting coverage; will be provided to that person or organization; 3. Is in effect at the time of the: a. Cancellation; b, Nonrenewal; or c. Material change reducing or restricting coverage;and 4. Is on file at your agent or broker's office for this policy IL70740116 Policy Effective Dates: 11/2/2U2O'11/3/2O31 THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. NOTICE OF CANCELLATION,ON NONRENEWAN OR MATERIAL CHANGE — THIRD PARTY This endorsement modifies insurance provided under the following: AUTO OExLL*S[UvEu*GeFORM BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL UMBRELLA L|ABUL|TY COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM TRUCKERS COVERAGE FORM Subject tothe cancellation and/orvonrenewa| provisions of the Coverage Form to which this endorsement is attached,we will not: 1. Cancel; Z. Nonnenew; or. 3. MatesaJ.ly change(reduce or restrict) this Coverage Fonm, except for nonpayment of pemnlum, until we provide at least-3 0---days written notice of such cancellation, nonrenewal or material change. Written notice will be to the person or organization named in the Schedule. This notification of cancellation, nonrmnevva| or material change to the person or organization named in the Schedule is intended as a courtesy only. If the person o, organization named in the Schedule does not receive such notification within the time frame stated in this endorsement, this will not: 1. Extend any Coverage Form cancellation cla»e� 2. Negate the cancellation as to any insured or any certificate holder; ]. Provide any additional insurance that would not have been provided in the absence of this endorsement: or 4. Impose liability ofany kind upon us, This endorsement does not entitle the person or organization named in the Schedule to any benefits, rights or protection under this Coverage Form. SCHEDULE Name Of Person O,Organization Mailing Address Any person or organization holding a certificate of insurance issued The address shown for that person or organization in for you, provided the certificate: that certificate of insurance 1� Refers to this policy: 2. States that notice of: a. Cancellation,- b. Nonneoewa8� or c Material change reducing or restricting coverage; will 6e provided to that person ororganization; 3. |sineffect at the time of the: a. Cancellation; b. NonrenewaU� or c Material change reducing o,restricting coverage; and 4. Is on 0c at you,agent or broker's office for this policy |L7O74U1 16 Policy#WC209452606 Effective Dates: 1 1/212020-1 112/202 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US Number of Clays Notice 60 For any statutorily permitted reason other than nonpayment of premium,the number of days required for notice of cancellation is increased to the number of days shown in the Schedule above. If this policy is cancelled by us we will send the Named Insured and any party listed in the following schedule notice of cancellation based on the number of days notice shown above. SCHEDULE Name of Person or Organization The Name of Person or Organization is any person or organization holding a certificate of insurance issued for you, provided the certificate: 1. Refers to this policy; 2. States that notice of: a. Cancellation; b. Nonrenewal; or c. Material change reducing or restricting coverage; will be provided to that person or organization; 3. Is in effect at the time of the: a. Cancellation; b, Nonrenewal; or c. Material change reducing or restricting coverage; and 4. Is on file at your agent or broker's office for this policy. Mailing Address The Mailing Address is the address shown for that person or organization in that certificate of insurance. IL 70 45 05 07 Policy#CU209294206 Effective Dates: 11/2/2020-11/2/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL CHANGE -- THIRD PARTY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO}COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE. FORM TRUCKERS COVERAGE FORM Subject to the cancellation and/or nonrenewal provisions of the Coverage Form to which this endorsement is attached, we will not: 1. Cancel; 2. Nonrenew; or, 3. Materially change(reduce or restrict) this Coverage Form, except for nonpayment of premium, until we provide at least days written notice of such cancellation, nonrenewal or material change.Written notice will be to the person or organization named in the Schedule. This notification of cancellation, nonrenewal or material change to the person or organization named in the Schedule is intended as a courtesy only. If the person or organization named in the Schedule does not receive such notification within the time frame stated in this endorsement, this will not: 1. Extend any Coverage Form cancellation date; 2. Negate the cancellation as to any insured or any certificate holder; 3. Provide any additional insurance that would not have been provided in the absence of this endorsement; or 4. Impose liability of any kind upon us. This endorsement does not entitle the person or organization named in the Schedule to any benefits, rights or protection under this Coverage Form, SCHEDULE Name Of Person Or Organization Mailing Address Any person or organization holding a certificate of insurance issued The address shown for that person or organization in for you, provided the certificate: that certificate of insurance 1. Refers to this policy; 2. States that notice of: a. Cancellation; b, Nonrenewal'; or c. Material change reducing or restricting coverage; will be provided to that person or organization; 3. Is in effect at the time of the; a. Cancellation; b. Nonrenewal; or c. Material change reducing or restricting coverage; and 4. Is on file at your agent or broker's office for this policy IL70740116