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Backup Document 06/28/2022 Item #16E 1 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 16 E 1 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initialsit Date 1. Risk Risk Management C2alCo f 2Y f Z2— 2. County Attorney Office Ril County Attorney Office �5� 4. BCC Office Board of County //f / /� Commissioners LP bv ly !/ 7 S/L Z 4. Minutes and Records Clerk of Court's OfficL Ipd Va. rAvneN 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Patrick O'Quinn/PURCHASING Contact Information 239-252-8407 Contact/ Department Agenda Date Item was JUNE 28, 2022 Agenda Item Number 16.E.1 ✓ Approved by the BCC Type of Document ASSUMPTION AGREEMENT V Number of Original 1 Attached Documents Attached PO number or account N/A 18-7443 RELADYNE number if document is RELADYNE FLORIDA,LLC to be recorded FLORIDA, LLC INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. _ 3. Original document has been signed/initialed for legal sufficiency. (All documents to be PRO signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's /�/' N/A Office and all other parties except the BCC Chairman and the Clerk to the Board d V 5. The Chairman's signature line date has been entered as the date of BCC approval of the PRO document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's PRO _signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE.Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 6/28/2022 and all changes made during MEM not the meeting have been incorporated in the attached document. The County /�t ��,,pl�tion for Attorney's Office has reviewed the changes,if applicable. ° ettiUline. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the Risk Managemesittion for Chairman's signature. this line. 16E1 ASSUMPTION AGREEMENT This Assumption Agreement is made and entered into on this 1?-6% of 7Une 2022 by and between RELADYNE FLORIDA, LLC ("Reladyne") and COLLIER COUNTY, a political subdivision of the State of Florida ("County"), (collectively the"Parties"). WHEREAS, on December 11, 2018 (Agenda Item 16E2) the County awarded a RFQ No. 18-7443, "Motor Oils, Lubricants and Fluids" as a PO Driven Agreement to Flamingo Oil Corporation ("Flamingo"), and attached hereto as Exhibit"A" is a copy of the Award Letter; and WHEREAS, on February 1, 2021, Reladyne, a Delaware limited liability company registered to do business in Florida, and merged with Flamingo, with Reladyne as the surviving entity which is memorialized in the attached Exhibit"B;" and WHEREAS, Reladyne, hereby represents to Collier County that by virtue of the merger, it is the successor in interest in relation to the Agreement; and WHEREAS,the Parties wish to formalize Reladyne's assumption of rights and obligations under the Agreement effective as of the date first above written. NOW THEREFORE, IN CONSIDERATION of the mutual promises in this Assumption Agreement, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged by the Parties, it is agreed as follows: 1. Reladyne accepts and assumes all rights, duties, benefits, and obligations of Flamingo under the PO Driven Agreement, including all existing and future obligations to pay and perform under the Agreement. 2. Reladyne will promptly deliver to County evidence of insurance consistent with the Agreement. 3. Further supplements to, or modifications of, the Agreement shall be approved in writing by both parties. 4. Notice required under the Agreement to be sent to Reladyne shall be directed to: VENDOR: Reladyne Florida, LLC 205 NE 179`h Street, Miami, FL 33162 Phone: (904) 386-1099 Attention: Jon Sistrunk 5. The County hereby consents to Reladyne's assumption of the PO Driven Agreement in order to continue the services provided under Agreement No. 18-7443. No waivers of performance or extensions of time to perform are granted or authorized. The County will treat Page 1 of 2 16E1 Reladyne as it would have Flamingo for all purposes under the Agreement. Except as provided herein, all other terms and conditions of the Agreement remain in full force and effect. IN WITNESS WHEREOF,the undersigned have executed and delivered this Assumption Agreement effective as of the date first above written. ATTEST: f BOARD OF COUNTY COMMISSIONERS Crystal K. I{ ze1, Clerk COLLIER COUNTY, FLORIDA & Compticl0, 01011/111° By: -�r By: ;,,.; Wil;:m L. McDaniel, Jr., Chair Attest o Cha eputy rk signature or t`l Approved to Form and Leg ity: By: Qlk -(1) ssistant County Attorney Reladyne's Witnesses: Reladyne Florida,LLC ).eif, ad-Li o% By: t / First Witness Signature.,' U Jon Sistrunk Larry Stoddard, President & CEO TType/print signature and titleT TType/print witness nameT Patize._A yi/efrte,2.4.7 Second Witness Patrick Hennessey TType/print witness nameT Page 2 of 2 0) a,0 " EXHIBIT A 1 6 E 1 From: VannOoal To: "FLA.orders.MiamiOreladvne.com";"achaninkbird.com" Cc: BurksMichael;Renewals Subject: Award of Bid# 18-7443"Motor Oils,Lubricants and Fluids" Date: Tuesday,December 11,2018 12:52:00 PM Attachments: imaoe001.ipq Dear Mr. Moseley: This email serves as notification that you have been awarded the above Bid # 18-7443 "Motor Oils, Lubricants and Fluids" in accordance with the terms, conditions and the specifications of the solicitation. A formal contract for this service will not be necessary. The Collier County department will forward a purchase order which will serve as the County's agreement to your proposal. Thank you for your interest in Collier County, and congratulations on the award of this solicitation. If there are any questions, please do not hesitate to contact Michael Burks, Project Manager, at 239-252-4135. Respectfully, ()Ad mil. Tema Procurement Technician New Logo Version email dec92017 Collier County Procurement Services NOTE:Email Address Has Changed 3295 Tamiami Trail East Naples, FL 34112 (239) 252-6020 Opal.VannPcolliercountyfl.gov Collier County Procurement Services is pleased to announce, it has partnered with BidSync to provide Free web-based Bidding services to its vendors, suppliers and contractors. We are now"live on the new bidding platform. Register today at www.bidsync.com. For Registration Assistance, please contact BidSync customer service at 800-990-9339 Or email: support@bidsync.com Ct'C EXHIBIT B 1 6 E 1 • VI • mic (Requestor's Name) ' w (Address) 700358545987 (Address) (City/State/Zip/Phone#) El PICK-UP WAIT 11 MAIL (Business Entity Name) (Document Number) Certified Copies Certificates of Status • r Special Instructions to Filing Officer: • Office Use Only • "t' • r n • • r--�c - O I E1 Sunshine State Corporate Compliance Company 3158 ta4s%o e Drive, T 1/a/cassee, F%opida 32372 (850) 656-4724 DATE 02/01/2021 "WALK IN*" ENTITY NAME RELADYNE FLORIDA, LLC DOCUMENT NUMBER **P1 4(fE F/CE 77/Er1774C1/0 ANTI leer-am" Pla,;( a?, XXXXXX Cert0ad Copy Cer*ate of feaeuK **PtEASEOBTA/N 77/EFOh101//Nc FOR 77/E48OVEENT/T7/** Cerci4ad Coo, o// r &4,,teRa e,rte Cerr cat o/rood Star4 **4Po 77af,/Nl74,f0%aEPr/f/C 1770#** Cda/vr,e1OFDFS7/NAT/D/V N6/,f8f,P OFCEPT/F/G1'TES,e atSTEO TOTAL OWED 5195.00 ACCOUNT #: 120160000072 • PPeaso call Tyra at de aI&e Itutee ' �a� a�r� issues o/, co/rcetw. Thud ra so Nuc/,/ 16E1 FLORIDA DEPARTMENT OF STATE Division of Corporations February 2, 2021 SUNSHINE STATE CORRECTED Please Allow For Same File Date SUBJECT: FLAMINGO OIL CORPORATION Ref. Number: P99000005737 We have received your document for FLAMINGO OIL CORPORATION and the authorization to debit your account in the amount of $195.00. However, the document has not been filed and is being returned for the following: As a condition of a merger, pursuant to s.605.0212(8) and/or s.607.1622 (8), Florida Statutes, each party to the merger must be active and current in filing its annual reports with the Department of State through December 31 of the calendar year in which the articles of merger are submitted for filing. Please return your document, along with a copy of this letter, within 60 days or your filing will be considered abandoned. If you have any questions concerning the filing of your document, please call (850) 245-6050. Yasemin Y Sulker Regulatory Specialist Ill Letter Number: 021A00002335 1`7 T� '. i c)o www.sunbiz.org 16E1 COVER LETTER TO: Amendment Section Division of Corporations SUBJECT: RelaDyne Florida, LLC Name of Surviving Party The enclosed Certificate of Merger and fee(s)arc submitted for filing. Please return all correspondence concerning this matter to: Julie A. Taylor Contact Person c/o Fredrikson & Byron, PA Finn/Company 200 S. 6th Street, Suite 4000 Address Minneapolis, MN 55402 City, State and Zip Code jtaylor©fredlaw.com E-mail address: (to be used for future annual report notification) For further information concerning this matter, please call: Julie A. Taylor at ( 612 )492-7716 Name of Contact Person Area Code Daytime Telephone Number C3 Certified copy(optional) S30.00 STREET ADDRESS: MAILING ADDRESS: Amendment Section Amendment Section Division of Corporations Division of Corporations Clifton Building P. O. Box 6327 2661 Executive Center Circle Tallahassee, FL 32314 Tallahassee, FL 32301 CR2EOS0 (2/14) co 16E1 • • Articles of Merger For Florida Limited Liability Company The following Articles of Merger is submitted to merge the following Florida Limited Liability Company(ics) in accordance with s. 605.1025. Florida Statutes. FIRST: The exact name, fortn/entity type. and jurisdiction for each merging party are as follows: Name Jurisdiction Form/Entity Type Flamingo Oil Corporation Florida corporation Flamingo Shop Scry Corp. Florida corporation Jack Becker Distributors, Inc. Florida corporation Seaboard Distribution. Inc. Florida corporation SECOND: The exact name. form/entity type. and jurisdiction of the surviving party are as follows: Na11C Jurisdiction Form/Entity Type RclaDvne Florida,LLC Delaware limited liability company THIRD: The merger was approved by each domestic merging entity that is a limited liability company in accordance with ss.605.1021-605.1026; by each other merging entity in accordance with the laws of its jurisdiction; and by each member of such limited liability company who as a result of the merger will have interest holder liability under s.605.1023(I)(b). GQ,O • 16E1 FOURTH: Please check one of the boxes that apply to surviving entity:(if applicable) NOT APPLICABLE This entity exists before the merger and is a domestic filing entity, the amendment, if any to its public organic record are attached. ❑ This entity is created by the merger and is a domestic filing entity, the public organic record is attached. ❑ This entity is created by the merger and is a domestic limited liability limited partnership or a domestic limited liability partnership, its statement of qualification is attached. ❑ This entity is a foreign entity that does not have a certificate of authority to transact business in this state.The mailing address to which the department may send any process served pursuant to s.605.0117 and Chapter 48, Florida Statutes is: FIFTH: This entity agrees to pay any members with appraisal rights the amount, to which members are entitled under ss.605.1006 and 605.1061-605.1072. F.S. SIXTH: if other than the date of filing, the delayed effective date of the merger, which cannot be prior to nor more than 90 days after the date this document is filed by the Florida Department of State: Note: If the date inserted in this block does not meet the applicable statutory filing requirements, this date sill not be listed as the document's effective date on the Department of State's records. SEVENTH: Signature(s) for Each Party: rri cp Typed:or'Printed Name of Entity/Organization: Si'natu s,: Name of fitfiividush- Flamingo Oil Corporation Larry 1fStoddari : ' .-rt --- C''i rn Flamingo Shop Sery Corp. Larry J;Stoddartr Jack Becker Distributors,Inc. Larry J.St�dard Seaboard Distribution,Inc. Larry I.Stoddard Corporations: Chairman. Vice Chairman, President or Officer (Jun directors selected, signature<jincorporator.) General partnerships: Signature of a general partner or authorized person Florida Limited Partnerships: Signatures of all general partners Non-Florida Limited Partnerships: Signature of a general partner Limited Liability Companies: Signature of an authorized person Fees: For each Limited Liability Company: $25.00 For each Corporation: S35.00 For each Limited Partnership: S52.50 For each General Partnership: $25.00 For each Other Business Entity: $25.00 Certified Copy(optional): S30.00 �i�0 Co icr County1bE1 Administrative Services Department Procurement Services Division NEW BUSINESS/VENDOR FORM For all Board approved contracts, the Board of County Commissioners shall approve all assignments of contracts requested by the predecessor contracting party, per(Procurement Ordinance (19)(8)).Upon receipt of all proper documentation, Collier County Procurement will draft an Assumption Agreement which will be presented at the next available board meeting for Board approval and execution. Concerning Collier County Agreement#/Title: #18-7443 "Motor Oil, Lubricants and Fluids" with Flamingo Oil Corporation (current vendor) Please select one of the following: ❑� Merger ❑Acquisition ❑ Change in Business Organization (i.e. Corporation to LLC,Sole Proprietor to Partnership, Etc.) ❑ Other ADDITIONAL Documentation cannot be in the names of affilates,subsidiaries or parent companies.You will be notified if any REQUIRED additional information is needed based on the particulars of your firm's merger or acquisition. DOCUMENTS 1. Formal documentation of the acquisition/merger, signed by the Corporate Officer(s),showing the effective date of purchase, and/or a detailed Asset Purchase Agreement. 2. Company W-9 3. Current Certification from the Florida Department of State, Division of Corporations showing firm's name 4. Certificates of insurance meeting contractual insurance requirements 5. Department of Homeland Security's E-Verify MOU or profile page 6. Corporate resolution listing the signatory as authorized to sign 7. Business License 8. Required licenses/certifications to perform duties/tasks under Agreement(if applicable) Email this completed form along with the above listed documents to: PurOps@colliercountyfl.gov or Priscilla.Doria@colliercountvfl.gov NEW BUSINESS INFORMATION Legal Name(as registered with the IRS) RELADYNE FLORIDA, LLC Assumed Name(doing business as) FEIN-TAX ID Principal Address Mailing/Remittance Address (if different from above) Point of Contact Name/Title: Phone Number: Email: By submitting this form,you certify that: (a)you are authorized to represent the business listed above;and(b)all the information you have provided above is true and correct; Your Name(Print Name)&Title Signature Date Phone/Email New Business/Vendor Form(Version 3)1/8/202D"`O 16E1. > W 9 Request for Taxpayer Give Farm to the elei..eR•r,.t•r+, :,Hitt Identification Number and Certification reeproster. On not tyriewtmeei rt the t oak•ork %end to the fPS, Infamy a'tiwentti Senses i•Go to www.inever/forrn Wg for InetnsetIons itnd the latest Information. j 1 Name(ae 0.'0'0 ",OM vsktr 41t1,1•1•her hnWii NAna is rgV**ii CM Ihh Noe,cM not tI4nvs it,lh firm hlnr,k - --'.--.a,e.__ — RECADYNF FI.ORIf>A,l.t.e f1 0usvies.a reenikdh••e redeett cote*:nMeae N iSe,.vol itty i eltnve 3 Clkek*aonskpm re bok kor sonw el tek GY* leilll,r,ut the p+wri>ri whose rNlrtie la n.,tnr»tt nit line 1.Cherrk rune*no rd the 1 4 ErSr^pi✓/nrs(rrr4M.rpoly 1 tiN110.4r1q"riven R+rwer. , nnotAfr.nrlft...1 >rii nHrr-#,hats;we ownrr.hnr's fin()nr)w 1) r_ , S 1 l. tMrveeiaiskee tx1 t eiM:v e,. Li c[kvtxrerio [11 9 t%orixnntir!ri I ,.1 rtertnerxhip 1'1 Tnxmestele i ee Q memt.e tli" Fr: rrrrr'tN pe'r^'r.rrvte�i!ar,�j ,a� 1 L� It fahl iutugty:ornrvsnv.Enter the tits daeeifkcetlon(C-C cortxxnIitni,fi-S cpporehon,i9-.P�irtnurship)► C t F Moto;c't+us.1,the t +txnyviaie box m the i,ri etxive t the tax die fi.aIion nl Ifni ainglq-rv,emlw swoon. Din not checir Fxnr+sptvir,nrorn'iArr A reprtrnp Lc c:e t"e LL.,s Oaixifreo Si a IdnQle-menbte La;that Is disregre tied IT the owrH,r unless the owner rot the(LC is soother I I that is not d sr ardpct from the owner ter U S.federal tax innposes,Otherwise,a single-member 1.1,C the c" (II ..- —_-_. --- ........__. 1 tt.1Ysrw9aril4t7 i+'om tier owlet snrutd rtxtrl.the appropriate lox lot the inx ela!MfirjitIOn of its(WOW. :.... Other(,ale IrUUru(lvi>,it 0rx++,. ,,,„,n.r+,.�.,r.w»a.rw,9 5 address(ixvnixr.stra*ed,ono apt.or suite no.i See instructions.._._. RtnpreytM's name arid address,opYibraaf) f P°BOX 645857 ,. _ _. .... __..._...x......___ i 8 ry,state,and ZIP +Ae €CAN+CINNAT1,OH 45264-5857 7 test t$tzxrri r4ember(s)here(colonaft Part I Taxpayer Identification Number(TINT Erne yarn T1N in the appropriate box,The TIN provided must match the name given on line 1 to avoid I.Social s'eurtty slumbers tra _ cks;wiihtxrlding,For individuals,this is generally your social security number(SSN).However,for a II resiaere alien,sole propretor,or disregarded entity,see the Instructions for Part I,later.For other - i entities,it is your employer identification number(EIN).If you do not have a number,see How to get a 17N,tater, or Note:It the account is in more than one name,see the instructions for line 1.Also see What Name and {Employ's identification number Humber To Give the Requester for guidelines on whose number to enter. ,� 8 2 - 4 3 411 01, 810 M Certification 1 ' Under penalties of perjury.t certify that: 1.The number shown on this form Is my correct taxpayer identification number(or I am wafting for a number to be issued to me):and 2.i am not sue ect to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified oy the Internal Revenue Service(IRS)that i am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notitieo me mat i am no longer sub)ect to backup withholding;and 3.I am a U.S,citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. C,erefication instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you nave tailed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid. acquisition or abandonment of secured property.cancellation of debt,contnbulions to an individual retirement arrangement(iRA),and generally,payments firer treaty interest and dividends,you ate not required to sign the certification,but you must provide your correct TIN.See the instructions fox Pan II,tater, Sign —_ Kn.e ot a� /�,� Here I u.s.person► a. ` Date► (Art 'n,�.. v+ 3 :1-0 ;A- 3.- General instructions •Form 1099-DiV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross rioted. proceeds) Future developments.For the latest iniormation about developments •Form 1099-B(stock or mutual fund sales and cotter')other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they worerh6shosrl,go to www.irsyouvlrnrrriW9. •Form 1099-S(proceeds horn real estate list Purpose of Form •Form 1099-K(merchant card and third party network thansactions An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home nualgage interest), 1098-e(stuff tit tear,interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceed debt) (SSN),individual taxpayer identrfir aiirxt number(ITIN),adoption •Form 1099-A(acquisition or abarsionnernt tit secured property) taxpayer identification number(ATtN),or employer identification number (EIN),to report on an information return the arnounit paid to you,or other Use Form W-8 onevil you are a U,S.posies pncluctiril a resicsent amount reportable on an information return.Examples of informatiwi alien),to provide your correct TIN. returns include,but are riot limited to,the following_ tfyou tie rust return Form W 9 to ire requester with a TI/v,you inapt •Form 1t'799-INT(interest earned or paid) tie subjeci fu backup wilflhoicrulg. See What iy backup withtoklirtg, Baler i,,ri Nu. tri.'aix ..._Form W-9(Rev.mo-201dt 16E1 • 0 2 III CI z X a C c 0 a n v1 C\ C\ > c c G1 c c cc E a C Fe c E. U. 2 i C y.,--t w»$ E. L a m,: E ,,,-I a E ..cc E. za..—1 ‘, -- a a --,, E x 0 '' ...; c Z - Ti Em«.ii T c 77. r as11:01/ ( a) Z (I)U) �_ E a Sim ' Z A IP ,c-Po LL N C �, O Oc a0 0 Wr rn 0 M O UCn`W U LLl W i ce oNo o ❑ Q () c�I) 'tea R o Z O J 0 0 Q J. 0 .c o ._ Q cow co W' M a1 a o ❑ 1` Ce in LNf) ct •7 C ca E O W W Z L Y.1 -0 J o (13 O O O O aa)i `c, tn ' LL cC Z 0 L.E -0 (� .. i C� Q 2 ca .Q W �+ .O < Z < -0 Z < Z3 E J >- CD z �, Z E a g = W w +) '� O U = O U cm r i ca p W O W cC 's= co z vu co Z u a Li_ O u ❑ Li- ❑ E/) CO a. aO U 2 a0 U WI aiE ®1 a a V. N. V p co V I C ' 16E1 E II z Ct C II R at cc c. r. c c c cc E C a c LL LL 2 } C Q LL a a L C a R C 2 I R a v°Z R I I a c C a L at a E a 2 l5 ii t4 6 i 2 EEEE O O O O jj a lL a IL LL c a I a a a 2 a) (1) a) as a7 >s! 6) :; 01 F. C1 o 1 i c Q N N v �. o w 0 O O .- > > > r H f w Cl) CD O O O a I— O -CD Q N N N a ( z V it . Q 'a N Ln M C J N 0 , M cu N N O 0 0 0 -o la„ CD a z — Cr) O in LL O O O W W LL1 Cr. O w M �� w V' Cr W C _ .s C 13 I— Z J O y 2 _ cmswi ¢ d Q c c Q a i a) i 0 o Fn w c z CO I— f— O co < < < L0 C. a CL D O Q J Z Q 0. CD +d i I i i Ct O Q N 06 0 12 O Z CC > tU N c) rn co O V) I— •a U al 2 ? .. 0 0Csi 0 0 c Z F. Q E m O Z 0 a m o N (V N Z ~ (N J a CO - co — c w O O O 0 v N cn o c. L 0 — 0- < Z F— CO a0 0 < Ce N N N C] C C) o V a a u. V V cou RJ C � L Pag 1 Aa��� DATE(MM/D� , �. CERTIFICATE OF LIABILITY INSURANCE 03/22/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd (A/C.No.Ext): (A/C,No): P.O. Box 305191 E-MAIL ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAIC# INSURERA: Nationwide Agribusiness Insurance Company 28223 INSURED INSURERS: Westchester Fire Insurance Company 10030 RelaDyne Florida LLC 205 NE 179th Street INSURERC: Allied World Assurance Company Limited D1571 Miami, FL 33162 INSURERD: Illinois Union Insurance Company 27960 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W24194165 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 EFF POLICY EXPD/ LIMITS LTR INSD WVD POLICY NUMBER (MM/DYYYYI (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 5,000 Y CPP143237A 11/01/2021 11/01/2022 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X ' X I LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y CPP143237A 11/01/2021 11/01/2022 BODILYINJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED I PROPERTY DAMAGE $ 6815SS ONLY kas ONLY (Per accident) X X $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS-MADE CU143237A 11/01/2021 11/01/2022 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 No N/A WCC1432378 04/01/2022 04/01/2023 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess Liability G46836224005 11/01/2021 11/01/2022 Each Occurrence $5,000,000 General Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: For any and all work performed on behalf of Collier County. Commercial Umbrella/Excess is following form. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION I 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 Collier County 3295 Tamiami Trail East, Bldg. C2 v<t Lr �4ea�Y Naples, FL 34112 ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD �^ O SR ID: 22358277 BATCH: 2455879 !' AGENCY CUSTOMER ID: 1 5 E 1 LOC#: AC RD ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED RelaDyne Florida LLC Willis Towers Watson Northeast, Inc. 205 NE 179th Street POLICY NUMBER Miami, FL 33162 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Collier County is included as an Additional Insured as respects to General Liability and Auto Liability. General Liability and Auto Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured. INSURER AFFORDING COVERAGE: Allied World Assurance Company Limited NAIC#: D1571 POLICY NUMBER: 03131211 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occurrence $5,000,000 Aggregate $5,000,000 INSURER AFFORDING COVERAGE: Illinois Union Insurance Company NAIC#: 27960 POLICY NUMBER: PPL G28167945 002 EFF DATE: 09/28/2021 EXP DATE: 09/28/2024 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Pollution Legal Liability Per Incident $10,000,000 SIR $100,000 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 SR ID: 22356277 BATCH: 2455879 CERT: W24194165 GQ' 16E1 CPP143237A COMMERCIAL GENERAL LIABILITY CG 20 43 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 4. Engineering services, including related include as an additional insured any person(s) or supervisory or inspection services; organization(s) for whom you have agreed in 5. Medical, surgical, dental, X-ray or nursing writing in a contract or agreement that such services treatment, advice or instruction; person(s) or organization(s) be added as an additional insured on your policy. Such person(s) 6. Any health or therapeutic service treatment, or organization(s) is an additional insured only with advice or instruction; respect to liability for: 7. Any service, treatment, advice or instruction for 1. "Bodily injury" or "property damage" not the purpose of appearance or skin included in the "products-completed operations enhancement, hair removal or replacement, or hazard"; or personal grooming or therapy; 2. "Personal and advertising injury"; 8. Any service, treatment, advice or instruction relating to physical fitness, including service, caused by, in whole or in part, your acts or omissions or the acts or omissions of those acting treatment, advice or instruction in connection with diet, cardiovascular fitness, bodybuilding on your behalf in the performance of your or physical training programs; operations. B. The insurance afforded to such additional insured 9. Optometry or optical or hearing aid services described in Paragraph A. of this endorsement: including the prescribing, preparation, fitting, demonstration or distribution of ophthalmic 1. Only applies to the extent permitted by law; lenses and similar products or hearing aid and devices; 2. Will not be broader than that which you are 10. Body piercing services; required by the contract or agreement to 11. Services in the practice of pharmacy; provide for such additional insured. C. With respect to insurance afforded to these 12. Law enforcement or firefighting services; and additional insureds, the following additional 13. Handling, embalming, disposal, burial, exclusion applies: cremation or disinterment of dead bodies. This insurance does not apply to "bodily injury", This exclusion applies even if the claims against "property damage" or "personal and advertising any insured allege negligence or other wrongdoing injury" due to rendering of or failure to render any in the supervision, hiring, employment, training or professional service. This includes but is not monitoring of others by that insured, if the limited to: "occurrence" which caused the "bodily injury" or • "property damage", or the offense which caused 1. Legal, accounting or advertising services; the "personal and advertising injury", involved the 2. Preparing, approving, or failing to prepare or rendering of or failure to render any professional approve, maps, shop drawings, opinions, service. reports, surveys, field orders, change orders or drawings or specifications; 3. Inspection, supervision, quality control, architectural or engineering activities done by or for you on a project on which you serve as construction manager; CG 20 43 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 �Q,0 16E1 D. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III—Limits Of Insurance: whichever is less. The most we will pay on behalf of the additional This endorsement shall not increase the insured is the amount of insurance: applicable limits of insurance. 1. Required by the contract or agreement described in Paragraph A.; or Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 43 12 19 G4,0 16E1 POLICY NUMBER: CPP143237A COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person(s)or organization(s)with whom you have agreed to such notice, in a valid written contract or written agreement As required by contract that has been executed prior to the loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations hazard". 1. Required by the contract or agreement; or However 2. Available under the applicable limits of insurance; 1. The insurance afforded to such additional insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 0 CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Q* G 16E1 CPP143237A COMMERCIAL GENERAL LIABILITY CG20011219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 OP Policy No. CPP143237A, CU143237A, WCC143237B 1 6 E I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURER CANCELLATION TERMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL LIABILITY UMBRELLA COVERAGE FORM WORKERS COMPENSATION COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. Should any of the above described policies be cancelled before the expiration date thereof, the insurer will send 30 days' notice of cancellation to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. MLCC491 1118 Page 1 of 1 Cp,O 16E1 CPP143237A COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION 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 Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance - Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under such an "insured" under your policy provided that: other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 CN° Policy CPP143237A COMMERCIAL 4CF 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM is amended to include the following additions and extensions of coverage: A. NEWLY ACQUIRED OR FORMED ENTITIES B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE C. BLANKET ADDITIONAL INSURED- REQUIRED BY CONTRACT D. EMPLOYEES AS INSUREDS- NONOWNED AUTOS E. EMPLOYEE HIRED AUTOS F. SUPPLEMENTARY PAYMENTS - BAIL BONDS G. SUPPLEMENTARY PAYMENTS - LOSS OF EARNINGS H. FELLOW EMPLOYEE COVERAGE I. PROPERTY OF OTHERS J. PERSONAL EFFECTS COVERAGE K. AUTO MEDICAL PAYMENTS COVERAGE - INCREASED LIMITS L. EXPANDED TOWING COVERAGE M. AUTO LOAN OR LEASE COVERAGE N. RENTAL REIMBURSEMENT COVERAGE O. EXPANDED TRANSPORTATION EXPENSE P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE R. PHYSICAL DAMAGE -TWO OR MORE DEDUCTIBLES S. BLANKET WAIVER OF SUBROGATION T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS A. NEWLY ACQUIRED OR FORMED ENTITIES The Named Insured shown in the Declarations is amended to include any organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority (more than 50%) interest; if there is no other similar insurance available to that organization. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization, or the end of the policy period, whichever comes first. B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE The following is added to Paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I - COVERED AUTOS: If Physical Damage Coverage is provided on a covered "auto" you own that is out of service because of its breakdown, repair, servicing, "loss", or destruction, then you have coverage for any "auto" you do not own, while used with the permission of its owner as a temporary substitute for the covered out of service "auto". The deductible for the temporary substitute "auto" will be the same as the applicable deductible for the covered "auto" it replaces. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 1 of 6 GQ,O 16E1 COMMERCIAL AUTO C. BLANKET ADDITIONAL INSURED — REQUIRED BY CONTRACT The following is added to Paragraph A.1. Who Is An Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person(s) or organization(s) is an additional "insured" with whom you have agreed in a valid written contract or agreement, executed prior to any "accident" or "loss", that such person(s) or organization(s) be added as an additional "insured" on your policy. Such persons or organizations are additional "insureds", but only with respect to liability for "bodily injury" or "property damage" caused by an "accident" that is, in whole or in part, caused by your acts or omissions or the acts or omissions of those acting on your behalf and resulting from the ownership, maintenance or use of a covered "auto". D. EMPLOYEES AS INSUREDS — NONOWNED AUTOS The following is added to the SECTION II — COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. EMPLOYEE HIRED AUTOS 1. Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the BUSINESS AUTO COVERAGE FORM is replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: a. Any covered "auto" you lease, hire, rent or borrow; and b. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". F. SUPPLEMENTARY PAYMENTS — BAIL BONDS The following replaces Paragraph A.2.a. (2) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Includes copyrighted material of Insurance Services Office. Inc.,with its permission. CCAB191 1013 Page 2 of 6 1 6 E I COMMERCIAL AUTO G. SUPPLEMENTARY PAYMENTS — LOSS OF EARNINGS The following replaces Paragraph A.2.a. (4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. H. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion contained under the COVERED AUTOS LIABILITY COVERAGE does not apply. I. PROPERTY OF OTHERS The Care, Custody Or Control Exclusion in SECTION II — COVERED AUTOS LIABILITY COVERAGE does not apply to "property damage" to property, other than your property, up to an amount not exceeding $3,000 in any one "accident". This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. J. PERSONAL EFFECTS COVERAGE The following is added to Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $1,000 for the "loss" to personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. K. AUTO MEDICAL PAYMENTS COVERAGE — INCREASED LIMITS In the event of a covered "loss" where Auto Medical Payments Coverage applies, we will double the Limit Of Insurance for Medical Payments shown in the Declarations for each "insured" who was wearing a seat belt at the time of the "accident". This limit is the most we will pay for all covered medical expenses regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident". L. EXPANDED TOWING COVERAGE The following replaces Paragraph A.2. of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to: 1. $100 for a covered "auto" you own of the private passenger type; or 2. $500 for a covered "auto" you own that is not of the private passenger type; for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 3 of 6 16E1 COMMERCIAL AUTO M. AUTO LOAN OR LEASE COVERAGE Physical Damage Coverage is amended by the addition of the following: 1. In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan, including up to a maximum of $500 for early termination fees or penalties, for a covered "auto", less: a. The amount paid under the policy's Physical Damage Coverage; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs of extended warranties, Credit Life insurance, Health, Accident, or Disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. 2. This coverage only applies to a "loss" which is also covered under this policy for Comprehensive, Specified Causes Of Loss, or Collision Coverage. 3. Coverage does not apply to any unpaid amount due on a loan for which the covered "auto" is not the sole collateral. 4. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. N. RENTAL REIMBURSEMENT COVERAGE 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of "loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 2. This coverage applies only to a covered "auto" for which Physical Damage Coverage is provided on this policy. 3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. b. 30 days. 4. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses incurred. b. $75 for any one day or for a maximum of 30 days. 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Expanded Transportation Expense Coverage Extension in this form. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 4 of 6 GAO 16E1 COMMERCIAL AUTO 7. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. O. EXPANDED TRANSPORTATION EXPENSE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE is replaced by the following: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO The following is added to Paragraph A.4. of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $5,000 for the expense of recovering a stolen covered "auto" to you. We will pay only for those covered "autos" for which you carry Comprehensive or Specified Causes Of Loss Coverage. Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE The following is added to Paragraph B.3.a. of SECTION III — PHYSICAL DAMAGE COVERAGE: Mechanical breakdown does not include the accidental discharge of an airbag. R. PHYSICAL DAMAGE —TWO OR MORE DEDUCTIBLES The following is added to Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE: When two or more covered "autos" sustain "loss" in the same collision, the "loss" will be reduced by the largest single deductible that applies. For purposes of this coverage, an "auto" and its attached "trailer" are two separate "autos". S. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply, but only when the Named Insured agrees that subrogation is waived prior to the "accident" or the "loss" under the terms of a written contract entered into between the Named Insured and an entity that is part of that contract. includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 5 of 6 G�,0 16E1 COMMERCIAL AUTO T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The following replaces Paragraph A.2.a. Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV— BUSINESS AUTO CONDITIONS: We have no duty to provide coverage under this policy unless there has been full compliance with the following duties: a. In the event of "accident", claim, "suit", or "loss", your insurance manager or any other person you designate as responsible for insurance-related matters must notify us promptly of an "accident" or a "loss", regardless of the amount, which may result in a claim. Include: (1) How, when and where the "accident" or "loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Paragraph A.2.b.(2) Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: b. Additionally, you and any other involved "insured" must: (2) Notify us and send us copies of any request, demand, order, notice, summons or legal papers received concerning the claim or "suit" as soon as practicable. For the purposes of this coverage provided, you are presumed to have knowledge of the "accident" or "loss" when it has been reported to the insurance manager or any other person you designate as responsible for insurance-related matters. U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following Condition is added to SECTION IV — BUSINESS AUTO CONDITIONS: Unintentional Failure To Disclose Hazards Failure by you to disclose to us all hazards existing as of the inception date of this policy shall not prejudice us with respect to the coverage afforded by this policy, provided such error or omission is not intentional. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 6 of 6 _ 1 6 E I Page 1 of 2 O 0AC DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 03/22/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd (AICl3 €AO• 1-877-945-7378 (AIC,No): 1-888-467-2378 E-MAIL certificates9willis.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER(S)AFFORDINGCOVERAGE NAICI INSURERA: Nationwide Agribusiness Insurance Company 28223 INSURED INSURERB: Westchester Fire Insurance Company 10030 RelaDyne Florida LLC 205 NE 179th Street INSURERC: Allied World Assurance Company Limited D1571 Miami, FL 33162 INSURERD: Illinois Union Insurance Company 27960 INSURER E: INSURER F: i COVERAGES CERTIFICATE NUMBER:W24194165 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAEWED CLAIMS-MADE I X OCCUR PREMISES(Ea occurrence) $ 100,000 A MED EXP(Any one person) $ 5,000 Y CPP143237A 11/01/2021 11/01/2022 PERSONAL A ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY x PE i X I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED Y CPP143237A 11/01/2021 11/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ cN4M ONLY N ABS ONLY (Per accident) X X $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCCEESSLIAB CLAIMS-MADE CU143237A 11/01/2021 11/01/2022 AGGREGATE $ 4,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EERH AND EMPLOYERS'LIABILITY Y/N - 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 No NIA WCC143237B 04/01/2022 04/01/2023— ----__--- --- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Excess Liability G46836224005 11/01/2021 11/01/2022 Each Occurrence $5,000,000 General Aggregate $5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE: For any and all work performed on behalf of Collier County. Commercial Umbrella/Excess is following form. SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Collier County 3295 Tamiami Trail. East, Bldg. C2 i&c.A. 5(�k. �` Naples, FL 34112 1h..� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i;° sR ID: 22358277 BATCH: 2455879 16E1 AGENCY CUSTOMER ID: LOC#: ACORN ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Northeast, Inc. RelaDyne Florida LLC 205 NE 179th Street POLICY NUMBER Miami, FL 33162 See Page 1 CARRIER NAIL CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Collier County is included as an Additional Insured as respects to General Liability and Auto Liability. General Liability and Auto Liability policies shall be Primary and Non-contributory with any other insurance in force for or which may be purchased by Additional Insured. INSURER AFFORDING COVERAGE: Allied World Assurance Company Limited NAIC#: D1571 POLICY NUMBER: 03131211 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Excess Liability Each Occurrence $5,000,000 Aggregate $5,000,000 INSURER AFFORDING COVERAGE: Illinois Union Insurance Company NAIC#: 27960 POLICY NUMBER: PPL G28167945 002 EFF DATE: 09/28/2021 EXP DATE: 09/28/2024 TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Pollution Legal Liability Per Incident $10,000,000 SIR $100,000 ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 SR ID: 22358277 BATCH: 2455879 CERT: W24194165 C)tv 16E1 CPP143237A COMMERCIAL GENERAL LIABILITY CG 20 43 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to 4. Engineering services, including related include as an additional insured any person(s) or supervisory or inspection services; organization(s) for whom you have agreed in 5. Medical, surgical, dental, X-ray or nursing writing in a contract or agreement that such services treatment, advice or instruction; person(s) or organization(s) be added as an additional insured on your policy. Such person(s) 6. Any health or therapeutic service treatment, or organization(s) is an additional insured only with advice or instruction; respect to liability for: 7. Any service, treatment, advice or instruction for 1. "Bodily injury" or "property damage" not the purpose of appearance or skin included in the "products-completed operations enhancement, hair removal or replacement, or hazard"; or personal grooming or therapy; 2. "Personal and advertising injury"; 8. Any service, treatment, advice or instruction caused b in whole or in relating to physical fitness, including service, y, part, your acts or treatment, advice or instruction in connection omissions or the acts or omissions of those acting with diet, cardiovascular fitness, bodybuilding on your behalf in the performance of your or physical training programs; operations. 9. Optometry or optical or hearing aid services B. The insurance afforded to such additional insured including the prescribing, preparation, fitting, described in Paragraph A. of this endorsement: demonstration or distribution of ophthalmic 1. Only applies to the extent permitted by law; lenses and similar products or hearing aid and devices; 2. Will not be broader than that which you are 10. Body piercing services; required by the contract or agreement to 11. Services in the practice of pharmacy; provide for such additional insured. C. With respect to insurance afforded to these 12. Law enforcement or firefighting services; and additional insureds, the following additional 13. Handling, embalming, disposal, burial, exclusion applies: cremation or disinterment of dead bodies. This insurance does not apply to "bodily injury", This exclusion applies even if the claims against "property damage" or "personal and advertising any insured allege negligence or other wrongdoing injury" due to rendering of or failure to render any in the supervision, hiring, employment, training or professional service. This includes but is not monitoring of others by that insured, if the limited to: "occurrence" which caused the "bodily injury" or • 1. Legal, accounting or advertising services; "property damage", or the offense which caused the "personal and advertising injury", involved the 2. Preparing, approving, or failing to prepare or rendering of or failure to render any professional approve, maps, shop drawings, opinions, service. reports, surveys, field orders, change orders or drawings or specifications; 3. Inspection, supervision, quality control, architectural or engineering activities done by or for you on a project on which you serve as construction manager; CG 20 43 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 16E1 D. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III—Limits Of Insurance: whichever is less. The most we will pay on behalf of the additional This endorsement shall not increase the insured is the amount of insurance: applicable limits of insurance. 1. Required by the contract or agreement described in Paragraph A.; or Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 43 12 19 G�,0 16E1 POLICY NUMBER: CPP143237A COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person(s)or organization(s)with whom you have agreed to such notice,in a valid written contract or written agreement As required by contract that has been executed prior to the loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the"products-completed operations hazard". 1. Required by the contract or agreement; or However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law; and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 0 CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Gp+ 16E CPP143237A COMMERCIAL GENERAL LIABILITY CG20011219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 16E1 Policy No. CPP143237A, CU143237A,WCC143237B THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURER CANCELLATION TERMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL LIABILITY UMBRELLA COVERAGE FORM WORKERS COMPENSATION COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. Should any of the above described policies be cancelled before the expiration date thereof, the insurer will send 30 days' notice of cancellation to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. MLCC491 1118 Page 1 of 1 Cp,O 16E1 CPP143237A COMMERCIAL AUTO CA 04 49 11 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION 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 Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance - Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under such an "insured" under your policy provided that: other insurance; and 1. Such "insured" is a Named Insured under such 2. You have agreed in writing in a contract or other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from agreement that this insurance would be any other insurance available to such primary and would not seek contribution from "insured". any other insurance available to such "insured". CA 04 49 11 16 ©Insurance Services Office, Inc., 2016 Page 1 of 1 16EI Policy CPP143237A COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTO PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM The BUSINESS AUTO COVERAGE FORM is amended to include the following additions and extensions of coverage: A. NEWLY ACQUIRED OR FORMED ENTITIES B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE C. BLANKET ADDITIONAL INSURED-REQUIRED BY CONTRACT D. EMPLOYEES AS INSUREDS- NONOWNED AUTOS E. EMPLOYEE HIRED AUTOS F. SUPPLEMENTARY PAYMENTS-BAIL BONDS G. SUPPLEMENTARY PAYMENTS-LOSS OF EARNINGS H. FELLOW EMPLOYEE COVERAGE I. PROPERTY OF OTHERS J. PERSONAL EFFECTS COVERAGE K. AUTO MEDICAL PAYMENTS COVERAGE- INCREASED LIMITS L. EXPANDED TOWING COVERAGE M. AUTO LOAN OR LEASE COVERAGE N. RENTAL REIMBURSEMENT COVERAGE O. EXPANDED TRANSPORTATION EXPENSE P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE R. PHYSICAL DAMAGE-TWO OR MORE DEDUCTIBLES S. BLANKET WAIVER OF SUBROGATION T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS A. NEWLY ACQUIRED OR FORMED ENTITIES The Named Insured shown in the Declarations is amended to include any organization you newly acquire or form, other than a partnership, joint venture, or limited liability company, and over which you maintain ownership or majority (more than 50%) interest; if there is no other similar insurance available to that organization. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization, or the end of the policy period, whichever comes first. B. TEMPORARY SUBSTITUTE AUTOS - PHYSICAL DAMAGE COVERAGE The following is added to Paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I - COVERED AUTOS: If Physical Damage Coverage is provided on a covered "auto" you own that is out of service because of its breakdown, repair, servicing, "loss", or destruction, then you have coverage for any "auto' you do not own, while used with the permission of its owner as a temporary substitute for the covered out of service "auto". The deductible for the temporary substitute "auto" will be the same as the applicable deductible for the covered "auto" it replaces. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 1 of 6 0,0 1 6 E I COMMERCIAL AUTO C. BLANKET ADDITIONAL INSURED — REQUIRED BY CONTRACT The following is added to Paragraph A.1. Who Is An Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person(s) or organization(s) is an additional "insured" with whom you have agreed in a valid written contract or agreement, executed prior to any "accident" or "loss", that such person(s) or organization(s) be added as an additional "insured" on your policy. Such persons or organizations are additional "insureds", but only with respect to liability for "bodily injury" or "property damage" caused by an "accident" that is, in whole or in part, caused by your acts or omissions or the acts or omissions of those acting on your behalf and resulting from the ownership, maintenance or use of a covered "auto". D. EMPLOYEES AS INSUREDS — NONOWNED AUTOS The following is added to the SECTION II — COVERED AUTOS LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured provision: Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. EMPLOYEE HIRED AUTOS 1. Changes In Covered Autos Liability Coverage The following is added to the Who Is An Insured Provision: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your business. 2. Changes In General Conditions Paragraph 5.b. of the Other Insurance Condition in the BUSINESS AUTO COVERAGE FORM is replaced by the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: a. Any covered "auto" you lease, hire, rent or borrow; and b. Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". F. SUPPLEMENTARY PAYMENTS — BAIL BONDS The following replaces Paragraph A.2.a. (2) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CCAB191 1013 Page 2 of 6 16E1 COMMERCIAL AUTO G. SUPPLEMENTARY PAYMENTS — LOSS OF EARNINGS The following replaces Paragraph A.2.a. (4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. H. FELLOW EMPLOYEE COVERAGE The Fellow Employee Exclusion contained under the COVERED AUTOS LIABILITY COVERAGE does not apply. I. PROPERTY OF OTHERS The Care, Custody Or Control Exclusion in SECTION II —COVERED AUTOS LIABILITY COVERAGE does not apply to "property damage" to property, other than your property, up to an amount not exceeding $3,000 in any one "accident". This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. J. PERSONAL EFFECTS COVERAGE The following is added to Paragraph A.4. Coverage Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $1,000 for the "loss" to personal effects which are: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage applies as a result of a covered "loss", without applying a deductible. Coverage is excess over any other valid and collectible insurance. K. AUTO MEDICAL PAYMENTS COVERAGE — INCREASED LIMITS In the event of a covered "loss" where Auto Medical Payments Coverage applies, we will double the Limit Of Insurance for Medical Payments shown in the Declarations for each "insured" who was wearing a seat belt at the time of the 'accident". This limit is the most we will pay for all covered medical expenses regardless of the number of covered "autos", "insureds", premiums paid, claims made or vehicles involved in the "accident". L. EXPANDED TOWING COVERAGE The following replaces Paragraph A.2. of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to: 1. $100 for a covered "auto" you own of the private passenger type; or 2. $500 for a covered "auto" you own that is not of the private passenger type; for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CCAB191 1013 Page 3 of 6 16E1 COMMERCIAL AUTO M. AUTO LOAN OR LEASE COVERAGE Physical Damage Coverage is amended by the addition of the following: 1. In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan, including up to a maximum of $500 for early termination fees or penalties, for a covered "auto", less: a. The amount paid under the policy's Physical Damage Coverage; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (3) Security deposits not returned by the lessor; (4) Costs of extended warranties, Credit Life insurance, Health, Accident, or Disability insurance purchased with the loan or lease; and (5) Carry-over balances from previous loans or leases. 2. This coverage only applies to a "loss" which is also covered under this policy for Comprehensive, Specified Causes Of Loss, or Collision Coverage. 3. Coverage does not apply to any unpaid amount due on a loan for which the covered "auto" is not the sole collateral. 4. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. N. RENTAL REIMBURSEMENT COVERAGE 1. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of"loss" to a covered "auto". Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". No deductibles apply to this coverage. 2. This coverage applies only to a covered "auto" for which Physical Damage Coverage is provided on this policy. 3. We will pay only for those expenses incurred during the policy period beginning 24 hours after the "loss" and ending, regardless of the policy's expiration, with the lesser of the following number of days: a. The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused by theft, this number of days is added to the number of days it takes to locate the covered "auto" and return it to you. b. 30 days. 4. Our payment is limited to the lesser of the following amounts: a. Necessary and actual expenses incurred. b. $75 for any one day or for a maximum of 30 days. 5. This coverage does not apply while there are spare or reserve "autos" available to you for your operations. 6. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Expanded Transportation Expense Coverage Extension in this form. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 4 of 6 16E1 COMMERCIAL AUTO 7. This endorsement does not apply to any covered "auto" for which broader coverage is provided by any other endorsement form on this policy. O. EXPANDED TRANSPORTATION EXPENSE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE is replaced by the following: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense incurred by you because of the total theft of a covered "auto" of the private passenger type. We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". P. EXPENSE YOU INCUR TO RECOVER A STOLEN AUTO The following is added to Paragraph A.4. of SECTION III — PHYSICAL DAMAGE COVERAGE: We will pay up to $5,000 for the expense of recovering a stolen covered "auto" to you. We will pay only for those covered "autos" for which you carry Comprehensive or Specified Causes Of Loss Coverage. Q. ACCIDENTAL AIRBAG DISCHARGE COVERAGE The following is added to Paragraph B.3.a. of SECTION III — PHYSICAL DAMAGE COVERAGE: Mechanical breakdown does not include the accidental discharge of an airbag. R. PHYSICAL DAMAGE —TWO OR MORE DEDUCTIBLES The following is added to Paragraph D. Deductible of SECTION III — PHYSICAL DAMAGE COVERAGE: When two or more covered "autos" sustain "loss" in the same collision, the "loss" will be reduced by the largest single deductible that applies. For purposes of this coverage, an "auto" and its attached "trailer" are two separate "autos". S. BLANKET WAIVER OF SUBROGATION The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply, but only when the Named Insured agrees that subrogation is waived prior to the "accident" or the "loss" under the terms of a written contract entered into between the Named Insured and an entity that is part of that contract. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CCAB191 1013 Page 5 of 6 co 16E COMMERCIAL AUTO T. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The following replaces Paragraph A.2.a. Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV— BUSINESS AUTO CONDITIONS: We have no duty to provide coverage under this policy unless there has been full compliance with the following duties: a. In the event of "accident", claim, "suit", or "loss", your insurance manager or any other person you designate as responsible for insurance-related matters must notify us promptly of an "accident" or a "loss", regardless of the amount, which may result in a claim. Include: (1) How, when and where the "accident" or"loss" occurred; (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. Paragraph A.2.b.(2) Duties In The Event Of Accident, Claim, Suit Or Loss of SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: b. Additionally, you and any other involved "insured" must: (2) Notify us and send us copies of any request, demand, order, notice, summons or legal papers received concerning the claim or"suit" as soon as practicable. For the purposes of this coverage provided, you are presumed to have knowledge of the "accident" or "loss" when it has been reported to the insurance manager or any other person you designate as responsible for insurance-related matters. U. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following Condition is added to SECTION IV— BUSINESS AUTO CONDITIONS: Unintentional Failure To Disclose Hazards Failure by you to disclose to us all hazards existing as of the inception date of this policy shall not prejudice us with respect to the coverage afforded by this policy, provided such error or omission is not intentional. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. Includes copyrighted material of Insurance Services Office, Inc.,with its permission. CCAB191 1013 Page 6 of 6