Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Certificate of Insurance
71/21/2025 E(MM/DD/YYYY) A�" 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 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 IMA Select LLC PHONE IMA Certificate Team FAX 14221 Dallas Parkway A/C No Ext: 316-267-9221 A/c,No): E-MSuite 700 ADDRESS: certificates@imacorp.com Dallas TX 75254 INSURER(S)AFFORDING COVERAGE NAIC# License#:PC-1115916 INSURERA: Underwriters at Lloyd's, London 15642 INSURED GANDSME-01 INSURER B: G and S Mechanical USA, Inc. 3409 West Harry St. INsuRERc: Wichita KS 67213 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:360772621 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAM CLAIMS-MADE OCCUR PREM SESO a occur ence $ �w MED EXP(Any one person) $ jRk PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: 'i �r GENERAL AGGREGATE $ POLICY PE CT LOC '"'""""""`""�- 'lu m� PRODUCTS-COMP/OP AGG $ OTHER: I... 1 21 25 ,. $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ WAMM —. Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability PF00726A23 1/12/2025 1/12/2026 See Below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liability:$2,000,000 Per Claim;$2,000,000 Aggregate;$25,000 Retention; Retroactive Date 1/12/2023. 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 BOCC 1100 Simonton St. AUTHORIZED REPRESENTATIVE Key West FL 33040 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCE ISSUE 25/02/Y/MM/DD) 25/02/24 BROKER This certificate is issued as a matter of information onlyand confers Wilson M. Beck Insurance Services(Victoria) Inc. no rights upon the certificate holder.This certificate does not amend, #350 4396 West Saanich Road Victoria BC V8Z 3E9 extend or alter the coverage afforded bythe policies below. COMPANY Federal Insurance Company A INSURED's FULL NAME AND MAILING ADDRESS COMPANY G&S Mechanical USA, Inc. B 3409 West Harry Street, COMPANY Wichita, KS 67213 C COMPANY D COMPANY E COVERAGES 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. TYPE OF INSURANCE CO POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS OF LIABILITY LTR DATE(YY/MM/DD) DATE(YY/MM/DD) (Canadian dollars unless indicated otherwise) COMMERCIAL GENERAL LIABILITY A Policy No.99508397 25/02/28 26/02/28 Per Occurrence 2,000,000 USD Primary Non-Contributory Clause AM Best:A++ Aggregate Limit 2,000,000 USD AM Best:002084 NAIC:20281 Products—Comp/Ops Agg 2,000,000 USD Personal Injury Agg 2,000,000 USD Advertising Injury Agg 2,000,000 USD Tenant's Legal Liability 1,000,000 USD IS Medical Expenses Limit 10,000 US ,,, . 3 6 25 DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS/ADDITIONAL INSURED Reference:All Operations of the Named Insured as Described in the Policy Declarations. It is hereby understood and agreed that the Certificate Holder is added as Additional Insured to the Commercial General Liability Coverage Policy but only with respect to liability arising out of the Named Insured's sole negligence. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL Monroe Count BOCC SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY Y KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 1100 Simonton St., Key West FL 33040 AUTHORIZED REPRESENTATIVE ��9 Client#: 1266945 GSMEC DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 9/27/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Paul Abawi NAME: USI Insurance Services LLC PHONE 775-335-2105 FAX 2375 E. Camelback Rd, Suite 740 AMA No,Ext: (A/c,No): ADDRESS: paul.abawi@usi.com Phoenix,AZ 85016 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Property Cas.Co.of America 25674 INSURED INSURER B:Travelers Indemnity Co of America 25666 G &S Mechanical USA Inc. INSURER C 3409 W Harry St INSURER D Wichita, KS 67213 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY j° k NT EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR "°"""� -^ PREMISES Ea occurrence $ .. MED EXP(Any one person) $ 2 4 24 ...._„,„,„„ __tea, PERSONAL&ADV INJURY $ GATE GENERAL GEN POLICY E PE OT APPLIESPOECR: M t ,,,, W PRODUCTSGCOMP COMP/OP AGG $ OTHER: $ B AUTOMOBILE LIABILITY X X BA6N396236 10/01/2024 10/01/202 (CEO MaccidentS BINED INGLE LIMIT 1 r 000r 000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A UMBRELLA LAB X OCCUR X X EX8N968484 10/01/2024 10/01/2025 EACH OCCURRENCE $5 000 000 X EXCESS LAB CLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION X U136J622054 10/01/2024 10/01/202 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 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 A Installation 630507OM206 10/01/2024 10/01/2025 $350,000 Limit Floater $2,500 Deductible DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Installation Floater Coverages: At any installation premises or temporary storage premises: $350,000 At any other not owned, leased, or regularly operated premises: $25,000 Personal property in transit: $350,000 Deductible: $2,500 (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Monroe Count BOCC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1100 Simonton St ACCORDANCE WITH THE POLICY PROVISIONS. Key West, FL 33040 AUTHORIZED REPRESENTATIVE �• ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S46402832/M46376769 VAPZP DESCRIPTIONS (Continued from Page 1) The Automobile Liability&Excess Liability policies include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status,and only with regard to work performed on behalf of the named insured.The Automobile Liability, Excess Liability,and Workers Compensation policies provides a Waiver of Subrogation when required by written contract. RE:Various Jobs and Projects SAGITTA 25.3(2016/03) 2 of 2 #S46402832/M46376769 POLICY NUMBER: BA6N396236 COMMERCIAL AU-O ❑❑I❑EN❑OR❑EMEN❑ C❑AN❑E❑ ❑❑E POLICY❑PLEA❑E REA❑ I❑CARE❑ULLY❑ BU❑INE❑❑ AU❑O E❑ ❑EN❑ION EN❑OR❑EMEN❑ -1 e Edor Eeme--modi fie❑i-iu-ce Cro Ei ded a Eder Ee 9110 -i❑❑ BU❑[NE-AU=O CO❑ERA❑E ❑ORM ❑ENERAL -E❑CRIP❑10N O_ CO❑ERA❑E - =s eCdorCeme=broCde=coCerF1c❑❑o❑efcrfcoferF1c -or =y i iry-dEtnF] i, or medic❑ e❑-ewe❑deEcribed i -y o__e :To3:io=o =i e-dorEeme-m y be eEcluded or limi-ed by Fo Eer e Edor Eeme=9 _e C o Eer F] c P Er❑ - d EEe Ce co Cer Fe bro Ede Ct=Cro Ci Cio EEdo -o_ --Ay _e e E:le= co Eer❑ e i e Ecluded or limi-ed by Cuc❑- e-dor Eeme=__e _ollo=i- li s— i ❑Ee Eer❑co Eer- ❑ e de Seri Eio❑o 1y Limi=fib==d e Eclu Cio=m y ❑Ily 9 Ee Ee co Eer❑=e EERe Ed :11 _e :To 3:io❑❑o_=i e dor Eeme==d _e re❑-o=your -olicy c:te Willy 9 de Eermi Ee ri E=EEdu fie Q❑Ld _--i-::Ed i=_o co Eered A- BROA_ DORM NAME-IN__JRE- __ ❑IRE- AU❑O P_Y_ICAL ❑AMA❑E ❑LO❑❑0E B- BLAN_E- AI=IONALIN--JRE - U❑E -INCREA_T - LIMI - I❑ P Y_ICAL ❑AMA❑E ❑ ❑RAN-POR❑A❑ION C❑ EMPLOYEE -IRE AU-O E❑PEN❑E--INCREA_T_ - LIMI - _- EMPLOYEE-A- INURE❑ - PER❑ONAL PROPER❑Y E= _-JPPLEMEN-ARY PAYMEN= - INCREA=E ❑ AIRBA-❑ LIMI L- NO SCE AN- -NO- LE E 0- ACCI -EN -OR -IRE- AU_O - LIMI-E_ - ORL I E CO LO❑❑ ERA-E -IN EMNI__YBA-1 M- BLAN❑E_ -Al-ER O_ �:JBRO❑A❑ION ❑_ -AI-ER O= _E-UC-IBLE _ ❑LA— N- UNIN=EN=lONAL ERROR❑OR OMI❑ElON❑ PRO❑ICON❑ A❑ BROA_ ❑ORM NAME-IN__JRE- =i i❑urQ ee die❑-sl o1y 9 _e eE[e=FFTT- -_e -ollo=i- i Edded 9 PErEEr❑Z A❑ E -o I E&Eo❑ or or--io❑EuEliTe❑❑= - "iZ hired" A- I—uredCb__EC❑lON II - CO❑ERE❑ AU O❑ uEder _e _o I=A I❑ired EroEiEro❑co—,Eed LIABILI=Y CO❑ERA❑E: i Eec fio❑II A Y or❑-3—ib❑you -e-1y Ec Euire or 9rm dur - C- EMPLOYEE -IRE- AU❑O i- _e -olicy Ecriod oEer =sc you mJ-Ii❑ _ __e -ollo=i- i Edded 9 PErEEr= A= or more o❑EerEi❑iEFereQ==d i= :b❑ ❑ Co I❑A- IE[hred❑o_ _EC❑[ON II - CO_- Ee-rely i❑ired -or BuEiEeQ=Au9 CoEcr❑bE ERE AU O LIABILI__ CO❑ERA❑E: Cofer❑ e u❑der =i_ :to3:io❑i❑ ❑T rded o1y u❑❑ A "emAoyee" oyouur❑i_ "i❑fired" _31e A _e ==d y ❑Ter you Ec Euire or -onu _e or o Ecr�i= - "_u W 3red or re FTcid a Eder ❑ ❑=i—o❑or _e e- o _e -olicy :briod❑-3c= co❑rEc❑ or EEreeme= i_ - "emAoyee P efer i-e11lier❑ ❑ me❑❑i your ❑emni Elio=❑sle ❑er:6rmi-= dudbErel-ed 9 _e coEduc❑o your bud::] B❑ BLAN❑E❑A❑❑IEIONALIN❑URE❑ Ee= _ 011o_i❑_ i= Edded sI PCrQr—cCi= A 2_ ❑ s>llo=i- reElEcefPEr-�--bfi_ B❑= ❑ -b I❑A❑ IELhred_b-EEC EION II ❑ CO❑ERE❑ 0-er IEEur-ce❑o _EC❑ION I- BUS AU❑O❑ LIABIL,I❑YCO❑ERA❑E: NE-❑AU❑OCON ICON -: Ay Ebrfb❑or or—moo❑ _-- i❑reC3iired u-der b❑ or -fired Aug PCyfic❑ CCm�e Co❑er- ❑ ❑ri E1b-co E1ijEe❑or ❑`reeme Abe wee❑you ❑C-I --c;❑-e -ollo i- Ere deemed 9 be co EbrCb❑ or or—moo-- iE Cited ❑C l ered "CustL�you o -❑ e Ebcu Cbd by you be Cbre ❑e "bodily i-wry" or — A Y co Eered "_u W you le-o f�ire❑ "fro-eriy dEmEEb" occur❑ =d =--: i_ i= eLtFccf re--or borro❑❑❑ d duri= =e Ebriod❑:6 be CLmed - Eddi❑ 2- A y co(ered "_u W 3red or re❑Ad by io❑1 i❑[iftred i= - "iEliftred" -or Co❑ered Au[b❑ your "emdoyee" uEder ❑ co�rEc❑i❑ Li:])iliy CoEbr❑Cbmu_o-1y -or dCinFT_i-,❑:6 ❑C3c- _ "emdoyee❑7 ❑Eme❑ -i your CA 3 3 _2 ❑❑ ❑2❑❑ —e _rSeler❑I_dem::i�y Com❑=y_11ri❑Sre_er_ed❑ PFe —o_E I_clude-co yri _edm=eri7o-I_uuTce -er::ice_O=ice:ls i-i--ermi=io !_ COMMERCIAL AU EO You Eree b m 1❑❑i❑ :11 re Cuired or 2- I or o your co Wired comCulCory iEiuEce i_ y Cuc❑ couE -:i coCerEe die❑o1y i_ _e eCeEo_❑ Com ry u b _e mi3mum limi re:bired by - o-your co Wired loci 1 Your ❑ilure b com Ay i com Eul Cory i Eur Ebe re Euireme E ill No deduc table C y b E Per Co m Pro Eery A IRB -o- iE1id� _e coEerEe Forded by A c❑ � -olicy-bu ❑e -ill o 1y be li-ble b -e IRB Eme eEe=Ee -ould Ee bee❑ liEble -_e bllo_i- i- Cdded b PCrEi7=B3FF--FEclu❑ d you comAied _i- _e com:bEbry i= Eio=o_ -EC❑ION III P_Y::ICAL ❑AMA❑E Cur❑=ce re3iiremeFTT_F CO❑ERA❑E: A- I-i❑'u Eder Q-ood ❑e Cre _o — ::dmi❑ E❑cluCio❑3=doe❑-o_ —1y 9 "low' 9 o-e or -ed or Cu-oTiCed i❑urer ouTrde -e more Grb=i- ❑coCered"_tb" you o-- 'i- U Ci Ced ❑Ee❑ o Americ=i Cerri brie❑ I-b due b C c Cu Ce o-er ❑c Cu Ce o_"lo - _d Eon-io=Puerb Rico =d C= _e -or i PCTErEE A❑]b❑ =d A-TTa=bu Ed E e Eume _o re=6❑ibili S -or Te o Ay: :iir::i-3E o cer Ilk Ee❑o i❑=urQ=ce❑or I "_u9" i ❑co❑cred"1r9" -or Commie❑ -or com❑iEce i- y --y i _e 1 ❑ ❑cEiEe CoEer❑ c uEder =i_ :blicy- o-o-brcouErie❑rel=::19 i❑iir❑=ce❑ b❑ _e Grb=Cre -o co❑cred uEder y -Cr- ❑_ -AI-ER O'❑ E UC IBLE ❑LA❑❑ rEEFy E::Ed -_e bllo-i- i Cdded b PCrEr= '❑❑ ❑edue❑E c❑ ❑_e Grb=Sere _o_i❑d:dbZlly i❑IEed❑ ble❑o_ -EC❑10N III '❑ P-Y::ICAL ❑AMA-E -e -ill -y u b CmEi mum o❑ ❑CT❑- -or E1:y CO❑ERA❑E: o_e "lo-9'❑ No deducilble -or ❑ coCered "_tb" -ill -1y b L- NONCE AN- _-NO- LE_-E O- ACCI-EN-OR ❑=dEinEe i _e ❑=i re Erred rEer FFTT- LOEE reQCced❑ -_e bllo i- i Cdded b PCrEr= A2=o❑ ❑_ -IRE_ AU❑O P-Y::ICAL -AMA_E ❑LO❑❑O❑ _EC❑ION L C BU�:TNE❑❑AU O CON-I_ION U_E INCREA F LIMI- Your du b 1_e u-or our Cu-oriCedre Ere Ce FTFF -_e bllo-i-- reQEce❑-e 1— CeEeEee o-PCr= i-e 'Om❑❑::b1ce o_ _e ":bcide❑- or "low' Cr=A=[b-C,o= O- UCe EEeEemo_ ❑EC❑ lie o1y ❑:b❑ _e ":bcide= or "low' i_ Zb❑❑ SON III P Y::ICAL AMA E CO❑ERA❑E: b: ❑o❑ear❑-e mo=Ee -ill -y -r y eEeEe❑ E You :i-you Ere _ i::dildu:l- -or to o aEb i -6 -er d-y b ❑mErmumo❑ I- A Er-er ❑you Ere ❑Er-er A= FTT-Fs>r y o cide❑ ❑ -c- A member -you Ere Climi-ed li-biliy com I'❑ P-Y::ICAL -AMA-E ❑RAN-POR❑A❑1ON ==y- E❑PENS❑❑INCREA=I- LIMI❑ A- A e:bcur:b oTicer❑direcbr or i❑&-ce ❑_e bllo-i-- reElEce❑-e it CeTeCce i PCrE m er you Cre ❑cor❑orEiioCor oTcr or Ef A ❑r br=61- E❑ e Ee m o❑ =-=10-Dor _EC❑ION III P_Y::ICAL ❑AMA❑E CO❑ER- _ A y "emAoyee" Ar❑bri:bd by you 9 1� 3�❑ A E: ice o _e ":bcide= or "lo-' -e ill -I u- 9 -er d-y b ❑mEimum o❑ M❑ BLAN❑E❑ ❑AI❑ER O❑ QJBRO❑AEION F❑TTl -or bm::br3y r==brSio❑ e❑Eb❑� i= ❑Ec :bllo❑i❑❑ reQCbe❑PCr Lr❑❑-' AFFtl -r❑❑ Her curred by you becEuEb o _e b=l -e o ❑co= O❑ Ri O❑ RecoLi�ry Am=OElli�r❑ ❑o UEIE ered "_tb" o _e Eri e eEer CyEe❑ o- ❑ECEION I❑ ❑ BU❑lNE❑❑ AU❑O CON❑I PER❑ONAL PROPER❑Y EIONC: -_e b110-i- i- Edded b PCrEEr= A=Co❑er- ❑LI ❑r❑ 1 11 r O❑ Rim O❑ RecoEi�ry Am= Ee EEeCCroCEo _EC❑10N III ❑ P❑Y=ICAL O❑Ibr❑❑o U -AMA iECO BRA E: ❑e ❑AEe y ri❑❑7o❑recoEery ❑em-_ � Per L6m Pro L�rCy FFTA FTTy LbrCb❑or orEl-Li El b ❑e e❑- - re L3tired o❑ you by ❑ ❑ri�❑co L LvLb E e ill -y u b �i>r "lo- b ❑e Cri E= d FT_bd ❑3I e Lbcu Led 1 for b ::Ey "Lbcide m Erel -d o Ter Eer Co EA Ero Eer Cy -1c- i❑ or "lo-❑ Lro Llded ❑]- -e "Lbcide m or "lo- E O❑:bd by - "i❑1itred"❑Ed Crilb❑ ou❑ o❑ oEer❑Ci)om coEldmdFIfid by CA 3 3 _2 ❑❑ ❑2❑L _-e -rSeler❑I_dems�y Com❑=y_11ri❑Sre_er_ed❑ PEc 3 o_E I_elude-co yri _edm=eri7o-1_uur=ce -er::ice_O=ice:ls i-i--ermi=io !_ TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB6J622054 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. PAGE 1 OF 1 _TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB6J622054 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR SWITCHGEAR AND SWITCHBOARD APPARATUS WHICH THE INSURED HAS AGREED MANUFACTURING BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. 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 10/01/2024 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by ST ASSIGN: Page 1 of 1 WORKERS COMPENSATION TRAVELERS Jam' AND EMPLOYERS LIABILITY POLICY ONE TOWER SQUARE HARTFORD CT 06183 ENDORSEMENT WC 99 03 J9 (00) - 001 POLICY NUMBER: UB6J622054 KANSAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Kansas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us, and 1. Such written contract is not a construction contract subject to the Kansas Fairness in Private Construction Contract Act (Kan. Stat. Sections 16-1801 through 16-1807) or the Kansas Fairness in Public Construction Con- tract Act (Kan. Stat. Sections 16-1901 through 16-1908), or any amendments to those laws; or 2. This policy is part of a consolidated or wrap-up insurance program. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. 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 issuance of the policy.) Endorsement Effective 10/01/2024 Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by Page 1 of 1 ©Copyright 2014 National Council on Compensation Insurance, Inc.All Rights Reserved. TRAVELERS JW WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 42 03 04( B) — 001 POLICY NUMBER: UB6J622054 TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. 1• ❑ Specific Waiver ❑X Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 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 10/01/2024 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by Page 1 of 1 ©Copyright 2014 National Council on Compensation Insurance, Inc.All Rights Reserved. Policy Number: EX8N968484 EXCESS (FOLLOWING FORM) (2) Warlike action by a military force, includ- If a policy of "underlying insurance" that is imme- ing action in hindering or defending diately underlying this policy applies a separate against an actual or expected attack, by products-completed operations aggregate limit in any government, sovereign or other au- that same policy, a separate Aggregate Limit will thority using military personnel or other apply to all damages covered under this policy agents; or that would have been subject to such products- (3) Insurrection, rebellion, revolution, completed operations aggregate limit in that pol- usurped power, or action taken by gov- icy of"underlying insurance". ernmental authority in hindering or de- 3. Subject to Paragraph 2. above, the Occurrence fending against any of these. Limit is the most we will pay for all damages cov- ered under this policy arising out of any one "event" to which the applicable "controlling under- Any person or organization qualifying as an insured lying insurance" applies a limit of insurance that is under the "controlling underlying insurance" is an in- separate from the aggregate limit of insurance sured under this policy. under that insurance. If you have agreed to provide insurance for that per- 4. The limits of this insurance apply separately to son or organization in a written contract or agreement: each consecutive annual period and to any re- f. The limits of insurance afforded to such person or maining period of less than 12 months. The policy organization will be: period begins with the effective date shown in the Declarations. If the policy period is extended after a. The amount by which the minimum limits of issuance for an additional period of less than 12 insurance you agreed to provide such person months, the additional period will be deemed part or organization in such written contract or of the last preceding period. agreement exceed the total limits of insur- ance of all applicable "underlying insurance"; SECTION IV—CONDITIONS or 1. APPEALS b. The Limits of Insurance of this policy shown a. If the insured or the insured's "underlying in- in the Declarations; surer" elects not to appeal a judgment which whichever is less; and exceeds the "applicable underlying limit", we 2. Coverage under this policy does not apply to such may do so. person or organization if the minimum limits of in- b. If we appeal such a judgment, we will pay all surance you agreed to provide such person or or- costs of the appeal. These sums are in addi- ganization in such written contract or agreement tion to the "applicable limit of insurance". In are wholly within the total limits of insurance of all no event will our liability exceed the "applica- applicable "underlying insurance". ble limit of insurance". SECTION III—LIMITS OF INSURANCE 2. BANKRUPTCY 1. The Limits of Insurance shown in the Declarations Bankruptcy or insolvency of the insured or of the and the rules below fix the most we will pay re- insured's estate will not relieve us of our obliga- gardless of the number of: tions under this insurance. a. Insureds; In the event of bankruptcy or insolvency of any b. Claims made or"suits" brought; or "underlying insurer", this insurance will not re- place such bankrupt or insolvent "underlying in- c. Persons or organizations making claims or surer's" policy, and this insurance will apply as if bringing "suits". such "underlying insurer" not become bankrupt or 2. The Aggregate Limit is the most we will pay for all insolvent. damages covered under this policy, except: 3. CANCELLATION a. Damages because of injury or damage in- a. The first Named Insured shown in the Decla- cluded in the "auto hazard"; or rations may cancel this insurance by mailing b. Damages because of injury or damage for or delivering to us advance written notice of which insurance is provided under any Air- cancellation. craft Liability coverage included as "control- ling underlying insurance" to which no aggre- gate limit applies. XP 00 01 05 14 0 2013 The Travelers Indemnity Company.All rights reserved. Page 3 of 7 EXCESS (FOLLOWING FORM) POLICY NUMBER: EX81\1968484 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF RIGHTS OF RECOVERY FROM OTHERS This endorsement modifies insurance provided under the following: EXCESS (FOLLOWING FORM) LIABILITY INSURANCE SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS Name of Person or Organization: ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT OR AGREEMENT TO WAIVE YOUR RIGHT OF RECOVERY. PROVISIONS organization shown in the Schedule Of Designated The following is added to Paragraph 11., OUR RIGHT Persons Or Organizations above in a contract or TO RECOVERY FROM OTHERS, in SECTION IV — agreement that is executed before loss. In that case, CONDITIONS: we will waive any right of recovery we would otherwise have against such person or organization. If the insured has rights to recover all or part of any payment we have made under this insurance, those rights are transferred to us unless the insured has waived its rights of recovery against a person or XP 00 9110 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1