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HomeMy WebLinkAboutA7261 - NAI CONSULTING INC.ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) ~-07/15/2025 ,.......--., THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES N OT AFFI RMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE O F INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUT HORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL IN SURED, t he policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such e n dorsement(s). PRODUCER CONTACT Marsh Affinity NAME: PHONE 800·743-8130 l FAX Marsh Affinity (AJC , No, Ext): (AJC, No): a division of Marsh USA LLC. E-MAIL ADPTotalSource@marsh.com ADDRESS: PO BOX 14404 RECEIVED Des Moines, IA 50306-9686 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : AIU Insurance Company 19399 INSURED JUL 22 2025 INSURERB : ADP TolalSource DE IV , Inc. INSURERC: 5800 Windward Par1<way OFFICE OF THE CITY CLERK INSURERD : Alpharetta , GA 30005 L/C/F: INSURER E : Opterra Energy Services, LLC INSURER F: 35 NORTH LAKE AVE SUITE 900 PASADENA, CA 91101 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLI CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWITHSTANDING ANY REQUIREM ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF ICATE MAY BE ISSUED OR MAY PERTAIN, THE INS URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT IONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD L SUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS LTR INSD WVO (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -□ CLAI MS-MADE □occuR DAMAGE TO RENTED PREMISES (Ea oocurrence) $ -MED EXP (Any one person) $ -PERSONAL & ADV INJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s R POLICY □ j:c?T □ LOG PRODUCTS • COM P/OP AGG s OTHER s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s I (Ea accident) -ANY AUTO BODILY INJURY (Per person) s --O'IVNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS -HIRED 1--NON-OWNED PROPERTY DAMAGE $ -AUTOS ONLY -AUTOS ONLY [(Per accident) $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ -EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED I \ RETENTION S $ WORKERS CO MPENSATION X ls'fil'ruTE I le'R"" l>.NO EMPLOYERS' LIABILITY YIN ANYPROP RIETOR/PARTNER/EXECUTIVE !K] X E.L. EACH ACCIDENT s 2,000,000 A OFFICER/MEMBER EXCLUDED? NIA WC 063573883 CA 07/01/2025 07/0 1/2026 !Mandatory in NH) E.L. DISEASE · EA EMPLOYEE s 2,000 ,000 f yes, descrrbe under E.L. DISEASE· POLICY L IMIT s DESCRIPTION OF OPERATIONS belo,v 2 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) All worksile employees working for Oplerra Energy Services, LLC paid under ADP TOTALSOURCE, INC.'s payrol~ are covered under the above stated policy. See attached certificate holder notice of cancellation. Proprietor/Partner/Executive Officer/Member are not excluded as long as the~ are in the ADPTS payroll or have completed the SEI Participation Addendum. WAIVER OF SUB OGAllON IN FAVOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY Opterra Energy Services, LLC AS REQU IRED BY WRITTEN CONTRACT. RE:CN-001326 C ERTIFICATE HOLDER CANCELLAT ION City of Pa lm Springs 3200 E. Ta hquitz Canyon Way Palm Springs, CA 92263 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPR ESE NTATIVE ACORD 25 (2016 /03) The ACORD name and logo are regist ered marks o f ACORD rt~ BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT T his endo rseme nt changes t he policy to w hich it is attached effective on the inception date of the po licy unless a different date is indicated below. (The following "attaching clause" need be completed on ly when t his endorsement is issued subsequent to preparation of the policy). This endorsement, effective 07/01 /2025 12:01 AM Issued t o ADP TotalSource DE IV , Inc. 5800 Windward Parkway Alpharetta , GA 30005 UC /F: Opterra Energy Services , LLC 35 NORTI-t LAKE AVE SUITE 900 PASADENA , CA 9 1101 By AIU Insurance Company forms a part of Policy No . WC 06357388 3 CA We have a right to recover our payments f rom anyone liable for an injury covered by t hi s policy. We wi ll not enforce our right agai nst any person or organization with whom you have a written cont ract t hat requ ires you to obt ain this agreement from us, as regards any work you perform for such person or organization. T he additional premium for this endorsement shall be_% of the total estimat ed workers compe nsation premium for t his policy . A NY PERSON OR O RGANI ZATI O N TO W HOM YOU BECOME OBLI GATED TO WAIVE YOUR RIG HTS OF RECOVERY AGAINST , UNDER A NY CONTRACT OR AGREEMENT YOU ENTE R INTO PRIOR TO T HE OCCURREN CE OF LOSS WC 04 03 61 (Ed. 11 /90) Countersigned by----~---·_:_·~ ..... ' ____;c--,-,q;_' _________ _ Autho~ Representative TH IS ENDORSEMENT CHANG ES THE PO LI CY. PLEASE READ IT C AREFULLY. This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following" attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 07/15/2025 forms a part of Policy No. WC 0 63573 883 C A Issued to Opterra Ene rgy Service s, LLC By AIU Insurance Company LIMITED ADVICE OF CANCELLATION TO SCHEDULED ENTITIES (WORKERS ' COMPENS ATION ONLY ) This policy is amended as follows: In th e event that the In sure r cancels this policy for any reason other than non-payment of premium , and 1. the cancellation effective date is prior to t his policy's expiration date; 2. the Named Insured or, if applicable , any other employers named in Item 1 of the Information Page is under an existing contractual obligation to notify a certificate holder(s) when this policy is canceled (hereinafter, the "Certificate Holder(s)") and the Named Insu red has provided the Insu re r, either directly or through its broker of record , either: (a) the name of the entity shown on the certificate , a contact name at such entity and the U.S. Postal Service mailing address of each such entity; or (b) the email address of a contact at each such entity; and 3. prior to the effective date of cancellation , the Named Insured confirms to the Insure r, either d irectly or through its broker of record , t hat the persons or organizations set forth in the Schedule below, as well as their respective addresses listed, should continue to be a part of the Schedule and, if not, the names of the persons or organizations that should be deleted, the Insurer will provide advice of cancellation (the "Advice") to each such Certificate Holder(s) confirmed by the Name d In sured in writin g to be correctly a part of the Schedule within 30 days after the Named Insured confirms the accuracy of the Schedule below with the Insurer; provided , however, that if a specific number of days is not stated above , then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the Nam ed Insured confirms the accuracy of the Schedule below with the In sure r. Proof of the In surer emailing the Advice , using the information provided and subsequently confirmed by the Named Insured in writing, will serve as proof that the Ins ure r has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cance llation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The f ollowing definitions apply to this endorsement: 1. Named In su red means the first named employer in Item 1 of the Information Page of this pol icy. 2. Ins urer means the insurance company shown in the header on the Information Page of this policy. W C 99 00 58 (Ed . 04/1 1) Page 1 of 2 SCHEDULE NAME OF PERSON OR ORGANIZATION City of Palm Springs All other tenns. conditions and exclusions sha ll remain the same. WC 99 00 58 (Ed. 04/11) Page 2 of 2 E -MAIL OR U .S POSTAL SERVICE ADDRESS 3200 E. Tahquitz Canyon Way Palm Springs, CA 92263 AUTHORIZED REPRESENTATIVE ~ /Oess NAICONS•01 2J712024 °"'2'' /2024 , 66 � o CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the tennis 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 andorsema s . PRoo . Llcerree a 0757776 c TACT To Delgado HUB International Insurance Services Inc. 75030 Gerald Ford Drive Suite 201 RECEIVED NE e : (760) 36"700 4261 FAAAz: aP.(760) 360 -0717 IMs, tona.daigado@hubinternational.com Palm Desert, CA 92211 JUL 16 2024 a asualty NACa RERA:ContinentelCaswl Company 20443 INSURED INSAIRERB:Hanover Insurance Company 22292 N RERc: NAIConsulting, InDFFICE OF THE CITY CLERK 689S5 Adelina Road INSURER 0: Cathedral City, CA 92234 N NSUIEII F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP 2/29/2026 LIMA A X COMMERCIALOENERALLIA ILITI CLAIMS�MADE I A OCCUR X B 4017307305 2J2812D24 EACH OCCURRENCE S 2,000,000 DAMAGE TO RENTED MED EXP o 300,000 10,000 PERSIONAL&ADVINJURY 2,000,000 GENL AGGREGATE LIMIT APPLIES PER X POLICY j Oj O LOC OTIER GENERAL AGGREGATE S 4,000,000 PRODUCTS _ CONPIOP AGO 4,000,000 BLKT ADDL INSUR Included A AUTOMOBLELIABa ANY AUTO GAPED SCHEDULED (AUTOS ONLYMIAUUTTO{$ �.NEp MROS ONLY AUTOS ONLY B 4017307305 2/2812024 212812025 Cp INEDSINGLEUMR S 1,1)00,000 BODILY INJURY Par S Ix 8001 Y Y Pe�ERT rMMAGE UMBRELLA LIAB lIIOlSS LIAR OCCUR CIAIMS4AADE EACH Poi 1 AGGREGATE S DED RETENTIONS 'ATORI(ERSCOMPENSATION AND ta1ROYl113' LIABILITY Y I N ANY PROPmETCRPARTWR,EXECUTNE ❑ pFFI(EAMIEMBER EXCLUDEO9 1Wy1In FFund m. aml0a cedar DESCRIPTION T N/A PER TH. E.L. EACHACCIDENT E 1. EA EMPLOY V LIMIT B B Professional Llab Professional Liab. LH3690054614 LH3890OS4614 111112023 11111112023 11N/2025 111"112025 Each Claim Aggregate 2,000,000 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AOYXIonri Ramanu Sc1wd^ mrY a M~ Y mon aWcr Is,agWaa) The City of Palm Springs, its officials, employees and agents are named as additional insured as respect City of Palm Springs Contract No. 2019-03. This insurance Is primary and non contributory over any Insurance the City may have as respects City of Palm Springs contract No. 2019.03.. 30 day notice of cancellation, 10 day for nonpayment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Paint Springs Attn: Engineering Services Department CE WILL BE DELIVERED IN THE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS. 3200 E. TahqultE Canyon Way AUTtMIZEDD REPRESENTATIVE7 1%0 Y Palm Springs, CA 92262 ACORD 25 (2018f03) 0 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA SB-146932-E (Ed. 06111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed, because of a wdtten contract or ,agreement to provide insurance, but only with respect to "bodily Injury' or "property damage" arising out of your.products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional ekciUsions: ' 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor Is obligated to pay damages by reason of the assumption of liability In a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have In the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; - e; Any failure to make such inspections, Adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installatian, servicing or repair operations, except such operations performed at the vendors premises in connection with the sale of the product; g. Products which, after disMbution or sale by you, have been labeled or relabeled or used as a container, part or Ingredient of any other thing or substance by or for the vendor; or It. "Bodily Injury' or "property damage arising out of the sole negligence of the vendor for Its own acts or omission or those of Its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. orf.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, In connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2, does not apply If "bodily injury" or "Property damage" included within the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. 2. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs 2.a. through 2.1h. below whom you are required to add as an additional insured on this policy under a written contract or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy, and 2. Executed prior to the "bodily injury," "property damage" or "personal and advertising injury," but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. Additional Insured —Your Work That person or organization for whom you do work is an additional insured solely for Ilability, SB-146932-E Page 1 of 5 (Ed. 06111) CAM SS-146932-E (Ed. 06111) due -to your negligence specifically resulting This insurance does not apply to "bodily from your work for the additional insured _injury, °property, damage" or "personal and which is the subject of the written, contract or advertising injury' arising out of operations written agreement. No coverage applies to performed for the state or municipality. liability resulting from the sole negligence of c C. Controlling Interest the additional insured. The insurance provided to the additional Any persons or organizations with a insured is limited as follows: controlling interest in you but only with respect to their liability arising out of: (1) The Limits of Insurance applicable to the additional insured are those specified In (1) Their financial control of you; or the written contract or written agreement (2) Premises they own, maintain or control or In the Declarations of this policy, while you lease or occupy these whichever is less. These Limits of premises. Insurance are inclusive of, and not In addition to, the Limits of Insurance shown This insurance does not apply to structural In the Declarations. alterations, new construction and demolition operations performed by or for such additional (2) The coverage provided to the additional insured. insured by this endorsement.: and . paragraph F:9. of the definition of "insured d. Managers or Lessors of Premises contract under Liability and Medical A manager or lessor of premises but only with Expenses Definitions do not apply to respect to liability arising out of the ownership, "bodily Injury" or "property damage" maintenance or use of that specific part of the arising out of the "products -completed premises leased to you and subject to the operations hazard" unless required by the following additional exclusions: written contract or written agreement. This insurance does not apply to: (3) The insurance provided'to the additional insured does not apply to °bodily Injury," (1) Any "occurrence' which takes place after "property damage,, or "personal and you cease to be a tenant in that premises; advertising Injury' arising out of the or rendering or failure to render any (2) Structural alterations, new construction or professional services. demolition operations performed by or on b. State or Political Subdivisions behalf of such additional insured. A state or political subdivision subject to the e. Mortgagee, Assignee or Receiver y; following provisions: A mortgagee, assignee or receiver but only (1) This insurance applies only with respect with respect to their liability as mortgagee, - to the following hazards for which the assignee, or receiver and arising out of the _ state or political subdivision has issued a ownership, maintenance, or use of a premises by permit in connection with premises you you. own, rent, or control and to which this This insurance does not apply to structural insurance applies: alterations, new construction or demolition (a) The existence, maintenance, repair, operations performed by or for such additional construction, erection, or removal of insured. e advertising signs, awnings, canopies, f. Owners/Other Interests - Land Is Leased en cellar entrances, coal holes, driveways, manholes, marquees, An owner or other interest from whom land hoistaway openings, sidewalk vaults, has been leased by you but only with respect street banners, or decorations and to liability arising out of the ownership, B simi ar exposures; or maintenance or use of that specific part of the c {b) The construction, erection, or land leased to you and subject to the following ® removal of elevators; or additional exclusions: e (2) This insurance applies only with respect This insurance does not apply to: to operations performed by you or on your (1) Any "occurrence" which takes place o behalf for whit_ h the state or political after you cease to lease that land; or subdivision.has issued a permit. SB-146932-E Page 2 of 5 (Ed. 06/11) CAA (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. g. Co-owner of Insured Premises A co-owner of a premises co -owned by you and coveredunder this insurand but only with respect to the co -owners liability as co- owner of such premises. h. Lessor of Equipment Any person or organization from -whom you lease equipment. Such person or organization are insureds only with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their written contract or agreement with you for such leased equipment ends. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: This insurance does not apply: (1) To any "occurrence" which takes place after the equipment lease expires; or ' (2) To "bodily injury, 'property damage" or "personal and advertising injury' arising out of the sole negligence of such additional insured. Any insurance provided to an additional insured designated under paragraphs b, through h. above does not apply to "bodily InJury' or "property damage" included within the "products -completed. operations hazard." 3. The following is added to Paragraph H. of .the BUSINESSOWNERS COMMON POLICY CONDITIONS; H. Other Insurance 4. This insurance is excess over any other insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. 4. .LEGAL LIABILITY —DAMAGE TO PREMISES A. Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. SB-146932-E (Ed. 06l11) Damage To Property, is replaced by the following: k., Damage To Property 'Property damage to: 1. Property you own, rent or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement enhancement, restoration or maintenance of such property for any reason, including prevention of Injury to a person or damage to anther's property; 2. Premises you sell, give away or abandon, if the "property damage" arises out of any part of those premises; 3. Property loaned to you; 4. Personal property. In the care, custody or control of the insured; S. That particular part of any real property on which you or any contractors or subcontractors working directly or indirectly In your behalf are performing operations, if the "property damage" arises out of those operations; or 6. That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraph 2 of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs 1, 3, and 4, of this exclusion do not apply to "property damage" (other than damage by fire or explosion) to premises: (1) rented to you: (2) temporarily occupied by you with the permission of the owner, or (3) to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section D — Liability and Medical Expenses Limits of Insurance. SB-146932-E Page 3 of 5 (Ed. 06111) CNA Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included In the "products -completed operations hazard." B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last paragraph of 2. Exclusions is deleted and replaced by the following: Exclusions c, d, e, f, g, h, 1, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described In Section D. Liability And Medical Expenses Limits Of Insurance. C. The first Paragraph under item S. Damage To Premises Rented To You Limit of Section D. Liability And Medical Expenses Limits Of Insurance Is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you, or temporarily occupied by you, with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days. is the Damage to Premises Rented to You limit shown in the Declaration. xi 5, Blanket Waiver of Subrogation We waive any right of recovery we may have a against: a a. Any person. or organization with whom you have a written contract that requires such a waiver. 6. Broad Knowledge of Occurrence im The following items are added to E. ® Businessowners General Liability Conditions In the Businessowners Liability Coverage ® Form: e. Paragraphs a, and b. apply to you or to any additional insured only when such "occurrence; offense, caim or "suit" is known to: C Q (1) You or any additional insured that is an individual; a SB-146932-E (Ed. 06111) (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any 'executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Airy trustee, if you or an additional insured is a trust;.or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e, applies separately to you and any additional insured. 7. Bodily Injury Section F. Liability and Medical Expenses Definitions, item 3. "Bodily Injury" Is deleted and replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental Injury by that person at any time which results as a consequence of the bodily Injury, sickness or disease. 8. Expanded Personal and Advertising Injury Definition a. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, in the Businessowners General .Liability Coverage Form: h. Discrimination or humiliation that results in Injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: 1. Not done intentionally by or at the direction of: a. The insured; or b. Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2. Not directly or Indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. b. The following Is added to Exclusions, Section B.: SB-146932-E (Ed. 06111) Page 4 of 5 SB-146932-E CAM -(Ed. 06111) (15)Discrimination Relating to Room, Personal and Advertising, Injury Liability is Dwelling or Premises excluded either by the provisions of the Policy Caused . by discrimination directly . or or by endorsement. indirectly related to the sale, rental,'lease 9. Personal and Advertising Injury Redefined or sublease or prospective sale, rental, Section F. Liability and Medical Expenses lease or sublease of any room, dwelling Definitions, item 14, Personal Advertising Injury, or premises by or at the direction of any Paragraph c. is replaced by the following: insured. (16J Fines or Penalties c. The wrongful eviction from, wrongful entry Into, or invasion of the right of private Fines or penalties levied or imposed by a occupancy of a room dwelling or premises governmental entity because of that a person or organization occupies discrimination. committed by or on behalf of irs owner, c. This provision (Expanded Personal and landlord or lessor. Advertising Injury) does not apply if SB-146932-E Page 5 of 5 (Ed. 06111) ACOR" CERTIFICATE OF LIABILITY INSURANCE Ill DATE (024 YYYIT os/aerzoza THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rightsto the certificate holder in lieuof such endorsement(s). PRODUCER NAMEOT Marsh Affinity Affinity PHOMarsh A/C No, Exit: 800-7438130 AfC, No: ADDAIL RESS: AOPTolal5oulceQmarsh.com a division of Marsh USA LLC PO BOX 14404 Des Moines, IA 50306-9686 INSURER(S) AFFORDING COVERAGE NAIL# INSURER A: AIU Insurance Company 19399 INSURED INSURER B: INSURER C: ADP TulalSource DE IV, Inc. INSURER D: 6800 Windward Parkway Alpharetta, GA 30005 UC/F: INSURER E: INSURER F: NAI CONSULTING, INC. 68955 Adelina Rd Cathedral City, CA 92234 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CR 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. RISK LTR TYPEOFINSURANCE ADDLSUBR INSD WVD pOUCY NUMBER POLICYEFF (MMIDDNYYY) POLICY EXP (MWDDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS -MADE ❑OCCUR DAMAGE TOR PREMISES ISa ocourtea, S MED EXP (Anyone person) $ PERSONAL B ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PROT �LOC POLICY n PRODUCTS-COMP/OP AGO 8 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) S ANY AUTO BODILY INJURY (Per accident) S OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTYDAMAGE Peraccident S HIRED NON -OWNED AUTOS ONLY nAUTOS ONLY S UMBRELLA LIAR OCCUR EACH OCCURRENCE S AGGREGATE S EXCESSLIAS CLAIMS -MADE LIED, I IRErENTIONS S WORKERS CO M PENSATION AND EMPLOYERS'LIABILITY YIN X STATUTE ER EL. EACH ACCIDENT S 2,000.000 A ANYPROPRIETOPoPARTNITUEXECUTNE OFFICER/MEMBER EXCLUDED? ❑ 1Mandatory in NH) ffEyes. CRIPTIONantler DESCRIPTION under OPERATIONS below WA X WC 0a8414833 CA 07/01/2024 07/01/2025 EL DISEASE -EA EMPLOYEE S 2,DO0,000 E.L. DISEASE -POLICY LIMIT S 2000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AB worksite employees working for NAI CONSULTING. INC. paid underADP TOTALSOURCE, INC.'s payroll, are covered under the above stated poll cy WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY NAI CONSULTING, INC. AS REQUIRED BY WRITTEN CONTRACT. RE: Contract#: 2024-01 CERTIFICATE HOLDER UANULLLAI IUIN City of Palm Springs ATM: City Manager SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3200 E. Tahquitz Canyon Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Palm Springs. CA 92262 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed ,only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 07/01/2024 12:01 AM forms a part of Policy No. WC 088414833 CA Issued to . ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 UC/F: NAI CONSULTING, INC. 68955 Adelina Rd Cathedral City, CA 92234 By AIU Insurance Company We have a 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 with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be _% of the total estimated workers compensation premium for this policy. ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACTOR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS WC 04 03 61 Countersigned by (Ed. 11/90) Authorized Representative NAICONS-01 TDELGAD DATE)MMIDD/YYYY) 10/26/2023 ACORO" CERTIFICATE OF LIABILITY INSURANCE A-72,6 ( THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER License # 0757T76 CONTACT Tona Delgado NAME: HUB International Insurance Services Inc. PHONE No, F,p: (760) 360�7004251 FAI�C,Ha:(750) 360-0717 75030 Gerald Ford Drive EMAIL Suite 201 ADDRESS, tona.delgado@hubintemational.com Palm Desert, CA 92211 INSUREPAS) AFFORDING COVERAGE NAN:$ INSURERA: Continental Casualty Company 20443 INSURED INSURER B: Hanover Insurance Company 22292 INSURER C : NAI Consulting, Inc. INSURER D : 68955 Adelina Road Cathedral City, CA 92234 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSO SUER MD POLICY NUMBER POUCY EFF POLICY EXP-1.111 LIMITS A COMMERCNLGENERAL LIABILITY EACH OCCURRENCE s 2,000,000 CWMS-MADE X OCCUR X 134017307305 2128/2023 2/28/2024 DAMAGE TO RENTED PREMISES fraoccuirencelMED s 300,000 rX EXP Any nne arson $ 10,000 PERSONAL a ADV INJURY s 2'000'000 GENT AGGREGATE pLRIM�pIT. APPLIES PEfU X POLICY �X JECT flLOC GENERAL AGGREGATEF$- PRODUCTS -COMP/OP AGOTHER. BLKT ADDL INSURA AUTOMOBILE LIABILITY COMBINMa dED SINGLE LIMITANYAUTOB BODILY INJURY Per 4017307305 2/28/2023 2/28/2024 AURTEO�ES ONLYAU��TN�.IO�{S1WyUyNN�EEDpBODILY INJURY Per aodde Pe�ad�ent X AUTOS ONLY X AUTOSONLY UMBRELLA UAS OCCUR EACH OCCURRENCE $ AGGREGATE s EXCESSL CLAIMSMADE DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ )Mzndalcayln NHR ExClU0ED9 NIA ER OTH- PER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE R yes, descnbe wder DESCRIPTION OF OPERATION IaHaw E.L. DISEASE -POLICY LIMIT B Professional Liab LH3890054614 11/112023 11/1/2025 Each Claim 2,000,000 B Professional Liab. LH3890054614 11/1/2023 11MI2025 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (ACORD 101, Additlonel Remarks Schedule, may Iro atlached R more apace is required) The City of Palm Springs, its officials, employees and agents are named as additional Insured as respect City of Palm Springs Contract No. 2019-03. This Insurance is primary and non contributory over any Insurance the City may have as respects City of Palm Springs contract No. 2019-03.. 30 day notice of cancellation, 10 day for nonpayment of premium RECEIVED ' �JCT 3 0 �__:. rity Hall City of Palm Springs Attn: Engineering Services Department 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A}UT^MOWE/D REPRESENTATIVE UT v _ '_e,xz-- ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA SB-146932-E (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED —BLANKET VENDORS WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed, because of a written contract or agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omission or those of its employees or anyone else acting on Its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if "bodily injury" or "property damage" included within the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. 2. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs 2.a. through 2.h. below whom you are required to add as an additional insured on this policy under a written contract or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy, and 2. Executed prior to the "bodily Injury," "property damage" or "personal and advertising Injury," but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. Additional Insured —Your Work That person or organization for whom you do work is an additional insured solely for liability SB-146932-E (Ed.06/11) Page 1 of 5 CNA SB-146932-E (Ed. 06/11) due to your negligence specifically resulting from your work for the additional insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional insured. The insurance provided to the additional insured is limited as follows: (1) The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the Declarations. (2) The coverage provided to the additional insured by this endorsement and paragraph F.9. of the definition of "insured contract" under Liability and Medical Expenses Definitions do not apply to "bodily injury" or "property damage" arising out of the "products -completed operations hazard" unless required by the written contract or written agreement. (3) The insurance provided to the additional insured does not apply to "bodily injury," "property damage," or "personal and advertising Injury" arising out of the rendering or failure to render any professional services. b. State or Political Subdivisions A state or political subdivision subject to the following provisions a (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or C (2) This insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. This insurance does not apply to "bodily injury," "property damage" or "personal and advertising injury' arising out of operations performed for the state or municipality. c. Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. d. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. e. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. f. Owners/Other Interests — Land is Leased An owner or other interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions. This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to lease that land; or SB-146932-E (Ed. 06/11) Page 2 of 5 SB-146932-E CNA (Ed. 06/11) (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition operations following: performed by or on behalf of such k. Damage To Property additional insured. g. Co-owner of Insured Premises "Property damage" to: A co-owner of a premises co -owned by you 1. Property you own, rent or occupy, and covered under this insurance but only including any costs or expenses incurred by you, or any other person, with respect to the co -owners liability as co- organization or entity, for repair, owner of such premises. replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such Any person or organization from whom you property for any reason, including prevention Injury a person or lease equipment. Such person or organization damage to an other's property; are insureds only with respect to their liability arising out of the maintenance, operation or 2. Premises you sell, give away or use by you of equipment leased to you by abandon, if the "property damage" such person or organization. A person's or arises out of any part of those organization's status as an insured under this premises; endorsement ends when their written contract 3. Property loaned to you; or agreement with you for such leased equipment ends. 4. Personal property in the care, With respect to the insurance afforded these custody or control of the insured; additional insureds, the following additional 5. That particular part of any real exclusions apply: property on which you or any This insurance does not apply: contractors or subcontractors working directly or indirectly in your behalf are (1) To any "occurrence" which takes place performing operations, if the "property after the equipment lease expires; or damage" arises out of those (2) To "bodily injury," "property damage" or operations; or "personal and advertising Injury" arising 6. That particular part of any property out of the sole negligence of such that must be restored, repaired or additional insured. replaced because "your work" was Any insurance provided to an additional insured incorrectly performed on it. designated under paragraphs b. through h. above Paragraph 2 of this exclusion does not does not apply to "bodily injury" or "property apply if the premises are "your work" and damage" included within the "products -completed were never occupied, rented or held for operations hazard." rental by you. 3. The following is added to Paragraph H. of the Paragraphs 1, 3, and 4, of this exclusion BUSINESSOWNERS COMMON POLICY do not apply to "property damage" (other CONDITIONS: than damage by fire or explosion) to H. Other Insurance premises: 4. This insurance is excess over any other (1) rented to you: insurance naming the additional insured (2) temporarily occupied by you with the as an insured whether primary, excess, permission of the owner, or contingent or on any other basis unless a (3) to the contents of premises rented to written contract or written agreement you for a period of 7 or fewer specifically requires that this insurance be consecutive days. either primary or primary and A separate limit of insurance applies to noncontributing. Damage To Premises Rented To You as 4. LEGAL LIABILITY— DAMAGE TO PREMISES described In Section D — Liability and A. Under B. Exclusions, 1. Applicable to Medical Expenses Limits of Insurance. Business Liability Coverage, Exclusion k. SB-146932-E Page 3 of 5 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the "products -completed operations hazard." B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last paragraph of 2. Exclusions is deleted and replaced by the following: Exclusions c, d, e, f, g, h, 1, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. C. The first Paragraph under item 5. Damage To Premises Rented To You Limit of Section D. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you, or temporarily occupied by you, with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You limit shown in the Declaration. S. Blanket Waiver of Subrogation We waive any right of recovery we may have s against: a. Any person or organization with whom you have a written contract that requires such a waiver. 6. Broad Knowledge of Occurrence The following items are added to E. Businessowners General Liability Conditions in the Businessowners Liability Coverage Form: e. Paragraphs a. and b. apply to you or to any additional insured only when such occurrence," offense, claim or "suit' is known to: (1) You or any additional insured that is an individual; (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e. applies separately to you and any additional insured. 7. Bodily Injury Section F. Liability and Medical Expenses Definitions, item 3. "Bodily Injury" is deleted and replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily Injury, sickness or disease. 8. Expanded Personal and Advertising Injury Definition a. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, in the Businessowners General Liability Coverage Form: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: 1. Not done intentionally by or at the direction of: a. The insured; or b. Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2. Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. b. The following is added to Exclusions, Section B.: SB-146932-E (Ed. 06/11) Page 4 of 5 ��a SB-146932-E (Ed. 06/11) (15)Discrimination iftlating to Room, Personal and Advertising Injury Liability is Dwelling or Premises excluded either by the provisions of the Policy Caused by discrimination directly or or by endorsement. indirectly related to the sale, rental, lease 9. Personal and Advertising Injury Redefined or sub -lease or prospective sale, rental, Section F. Liability and Medical Expenses lease sublease any room, dwelling Definitions, item 14, Personal Advertising Injury, insured.premises Paragraph c. is replaced by the following: (16)Fines or Penalties c. The wrongful eviction from, wrongful entry into, or invasion of the right of private Fines or penalties levied or imposed by a occupancy of a room dwelling or premises governmental entity because of that a person or organization occupies discrimination. committed by or on behalf of it's owner, c. This provision (Expanded Personal and landlord or lessor. Advertising Injury) does not apply if SB-146932-E Page 5 of 5 (Ed. 06/11) NAICONS-01 TDELGA ACORO CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 21712024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 CONTACT Tona Delgado NAME FAX HUB International Insurance Services Inc. PHONE 75030 Gerald Ford Drive (A/c. No. E:t): (760) 360-4700 4251 (A/c, No):(760) 360-0717 Suite 201 AD RE ; tona.delgado@hubinternational.com Palm Desert, CA 92211 INCIIRFRICI aFFnRINNG COVERAGE NAIC i# INSURED NAI Consulting, Inc. 68955 Adelina Road Cathedral City, CA 92234 e roc !`CDTICIr`ATC AIIIMRCR• R A: Continental Casual R B: Hanover Insurance RC: INSURER F : REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMI IYYYY POLICY EXP MM/DD/YY Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS -MADE � OCCUR X B 4017307305 2/28/2024 2/28/2025 PREMtSESDAMAGE TO RENToccED rren S 300,000 10,000 MED EXP (An one person)S 2,000,000 PERSONAL & ADV INJURY $ 4,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S PRODUCTS - COMP/OPAGG S 4,000,000 X POLICY F_x1 PEA LOC BLKT ADDL INSUR Included OTHER I S COMBINED S INGLE LIMIT Ea accident 1,000,000 $ A AUTOMOBILE LIABILITY BODILY INJURY Perperson) S ANY AUTO B 4017307305 2/2812024 2/28/2025 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ X HIRED X NON -AWNED AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED I I RETENTIONS S PER OTH- WORKERS COMPENSATION TAT ER AND EMPLOYERS' LIABILITY YIN AApNY PROPRIETOR/PARTNER/EXECUTIVE C E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (MFandatory in NHj EXCLUDE[ ? ❑ N / A E.L. DISEASE -POLICY LIMIT $ If yes describe under DESCRIPTION OF OPERATIONS below B Professional Liab LH3890054614 11/1/2023 11/1/2025 Each Claim 2,000,000 B Professional Liab. LH3890054614 11/1/2023 11/1/2025 Aggregate 4,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Palm Springs, its officials, employees and agents are named as additional Insured as respect City of Palm Springs Contract No. 2019-03. This q r Vtibmay have as respects City of Palm Springs contract No. 2019-03. . 30 day notice of insurance is primary and non contributory over any RIM cancellation, 10 day for nonpayment of premium j I j ��// F-EB 2 2 2024 City Hall CERTIFICATE HOLDER I "" " . L A1Nt LLLA I Ivry City of Palm Springs Attn: Engineering Services Department 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CURHURA I IUN. An rignis reservea. The ACORD name and logo are registered marks of ACORD Y 1 CHA SB-146932-E (Ed. 06111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED —BLANKET VENDORS WHO IS AN INSURED is amended to include as an additional insured any person or organization (referred to below as vendor) with whom you agreed, because of a written contract or agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. "Bodily injury' or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its SB-146932-E (Ed. 06111) own acts or omission or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Subparagraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 3. This provision 2. does not apply to any vendor included as an insured by an endorsement issued by us and made a part of this Policy. 4. This provision 2. does not apply if "bodily injury" or "property damage" included within the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. 2. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED is amended to include as an insured any person or organization (called additional insured) described in paragraphs 2.a. through 2.h. below whom you are required to add as an additional insured on this policy under a written contract or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily injury," "property damage" or "personal and advertising injury," but Only the following persons or organizations are additional insureds under this endorsement and coverage provided to such additional insureds is limited as provided herein: a. Additional Insured —Your Work That person or organization for whom you do work is an additional insured solely for liability Page 1 of 5 I SB-146932-E CHA (Ed. 06/11) (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition operations following: performed by or on behalf of such k. Damage To Property additional insured. g. Co-owner of Insured Premises "Property damage" to: A co-owner of a premises co -owned by you 1. Property you own, rent or occupy, including any costs or expenses and covered under this insurance but only incurred by you, or any other person, with respect to the co -owners liability as co- organization or entity, for repair, owner of such premises. replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such property for any reason, including An person or organization from whom you Y Pe r9 y prevention of injury to a person or lease equipment. Such person or organization damage to another's property; are insureds only with respect to their liability arising out of the maintenance, operation or 2. Premises you sell, give away or use by you of equipment leased to you by abandon, if the "property damage" such person or organization. A person's or arises out of any part of those organization's status as an insured under this premises; endorsement ends when their written contract 3. Property loaned to you; or agreement with you for such leased equipment ends. 4. Personal property in the care, custody or control of the insured; With respect to the insurance afforded these additional insureds, the following additional 5. That particular part of any real exclusions apply: property on which you or any contractors or subcontractors working This insurance does not apply: directly or indirectly in your behalf are (1) To any "occurrence" which takes place performing operations, if the "property after the equipment lease expires; or damage" arises out of those operations; or 2 To "bodily injury," "pro ert damage" or "personal and advertising injury" arising 6. That particular part of any property out of the sole negligence of such that must be restored, repaired or additional insured. replaced because "your work" was incorrectly performed on it. Any insurance provided to an additional insured designated under paragraphs b. through h. above Paragraph 2 of this exclusion does not does not apply to "bodily injury" or "property apply if the premises are "your work" and damage" included within the "products -completed were never occupied, rented or held for operations hazard." rental by you. 3. The following is added to Paragraph H. of the Paragraphs 1, 3, and 4, of this exclusion BUSINESSOWNERS COMMON POLICY do not apply to "property damage" (other CONDITIONS: than damage by fire or explosion) to premises: H. Other Insurance (1) rented to you: 4. This insurance is excess over any other (2) temporarily occupied you with the insurance naming the additional insured permission of the owner, or as an insured whether primary, excess, contingent or on any other basis unless a (3) to the contents of premises rented to written contract or written agreement you for a period of 7 or fewer specifically requires that this insurance be consecutive days. either primary or primary and A separate limit of insurance applies to noncontributing. Damage To Premises Rented To You as 4. LEGAL LIABILITY — DAMAGE TO PREMISES described in Section D — Liability and Medical Expenses Limits of Insurance. A. Under B. Exclusions, 1. Applicable to Business Liability Coverage, Exclusion k. SB-146932-E Page 3 of 5 (Ed. 06111) r , . --6.'rri.. CHA SB-146932-E (Ed. 06/11) Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph 6 of this exclusion does not apply to "property damage" included in the "products -completed operations hazard." B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last paragraph of 2. Exclusions is deleted and replaced by the following: Exclusions c, d, e, f, g, h, I, k, I, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. C. The first Paragraph under item 5. Damage To Premises Rented To You Limit of Section D. Liability And Medical Expenses Limits Of Insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you, or temporarily occupied by you, with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Premises Rented to You limit shown in the N Declaration. h 5. Blanket Waiver of Subrogation o We waive any right of recovery we may have against: a o a. Any person or organization with whom you have a written contract that requires such a waiver. 6. Broad Knowledge of Occurrence _. The following items are added to E. Businessowners General Liability Conditions in the Businessowners Liability Coverage Form: e. Paragraphs a. and b. apply to you or to any additional insured only when such "occurrence," offense, claim or "suit' is known to: (1) You or any additional insured that is an individual; SB-146932-E (Ed. 06/11) (2) Any partner, if you or an additional insured is a partnership; (3) Any manager, if you or an additional insured is a limited liability company; (4) Any "executive officer" or insurance manager, if you or an additional insured is a corporation; (5) Any trustee, if you or an additional insured is a trust; or (6) Any elected or appointed official, if you or an additional insured is a political subdivision or public entity. This paragraph e. applies separately to you and any additional insured. 7. Bodily Injury Section F. Liability and Medical Expenses Definitions, item 3. "Bodily Injury" is deleted and replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 8. Expanded Personal and Advertising Injury Definition a. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, in the Businessowners General Liability Coverage Form: h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is: 1. Not done intentionally by or at the direction of: a. The insured; or b. Any "executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the insured; and 2. Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any insured. b. The following is added to Exclusions, Section B.: Page 4 of 5 CNA SB-146932-E (Ed. 06/11) (15) Discrimination Relating to Room, Dwelling or Premises Caused by discrimination directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured. (16) Fines or Penalties Fines or penalties levied or imposed by a governmental entity because of discrimination. c. This provision (Expanded Personal and Advertising Injury) does not apply if SB-146932-E (Ed. 06111) Personal and Advertising Injury Liability is excluded either by the provisions of the Policy or by endorsement. 9. Personal and Advertising Injury Re -defined Section F. Liability and Medical Expenses Definitions, item 14, Personal Advertising Injury, Paragraph c. is replaced by the following: c. The wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of it's owner, landlord or lessor. Page 5 of 5 AC<:)RL> CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDYYIY) 05106/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh Affinity Marsh Affinity PHONE 800-743-8130 FAX A/C, No, Ex[): AIC, No E-MAIL ADPTota lSource@marsh.com ADDRESS: a division of Marsh USA LLC. INSURERS) AFFORDING COVERAGE NAIC # PO BOX 14404 Des Moines, IA 50306-9686 INSURER A: AIU Insurance Company 19399 INSURED INSURER B : INSURER C : ADP TotalSource DE IV, Inc. INSURER D: 5800 Windward Parkway INSURER E : Alpharetta, GA 30005 UC/F: INSURER F: NAI CONSULTING, INC. 68955 ADELINA RD Cathedral City, CA 92234 ^^WCDAnce f`FRTICI(:ATF NIIMF2FR• 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 TYPEOFINSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICYEFF (MM/DDIYYYY) POLICYEXP (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE ❑OCCUR DAMAGETO occurrRENTED PREMISESSence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY ❑ PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB H CLAIMS -MADE DED I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? ( Mandatory in NH) f yes, describe under DESCRIPTION OF OPERATIONS below NIA x WC 034219474 CA 07/01/2023 07/01/2024 PER 7 X STATUTE ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE -EA EMPLOYEE $ 2.000.000 E.L. DISEASE -POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) WAIVER OF SUBROGATION IN FAVOR OF CERTIFICATE HOLDER AS RESPECTS OF JOB PERFORMED BY NAI CONSULTING, INC. AS REQUIRED BY WRITTEN CONTRACT.AII worksite employees working for NAI CONSULTING, INC., paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. Contract No. 2019-03 CPRTIFIRATF NAI I'1FR CANCELLATION City of Palm Springs 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262 26 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPOFWION. All rights reserved. The ACORD name and logo are registered marks of ACORD )UR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 07/01/2023 12:01 AM Issued to ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alppharetta, GA 30005 L/C/F: NAI CONSULTING, INC. 68955 ADELINA RD Cathedral City, CA 92234 By AIU Insurance Company forms a part of Policy No. WC 034279474 CA We have a 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 with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be _% of the total estimated workers compensation premium for this policy. ANY PERSON OR ORGANIZATION TO WHOM YOU BECOME OBLIGATED TO WAIVE YOUR RIGHTS OF RECOVERY AGAINST, UNDER ANY CONTRACT OR AGREEMENT YOU ENTER INTO PRIOR TO THE OCCURRENCE OF LOSS WC 04 03 61 (Ed. 11/90) Countersigned by Authorized Representative