Certificates of Insurance DATE(MMIDD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE 09/27/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME: Kayla Ferrell
MARSH RISK&INSURANCE SERVICES
FOUR EMBARCADERO CENTER,SUITE 1100
CALIFORNIA LICENSE NO.0437153 E-MAIL
ADDREss: Kayla.Ferrell@marsh.com
SAN FRANCISCO,CA 94111
INSURER(S)AFFORDING COVERAGE NAIC#
CN 1 02460432-STND-GAUW-22-23 SC 33802 INSURERA:Zurich American Insurance Company 16535
INSURED Tesla,Inc. INSURER B:American Zurich Insurance Company 40142
3500 Deer Creek Road INSURERC:N/A N/A
Palo Alto,CA 94304 INSURER D:N/A N/A
INSURERE:N/A N/A
INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-003955975-01 REVISION NUMBER: 10
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 ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY X GLO 1074588-05 10/31/2022 10/31/2023 EACH OCCURRENCE $ 2,500,000
CLAIMS-MADE X OCCUR Includes Host Liquor Liability DAMAGE TO RENTED 2,50Q,000
PREMISES(Ea occurrence) $
X SIR:$1,000,000 MED EXP(Any one person) $ 5,000
X Tort Contrac Liab,No XCU Excl PERSONAL&ADV INJURY $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
X POLICY Jtci LOC PRODUCTS-COMP/OPAGG $ N/A
X OTHER: Pruemises&Operations only $
A AUTOMOBILE LIABILITY X BAP1074586-05 10/31/2022 10/31/2023 COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOSONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOSONLY AUTOS ONLY (Per accident)
L $
UMBRELLA LAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
B WORKERS COMPENSATION WC 1074583-05(AOS) 10/31/2022 10/31/2023 X STATUTE OERH
AND EMPLOYERS'LIABILITY
A Y/N WC 1074584-05(MA,WI) 10/31/2022 10/31/2023
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
A OFFICER/MEMBER EXCLUDED? N/A CA XSWC EWS 1074585-05 $50M is XS 10/31/2022 10/31/2023
(Mandatory in NH) ( E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 10M SIR XS 1 M EE/EA i 10M SIR,
$ s $
DESCRIPTION OF OPERATIONS below ) E.L.DISEASE-POLICY LIMIT $ 1,000,000
APP Sft T
I "f
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,maybe attached if more ace is required) ay 77;. 7
( Y P 9 )Re:SC—Supercharger DA "-"'^"®/4NP
,..
Supercharger TRT ID:33802 -�
Supercharger Address:9400 Overseas Hwy,Marathon,FL 33050
Monroe County,and the Monroe County Board of Commissioners are included as Additional Insured on the General Liability and Auto Liability policies as required by written contract,but only with respect to liability
arising out of the Named Insured's operations.
CERTIFICATE HOLDER CANCELLATION
Monroe County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1100 Simonton Street, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Key West,FL 33040 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: GLO 1074588-05 COMMERCIAL GENERAL LIABILITY
CG 2010 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location(s) Of Covered Operations
ANY PERSON OR ORGANIZATION TO WHOM ANY LOCATION WHERE WORK OR
OR TO WHICH YOU ARE REQUIRED TO OPERATIONS PERFORMED BY THE
PROVIDE ADDITIONAL INSURED STATUS INSURED OR ON THEIR BEHALF.
IN A WRITTEN CONTRACT OR WRITTEN
AGREEMENT EXECUTED PRIOR TO LOSS,
EXCEPT WHERE SUCH CONTRACT OR
AGREEMENT IS PROHIBITED BY LAW.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
CG 2010 0413 O Insurance Services Office, Inc., 2012 Page 1 of
A. Section II - Who Is An Insured is amended to 1. All work, including materials, parts or equipment
include as an additional insured the person(s) or furnished in connection with such work, on the
organization(s)shown in the Schedule, but only with project (other than service, maintenance or
respect to liability for "bodily injury", "property repairs) to be performed by or on behalf of the
damage" or "personal and advertising injury" additional insured(s) at the location of the
caused, in whole or in part, by: covered operations has been completed; or
1. Your acts or omissions; or 2. That portion of "your work" out of which the
2. The acts or omissions of those acting on your injury or damage arises has been put to its
behalf; intended use by any person or organization
other than another contractor or subcontractor
in the performance of your ongoing operations for engaged in performing operations for a principal
the additional insured(s) at the location(s) as a part of the same project.
designated above.
C. With respect to the insurance afforded to these
However: additional insureds, the following is added to
1. The insurance afforded to such additional Section III - Limits Of Insurance:
insured only applies to the extent permitted by If coverage provided to the additional insured is
law;and required by a contract or agreement, the most we
2. If coverage provided to the additional insured is will pay on behalf of the additional insured is the
required by a contract or agreement, the amount of insurance:
insurance afforded to such additional insured 1. Required by the contract or agreement; or
will not be broader than that which you are
required by the contract or agreement to provide 2. Available under the applicable Limits of
for such additional insured. Insurance shown in the Declarations,
B. With respect to the insurance afforded to these whichever is less.
additional insureds, the following additional This endorsement shall not increase the applicable
exclusions apply: Limits of Insurance shown in the Declarations.
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
CG 2010 0413 O Insurance Services Office, Inc., 2012 Page 2 of