COMPLETED BOARD ORDER"�|E]Z(�25
Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement Nos. A-11957; A-12103
a. Approve Amendment No. 5 to Professional Services
Agreement No. A-11957 with California Code Check, Inc.
CCC) to continue to provide services associated with plan
check, inspection and related services to the Monterey
County Building Services Department, in the amount of
$165,000 for a total amount not to exceed $552,446
through June 30, 2012; and
b. Approve Amendment No. 3 to Professional Services
Agreement No. A-12103 with CSG Consultants, Inc.
CSG) to continue to provide services associated with plan
review services to the Monterey County Building Services
Department, in the amount of $105,000 for a total amount
not to exceed $307,446 through June 30, 2012; and
c. Authorize the Contracts/Purchasing Officer to execute the
Amendments to the Professional Services Agreements and
future amendments that do not significantly alter the scope
of work or change the approved Agreement amounts.........
Upon motion of Supervisor Parker, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby;
a. Approved Amendment No. 5 to Professional Services Agreement No. A-11957 with
California Code Check, Inc. CCC) to continue to provide services associated with plan
check, inspection and related services to the Monterey County Building Services
Department, in the amount of $165,000 for a total amount not to exceed $552,446
through June 30, 2012; and
b. Approved Amendment No. 3 to Professional Services Agreement No. A-12103 with CSG
Consultants, Inc. CSG) to continue to provide services associated with plan review
services to the Monterey County Building Services Department, in the amount of
$105,000 for a total amount not to exceed $307,446 through June 30, 2012; and
c. Authorized the Contracts/Purchasing Officer to execute the Amendments to the
Professional Services Agreements and future amendments that do not significantly alter
the scope of work or change the approved Agreement amounts.
PASSED AND ADOPTED on this 7th day of February, 2012, by the following vote, to-wit:
AYES: Supervisors Armenta, Supervisor Calcagno, Salinas, Potter and Parker
NOES: None
ABSENT: None
I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby certify
that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in the minutes
thereof of Minute Book 76 for the meeting on February 7, 2012.
Dated: February 9, 2012 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By
Deputy
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COMPLETED BOARD ORDER"�|E]Z(�AMENDMENT NO.5
TO PROFESSIONAL SERVICES AGREEMENT
BETWEEN COUNTY OF MONTEREY AND
CALIFORNIA CODE CHECK, INC.
THIS AMENDMENT NO. 5 to the Professional Services Agreement between the County of
Monterey, a political subdivision of the State of California hereinafter, County") and California
Code Check, Inc. hereinafter, CONTRACTOR") is hereby entered into between the County
and the CONTRACTOR collectively, the County and CONTRACTOR are referred to as the
parties").
WHEREAS, CONTRACTOR entered into a Professional Services Agreement with County on
January 19, 2011 hereinafter, Agreement"); and
WHEREAS, Agreement was amended by the parties on April 8, 2011 hereinafter,
Amendment No. I"), May 17, 2011 hereinafter, Amendment No. 2"), June 7, 2011
hereinafter, Amendment No. 3"), and October 4, 2011 hereinafter, Amendment No. 4"); and
WHEREAS, additional time and funding are necessary to meet the increased demand in the
Building Services Department for completion of plan check, inspection and related services
within statutory timelines; and
WHEREAS, the parties wish to further amend the Agreement to extend the term to June 30,
2012 and increase the amount by $165,000 to continue to provide tasks identified in the
Agreement.
NOW, THEREFORE, the parties agree to amend the Agreement as follows:
1. Amend the second sentence of Paragraph 2, Payments by County", to read as follows:
The total amount payable by County to CONTRACTOR under this Agreement shall not
exceed the sum of $552,446.
2. Amend the first sentence of Paragraph 3, Term of Agreement", to read as follows:
The term of this Agreement is from January 19, 2011 to June 30, 2012, unless sooner
terminated pursuant to the terms of this Agreement.
3. All other terms and conditions of the Agreement remain unchanged and in full force.
4. This Amendment No. 5 shall be attached to the Agreement and incorporated therein as if
fully set forth in the Agreement.
Amendment No. 5 to Professional Services Agreement
California Code Check, Inc.
Plan Check, Inspection and Related Services
RMA Building Services Department
Term: January 19, 2011- June 30, 2012
Not to Exceed: $552,446
Page 1 of 2
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COMPLETED BOARD ORDER"�|E]Z(�IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 5 to the
Professional Services Agreement as of the day and year written below:
COUNTY OF MONTEREY CONTRACTOR*
By:
Contracts/Purchasing Officer
Date: By:
Its:
Date:
By:
California Code Check, Inc.
Contractor's Business Name
N
igiiature of Chair,(President or Vice President)
Approved as to Form and Legality Signature of Secretary, Asst. Secretary, CFO,
Office of the County Counsel Treasurer or Asst. Treasurer)
By: &6Dc`-,,
Its:
Deputy County Counsel
Date: Y o~
Date:
Approved as to Indemnity and Insurance Provisions
By:
Risk Management
Print N e and Title)
Date:
*INSTRUCTIONS: IF CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal
name of the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a
partnership, the name of the partnership shall be. set forth above together with the signature of a partner who has authority to
execute this Agreement on behalf of the partnership. IF CONTRACTOR is contracting in an individual capacity, the individual
shall set forth the name of the business, if any, and shall personally sign the Agreement.
Amendment No. 5 to Professional Services Agreement
California Code Check, Inc.
Plan Check, Inspection and Related Services
RMA Building Services Department
Term: January 19, 2011- June 30, 2012
Not to Exceed: $552,446
Paget of 2
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COMPLETED BOARD ORDER"�|E]Z(� NOTEXTPAGE
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COMPLETED BOARD ORDER"�|E]Z(�CERTIFICATE OF INSURANCE
This certifies that STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Name of policyholder CALIFORNIA CODE CHECK INC.
Address of policyholder 1000 BUSINESS CENTER CIR, STE 200, NEWBURY PARK CA 91320
Location of operations
Description of operations ENGINEERING
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date i Expiration Date at beginning of policy period)
92-92-4335-7 Comprehensive
Business Liability 11/03/11 11/03/12
BODILY INJURY AND
PROPERTY DAMAGE
This insurance includes:
Products Completed Operations
Contractual Liability
Underground Hazard Coverage Each Occurrence $ 1, 000, 000. 00
Personal Injury
Advertising Injury General Aggregate $2,000,000.00
Explosion Hazard Coverage
Collapse Hazard Coverage Products Completed $2,000,000.00
Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date Expiration Date Combined Single Limit)
Umbrella Each Occurrence $
Other Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability
Each Accident $
Disease Each Employee $
Disease Policy Limit $
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date at beginning of policy period)
THE CERTIFICATE OF IN SURANCE IS NOT A CONT RACT OF INSURANCE AND NEITH ER AFFIRMATIVELY NOR NEGATIVELY
AMENDS. EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
County of
is
named
as
additional
insured.
Name and Address of Certificate Holder
County of Monterey
Salinas Permit Center
168 W. Alisal St, 2nd Fl.
Salinas, CA 93901
Title
Agent's Code Stamp
AFO Code F773
Monterey
If any of the described policies are canceleo Detore
its expiration date, State Farm will try to mail a written
notice to the certificate holder 3o days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
Farm or I gen r representatives.
10/28/2011
Date
558-994 a.3 04-1999 Printed in U.S.A.
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COMPLETED BOARD ORDER"�|E]Z(�GENERAL LIABILITY/AUTOMOBILE LIABILITY
SPECIAL ENDORSEMENT
FOR THE COUNTY OF MONTEREY, CALIFORNIA
PERMIT/PO/SA/SPECIFICATION/CONTRACT NUMBER
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY INSURANCE COVERAGE PART
AUTOMOBILE LIABILITY INSURANCE COVERAGE PART
In consideration of the premium charged and notwithstanding any inconsistent statement in
the later policy to which this endorsement is attached or in any endorsement which now or
later attaches to the policy, the Company agrees as follows:
ADDITIONAL INSURED: The County of Monterey, its officers, agents and employees are
included as additional insureds, with respect to liability and defense of claims and suits arising out
of the operations and uses performed by or on behalf of the named insured.
CONTRIBUTION WAIVED: The insurance is primary. The County of Monterey's insurance
program shall be excess of this insurance. The Company shall not seek contribution from the
County and its insurers.
SEPARATION OF INSURED: This insurance applies separately to each insured against whom
claim is made or suit is brought, except that the naming of multiple insureds shall not increase the
Company's limits of liability. The inclusion of any person, organization, firm or entity as an insured
under the policy shall not affect any right which such person, organization, firm or entity would
have as a claimant if not so included.
CANCELLATION NOTICE: If the Company elects to cancel or terminate this insurance before
the stated expiration date, or declines to renew a continuous policy, or reduces the stated limits
other than by impairment of an aggregate limit, the Company shall mail written notice to the
County at least 30 days in advance of such election. For non-payment of premium, the Company
shall give the County at least 10 days advance written notice of cancellation or termination.
Except as stated above, all other endorsements, provisions, conditions, limits and exclusions
of this insurance shall remain unchanged.
COMMERCIAL GENERAL LIABILITY POLICY NUMBER:
AUTOMOBILE LIABILITY POLICY NUMBER:
9a 0;13S 7
By my signature on this endorsement, I warrant that I have authority to bind the
insurance company and do so bind the company to this endorsement:
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�
ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
9/9/2011
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
VROMAN INSURANCE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2814 Camino Dos Rios #409 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Newbury Park, CA 91320
805 375 5768 FAX 805 376 2376 INSURERS AFFORDING COVERAGE NAIC#
INSURED CALIFORNIA CODE CHECK, INC INSURER A FARMERS INSURANCE GROUP
1000 BUSINESS CENTER CIR,STE 200 INSURER B
NEWBURY PARK CA 91320 INSURER C
INSURER D
INSURER E
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR b'L
NERD
TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE MM/DD/YYI POLICY EXPIRATION
DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $
CLAIMSMADE F7 OCCUR MEDEXP(Anyoneperson) $
PERSONAL BADVINJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OPAGG $
POLICY PRO LOC
JECT
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT
1 0
ANYAUTO
Ea accident) $
00 000
r r
X ALLOWNEDAUTOS BODILYINJURY
E SCHEDULED AUTOS Per person)
$
A HIRED AUTOS 135738513 09/09/11 11/11/12 BODILYINJURY
NON-OWNED AUTOS HH#0913877992 Peracadent) $
PROPERTY DAMAGE
Peraccident) $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO OTHER THAN EAACC $
AUTOONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000
X OCCUR CI CLAIMS MADE AGGREGATE $
600595413 09/09/11 11/11/12 $
A DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND U- ER-
TORYLIMI ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED? E.L. DISEASE EA EMPLOYE S
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE POLICY LIMIT
S
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BYENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
COUNTY OF MONTEREY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MA3O DAYS WRITTEN
SALINAS PERMIT CENTER
168 WEST ALISAL ST. 2ND FLOOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
SALINAS CA 93901 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES
AUTHORIZED RE RESENT4T(VE
ACORD25 2001/08)
ACORD CORPORATION 1988
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�09/08/2011 15:57� 8054994489 CA CODE CHECK PAGE 04/07
GENERAL LIABILITY/AUTOMOBILE LIABILITY
SPECIAL ENDORSEMENT
FOR THE COUNTY OF MONTEREY, CALIFORNIA
PERMIT/PO/SA/SPECIFICATION/CONTRACT NUMBER
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY INSURANCE COVERAGE PART
AUTOMOBILE LIABILITY INSURANCE COVERAGE PART
In consideration of the premium charged and notwithstanding any inconsistent statement in
the later policy to which this endorsement is attached or in any endorsement which now or
later attaches to the policy, the Company agrees as follows:
ADDITIONAL INSURED: The County of Monterey, its officers, agents and employees are
included as additional insureds, with respect to liability and defense of claims and suits arising out
of the operations and uses performed by or on behalf of the named insured.
CONTRIBUTION WAIVED: The insurance is primary. The County of Monterey's insurance
program shall be excess of this insurance. The Company shall not seek contribution from the
County and its insurers.
SEPARATION OF INSURED: This insurance applies separately to each insured against whom
claim is made or suit is brought, except that the naming of multiple insureds shall not increase the
Company's limits of liability. The inclusion of any person, organization, firm or entity as an insured
under the policy shall not affect any right which such person, organization, firm or entity would
have as a claimant if not so included.
CANCELLATION NOTICE: If the Company elects to cancel or terminate this insurance before
the stated. expiration date, or declines to renew a continuous policy, or reduces the stated limits
other than by impairment of an aggregate limit, the Company shall mail written notice to the
County at least 30 days in advance of such election. For non-payment of premium, the Company
shall give the County at least 10 days advance written notice of cancellation or termination.
Except as stated above, all other endorsements, provisions, conditions, limits and exclusions
of this insurance shall remain unchanged.
COMMERCIAL GENERAL LIABILITY POLICY NUMBER;
AUTOMOBILE LIABILITNJl~Qg$g;7 g 9 2
13573 85 1 3 ittii
By my signature on this endorsement, I warrant that I have authority to bind the
insurance company and do so bind the company to this endorsement:
AUTHORIZED REPRESENTATI E'SSICNATURE:
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z (�ACORD
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM0DDIYY)
7
8 24 2011
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
199 S Los Robles Ave Ste 540 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Pasadena
CA 91101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
626 844-3070 INSURERS AFFORDING COVERAGE
INSURED INSURERA: U S Specialty insurance Company
California Code Check
INSURERB
1000 Business Center Circle, Suite: 200
2
b
k
9 INSURER C
New
ury Par
CA
13
0
805-499-4584 1 INSURER D:
I INSURER E
COVERAGES
HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
OTWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE
DATE fUM/DDfYY1 POLICY EXPIRATION
DATE LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE Any one fire) S
CLAIMS MADE OCCUR MED EXP Any one person) S
PERSONAL & ADV INJURY S
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG S
PRO-
POLICY
LOC
U TOMOBILE LIABILITY COMBINED SINGLE LIMIT
S
ANY AUTO Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS Per person)
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS Per accident)
PROPERTY DAMAGE
Per accident) $
GARAGE LIABILITY AUTO ONLY EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG S
EXCESS LIABILITY EACH OCCURRENCE S
J CLAIMS MADE
OCCUR E AGGREGATE S
S
DEDUCTIBLE $
RETENTION S S
STATUS OTH-
TNI
WORKERS COMPENSATION AND OORY
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT $
E.L. DISEASE EA EMPLOYEE S
E.L. DISEASE POLICY LIMIT S
A OTHER
USS1122072 19/4/2011 X9/4/2012
S1,000,000 per claim
Professional Liability 1 $2,000,000 Annual Aggr
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
EFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
County of Monterey ILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
Salinas Permit Center NAMED TO THE LEFT.
168 W A lisal St, 2nd Fl
Salinas CA 93901
AUTHORIZED REPRESENTATI
ACORD 25-S 7/97)
C
P
10 Day for
ORD CORPORATION 1988
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z
(�ACORa
CERTIFICATE OF LIABILITY INSURANCE
1 F DATE
12/15/2011)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
MFA
NONT CT Shanna Hogan
Hogan Insurance FAX
PHONE 805) 379-2203 AIC 805) 379-5299
License #0C54750 EAbmAg'LS,: shanna@hoganins. com
P.O. Box 7419 INSURER(S) AFFORDING COVERAGE NAIC II
Thousand Oaks CA 91359 INSURER A:Pref erred Employers Insurance 10900
INSURED INSURERS:
California Code Check, Inc. INSURER C
1000 Business Center Cir # 200 INSURER D
INSURER E
Thousand Oaks CA 91320 INSURER F
COVERAGES
CERTIFICATE NUMBER:CL11121506788
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.
ILTR TYPE OF INSURANCE POLICY NUMBER MM DOY/YYYY MM/OOYIYYEXP
YY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY AU U
PREM I occurrence)
S
CLAIMS-MADE U OCCUR MED EXP Any one person) S
PERSONALS ADV INJURY $
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER
PRODUCTS COMPIOP AGG $
1 RO. LOC
POLICY P
IrCT F
S
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea acatlenl
ANY AUTO BODILY INJURY Per person) S
ALL OWNED
AUTOS SCHEDULED
AUTOS
BODILY INJURY Peracudenl)
$
H
HIRED AUTOS NON-OWNED
AUTOS PROPERTY DAMAGE
Per accident
S
$
UMBRELLA LIAR
H OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
A WORKERS COMPENSATION
ANOEMPLOYERS' LIABILITY X INC STATU- 0TH-
LIM T,
Y I N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER E
DED'
NIA
E.L EACH ACCIDENT
$ 11000,000
XCLU
Mandatory In NH) 145174-1 /1/2012 /1/2013 EL. DISEASE EA EMPLOYE S 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE POLICY LIMIT
S 1 000 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORO 101, AddItlonal Remarks Schedule, If more apace is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
County of Monterey ACCORDANCE WITH THE POLICY PROVISIONS.
Salinas Permit Center
168 W. Alisal St, 2nd Fl. AUTHORIZEDREPRESENTA71VE
Salinas, CA 93901
Robert Hogan/SH
ACORD 25 2010/05) 1988-2010 ACORD CORPORATION. All rights reserved.
INSO25 onjnn51m Th. A(alPrl nvmn l Innn aro ronictnrorl mark. of Ar t*)Drl
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40949-U01
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$105,000-U012
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COMPLETED BOARD ORDER"�|E]Z
(�AMENDMENT NO. 3
TO PROFESSIONAL SERVICES AGREEMENT
BETWEEN COUNTY OF MONTEREY AND
CSG CONSULTANTS, INC.
THIS AMENDMENT NO. 3 to the Professional Services Agreement between the County of
Monterey, a political subdivision of the State of California hereinafter, County") and CSG
Consultants, Inc. hereinafter, CONTRACTOR") is hereby entered into between the County and
the CONTRACTOR collectively, the County and CONTRACTOR are referred to as the
parties").
WHEREAS, CONTRACTOR entered into a Professional Services Agreement with County on
April 26, 2011 hereinafter, Agreement"); and
WHEREAS, Agreement was amended by the parties on June 24, 2011 hereinafter,
Amendment No. 1"), and October 4, 2011 hereinafter, Amendment No. 2"); and
WHEREAS, additional time and funding are necessary to meet the increased demand in the
Building Services Department for completion of plan review services within statutory timelines;
and
WHEREAS, the parties wish to further amend the Agreement to extend the term to June 30,
2012 and increase the amount by $105,000 to continue to provide tasks identified in the
Agreement.
NOW, THEREFORE, the parties agree to amend the Agreement as follows:
1. Amend the second sentence of Paragraph 2, Payments by County", to read as follows:
The total amount payable by County to CONTRACTOR under this Agreement shall not
exceed the sum of $307,446.
2. Amend the first sentence of Paragraph 3, Term of Agreement", to read as follows:
The term of this Agreement is from April 11, 2011 to June 30, 2012, unless sooner
terminated pursuant to the terms of this Agreement.
3. All other terms and conditions of the Agreement remain unchanged and in full force.
4. This Amendment No. 3 shall be attached to the Agreement and incorporated therein as if
fully set forth in the Agreement.
Amendment No. 3 to Professional Services Agreement
CSG Consultants, Inc.
Plan Review Services
RMA Building Services Department
Term: April 11, 2011 June 30, 2012
Not to Exceed: $307,446
Page 1 of 2
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MG107839-U03
AS107865-U03
AS107871-U03
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DO109594-U03
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1/30/2012-U011
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COUNTY-U012
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OF-U012
$165,000-U012
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TOTAL-U012
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$105,000-U012
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TO-U012
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COMPLETED BOARD ORDER"�|E]Z
(�I
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COMPLETED BOARD ORDER"�|E]Z
(�IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 3 to the
Professional Services Agreement as of the day and year written below:
COUNTY OF MONTEREY
CONTRACTOR*
By: CSG Consultants, Inc.
Contracts/Purchasing Officer
Date: By:
Its:
Approved as to Form and Legality
Office of the County Counsel
By:
Contractor's Business Name
CL'p`tJ 1iav1000t7 PfPS['aJ
Print ame and itle)
Signature of Secretary, Aist. Secretary, CFO,
Treasurer or Asst. Treasurer)
By: MA Ay d-utvn.~ Its: C Im E s fb kt`[lQi &d. Sen c lzl2y
Deputy County Counsel
Print Name and Title)
Date: 1' a~ la Date: 7 f Z 3 21 i 2
Approved as to Fiscal Prgv#ions
By:
Date:
Approved as to Indemnity and Insurance Provisions
By:
Risk Management
Date:
*INSTRUCTIONS: IF CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal
name of the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a
partnership, the name of the partnership shall be set forth above together with the signature of a partner who has authority to
execute this Agreement on behalf of the partnership. IF CONTRACTOR is contracting in an individual capacity, the individual
shall set forth the name of the business, if any, and shall personally sign the Agreement.
Amendment No. 3 to Professional Services Agreement
CSG Consultants, Inc.
Plan Review Services
RMA Building Services Department
Term: April 11, 2011- June 30, 2012
Not to Exceed: $307,446
Page 2 of 2
BIB]
40949-U01
COMPLETED-U02
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FO107762-U03
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COMPLETED BOARD ORDER"�|E]Z(� NOTEXTPAGE
BIB]
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AS107871-U03
AI109230-U03
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COMPLETED BOARD ORDER"�|E]Z(�
CERTIFICATE OF LIABILITY INSURANCE DATE MMIDDIYYYY)
01/111/2 1/2012
2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 0726293 1-415-546-9300 CONTACT Don Tarantino
NAME:
Arthur J. Gallagher & Co.
License #0726293
of California
Inc
B
k
I
P
NE 415-536-8617 FAX No:415-536-8627
Al HOC. No, AJC
nsurance
ro
ers
One Market Plaza, Spear Tower ADDRESSE-MAIL don_tarantino@ajg.com
Suite 200
41
5
INSURER(S) AFFORDING COVERAGE
NAIC #
San Francisco, CA 9
0 INSURER A: TRAVELERS PROP CAS CO OF AMER 25674
INSURED INSURER B: SENTINEL INS CO LTD 11000
CSG Consultants Inc. INSURER CARCH INS CO 11150
1700 S. Amphlett Blvd 3rd Floor INSURER D:
INSURERE:
San Mateo, CA 94402
INSURER F
COVERAGES
003
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.
INTR
TYPE OF INSURANCE ADDL SUER
POLICY NUMBER POLICY EFF
IDD/VYYY
M POLICY EXP
MMIDDNYYY LIMITS
A GENERAL LIABILITY X 680294M0850-TIL-11 12/04/1 12/04/12 EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTE 00D
000
1
COMMERCIAL GENERAL LIABILITY P ISES a occurrence) $
CLAIMS-MADE I F-7-1 OCCUR MED EXP Any one person) $ 10, 000
PERSONAL & ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OPAGG $ 2,000,000
RO X LOC
POLICY P
JFCT S
A AUTOMOBILE LIABILITY X BA461M7 612 12/04/13 12/04/12 C
Ea OMBINED SINGLE LIMIT accident)
1,000,000
ANY AUTO BODILY INJURY Per person) S
ALL OWNED SCHEDULED
AUTOS BODILY INJURY Per accident) S
AUTOS NON-OWNED PROPERTY DAMAGE S
X HIRED AUTOS X AUTOS Per accident)
$
A X UMBRELLALIAB X OCCUR CUP294M1060 12/04/1 12/04/12 EACH OCCURRENCE $ 5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5, 000, D00
DED RETENTIONS Following Form $
B WORKERS COMPENSATION X 57WEEP4360 12/04/1 12/04/12 X WC ST1A~TIU- OTH-I CRY
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE
E.L. EACH ACCIDENT
$ 1,000,000
OFFICERIMEMBER EXCLUD F
ED?
Mandatory In NH) N I A
E.L. DISEASE EA EMPLOYE
$ 1,000,000
If ves, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE POLICY LIMIT 2,000,000
S
C Prof Liability AEP004731500 12/04/1 12/04/12 Limit 3Mil/3Mi1
Retention 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
County of Monterey, its agents, officers and employees, it is understood and agreed that this insurance is
primary Gen Liability and Auto Liability) and another insurance maintained by the Additional Insured shall be
excess only and not contributing with this insurance in regards to all operations as pertains to
the Named Insured
Gen Liability Additional insured endt CG D3820907 / Other Insurance-Additional Insureds CG D0370405
Auto Coverage Plus Endt CA74 20 07.10 & Business Auto Coverage Form CA 0001 03 10 rev 02-11)
Work Comp Broad Form Endt WC 99 03 03 B Re: All Operations of the Named Insured
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
County of Monterey THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Contracts/Purchasing Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
166 West Alisal St., 3rd FL AUTHORIZED REPRESENTATIVE
Salinas, CA 93901
USA
CERTIFICATE NUMBER: 25117
CANCELLATION
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 2010/05) The ACORD name and logo are registered marks of ACORD
abreen
25117003
BIB]
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COMPLETED BOARD ORDER"�|E]Z(�POLICY NUMBER: GBD-294MOS50-TI L-1 I
COMMERCIAL GENERAL LIABILITY
ISSUE DATE: 11-07-11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURE
ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAME OF PERSON(S) OR ORGANIZATION(S):
COUNTV OF MONTEREY
I'TS"AGENTS OFFICERS AND EMPLOYEES
CONTRACTS/PURCHASING DEPT.
iGS WEST ALISAL ST, 3RD FL
SALINAS, CA 93901
PROJECTILOCATION OF COVERED OPERATIONS:
AS PER WRITTEN CONTRACT OR AGREEMENT
PROVISIONS
A. The following is added to WHO IS AN INSURED
Section II):
The person or organization shown in the Sohod-
ule above is an additional Insured on this Cover-
but only with respect to liability for bod-
age Part
Ily Injury", property damage" or personal Injury"
MZ"_
caused, In whole or in part, by your acts or omis-
N clone or the acts or omissions of those acting on
your behalf:
a. In the performance of your ongoing opera-
tions;
b. In connection with premises owned by or
rented to you; or
c. In connection with your work" and included
within the products-completed operations
hazard".
Such person or organization does not qualify as
an additional insured for bodily injury", property
damage" or personal Injury" for which that per-
son or organization has assumed liability in a con-
tract or agreement,
CG IDS 820907
The Insurance provided to such additional insured
is limited as follows:
d. This insurance does not apply to the render-
ing of or failure to render any professional
services".
e. The limits of insurance afforded to the addi-
tional insured shall be the limits which you
agreed In that contract or agreement requir-
ing insurance" to provide for that additional
Insured, or the limits shown In the Declara-
tions for this Coverage Part, whichever are
less, This endorsement does not Increase the
limits of insurance stated in the LIMITS OF
INSURANCE Section 111) for this Coverage
Part,
B. The following is added to Paragraph a. of 4.
Other Insurance in COMMERCIAL GENERAL
LIABILITY CONDITIONS Section IV);
However, If you specifically agree in a contract or
agreement requiring insurance" that, for the addi-
tional insured shown in the Schedule, the Insur-
ance provided to that additional insured under this
2007 The Travelers Companies, Inc. Page 1 of 2
includes the copyrighted material of Insurance Services Office, Inc,, with Its permission
004270
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AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL GENERAL LIABILITY
Coverage Part must apply on e primary basis, or
a primary and non-contributory basis, this insur-
ance Is primary to other insurance that is avail-
able to such additional insured which covers such
additional insured as a named insured, and we
will not share with the other insurance, provided
that:
1) The bodily Injury" or property damage" for
which coverage is sought occurs: and
2) The personal Injury" for which coverage Is
sought arises out of an offense committed;
after you have entered Into that contract or
agreement requiring insurance" for such addi-
tional insured. But this Insurance still Is excess
over valid and collectible other insurance,
whether primary, excess, contingent or on any
other basis, that is available to the additional in-
sured when the additional insured is also an addi-
tional insured under any other insurance.
C. The following is added to Paragraph a. Transfer
Of Rights Of Recovery Against Others To Us
In COMMERCIAL GENERAL LIABILITY COIU-
DITIONS Section IV):
We waive any rights of recovery we may have
against the additional insured shown in the
Schedule above because of payments we make
for bodily injury", property damage" or personal
injury" arising out of your work" on or for the pro-
ject, or at the location, shown In the Schedule
above, performed by you, or on your behalf, un-
der a contract or agreement requiring insurance"
with that additional insured, We waive these
rights only where you have agreed to do so as
part of the contract or agreement requiring insur-
ance" with that additional insured entered into by
you before, and In effect when, the bodily injury"
or property damage" occurs, or the personal In-
jury" offense is committed,
D. The following definition Is added to DEFINITIONS
Section V):
Contract or agreement requiring insurance"
means that part of any contract or agreement un-
der which you are required to include the person
or organization shown in the Schedule as an ad-
ditional insured on this Coverage Part, provided
that the bodily injury" and property damage" oc-
curs, and the personal injury" is caused by an of-
fense committed:
a. After you have entered into that contract or
agreement;
b. While that part of the contract or agreement is
in effect; and
c. Before the end of the policy period.
Page 2 of 2 0 2007 The Travelers Companies, Inc CO D3 02 09 07
Includes the copyrighted material of Insurance Services office, Inc� with Its permission
BIB]
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AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any
Injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage Is excluded or limited by such an endorsement, The following listing is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsemeni and the rest of your policy carefully to determine rights, duties, and what Is and is not covered.
A. BLANKET ADDITIONAL INSURED
B. EMPLOYEE HIRED AUTO
C. EMPLOYEES AS INSURED
D. SUPPLEMENTARY PAYMENTS INCREASED
LIMITS
E. TRAILERS INCREASED LOAD CAPACITY
F. HIRED AUTO PHYSICAL DAMAGE
G. PHYSICAL DAMAGE TRANSPORTATION
EXPENSES INCREASED LIMIT
A. BLANKET ADDITIONAL INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II LIABILITY COV-
ERAGE:
e~
Any, person or organization who is required under
a written contract or agreement between you and
that person or organization, that Is signed and
executed by you before the bodily injury" or
mid property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional insured is an insured" for Liability Cover-
age, but only for damages to which this insurance
x=-
applies and only to the extent that person or or-
ganization qualifies as an insured" under the
Who Is An Insured provision contained In Section
II.
B. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A.1.,
Who is An Insured, of SECTION II LI-
ABILITY COVERAGE:
An employee" of yours Is an insured" while
operating a covered auto" hired or rented
under a contract or agreement in that em-
ployee's" name, with your permission, while
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT INCREASED LIMIT
I, WAIVER OF DEDUCTIBLE GLASS
J. PERSONAL EFFECTS
K. AIRBAGS
L. AUTO LOAN LEASE GAP
M. BLANKET WAIVER OF SUBROGATION
performing duties related to the conduct of
your business.
2. The following replaces Paragraph b. in B.5.,
Other Insurance, of SECTION IV BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered autos" you own:
1) Any covered auto" you lease, hire,
rent or borrow; and
2) Any covered auto" hired or rented by
your employee" under a contract In
that Individual employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business.
However, any auto" that Is leased, hired,
rented or borrowed with a driver is not a
covered auto".
C. EMPLOYEES AS INSURED
The following Is added to Paragraph A.1., Who Is
An Insured, of SECTION II LIABILITY COV-
ERAGE:
CA T4 20 07 10 02010 The Travelers Indemnity Company. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc. with Its permission.
Page 1 of 3
001001)
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COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
Any employee" of yours is an Insured" while us-
ing a covered auto" you don't own, hire or borrow
in your business or your personal affairs.
D. SUPPLEMENTARY PAYMENTS INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2) of
SECTION 19 LIABILITY COVERAGE:
2) Up to $3,000 for cost of bail bonds in-
cluding bonds for related traffic law viola-
tions) required because of an accident"
we cover. We do not have to furnish
these bonds.
2. The following replaces Paragraph A.2.a.(4) of
SECTION II LIABILITY COVERAGE:
4) All reasonable expenses incurred by the
insured" at our request, including actual
loss of earnings up to $500 a day be-
cause of time off from work.
E. TRAILERS INCREASED LOAD CAPACITY
The following replaces Paragraph C.I. of SEC-
TION I COVERED AUTOS:
1. Trailers" with a load capacity of 3,000
pounds or less designed primarily for travel
on public roads.
F. HIRED AUTO PHYSICAL DAMAGE
The following Is added to Paragraph A.4., Cover-
age Extensions, of SECTION III PHYSICAL
DAMAGE COVERAGE:
Hired Auto Physical Damage Coverage
If hired autos" are covered autos" for Liability
Coverage but not covered autos" for Physical
Damage Coverage, and this policy also provides
Physical Damage Coverage for an owned auto",
then the Physical Damage Coverage Is extended
to autos" that you hire, rent or borrow subject to
the following:
1) The most we will pay for loss" in any one
accident" to a hired, rented or borrowed
auto" is the lesser of:
a) $50,000;
b) The actual cash value of the damaged or
stolen property as of the time of the
loss"; or
c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
2) An adjustment for depreciation and physical
condition will be made In determining actual
cash value in the event of a total loss".
3)
4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
covered auto",
5) This Coverage Extension does not apply to:
a) Any auto" that is hired, rented or bor-
rowed with a driver; or
b) Any auto" that is hired, rented or bor-
rowed from your employee".
G. PHYSICAL DAMAGE TRANSPORTATION
EXPENSES INCREASED LIMIT
The following replaces the first sentence in Para-
graph A.4.a., Transportation Expenses, of
SECTION III PHYSICAL DAMAGE COVER-
AGE:
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
ered auto" of the private passenger type.
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT INCREASED LIMIT
Paragraph C.2 Limit Of Insurance, of SEC-
TION III PHYSICAL DAMAGE COVERAGE is
deleted.
1. WAIVER OF DEDUCTIBLE GLASS
The following Is added to Paragraph D., Deducti-
ble, of SECTION III PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered auto" will apply to
glass damage if the glass is repaired rather than
replaced.
J. PERSONAL EFFECTS
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III PHYSICAL
DAMAGE COVERAGE:
Personal Effects Coverage
We will pay up to $400 for loss" to wearing ap-
parel and other personal effects which are:
1) Owned by an insured"; and
2) In or on your covered auto".
This coverage only applies In the event of a total
theft of your covered auto".
No deductibles apply to Personal Effects cover-
age.
If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of betterment.
Page 2 of 3 2010 The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10
Includes copyrighted material of Insurance Services Office, Inc. with Its permission.
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
or.--
K, AIRBAGS
The following Is added to Paragraph 6.3., Exclu-
sions, of SECTION III PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to loss" to one or
more airbags in a covered auto" you own that In-
flate due to a cause other than a cause of loss"
set forth In Paragraphs A.1& and A.1.c., but
only:
a. If that auto" is a covered auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one loss".
L. AUTO LOAN LEASE GAP
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III PHYSICAL
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private
Passenger Type Vehicles
In the event of a total loss" to a covered auto" of
the private passenger type shown in the Schedule
or Declarations for which Physical Damage Cov-
erage is provided, we will pay any unpaid amount
due on the lease or loan for such covered auto"
less the following:
1) The amount paid under the Physical Damage
2) Any:
a) Overdue lease or loan payments at the
time of the loss";
b) Financial penalties Imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
c) Security deposits not returned by the les-
sor;
d) Costs for extended warranties, Credit Life
e)
Insurance, Health, Accident or Disability
insurance purchased with the loan or
lease; and
Carry-over balances from previous loans
or leases.
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Or Rights Of Recovery Against Others To Us,
of SECTION IV BUSINESS AUTO CONDI-
TIONS:
5. Transfer Of Rights Of Recovery Against
Others To Us
We waivetany right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract exe-
cuted prior to any accident" or loss", pro-
vided that the accident" or loss" arises out of
the operations contemplated by such con-
tract. The waiver applies only to the person or
organization designated in such contract.
Coverage Section of the policy for that auto";
and
0
o=
m
Cq
9MM
CA T4 20 07 10 2010 The Travelers Indemnity Company. All rights reserved.
includes copyrighted material of Insurance Services Office, Inc. with Its permission.
Page 3 of 3
001940
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
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TO-U012
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SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
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DEPARTMENT,-U012
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$165,000-U012
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$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
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A-12103-U012
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DEPARTMENT,-U012
IN-U012
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$307,446-U012
THROUGH-U012
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30,-U012
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C.-U012
AUTHORIZE-U012
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CONTRACTS/PURCHASING-U012
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AMENDMENTS-U012
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AGREEMENTS-U012
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AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
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SCOPE-U012
OF-U012
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CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
BUSINESS AUTO COVERAGE FORM
IHEE~
o__
m=
C"
x
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and is not covered.
Throughout this policy the words you" and your" re-
fer to the Named Insured shown in the Declarations,
The words we", us" and our" refer to the company
providing this insurance.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section V
Definitions.
Symbol
I Any Auto"
SECTION I COVERED AUTOS
Item Two of the Declarations shows the autos" that
are covered autos" for each of your coverages. The
following numerical symbols describe the autos" that
may be covered autos". The symbols entered next to
a coverage on the Declarations designate the only
autos" that are covered autos".
A. Description Of Covered Auto Designation
Symbols
Description Of Covered Auto Designation Symbols
2 Owned Autos" Only those autos" you own and for Liability Coverage any trailers" you don't own
Only while attached to power units you own). This includes those autos" you acquire
ownership of after the policy begins.
3 Owned Private Only the private passenger autos" you own. This includes those private passenger
Passenger autos" you acquire ownership of after the policy begins.
Autos" Only
4 Owned Autos" Only those autos" you own that are not of the private passenger type and for
Other Than Liability Coverage any trailers" you don't own while attached to power units you
Private own). This includes those autos" not of the private passenger type you acquire
Passenger ownership of after the policy begins,
Autos" Only
5 Owned Autos" Only those autos" you own that are required to have no-fault benefits in the state
Subject To where they are licensed or principally garaged. This includes those autos" you
No-fault acquire ownership of after the policy begins provided they are required to have
no-fault benefits in the state where they are licensed or principally garaged.
6 Owned Autos" Only those autos" you own that because of the law in the state where they are
Subject To A licensed or principally garaged are required to have and cannot reject Uninsured
Compulsory Motorists Coverage. This includes those autos" you acquire ownership of after the
Uninsured policy begins provided they are subject to the same state uninsured motorists
Motorists Law requirement.
7 Specifically Only those autos" described in Item Three of the Declarations for which a premium
Described charge is shown and for Liability Coverage any trailers" you don't own while
Autos" attached to any power unit described in Item Three).
8 Hired Autos" Only those autos" you lease, hire, rent or borrow. This does not include any auto"
Only you lease, hire, rent or borrow from any of your employees", partners if you are a
partnership), members if you are a limited liability company) or members of their
households.
9 Non-owned Only those autos" you do not own, lease, hire, rent or borrow that are used in con-
Autos" Only nection with your business. This includes autos" owned by your employees",
partners if you are a partnership), members if you are a limited liability company) or
members of their households but only while used in your business or your personal
affairs.
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009 Page 1 of 12
001033
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
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2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
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TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
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DEPARTMENT,-U012
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JUNE-U012
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THE-U012
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AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
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SCOPE-U012
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WORK-U012
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CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
19 Mobile
Equipment
Subject To
Compulsory
Or Financial
Responsibility
Or Other Motor
Vehicle
Insurance Law
Only
Only those autos" that are land vehicles and that would qualify under the definition of
mobile equipment" under this policy if they were not subject to a compulsory or fi-
nancial responsibility law or other motor vehicle insurance law where they are li-
censed or principally garaged.
B. Owned Autos You Acquire After The Policy
Begins
1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered
next to a coverage in Item Two of the Decla-
rations, then you have coverage for autos"
that you acquire of the type described for the
remainder of the policy period.
2. But, if Symbol 7 is entered next to a coverage
in Item Two of the Declarations, an auto" you
acquire will be a covered auto" for that cov-
erage only if:
a. We already cover all autos" that you own
for that coverage or it replaces an auto"
you previously owned that had that cov-
erage; and
b. You tell us within 30 days after you ac-
quire it that you want us to cover it for that
coverage.
C. Certain Trailers, Mobile Equipment And Tem-
porary Substitute Autos
If Liability Coverage is provided by this coverage
form, the following types of vehicles are also cov-
ered autos" for Liability Coverage:
1. Trailers" with a load capacity of 2,000
pounds or less designed primarily for travel
on public roads.
2. Mobile equipment" while being carried or
towed by a covered auto".
3. Any auto" you do not own while used with
the permission of its owner as a temporary
substitute for a covered auto" you own that Is
out of service because of its:
a. Breakdown;
b. Repair;
c. Servicing;
d. Loss"; or
e. Destruction.
SECTION 11- LIABILITY COVERAGE
A. Coverage
We will pay all sums an insured" legally must pay
as damages because of bodily injury" or prop-
erty damage" to which this insurance applies,
caused by an accident" and resulting from the
ownership, maintenance or use of a covered
auto",
We will also pay all sums an insured" legally
must pay as a covered pollution cost or expense"
to which this insurance applies, caused by an
accident" and resulting from the ownership,
maintenance or use of covered autos". However,
we will only pay for the covered pollution cost or
expense" if there is either bodily injury" or prop-
erty damage" to which this insurance applies that
is caused by the same accident".
We have the right and duty to defend any in-
sured" against a suit" asking for such damages
or a covered pollution cost or expense". How-
ever, we have no duty to defend any insured"
against a suit" seeking damages for bodily in-
jury" or property damage" or a covered pollution
cost or expense" to which this insurance does not
apply. We may investigate and settle any claim or
suit" as we consider appropriate. Our duty to de-
fend or settle ends when the Liability Coverage
Limit of Insurance has been exhausted by pay-
ment of judgments or settlements.
1. Who Is An Insured
The following are insureds":
a. You for any covered auto".
b. Anyone else while using with your per-
mission a covered auto" you own, hire or
borrow except:
1) The owner or anyone else from
whom you hire or borrow a covered
auto".
41
Page 2 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
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PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
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MONTEREY-U012
COUNTY-U012
BUILDING-U012
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DEPARTMENT,-U012
IN-U012
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AMOUNT-U012
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JUNE-U012
30,-U012
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AMENDMENT-U012
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ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
5EHEEI
This exception does not apply if the cov-
ered auto" is a trailer" connected to a
covered auto" you own.
2) Your employee" if the covered auto"
is owned by that employee" or a
member of his or her household.
3) Someone using a covered auto"
while he or she is working in a busi-
ness of selling, servicing, repairing,
parking or storing autos" unless that
business is yours.
4) Anyone other than your employees",
partners if you are a partnership),
members if you are a limited liability
company) or a lessee or borrower or
any of their employees", while mov-
ing property to or from a covered
auto".
5) A partner if you are a partnership) or
a member if you are a limited liability
company) for a covered auto" owned
by him or her or a member of his or
her household.
c. Anyone liable for the conduct of an in-
sured" described above but only to the
extent of that liability.
2. Coverage Extensions
a. Supplementary Payments
We will pay for the insured":
1) All expenses we incur.
2) Up to $2,000 for cost of bail bonds
3)
0
5)
including bonds for related traffic law
violations) required because of an
accident" we cover, We do not have
to furnish these bonds.
The cost of bonds to release attach-
ments in any suit" against the in-
sured" we defend, but only for bond
amounts within our Limit of Insur-
ance.
4) All reasonable expenses incurred by
the insured" at our request, including
actual loss of earnings up to $250 a
day because of time off from work.
All court costs taxed against the in-
sured" in any suit" against the in-
sured" we defend. However, these
payments do not include attorneys'
fees or attorneys' expenses taxed
against the insured".
6) All interest on the full amount of any
judgment that accrues after entry of
the judgment in any suit" against the
insured" we defend, but our duty to
pay interest ends when we have paid,
offered to pay or deposited in court
the part of the judgment that is within
our Limit of Insurance.
These payments will not reduce the Limit
of Insurance.
b. Out-of-state Coverage Extensions
While a covered auto" is away from the
state where it is licensed we will:
1) Increase the Limit of Insurance for Li-
ability Coverage to meet the limits
specified by a compulsory or financial
responsibility law of the jurisdiction
where the covered auto" is being
used. This extension does not apply
to the limit or limits specified by any
law governing motor carriers of pas-
sengers or property.
2) Provide the minimum amounts and
types of other coverages, such as no-
fault, required of out-of-state vehicles
by the jurisdiction where the covered
auto" is being used.
We will not pay anyone more than once
for the same elements of loss because of
these extensions.
B. Exclusions
This insurance does not apply to any of the fol-
lowing:
1. Expected Or Intended Injury
Bodily injury" or property damage" expected
or intended from the standpoint of the in-
sured".
2. Contractual
Liability assumed under any contract or
agreement.
But this exclusion does not apply to liability
for damages:
a. Assumed in a contract or agreement that
is an insured contract" provided the
bodily injury" or property damage" oc-
curs subsequent to the execution of the
contract or agreement; or
b. That the insured" would have in the ab-
sence of the contract or agreement,
CA 00 01 03 10 Rev. 02-11) insurance Services Office, Inc., 2009 Page 3 of 12
001634
BIB]
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COMPLETED-U02
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COMPLETED BOARD ORDER"�|E]Z(�COMMERCIAL AUTO
3. Workers' Compensation
Any obligation for which the insured" or the
insured's" insurer may be held liable under
any workers' compensation, disability benefits
or unemployment compensation law or any
similar law.
4. Employee Indemnification And Employer's
Liability
Bodily injury" to:
a. An employee" of the insured" arising out
of and in the course of:
1) Employment by the insured"; or
2) Performing the duties related to the
conduct of the insured's" business;
or
b. The spouse, child, parent, brother or sis-
ter of that employee" as a consequence
of Paragraph a. above.
This exclusion applies:
1) Whether the insured" may be liable
as an employer or in any other ca-
pacity; and
2) To any obligation to share damages
with or repay someone else who
must pay damages because of the in-
jury.
But this exclusion does not apply to bodily in-
jury" to domestic employees" not entitled to
workers' compensation benefits or to liability
assumed by the insured" under an insured
contract". For the purposes of the coverage
form, a domestic employee" is a person en-
gaged in household or domestic work per-
formed principally in connection with a resi-
dence premises.
5. Fellow Employee
Bodily injury" to:
a. Any fellow employee" of the insured"
arising out of and in the course of the fel-
low employee's" employment or while
performing duties related to the conduct
of your business; or
b. The spouse, child, parent, brother or sis-
ter of that fellow employee" as a conse-
quence of Paragraph a. above.
6. Care, Custody Or Control
Property damage" to or covered pollution
cost or expense" involving property owned or
transported by the insured" or in the in-
sured's" care, custody or control. But this ex-
clusion does not apply to liability assumed
under a sidetrack agreement.
7. Handling Of Property
Bodily injury" or property damage" resulting
from the handling of property:
a. Before it is moved from the place where it
is accepted by the insured" for move-
ment into or onto the covered auto"; or
b. After it is moved from the covered auto"
to the place where it is finally delivered by
the insured".
8. Movement Of Property By Mechanical De-
vice
Bodily injury" or property damage" resulting
from the movement of property by a me-
chanical device other than a hand truck)
unless the device is attached to the covered
auto".
9. Operations
Bodily injury" or property damage" arising
out of the operation of:
a. Any equipment listed in Paragraphs 6.b.
and 6.c, of the definition of mobile
equipment"; or
b. Machinery or equipment that is on, at-
tached to or part of a land vehicle that
would qualify under the definition of mo-
bile equipment" if it were not subject to a
compulsory or financial responsibility law
or other motor vehicle insurance law
where it is licensed or principally garaged.
10. Completed Operations
Bodily injury" or property damage" arising
out of your work after that work has been
completed or abandoned.
In this exclusion, your work means:
a. Work or operations performed by you or
on your behalf; and
b. Materials, parts or equipment furnished in
connection with such work or operations.
Your work includes warranties or representa-
tions made at any time with respect to the fit-
ness, quality, durability or performance of any
of the items included in Paragraph a. or b.
above.
Your work will be deemed completed at the
earliest of the following times:
1) When all of the work called for in your
contract has been completed.
Page 4 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
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LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
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AI109230-U03
DO109594-U03
C15-U03
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17723-U05
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0=
h
Goo
2) When all of the work to be done at
the site has been completed if your
contract calls for work at more than
one site.
3) When that part of the work done at a
job site has been put to its intended
use by any person or organization
other than another contractor or sub-
contractor working on the same pro-
ject.
Work that may need service, maintenance,
correction, repair or replacement, but which is
otherwise complete, will be treated as com-
pleted.
11. Pollution
Bodily injury" or property damage" arising
out of the actual, alleged or threatened dis-
charge, dispersal, seepage, migration, re-
lease or escape of pollutants":
a. That are, or that are contained in any
property that is:
1) Being transported or towed by, han-
dled or handled for movement into,
onto or from the covered auto";
2) Otherwise in the course of transit by
3)
or on behalf of the insured"; or
Being stored, disposed of, treated or
processed in or upon the covered
auto";
b. Before the pollutants" or any property in
which the pollutants" are contained are
moved from the place where they are ac-
cepted by the insured" for movement into
or onto the covered auto"; or
c. After the pollutants" or any property in
which the pollutants" are contained are
moved from the covered auto" to the
place where they are finally delivered,
disposed of or abandoned by the in-
sured".
Paragraph a. above does not apply to fuels,
lubricants, fluids, exhaust gases or other simi-
lar pollutants" that are needed for or result
from the normal electrical, hydraulic or me-
chanical functioning of the covered auto" or
its parts, if:
1) The pollutants" escape, seep, mi-
grate or are discharged, dispersed or
released directly from an auto" part
designed by its manufacturer to hold,
store, receive or dispose of such pol-
lutants"; and
2) The bodily injury", property dam-
age" or covered pollution cost or ex-
pense" does not arise out of the op-
eration of any equipment listed in
Paragraphs 6.b. and 6.c, of the defi-
nition of mobile equipment".
Paragraphs b. and c. above of this exclusion
do not apply to accidents" that occur away
from premises owned by or rented to an in-
sured" with respect to pollutants" not in or
upon a covered auto" if:
a) The pollutants" or any property in
which the pollutants" are contained
are upset, overturned or damaged as
a result of the maintenance or use of
a covered auto"; and
b) The discharge, dispersal, seepage,
migration, release or escape of the
pollutants" is caused directly by such
upset, overturn or damage.
12.VVar
Bodily injury" or property damage" arising
directly or indirectly out of:
a. War, including undeclared or civil war;
b. Warlike action by a military force, includ-
ing action in hindering or defending
against an actual or expected attack, by
any government, sovereign or other au-
thority using military personnel or other
agents; or
c. Insurrection, rebellion, revolution,
usurped power or action taken by gov-
ernmental authority in hindering or de-
fending against any of these.
13. Racing
Covered autos" while used in any profes-
sional or organized racing or demolition con-
lest or stunting activity, or while practicing for
such contest or activity. This insurance also
does not apply while that covered auto" is
being prepared for such a contest or activity.
C. Limit Of Insurance
Regardless of the number of covered autos",
insureds", premiums paid, claims made or vehi-
cles involved in the accident", the most we will
pay for the total of all damages and covered pol-
lution cost or expense" combined resulting from
any one accident" is the Limit of Insurance for Li-
ability Coverage shown in the Declarations.
All bodily injury", property damage" and cov-
ered pollution cost or expense" resulting from
CA 00 01 03 10 Rev. 02-11) 0 Insurance Services Office, Inc., 2009
Page 5 of 12
001635
BIB]
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COMPLETED-U02
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2/10/2012-U04
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continuous or repeated exposure to substantially
the same conditions will be considered as result-
ing from one accident".
No one will be entitled to receive duplicate pay-
ments for the same elements of loss" under this
coverage form and any Medical Payments Cov-
erage endorsement, Uninsured Motorists Cover-
age endorsement or Underinsured Motorists
Coverage endorsement attached to this Coverage
Part.
SECTION III PHYSICAL DAMAGE COVERAGE
A. Coverage
1. We will pay for loss" to a covered auto" or
its equipment under:
a. Comprehensive Coverage
From any cause except:
1) The covered auto's" collision with
another object; or
2) The covered auto's" overturn.
b. Specified Causes Of Loss Coverage
Caused by:
Fire, lightning or explosion;
Theft;
Windstorm, hail or earthquake;
Flood;
Mischief or vandalism; or
The sinking, burning, collision or de-
railment of any conveyance transport-
ing the covered auto".
c. Collision Coverage
Caused by:
1) The covered auto's" collision with
another object; or
2) The covered auto's" overturn.
2. Towing
We will pay up to the limit shown in the Decla-
rations for towing and labor costs incurred
each time a covered auto" of the private
passenger type is disabled, However, the la-
bor must be performed at the place of dis-
ablement.
3. Glass Breakage Hitting A Bird Or Animal
Falling Objects Or Missiles
If you carry Comprehensive Coverage for the
damaged covered auto", we will pay for the
following under Comprehensive Coverage:
a. Glass breakage;
b. Loss" caused by hitting a bird or animal;
and
c. Loss" caused by falling objects or mis-
siles.
However, you have the option of having glass
breakage caused by a covered auto's" colli-
sion or overturn considered a loss" under
Collision Coverage.
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $20 per day to a maxi-
mum of $600 for temporary transportation
expense incurred by you because of the
total theft of a covered auto" of the pri-
vate passenger type. We will pay only for
those covered autos" for which you carry
either Comprehensive or Specified
Causes Of Loss Coverage. We will pay
for temporary transportation expenses in-
curred during the period beginning 48
hours after the theft and ending, regard-
less of the policy's expiration, when the
covered auto" is returned to use or we
pay for its loss".
b. Loss Of Use Expenses
For Hired Auto Physical Damage, we will
pay expenses for which an insured" be-
comes legally responsible to pay for loss
of use of a vehicle rented or hired without
a driver under a written rental contract or
agreement. We will pay for loss of use
expenses if caused by:
1) Other than collision only if the Decla-
rations indicate that Comprehensive
Coverage is provided for any covered
auto";
2) Specified Causes Of Loss only if the
Declarations indicate that Specified
Causes Of Loss Coverage is pro-
vided for any covered auto"; or
3) Collision only if the Declarations indi-
cate that Collision Coverage is pro-
vided for any covered auto".
However, the most we will pay for any
expenses for loss of use is $20 per day,
to a maximum of $600.
B. Exclusions
1. We will not pay for loss" caused by or result-
ing from any of the following. Such loss" is
excluded regardless of any other cause or
Page 6 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
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194-RMA-U08
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event that contributes concurrently or in any
sequence to the loss".
a. Nuclear Hazard
1) The explosion of any weapon em-
ploying atomic fission or fusion; or
2) Nuclear reaction or radiation, or ra-
dioactive contamination, however
caused.
b. War Or Military Action
1) War, including undeclared or civil
war;
2) Warlike action by a military force, in-
3)
cluding action in hindering or defend-
ing against an actual or expected at-
tack, by any government, sovereign
or other authority using military per-
sonnel or other agents; or
Insurrection, rebellion, revolution,
usurped power or action taken by
governmental authority in hindering
or defending against any of these.
2. We will not pay for loss" to any covered
auto" while used in any professional or or-
ganized racing or demolition contest or stunt-
ing activity, or while practicing for such con-
test or activity. We will also not pay for loss"
to any covered auto" while that covered
auto" is being prepared for such a contest or
activity.
3. We will not pay for loss" due and confined to:
a. Wear and tear, freezing, mechanical or
electrical breakdown.
b. Blowouts, punctures or other road dam-
age to tires.
This exclusion does not apply to such loss"
resulting from the total theft of a covered
auto".
4. We will not pay for loss" to any of the follow-
ing:
a. Tapes, records, discs or other similar au-
dio, visual or data electronic devices de-
signed for use with audio, visual or data
electronic equipment,
b. Any device designed or used to detect
speed-measuring equipment such as ra-
dar or laser detectors and any jamming
apparatus intended to elude or disrupt
speed-measurement equipment.
c. Any electronic equipment, without regard
to whether this equipment is permanently
installed, that reproduces, receives or
transmits audio, visual or data signals,
d. Any accessories used with the electronic
equipment described in Paragraph c.
above.
5. Exclusions 4.c. and 4.d. do not apply to
equipment designed to be operated solely by
use of the power from the auto's" electrical
system that, at the time of loss", is:
a. Permanently installed in or upon the cov-
ered auto";
b. Removable from a housing unit which is
permanently installed in or upon the cov-
ered auto";
c. An integral part of the same unit housing
any electronic equipment described in
Paragraphs a. and b. above; or
d. Necessary for the normal operation of the
covered auto" or the monitoring of the
covered auto's" operating system.
6. We will not pay for loss" to a covered auto"
due to diminution in value".
C. Limit Of Insurance
1. The most we will pay for loss" in any one
accident" is the lesser of:
a. The actual cash value of the damaged or
stolen property as of the time of the
loss"; or
b. The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality,
2. $1.000 is the most we will pay for loss" in
any one accident" to all electronic equipment
that reproduces, receives or transmits audio,
visual or data signals which, at the time of
loss", is:
a. Permanently installed in or upon the cov-
ered auto" in a housing, opening or other
location that is not normally used by the
auto" manufacturer for the installation of
such equipment;
b. Removable from a permanently installed
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipment; or
c. An integral part of such equipment.
3. An adjustment for depreciation and physical
condition will be made in determining actual
cash value in the event of a total loss".
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009
Page 7 of 12
001 U35
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40949-U01
COMPLETED-U02
BOARD-U02
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LI21329-U03
FO96183-U03
FO107762-U03
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4. If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of the betterment.
D. Deductible
For each covered auto", our obligation to pay for,
repair, return or replace damaged or stolen prop-
erty will be reduced by the applicable deductible
shown in the Declarations. Any Comprehensive
Coverage deductible shown in the Declarations
does not apply to loss" caused by fire or light-
ning.
SECTION IV BUSINESS AUTO CONDITIONS
The following conditions apply in addition to the
Common Policy Conditions:
A. Loss Conditions
1. Appraisal For Physical Damage Loss
If you and we disagree on the amount of
loss", either may demand an appraisal of the
loss". In this event, each party will select a
competent appraiser. The two appraisers will
select a competent and impartial umpire. The
appraisers will state separately the actual
cash value and amount of loss". If they fail to
agree, they will submit their differences to the
umpire, A decision agreed to by any two will
be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If we submit to an appraisal, we will still retain
our right to deny the claim.
2. Duties In The Event Of Accident, Claim,
Suit Or Loss
We have no duty to provide coverage under
this policy unless there has been full compli-
ance with the following duties:
a. In the event of accident", claim, suit" or
loss", you must give us or our authorized
representative prompt notice of the acci-
dent" or loss". Include:
1) How, when and where the accident"
or loss" occurred;
2) The insured's" name and address;
1)
3)
5)
Assume no obligation, make no pay-
ment or incur no expense without our
consent, except at the insured's"
own cost.
and
3) To the extent possible, the names
and addresses of any injured persons
and witnesses.
b. Additionally, you and any other involved
insured" must:
2) Immediately send us copies of any
4) Authorize us to obtain medical re-
request, demand, order, notice,
summons or legal paper received
concerning the claim or suit".
Cooperate with us in the investigation
or settlement of the claim or defense
against the suit".
cords or other pertinent information.
Submit to examination, at our ex-
pense, by physicians of our choice,
as often as we reasonably require.
c. If there is loss" to a covered auto" or its
equipment you must also do the follow-
ing:
1)
Promptly notify the police if the cov-
ered auto" or any of its equipment is
stolen.
2) Take all reasonable steps to protect
the covered auto" from further dam-
age. Also keep a record of your ex-
penses for consideration in the set-
tlement of the claim.
3) Permit us to inspect the covered
auto" and records proving the loss"
before its repair or disposition.
4) Agree to examinations under oath at
our request and give us a signed
statement of your answers.
3. Legal Action Against Us
No one may bring a legal action against us
under this coverage form until:
a. There has been full compliance with all
the terms of this coverage form; and
b. Under Liability Coverage, we agree in
writing that the insured" has an obliga-
tion to pay or until the amount of that ob-
ligation has finally been determined by
judgment after trial. No one has the right
under this policy to bring us into an action
to determine the insured's" liability.
4. Loss Payment Physical Damage Cover-
ages
At our option we may:
a. Pay for, repair or replace damaged or sto-
len property;
r
Page 8 of 12 Insurance Services Office, Inc� 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
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INC.-U07
194-RMA-U08
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LORI-U09
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1/30/2012-U011
CCC)-U012
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b. Return the stolen property, at our ex-
pense. We will pay for any damage that
results to the auto" from the theft; or
c. Take all or any part of the damaged or
stolen property at an agreed or appraised
value.
If we pay for the loss", our payment will in-
clude the applicable sales tax for the dam-
aged or stolen property.
5. Transfer Of Rights Of Recovery Against
Others To Us
If any person or organization to or for whom
we make payment under this coverage form
has rights to recover damages from another,
those rights are transferred to us. That person
or organization must do everything necessary
to secure our rights and must do nothing after
accident" or loss" to impair them.
B. General Conditions
1. Bankruptcy
Bankruptcy or insolvency of the insured" or
the insured's" estate will not relieve us of any
obligations under this coverage form.
2. Concealment, Misrepresentation Or Fraud
This coverage form is void in any case of
fraud by you at any time as it relates to this
coverage form. It is also void if you or any
other insured", at any time, intentionally con-
ceal or misrepresent a material fact concern-
ing:
5. Other insurance
a. This coverage form;
b. The covered auto"; 6.
c. Your interest in the covered auto"; or
d. A claim under this coverage form.
3. Liberalization
If we revise this coverage form to provide
more coverage without additional premium
charge, your policy will automatically provide
the additional coverage as of the day the re-
vision is effective in your state.
4. No Benefit To Bailee Physical Damage
Coverages
We will not recognize any assignment or
grant any coverage for the benefit of any per-
son or organization holding, storing or trans-
porting property for a fee regardless of any
other provision of this coverage form.
a. For any covered auto" you own, this
coverage form provides primary insur-
ance. For any covered auto" you don't
own, the insurance provided by this cov-
erage form is excess over any other col-
lectible insurance. However, while a cov-
ered auto" which is a trailer" is con-
nected to another vehicle, the Liability
Coverage this coverage form provides for
the trailer" is:
1) Excess while it is connected to a mo-
tor vehicle you do not own.
2) Primary while it is connected to a
covered auto" you own.
b. For Hired Auto Physical Damage Cover-
age, any covered auto" you lease, hire,
rent or borrow is deemed to be a covered
auto" you own. However, any auto" that
is leased, hired, rented or borrowed with
a driver is not a covered auto".
c. Regardless of the provisions of Para-
graph a. above, this coverage form's Li-
ability Coverage is primary for any liability
assumed under an insured contract".
d. When this coverage form and any other
coverage form or policy covers on the
same basis, either excess or primary, we
will pay only our share. Our share is the
proportion that the Limit of Insurance of
our coverage form bears to the total of
the limits of all the coverage forms and
policies covering on the same basis.
Premium Audit
a. The estimated premium for this coverage
form is based on the exposures you told
us you would have when this policy be-
gan. We will compute the final premium
due when we determine your actual ex-
posures. The estimated total premium will
be credited against the final premium due
and the first Named insured will be billed
for the balance, If any. The due date for
the final premium or retrospective pre-
mium is the date shown as the due date
on the bill. If the estimated total premium
exceeds the final premium due, the first
Named Insured will get a refund.
b. If this policy is issued for more than one
year, the premium for this coverage form
will be computed annually based on our
rates or premiums in effect at the begin-
ning of each year of the policy.
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009 Page 9 of 12
001637
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
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7. Policy Period, Coverage Territory
Under this coverage form, we cover acci-
dents" and losses" occurring:
a. During the policy period shown in the
Declarations; and
b. Within the coverage territory.
The coverage territory is:
1) The United States of America;
2) The territories and possessions of the
United States of America;
3) Puerto Rico;
4) Canada; and
5) Anywhere in the world if:
a) A covered auto" of the private pas-
senger type is leased, hired, rented
or borrowed without a driver for a pe-
riod of 30 days or less; and
b) The insured's" responsibility to pay
damages is determined in a suit" on
the merits, in the United States of
America, the territories and posses-
sions of the United States of America,
Puerto Rico or Canada or in a settle-
ment we agree to.
We also cover loss" to, or accidents" involv-
ing, a covered auto" while being transported
between any of these places.
8. Two Or More Coverage Forms Or Policies
Issued By Us
If this coverage form and any other coverage
form or policy issued to you by us or any
company affiliated with us applies to the
same accident", the aggregate maximum
Limit of Insurance under all the coverage
forms or policies shall not exceed the highest
applicable Limit of Insurance under any one
coverage form or policy. This condition does
not apply to any coverage form or policy is-
sued by us or an affiliated company specifi-
cally to apply as excess insurance over this
coverage form.
SECTION V DEFINITIONS
A. Accident" includes continuous or repeated expo-
sure to the same conditions resulting in bodily in-
jury" or property damage",
B. Auto" means:
1. A land motor vehicle, trailer" or semitrailer
designed for travel on public roads; or
2. Any other land vehicle that is subject to a
compulsory or financial responsibility law or
other motor vehicle insurance law where it is
licensed or principally garaged.
However, auto" does not include mobile equip-
ment".
C. Bodily injury" means bodily injury, sickness or
disease sustained by a person including death
resulting from any of these.
D. Covered pollution cost or expense" means any
cost or expense arising out of:
1. Any request, demand, order or statutory or
regulatory requirement that any insured" or
others test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in any
way respond to, or assess the effects of, pol-
lutants"; or
2. Any claim or suit" by or on behalf of a gov-
ernmental authority for damages because of
testing for, monitoring, cleaning up, removing,
containing, treating, detoxifying or neutraliz-
ing, or in any way responding to, or assessing
the effects of, pollutants".
Covered pollution cost or expense" does not in-
clude any cost or expense arising out of the ac-
tual, alleged or threatened discharge, dispersal,
seepage, migration, release or escape of pollut-
ants":
a. That are, or that are contained in any
property that is:
1) Being transported or towed by, han-
dled or handled for movement into,
onto or from the covered auto";
2) Otherwise in the course of transit by
or on behalf of the insured"; or
3) Being stored, disposed of, treated or
processed in or upon the covered
auto";
b, Before the pollutants" or any property in
which the pollutants" are contained are
moved from the place where they are ac-
cepted by the insured" for movement into
or onto the covered auto"; or
c. After the pollutants" or any property in
which the pollutants" are contained are
moved from the covered auto" to the
place where they are finally delivered,
disposed of or abandoned by the in-
sured".
Paragraph a. above does not apply to fuels,
lubricants, fluids, exhaust gases or other simi-
Page 10 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
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2/10/2012-U04
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NO.-U07
5-U07
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PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
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KAPWELLL-U10
1/30/2012-U011
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OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
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JUNE-U012
30,-U012
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AMENDMENT-U012
NO.-U012
3-U012
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PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
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THE-U012
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COUNTY-U012
BUILDING-U012
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IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
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TO-U012
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$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
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EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
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ALTER-U012
THE-U012
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OF-U012
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AGREEMENT-U012
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COMPLETED BOARD ORDER"�|E]Z (�I
W
U
OC=
o~_
M1
COMMERCIAL AUTO
lar pollutants" that are needed for or result
from the normal electrical, hydraulic or me-
chanical functioning of the covered auto" or
its parts, If:
1)
The pollutants" escape, seep, mi-
grate or are discharged, dispersed or
released directly from an auto" part
designed by its manufacturer to hold,
store, receive or dispose of such pol-
lutants"; and
2) The bodily injury", property dam-
age" or covered pollution cost or ex-
pense" does not arise out of the op-
eration of any equipment listed in
Paragraph 6.b, or 6.c. of the defini-
tion of mobile equipment".
Paragraphs b. and c. above do not apply to
accidents" that occur away from premises
owned by or rented to an insured" with re-
spect to pollutants" not in or upon a covered
auto" if:
a) The pollutants" or any property in
which the pollutants" are contained
are upset, overturned or damaged as
a result of the maintenance or use of
a covered auto"; and
b) The discharge, dispersal, seepage,
migration, release or escape of the
pollutants" is caused directly by such
upset, overturn or damage.
E. Diminution in value" means the actual or per-
ceived loss in market value or resale value which
results from a direct and accidental loss".
F. Employee" includes a leased worker". Em-
ployee" does not include a temporary worker".
G. Insured" means any person or organization quali-
fying as an insured in the Who Is An insured pro-
vision of the applicable coverage. Except with re-
spect to the Limit of Insurance, the coverage af-
forded applies separately to each insured who is
seeking coverage or against whom a claim or
suit" is brought.
H. Insured contract" means:
1. A lease of premises;
2. A sidetrack agreement;
3. Any easement or license agreement, except
in connection with construction or demolition
operations on or within 50 feet of a railroad;
4. An obligation, as required by ordinance, to in-
demnify a municipality, except in connection
with work for a municipality;
5. That part of any other contract or agreement
pertaining to your business including an in-
demnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
to pay for bodily injury" or property damage"
to a third party or organization. Tort liability
means a liability that would be imposed by
law in the absence of any contract or agree-
ment;
6. That part of any contract or agreement en-
tered into, as part of your business, pertaining
to the rental or lease, by you or any of your
employees", of any auto". However, such
contract or agreement shall not be considered
an insured contract" to the extent that it obli-
gates you or any of your employees" to pay
for property damage" to any auto" rented or
leased by you or any of your employees".
An insured contract" does not include that part of
any contract or agreement:
a. That indemnifies a railroad for bodily in-
jury" or property damage" arising out of
construction or demolition operations,
within 50 feet of any railroad property and
affecting any railroad bridge or trestle,
tracks, roadbeds, tunnel, underpass or
crossing;
b. That pertains to the loan, lease or rental
of an auto" to you or any of your em-
ployees", If the auto" is loaned, leased or
rented with a driver; or
c. That holds a person or organization en-
gaged in the business of transporting
property by auto" for hire harmless for
your use of a covered auto" over a route
or territory that person or organization is
authorized to serve by public authority.
1. Leased worker" means a person leased to you
by a labor leasing firm under an agreement be-
tween you and the labor leasing firm to perform
duties related to the conduct of your business.
Leased worker" does not include a temporary
worker".
J. Loss" means direct and accidental loss or dam-
age.
K. Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
1. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
CA 00 01 03 10 Rev, 02-11) Insurance Services Office, Inc., 2009
Page 11 of 12
001038
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
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2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
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$165,000-U012
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$552,446-U012
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ASSOCIATED-U012
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COUNTY-U012
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DEPARTMENT,-U012
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AMOUNT-U012
OF-U012
$105,000-U012
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$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
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C.-U012
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THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
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SERVICES-U012
AGREEMENTS-U012
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AMENDMENTS-U012
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SIGNIFICANTLY-U012
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OF-U012
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OR-U012
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AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z (�COMMERCIAL AUTO
2. Vehicles maintained for use solely on or next
to premises you own or rent;
3. Vehicles that travel on crawler treads;
4. Vehicles, whether self-propelled or not, main-
tained primarily to provide mobility to perma-
nently mounted:
a. Power cranes, shovels, loaders, diggers
or drills; or
b. Road construction or resurfacing equip-
ment such as graders, scrapers or rollers;
5. Vehicles not described in Paragraph 1., 2., 3.
or 4. above that are not self-propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the fol-
lowing types:
a. Air compressors, pumps and generators,
including spraying, welding, building
cleaning, geophysical exploration, lighting
and well-servicing equipment; or
b. Cherry pickers and similar devices used
to raise or lower workers; or
6. Vehicles not described in Paragraph 1., 2., 3.
or 4. above maintained primarily for purposes
other than the transportation of persons or
cargo. However, self-propelled vehicles with
the following types of permanently attached
equipment are not mobile equipment" but will
be considered autos":
a. Equipment designed primarily for:
1) Snow removal;
2) Road maintenance, but not construc-
tion or resurfacing; or
3) Street cleaning;
b. Cherry pickers and similar devices
mounted on automobile or truck chassis
and used to raise or lower workers; and
c. Air compressors, pumps and generators,
including spraying, welding, building
cleaning, geophysical exploration, lighting
or well-servicing equipment.
However, mobile equipment" does not include
land vehicles that are subject to a compulsory or
financial responsibility law or other motor vehicle
insurance law where it is licensed or principally
garaged. Land vehicles subject to a compulsory
or financial responsibility law or other motor vehi-
cle insurance law are considered autos".
L. Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
M. Property damage" means damage to or loss of
use of tangible property.
N. Suit" means a civil proceeding in which:
1. Damages because of bodily injury" or prop-
erty damage"; or
2. A covered pollution cost or expense";
to which this insurance applies, are alleged.
Suit" includes:
a. An arbitration proceeding in which such
damages or covered pollution costs or
expenses" are claimed and to which the
insured" must submit or does submit with
our consent; or
b. Any other alternative dispute resolution
proceeding in which such damages or
covered pollution costs or expenses" are
claimed and to which the insured submits
with our consent.
0. Temporary worker" means a person who is fur-
nished to you to substitute for a permanent em-
ployee" on leave or to meet seasonal or short-
term workload conditions.
P. Trailer" Includes semitrailer.
Page 12 of 12 insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
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TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
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THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z!(�COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE ADD TIONAL INSUREDS
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROVISIONS
COMMERCIAL GENERAL LIABILITY CONDITIONS
Section IV), Paragraph 4. Other Insurance), It;
amended as follows;
1. The following Is added to Paragraph a, Primary
Insurance:
However, If you specifically agree In a written con-
tract or written agreement that the Insurance pro-
vided to an additional Insured under this
Coverage Part must apply on a primary basis, or
a primary and non-contributory basis, this insur-
ance Is primary to other Insurance that is avail-
able to such additional Insured which covers such
additional Insured as a named Insured, and we
will not share with that other Insurance, provided
that:
a. The bodily Injury" or property damage" for
which coverage Is sought occurs; and
b. The personal Injury" or advertising Injury" for
which coverage Is sought arises out of an of-
fense committed
subsequent to the signing and execution of that
contract or agreement by you,
2. The first Subparagraph 2) of Paragraph b, Ex-
cass Insurance regarding any other primary In-
surance available to you is deleted.
3. The following Is added to Paragraph b, Sxceee
insurance, as an addItionai subparagraph under
Subparagraph 1);
That Is available to the Insured when the Insured
Is added as an additional.insured under any other
policy, Including any umbrella or excess policy,
CG DO 37 04 05 Copyright 2006 The St. Paul Travelers Companies, Inc, All rights reserved, Page I of I
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
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ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
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DEPARTMENT,-U012
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$165,000-U012
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$552,446-U012
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JUNE-U012
30,-U012
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B.-U012
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NO.-U012
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TO-U012
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A-12103-U012
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INC.-U012
CSG)-U012
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PLAN-U012
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TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
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$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
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TO-U012
EXECUTE-U012
THE-U012
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TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
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OR-U012
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COMPLETED BOARD ORDER"�|E]Z"(�THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WORKERS' COMPENSATION BROAD FORM ENDORSEMENT
EXTENDED OPTIONS
P key Number: 57 WE EP4360 Endorsement Number:
Effective Date: 12/04/11 Effective hour Is the same as stated on the Information Page of the policy.
Nam d Insured and Address: CSG CONSULTANTS INC
1700 S AMPI-ILETT BLVD 3RD FL
SAN MATEO, CA 94402
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section ti of this endorsement provides additional coverage usually only provided by endorsement.
Section III of this endorsement is a Schedule of Covered States.
You may use the Index to locate these coverage features quickly:
INDEX
I=
lim
SUBJE C PAGE SUBJECT
SECTION I 2 B. Part One Does Not Apply 3
PARTS ONE and TWO 2 C. Application of Coverage 3
01 We Will Also Pay 2 D. Additional Exclusions 3
PART-THREE 2 E. West Virginia 3
02 How This Insurance Works 2 EXTENDED OPTIONS 4
PART- SIX 2 01 Employers' Liability Insurance 4
03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4
04 Liberalization 2 Hazards
SECTION II 2 03 Waiver of Our Right to Recover from 4
VOLUNTARY COMPENSATION INSURANCE 2 Others
05 Voluntary Compensation Insurance 04 Foreign Voluntary Compensation 4
A. How This insurance Applies 2 A. How This Reimbursement Applies 4
B. We Will Pay 2 B. We Will Reimburse 4
C. Exclusions 3 C. Exclusions 4
D. Before We Pay 3 D, Before We Pay 5
E. Recovery From Others 3 E. Recovery From Others 5
F. Employers' Liability Insurance 3 F. Reimbursement For Actual Loss 5
EMPLOYERS' LIABILITY STOP GAP 3 Sustained
ENDORSEMENT 3 G. Repatriation 5
00 Employers' Liability Stop Gap H. Endemic Disease 5
Coverage 3 05 Longshore and Harbor Workers' S
A. Stop Gap Coverage Limited to
Montana, North Dakota, Ohio, 3 Compensation Act Coverage
Endorsement
Washington, West Virginia and SECTION III 6
Wyoming 01 Schedule of Covered States 6
Form WC 99 03 03 B Printed in U.S.A. Ed. 8100)
Process Dal 11116111
Peg 9 of 0
Potioy Expiration Dot 12 / 04 /12
C 2000, The Hartford
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
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LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
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AS107865-U03
AS107871-U03
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DO109594-U03
C15-U03
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ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
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NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
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A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
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LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
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CONTINUE-U012
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THE-U012
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DEPARTMENT,-U012
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$552,446-U012
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JUNE-U012
30,-U012
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JUNE-U012
30,-U012
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THE-U012
CONTRACTS/PURCHASING-U012
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OF-U012
WORK-U012
OR-U012
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THE-U012
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COMPLETED BOARD ORDER"�|E]Z#(�SECTION I
PARTS ONE end TWO
1. WE WILL ALSO PAY
D. We Will Also Pay of Part One WORKERS'
COMPENSATION INSURANCE); and
E. We Will Also Pay of Part Two EMPLOYERS'
LIABILITY INSURANCE) Is replaced by the
following;
We Wlli Also Pay
We will also pay these costs, In addition to
other amounts payable under this Insurance,
as part of any claim, proceeding, or suit we
defend:
1. reasonable expenses Incurred at our
request, INCLUDING loss of earnings;
2. premiums for bonds to release
attachments and for appeal bonds In bond
amounts up to the limit of our liability
under this Insurance;
3. litigation costs taxed against you;
4. Interest on a judgment as required by law
until we offer the amount due under this
law; and
5. expenses we Incur.
PARTTHREE
2. Now This Insurance Applies
Paragraph 4. of A. How This inauranc Appli a
of Part S Other States Insurance) Is replaced by
the following:
4. If you have wort; on the effective data of this
policy In any state not listed In Item S.A. of the
information Page, coverage will not be
afforded for that state unless we are notified
within siuttr days.
PART SI}
S. Transfer Of Your Rights and Duties
C. Transfer Of Your Rights and Dull s of Part d
Conditions) is replaced by the following:
Your rights or duties under this policy may not
be transferred without our written consent.
If you die and we receive notice within sixty
days after your death, we will cover your legal
representative as insured.
4. Liberalization
If we adopt a change In this form that would
broaden the coverage of this form without extra
charge, the broader coverage will apply to this
policy. It will apply when the change becomes
effective in your state.
SECTION II
VOLUNTARY COMPENSATION AND EMPLOYERS'
LIABILITY COVERAGE
S. V luntary Compensation insurance
A. H w This insurance Applies
This insurance applies to bodily Injury by
accident or bodily Injury by disease. Bodily
Injury includes resulting death,
1. The bodily Injury must be sustained by any
officer or employee not subject to the
workers' compensation law of any state
shown in Item S.A. of the Information
Page.
2. The bodily Injury must arise out of and In
the course of employment or Incidental to
work in a state shown In Item C.A. of the
Information Page.
3. The bodily Injury must occur in the United
States of America, Its territories or
possessions, or Canada, and may occur
elsewhere If the employee Is a United
States or Canadian citizen, or otherwise
legal resident, and legally employed, In the
United States or Canada and temporarily
away from those places.
4. Bodily Injury by accident must occur
during the policy period.
6, Bodily Injury by disease must be caused
or aggravated by the conditions of the
F nn WC SD 03 03 E Printed In U.S.A. Ed. 8/00) Peg 2 of 6
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
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LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
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2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
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SERVICES-U07
AGREEMENT-U07
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A-11957-U07
CALIFORNIA-U07
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INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
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CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
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THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
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$165,000-U012
A-U012
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$552,446-U012
THROUGH-U012
JUNE-U012
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OF-U012
$105,000-U012
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TOTAL-U012
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$307,446-U012
THROUGH-U012
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AUTHORIZE-U012
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9
officers or employee's employment, The
officer's or employee's last day of last
exposure to the conditions causing or
aggravating such bodily Injury by disease
must occur during the policy period.
B. We Will Pay
We will pay an amount equal to the benefits
that would be required of you as If you and
your employees were subject to the workers'
compensation law of any state shown In Item
S.A. of the Information Page. We will pay
those amounts to the persons who would be
entitled to them under the law,
C. Exclusion
This insurance does not cover:
1. any obligation Imposed by workers'
compensation or occupational disease law
or any similar law.
2. bodily Injury Intentionally caused or
aggravated by you.
3. officers or employees who have elected
not to be subject to the state workers'
compensation law.
4. partners or sole proprietors not covered
under the Standard Sole Proprietors,
Partners, Officers and Others Coverage
Endorsement.
D. Before We Pay
Before we pay benefits to the persons entitled
to them, they must:
1. Release you and us, In writing, of all
responsibility for the Injury or death.
2. Transfer to us their right to recover from
others who may be responsible for the
injury or death.
3. Cooperate with us and do everything
necessary to enable us to enforce the right
to recover from others.
If the persons entitled to the benefits of this
insurance fall to do those things, our duty to
It~
0
0
pay ends at once. If they claim damages from
you or from us for the injury or death, our duty
to pay ends at once.
E. Recovery From Others
If we make a recovery from others, we will
keep an amount equal to our expenses of
recovery and the benefits we paid, We will
pay the balance to the persons untitled to It,
F tm WC 99 03 03 B Printed In U.S.A. Ed. 8/00)
If the persons entitled to the benefits of this
Insurance make a recovery from others, they
must reimburse us for the benefits we paid
them.
F. Employers' Liability Insurance
Part Two Employers' Liability Insurance)
applies to bodily Injury covered by this
endorsement as though the State of
Employment was shown In Item 3.A, of the
Information Page.
This provision 5. does not apply In New. Jersey or
Wisconsin.
EMPLOYERS' LIABILITY STOP QAP COVERAGE
6. Employers' Liability Stop Gap Coverag
A. This coverage only applies In Montana, North
Dakota, Ohio, Washington, West Virginia and
Wyoming.
B. Part One Workers' Compensation Insurance)
does not apply to work In states shown in
Paragraph A above.
C. Part Two Employers' Liability Insurance)
applies in the states, shown In Paragraph A.,
as though they were shown In Item S.A. of the
Information Pago,
D. Part Two, Section C. Exclusions Is changed
by adding these exclusions.
This Insurance does not cover;
5. bodily Injury Intentionally caused or
aggravated by you or In Ohio bodily Injury
resulting from an act which is determined
by an Ohio court of law to have been
committed by you with the belief than an
Injury is substantially certain to occur.
However, the cost of defending such
claims or suits in Ohio is covered.
13. bodily Injury sustained by any member of
the flying crew of any aircraft.
14, any claim for bodily Injury with respect to
which you are deprived of any defense or
defenses or are otherwise subject to
penalty because of default In premium
under the provisions of the workers'
compensation law or laws of a state
shown In Paragraph A.
E, This Insurance applies to damages for which
you are liable under West Virginia Code Annot.
S234-2.
Page3 f 6
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
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AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
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AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z%(�EXTENDED OPTIONS
1. Emp) yers' Liability Insurance
Item S.E. of the Information Page is replaced by
the following:
B. Panployers' Liability insurance:
1. Part Two of the policy applies to work in
each state listed In Item 3.A.
The Limits of Liability under Part Two are
the higher of:
Bodily Injury
by Accident $500000 Each Accident
Bodily Injury
by Disease $500,000 Policy Limit
Bodily Injury
by Disease $500,000 Each Employee
OR
2. The amount shown in the Information
Page.
This provision 1 of EXTENDED OPTIONS does not
apply In New York because the Limits Of Our
Liability are unlimited.
In this provision the limits are changed from
$1500,000 to $1,000,000 In California.
2. Unint ntional Failure to Disclose Hazards
If you unintentionally should fall to disclose all
existing hazards at the inception date of your
policy, we shall not deny coverage under this
policy because of such failure.
3. Waiver of Our Right To Recover From Others
A. 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
any parson or organization for whom 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
agreement.
B. This provision 3. does not apply In the states
of Pennsylvania and Utah.
4. Foreign Voluntary Compensation and
Employers' Liability Reimbursement
A. How This Reimbursement Applies
This reimbursement provision applies to bodily
injury by accident or bodily Injury by disease.
Bodily Injury includes resulting death.
1. The bodily injury must be sustained by an
officer or employee.
2. The bodily Injury must occur in the course
of employment necessary or incidental to
work In a country not listed In Exclusion
0.1, of this provision.
3. Bodily Injury by accident must occur
during the policy period.
4. Bodily Injury by disease must be caused
or aggravated by the conditions of your
employment. The officer or employee's
last exposure to those conditions of your
employment must occur during the policy
period.
B. We Will Reimburse
We will reimburse you for all amounts paid by
you whether such amounts are:
1. voluntary payments for the benefits that
would be required of you If you and your
officers or employees were subject to any
workers' compensation law of the state of
hire of the Individual employee.
2. sums to which Part Two Employers'
Liability Insurance) would apply if the
Country of Employment were shown in
Item S.A. of the Information Page.
C. Exclusions
This insurance does not cover:
1. any occurrences In the United States,
Canada, and any country or jurisdiction
which Is the subject of trade or economic
sanctions Imposed by the laws or
regulations of the United States of
America in effect as of the inception date
of this policy.
2. any obligation Imposed by a workers'
compensation or occupational disease
law, or similar law.
3. bodily injury Intentionally caused or
aggravated by you.
F rm WC 09 03 03 IS Printed In U.S.A. Ed. 8100) Page 4 f 0
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
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EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
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SCOPE-U012
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COMPLETED BOARD ORDER"�|E]Z&(�M
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4. liability for any consequence, whether
direct or Indirect, of war, Invasion, act of
Foreign enemy, hostilities whether war be
declared or not), civil war, rebellion,
revolution, insurrection or military or
usurped power. No endorsement now or
subsequently attached to this policy shall
be construed as overriding or waiving this
limitation unless specific reference Is
made thereto.
D. Before We Pay
Before we reimburse you for the benefits to the
persons entitled to them, you must have them:
1. release you and us, In writing, of all
responsibility for the Injury or death,
2. transfer to us their right to recover from
others who may be responsible for their
Injury or death,
9. cooperate with us and do everything
necessary to enable us to enforce the right
to recover from others.
If the persons entitled to the benefits paid fall
to do these things, our duty to reimburse ends
at once. If they claim damages from us for the
Injury or death, our duty to reimburse ends at
once.
E. Recovery From Others
It we make a recovery from others, we will
keep an amount equal to our expenses of
recovery and the benefits we reimbursed. We
will pay the balance to the persons entitled to
It. If persons entitled to the benefits make a
recovery from others, they must repay us for
the amounts that we have reimbursed you.
F. Reimbursement for Actual Lose Sustained
This endorsement provides only for
reimbursement for the loss you actually
sustain. In order for you to recover loss or
expenses under this reimbursement you must:
1. actually sustain and pay the loss or
expense In money after trial, or
2. secure our consent for the payment of the
loss or expense.
0. Repatriation
Our reimbursement Includes the additional
expenses of repatriation to the United States
F rm WC 99 03 03 B Printed In U,S.A. Ed. 0/00)
of America necessarily Incurred as a direct
result of bodily Injury,
Our reimbursement shall be limited as follows:
1. to the amount by which such expenses
exceed the normal cost of returning the
officer or employee if In good health, or
2. In the event of death, to the amount by
which such expenses exceed the normal
cost of returning the officer at, employee if
alive and In good health.
In no event shall our reimbursement exceed
the bodily injury by accident limit shown In
Item 3.8, of the Information Page as respects
any one such officer or employee whether
dead or alive.
K. Endemic Disease
The word disease" Includes any endemic
diseases,
The coverage applies as If endemic diseases
were Included In the provisions of the workers'
compensation law,
6. Longshore and Harbor Workers' Compensati n
Act Coverage
General Section C. Workers' Compensation
Law is replaced by the following:
C. Workers' Compensation Low
Workers' Compensation Law means the
workers or workers' compensation law and
occupational disease law of each state or
territory named In Item 3.A, of the Information
Page and the Longshore and Harbor Workers'
Compensation Act 33 USC Sections 901-
950). It Includes any amendments to those
laws that are In effect during the policy period.
It does not include any other federal workers
or workers' compensation law, other federal
occupational disease law or the provisions of
any law that provide nonoccupatlonal disability
benefits,
Part Two Employers' Liability Insurance), C.
Exclusions, exclusion B, does not apply to
work subject to the Longshore and Harbor
Workers' Compensation Act.
This coverage does not apply to work subject
to the Defense Base Act, the Outer
Continental Shelf Lands Act, or the
Nonapproprleted Fund Instrumentalities Act.
Page 6 of 6
BIB]
40949-U01
COMPLETED-U02
BOARD-U02
ORDER-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO109594-U03
C15-U03
COMPLETED-U03
BOARD-U03
ORDER-U03
2/10/2012-U04
HANCOCKD-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
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AMENDMENTS-U012
TO-U012
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PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
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OR-U012
CHANGE-U012
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APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
COMPLETED BOARD ORDER"�|E]Z'(�SECTION 910
1. SCHEDULE OF COVERED STATES
A, This endorsement only applies In the states
listed In this Schedule of Covered States.
B. It a stale, shown in Item M. of the Information
Page, approves this endorsement after the
effective date of this policy, this endorsement
will apply to this polloy. The coverage will
apply In the new state on the efteotlve date of
the state approval.
C. Schedule of Covered States:
CA
Countersigned by
Authorized Representative
F tm WC 99 03 03 B Printed In U.S.A. Ed. 13/00) Pao 6 of 6
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COMPLETED BOARD ORDER"�|E]Z((�SUPPLEMENT TO CERTIFICATE OF INSURANCE
NAME OF INSURED: C5G Consultants Inc.
Additional Description of Operations/Remarks from Page 1:
Additional Information:
DATE
01/11/2012
SUPP 05/04)
BIB]
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SIGNED BOARD REPORT"�|E]��MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: February 7, 2012 Consent AGENDA NO.: a
SUBJECT: a. Approve Amendment No. 5 to Professional Services Agreement No. A-11957
with California Code Check, Inc. CCC) to continue to provide services
associated with plan check, inspection and related services to the Monterey
County Building Services Department, in the amount of $165,000 for a total
amount not to exceed $552,446 through June 30, 2012; and
b. Approve Amendment No. 3 to Professional Services Agreement No. A-12103
with CSG Consultants, Inc. CSG) to continue to provide services associated with
plan review services to the Monterey County Building Services Department, in
the amount of $105,000 for a total amount not to exceed $307,446 through June
30, 2012; and
c. Authorize the Contracts/Purchasing Officer to execute the Amendments to the
Professional Services Agreements and future amendments that do not
significantly alter the scope of work or change the approved Agreement amounts.
DEPARTMENT: RMA Building Services
RECOMMENDATIONS:
It is recommended that the Board of Supervisors:
a. Approve Amendment No. 5 to Professional Services Agreement No. A-11957 with California
Code Check, Inc. CCC) to continue to provide services associated with plan check, inspection
and related services to the Monterey County Building Services Department, in the amount of
$165,000 for a total amount not to exceed $552,446 through June 30, 2012; and
b. Approve Amendment No. 3 to Professional Services Agreement No. A-12103 with CSG
Consultants, Inc. CSG) to continue to provide services associated with plan review services to
the Monterey County Building Services Department, in the amount of $105,000 for a total
amount not to exceed $307,446 through June 30, 2012; and
c. Authorize the Contracts/Purchasing Officer to execute the Amendments to the Professional
Services Agreements and future amendments that do not significantly alter the scope of work or
change the approved Agreement amounts.
SUMMARYIDISCUSSION:
Amendment No. 5 to Professional Services Agreement PSA) No. A-11957 with CCC and
Amendment No. 3 to PSA No. A-12103 with CSG will allow for the continuation of plan
check/review, inspection and related services to assist the Building Services Department in meeting
statutory timelines while maintaining an acceptable level of service. This assistance is necessary
due to a change in practices to alleviate problems brought on by departmental changes and the
adoption of new codes in January 2011. See synopsis of PSAs below:
CCC PSA/
Amendment BOS
Approval Contracts/Purchasing Officer
Executed PSA Term Expiration/
Amendment Extension PSA Amount/
Amendment Increase
PSA N/A 1/19/11 June 30, 2011 $100,000
1 3/22/11 4/8/11 $ 65,000
2 5/3/11 5/17/11 $120,000
3 N/A 6/7/11 Extended Through 12/31 /11 $ 0
4 09/20/11 10/4/11 Extended Through 3/31/12 $102,446
5 Pending Pending Extended Through 6/30/12 $ 165,000
TOTAL $552,446
BIB]
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SIGNED BOARD REPORT"�|E]��Amendments to PSAs with CCC and CSG
February 7, 2012
Page 2
CSG PSA/
Amendment BOS
Approval Contracts/Purchasing Officer
Executed PSA Term Expiration/
Amendment Extension PSA Amount/
Amendment Increase
PSA N/A 4/26/11 June 30, 2011 $ 25,000
1 N/A 6/24/11 Extended Through 12/31/11 $ 75,000
2 9/20/11 10/4/11 Extended Through 3/31/12 $102,446
3 Pending Pending Extended Through 6/30/12 $ 105,000
TOTAL $307,446
OTHER AGENCY INVOLVEMENT:
The Office of the County Counsel and Auditor-Controller's Office have reviewed and approved the
Amendments as to form and legality, and fiscal provisions, respectively.
FINANCING:
There is no impact to the General Fund as a result of the recommended action. If the Building
Services Department experiences an increase in the number of permits and associated revenues and
expenditures that exceed the adopted budget for FY 2011-12, an additional item will be brought
before the Board of Supervisors for consideration. At this time there are sufficient resources are
available to fund the increase in the PSAs through June 30, 2012.
Approved by:
Karen Riley-Olm 831) 755-5132
Management An lyst II
Date: January 30, 2012
el A. Rodrig.c, C
Chief Building 0
Attachments: Board Order; Amendment No. 5 to PSA with CCC; Amendment No. 3 to PSA with
CSG; on file with the Clerk of the Board)
BIB]
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FULLY EXECUTED AGREEMENT, AME�e�AMENDMENT NO.5
TO PROFESSIONAL SERVICES AGREEMENT
BETWEEN COUNTY OF MONTEREY AND
CALIFORNIA CODE CHECK, INC.
THIS AMENDMENT NO. 5 to the Professional Services Agreement between the County of
Monterey, a political subdivision of the State of California hereinafter, County") and California
Code Check, Inc. hereinafter, CONTRACTOR") is hereby entered into between the County
and the CONTRACTOR collectively, the County and CONTRACTOR are referred to as the
parties").
WHEREAS, CONTRACTOR entered into a Professional Services Agreement with County on
January 19, 2011 hereinafter, Agreement"); and
WHEREAS, Agreement was amended by the parties on April 8, 2011 hereinafter,
Amendment No. I"), May 17, 2011 hereinafter, Amendment No. 2"), June 7, 2011
hereinafter, Amendment No. 3"), and October 4, 2011 hereinafter, Amendment No. 4"); and
WHEREAS, additional time and funding are necessary to meet the increased demand in the
Building Services Department for completion of plan check, inspection and related services
within statutory timelines; and
WHEREAS, the parties wish to further amend the Agreement to extend the term to June 30,
2012 and increase the amount by $165,000 to continue to provide tasks identified in the
Agreement.
NOW, THEREFORE, the parties agree to amend the Agreement as follows:
1. Amend the second sentence of Paragraph 2, Payments by County", to read as follows:
The total amount payable by County to CONTRACTOR under this Agreement shall not
exceed the sum of $552,446.
2. Amend the first sentence of Paragraph 3, Term of Agreement", to read as follows:
The term of this Agreement is from January 19, 2011 to June 30. 2012, unless sooner
terminated pursuant to the terms of this Agreement.
3. All other terms and conditions of the Agreement remain unchanged and in full force.
4. This Amendment No. 5 shall be attached to the Agreement and incorporated therein as if
fully set forth in the Agreement.
Amendment No. 5 to Professional Services Agreement
California Code Check, Inc.
Plan Check, Inspection and Related Services
RMA Building Services Department
Term: January 19, 2011- June 30, 2012
Not to Exceed: $552,446
Page 1 of 2
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FULLY EXECUTED AGREEMENT, AME�e�N
IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 5 to the
Professional Services Agreement as of the day and year written below:
CONTRACTOR*
California Code Check, Inc.
Contracts/Purchasing Officer
Date: By:
pproved as to Form and Legality
Office of the County Counsel Its:
Date:
By:
By: o(D~- Its:
Deputy County Counsel
Date: ir~)-4 I
Date:
Contractor's Business Name
ident or Vice Preside
P t Name and Trt
SIgii iUfe Secretary, Asst. Secretary, CFO,
Treasurer or Asst. Treasurer)
Approved as to Indemnity and Insurance Provisions BRED
Date:
*INSTRUCTIONS: IF CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal
name of the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a
partnership, the name of the partnership shall be set forth above together with the signature of a partner who has authority to
execute this Agreement on behalf of the partnership. IF CONTRACTOR is contracting in an individual capacity, the individual
shall set forth the name of the business, if any, and shall personally sign the Agreement.
By:
Risk Management
FFi 82012
CCC
Amendment No. 5 to Professional Services Agreement
California Code Check, Inc.
Plan Check, Inspection and Related Services
RMA Building Services Department
Term: January 19, 2011- June 30, 2012
Not to Exceed: $552,446
Page 2 of 2
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CODE-U02
CHECK,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110860-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�e�CERTIFICATE OF INSURANCE
This certifies that STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
STATE FARM LLOYDS, Dallas, Texas
insures the following policyholder for the coverages indicated below:
Name of policyholder CALIFORNIA CODE CHECK INC.
Address of policyholder 1000 BUSINESS CENTER CIR. STE 200, NEWBURY PARK CA 91320
Location of operations
Description of operations ENGINEERING
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date at beginning of policy period)
Comprehensive BODILY INJURY AND
92-92-4335-7 Business Liability 11/03/11 11/03/12
PROPERTY DAMAGE
This insurance includes:
Products Completed Operations
Contractual Liability
Underground Hazard Coverage Each Occurrence $ 1, 000, 000.00
Personal Injury
Advertising Injury General Aggregate $ 2, 000, 000.00
Explosion Hazard Coverage
Collapse Hazard Coverage Products Completed $ 2, 0 0 0, 00 0. 00
Operations Aggregate
13
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date Expiration Date Combined Single Limit)
Umbrella Each Occurrence $
Other Aggregate $
Part 1 STATUTORY
Part 2 BODILY INJURY
Workers' Compensation
and Employers Liability Each Accident $
Disease Each Employee $
Disease Policy Limit $
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Data at beginning of policy period)
THE CERTIFICATE OF IN SURANCE IS NOT A CONTR ACT OF INSURANCE AND NEITH ER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
County
of
Monterey
is
named
as
additional
insured.
Name and Address of Certificate Holder
County of Monterey
Salinas Permit Center
168 W. Alisal St, 2nd Fl.
Salinas, CA 93901
If any of the described policies are canceled before
Its expiration date, State Farm will try to mail a written
notice to the certificate holder 3 o days before
cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
Farm or its aR ent& representatives.
Signaiu of r resentative
Title
Agent's Code Stamp
AFO Code F773
10/28/2011
Date
558-994 a.3 04-1999 Printed in U.S.A.
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
5-U02
PSA-U02
BETWEEN-U02
COMO-U02
&-U02
CALIFORNIA-U02
CODE-U02
CHECK,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110860-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�e�GENERAL LIABILITY/AUTOMOBILE LIABILITY
SPECIAL ENDORSEMENT
FOR THE COUNTY OF MONTEREY, CALIFORNIA
PERMIT/PO/SA/SPECIFICATION/CONTRACT NUMBER
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY INSURANCE COVERAGE PART
AUTOMOBILE LIABILITY INSURANCE COVERAGE PART
In consideration of the premium charged and notwithstanding any inconsistent statement in
the later policy to which this endorsement is attached or in any endorsement which now or
later attaches to the policy, the Company agrees as follows:
ADDITIONAL INSURED: The County of Monterey, its officers, agents and employees are
included as additional insureds, with respect to liability and defense of claims and suits arising out
of the operations and uses performed by or on behalf of the named insured.
CONTRIBUTION WAIVED: The insurance is primary. The County of Monterey's insurance
program shall be excess of this insurance. The Company shall not seek contribution from the
County and its insurers.
SEPARATION OF INSURED: This insurance applies separately to each insured against whom
claim is made or suit is brought, except that the naming of multiple insureds shall not increase the
Company's limits of liability. The inclusion of any person, organization, firm or entity as an insured
under the policy shall not affect any right which such person, organization, firm or entity would
have as a claimant if not so included.
CANCELLATION NOTICE: If the Company elects to cancel or terminate this insurance before
the stated expiration date, or declines to renew a continuous policy, or reduces the stated limits
other than by impairment of an aggregate limit, the Company shall mail written notice to the
County at least 30 days in advance of such election. For non-payment of premium, the Company
shall give the County at least 10 days advance written notice of cancellation or termination.
Except as stated above, all other endorsements, provisions, conditions, limits and exclusions
of this insurance shall remain unchanged.
COMMERCIAL GENERAL LIABILITY POLICY NUMBER:
AUTOMOBILE LIABILITY POLICY NUMBER;
Ga-9a- 7?s-7
By my signature on this endorsement, I warrant that I have authority to bind the
insurance company and do so bind the company to this endorsement:
DATE SIGNED:
Ib)`3l'
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
5-U02
PSA-U02
BETWEEN-U02
COMO-U02
&-U02
CALIFORNIA-U02
CODE-U02
CHECK,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110860-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�e�ACORD� CERTIFICATE OF LIABILITY INSURANCE 9/DATE(MWDONY
9/2011
PRODUCER
VROMAN INSURANCE AGENCY
2814 Camino Dos Rios #409 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Newbury Park, CA 91320
805 375 5768 FAX 805 376 2376
INSURERS AFFORDING COVERAGE
NAIC#
INSURED CALIFORNIA CODE CHECK, INC INSURER A: FARMERS INSURANCE GROUP
1000 BUSINESS CENTER CIR,STE 200 INSURER B:
NEWBURY PARK CA 91320 INSURER C
INSURER D:
I INSURER E
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR D'L
NERD
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MM/DD/YYI POLICY EXPIRATION
DATE MM/DD/YY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY UA AG U HtNIt
P REMISES Ea occurence)
$
CLAIMSMADE 7 OCCUR MEDEXP(Anyoneperson) $
PERSONAL BADVINJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP/OP AGG $
RO- LOC
POLICY PJECT
AUT OMOBILE LIABILITY
COMBINEDSINGLELIMIT
ANYAUTO
Ea accident) $ 1 000 000
r r
X ALLOWNEDAUTOS
SCHEDULED AUTOS
BODILYINJURY
Per person)
$
A HIRED AUTOS 135738513 09/09/11 11/11/12 BODILYINJURY
NON-OWNED AUTOS HH#0913877992 Peraccident) $
PROPERTY DAMAGE
Peraccident) $
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANYAUTO OTHER THAN EAACC $
AUTOONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000
X OCCUR CI CLAIMS MADE AGGREGATE $
600595413 09/09/11 11/11/12 $
A DEDUCTIBLE $
RETENTION $ $
WORKERSCOMPENSATIONAND TORYLIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE
E.L. EACH ACCIDENT
S
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE EA EMPLOYE
S
It yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE POLICY LIMIT
$
OTHER
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
COUNTY OF MONTEREY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MA30 DAYS WRITTEN
SALINAS PERMIT CENTER
168 WEST ALISAL ST. 2ND FLOOR NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
SALINAS CA 93901 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES
AUTHORIZED RE RESENT4T(VE
vim`
ACORD25(2001/08) \ I ACORD CORPORATION 1988
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
5-U02
PSA-U02
BETWEEN-U02
COMO-U02
&-U02
CALIFORNIA-U02
CODE-U02
CHECK,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110860-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�e�09/08/2011 15:57 8054994489 CA CODE CHECK
GENERAL LIABILITY/AUTOMOBILE LIABILITY
SPECIAL ENDORSEMENT
FOR THE COUNTY OF MONTEREY, CALIFORNIA
PERMIT/PO/SA/SPECIFICATION/CONTRACT NUMBER
I
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY INSURANCE COVERAGE PART
PAGE 04/07
X AUTOMOBILE LIABILITY INSURANCE COVERAGE PART
In consideration of the premium charged and notwithstanding any inconsistent statement in
the later policy to which this endorsement is attached or in any endorsement which now or
later attaches to the policy, the Company agrees as follows:
ADDITIONAL INSURED: The County of Monterey, its officers, agents and employees are
included as additional insureds, with respect to liability and defense of claims and suits arising out
of the operations and uses performed by or on behalf of the named insured,
CONTRIBUTION WAIVED: The insurance is primary. The County of Monterey's insurance
program shall be excess of this insurance. The Company shall not seek contribution from the
County and, its insurers.
SEPARATION OF INSURED: This insurance applies separately to each insured against whom
claim is made or suit is brought, except that the naming of multiple insureds shall not increase the
Company's limits of liability. The inclusion of any person, organization, firm or entity as an insured
under the policy shall not affect any right which such person, organization, firm or entity would
have as a claimant if not so included.
CANCELLATION NOTICE: If the Company elects to cancel or terminate this insurance before
the stated, expiration date, or declines to renew a continuous policy, or reduces the stated limits
other than by impairment of an aggregate limit, the Company shall mail written notice to the
County at least 30 days in advance of such election. For non-payment of premium, the Company
shall give the County at least 10 days advance written notice of cancellation or termination.
Except as stated above, all other endorsements, provisions, conditions, limits and exclusions
of this insurance shall remain unchanged.
COMMERCIAL GENERAL LIABILITY POLICY NUMBER:
AUTOMOBILE LIABIL H P9Jr1LYNUM8F8:7 9 9 2
13573 85 1 3 HfU`J 1.itf
By my signature on this endorsement, I warrant that I have authority to bind the
Insurance company and do so bind the company to this endorsement:
AUTHORIZED REPRESENTATI E'S SIGNATURe:
4>,_
DATE IGNED:
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
5-U02
PSA-U02
BETWEEN-U02
COMO-U02
&-U02
CALIFORNIA-U02
CODE-U02
CHECK,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110860-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
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$165,000-U012
A-U012
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FULLY EXECUTED AGREEMENT, AME�e�ACORD
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMI)
8 24/2012
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey, Renton & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
199 S Los Robles Ave Ste 540 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Pasadena
CA 91101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
626 844-3070 INSURERS AFFORDING COVERAGE
INSURED INSURERA:U.S. Specialty Insurance Company
California Code Check
INSURER B:
1000 Business Center Circle, Suite: 200
b
P
k
CA 91320 INSURER C:
New
ury
ar
805-499-4584 INSURER D:
INSURER E
COVERAGES
HE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR POLICY EFFECTIVE POLICY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE Any one fire) S
CLAIMS MADE OCCUR MED EXP Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG S
POLICY PRO- LOC
AUT OMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO Ea accident)
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS
Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS
Per accident) $
PROPERTY DAMAGE
Per accident) S
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC 1 $
AUTO ONLY: AGG I S
EXCESS LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE $
RETENTION $ S
WC STAII
WORKERS COMPENSATION AND Fly ER
LIABILITY
E.L. EACH ACCIDENT S
E.L. DISEASE EA EMPLOYE $
E.L. DISEASE POLICY LIMIT S
A OTHER USS1122072 9/4/2011 9/4/2012 $1,000,000 per claim
Professional Liability $2,000,000 Annual Aggr
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES!EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
CERTIFICATE HOLDER
ADDITIONAL INSURED; INSURER LETTER:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
County of Monterey ILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
Salinas Permit Center NAMED TO THE LEFT.
168 W A lisal St, 2nd Fl
Salinas CA 93901
1 1 1
AUTHORIZED REPRESENTATIV
ACORD 25-S 7/97)
CANCELLATION Day for
C
ORD CORPORATION 1988
J
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FULLY EXECUTED AGREEMENT, AME�e�ACOR
CERTIFICATE OF LIABILITY INSURANCE 12%i5/2o IYYYY)
11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
N E Shanna Rogan
Hogan Insurance PH, AX,
805) 3792203 Ate Not.(805)
License #0C54750 AMAZE shanna@hoganins.com
P.O. Box 7419 INSURER(S) AFFORDING COVERAGE NAIC 9
Thousand Oaks CA 91359 INSURER A:Preferred Employers Insurance 10900
INSURED INSURER B
California Code Check, Inc. INSURER C
1000 Business Center Cir # 200 INSURER D:
INSURER E
Thousand Oaks CA 91320 INSURER F
COVERAGES
CERTIFICATE NUMBER:CL11121506788
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
LTR TYPE OF INSURANCE ADDL ISUBR I POLICY NUMBER MM DOY EFF MMIOO EXP
LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY PREMISES occurrence) S
CLAIMS-MADE F7 OCCUR MED EXP Any one person) $
PERSONAL & ADV INJURY S
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMPIOP AGG $
RO- LOC
POLICY P
JPCIT $
AUTOMOBILE LIABILITY MIN SINGLE LIMIT
Ee accident
ANY AUTO BODILY INJURY Per person) $
ALL OWNED
AUTOS SCHEDULED BODILY INJURY Par accident) S
HIRED AUTOS NON-OWNED
AUTOS PROPERTY DAMAGE
Per ecadent) $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR H CLAIMS-MADE AGGREGATE $
DED RETENTIONS $
A WORKERS COMPENSATION
X W_ STATU- O H-
ANOEMPLOYERS
LIABILITY
N
ANY PROPRIETORIPARTNER/EXECUTIVE Y
A
E.L. EACH ACCIDENT
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
Mandatory In NH) NI
WKN 145174-1
/1/2012
/1/2013
E.L. DISEASE EA EMPLOYE
S 1,000,000
It yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE POLICY LIMIT
$ 1 000 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORO101. Additional Remarks Schedule, If more space Is required(
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.
County of Monterey
i
C
enter
Salinas Perm
t
168 W. Alisal St, 2nd Fl.
AUTHORIZEOREPRESENTATIVE
Salinas, CA 93901
Robert Hogan/SH r
ACORD 25 2010106)
1NS025 r,mnn.5i ni
1988-2010 ACORD CORPORATION. All rights reserved.
The nrfuarl name and Innn arc ranicferad manic of Af:fPr1
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A-U012
TOTAL-U012
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THROUGH-U012
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FULLY EXECUTED AGREEMENT, AME�� �AMENDMENT NO. 3
TO PROFESSIONAL SERVICES AGREEMENT
BETWEEN COUNTY OF MONTEREY AND
CSG CONSULTANTS, INC.
THIS AMENDMENT NO. 3 to the Professional Services Agreement between the County of
Monterey, a political subdivision of the State of California hereinafter, County") and CSG
Consultants, Inc. hereinafter, CONTRACTOR") is hereby entered into between the County and
the CONTRACTOR collectively, the County and CONTRACTOR are referred to as the
parties").
WHEREAS, CONTRACTOR entered into a Professional Services Agreement with County on
April 26, 2011 hereinafter, Agreement"); and
WHEREAS, Agreement was amended by the parties on June 24, 2011 hereinafter,
Amendment No. 1"), and October 4, 2011 hereinafter, Amendment No. 2"); and
WHEREAS, additional time and funding are necessary to meet the increased demand in the
Building Services Department for completion of plan review services within statutory timelines;
and
WHEREAS, the parties wish to further amend the Agreement to extend the term to June 30,
2012 and increase the amount by $105,000 to continue to provide tasks identified in the
Agreement.
NOW, THEREFORE, the parties agree to amend the Agreement as follows:
1. Amend the second sentence of Paragraph 2, Payments by County", to read as follows:
The total amount payable by County to CONTRACTOR under this Agreement shall not
exceed the sum of $307,446.
2. Amend the first sentence of Paragraph 3, Term of Agreement", to read as follows:
The term of this Agreement is from April 11. 2011 to June 30. 2012, unless sooner
terminated pursuant to the terms of this Agreement.
3. All other terms and conditions of the Agreement remain unchanged and in full force.
4. This Amendment No. 3 shall be attached to the Agreement and incorporated therein as if
fully set forth in the Agreement.
Amendment No. 3 to Professional Services Agreement
CSG Consultants, Inc.
Plan Review Services
RMA Building Services Department
Term: April 11, 2011 June 30, 2012
Not to Exceed: $307,446
Page 1 of 2
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FULLY EXECUTED AGREEMENT, AME�� �IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 3 to the
Professional Services Agreement as of the day and year written below:
CONTRACTOR*
on ac urc asmg icer
Date: By:
Its:
Date:
Approved as to Form and Legality
Office of the County Counsel
Deputy County Counsel
By:
Its:
CSG Consultants, Inc.
Contractor's Business Name
Signature of Secretary, Asst. Secretary, CFO,
Treasurer or Asst. Treasurer)
hclr~~S t~e~ &,S1 C rtc16tr
Print Name and Title)
Date: k a q \ Date: 7Z
/2-0 Q-
By:
VM M
d
Date:
E pEp
FEB 28 2012
Approved as to Indemnity and Insurance Provisions Cec
By:
Risk Management
Date:
*INSTRUCTIONS: IF CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal
name of the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a
partnership, the name of the partnership shall be set forth above together with the signature of a partner who has authority to
execute this Agreement on behalf of the partnership. IF CONTRACTOR is contracting in an individual capacity, the individual
shall set forth the name of the business, if any, and shall personally sign the Agreement.
Amendment No. 3 to Professional Services Agreement
CSG Consultants, Inc.
Plan Review Services
RMA Building Services Department
Term: April 11, 2011- June 30, 2012
Not to Exceed: $307,446
iscal Pr
Page 2 of 2
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FULLY EXECUTED AGREEMENT, AME�� �A 1:>� CERTIFICATE OF LIABILITY INSURANCE 0 D1/11IDDIYYYY)
01/11/2012
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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 0726293 1-415-546-9300 CONTACT Don Tarantino
NAME:
Arthur J. Gallagher & Co.
License #0726293
nia
Inc
f C
lif
B
k
I PHONE FAX
IC l
415-536-8617 A!C No:415-536-8627
a
or
nsurance
ro
ers o
One Market Plaza, Spear Tower ADDRESS: E-MAIL don tarantinolajgcom
Suite 200
INSURER(S) AFFORDING COVERAGE
NAIL #
San Francisco, CA 94105 INSURERA: TRAVELERS PROP CAS CO OF AMER 25674
INSURED INSURERS SENTINEL INS CO LTD 11000
CSG Consultants inc. INSURER C ARCH INS CO 11150
1700 S. Amphlett Blvd 3rd Floor INSURER D
INSURER E
San Mateo, CA 94402
INSURER F:
COVERAGES
25117003
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
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED.
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 AOD SUER POLICY NUMBER MMIDDMYYY MMIDDIYYEXP
YY
LIMITS
A GENERAL LIABILITY X 680294M0850-TIL-11 12/04/1 12/04/12 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PRMAGES ENTED $ 1,000,000
CLAIMS-MADE FYI OCCUR MED EXP Any one person) $ 10, 000
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 2,000,000
POLICY PRO- X LOC $
A AUTOMOBILELIABILnY X BA461M7612 12/04/13 12/04/12 COMBINED SINGLE LIMIT
ccl an 1,000,000
X ANY AUTO BODILY INJURY Per person) $
ALL OWNED SCHEDULED
AUTOS BODILY INJURY Per accident) $
AUTOS NON-OWNED PROPERTY DAMAGE $
X HIRED AUTOS X UTOS Per a t
A
A X UMBRELLALIAB X OCCUR CUP294M1060 12/04/1 12/04/12 EACH OCCURRENCE $ 5,000,000
EXCESS LIAR F-I CLAIMS-MADE AGGREGATE $ 5, 000, D00
DED RETENTION$ Following Form $
B WORKERS COMPENSATION X 57WEEP4360 12/04/1 12/04/12 X WCSTATU� OTH. iTnRYIIMITS FR_
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR!PARTNERIEXECUTIVE a
E.L. EACH ACCIDENT
$ 1,000,000
OFFICERIMEMBER EXCLUDED?
Mandatory In NH) NIA
E.L. DISEASE EA EMPLOYE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE POLICY LIMIT 1,000 000
$
C Prof Liability AEP004731500 12/04/1 12/04/12 Limit 3Mil/3Mil
Retention 50,000
DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
County of Monterey, its agents, officers and employees, it is understood and agreed that this insurance is
primary Gen Liability and Auto Liability) and another insurance maintained by the Additional Insured shall be
excess only and not contributing with this insurance in regards to all operations as pertains to
the Named Insured
Gen Liability Additional Insured endt CO D3820907 / Other Insurance-Additional Insureds CO D0370405
Auto Coverage Plus Endt CA T4 20 07 10 & Business Auto Coverage Form CA 00 01 03 10 rev 02-11)
Work Comp Broad Form Endt WC 99 03 03 B Re: All Operations of the Named Insured
CERTIFICATE HOLDER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
County of Monterey THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Contracts/Purchasing Dept. ACCORDANCE WITH THE POLICY PROVISIONS.
168 West Alisal St., 3rd FL AUTHORIZED REPRESENTATIVE
Salinas, CA 93901
USA
CERTIFICATE NUMBER:
CANCELLATION
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 2010105) The ACORD name and logo are registered marks of ACORD
abreen
25117003
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FULLY EXECUTED AGREEMENT, AME�� �SUPPLEMENT TO CERTIFICATE OF INSURANCE
NAME OF INSURED: CSG Consultants inc.
Additional Description of Operations/Remarks from Page 1:
Additional Information:
DATE
01/11/2012
SUPP 05/04)
BIB]
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FULLY EXECUTED AGREEMENT, AME�� �POLICY NUMBER: 6BO-294MOS50-TI L-1 1
COMMERCIAL GENERAL LIABILITY
ISSUE DATE: 11-07-11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED
ARCHITECTS, ENGINEERS AND SURVEYORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
rC
Miam
o1=1
NAME OF PERSON(S) OR ORGANIZATION(S):
COUNTY OF MONTEREY:
ITS AGENTS. OFFICERS AND EMPLOYEES
CONTRACTS/PURCHASING DEPT.-
11 G8 WEST ALISAL ST, 3RD FL
SALINAS, CA 93901
PROJECT/LOCATION OF COVERED OPERATIONS:
AS PER WRITTEN CONTRACT OR AGREEMENT
PROVISIONS
A. The following is added to WHO IS AN INSURED
Section II):
The person or organization shown in the Sched-
ule above Is an additional Insured on this Cover-
age Part, but only with respect to liability for bod-
ily Injury', property damage" or personal injury"
caused, In whole or in part, by your acts or omis-
sions or the acts or omissions of those acting on
your behalf:
a. In the performance of your ongoing opera-
tions;
b. In connection with premises owned by or
rented to you: or
c. In connection with your work" and included
within the products-completed operations
hazard".
Such person or organization does not qualify as
an additional insured for bodily injury", property
damage" or personal Injury" for which that per-
son or organization has assumed liability in a con-
tract or agreement,
CG D3 82 09 07
The Insurance provided to such additional Insured
is limited as follows:
d. This insurance does not apply to the render-
ing of or failure to render any professional
services".
e. The limits of insurance afforded to the addi-
tional Insured shall be the limits which you
agreed In that contract or agreement requir-
ing insurance" to provide for that additional
Insured, or the limits shown In the Declara-
tions for this Coverage Part, whichever are
less. This endorsement does not Increase the
limits of insurance stated in the LIMITS OF
INSURANCE Section 111) for this Coverage
Part.
B. The following is added to Paragraph a. of 4.
Other Insurance In COMMERCIAL GENERAL
LIABILITY CONDITIONS Section IV):
However, if you specifically agree in a contract or
agreement requiring insurance" that, for the addi-
tional insured shown In the Schedule, the insur-
ance provided to that additional insured under this
02007 The Travelers Companies, Inc. Page 1 of 2
Includes the copyrighted material of Insurance Services Office, Inc., with Its permission
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INC.-U02
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AMOUNT-U012
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THROUGH-U012
JUNE-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL GENERAL LIABILITY
Coverage Part must apply on a primary basis, or
a primary and non-contributory basis, this insur-
ance Is primary to other insurance that Is avail-
able to such additional insured which covers such
additional Insured as a named Insured, and we
will not share with the other insurance, provided
that:
1) The bodily Injury" or property damage" for
which coverage is sought occurs; and
2) The personal Injury" for which coverage Is
sought arises out of an offense committed;
after you have entered Into that contract or
agreement requiring Insurance" for such addi-
tional insured. But this Insurance still Is excess
over valid and collectible other insurance,
whether primary, excess, contingent or on any
other basis, that is available to the additional in-
sured when the additional insured is also an addi-
tional Insured under any other insurance,
C. The following Is added to Paragraph 8. Transfer
Of Rights Of Recovery Against Others To Us
In COMMERCIAL GENERAL LIABILITY CON-
DITIONS Section IV):
We waive any rights of recovery we may have
against the additional insured shown in the
Schedule above because of payments we make
for bodily injury", property damage" or personal
injury" arising out of your work" on or for the pro-
ject, or at the location, shown In the Schedule
above, performed by you, or on your behalf, un-
der a contract or agreement requiring insurance"
with that additional insured. We waive these
rights only where you have agreed to do so as
part of the contract or agreement requiring Insur-
ance" with that additional Insured entered into by
you before, and in effect when, the bodily injury"
or property damage" occurs, or the personal in-
jury" offense Is committed.
D. The following definition Is added to DEFINITIONS
Section V):
Contract or agreement requiring insurance"
means that part of any contract or agreement un-
der which you are required to Include the person
or organization shown in the Schedule as an ad-
ditional insured on this Coverage Part, provided
that the bodily injury" and property damage" oc-
curs, and the personal injury" Is caused by an of-
fense committed:
a. After you have entered into that contract or
agreement;
b. While that part of the contract or agreement is
in effect; and
c. Before the end of the policy period.
Page 2 of 2 2007 The Travelers Companies, Inc, CG D3 02 09 07
Includes the copyrighted material of Insurance Services Office, Inc., with Its permission
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30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
OTHER INSURANCE ADDITIONAL INSUREDS
This endorsement modifies Insurance provided under the following;
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PROVISIONS
COMMERCIAL GENERAL LIABILITY CONDITIONS
Ssutior- IV), Paragraph 4. Other insurance), Is
amended as follows;
1. The following Is added to Paragraph a. Primary
Insurance:
However, If you specifically agree In a written con-
tract or written agreement that the Insurance pro-
vided to an additional Insured under this 3.
Coverage Part must apply on a primary basis, or
a primary and non-contributory basis, this Insur-
ance Is primary to other Insurance that Is avail-
able to such additional Insured which covers such
additional Insured as a named Insured, and we
will not share with that other Insurance, provided
that:
a. The bodily Injury" or property damage" for
which coverage Is sought occurs; and
b. The personal Injury" of advertising Injury" for
which coverage is sought arises out of an of
fenas committed
subsequent to the signing and execution of that
contract or agreement by you,
The first Subparagraph 2) of Paragraph b. Ex-
cess Insurance regarding any other primary In-
surance available to you Is deleted.
The following Is added to Paragraph b. Excess
Insurance, as an additional subparagraph under
Subparagraph 1);
That Is available to the Insured when the Insured
Is added as an addittonal.insured under any other
policy, Including any umbrella or excess policy,
2.
CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc, All rights reserved, Page I of I
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
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3-U02
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INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
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CHECK,-U07
INC.-U07
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KAPWELL-U09
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1/30/2012-U011
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TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
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PLAN-U012
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RELATED-U012
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BUILDING-U012
SERVICES-U012
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IN-U012
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OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
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$552,446-U012
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30,-U012
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TO-U012
THE-U012
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BUILDING-U012
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THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
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FULLY EXECUTED AGREEMENT, AME�� �
COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAGE PLUS ENDORSEMENT
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi-
fied by the endorsement.
GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any
injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or
limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to
the extent that coverage Is excluded or limited by such an endorsement. The following listing Is a general cover-
age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en-
dorsement and the rest of your policy carefully to determine rights, duties, and what Is and is not covered.
A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC
B. EMPLOYEE HIRED AUTO EQUIPMENT INCREASED LIMIT
C. EMPLOYEES AS INSURED 1. WAIVER OF DEDUCTIBLE GLASS
D. SUPPLEMENTARY PAYMENTS INCREASED J. PERSONAL EFFECTS
LIMITS K. AIRBAGS
E. TRAILERS INCREASED LOAD CAPACITY L. AUTO LOAN LEASE GAP
F. HIRED AUTO PHYSICAL DAMAGE M. BLANKET WAIVER OF SUBROGATION
G. PHYSICAL DAMAGE TRANSPORTATION
EXPENSES INCREASED LIMIT
A. BLANKET ADDITIONAL INSURED
The following is added to Paragraph A.1., Who Is
An Insured, of SECTION II LIABILITY COV-
ERAGE:
Any person or organization who is required under
a written contract or agreement between you and
that person or organization, that Is signed and
o'=
x=
k_tM
executed by you before the bodily Injury" or
property damage" occurs and that is in effect
during the policy period, to be named as an addi-
tional Insured is an insured" for Liability Cover-
age, but only for damages to which this insurance
applies and only to the extent that person or or-
ganization qualifies as an insured" under the
Who Is An Insured provision contained in Section
II.
B. EMPLOYEE HIRED AUTO
1. The following is added to Paragraph A.1.,
Who Is An Insured, of SECTION 11 LI-
ABILITY COVERAGE:
An employee" of yours is an insured" while
operating a covered auto" hired or rented
under a contract or agreement in that em-
ployee's" name, with your permission, while
CA T4 20 07 10 2010 The Travelers Indemnity Company. All rights reserved.
Includes copyrighted material of Insurance Services Office, Inc. with its permission.
performing duties related to the conduct of
your business.
2. The following replaces Paragraph b. In B.5.,
Other Insurance, of SECTION IV BUSI-
NESS AUTO CONDITIONS:
b. For Hired Auto Physical Damage Cover-
age, the following are deemed to be cov-
ered autos" you own:
1) Any covered auto" you lease, hire,
rent or borrow; and
2) Any covered auto" hired or rented by
your employee" under a contract in
that Individual employee's" name,
with your permission, while perform-
ing duties related to the conduct of
your business.
However, any auto" that Is leased, hired,
rented or borrowed with a driver is not a
covered auto".
C. EMPLOYEES AS INSURED
The following Is added to Paragraph A.1., Who Is
An Insured, of SECTION II LIABILITY COV-
ERAGE:
Page 1 of 3
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FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
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AGREEMENT-U012
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CONSULTANTS,-U012
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CONTINUE-U012
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PROVIDE-U012
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ASSOCIATED-U012
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THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
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IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
41
Any employee" of yours Is an Insured" while us-
ing a covered auto" you don't own, hire or borrow
in your business or your personal affairs.
D. SUPPLEMENTARY PAYMENTS INCREASED
LIMITS
1. The following replaces Paragraph A.2.a.(2) of
SECTION 11- LIABILITY COVERAGE:
2) Up to $3,000 for cost of ball bonds in-
cluding bonds for related traffic law viola-
tions) required because of an accident"
we cover. We do not have to furnish
these bonds.
2. The following replaces Paragraph A.2.a.(4) of
SECTION II LIABILITY COVERAGE:
4) All reasonable expenses Incurred by the
Insured" at our request, Including actual
loss of earnings up to $500 a day be-
cause of time off from work.
E. TRAILERS INCREASED LOAD CAPACITY
The following replaces Paragraph C.I. of SEC-
TION I COVERED AUTOS:
1. Trailers" with a load capacity of 3,000
pounds or less designed primarily for travel
on public roads.
F. HIRED AUTO PHYSICAL DAMAGE
The following Is added to Paragraph A.4., Cover-
age Extensions, of SECTION III PHYSICAL
DAMAGE COVERAGE:
Hired Auto Physical Damage Coverage
If hired autos" are covered autos" for Liability
Coverage but not covered autos" for Physical
Damage Coverage, and this policy also provides
Physical Damage Coverage for an owned auto",
then the Physical Damage Coverage Is extended
to autos" that you hire, rent or borrow subject to
the following:
1) The most we will pay for loss" in any one
accident" to a hired, rented or borrowed
auto" is the lesser of
a) $50,000;
b) The actual cash value of the damaged or
stolen property as of the time of the
loss"; or
c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
2) An adjustment for depreciation and physical
condition will be made In determining actual
cash value in the event of a total loss".
3) If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of betterment.
4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
covered auto".
5) This Coverage Extension does not apply to:
a) Any auto" that is hired, rented or bor-
rowed with a driver; or
b) Any auto" that Is hired, rented or bor-
rowed from your employee".
G. PHYSICAL DAMAGE TRANSPORTATION
EXPENSES INCREASED LIMIT
The following replaces the first sentence In Para-
graph A.4.a., Transportation Expenses, of
SECTION III PHYSICAL DAMAGE COVER-
AGE:
We will pay up to $50 per day to a maximum of
$1,500 for temporary transportation expense in-
curred by you because of the total theft of a cov-
ered auto" of the private passenger type.
H. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT INCREASED LIMIT
Paragraph C.2 Limit Of Insurance, of SEC-
TION III PHYSICAL DAMAGE COVERAGE is
deleted.
1. WAIVER OF DEDUCTIBLE GLASS
The following Is added to Paragraph D., Deducti-
ble, of SECTION Ill PHYSICAL DAMAGE
COVERAGE:
No deductible for a covered auto" will apply to
glass damage if the glass Is repaired rather than
replaced.
J. PERSONAL EFFECTS
The following is added to Paragraph A.C. Cover-
age Extensions, of SECTION Ill PHYSICAL
DAMAGE COVERAGE:
Personal Effects Coverage
We will pay up to $400 for loss" to wearing ap-
parel and other personal effects which are:
1) Owned by an insured"; and
2) In or on your covered auto".
This coverage only applies in the event of a total
theft of your covered auto".
No deductibles apply to Personal Effects cover-
age.
Page 2 of 3 0 2010 The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10
Inoludee copyrighted material of Insurance Services Office, Inc. with Its permission.
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
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KAPWELLL-U10
1/30/2012-U011
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TO-U012
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AMOUNT-U012
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30,-U012
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FULLY EXECUTED AGREEMENT, AME��
�COMMERCIAL AUTO
m-
O=
C=
K. AIRBAGS
The following Is added to Paragraph B.3., Exclu-
sions, of SECTION III PHYSICAL DAMAGE
COVERAGE:
Exclusion 3.a. does not apply to loss" to one or
more airbags In a covered auto" you own that In-
flate due to a cause other than a cause of loss"
set forth In Paragraphs A.1.b. and A.1.c., but
only:
a. If that auto" is a covered auto" for Compre-
hensive Coverage under this policy;
b. The airbags are not covered under any war-
ranty; and
c. The airbags were not intentionally inflated.
We will pay up to a maximum of $1,000 for any
one loss".
L. AUTO LOAN LEASE GAP
The following is added to Paragraph A.4., Cover-
age Extensions, of SECTION III PHYSICAL
DAMAGE COVERAGE:
Auto Loan Lease Gap Coverage for Private
Passenger Type Vehicles
In the event of a total loss" to a covered auto" of
the private passenger type shown in the Schedule
or Declarations for which Physical Damage Cov-
erage Is provided, we will pay any unpaid amount
due on the lease or loan for such covered auto"
less the following:
1) The amount paid under the Physical Damage
Coverage Section of the policy for that auto";
and
2) Any:
a) Overdue lease or loan payments at the
time of the loss";
b) Financial penalties Imposed under a
lease for excessive use, abnormal wear
and tear or high mileage;
c) Security deposits not returned by the les-
sor;
d) Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or
lease; and
e) Carry-over balances from previous loans
or leases.
M. BLANKET WAIVER OF SUBROGATION
The following replaces Paragraph A.5., Transfer
Of Rights Of Recovery Against Others To Us,
of SECTION IV BUSINESS AUTO CONDI-
TIONS:
5. Transfer Of Rights Of Recovery Against
Others To Us
We waive any right of recovery we may have
against any person or organization to the ex-
tent required of you by a written contract exe-
cuted prior to any accident" or loss", pro-
vided that the accident" or loss" arises out of
the operations contemplated by such con.
tract. The waiver applies only to the person or
organization designated in such contract.
CA T4 20 07 10 0 2010 The Travelers Indemnity Company. All rights reserved.
includes copyrighted material of Insurance Services Office, Inc. with Its permission.
Page 3 of 3
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FULLY-U02
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AGREEMENT,-U02
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CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
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SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
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FULLY EXECUTED AGREEMENT, AME��
�COMMERCIAL AUTO
BUSINESS AUTO COVERAGE FORM
a__
M
rni
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and is not covered,
Throughout this policy the words you" and your" re-
fer to the Named Insured shown in the Declarations.
The words we", us" and our" refer to the company
providing this insurance.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section V
Definitions.
Symbol
I Any Auto"
SECTION I COVERED AUTOS
Item Two of the Declarations shows the autos" that
are covered autos" for each of your coverages. The
following numerical symbols describe the autos" that
may be covered autos". The symbols entered next to
a coverage on the Declarations designate the only
autos" that are covered autos".
A. Description Of Covered Auto Designation
Symbols
Description Of Covered Auto Designation Symbols
2 Owned Autos" Only those autos" you own and for Liability Coverage any trailers" you don't own
Only while attached to power units you own). This includes those autos" you acquire
ownership of after the policy begins.
3 Owned Private Only the private passenger autos" you own. This includes those private passenger
Passenger autos" you acquire ownership of after the policy begins.
Autos" Only
4 Owned Autos" Only those autos" you own that are not of the private passenger type and for
Other Than Liability Coverage any trailers" you don't own while attached to power units you
Private own). This includes those autos" not of the private passenger type you acquire
Passenger ownership of after the policy begins.
Autos" Only
5 Owned Autos" Only those autos" you own that are required to have no-fault benefits in the state
Subject To where they are licensed or principally garaged. This includes those autos" you
No-fault acquire ownership of after the policy begins provided they are required to have
no-fault benefits in the state where they are licensed or principally garaged.
6 Owned Autos" Only those autos" you own that because of the law in the state where they are
Subject To A licensed or principally garaged are required to have and cannot reject Uninsured
Compulsory Motorists Coverage. This includes those autos" you acquire ownership of after the
Uninsured policy begins provided they are subject to the same state uninsured motorists
Motorists Law requirement.
7 Specifically Only those autos" described in Item Three of the Declarations for which a premium
Described charge is shown and for Liability Coverage any trailers" you don't own while
Autos" attached to any power unit described in Item Three).
8 Hired Autos" Only those autos" you lease, hire, rent or borrow. This does not include any auto"
Only you lease, hire, rent or borrow from any of your employees", partners if you are a
partnership), members if you are a limited liability company) or members of their
households.
9 Non-owned Only those autos" you do not own, lease, hire, rent or borrow that are used in con-
Autos" Only nection with your business, This includes autos" owned by your employees",
partners if you are a partnership), members if you are a limited liability company) or
members of their households but only while used in your business or your personal
affairs.
CA 00 01 03 10 Rev. 02-11) 0 Insurance Services Office, Inc., 2009 Page 1 of 12
001833
BIB]
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$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
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TO-U012
PROFESSIONAL-U012
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$105,000-U012
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THE-U012
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AMENDMENTS-U012
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�COMMERCIAL AUTO
19 Mobile
Equipment
Subject To
Compulsory
Or Financial
Responsibility
Or Other Motor
Vehicle
Insurance Law
Only
Only those autos" that are land vehicles and that would qualify under the definition of
mobile equipment" under this policy if they were not subject to a compulsory or fi-
nancial responsibility law or other motor vehicle insurance law where they are li-
censed or principally garaged.
B. Owned Autos You Acquire After The Policy
Begins
1. If Symbols 1, 2, 3, 4, 5, 6 or 19 are entered
next to a coverage in Item Two of the Decla-
rations, then you have coverage for autos"
that you acquire of the type described for the
remainder of the policy period.
2. But, if Symbol 7 is entered next to a coverage
in Item Two of the Declarations, an auto" you
acquire will be a covered auto" for that cov-
erage only if:
a. We already cover all autos" that you own
for that coverage or it replaces an auto"
you previously owned that had that cov-
erage; and
b. You tell us within 30 days after you ac-
quire it that you want us to cover it for that
coverage.
C. Certain Trailers, Mobile Equipment And Tem-
porary Substitute Autos
If Liability Coverage is provided by this coverage
form, the following types of vehicles are also cov-
ered autos" for Liability Coverage:
1. Trailers" with a load capacity of 2,000
pounds or less designed primarily for travel
on public roads.
2. Mobile equipment" while being carried or
towed by a covered auto".
3. Any auto" you do not own while used with
the permission of its owner as a temporary
substitute for a covered auto" you own that Is
out of service because of its:
a. Breakdown;
b. Repair;
c. Servicing;
d. Loss"; or
e. Destruction.
SECTION It LIABILITY COVERAGE
A. Coverage
We will pay all sums an insured" legally must pay
as damages because of bodily injury" or prop-
erty damage" to which this insurance applies,
caused by an accident" and resulting from the
ownership, maintenance or use of a covered
auto".
We will also pay all sums an insured" legally
must pay as a covered pollution cost or expense"
to which this insurance applies, caused by an
accident" and resulting from the ownership,
maintenance or use of covered autos". However,
we will only pay for the covered pollution cost or
expense" if there is either bodily injury" or prop-
erty damage" to which this insurance applies that
is caused by the same accident".
We have the right and duty to defend any in-
sured" against a suit" asking for such damages
or a covered pollution cost or expense". How-
ever, we have no duty to defend any insured"
against a suit" seeking damages for bodily in-
jury" or property damage" or a covered pollution
cost or expense" to which this insurance does not
apply. We may investigate and settle any claim or
suit" as we consider appropriate. Our duty to de-
fend or settle ends when the Liability Coverage
Limit of Insurance has been exhausted by pay-
ment of judgments or settlements.
1. Who Is An Insured
The following are insureds":
a. You for any covered auto".
b. Anyone else while using with your per-
mission a covered auto" you own, hire or
borrow except:
1) The owner or anyone else from
whom you hire or borrow a covered
auto".
Page 2 of 12 Insurance Services Office, Inc., 2009 CA 00 01 0310 Rev. 02-11)
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
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THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
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TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
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FUTURE-U012
AMENDMENTS-U012
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FULLY EXECUTED AGREEMENT, AME��
�COMMERCIAL AUTO
M
0
001634
3)
This exception does not apply if the cov-
ered auto" is a trailer" connected to a
covered auto" you own.
2) Your employee" if the covered auto"
is owned by that employee" or a
member of his or her household.
Someone using a covered auto"
while he or she is working in a busi-
ness of selling, servicing, repairing,
parking or storing autos" unless that
business is yours.
4) Anyone other than your employees",
partners if you are a partnership),
members if you are a limited liability
company) or a lessee or borrower or
any of their employees", while mov-
ing property to or from a covered
auto".
5) A partner if you are a partnership) or
a member if you are a limited liability
company) for a covered auto" owned
by him or her or a member of his or
her household.
c. Anyone liable for the conduct of an in-
sured" described above but only to the
extent of that liability.
2. Coverage Extensions
a. Supplementary Payments
We will pay for the insured":
1) All expenses we incur.
2) Up to $2,000 for cost of bail bonds
3)
5)
4) All reasonable expenses incurred by
including bonds for related traffic law
violations) required because of an
accident" we cover. We do not have
to furnish these bonds.
The cost of bonds to release attach-
ments in any suit" against the in-
sured" we defend, but only for bond
amounts within our Limit of Insur-
ance.
the insured" at our request, including
actual loss of earnings up to $250 a
day because of time off from work.
All court costs taxed against the in-
sured" in any suit" against the in-
sured" we defend. However, these
payments do not include attorneys'
fees or attorneys' expenses taxed
against the insured".
6) All interest on the full amount of any
judgment that accrues after entry of
the judgment in any suit" against the
insured" we defend, but our duty to
pay interest ends when we have paid,
offered to pay or deposited in court
the part of the judgment that is within
our Limit of Insurance.
These payments will not reduce the Limit
of Insurance.
b. Out-of-state Coverage Extensions
While a covered auto" is away from the
state where it is licensed we will:
1) Increase the Limit of Insurance for Li-
ability Coverage to meet the limits
specified by a compulsory or financial
responsibility law of the jurisdiction
where the covered auto" is being
used. This extension does not apply
to the limit or limits specified by any
law governing motor carriers of pas-
sengers or property.
2) Provide the minimum amounts and
types of other coverages, such as no-
fault, required of out-of-state vehicles
by the jurisdiction where the covered
auto" Is being used.
We will not pay anyone more than once
for the same elements of loss because of
these extensions.
B. Exclusions
This insurance does not apply to any of the fol-
lowing:
1. Expected Or Intended Injury
Bodily injury" or property damage" expected
or intended from the standpoint of the in-
sured".
2. Contractual
Liability assumed under any contract or
agreement,
But this exclusion does not apply to liability
for damages:
a. Assumed in a contract or agreement that
is an insured contract" provided the
bodily injury" or property damage" oc-
curs subsequent to the execution of the
contract or agreement; or
b. That the insured" would have in the ab-
sence of the contract or agreement.
CA 00 01 03 10 Rev. 02-11) insurance Services Office, Inc., 2009
Page 3 of 12
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
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CHECK,-U012
INSPECTION-U012
RELATED-U012
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TO-U012
THE-U012
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SERVICES-U012
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IN-U012
THE-U012
AMOUNT-U012
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$165,000-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
3. Workers' Compensation
Any obligation for which the insured" or the
insured's" insurer may be held liable under
any workers' compensation, disability benefits
or unemployment compensation law or any
similar law.
4. Employee Indemnification And Employer's
Liability
Bodily injury" to:
a. An employee" of the insured" arising out
of and in the course of:
1) Employment by the insured"; or
2) Performing the duties related to the
conduct of the insured's" business;
or
b. The spouse, child, parent, brother or sis-
ter of that employee" as a consequence
of Paragraph a. above.
This exclusion applies:
1) Whether the insured" may be liable
as an employer or in any other ca-
pacity; and
2) To any obligation to share damages
with or repay someone else who
must pay damages because of the in-
jury,
But this exclusion does not apply to bodily in-
jury" to domestic employees" not entitled to
workers' compensation benefits or to liability
assumed by the insured" under an insured
contract". For the purposes of the coverage
form, a domestic employee" is a person en-
gaged in household or domestic work per-
formed principally in connection with a resi-
dence premises.
5. Fellow Employee
Bodily injury" to:
a. Any fellow employee" of the insured"
arising out of and in the course of the fel-
low employee's" employment or while
performing duties related to the conduct
of your business; or
b. The spouse, child, parent, brother or sis-
ter of that fellow employee" as a conse-
quence of Paragraph a. above.
6. Care, Custody Or Control
Property damage" to or covered pollution
cost or expense" involving property owned or
transported by the insured" or in the in-
sured's" care, custody or control. But this ex-
clusion does not apply to liability assumed
under a sidetrack agreement.
7. Handling Of Property
Bodily injury" or property damage" resulting
from the handling of property:
a. Before it is moved from the place where it
is accepted by the insured" for move-
ment into or onto the covered auto"; or
b. After it is moved from the covered auto"
to the place where it is finally delivered by
the insured",
8. Movement Of Property By Mechanical De-
vice
Bodily injury" or property damage" resulting
from the movement of property by a me-
chanical device other than a hand truck)
unless the device is attached to the covered
auto".
9. Operations
Bodily injury" or property damage" arising
out of the operation of:
a. Any equipment listed in Paragraphs 6.b.
and 6.c. of the definition of mobile
equipment"; or
b. Machinery or equipment that is on, at-
tached to or part of a land vehicle that
would qualify under the definition of mo-
bile equipment" if it were not subject to a
compulsory or financial responsibility law
or other motor vehicle insurance law
where it is licensed or principally garaged.
10. Completed Operations
Bodily injury" or property damage" arising
out of your work after that work has been
completed or abandoned.
In this exclusion, your work means:
a. Work or operations performed by you or
on your behalf; and
b. Materials, parts or equipment furnished in
connection with such work or operations.
Your work includes warranties or representa-
tions made at any time with respect to the fit-
ness, quality, durability or performance of any
of the items included in Paragraph a. or b.
above.
Your work will be deemed completed at the
earliest of the following times:
1) When all of the work called for in your
contract has been completed.
Page 4 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
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40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
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KAPWELLL-U10
1/30/2012-U011
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AMOUNT-U012
OF-U012
$165,000-U012
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$552,446-U012
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AGREEMENT-U012
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OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
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$307,446-U012
THROUGH-U012
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30,-U012
2012;-U012
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THE-U012
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TO-U012
THE-U012
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SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
M
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2) When all of the work to be done at
the site has been completed if your
contract calls for work at more than
one site.
3) When that part of the work done at a
job site has been put to its intended
use by any person or organization
other than another contractor or sub-
contractor working on the same pro-
ject.
Work that may need service, maintenance,
correction, repair or replacement, but which is
otherwise complete, will be treated as com-
pleted.
11. Pollution
Bodily injury" or property damage" arising
out of the actual, alleged or threatened dis-
charge, dispersal, seepage, migration, re-
lease or escape of pollutants":
a. That are, or that are contained in any
property that is:
1) Being transported or towed by, han-
dled or handled for movement into,
onto or from the covered auto";
2) Otherwise in the course of transit by
or on behalf of the insured"; or
3) Being stored, disposed of, treated or
processed in or upon the covered
auto";
b. Before the pollutants" or any property in
which the pollutants" are contained are
moved from the place where they are ac-
cepted by the insured" for movement into
or onto the covered auto"; or
c. After the pollutants" or any property in
which the pollutants" are contained are
moved from the covered auto" to the
place where they are finally delivered,
disposed of or abandoned by the in-
sured".
Paragraph a. above does not apply to fuels,
lubricants, fluids, exhaust gases or other simi-
lar pollutants" that are needed for or result
from the normal electrical, hydraulic or me-
chanical functioning of the covered auto" or
its parts, if:
1) The pollutants" escape, seep, mi-
grate or are discharged, dispersed or
released directly from an auto" part
designed by its manufacturer to hold,
store, receive or dispose of such pol-
lutants"; and
2) The bodily injury", property dam-
age" or covered pollution cost or ex-
pense" does not arise out of the op-
eration of any equipment listed in
Paragraphs 6.b. and 6.c. of the defi-
nition of mobile equipment".
Paragraphs b. and c. above of this exclusion
do not apply to accidents" that occur away
from premises owned by or rented to an in-
sured" with respect to pollutants" not in or
upon a covered auto" if:
a) The pollutants" or any property in
which the pollutants" are contained
are upset, overturned or damaged as
a result of the maintenance or use of
a covered auto"; and
b) The discharge, dispersal, seepage,
migration, release or escape of the
pollutants" is caused directly by such
upset, overturn or damage.
12. War
Bodily injury" or property damage" arising
directly or indirectly out of:
a. War, including undeclared or civil war;
b. Warlike action by a military force, includ-
ing action in hindering or defending
against an actual or expected attack, by
any government, sovereign or other au-
thority using military personnel or other
agents; or
c. Insurrection, rebellion, revolution,
usurped power or action taken by gov-
ernmental authority in hindering or de-
fending against any of these.
13. Racing
Covered autos" while used in any profes-
sional or organized racing or demolition con-
test or stunting activity, or while practicing for
such contest or activity. This insurance also
does not apply while that covered auto" is
being prepared for such a contest or activity.
C. Limit Of Insurance
Regardless of the number of covered autos",
insureds", premiums paid, claims made or vehi-
cles involved in the accident", the most we will
pay for the total of all damages and covered pol-
lution cost or expense" combined resulting from
any one accident" is the Limit of Insurance for Li-
ability Coverage shown in the Declarations.
All bodily injury", property damage" and cov-
ered pollution cost or expense" resulting from
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009
Page 5 of 12
001635
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
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THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
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$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
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AUTHORIZE-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
continuous or repeated exposure to substantially
the same conditions will be considered as result-
ing from one accident".
No one will be entitled to receive duplicate pay-
ments for the same elements of loss" under this
coverage form and any Medical Payments Cov-
erage endorsement, Uninsured Motorists Cover-
age endorsement or Underinsured Motorists
Coverage endorsement attached to this Coverage
Part.
SECTION III PHYSICAL DAMAGE COVERAGE
A. Coverage
1. We will pay for loss" to a covered auto" or
its equipment under:
a. Comprehensive Coverage
From any cause except:
1) The covered auto's" collision with
another object; or
2) The covered auto's" overturn.
b. Specified Causes Of Loss Coverage
Caused by:
1) Fire, lightning or explosion;
2) Theft;
3) Windstorm, hail or earthquake;
4) Flood;
5) Mischief or vandalism; or
6) The sinking, burning, collision or de-
railment of any conveyance transport-
ing the covered auto".
c. Collision Coverage
Caused by:
1) The covered auto's" collision with
another object; or
2) The covered auto's" overturn.
2. Towing
We will pay up to the limit shown in the Decla-
rations for towing and labor costs incurred
each time a covered auto" of the private
passenger type is disabled, However, the la-
bor must be performed at the place of dis-
ablement.
3. Glass Breakage Hitting A Bird Or Animal
Falling Objects Or Missiles
If you carry Comprehensive Coverage for the
damaged covered auto", we will pay for the
following under Comprehensive Coverage:
a. Glass breakage;
b. Loss" caused by hitting a bird or animal;
and
c. Loss" caused by falling objects or mis-
siles.
However, you have the option of having glass
breakage caused by a covered auto's" colli-
sion or overturn considered a loss" under
Collision Coverage.
4. Coverage Extensions
a. Transportation Expenses
We will pay up to $20 per day to a maxi-
mum of $600 for temporary transportation
expense incurred by you because of the
total theft of a covered auto" of the pri-
vate passenger type. We will pay only for
those covered autos" for which you carry
either Comprehensive or Specified
Causes Of Loss Coverage. We will pay
for temporary transportation expenses in-
curred during the period beginning 48
hours after the theft and ending, regard-
less of the policy's expiration, when the
covered auto" is returned to use or we
pay for its loss",
b. Loss Of Use Expenses
For Hired Auto Physical Damage, we will
pay expenses for which an insured" be-
comes legally responsible to pay for loss
of use of a vehicle rented or hired without
a driver under a written rental contract or
agreement. We will pay for loss of use
expenses if caused by:
1) Other than collision only if the Decla-
rations indicate that Comprehensive
Coverage is provided for any covered
auto";
2) Specified Causes Of Loss only if the
Declarations indicate that Specified
Causes Of Loss Coverage is pro-
vided for any covered auto"; or
3) Collision only if the Declarations indi-
cate that Collision Coverage is pro-
vided for any covered auto".
However, the most we will pay for any
expenses for loss of use is $20 per day,
to a maximum of $600.
B. Exclusions
1. We will not pay for loss" caused by or result-
ing from any of the following. Such loss" is
excluded regardless of any other cause or
r
Page 6 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
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MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
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$307,446-U012
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30,-U012
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AGREEMENTS-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
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2
installed, that reproduces, receives or
transmits audio, visual or data signals,
d. Any accessories used with the electronic
equipment described in Paragraph c.
above.
5. Exclusions 4.c. and 4.d. do not apply to
equipment designed to be operated solely by
use of the power from the auto's" electrical
system that, at the time of loss", is:
a. Permanently installed in or upon the cov-
ered auto";
b. Removable from a housing unit which is
permanently installed in or upon the cov-
ered auto";
c. An integral part of the same unit housing
any electronic equipment described in
Paragraphs a. and b. above; or
d. Necessary for the normal operation of the
covered auto" or the monitoring of the
covered auto's" operating system.
6. We will not pay for loss" to a covered auto"
due to diminution in value".
auto" while used in any professional or or- C. Limit Of Insurance
event that contributes concurrently or in any
sequence to the loss".
a. Nuclear Hazard
1) The explosion of any weapon em-
ploying atomic fission or fusion; or
2) Nuclear reaction or radiation, or ra-
dioactive contamination, however
caused.
b. War Or Military Action
1) War, including undeclared or civil
war;
2) Warlike action by a military force, in-
cluding action in hindering or defend-
ing against an actual or expected at-
tack, by any government, sovereign
or other authority using military per-
sonnel or other agents; or
3) Insurrection, rebellion, revolution,
usurped power or action taken by
governmental authority in hindering
or defending against any of these.
2. We will not pay for loss" to any covered
ganized racing or demolition contest or stunt-
ing activity, or while practicing for such con-
test or activity. We will also not pay for loss"
to any covered auto" while that covered
auto" is being prepared for such a contest or
activity.
3. We will not pay for loss" due and confined to:
a. Wear and tear, freezing, mechanical or
electrical breakdown,
b. Blowouts, punctures or other road dam-
age to tires.
This exclusion does not apply to such loss"
resulting from the total theft of a covered
auto".
4. We will not pay for loss" to any of the follow-
ing:
a. Tapes, records, discs or other similar au-
dio, visual or data electronic devices de-
signed for use with audio, visual or data
electronic equipment.
b. Any device designed or used to detect
speed-measuring equipment such as ra-
dar or laser detectors and any jamming
apparatus intended to elude or disrupt
speed-measurement equipment.
c. Any electronic equipment, without regard
to whether this equipment is permanently
1. The most we will pay for loss" in any one
accident" is the lesser of:
a. The actual cash value of the damaged or
stolen property as of the time of the
loss"; or
b. The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
2. $1,000 is the most we will pay for loss" in
any one accident" to all electronic equipment
that reproduces, receives or transmits audio,
visual or data signals which, at the time of
loss", is:
a. Permanently installed In or upon the cov-
ered auto" in a housing, opening or other
location that is not normally used by the
auto" manufacturer for the installation of
such equipment;
b. Removable from a permanently installed
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipment; or
c. An integral part of such equipment.
3. An adjustment for depreciation and physical
condition will be made in determining actual
cash value in the event of a total loss".
CA 00 01 03 10 Rev. 02-11) 0 Insurance Services Office, Inc., 2009
Page 7 of 12
001036
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
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TO-U012
THE-U012
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BUILDING-U012
SERVICES-U012
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IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
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$105,000-U012
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AMOUNT-U012
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$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
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THE-U012
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AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
4. If a repair or replacement results in better
than like kind or quality, we will not pay for the
amount of the betterment.
D. Deductible
For each covered auto", our obligation to pay for,
repair, return or replace damaged or stolen prop-
erty will be reduced by the applicable deductible
shown in the Declarations. Any Comprehensive
Coverage deductible shown in the Declarations
does not apply to loss" caused by fire or light-
ning.
SECTION IV BUSINESS AUTO CONDITIONS
The following conditions apply in addition to the
Common Policy Conditions:
A. Loss Conditions
1. Appraisal For Physical Damage Loss
If you and we disagree on the amount of
loss", either may demand an appraisal of the
loss". In this event, each party will select a
competent appraiser. The two appraisers will
select a competent and impartial umpire. The
appraisers will state separately the actual
cash value and amount of loss". If they fail to
agree, they will submit their differences to the
umpire. A decision agreed to by any two will
be binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If we submit to an appraisal, we will still retain
our right to deny the claim.
2. Duties In The Event Of Accident, Claim,
Suit Or Loss
We have no duty to provide coverage under
this policy unless there has been full compli-
ance with the following duties:
a. In the event of accident", claim, suit" or
loss", you must give us or our authorized
representative prompt notice of the acci-
dent" or loss". Include:
1) How, when and where the accident"
or loss" occurred;
2) The insured's" name and address;
1)
3)
Assume no obligation, make no pay-
ment or incur no expense without our
consent, except at the insured's"
own cost.
and
3) To the extent possible, the names
and addresses of any injured persons
and witnesses.
b. Additionally, you and any other involved
insured" must:
2) Immediately send us copies of any
request, demand, order, notice,
summons or legal paper received
concerning the claim or suit".
Cooperate with us in the investigation
or settlement of the claim or defense
against the suit".
4) Authorize us to obtain medical re-
cords or other pertinent information.
5) Submit to examination, at our ex-
pense, by physicians of our choice,
as often as we reasonably require.
c. If there is loss" to a covered auto" or its
equipment you must also do the follow-
ing:
1)
3)
2) Take all reasonable steps to protect
Promptly notify the police if the cov-
ered auto" or any of its equipment is
stolen.
the covered auto" from further dam-
age. Also keep a record of your ex-
penses for consideration in the set-
tlement of the claim.
Permit us to inspect the covered
auto" and records proving the loss"
before its repair or disposition.
4) Agree to examinations under oath at
our request and give us a signed
statement of your answers.
3. Legal Action Against Us
No one may bring a legal action against us
under this coverage form until:
a. There has been full compliance with all
the terms of this coverage form; and
b. Under Liability Coverage, we agree in
writing that the insured" has an obliga-
tion to pay or until the amount of that ob-
ligation has finally been determined by
judgment after trial. No one has the right
under this policy to bring us into an action
to determine the insured's" liability.
4. Loss Payment Physical Damage Cover-
ages
At our option we may:
a. Pay for, repair or replace damaged or sto-
len property;
I.
Page 8 of 12 0 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
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3-U02
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BETWEEN-U02
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FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
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MARCELLAC-U04
17723-U05
1-U06
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AMENDMENT-U07
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A-11957-U07
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TO-U012
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THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
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THE-U012
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THE-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
M
o
0
N'
REE9
0
b. Return the stolen property, at our ex-
pense. We will pay for any damage that
results to the auto" from the theft; or
c. Take all or any part of the damaged or
stolen property at an agreed or appraised
value.
If we pay for the loss", our payment will in-
clude the applicable sales tax for the dam-
aged or stolen property.
5. Transfer Of Rights Of Recovery Against
Others To Us
If any person or organization to or for whom
we make payment under this coverage form
has rights to recover damages from another,
those rights are transferred to us. That person
or organization must do everything necessary
to secure our rights and must do nothing after
accident" or loss" to impair them.
B. General Conditions
1. Bankruptcy
Bankruptcy or insolvency of the insured" or
the insured's" estate will not relieve us of any
obligations under this coverage form.
2. Concealment, Misrepresentation Or Fraud
This coverage form is void in any case of
fraud by you at any time as it relates to this
coverage form. It is also void if you or any
other insured", at any time, intentionally con-
ceal or misrepresent a material fact concern-
ing:
a. This coverage form;
b. The covered auto";
c. Your interest in the covered auto"; or
d. A claim under this coverage form.
3. Liberalization
If we revise this coverage form to provide
more coverage without additional premium
charge, your policy will automatically provide
the additional coverage as of the day the re-
vision is effective in your state.
4. No Benefit To Bailee Physical Damage
Coverages
We will not recognize any assignment or
Other Insurance
a. For any covered auto" you own, this
coverage form provides primary insur-
ance. For any covered auto" you don't
own, the insurance provided by this cov-
erage form is excess over any other col-
lectible insurance. However, while a cov-
ered auto" which is a trailer" is con-
nected to another vehicle, the Liability
Coverage this coverage form provides for
the trailer" is:
1) Excess while it is connected to a mo-
tor vehicle you do not own.
2) Primary while it is connected to a
covered auto" you own.
b. For Hired Auto Physical Damage Cover-
age, any covered auto" you lease, hire,
rent or borrow is deemed to be a covered
auto" you own. However, any auto" that
is leased, hired, rented or borrowed with
a driver is not a covered auto".
c. Regardless of the provisions of Para-
graph a. above, this coverage form's Li-
ability Coverage is primary for any liability
assumed under an insured contract".
d. When this coverage form and any other
coverage form or policy covers on the
same basis, either excess or primary, we
will pay only our share. Our share is the
proportion that the Limit of Insurance of
our coverage form bears to the total of
the limits of all the coverage forms and
policies covering on the same basis.
6. Premium Audit
a. The estimated premium for this coverage
form is based on the exposures you told
us you would have when this policy be-
gan. We will compute the final premium
due when we determine your actual ex-
posures. The estimated total premium will
be credited against the final premium due
and the first Named Insured will be billed
for the balance, if any. The due date for
the final premium or retrospective pre-
mium is the date shown as the due date
on the bill. If the estimated total premium
exceeds the final premium due, the first
Named Insured will get a refund.
b. If this policy is issued for more than one
year, the premium for this coverage form
will be computed annually based on our
rates or premiums in effect at the begin-
ning of each year of the policy.
grant any coverage for the benefit of any per-
son or organization holding, storing or trans-
porting property for a fee regardless of any
other provision of this coverage form.
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009 Page 9 of 12
001837
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
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APPROVED-U012
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FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
7. Policy Period, Coverage Territory
Under this coverage form, we cover acci-
dents" and losses" occurring:
a. During the policy period shown in the
Declarations; and
b. Within the coverage territory.
The coverage territory is:
1) The United States of America;
2) The territories and possessions of the
United States of America;
3) Puerto Rico;
4) Canada; and
5) Anywhere in the world if:
a) A covered auto" of the private pas-
senger type is leased, hired, rented
or borrowed without a driver for a pe-
riod of 30 days or less; and
b) The insured's" responsibility to pay
damages is determined in a suit" on
the merits, in the United States of
America, the territories and posses-
sions of the United States of America,
Puerto Rico or Canada or in a settle-
ment we agree to.
We also cover loss" to, or accidents" involv-
ing, a covered auto" while being transported
between any of these places.
8. Two Or More Coverage Forms Or Policies
Issued By Us
If this coverage form and any other coverage
form or policy issued to you by us or any
company affiliated with us applies to the
same accident", the aggregate maximum
Limit of Insurance under all the coverage
forms or policies shall not exceed the highest
applicable Limit of Insurance under any one
coverage form or policy, This condition does
not apply to any coverage form or policy is-
sued by us or an affiliated company specifi-
cally to apply as excess insurance over this
coverage form.
SECTION V DEFINITIONS
A. Accident" includes continuous or repeated expo-
sure to the same conditions resulting in bodily in-
jury" or property damage".
B. Auto" means:
1. A land motor vehicle, trailer" or semitrailer
designed for travel on public roads; or
2. Any other land vehicle that is subject to a
compulsory or financial responsibility law or
other motor vehicle insurance law where it is
licensed or principally garaged.
However, auto" does not include mobile equip-
ment".
C. Bodily injury" means bodily injury, sickness or
disease sustained by a person including death
resulting from any of these.
D. Covered pollution cost or expense" means any
cost or expense arising out of:
1. Any request, demand, order or statutory or
regulatory requirement that any insured" or
others test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in any
way respond to, or assess the effects of, pol-
lutants"; or
2. Any claim or suit" by or on behalf of a gov-
ernmental authority for damages because of
testing for, monitoring, cleaning up, removing,
containing, treating, detoxifying or neutraliz-
ing, or In any way responding to, or assessing
the effects of, pollutants",
Covered pollution cost or expense" does not in-
clude any cost or expense arising out of the ac-
tual, alleged or threatened discharge, dispersal,
seepage, migration, release or escape of pollut-
ants":
a. That are, or that are contained in any
property that is:
1) Being transported or towed by, han-
dled or handled for movement into,
onto or from the covered auto";
2) Otherwise in the course of transit by
or on behalf of the insured"; or
3) Being stored, disposed of, treated or
processed in or upon the covered
auto";
b. Before the pollutants" or any property in
which the pollutants" are contained are
moved from the place where they are ac-
cepted by the insured" for movement into
or onto the covered auto"; or
c. After the pollutants" or any property in
which the pollutants" are contained are
moved from the covered auto" to the
place where they are finally delivered,
disposed of or abandoned by the in-
sured".
Paragraph a. above does not apply to fuels,
lubricants, fluids, exhaust gases or other simi-
Page 10 of 12 Insurance Services Office, Inc., 2009 CA 00 01 0310 Rev. 02-11)
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
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AMOUNT-U012
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$552,446-U012
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JUNE-U012
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CSG-U012
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C.-U012
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THE-U012
PROFESSIONAL-U012
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APPROVED-U012
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AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
1
i=t
0
fl
0
lar pollutants" that are needed for or result
from the normal electrical, hydraulic or me-
chanical functioning of the covered auto" or
Its parts, if:
1) The pollutants" escape, seep, mi-
grate or are discharged, dispersed or
released directly from an auto" part
designed by its manufacturer to hold,
store, receive or dispose of such pol-
lutants"; and
2) The bodily injury", property dam-
age" or covered pollution cost or ex-
pense" does not arise out of the op-
eration of any equipment listed in
Paragraph 6.b. or 6.c. of the defini-
tion of mobile equipment".
Paragraphs b. and c. above do not apply to
accidents" that occur away from premises
owned by or rented to an insured" with re-
spect to pollutants" not in or upon a covered
auto" if:
a) The pollutants" or any property in
which the pollutants" are contained
are upset, overturned or damaged as
a result of the maintenance or use of
a covered auto"; and
b) The discharge, dispersal, seepage,
migration, release or escape of the
pollutants" is caused directly by such
upset, overturn or damage.
E. Diminution in value" means the actual or per-
ceived loss in market value or resale value which
results from a direct and accidental loss",
F. Employee" includes a leased worker". Em-
ployee" does not include a temporary worker".
G. Insured" means any person or organization quali-
fying as an insured in the Who Is An Insured pro-
vision of the applicable coverage. Except with re-
spect to the Limit of Insurance, the coverage af-
forded applies separately to each insured who is
seeking coverage or against whom a claim or
suit" is brought.
H. Insured contract" means:
1. A lease of premises;
2. A sidetrack agreement;
3. Any easement or license agreement, except
in connection with construction or demolition
operations on or within 50 feet of a railroad;
4. An obligation, as required by ordinance, to in-
demnify a municipality, except in connection
with work for a municipality;
5. That part of any other contract or agreement
pertaining to your business including an in-
demnification of a municipality in connection
with work performed for a municipality) under
which you assume the tort liability of another
to pay for bodily injury" or property damage"
to a third party or organization. Tort liability
means a liability that would be imposed by
law in the absence of any contract or agree-
ment;
6. That part of any contract or agreement en-
tered into, as part of your business, pertaining
to the rental or lease, by you or any of your
employees", of any auto". However, such
contract or agreement shall not be considered
an insured contract" to the extent that it obli-
gates you or any of your employees" to pay
for property damage" to any auto" rented or
leased by you or any of your employees".
An insured contract" does not include that part of
any contract or agreement:
a. That indemnifies a railroad for bodily in-
jury" or property damage" arising out of
construction or demolition operations,
within 50 feet of any railroad property and
affecting any railroad bridge or trestle,
tracks, roadbeds, tunnel, underpass or
crossing;
b. That pertains to the loan, lease or rental
of an auto" to you or any of your em-
ployees", If the auto" is loaned, leased or
rented with a driver; or
c. That holds a person or organization en-
gaged in the business of transporting
property by auto" for hire harmless for
your use of a covered auto" over a route
or territory that person or organization is
authorized to serve by public authority.
1. Leased worker" means a person leased to you
by a labor leasing firm under an agreement be-
tween you and the labor leasing firm to perform
duties related to the conduct of your business.
Leased worker" does not include a temporary
worker".
J. Loss" means direct and accidental loss or dam-
age.
K. Mobile equipment" means any of the following
types of land vehicles, including any attached
machinery or equipment:
1. Bulldozers, farm machinery, forklifts and other
vehicles designed for use principally off public
roads;
CA 00 01 03 10 Rev. 02-11) Insurance Services Office, Inc., 2009
Page 11 of 12
001038
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
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CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �COMMERCIAL AUTO
2. Vehicles maintained for use solely on or next
to premises you own or rent;
3. Vehicles that travel on crawler treads;
4. Vehicles, whether self-propelled or not, main-
tained primarily to provide mobility to perma-
nently mounted:
a. Power cranes, shovels, loaders, diggers
or drills; or
b. Road construction or resurfacing equip-
ment such as graders, scrapers or rollers;
5. Vehicles not described in Paragraph 1., 2., 3.
or 4. above that are not self-propelled and are
maintained primarily to provide mobility to
permanently attached equipment of the fol-
lowing types:
a. Air compressors, pumps and generators,
including spraying, welding, building
cleaning, geophysical exploration, lighting
and well-servicing equipment; or
b. Cherry pickers and similar devices used
to raise or lower workers; or
6. Vehicles not described in Paragraph 1., 2., 3.
or 4. above maintained primarily for purposes
other than the transportation of persons or
cargo. However, self-propelled vehicles with
the following types of permanently attached
equipment are not mobile equipment" but will
be considered autos":
a. Equipment designed primarily for:
1) Snow removal;
2) Road maintenance, but not construc-
tion or resurfacing; or
3) Street cleaning;
b. Cherry pickers and similar devices
mounted on automobile or truck chassis
and used to raise or lower workers; and
c. Air compressors, pumps and generators,
including spraying, welding, building
cleaning, geophysical exploration, lighting
or well-servicing equipment.
However, mobile equipment" does not include
land vehicles that are subject to a compulsory or
financial responsibility law or other motor vehicle
insurance law where it is licensed or principally
garaged. Land vehicles subject to a compulsory
or financial responsibility law or other motor vehi-
cle insurance law are considered autos".
L. Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including smoke,
vapor, soot, fumes, acids, alkalis, chemicals and
waste. Waste includes materials to be recycled,
reconditioned or reclaimed.
M. Property damage" means damage to or loss of
use of tangible property.
N. Suit" means a civil proceeding in which:
1. Damages because of bodily injury" or prop-
erty damage"; or
2. A covered pollution cost or expense";
to which this insurance applies, are alleged.
Suit" includes:
a. An arbitration proceeding in which such
damages or covered pollution costs or
expenses" are claimed and to which the
insured" must submit or does submit with
our consent; or
b. Any other alternative dispute resolution
proceeding in which such damages or
covered pollution costs or expenses" are
claimed and to which the insured submits
with our consent.
O. Temporary worker" means a person who is fur-
nished to you to substitute for a permanent em-
ployee" on leave or to meet seasonal or short-
term workload conditions.
P. Trailer" Includes semitrailer.
Page 12 of 12 Insurance Services Office, Inc., 2009 CA 00 01 03 10 Rev. 02-11)
BIB]
40989-U01
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AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
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THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
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AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
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17723-U05
1-U06
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AGREEMENT-U07
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CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
OFFICER-U012
TO-U012
EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WORKERS' COMPENSATION BROAD FORM ENDORSEMENT
EXTENDED OPTIONS
H
P lacy Number. 57 WE EP4360 Endorsement; Number:
Effective Date: 12104/11 Effective hour Is the same as stated on the Information Page of the policy.
Natn d Insured and Address: CSG CONSULTANTS INC
1700 S AMPHLETT BLVD 3RD FL
SAN MATEO, CA 94402
M
m
on
am
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section ii of this endorsement provides additional coverage usually only provided by endorsement.
Section III of this endorsement Is a Schedule of Covered States.
You may use the index to locate these coverage features quickly:
SUBJECT PEE T
SECTION I 2 8. Part One Does Not Apply 3
PARTS ONE and TWO 2 C. Application of Coverage 3
01 We Will Also Pay 2 D. Additional Exclusions 3
PART-THREE 2 E. West Virginia 3
02 How This Insurance Works 2 EXTENDED OPTIONS 4
PART- SIX 2 01 Employers' Liability Insurance 4
03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4
04 Liberalization 2 Hazards
SECTION Ii 2 03 Waiver of Our Right to Recover from 4
VOLUNTARY COMPENSATION INSURANCE 2 Others
05 Voluntary Compensation Insurance 04 Foreign Voluntary Compensation 4
A. How This Insurance Applies 2 A. How This Reimbursement Applies 4
B. We Will Pay 2 B. We Will Reimburse 4
C. Exclusions 3 C, Exclusions 4
D. Before We Pay 3 D, Before We Pay 5
E. Recovery From Others 3 E. Recovery From Others 5
F. Employers' Liability Insurance 3 F. Reimbursement For Actual Loss 5
EMPLOYERS' LIABILITY STOP GAP 3 Sustained
ENDORSEMENT 3 0. Repatriation 5
06 Employers' Liability Stop Gap H. Endemic Disease 5
Coverage 3 05 Longehore and Harbor Workers' 5
A. Stop Gap Coverage Limited to Compensation Act Coverage
3
Ohio
Montana
North Dakota Endorsement
West Virginia and
Washington SECTION III 6
Wyoming 01 Schedule of Covered States 6
Form WC 99 03 03 B Printed In U.S.A. Ed. 8100)
Process Dal 11116111
2000, The Hartford
Pag 1 of 6
Policy Expiration Oat 12 / 04 /12
BIB]
40989-U01
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AMENDMENT-U02
NO.-U02
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BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
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TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
B.-U012
APPROVE-U012
AMENDMENT-U012
NO.-U012
3-U012
TO-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENT-U012
NO.-U012
A-12103-U012
CSG-U012
CONSULTANTS,-U012
INC.-U012
CSG)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
REVIEW-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
C.-U012
AUTHORIZE-U012
THE-U012
CONTRACTS/PURCHASING-U012
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EXECUTE-U012
THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
PROFESSIONAL-U012
SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
DO-U012
SIGNIFICANTLY-U012
ALTER-U012
THE-U012
SCOPE-U012
OF-U012
WORK-U012
OR-U012
CHANGE-U012
THE-U012
APPROVED-U012
AGREEMENT-U012
AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �SECTION I
PARTS ONE and TWO
1. WE WILL ALSO PAY
D. We Will Also Pay of Part One WORKERS'
COMPENSATION INSURANCE); and
E. We Will Also Pay of Part Two EMPLOYERS'
LIABILITY INSURANCE) Is replaced by the
following:
We Will Also Pay
We will also pay these costs, in addition to
other amounts payable under this insurance,
as part of any claim, proceeding, or suit we
defend:
1. reasonable expenses Incurred at our
request, INCLUDING loss of earnings;
2. premiums for bonds to release
attachments and for appeal bonds In bond
amounts up to the limit of our liability
under this Insurance;
3. litigation costs taxed against you,
4. Interest on a judgment as required by law
until we offer the amount due under this
law; and
5. expenses we Incur.
PARTTHREE
2. How This Insurance Applies
Paragraph 4. of A. How This Inaurano Appli a
of Part 3 Other States Insurance) Is replaced by
the following:
4. It you have work on the effective date of this
policy In any state not listed in Item 3.A. of the
Information Page, coverage will not be
afforded for that state unless we are notified
within sixty days.
PART SIX
3. Transfer Of Your Rights and Duties
C. Transfer Of Your Rights and Dull a of Part 6
Conditions) Is replaced by the following:
Your rights or duties under this policy may not
be transferred without our written consent.
If you die and we receive notice within sixty
days after your death, we will cover your legal
representative as insured.
4. Liberalization
If we adopt a change in this form that would
broaden the coverage of this form without extra
charge, the broader coverage will apply to this
policy. It will apply when the change becomes
effective In your state.
SECTION II
VOLUNTARY COMPENSATION AND EMPLOYERS'
LIABILITY COVERAGE
S. V luntary Compensation Insurance
A. H w This Insurance Applies
This insurance applies to bodily Injury by
accident or bodily injury by disease. Bodily
Injury includes resulting death.
1. The bodily Injury must be sustained by any
officer or employee not subject to the
workers' compensation law of any state
shown In item S.A. of the Information
Page.
2. The bodily Injury must arise out of and In
the course of employment or incidental to
work in a state shown in Item S.A. of the
Information Page.
3. The bodily Injury must occur In the United
States of America, its territories or
possessions, or Canada, and may occur
elsewhere It the employee Is a United
States or Canadian citizen, or otherwise
legal resident, and legally employed, in the
United States or Canada and temporarily
away from those places.
4. Bodily Injury by accident must occur
during the policy period.
5, Bodily injury by disease must be caused
or aggravated by the conditions of the
F rm WC 90 03 03 0 Printed In U.S.A. Ed. 8/00) Peg 2 of 6
BIB]
40989-U01
FULLY-U02
EXECUTED-U02
AGREEMENT,-U02
AMENDMENT-U02
NO.-U02
3-U02
PSA-U02
BETWEEN-U02
THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
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OF-U012
$105,000-U012
A-U012
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AMOUNT-U012
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THROUGH-U012
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FULLY EXECUTED AGREEMENT, AME�� �H
M
0
officer's or employee's employment. The
officer's or employee's last day of last
exposure to the conditions causing or
aggravating such bodily Injury by disease
must occur during the policy period.
0. We Will Pay
We will pay an amount equal to the benefits
that would be required of you as If you and
your employees were subject to the workers'
compensation law of any state shown In Item
S.A. of the Information Page. We will pay
those amounts to the persons who would be
entitled to them under the law.
C. Exclusion
This Insurance does not cover:
1. any obligation Imposed by workers'
compensation or occupational disease law
or any similar law.
2. bodily injury Intentionally caused or
aggravated by you.
3. officers or employees who have elected
not to be subject to the state workers'
compensation law.
4. partners or sole proprietors not covered
under the Standard Sole Proprietors,
Partners, Officers and Others Coverage
Endorsement.
D. Before We Pay
Before we pay benefits to the persons entitled
to them, they must:
1. Release you and us, In writing, of all
responsibility for the injury or death.
2. Transfer to us their right to recover from
others who may be responsible for the
injury or death.
3. Cooperate with us and do everything
necessary to enable us to enforce the right
to recover from others.
lip If the persons entitled to the benefits of this
Insurance fall to do those things, our duty to
pay ends at once. If they claim damages from
you or from us for the Injury or death, our duty
e to pay ends at once.
am
E. nacovery From Utther9
If we make a recovery from others, we will
keep an amount equal to our expenses of
recovery and the benefits we paid. We will
pay the balance to the persons entitled to It.
F rm WC 99 03 03 9 Printed In U.S.A. Ed. 8/00)
If the persons entitled to the benefits of this
insurance make a recovery from others, they
must reimburse us for the benefits we paid
them.
F. Employers' Liability Insurance
Part Two Employers' Liability Insurance)
applies to bodily Injury covered by this
endorsement as though the State of
Employment was shown In Item S.A. of the
Information Page.
This provision 5. does not apply In New. Jersey or
Wisconsin.
BAPLOYERS' LIABILITY STOP GAP COVERAGE
6. Employers' Liability Stop Gap Coverag
A. This coverage only applies In Montana, North
Dakota, Ohio, Washington, West Virginia and
Wyoming.
B. Part One Workers' Compensation Insurance)
does not apply to work In states shown In
Paragraph A above.
C. Part Two Employers' Liability Insurance)
applies In the states, shown In Paragraph A.,
as though they were shown In Item S.A. of the
Information Page.
D. Part Two, Section C. Exclusions is changed
by adding these exclusions.
This Insurance does not cover;
5. bodily Injury Intentionally caused or
aggravated by you or in Ohio bodily Injury
resulting from an act which is determined
by an Ohio court of law to have been
committed by you with the belief than an
Injury Is substantially certain to occur.
However, the cost of defending such
claims or suits in Ohio Is covered.
13. bodily Injury sustained by any member of
the flying crew of any aircraft.
14, any claim for bodily Injury with rospect to
which you are deprived of any defense or
defenses or are otherwise subject to
penalty because of default in premium
under the provisions of the workers'
compensation law or laws of a state
shown in Paragraph A.
E, This insurance applies to damages for which
you are liable under West Virginia Code Annot.
S 23-4-2.
Page3 fa
BIB]
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THE-U02
COMO-U02
&-U02
CSG-U02
CONSULTANTS,-U02
INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
AS107865-U03
AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
AGREEMENTS-U03
3/20/2012-U04
MARCELLAC-U04
17723-U05
1-U06
A.-U07
APPROVE-U07
AMENDMENT-U07
NO.-U07
5-U07
TO-U07
PROFESSIONAL-U07
SERVICES-U07
AGREEMENT-U07
NO.-U07
A-11957-U07
CALIFORNIA-U07
CODE-U07
CHECK,-U07
INC.-U07
194-RMA-U08
KAPWELL-U09
LORI-U09
KAPWELLL-U10
1/30/2012-U011
CCC)-U012
TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
ASSOCIATED-U012
PLAN-U012
CHECK,-U012
INSPECTION-U012
RELATED-U012
SERVICES-U012
TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$165,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$552,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
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APPROVE-U012
AMENDMENT-U012
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3-U012
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NO.-U012
A-12103-U012
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TO-U012
CONTINUE-U012
TO-U012
PROVIDE-U012
SERVICES-U012
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TO-U012
THE-U012
MONTEREY-U012
COUNTY-U012
BUILDING-U012
SERVICES-U012
DEPARTMENT,-U012
IN-U012
THE-U012
AMOUNT-U012
OF-U012
$105,000-U012
A-U012
TOTAL-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$307,446-U012
THROUGH-U012
JUNE-U012
30,-U012
2012;-U012
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THE-U012
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AGREEMENTS-U012
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SIGNIFICANTLY-U012
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OF-U012
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AMOUNTS.-U012
FULLY EXECUTED AGREEMENT, AME�� �EXTENDED OPTIONS
1. Empl yens' Liability Insurance
item 3.B. of the Information Page Is replaced by
the following:
B. Employers' Liability insurance:
1. Part Two of the policy applies to work in
each stale listed in Item M.
The Limits of Liability under Part Two are
the higher of;
Bodily Injury
by Accident $500,000
Bodily Injury
by Disease $500,000
Each Accident
Policy Limit
Bodily Injury
by Disease $500,000 Each Employee
OR
2. The amount shown In the Information
Page.
This provision 1 of EXTENDED OPTIONS does not
apply in New York because the Limits Of Our
Liability are unlimited.
In this provision the limits are changed from
$500,000 to $1,000,000 In California.
2. Untnt ntionai Failure to Disclose Hazards
If you unintentionally should fall to disclose all
existing hazards at the inception date of your
policy, we shall not deny coverage under this
policy because of such failure.
3. Waiver of Our Right To Recover From Others
A. 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
any person or organization for whom 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
agreement,
8. This provision S. does not apply In the slates
of Pennsylvania and Utah.
4. Foreign Voluntary Compensation and
Employers' Liability Reimbursement
A. How This Reimbursement Applies
This reimbursement provision applies to bodily
injury by accident or bodily Injury by disease.
Bodily Injury Includes resulting death.
1. The bodily Injury must be sustained by an
officer or employee.
2. The bodily Injury must occur in the course
of employment necessary or Incidental to
work In a country not listed In Exclusion
0.1. of this provision.
3. Bodily Injury by accident must occur
during the policy period,
4. Bodily Injury by disease must be caused
or aggravated by the conditions of your
employment, The officer or employee's
last exposure to those conditions of your
employment must occur during the policy
period.
S. We Will Reimburse
We will reimburse you for all amounts paid by
you whether such amounts are:
1, voluntary payments for the benefits that
would be required of you if you and your
officers or employees were subject to any
workers' compensation law of the state of
hire of the Individual employee.
2. sums to which Part Two Employers'
Liability Insurance) would apply If the
Country of Employment were shown In
item 3.A, of the Information Page.
C. Exclusions
This Insurance does not cover:
1. any occurrences In the United States,
Canada, and any country or jurisdiction
which Is the subject of trade or economic
sanctions imposed by the laws or
regulations of the United States of
America in effect as of the inception data
of this policy,
2. any obligation Imposed by a workers'
compensation or occupational disease
law, or similar law.
8. bodily injury Intentionally caused or
aggravated by you.
F nn WC 99 03 03 8 Printed in U.B.A. Ed. 0100) Page 4 f 6
BIB]
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C.-U012
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TO-U012
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THE-U012
AMENDMENTS-U012
TO-U012
THE-U012
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SERVICES-U012
AGREEMENTS-U012
FUTURE-U012
AMENDMENTS-U012
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FULLY EXECUTED AGREEMENT, AME�� �M
0
4. liability for any consequence, whether
direct or Indirect, of war, Invasion, act of
Foreign enemy, hostilities whether war be
declared or not), civil war, rebellion,
revolution, insurrection or military or
usurped power. No endorsement now or
subsequently attached to this policy shall
be construed as overriding or waiving this
limitation unless specific reference Is
made thereto.
D. Before We Pay
Before we reimburse you for the benefits to the
persons entitled to them, you must have them:
t. release you and us, In writing, of all
responsibility for the Injury or death,
2. transfer to us their right to recover from
others who may be responsible for their
Injury or death,
3. cooperate with us and do everything
necessary to enable us to enforce the right
to recover from others.
If the persons entitled to the benefits paid fall
to do these things, our duty to reimburse ends
at once. If they claim damages from us for the
M Injury or death, our duty to reimburse ends at
C
e
0
0
IBM"
e
once.
E. Recovery From Others
If we make a recovery from others, we will
keep an amount equal to our expenses of
recovery and the benefits we reimbursed. We
will pay the balance to the persons entitled to
It. If persons entitled to the benefits make a
recovery from others, they must repay us for
the amounts that we have reimbursed you.
F. Reimbursement for Actual Loss Sustained
This endorsement provides only for
reimbursement for the loss you actually
sustain. In order for you to recover loss or
expenses under this reimbursement you must:
1. actually sustain and pay the loss or
expense In money after trial, or
2. secure our consent for the payment of the
loss or expense.
G. Repatriation
Our reimbursement includes the additional
expenses of repatriation to the United States
F rm WC 99 03 03 8 Printed In U,S.A. Ed. 8100)
of America necessarily Incurred as a direct
result of bodily Injury.
Our reimbursement shall be limited as follows:
1. to the amount by which such expenses
exceed the normal cost of returning the
officer or employee if in good health, or
2. In the event of death, to the amount by
which such expenses exceed the normal
cost of returning the officer or employee if
alive and In good health.
In no event shall our reimbursement exceed
the bodily Injury by accident limit shown In
Item 3.9, of the information Page as respects
any one such officer or employee whether
dead or alive.
H. Endemic Disease
The word disease" Includes any endemic
diseases.
The coverage applies as If endemic diseases
were Included In the provisions of the workers'
compensation law.
6. Longshore and Harbor Workers' Compensaii n
Act Coverage
General Section C. Workers' Compensation
Law Is replaced by the following:
C. Workers' Compensation Law
Workers' Compensation Law means the
workers or workers' compensation law and
occupational disease law of each state or
territory named In Item 3.A, of the Information
Page and the Longshore and Harbor Workers'
Compensation Act 33 USC Sections 901-
950). It Includes any amendments to those
laws that are In effect during the policy period.
It does not include any other federal workers
or workers' compensation law, other federal
occupational disease law or the provisions of
any law that provide nonoccupatlonai disability
benefits.
Part Two Employers' Liability Insurance), C.
Exclusions, exclusion B, does not apply to
work subject to the Longshore and Harbor
Workers' Compensation Act.
This coverage does not apply to work subject
to the Defense Bass Act, the Outer
Continental Shelf Lands Act, or the
Nonapproprlated Fund Instrumentalities Act.
Page a of 6
BIB]
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CSG-U02
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INC.-U02
LI21329-U03
FO96183-U03
FO107762-U03
FO107838-U03
MG107839-U03
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AS107871-U03
AI109230-U03
DO110862-U03
C5-U03
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3/20/2012-U04
MARCELLAC-U04
17723-U05
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THROUGH-U012
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30,-U012
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FULLY EXECUTED AGREEMENT, AME�� �SECTION III
1. SCHEDULE OF COVERED STATES
A. This endorsement only applies in the states
listed in this Schedule of Covered States.
B. It a stale, shown In Item 3.A. of the Information
Page, approves this endorsement after the
effective date of this policy, this endorsement
will apply to this policy. The coverage will
apply in the new state an the effective date of
the stale approval.'
C. Schedule of Covered States:
CA
Countersigned by
Authorized Representative
F rm WC 99 03 03 B Printed in U.S.A. Ed. 8/00) Pan 6 Of 6
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