Sluss&Padg, COI - February 13, 2023 - DCSD Board Meeting Archive

SLUSPAD-01 BMILES
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 6/14/2022
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).
CONTACT Kyle Evert
PRODUCER NAME:
American Global LLC PHONE FAX
(A/C, No, Ext): (404) 400-3044 (A/C, No):
3330 Cumberland Blvd E-MAIL
Suite 675 ADDRESS: kyle.evert@americanglobal.com
Atlanta, GA 30339
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Zurich American Insurance Company 16535
INSURED INSURER B : American Guarantee and Liability Insurance 26247

Sluss + Padgett, Inc. INSURER C : Columbia Casualty Company 31127
5924 Peachtree Corners East INSURER D :
Norcross, GA 30071
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 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 (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
2,000,000
CLAIMS-MADE X OCCUR
X X GLO4342306-03 6/30/2022 6/30/2023 DAMAGE TO RENTED
PREMISES (Ea occurrence) $
1,000,000
MED EXP (Any one person) $
10,000
PERSONAL & ADV INJURY $
2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
4,000,000
X POLICY X PRO-JECT LOC PRODUCTS - COMP/OP AGG $
4,000,000
OTHER:
EMPLOYEE BENEFI $
3,000,000
A AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident) $
1,000,000
X ANY AUTO X X BAP4398098-03 6/30/2022 6/30/2023 BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident) $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident) $
$
B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $
9,000,000
EXCESS LIAB CLAIMS-MADE X X AUC 4398101-03 6/30/2022 6/30/2023 AGGREGATE $
9,000,000
DED X RETENTION $ 0 $
B WORKERS COMPENSATION X PER
STATUTE
OTH-
ER
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE X WC4342307-03 6/30/2022 6/30/2023 E.L. EACH ACCIDENT $
1,000,000
OFFICER/MEMBER EXCLUDED? N N/A
1,000,000
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
C Professional Liab. CEO 6080193744 6/30/2022 6/30/2023 Limits Occ./Agg. 2,000,000
C Pollution Liab. CEO 6080193744 6/30/2022 6/30/2023 Limits Occ./Agg. 2,000,000

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
21-752-011
Dekalb County School Distric and Dekalb County School Board are included as Additional Insured in accordance with the policy provisions of the General
Liability, Auto Liability and Umbrella Liability Policies. A Waiver of Subrogation is granted in favor of Dekalb County School Distric and Dekalb County School
Board in accordance with the policy provisions of the General Liability, Auto Liability, Umbrella Liability policies. Waiver of Subrogation applies to the
Workers Compensation policy per the attached endorsement if permissable by law.

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Dekalb County Board of Education ACCORDANCE WITH THE POLICY PROVISIONS.
Sam A. Moss Service Center
1780 Montreal Road
Attn: D Benjamin Estill, II, Chief Operating Officer AUTHORIZED REPRESENTATIVE
Tucker, GA 30084

ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Policy No. BAP-4398098-02

agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate
the insurance afforded by this policy.
Include, as soon as practicable:
(1) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written
notice of the claim or "suit" including, but not limited to, the date and details of such claim or "suit";
(2) The "insured’s" name and address; and
(3) To the extent possible, the names and addresses of any injured persons and witnesses.
If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your
failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon
as practicable after the fact of the delay becomes known to you.
P. Waiver of Transfer Of Rights Of Recovery Against Others To Us
The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver only
applies to the person or organization designated in the contract.
Q. Employee Hired Autos – Physical Damage
Paragraph b. of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other
Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replaced
by the following:
For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own:
(1) Any covered "auto" you lease, hire, rent or borrow; and
(2) Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" or
elected or appointed official with your permission while being operated within the course and scope of that
"employee's" employment by you or that elected or appointed official’s duties as respect their obligations to you.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
R. Unintentional Failure to Disclose Hazards
The following is added to the Concealment, Misrepresentation Or Fraud Condition:
However, we will not deny coverage under this Coverage Form if you unintentionally:
(1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or
(2) Make an error, omission, improper description of "autos" or other misstatement of information.
You must notify us as soon as possible after the discovery of any hazards or any other information that was not
provided to us prior to the acceptance of this policy.
S. Hired Auto – World Wide Coverage
Paragraph 7a.(5) of the Policy Period, Coverage Territory Condition is replaced by the following:
(5) Anywhere in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less,
T. Bodily Injury Redefined
The definition of "bodily injury" in the Definitions Section is replaced by the following:
"Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,
resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease.

U-CA-424-F CW (04-14)
Page 5 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PROPOSAL
Policy No. AUC 4398101-02

b. The CAN-SPAM Act of 2003, including any amendment of or addition to such law;
c. The Fair Credit Reporting Act (FCRA) and any amendment or addition to such law including the Fair and
Accurate Credit Transactions Act (FACTA); or
d. Any federal, state or local statute, ordinance, or regulation, other than the TCPA, CAN-SPAM Act of 2003
or FCRA and their amendments and additions, that addresses, prohibits or limits the printing,
dissemination, disposal, collecting, recording, sending, transmitting, communicating or distribution of
material or information.
WAR AND MILITARY ACTION
7. Arising directly or indirectly out of:
a. War, including undeclared or civil war;
b. Warlike action by a military force, including action in hindering or defending against an actual or expected
attack, by any government, sovereign or other authority using military personnel or other agents; or
c. Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or
defending against any of these,
regardless of any other cause or event that contributes concurrently or in any sequence to injury or damage.
B. Under Coverage A this policy does not apply to any liability, damage, loss, cost or expense:
POLLUTION
1. Arising directly or indirectly out of the actual, alleged or threatened discharge, dispersal, seepage, migration,
release or escape of pollutants:
a. At or from any premises, site or location which is or was at any time owned or occupied by, or rented or
loaned to, any insured. However, this subparagraph does not apply to:
(1) Bodily injury if sustained within a building and caused by smoke, fumes, vapor or soot produced by or
originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is
used to heat water for personal use, by the building's occupants or their guests;
(2) Bodily injury or property damage for which you may be held liable, if you are a contractor, and the
owner or lessee of such premises, site or location has been added to underlying insurance as an
additional insured with respect to your ongoing operations performed for that additional insured at that
premises, site or location and such premises, site or location is not and never was owned or occupied
by, or rented or loaned to, any insured, other than that additional insured; or
(3) Bodily injury or property damage arising out of heat, smoke or fumes from a hostile fire;
b. At or from any premises, site or location which is or was at any time used by or for any insured or others
for the handling, storage, disposal, processing or treatment of waste;
c. Which are or were at any time transported, handled, stored, treated, disposed of, or processed as waste by
or for any insured or any person or organization for whom you maybe legally responsible; or
d. At or from any premises, site or location on which any insured or any contractors or subcontractors
working directly or indirectly on any insured’s behalf are performing operations if the pollutants are
brought on or to the premises, site or location in connection with such operations by such insured,
contractor or subcontractor. However, this subparagraph does not apply to:
(1) Bodily injury or property damage arising out of the escape of fuels, lubricants or other operating fluids
which are needed to perform the normal electrical, hydraulic or mechanical functions necessary for the
operation of mobile equipment or its parts, if such fuels, lubricants or other operation fluids escape
from a vehicle part designed to hold, store or receive them. This exception does not apply if the bodily
injury or property damage arises out of the intentional discharge, dispersal or release of the fuels,
lubricants or other operating fluids, or if such fuels, lubricants or other operating fluids are brought on
or to the premises, site or location with the intent that they be discharged, dispersed or released as
part of the operations being performed by such insured, contractor or subcontractor;
(2) Bodily injury or property damage sustained within a building and caused by the release of gases,
fumes or vapors from materials brought into that building in connection with operations being
performed by you or on your behalf by a contractor or subcontractor;

U-UMB-103-C CW (03/10)
Page 6 of 19
c. The duties and requirements imposed upon any insured under this policy will not apply to any
non-admitted jurisdiction. However, with respect to any claims made or suits brought in a
non-admitted jurisdiction, it will be the duty of the first Named Insured to do or cause the applicable
qualified entity to do such things as would be required of such qualified entity if Coverage A applied
directly to such claim or suit, including:
(1) Make such investigation, defense or settlement as we deem reasonable;
(2) Obtain our approval for any payment; and
(3) Effect approved payments to others, in accordance with the terms and conditions of this insurance.
d. Under Coverage B, this policy does not apply to any liability, damage, loss, cost or expense arising out of
any operations or activities of a qualified entity.
e. We will promptly pay the first Named Insured at the mailing address listed in Item 2. of the Declarations
the amount of damages covered under the terms of this policy. If the first Named Insured or any qualified
entity recovers from any third party all or part of any amount that we have paid pursuant to this insurance,
the first Named Insured will promptly reimburse the amount of any such recovery to us.
10. Legal Action Against Us
There will be no right of action against us under this insurance unless:
a. You have complied with all the terms of this policy; and
b. The amount you owe has been determined by settlement with our consent or by actual trial and final
judgment.
This insurance does not give anyone the right to add us as a party in an action against you to determine your
liability.
11. Maintenance of Underlying Insurance
During the period of this policy, you agree:
a. To keep the policies listed in the Schedule of Underlying Insurance in full force and effect;
b. That the Limits of Insurance of the policies listed in the Schedule of Underlying Insurance will be
maintained except for any reduction or exhaustion of limits by payment of claims or suits for damages
covered by underlying insurance;
c. The policies listed in the Schedule of Underlying Insurance may not be canceled or not renewed by you
without notifying us, and you agree to notify us in the event an insurance company cancels or declines to
renew any policy listed in the Schedule of Underlying Insurance; and
d. Renewals or replacements of the policies listed in the Schedule of Underlying Insurance will not be
materially changed without our agreement.
If you fail to comply with these requirements, we will only be liable to the same extent that we would have been
had you fully complied with these requirements.
12. Miscellaneous Unintentional Errors and Omissions
Any unintentional error or omission in the description of, or failure to describe completely, any premises or
operations intended to be covered by this policy, shall not invalidate or affect the coverage for those operations
or premises. However, the insured must report such error or omission to the company as soon as practicable
after its discovery.
13. Other Insurance
If other insurance applies to damages that are also covered by this policy, this policy will apply excess of the
other insurance. However, this provision will not apply:
a. If the other insurance is written to be excess of this policy; or
b. With respect to Coverage A only, if the named insured has agreed in a written contract to carry insurance
to apply prior to and be non-contributory with that of another person or organization's insurance, but only
as respects damages arising out of insured operations or work on behalf of the named insured performed
under such written contract. The limits available to the other person or organization will be the lesser of the
policy limits or the minimum limits required by such written contract. In that case, other insurance of that
person or organization will apply as excess and not contribute prior to the insurance afforded by this policy.

U-UMB-103-C CW (03/10)
Page 17 of 19
Policy No. AUC 4398101-02

Nothing herein will be construed to make this policy subject to the terms, conditions and limitations of such
other insurance.
14. Premium
The premium for this policy as stated in Item 6. of the Declarations is a flat premium. It is not subject to
adjustment unless an endorsement is attached to this policy.
15. Separation of Insureds
Except with respect to the Limits of Insurance, and any rights or duties specifically assigned to the first Named
Insured, this insurance applies:
a. As if each named insured were the only named insured; and
b. Separately to each insured against whom claim is made or suit is brought.
16. Terms Conformed to Statute
The terms of this policy which are in conflict with the statutes, laws, ordinances or regulations in any country,
jurisdiction, state or province where this policy is issued are amended to conform to such statutes, laws,
ordinances or regulations. If we are prevented by law or statute from paying on behalf of the insured, then we
will, where permitted by law or statute, indemnify the insured.
17. Transfer of Rights of Recovery Against Others to Us
a. 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. The insured must do nothing after the 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 any insured is required by a written contract or agreement which is executed before a loss to
waive their rights of recovery from others, we agree to waive our rights of recovery. This waiver of rights
shall not be construed to be a waiver with respect to any other operations for which the insured has not
waived their rights of recovery by contract.
b. Any amount recovered will be apportioned in the inverse order of payment of loss to the extent of actual
payment. The expenses of all such recovery proceedings will be apportioned in the ratio of respective
recoveries.
18. Transfer of Your Rights and Duties
Your rights and duties under this insurance may not be transferred without our written consent. If you die, then
your rights and duties will be transferred to your legal representative, but only while acting within the scope of
duties as your legal representative. Until your legal representative is appointed, anyone having temporary
custody of your property will have your rights and duties but only with respect to that property.
19. When Loss is Payable
Coverage under this policy will not apply until the insured, or the insured’s underlying insurer has paid or is
legally obligated to pay the full amount of the Underlying Limits of Insurance or Retained Limit.
When the amount of loss is determined by an agreed settlement or on a final judgment against an insured
obtained after an actual trial, we will promptly pay on behalf of the insured the amount of loss covered under
the terms of this policy. The first Named Insured will promptly reimburse us for any amount within the
Retained Limit paid by us.
20. Violation of Economic or Trade Sanctions
If coverage for a claim or suit under this policy is in violation of any economic or trade sanctions of the United
States of America then coverage for that claim or suit will be null and void.
B. The following Condition is applicable to Coverage A and Coverage B:
1. Notice of Occurrence, Claim or Suit
a. You must see to it that we are notified as soon as practicable of an occurrence which may result in
damages covered by this policy.
To the extent possible, notice will include:
(1) How, when and where the occurrence took place;

U-UMB-103-C CW (03/10)
Page 18 of 19
Additional Insured – Automatic – Owners, Lessees Or
Contractors

Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
GLO-4342306-02 06/30/2021 06/30/2022 39348000 INCL

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

Named Insured: SLUSS + PADGETT INC.
Address (including ZIP Code):
5924 Peachtree Corners East
Norcross, GA 30071
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part

A. Section II – Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal
and advertising injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf,
in the performance of your ongoing operations or "your work" as included in the "products-completed operations
hazard", which is the subject of the written contract or written agreement.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to
render, any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the
"bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.

U-GL-1175-F CW (04/13)
Page 1 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PROPOSAL
C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV –
Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim;
2. We receive written notice of a claim or "suit" as soon as practicable; and
3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV – Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV – Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any
policy in which the additional insured is a Named Insured on such other policy and where our policy is required by
a written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III – Limits Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or
2. Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.

All other terms and conditions of this policy remain unchanged.

U-GL-1175-F CW (04/13)
Page 2 of 2
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PROPOSAL
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 04-84)

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 under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule

ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR
AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF
SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT
PERSON AND/OR ORGANIZATION OR SCHEDULED AND PREMIUM CHARGE.

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 Policy No.WC-4342307-02 Endorsement No.
06/30/2021
Insured Premium $

Insurance Company Countersigned by
American Zurich Insurance Company

WC124 (4-84) Page 1 of 1
WC 00 03 13 Copyright 1983 National Council on Compensation Insurance, Inc. Uniform FormsTM
Waiver Of Subrogation (Blanket) Endorsement

Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add’l Prem. Return Prem.
GLO-4342306-02 06/30/2021 06/30/2022 39348000 $ INCL $

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the:

Commercial General Liability Coverage Part

The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition:
If you are required by a written contract or agreement, which is executed before a loss, to waive your rights of recovery from
others, we agree to waive our rights of recovery. This waiver of rights shall not be construed to be a waiver with respect to
any other operations in which the insured has no contractual interest.

U-GL-925-B CW (12/01)
Page 1 of 1
PROPOSAL
Coverage Extension Endorsement

Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add’l. Prem Return Prem.
BAP-4398098-02 06/30/2021 06/30/2022 39348000 INCL

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the:
Business Auto Coverage Form
Motor Carrier Coverage Form

A. Amended Who Is An Insured
1. The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage:
The following are also "insureds":
a. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts
performed within the scope of employment by you. Any “employee” of yours is also an “insured” while
operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your
permission, while performing duties related to the conduct of your business.
b. Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or
borrow to transport your clients or other persons in activities necessary to your business.
c. Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement.
d. Where and to the extent permitted by law, any person(s) or organization(s) where required by written contract
or written agreement with you executed prior to any "accident", including those person(s) or organization(s)
directing your work pursuant to such written contract or written agreement with you, provided the "accident"
arises out of operations governed by such contract or agreement and only up to the limits required in the
written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less.
2. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other
Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form:
Coverage for any person(s) or organization(s), where required by written contract or written agreement with you
executed prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained
by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond
the terms and conditions of the Coverage Form.
B. Amendment – Supplementary Payments
Paragraphs a.(2) and a.(4) of the Coverage Extensions Provision in Section II – Covered Autos Liability
Coverage are replaced by the following:
(2) Up to $5,000 for the 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.

U-CA-424-F CW (04-14)
Page 1 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PROPOSAL
Policy No. BAP-4398098-02

U-CA-424-F CW (04-14)
Page 5 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
PROPOSAL

Agenda Item