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HomeMy WebLinkAboutAdminSure Inc. - Workers Compensation Claims Administrative Services - 2022AMENDMENT TO THE AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND ADMINSURE, INC. THIS FIRST AMENDMENT TO .t,FIE AGREEMENT is entered into by and between the CITY OF NATIONAL AL, CITY, a municipal corporation ("CITY"), and ADMINSURE, U1 E, i ., a Third Party Administrator of Workers' Compensation Programs ("CONTRACTOR"). RECITALS WHEREAS, , the CITY and the CONTRACTOR entered into an Agreement on August 1, 2021 ("Agreernent"), wherein the CONTRACTOR agreed to provide comprehensive Workers' Compensation claims administrative services. through July 31, 2022 with the option to extend this term for an additional ore -year extension; and 'WHEREAS, the parties desire to amend the Agreement by exercising the additional one- year option to extend the term of the Agreement to July 31, 202 and WHEREAS, as stated in Exhibit E to the original Agreement, the total compensation for providing the scope of services shall have a not -to -exceed amount of 1100,22 between August I, 2022 through July 31, 2023. AGREEMENT NOW, THEREFORE the parties hereto agree that: l . The August 1, 2021 Agreement in exercise of the option provision is hereby amender to extcnd the term of the Agreement by one year, to July 31, 2023. 2, The Administrative Services Director is the designated Project Coordinator for the City in regards to this Agreement. TT`hetotal compensation for the extended term between August 1, 2022 through July 31, 2023 shall have a not -to -exceed mount of $100,224, as stated in Exhibit "B" of the August 1, 2021 Agreement. The parties further agree that, with the foregoing exceptions, each and every other term and provision of the August 1, 2021 Agreement shall remain in full force and effect. [Signatures on Following Page] Amended Agreement Page I of 2 City of National City and Revised July 2021 Adrninsur . IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year written below. CITY OF NATIONAL CITY By: Br, * " au l ston, City Manager er Date: APPROVED TO FORM: (A/ame) (Title) saivIe4 Atibtryieg A. MIN LJ E, INC. Alithia Vargas-Fl Pres ident/D it ect r of Operations Date: By. Ashley Sells Corporate Secretary Date: -It AmendedAgreement Page 2 of City ol-National City and Revised July 2021 Adlm nsure. Inc. IPA. Fees Year 1 Year 2 Year Year 5 Total Summary of TPA Fees with Bill Review Services Group Pricing Services Included (V/N) If no, include fee ii1 SEA Fee Conversion Fee License fee for VOS Monthly reports SIP Annual Report DWC-1, posters, pamphlets Index checking Attendance at i;rp,r=inEs. Storage of claims DR Stat approvals Filing fees Correspondence fees Medical Provider Network w Yes Yes fees shall b, between t. See Uti1izai Annual Maintenance Fee Creation of MPN At -Cost; De MPN Update fees Other Medical 51WW Review Same as abio ion Review endent on Same as abo\'e _o no charge e City and t tiiheIt any PN fe( Exhibit 13 City of National City Fees 97, 305 1-011:1,22: 103, 3 0 1D6,327 109, 517 ch ice of MPN .-ovicar ( s s for our se j ces--� d w shall net add on any fee to the C7 t ' s choice of MPN provider r s fee. Per bill In Patient Medical Fee chedule (IMFS) PPO Network - (? S7 o t• savings fee .J. Cap *Cap :$ 1 0 Pharmacy U&C Savings Outpatient Negotiated 0, plus .60 -: sn s e - i 1 / CjCR fee when No additional], fee applicable( Shal1 niot e c ed 25% lof PPOI savings are rip PPj sa ' ins No additional fee No additionsfr fee No addlionar fee ANo additions]. f e e T he1re are np PPC fees if the/ Le 1 Medical EDI Duplicates tee Nurse Case Managemen Early intervention/Triage No + it zorsc: 1 fee No adds, icr fee o no pray. a o aUe anagemen reference *** Utilization Review ***Please see below . *, ** It Leval Peer Review rPeerto Peer Other L) rvLoes. u ze *Fiat fee, 5t of billed charges capped at $ 750, or flat fee of $B5/$170 per decision/review. *plat Physician Review fee billed at cost , at the rate of $200 per hour, tilled in 10-m± .uto increments. 1 ADMSU-1 CERTIFICATE OF LIABILITY INSURANCE OP 1D' M5 DATE (MMIDDfYYYV) 06/07/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, die poliey(ic s) 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 endorserent(s). PRODUCER Digital Insurance LLC formerly Huntleigh McGehee 8235 Forsyth Boulevard, #1200 Clayton, MO 63105 314-746-4700 ,arumsure, Inc. 3380 Shelby St Ontario, CA 91764 COVERAGES CERTIFICATE NUMBER: CONTACT _NAME: PHONE 314-746-4700 (ANC, No, Ext}: E-MAIL ADDRESS: FAX 314-889 '3700 (A/C, No): INSURER(S) AFFORDING COVERAGE INSURER A: Nat'l Fire Ins Co of Hartford INSURER B : Continental Insurance Co. INSURER c : Evanston Insurance Company INSURER D : Lloyds of London INSURER E : INSURER F : NAIC 20478 35289 35378 047944 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE II.=:CURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINIG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OP 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 LTRiNSD TYPE OF INSURANCE ADD VIER WVDtllr POLICY NUMBER POLICY EFF M/ D YYYYi POLICY EXP IMl�l!£}I}IYVYY LIMITS A x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 110001000 CLAIMS -MADE IX OCCUR 7018013763 01/01/2022 0110112023 DAl4�AGE TC) REI�ITED RREMISF LEia o: trance) 100,000 MED EXP (Any one person) $ 15,000 PERSONAL & AM/INJURY $ 1,1,000,000 GE 'I_ AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOG PRODUCTS - COMPICP AGG 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COM- Ea e'B SINGLE rL LIMIT 120002000 BODILY INJURY Per person) ANY AUTO BUA7018013777 01/01/2022 01/01/2023 BODILY INJURY (Per accident) OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-Q'Vi+I ED AUTOS O IL( PROPERTY DAMAGE Per accident) $ $ B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 6,000,000 AGGREGATE 6,000,000, _ EXCESS LIAB CLAIMS -MADE 7018013813 01/01/2022 ' 01/01/2023 s DEDf RETENTION $ B WORKERS �Ak1r COMPENSATION EMPLOYERS' LIABILITY f I N C "18013T8+0 - CA 01/011 /2022 01/01/2023 I STATUTE PER OTH - ER E.L, EACH ACCIDENT 1,0001000 L ANY c PR 3PRIETOR/PARTI IER! ECUTIV'E FICER/MEMBER EXCLUDED? N IA ►11�C 18IJ1 79+4 011(i1l2022 011011202 E.L. DISEASE - EA EMPLOYE 000' 000 # : (mandatory If DESCRIPTION In Ne-1 es, describe under OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1000000 ' ' ClaimlAgg Aggregate 5,000,000 2,000,000 C D Professional Cyber Liability MKLV3PE0003233 CY100852022 01/01/2022 01/01/2022 01/01/2023 0110112023 DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached IF more space is required) Cityof National City.is named additional insured as respects General -Liilit where required by written contract. Waiver of Subroggation is applicable as respects Workers Compensation where required bywritten contract, CEF TII=ICATE HOLDER City of National City 140 E. 12th Street Ste A National City, CA 91950 CANCELLATION CITYF2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 7HE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) CI 1988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD Adman ur , Inc. INSURED'S NAME ADMSU-1 OP ID: M5 PAGE 2 mite 06107/2022 BHA Workers Compensation And Employers Liability Insurance Policy Endorsement ergt We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall riot operate directly or indirectly to benefit anyone not named in the Sin chile. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Farm No: WC 00 03 13 (04-1984] Endorsement Effective Date: Endorsemem Expiration Date: Endorsement No: 2; Page: 1 of 1 Underwriting Company: The Continental Insurance Company, 151 N Franklin St; Ciago, 60606 Policy No: WC 7 18013794 Policy Effective Date: 01/011 0 2 Policy Page: 35 of 55 Copyright 1983 National Council on Compensation Insurance. Workers Compensation And Employers Liability Insurance Policy Endorsernatit - am r tam r-lmnr-,•••••••-s• r • rev - -.1r it - P•“,11••••,-.• m•-••^1,- -- 411- ri:;1141:7,0 - - qt•-.."•1 •-• :=410 • We have the right to recover our payments from anyone liable for an injury covert 11r/this policy. We will not enforce our right against the person or organization named in the Schedule. This 4ireement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not oper-ate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our ghi to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. • e •-e • • e ,,, fi This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurr-s, 'takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date is shown below, and expires concurrently with said policy unless another expiration date is shown below. 11 news ..... r Pars • e e Form No: WC 00 03 13 104 19841 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 2; Page: 1 of 1 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chi ago, IL 60606 Policy No: WC 7 18013794 Policy Effective Date: 01/01.0'2022 Policy Page: 35 of 55 ... . go. h.q. ot e. Ho. 4imccdigioe.s•fia Mt. e I 0 1.2..1-lioN1,14... • UM. 1.1 II .44 11014 nap 000 I lea* • ifinite%S.4,1fict • ...I. •••.% • es-.•v toil .M%se4usp#n,,.qaa.stwl**c-uMsn..$�a.ttl itua I PHA 1144 114 • 144041,11 4.14I OH OF 114.1%**.. 11-4-1111141-0.14, Copyright 19.83 Natinnal Council on Cnmnensation Insurance. 03C720DC 3701aO13r6315 IMONINMEM CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. if any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision: and the changes made by this endorsement with respect to such provision do not apply. TABLE OF CONTENTS 1. Additional Insureds . Additional Insured - Primary And Non -Contributory To Additional Insured's Insurance . Bodily Injury - Expanded Definition 4. Broad Knowledge of occurrence/ Notice of occurrence . Broad Named Insured 6, Estates Legal Representatives and Spouses 7. Expected Or Intended Injury - Exception for Reasonable Force 8. In Rem Actions 9. Incidental Health Care Malpractice Coverage 10. Joint Ventures/Partnership/Limited Liability Companies 11. Legal Liability - Damage To Premises 12. Medical Payments 13. Non -owned Aircraft Coverage 1. Non -owned Watercraft 15. Personal And Advertising Injury - Discrimination or Humiliation 16. Personal And Advertising Injury - Limited Contractual Liability 17. Property Damage - Elevators 18. Supplementary Payments 19. Unintentional Failure To Disclose Hazards 20. Waiver of Subrogation - Blanket CNA-7510 X (1-15) Page 14 Nat' 1 Fire Iris Co cif Hartford Insured Name: ADNINS E , INC Copyright CNA Ail Rights Resented. Includes copynghtec nriateria of Insurance Services Office, Inc., with its permission. Policy No: 71318013763 Endorsement No: 5 Effective Date: oil pi/20 2 CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A. through K. below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement, provided such contract or agreement: (1) is currently in effect or becomes effective during the terra of this Coverage Part; and (2) was executed prior to: (a) the bodily injury or property damage; or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However, subject always to the terms and conditions of this policy, including the limits of insurance} the Insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement; or (2) coverage broader than required by such contract or agreement, and in no event broader than that described by the applicable paragraph A. through K. below, Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured, butonly with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury arising out of: 1. such person or organization's financial control of Named Insured; or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolitionoperations performed by, on behalf of, or for such additional insured. B. Co.owner of Insured Premises A co-owner of a premises co -owned by a Named Insured and covered under this insurance but only with respect to such co -owner's liability for bodily injury, property damage or personal and advertising injury as co-owner of such premises. C. Grantor of Franchise Any person o, organization that has granted a franchise to a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury as grantor of a franchise to the Named Insured. D. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part; by the Named Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. CNA75102XX(1-1 ) Policy No: 7018013763 Page 2 of 14 Endorsement No: 5 Nat'l Fire Ins Co of Hartford Effective Date: 0 V 01. / 202.2 Insured Name: ADMINSURE, INC. Copyright CNA Aid Fights Resented. Includes copyrighted material of Insurance, Services Office, Inc., with its p rm3ssinn. 00020006370180137631823 jai ammrmsiumi DNA CNA PARAMOUNT Financial services - General Liability Extension Endorsement E. Lessor of Land Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury! property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land, provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. Lessor of Premises An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named insured, and provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does net apply to structural alterations, new construction or demolition operations performed by, on behalf ot, or for such additional insured. G Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership, maintenance, or use of a premises by a Named insured. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of, or for such additional insured. H. State or Governmental Agency or Subdivision or Political subdivisions — Permits A state or governmental agency or subdivision or political Subdivision that has issued a permit or authorization but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury, property damage or personal and advertising injury arising out of: I. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection, or removal of adverlisirig 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. the ownership, maintenance or use of any elevators covered by this insurance; or 2. the permitted or authorized operations performed by a Named insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a, Bodily injury, property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or b, Bodily injury or property damage included within the products -completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. NA 5I0 X (1-15) 14 Nat ` 1 Fire Iris Co of Hartford Insured Lame: ADMINSURE I INC. Copyright CNA All Rights Reserved, Policy o: 7O18o1376 3 Endorsement No: 5 Effective Date: 0i/01/2022 Includes capynghted material of Insurance Services office, Inc., with its permission. CNA CNA PARAMOUNT Einancia - General Liability Extension Endorsement IM Trade Show Event Lessor I. • with respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional insured, but only with respect to such person or organizations liability for bodily injury, property damage or personal nd advertising injury caused by: a. the Named Insured'Insured's acts or omissions; or b. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products -completed operations hazard, J. Vendor , Any person or organization but only with respect to such person or organization's liability for bodily injury or property damage arising out of your products which are distributedorsold i the re i r C0LIESO Of such porson or organization's business, provided that: lo The coverage granted by this paragraph does not apply to: bodily Injury or property damage for which such person or organization is obligated to pay damages by reason of the assumption of liability in a contract or agreement unless such liability exists in the absence of the contract or agreement; b. any express warranty unauthorized by the Named insured; -. ._a by.sisal- r- k ; .I- no, a -ire -any -product made-i nti n II . . . -person-or r ni ati n; o repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions ction from the manufacturer, and then repackaged in the original container; e. any failure to make, any inspections, adjustments, tests or servicing that such person or organization has agreed to make or normally undertakes to make in the usual course of businerss, in or necti n with the distribution or sale of the products; f. , demonstration, installation, servicing or repair operations, except such operations performed at such • person or organization's premises in connection with the sale of a product: g. products which, after distribution or sale by the Named Insured, have been labeled or relabeled or used as a container/ part or ingredient of any other thing or substance by or for such person or organization: or bodily injury or property damage arising out of the sole negligence of such person or organization for its own acts or omissions 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 de or f. above; or such inspections, adjustments, tests or servicing as such person or organization has agreed with the Named Insured to make or normally undertakes to rake in the usual course of business, in connection with the distribution or sale of the products. CNA75102XX 1-15) Policy No: '7018013763 Page 4 of 14 Endorsement o: Nat' I Fire Ins CD of Hartford Effective Date: oil 01/ Insured Name: ADM INSURE, INC . Copyright CNA Ail Ri htri Rosarveri, includes s copyrrighted materiel of insurance Ser.oirms Office, inc., with its permission, 00021310C6:37015013-TE31B24 CNA PARAMOUNT Financial Services - General Liability Extension Endorsement . 'This Paragraph J. does not apply to any Insured person or organization, from whom the Named Insured has acquired such products; nor to any ingredient, part or container, entering into, accompanying or containing such products, 0 . This Paragraph J. also does not apply: a. to any vendor specifically scheduied as an additional insured by endorsement to this Coverage Part; . to any of your products for which coverage is excluded by endorsement to this Coverage Part: nor ca if bodily injury or property damage included within the products-compteted operations .hazard i . excluded by endorsement to this Coverage Part. K. Other Person Or Organization Any person or organization who is not an additional insured under Paragraphs A. through J. above, Such additional insured is n insured solely for bodily injury, property damage or personal and advertising •Injury for which such additional insured is liable because of the Named Insurecrs acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: le, for bodily Injury, property damages or personal and advertising injury arising out of the rendering or failure to render any professionalservice; . for bodily injury or property damage included within the products -completed operations hazard; nor . who is specifically scheduled as an additional insured on another endorsement to this Coverage Part. . ADDITIONAL INSURED - PRIMARY AND WON-CONTRIBLITORY TO ADDITIONAL INSURER'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended t add the following paragraph: If the Named Insured has agreed in writing in contract or agreement that this insurance is primary and non- contributoryrelative to an additional in ur d's own insurance, then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 24, the additional in r `s own insurance means insurance on which the additional insured is a named insured. B. With respect to persons or organizations that qualify as additional Insureds pursuant to paragraph tit of this endorsement} the following sentence is added to the paragraph above: Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to. such person or organization is excess of any other insurance available to such person or organization. . BODILY INJURY — EXPANDED DEFINITION (115) Page 5 of 14 Nat'l Fire Ins Co of Hartford insured Name: ADMINSURE INC. Copyright CNA Ali Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission, Under DEFINITIONS, the definItion of bodily injury is deleted and replaced by the following', Bodily injury means physical injury sickness or disease sustained by a person; including death, humiliation; shock, mental anguish or mental injury sustained by that person at any time which results as. a consequenceof the physicai injury, sickness or disease, BROAD KNOWLEDGE OF OCCURRENCE' NOTICE OF OCCURRENCE Under CONDITIONS; the condition entitled Duties in The Event of Occurrence, Offense, Claim or Suit is amended to add the foltowing provisions: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must Nye the Insurer or the Insurer's authorized representative notice f an occurrence, offense or claim only when the occurrence; offense or claim is known to a natural person Named Insured, to a Policy 1 ,7E8013163 Endorsement No: Effective Date: 01. 1 CNA CNA PARAMOUNT Financial Services -General Liability Extension Endorsement partner, executive officer, manager or member of a Named Insured, or to an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence, offense or claim. 5. BROAD NAMED INSURED WHO IS N INSURED is amended to delete its Paragraph 3. in its entirety and replace It with the following: 3. Pursuant to the limitations described in Paragraph 4. below, any organization in which the First Named Insured has management control directly or indirectly: a. on the effective date of this Coverage Part: or b by reason of a Named Insured creating or acquiring the organization during the policy period, qualifies as a Named Insured, provided that there is no other similar liability insurance, whether_. primary, contributory, excess, contingent or otherwise, which provides coverage to such organization, or which would have provided coverage but for the exhaustion of its limit* and without regard to whether its coverage is broader or narrower than that provided by this insurance. But this BROAD NAMED INSURED provision does not apply to any organization for which coverage is excluded by another endorsement attached to this Coverage Part. For the purpose of this provision f and of this endorsement's JOINT VENTURES PARTNERSHIP HIP 1 LIMITED LIABILITY COMPANIES provision, management control means owning interests representing rnore than 50% of the voting, appointment or designation power for the selection of a majority of: the Board of Directors of a corporation; the management committee members of a joint venture; the management board of a limited liability company; the general partners of a limited partnership: or the partnership managers of a general partnership. 4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance does not apply to: a. bodily injury or property damage that first occurred prior to the date of management control, or that first occurs after management control ceases; nor i, personal or advertising injury caused by an offense that first occurred prior to the date of management control or that first occurs after management control ceases. 54 The insurance provided by this Coverage Part applies to Named Insureds when trading under their- own names or under such other trading names or doing -business -as names (dba) as any Named Insured should choose to employ. 6. ESTATES, LEGAL REPRESENTATIVES1 AND SPOUSES The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under this policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks damages from marital community property, jointly held property or property transferred from such natural person Insured to such spouse. No coverage is provided for any act, error or omission of an estate, heir, legal representative, or spouse outside the scope of such person's capacity or status as such, provided however that the spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership. CNA751 XX (1-15) Policy No: 7018013763 Page 6 of 14 Endorsement No: 5 Nat'l Fire Ins Co of Hartford Effective Date: 01 01, 0 2 Insured Name: ADMINSURE, INC . Copyright Ct4'\ All Rights Rc erv+-:di: Iodides copyrighted material of In^ urance snrvims Office, inc.. with its permission. C1)O2IOOC637O 1aC 13T&&1 B25 MEM IMMINEM CNA CNA PARAMOUNT Financial Services -General Liability Extension Endorsement Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named Insured's business. 7, EXPECTED OR INTENDED INJURY — EXCEPTION FOR REASONABLE FORCE Under COVERAGES, Coverage Bodily Injury And Property Damage Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it E rith the foil winc This insurance does not apply to: Expected or Intended Injury Bodily injury or property damage expected or intended from the standpoint of the Insured. This exclusion does not apply to bodily injury or property damage resulting from the use of reasonable force to protect persons or property. 8. IN REM ACTIONS A quasi in rem action against any vessel owned or operated by or for the Named insured, or chartered by or for the Named Insured, will be treated in the sane manner as though the action were in personam against the Named, Insured. 9, INCIDENTAL HEALTH CARE MALPRACTICE E O ER E Solely with respect to bodily i n j u r-y that arises out of a health care incident: A. Under COVERAGES, Coverage A — Bodily Injury And Property Damage Liability, the Insuring Agreement is amended to replace Paragraphs L.b.(1) and 1.b.() with the following: b. This insurance applies to bodily injury provided that the professional health care services are incidental to the Named Insured's primary business purpose, and only if: (1) such bodily injury is caused by an occurrence that takes place in the coverage territory. (2) the bodily injury first occurs during the policy period, Ail bodily injury arising from an occurrence will be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence; and B. Under COVERAGES, Coverage A — Bodily Injury And Property Damage Liability, the paragraph entitled Exclusions is amended to: add the following to the Employers Liability exclusion: This exclusion applies only if the bodily injury arising from a health care incident is covered by other liability insurance available to the Insured (or which would have been available but for exhaustion of its limits). U. delete the exclusion entitled Contractual Liability and replace it with the following:: This insurance does not apply to: Contractual Liability the Insured's actual or alleged liability under any oral or written contract or agreement, including but not limited to express warranties or guarantees. till. add the following additional exclusions. This insurance does not apply to: CNA75102XX(1 15) Policy o: 7018013763 Page 7 of 14 Endorsement No: Nat'l Fire Ins Co of Hartford Effective Date: O1 al 2022 Insured Name: ADNI INSURE , INC . Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission. DNA CNA PARAMOUNT Finandal Services - General Liability Exten&on Endorsement 'Discrimination any actual or alleged discrimination, humiliation or harassment that includes but shall net be limited to claims based on an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual orientation, Dishonesty or Crime Any actual or alleged dishonest; criminal or malicious act, error or omission. MedicareiMedicaid Fraud any actual or alleged violation of law with respect to Vedicare, Medica4, Titer! .or any similar federal, state or local governmental program. Services Excluded by Endorsement Any health care incident for which coverage is excluded by endorsement C. DEFINITIONS is amended add the following definitions! Health care Incident means are ay error or omission by the Named Insured's employees or volunteer workers in the rendering a. professional health care services on behalf of the Named Insured or b. Good Samaritan services rendered In an emergency and for which no payment is demanded or received. i .Professional health care services means ny health ,oare services or the related furnishing of food, ,beverages, medical supplies or appliances by the following providers in their capacity as such Out solely to the -extent they-ate..duly-licensed-a-required: ..---...__ Physician; Nurse; ' a Nurse practitioner; i Emergency medical t to n i l n; e. Paramedic; f. Dentist; g. Physical therapist: . . Psychologist; Speech therapist; JI Other allied health professional; or Professional health care services doegnot include any services rendered in connection with human clinical trials or product testing. 1. delete the definition of occurrence and replace it with the following: Occurrence means a health care incident. All acts, errors or omissions that are logically connected by any common fact, circumstance, situation, transaction: event, advice or decision will be considered to constitute single occurrence; CNA751 02XX 1-1 Policy No:7018013'763 Page 8 of 14 Endorsement Nat'l Fire Iris Co of Hartford Effective Date: oil al/ Insured Name: AURL INC. ajiyrljht CNA All ROM Ot s rvarf, Inciuudas copyrighted mat vial 1n un n e Services Office., inG., with i*tn permi sica, 0DO2ODC6370160137iB25 MENIMIN MainMB CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement rir. amend the definition of Insured to: . add the following: • a darned Insured's employees are Insureds with respect to: (1) bodily injury to a co -employee while in the course of the co -employee's employment by the Named Insured or while performing duties related to the conduct of the Named Insured's business; and (2) bodily injury to a volunteer worker while performing duties related to the conduct of the Named Insured's business; when such bodily injury arises out of a health care incident. the Named Insured's volunteer workers are Insureds with respect to: (1) bodily injury to a cc -volunteer worker while perfarmrng duties related to the conduct of the Named Insured's business. a n d (2) bodily injury to an employee while in the course of the employee's employment by the Caned Insured or while performing duties related to the conduct of the Named insureds business; when such bodily injury arises out of a health care incident. b. delete Subparagraphs (a), (b), (c) and (d) of Paragraph .a.(1) of WHO IS AN INSURED. c . add the following. Insured does not include any physician while acting iri his or her capacity as such. D. The Other Insurance condition is amended to delete Paragraph b.(1) in its entirety .and replace it with the following: Other Insurance b. Excess Insurance (1) To the extent this insurance applies, it is excess over any other insurance, self' insurance or risk transfer instrument, whether primary, excess, contingent or on any other basis, except for insurance purchased specifically by the Named Insured to be excess of this coverage. 10. JOINT VENTURES I PARTNERSHIP TNERSHIP f LIMITED LIABILITY OMP l IES WHO IS AN INSURED is amended to delete its last paragraph and replace it with the following: No person or organization is an Insured with respect to the conduct of any current or past partnership, joint venture or limited liability company in which a Named Insured's interest does/did not rise to the level of management control, except that if the Named Insured was a joint venturer, partner, or member of such an entity, and such entity terminated prior to or during the policy period, then such Named insured is an Insured with respect to its interest in such joint venture, partnership or limited liability company but only to the extent that a. any offense giving rise to personal and advertising Injury occurred prior to such termination date, and the personal and advertising injury arising out of such offense first occurred after such termination date; h. the bodily injury or property damage first occurred after such termination date; and c, there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or l i n sited U iabiiity company. CNA75102 X (1-1) Policy No: 7018 13763 Page 9 of 14 Endorsement t No: Nat'l Fire Ins Co of Hartford Effective Date: oii nil 2022 Insured Name. ADMINS E , INC. . Copyright CNA All Fights Reserved. Includes copyrighted materia of Insurance Services office, Inc., with its permission. CNA PARAMOUNT Financial Services - General Liability Extension Endorserrtent 11. LEGAL LIABILITY DAMAGE TO PREMISES A. Under COVERAGES Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete the first paragraph immediately following subparagraph the Damage to Property exclusion and replace it with the following: Paragraphs 1) (3) and this exclusion do not apply to property damage (other than damage by fire) to premises rented to the Named Insured or temporarily occupied by the Named Insured with the permission of the owner, nor to the contents of premises rented to the Named insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to Damage o Premises Rented To You as described in LIMITS OF INSURANCE. Under COVERAGES, Coverage A A- Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete its last paragraph and replaced it with the following: Exclusions c. through n. do not apply to damage by fire to premises while rented to Named Insured or temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of. premises rented to a Named Insured for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as descd bed in the UNITS OF INSURANCE Section, C. LIMITS OF INSURANCE is amended to delete Paragraph 6. (the Damage To Premises Rented You Limit) and replace it with the following: Subject to Paragraph 5w above, (the Each Occurrence Limit)„ the Damage To PremisesRented To You ,i it • is the most the Insurer will pay under COVERAGE A for damages because of property damage to: ai any one premises while rented to Named Insured or temporarily occupied by a Named Insured with the permission of the owner; and -- b. •-contents-of-such-premises-if -the-pri -i -rent• to the -Named -Insured -for a. period of-7- r.--fewer----- consecutive days. The Damage To Premises Rented To You Limit .i 1 y 000 1000v unless a higher Damage to Premises Rented to You Limit is shown [n the Declarations. D. The Other Insurance Condition is amended to delete Paragraph , 1 Oi , and replace it with the following: (fi)That is property insurance for premises rented to a Named insured# for premises temporarily occupied by the Named Insured with the permission of the owner; or for personal property of others in the Named Insureds' care, custody or control; E. This Provision 11. does not apply if liability for damage t . premises rented to a Named Insured is excluded by another endorsement attached to this Coverage Part. 12. MEDICAL PAYMENTS A. LIMITS OF INSURANCE is amended to delete Paragraph 7, (the Medical Expense Limit) and replace it with the following: , Subject to Paragraph Si above (the Each ocu.rr nee Limit), the Medical Expense Limit is the most the insurer will pay under Coverage C. Medical Payments for ail medical expenses because of bodily injury sustained by any one person. The Medical Expense Limit Is the greater of, (1) $15,000 unless a different amount Is shown here: or (2) the amount shown In the Declarations for Medical Expense Limit CNA75102XX(1-15) Page I 0 of 14 Endorsement No; Nat'l Fire Iris Co of Hartford Insured Name: : . I UR, INC Copyright CNA All Rights Reserved. includes nopyrighted material of Inmonncr Servicea Office, inc., with Its permission, Policy No: 7018013763 5 Effective Date: o f O I 2 0 3 OO 2ODC63" 18O1 T x 7 Mila mom MINWP MMOUWP MMOIMIN CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement B. Under COVERAGES, the Insuring rrn Agreement of Coverage C — Medical Payment Is amended to replace Paragraph I . t 3 with the following: ( The expenses are incurred and reported to the Insurer within three years of the date of the accident; and NON -OWNED AIRCRAFT Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the . paragraph entitled Exclusions Is amended as follows: The exclusion entitledit rr ft Auto or Watercraft is amended to add the following: This exclusion does not apply to n aircraft not owned by any Named Insured, provided that: the pilot in command holds a currently effective certificate issued by the duly constituted authority of the United States of America r Canada, designating that person as a commercial or airline.trpnsport pilot; the aircraft is rented with a trained, paid crew to the Named Insured; and . - 3 the aircraft Is not being used to carry persons or property for a charge. 14. NON -OWNED WATERCRAFT Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended to delete subparagraph of the exclusion _entitled .Aircraft, Auto :Or Watercraft, and replace it with the following This, exclusion does not apply to: watercraft that is not owned by any Named Insured, provided the watercraft is: (a) less than 75 feet long; and not being used to carry persons or property for a charge. 15r PERSONAL AND ADVERTISING INJURY DISCRIMINATION OR HUMILIATION A. -Under IN1TJ .. N5 the definition of personal and advertising injury Is amended to add the follovving tort: • Discrimination or humiliation that results in injury to the feelings or reputation of a natural person. B. Under COVERAGM Coverage 8 — Personal and Advertising Injury Liabilityl the paragraph entitled Exclusions is amended to: 1. delete the Exclusion entitled Knowing Violation Rights Of.Haber and replace it with the following:.. . This insurance does not apply to: Knowing Violation of Rights of Another Personal and advertising Injury caused by or at the direction of the Insured with the knowledge that the act would violate the rights of another and would inflict personal and advertising injury* This exclusion shall not - apply to discrimination or humiliation that results in injury to the feelings or reputation of a natural person, but only if such discrimination or humiliation is not done intentionally by or at the direction of: (a) the Named Insured; or any executive officer, director, stockholder, partners member or manager (if the Named Insured is limited liability company) of the Named Insured. CNA7511a2XX -1 ) Page 1Iofl Nat'l Fire Ins Co of Hartford Insured Name: ADMINSURE, INC. Copyright CNA Ail Rights Reserved, Inurui s copyrighted mateNal of Insurance Services Office, Inc,, with its permission. l lr y Io: 7018013763 Endorsement No: Effective Date:01/Di/2022 • CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement . add the following exclusions: This insurance does not apply to: Employment Related Discrimination Discrimination or humiliation directly or indirectly related to the employment prospective employment, past employment or termination of employment of any person by any Insured. Premises Related Discrimination discrimination or humiliation arising out of 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. Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity because of discrimination. The coverage provided by this PERSONAL AND ADVERTISING I INJURY -DISCRIMINATION OR HUMILIATION Provision does not apply to any person or organization whose status as an Insured derives solely from Provision 1. ADDITIONAL INSUREDS of this endorsement; or attachment of an additional insured endorsement to this Coverage Part. 16, PERSONAL AND ADVERTISING INJURY - LIMITED ITED CONTRACTUAL LIABILITY A. Under COVERAGES, Coverage B -Personal and Advertising Injury Liability, the paragraph entitled Exclusions is amended to delete the exclusion entitled Contractual Liability and replace it with the following: This insurance does not apply to: Contractual Liability Personal and advertising injury for which the Insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages: (1) that the Insured would have in the absence of the contract or agreement; or (2) assumed in a contract or agreement that is an insured contract provided the offense that caused such personal or advertising injury first occurred subsequent to the execution of such insured contract. Solely for the purpose of liability assumed in an insured contract, reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an Insured are deemed to be damages because of personal and advertising injury provided. (a) liability to such party for, or for the cost of, that parry's defense has also been assumed in such insured contract: and (b) such attorney fees and litigation expenses are for defense of such party against a civil or alternative dispute resolution proceeding in which covered damages are alleged. B. Solely for the purpose of the coverage provided by this paragraph, DEFINITIONS is amended to delete the definition of insured contract in its entirety, and replace it with the following: Insured contract means that part of a written contract or written agreement pertaining to the Named Insureds business under which the lamed Insured assumes the tort liability of another party to pay for personal or advertising injury arising out of the offense of false arrest. detention or imprisonment. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. CNA75102X (1-15) Policy No: 7018013763 Page 12 of 14 Endorsement o: 5 Nat'l Fire Ins Coof Hartford Effective Date: 01/01/ 0 2 insured Narne: ADMINSURE, INC. Copyright CNA AN Rights Resmed. Includes r;opynghteci matnrial crt trauma: rco Services o11ce, Inc.. with its permission. CNA CNA PARAMOUNT Financial Services - General Liability Extension Endorsement C. Solely for the purpose of the coverage provided by this paragraph, the following changes are made to the section entitled SUPPLEMENTARY PAYMENTS - COVERAGES A AND 8: 1. Paragraph 2.d. is replaced by the following: d. The allegations in the suit and the information the insurer knows about the offense alleged in such suit are such that no conflict appears to exist between the interests of the Insured and the interests of the indemnitee: The first unnumbered paragraph beneath Paragraph .f.()(b) is deleted and replaced by the following: So lore as the above conditions are met, attorneys fees incurred by the insurer in the defense of that indenri itee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred by the indemnitee at the insurer's request will be paid as defense costs. Notwithstanding the provisions of Paragraph e.( of the Contractual Liability exclusion (as amended by this Endorsement), such payments will not be deemed to be damages for personal and advertising injury and will not reduce the limits of insurance. D. This PERSONAL AL AND ADVERTISING INJURY RY - LIMITED CONTRACTUAL LIABiUT f Provision does not apply if Coverage B-Personal and Advertising Injury Liability is exuded by another endorsement attached to this Coverage Part. 17. PROPERTY DAMAGE - ELEVATORS A. Under COVERAGES, Coverage A - Bodily Injury and Property Damage Liability, the paragraph entitled Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs (3), (4) and (6) of the Damage to Property Exclusion do not apply to property damage that results from the use of elevators. B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE - ELEVATORS Provision, the Other Insurance conditions is amended to add the following paragraph: This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis that is Property insurance covering property of others damaged from the use of elevators. 18, SUPPLEMENTARY PAYMENTS The section entitled SUPPLEMENTARY PAYMENTS- COVERAGES A AND B is amended as follows: A. Paragraph 1.b. is amended to delete the S250 lirnit shown for the cost of bail bonds and replace it with a $5,000. limit; and B. Paragraph 1.d, is amended to delete the lirnit of $250 shore for daily Toss of earnings and replace it with a 1,00 . limit. 19. UNINTENTIONAL AL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally tails to disclose all existing hazards at the inception date of the Named Insureds Coverage Part, the Insurer will not derby coverage under this Coverage Part because of such failure. 20. WAIVER OF SUBROGATION - BLANKET Under CONDITIONS, the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations; or 2. your wore included in the products -completed operations hazard. CNA75102XX (1-15) Policy No: 70 8013 753 Page 13 of 14 Endorsement No. 5 Nat'l Fire Ins Coof Hartford Effective Date: 01 0112 c 2 ? Insured Name. ADMIWSURE , INC. Copyright CNA Ali Rights Reserved. Includes copyrighted .materiel of Insurance services office, Inc., with its permission. CNA CNA PARAMOUNT Financial Services -General Liability Extension Endorsement However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: ent: 1, is in effect or becomes effective during the terra of this Coverage Part; and 2. was executed prier to the bodily injury, property damage or personal and advertising injury giving rise to the claim. All other terms and conditions of the Policy remain unchanged, This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at thehour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA7510 (1-15) Page 14af14 'at ' 1 Fire ins Co of Hartford Insured Name: AD IN . Copyright CNA All Rights Reserved. includes copyrighted rnitoral rif Insurance Services Office, Inc., with its permission. Policy o: 7018013763 Endorsement No: 5 Effective late: 01/0112022 CNA Business Auto Policy Policy Endorsement THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Fore apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named insured: ADMINSURE, INC. Endorsement Effective Date: 01/01/2022 SCHEDULE Insurance Company: The Continental Insurance Company Policy Number: 7018013777 Effective Date: 01/01/2022 Expiration Date: 01 /01 /2023 Named Insured: ADMINSURE, INC. Address: 3380 SHELBY ONTARIO, ST CA 91764-5566 Additional insured (Lessor): Address: Designation Or Description Of "Leased Autos": Coverages Limit Of insurance Liability $1,000,000 Each"Accident" Comprehensive Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible For Each Covered "Leased Auto" Collision Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible For Each Covered "Leased Auto" Specified Causes Of Loss Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible For Each Covered "Leased Auto" Form No: CA 20 01 10 13 Endorsement Effective Gate: Endorsement No: 2; Page: 1 of 2 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 Endorsement Expiration Date: Policy No: BUA 701801 777 Policy Effective Date: 01 f01 / 0 2 Policy Page: 32 of 49 Copyright Insurance Services Officer 'Inc., 2011 CNA Business Auto Policy Policy Endorsernem Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any "leased auto" designated or described in the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes possession of the "leased auto", whichever occurs first. B. Loss Payable Clause 1. We will pay, as interest may appear, you and the lessor narned in this endorsement for "loss" to a " leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or ornissions on your part. 3. If we make any payment to the lessor, we will obtain his or her rights against any other party. C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common Policy Condition. 2. If y•ou cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. D. The lessor is not liable for payment of your premiums. E. ,Additional Definition As used in this endorsement: "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra " auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurance for the lessor. Form No: CA 20 01 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 2; Page: 2 of 2 Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 Policy No: BUA 701801 777 Policy Effective Date: 01 /01 /2022 Policy Page: 33 of 49 Copyright insurance Services Office, Inc., 2011