Cummins Inc COI 26

AID 1968350 · View on Simbli

Agenda Item

iv. Contract Ratification and Renewal ~ ITB 25-549 Automotive, Bus Repair, and Services ~ Associated Fuel, Clark Truck Repair, Cummins, Inc., First Services, Georgia Truck & Trailer Repair, LLC, Stivers Ford South, Yancey Bros. (Not to Exceed $1,800,000)

Summary: Presented By: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations
Request: It is requested that the DeKalb County Board of Education approve the first of four (1 of 4) contract renewals and ratifications for ITB 25-549, Automotive, Bus Repair and Services in the amount not to exceed $1,800,000:


Associated Fuel: 3/12/2026-3/11/2027*
Clark Truck Repair: 2/26/2026-2/25/2027*
Cummins Inc: 9/10/2026-9/9/2027
First Services: 2/26/226-2/25/2027*
Georgia Truck & Trailer Repair, LLC: 3/5/2026-3/4/2027*
Stivers Ford South: 2/26/2026-2/25/2027*
Yancey Bros: 5/14/2026-5/13/2027

*The contracts were executed at different times, resulting in varying effective and renewal dates and require ratification.
Why: This approval request is for contract renewal to provide automotive, bus repair and services. It will allow DeKalb County School District (DCSD) to continue receiving services for Automotive, Bus Repair, and Services. This contract renewal will provide supplemental support services to the Fleet Services maintenance staff when the scope of work is beyond their capabilities and/or specialized tools, software and computer programming are needed.
Details: On February 10, 2025, the Board approved the award of ITB 25-549 to Associated Fuel, Clark Truck Repair, Cummins, Inc., First Services, Georgia Truck & Trailer Repair, LLC, Stivers Ford South, Yancey Bros.

Automotive contractors will provide services to the Fleet Services Department that include repair, service, and maintenance of diesel, gasoline, propane, compressed natural gas (CNG) engines, transmission repair, electrical systems, air and hydraulic brake systems, on school buses, sedans, and light, medium and heavy-duty trucks on an as needed basis. The contract enables the District to schedule work efficiently and reduce delays in response to both preventive and emergency work order needs.

This recommendation is for the first of four ( #1 of 4) one (1) year contract renewal options and continues the award of services as originally approved by the Board. Due to differing effective dates, ratification is required for some contracts included in this solicitation.
Financial impact: The total budget for these services in an amount not to exceed $1,800,000, will be allocated from the General Operations Repair and Maintenance Service fund cost code: 100.2700.543000.00011.7190.1320.8013.040.0000.
Contact: Mr. Erick Hofstetter, Chief Operating Officer, Division of Operations, 678.975.5924
Mr. Raymond Stanley, Executive Director, Fleet and Transportation Services, Division of Operations, 678.676.1387
Dr. Chardra Carter, Director, Fleet Services, Division of Operations, 678.676.1387
Effective: Upon Board Approval
Status: Approved by the Office of Legal Affairs
                                                                                                                                                                   DATE (MM/DD/YYYY)
                                              CERTIFICATE OF LIABILITY INSURANCE                                                   8/13/2025
      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:                A. I. King Insurance Agency, Inc. (CMI)
   Aon Risk Services Central Inc.                                                            PHONE
                                                                                                                  317-841-6004
                                                                                                                                                  FAX
                                                                                                                                                  (A/C, No):          317-841-6006
                                                                                             (A/C, No, Ext):
   200 E Randolph St.                                                                        E-MAIL
   Chicago, IL 60601                                                                         ADDRESS:             cummins@aikinginsurance.com
                                                                                                                 INSURER(S) AFFORDING COVERAGE                               NAIC #

                                                                                             INSURER A : Swiss Re Corporate Solutions Elite Ins                             29700
 INSURED                                                                                     INSURER B : Old Republic Insurance Company                                     24147
   Cummins Inc.                                                                              INSURER C :
   500 Jackson Street
   Columbus IN 47201-6258                                                                    INSURER D :

                                                                                             INSURER E :

                                                                                             INSURER F :
 COVERAGES                                   CERTIFICATE NUMBER: 86679000                                                         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     ✓   COMMERCIAL GENERAL LIABILITY           ✓      ✓ CGP0000001-02                             8/1/2025      8/1/2026       EACH OCCURRENCE               $ 5,000,000
                                                                                                                                   DAMAGE TO RENTED
                 CLAIMS-MADE    ✓   OCCUR                                                                                          PREMISES (Ea occurrence)      $ 5,000,000
                                                                                                                                   MED EXP (Any one person)      $ 10,000
                                                                                                                                   PERSONAL & ADV INJURY         $ 5,000,000
        GEN'L AGGREGATE LIMIT APPLIES PER:                                                                                         GENERAL AGGREGATE             $ 5,000,000
                       PRO-
        ✓ POLICY       JECT          LOC                                                                                           PRODUCTS - COMP/OP AGG        $ 5,000,000

            OTHER:                                                                                                                                               $

  B                                                                                                                                COMBINED SINGLE LIMIT
        AUTOMOBILE LIABILITY
                                                   ✓      ✓ MWTB 317015 25                            8/1/2025      8/1/2026       (Ea accident)                 $ 2,000,000

        ✓   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)
                                                                                                                                   PHYSICAL DAMAGE               $ SELF-INSURED

  A     ✓   UMBRELLA LIAB       ✓   OCCUR          ✓      ✓ CGU0000001-02                             8/1/2025      8/1/2026       EACH OCCURRENCE               $ 20,000,000
            EXCESS LIAB             CLAIMS-MADE                                                                                    AGGREGATE                     $ 20,000,000

               DED          RETENTION $                                                                                                                          $
  B                                                                                                                                     PER             OTH-
        WORKERS COMPENSATION                              ✓ MWC 314311-25                             8/1/2025      8/1/2026       ✓    STATUTE         ER
        AND EMPLOYERS' LIABILITY
  B                                          Y/N            MWNEX 317722 (NY)                         8/1/2025      8/1/2026
        ANYPROPRIETOR/PARTNER/EXECUTIVE                                                                                            E.L. EACH ACCIDENT            $ 2,000,000
        OFFICER/MEMBER EXCLUDED?              N    N/A
        (Mandatory in NH)                                                                                                          E.L. DISEASE - EA EMPLOYEE $ 2,000,000
        If yes, describe under
        DESCRIPTION OF OPERATIONS below                                                                                            E.L. DISEASE - POLICY LIMIT   $ 2,000,000
  B     Excess Auto Liability                                  MWZX 317016 25                         8/1/2025      8/1/2026       Limit 3,000,000



 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

  RE:ITB 25-549 Automotive and Bus Repair Services
  DeKalb County School District, DeKalb County Board of Education is listed as additional insured with a waiver of subrogation as required by written
  contract. General Liability, Auto Liability and Umbrella Policies are primary & non-contributory.
  Should any of the above-described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy
  provisions.



 CERTIFICATE HOLDER                                                                          CANCELLATION

                                                                                               SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
   DeKalb County School District                                                               THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
   DeKalb County Board of Education                                                            ACCORDANCE WITH THE POLICY PROVISIONS.
   Attention: Risk Management Department
   1701 Mountain Industrial Blvd.                                                            AUTHORIZED REPRESENTATIVE
   Stone Mountain, GA 30083

                                                                                             Al King
                                                                                               © 1988-2015 ACORD CORPORATION. All rights reserved.
 ACORD 25 (2016/03)                                    The ACORD name and logo are registered marks of ACORD
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 1 of 12
This certificate cancels and supersedes ALL previously issued certificates.
                                    Cummins Inc.
           POLICY NUMBER: CGP0000001-02                                                                COMMERCIAL GENERAL LIABILITY
                                    08/01/2025                                                                        CG 20 10 12 19
                                    08/01/2026
                  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: COMMER-

               CIAL GENERAL LIABILITY COVERAGE PART

                                                                             SCHEDULE

                     Name Of Additional Insured Person(s)
                             Or Organization(s)                                              Location(s) Of Covered Operations
           All persons or organizations as required by written contract or         On File With Company
           agreement




           Information required to complete this Schedule, if not shown above, will be shown in the Declarations.


          A. Section II – Who Is An Insured is amended to                           B. With respect to the insurance afforded to these
             include as an additional insured the person(s) or                         additional insureds, the following additional exclu-
             organization(s) shown in the Schedule, but only                           sions apply:
             with respect to liability for "bodily injury", "property                   This insurance does not apply to "bodily injury" or
             damage" or "personal and advertising injury"                               "property damage" occurring after:
             caused, in whole or in part, by:
                                                                                        1. All work, including materials, parts or equip-
               1. Your acts or omissions; or                                               ment furnished in connection with such work,
               2. The acts or omissions of those acting on your                            on the project (other than service, mainte-
                  behalf;                                                                  nance or repairs) to be performed by or on be-
               in the performance of your ongoing operations for                           half of the additional insured(s) at the location
               the additional insured(s) at the location(s) desig-                         of the covered operations has been com-
               nated above.                                                                pleted; or
               However:                                                                 2. That portion of "your work" out of which the
                                                                                           injury or damage arises has been put to its
               1. The insurance afforded to such additional in-                            intended use by any person or organization
                  sured only applies to the extent permitted by                            other than another contractor or subcontractor
                  law; and                                                                 engaged in performing operations for a princi-
               2. If coverage provided to the additional insured is                        pal as a part of the same project.
                  required by a contract or agreement, the in-
                  surance afforded to such additional insured
                  will not be broader than that which you are
                  required by the contract or agreement to pro-
                  vide for such additional insured.



          CG 20 10 12 19                                  © Insurance Services Office, Inc., 2018                              Page 1 of 2
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 2 of 12
This certificate cancels and supersedes ALL previously issued certificates.
          C. With respect to the insurance afforded to these                        2. Available under the applicable limits of insurance;
             additional insureds, the following is added to Sec-                       whichever is less.
             tion III – Limits Of Insurance:                                            This endorsement shall not increase the applicable
               If coverage provided to the additional insured is                        limits of insurance.
               required by a contract or agreement, the most we
               will pay on behalf of the additional insured is the
               amount of insurance:
               1. Required by the contract or agreement; or




          Page 2 of 2                                   © Insurance Services Office, Inc., 2018                             CG 20 10 12 19
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 3 of 12
This certificate cancels and supersedes ALL previously issued certificates.
    Cummins Inc.
    CGP0000001-02
    08/01/2025                                                                                         COMMERCIAL GENERAL LIABILITY
    08/01/2026                                                                                                        CG 20 37 12 19

                  THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

                      ADDITIONAL INSURED – OWNERS, LESSEES OR
                       CONTRACTORS – COMPLETED OPERATIONS
          This endorsement modifies insurance provided under the following:

               COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COM-
               PLETED OPERATIONS LIABILITY COVERAGE PART

                                                                             SCHEDULE

                    Name Of Additional Insured Person(s)
                            Or Organization(s)                                   Location And Description Of Completed Operations
           All persons or organizations as required by written contract or       On File With Company
           agreement




           Information required to complete this Schedule, if not shown above, will be shown in the Declarations.


          A. Section II – Who Is An Insured is amended to                           B. With respect to the insurance afforded to these
             include as an additional insured the person(s) or                         additional insureds, the following is added to Sec-
             organization(s) shown in the Schedule, but only                           tion III – Limits Of Insurance:
             with respect to liability for "bodily injury" or "prop-                    If coverage provided to the additional insured is
             erty damage" caused, in whole or in part, by "your                         required by a contract or agreement, the most we
             work" at the location designated and described in                          will pay on behalf of the additional insured is the
             the Schedule of this endorsement performed for                             amount of insurance:
             that additional insured and included in the "prod-
             ucts-completed operations hazard".                                        1. Required by the contract or agreement; or
               However:                                                             2. Available under the applicable limits of insurance;
                                                                                       whichever is less.
               1. The insurance afforded to such additional in-
                  sured only applies to the extent permitted by                         This endorsement shall not increase the applicable
                  law; and                                                              limits of insurance.
               2. If coverage provided to the additional insured is
                  required by a contract or agreement, the in-
                  surance afforded to such additional insured
                  will not be broader than that which you are
                  required by the contract or agreement to pro-
                  vide for such additional insured.




          CG 20 37 12 19                                  © Insurance Services Office, Inc., 2018                             Page 1 of 1
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 4 of 12
This certificate cancels and supersedes ALL previously issued certificates.
               Cummins Inc.
               CGP0000001-02
               08/01/2025
               08/01/2026




86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 5 of 12
This certificate cancels and supersedes ALL previously issued certificates.
               Cummins Inc.
               CGP0000001-02
               08/01/2025
               08/01/2026




86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 6 of 12
This certificate cancels and supersedes ALL previously issued certificates.
               Cummins Inc.
               MWTB 317015 25
               08/01/2025
               08/01/2026

                IL 10 �12/06)              OLD REPUBLIC INSURANCE COMPANY

                               n-ns ENDORSEMENT CS-{ANGES TH= PCl.lCY. PLEASE READ IT CAREFULLY..


                                               ADDIT�ONAL INSURBD AND PRIMARY AND
                                                 NON-CONllRIBUfTORY ENDORSEMENT

                This endorsement mocr es insurance provided under iale ..oOa,Ying:

                          BUSINESS AUTO COVERAGE IFORM
                          MOTOR CARRIER COVERAGE FORM

                                                                               SCHEDULE
                Designated Person ls) or Organizalion(s,:

                .AJI persOC",s or organiza:icns where required by wriiten oon,rao,




                A         SECTIOJlil □ - COVERED AUTOS UABIUTY OOVERAG E, paragraph 1 .. Who Is An Insured is
                          amended :o indude :he per'SO.n(s} or organiza:i!Jlj(s) sho-1. in the .al::ove Schedu[e .as an
                                          i
                          m:ltiition.3.1 " nsured·. but on[y \vith rrespem to "accidents" arising out of your 'liOrK 11,hrle being
                          per.onned for such person(-s) ororganiz.a:ion(s}.

                B..       The follo-1.mg is added to me other Insurance Condition in the Business Auto Coverage Form
                          .and 1he otn"E!r Insuran ce - Primary And Ex�s Insur ance Provisions in 1he Mo:or Carner
                          Cover.::;ge Form and supersedes Gn)' provision :o the coriir,::uy:

                          This polfcy's Covered Au-�os Liabil y Co•.-erage is primary to and ,,.;11 not secek contribution from
                          .any o:her insurance available �o me ·insr..llJ1edr per'SO.n(s} or organiza1io.n(s) shown in 1t.e ebave
                          Sdhedule provided th.er

                          1.        Suc'h ·insured1· is a Named Insured under such other insuranoe; and

                          2.     Yoo have .agreed in ,Yriting c.n .a oomracl or 3greement chat this insriance would be
                                 pcimary and ,,.ould not seek oon:ributioo horn any ott-.er insurance .3.1,•.mable to s1Jdh
                                 "insured•.
                 PCA 048, 09 1fl                                                                               Page 1 • 1
                                        ln.clu:des ooi:yr1�E<I l'Tli1tel1i1l rJ 11"1:'Sunn.ce ser.1ces Ci'llce. mnr.., WO! ltti p=-:mssm




                                                                                           .
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 7 of 12
This certificate cancels and supersedes ALL previously issued certificates.
               Cummins Inc.
               MWTB 317015 25
               08/01/2025
               08/01/2026




86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 8 of 12
This certificate cancels and supersedes ALL previously issued certificates.
        Cummins Inc.
                         6ZLVV5H&RUSRUDWH6ROXWLRQV(OLWH,QVXUDQFH&RUSRUDWLRQ
        CGU0000001-02
        08/01/2025                                                                                               (QGRUVHPHQW1R
        08/01/2026

                            $'',7,21$/,1685('35,0$5<$1'121&2175,%8725<(1'256(0(17±
                                  $8720$7,&67$786:+(15(48,5(',1$*5((0(17%<<28

                            7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//<


               7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ

                       &200(5&,$/80%5(//$5(7$,1('/,0,7)250


                     6HFWLRQ,9'(),1,7,216.,QVXUHGLVDPHQGHGWRLQFOXGHWKHIROORZLQJDGGLWLRQDOSURYLVLRQ

                       :KHQ\RXDQGDQ\SHUVRQRURUJDQL]DWLRQKDYHDJUHHGLQZULWLQJLQDFRQWUDFWRUDJUHHPHQWWKDWVXFKSHUVRQ
                       RURUJDQL]DWLRQEHDGGHGDVDQDGGLWLRQDOLQVXUHGRQ\RXUSROLF\VXFKSHUVRQRURUJDQL]DWLRQVKDOOEHLQFOXGHG
                       DVDQDGGLWLRQDOLQVXUHGXQGHUWKLVSROLF\6XFKSHUVRQRURUJDQL]DWLRQLVDQDGGLWLRQDOLQVXUHGEXWRQO\ZLWK
                       UHVSHFWWRLWVOLDELOLW\IRUERGLO\LQMXU\SURSHUW\GDPDJHRUSHUVRQDODQGDGYHUWLVLQJLQMXU\FDXVHGLQ
                       ZKROHRULQSDUWE\\RXUDFWVRURPLVVLRQVRUWKHDFWVRURPLVVLRQVRIWKRVHDFWLQJRQ\RXUEHKDOI

                            LQWKHSHUIRUPDQFHRI\RXURQJRLQJRSHUDWLRQVRU

                            LQFRQQHFWLRQZLWK\RXUSUHPLVHVRZQHGE\RUUHQWHGWR\RX

                       +RZHYHU

                       D     7KHLQVXUDQFHDIIRUGHGWRVXFKDGGLWLRQDOLQVXUHGRQO\DSSOLHVWRWKHH[WHQWSHUPLWWHGE\ODZ

                       E     7KHLQVXUDQFHDIIRUGHGWRVXFKDGGLWLRQDOLQVXUHGZLOOQRWEHEURDGHUWKDQWKDWZKLFK\RXDUHUHTXLUHG
                              E\WKHFRQWUDFWRUDJUHHPHQWWRSURYLGHIRUVXFKDGGLWLRQDOLQVXUHGDQG

                       F     7KHLQVXUDQFHDIIRUGHGWRVXFKDGGLWLRQDOLQVXUHGFRYHUDJHZLOOQRWEHEURDGHUWKDQFRYHUDJHSURYLGHG
                              E\VFKHGXOHGXQGHUO\LQJLQVXUDQFH

                     6ROHO\ DV UHVSHFWV WKH LQVXUDQFH DIIRUGHG WR DQ\ SHUVRQ RU RUJDQL]DWLRQ V  E\ WKLV HQGRUVHPHQW
                       6HFWLRQ,,,/,0,762),1685$1&(LVDPHQGHGWRLQFOXGHWKHIROORZLQJDGGLWLRQDOSURYLVLRQ

                       7KHPRVWZHZLOOSD\RQEHKDOIRIDQ\DGGLWLRQDOLQVXUHGLVWKHDPRXQWRILQVXUDQFH

                            5HTXLUHGE\WKHFRQWUDFWRUDJUHHPHQWZKHUHE\\RXDJUHHGVXFKSHUVRQRURUJDQL]DWLRQVKDOOEHLQFOXGHG
                              DVDQDGGLWLRQDOLQVXUHGXQGHU\RXUSROLF\RU

                            $YDLODEOHXQGHUWKHDSSOLFDEOH/LPLWVRI,QVXUDQFHVKRZQLQWKH'HFODUDWLRQV

                       ZKLFKHYHULVOHVV

                     7KLVHQGRUVHPHQWVKDOOQRWLQFUHDVHWKHDSSOLFDEOH/LPLWVRI,QVXUDQFHVKRZQLQWKH'HFODUDWLRQV

                     6ROHO\DVUHVSHFWVWKHLQVXUDQFHDIIRUGHGWRDQ\SHUVRQRURUJDQL]DWLRQ V E\WKLVHQGRUVHPHQWWKHIROORZLQJLV
                       DGGHGWR6HFWLRQ9,&21',7,216/2WKHU,QVXUDQFHDQGVXSHUVHGHVDQ\SURYLVLRQWRWKHFRQWUDU\

                       3ULPDU\DQG1RQFRQWULEXWRU\,QVXUDQFH

                       7KLVLQVXUDQFHLVSULPDU\WRDQGZLOOQRWVHHNFRQWULEXWLRQIURPDQ\RWKHULQVXUDQFHDYDLODEOHWRDQDGGLWLRQDO
                       LQVXUHGXQGHU\RXUSROLF\SURYLGHGWKDW

                            7KHDGGLWLRQDOLQVXUHGLVD1DPHG,QVXUHGXQGHUVXFKRWKHULQVXUDQFHDQG




                                                                                                                           3DJHRI
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 9 of 12
This certificate cancels and supersedes ALL previously issued certificates.
                            <RXKDYHDJUHHGLQZULWLQJLQDFRQWUDFWRUDJUHHPHQWWKDWWKLVLQVXUDQFHZRXOGEHSULPDU\DQGZRXOG
                              QRWVHHNFRQWULEXWLRQIURPDQ\RWKHULQVXUDQFHDYDLODEOHWRWKHDGGLWLRQDOLQVXUHG




               $OORWKHUWHUPVDQGFRQGLWLRQVRIWKLVSROLF\VKDOOUHPDLQXQFKDQJHG
               7KLV HQGRUVHPHQW IRUPV D SDUW RI WKH SROLF\ WR ZKLFK DWWDFKHG HIIHFWLYH RQ WKH LQFHSWLRQ GDWH RI WKH SROLF\
               RWKHUZLVHVWDWHGKHUHLQ
                7KHLQIRUPDWLRQEHORZLVUHTXLUHGRQO\ZKHQWKLVHQGRUVHPHQWLVLVVXHGVXEVHTXHQWWRWKHSUHSDUDWLRQRIWKHSROLF\ 
               3ROLF\1XPEHUCGU0000001-02
               (QGRUVHPHQW(IIHFWLYH'DWH 08/01/2025
               1DPHG,QVXUHGCummins Inc.




                                                                                                                       3DJHRI
86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 10 of 12
This certificate cancels and supersedes ALL previously issued certificates.
                           Cummins Inc.

                                 08/01/2025        08/01/2026




                           CGU0000001-02




86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 11 of 12
This certificate cancels and supersedes ALL previously issued certificates.
       WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY                                         WC 00 03 13
                                                                                                               (Ed. 4-84)
       POLICY NUMBER: MWC 314311-25

                                 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 OR ORGANIZATIONS WHERE REQUIRED BY WRITTEN
       CONTRACT.
       NOT APPLICABLE IN CA, KY, NH, NJ, TX AND UT




       DATE OF ISSUE: 08/01/2025

       WC 00 03 13
       (Ed. 4-84)
       © 1983 National Council on Compensation Insurance.




86679000 | 25/26 GL AU UMB WC (Custom Merged) | Shelly Pence | 8/13/2025 10:24:48 AM (EDT) | Page 12 of 12
This certificate cancels and supersedes ALL previously issued certificates.