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HomeMy WebLinkAboutCity of Bremerton_PetroCard Inc._26-27 GAEW + 2nd XS + CPL_3-17-2026_1356925752SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 3/17/2026 Marsh &McLennan Agency LLC1031W4thAve,Suite 400AnchorageAK99501 Jamie Esquivel 907-276-5617 907-276-6292 jamie.esquivel@marshmma.com License#:82353 Evanston Insurance Company 35378 BRISTBAY10 Zurich American Insurance Company 16535PetroCard,Inc.730 S Central AvenueKent,WA 98032-0000 Navigators Specialty Insurance Company 36056 American Zurich Insurance Company 40142 1356925752 A X 1,000,000 X 300,000 X SIR $500k 10,000 1,000,000 2,000,000 X Y Y MKLV5ENV105568 4/1/2026 4/1/2027 2,000,000 B 1,000,000 X Y Y BAP927545025 4/1/2026 4/1/2027 CA X 10,000,000 X Y LA26EXC725167ICMKLV5EUE104728 4/1/20264/1/2026 N 4/1/20274/1/2027 10,000,000 DB X N Y WC588844821WC488669016 4/1/20264/1/2026 4/1/20274/1/2027 1,000,000 1,000,000 1,000,000 A ContractorsPollution Liability /ProfessionalLiability NN N MKLV5ENV105588 4/1/2026 4/1/2027 Per Claim LimitAggregateLimit $5,000,000$5,000,000 Re:Evidence of Insurance.Subject to said policy limits,terms,and exclusions. Certificate holder is included as an Additional Insured as respects to General Liability and Auto Liability coverage per attached endorsements.Waiver ofSubrogationappliestoGeneralLiability,Auto Liability,and Workers Compensation coverage per attached endorsements.Excess Liability follows form ofprimarypolicies.Primary Non-Contributory wording applies per attached endorsements. City of BremertonFinancialServices345SixthStreetSuite600BremertonWA98337-1873 ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD This is evidence of insurance procured and developed under the Alaska Surplus Lines Law, AS 21.34. It is not covered by the Alaska Insurance Guaranty Association Act, AS 21.80. Certificate of Liability25 PetroCard,Inc.Marsh &McLennan Agency LLC WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce ourright against the person or organization named in the Schedule. (This agreement applies only to the extent that youperform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS OR ORGANIZATIONS BUT LIMITED TO THE SCOPE OF WORK PERFORMED BY THE INSURED UNDER THE CONTRACT, AGREEMENT OR PERMIT. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.(The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No.Endorsement No. Insured Premium $INCL. Insurance Company AMERICAN ZURICH INSURANCE COMPANY Countersigned By WC 00 03 13 (Ed. 4-84) @ 1983 National Council on Compensation Insurance. 04/01/2026 WC588844821 PetroCard,Inc. NAV-ECD-6012 (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION SCHEDULE Name of Person or Organization: As required by written contract or agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to SECTION IV - CONDITIONS, 13. Transfer of Rights of Recovery Against Others. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or “your work” done under a contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. All other terms of the policy remain unchanged. INSURED: POLICY #: POLICY PERIOD: TO: PetroCard,Inc. LA26EXC725167IC 04/01/202704/01/2026 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1MEEI 2274-A 01 22 EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC PRIMARY AND NON-CONTRIBUTORY INSURANCE – ALASKA NATIVE CORPORATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM PROFESSIONAL LIABILITY COVERAGE FORM The following is added to the Other Insurance condition: Primary And Non-Contributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to the Person Or Organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. SCHEDULE ENVIRONMENTAL Person Or Organization: Where required by written contract INSURED: POLICY #: POLICY PERIOD: TO: PetroCard,Inc. 04/01/2026MKLV5ENV105568 04/01/2027 © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1.Your acts or omissions; or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is 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. B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2.That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 Name Of Additional Insured Person(s) Or Organization(s) Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. All locations Location(s) Of Covered Operations POLICY NUMBER: MKLV5ENV105077 INSURED: POLICY PERIOD: TO PetroCard,Inc. MKLV5ENV105568 04/01/202704/01/2026 © Insurance Services Office, Inc., 2012 Page 2 of 2 CG 20 10 04 13 2.Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. INSURED: Coverage Extension Endorsement This endorsement modifies insurance provided under the: Business Auto Coverage FormMotor Carrier Coverage Form A.Amended Who Is An Insured 1.The following is added to the Who Is An Insured Provision in Section II – Covered Autos Liability Coverage: The following are also "insureds": a.Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow for acts performed within the scope of employment by you. Any “employee” of yours is also an “insured” while operating an “auto” hired or rented under a contract or agreement in an “employee’s” name, with your permission, whileperforming duties related to the conduct of your business. b.Anyone volunteering services to you is an "insured" while using a covered "auto" you don’t own, hire or borrowto transport your clients or other persons in activities necessary to your business. c.Anyone else who furnishes an "auto" referenced in Paragraphs A.1.a. and A.1.b. in this endorsement. d.Where and to the extent permitted by law, any person(s) or organization(s) where required by written contractor written agreement with you executed prior to any "accident", including those person(s) or organization(s) directing your work pursuant to such written contract or written agreement with you,provided the "accident" B. arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement, or the Limits of Insurance shown in the Declarations, whichever is less. 2.The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s) or organization(s), where required by written contract or written agreement with youexecuted prior to any "accident", will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured" will apply on an excess basis. However, in no event will this coverage extend beyond theterms and conditions of the Coverage Form. Amendment – Supplementary Payments Paragraphs a.(2)and a.(4) of the Coverage Extensions Provision in Section II – Covered Autos Liability Coverage are replaced by the following: (2) (4) Up to $5,000 for the 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. 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. C.Fellow Employee Coverage The Fellow Employee Exclusion contained in Section II – Covered Autos Liability Coverage does not apply. U-CA-424-H-AK (10/21)Page 1 of 6 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No.Effective Date: PetroCard,Inc. 04/01/2026BAP927545025 D. E. Driver Safety Program Liability and Physical Damage Coverage 1. The following is added to the Racing Exclusion in Section II – Covered Autos Liability Coverage: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but notlimited to, auto or truck rodeos and other auto or truck agility demonstrations. 2. The following is added to Paragraph 2. in B.Exclusions of Section III – Physical Damage Coverage of theBusiness Auto Coverage Form and Paragraph 2.b. in B.Exclusions of Section IV – Physical Damage Coverage of the Motor Carrier Coverage Form: This exclusion does not apply to covered "autos" participating in a driver safety program event, such as, but not limited to, auto or truck rodeos and other auto or truck agility demonstrations. Lease or Loan Gap Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Lease Or Loan Gap Coverage In the event of a total "loss" to a covered "auto", we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. b. Any amount paid under the Any: Physical Damage Coverage Section of the Coverage Form; and (1) (2) (3) (4) (5) Overdue lease or loan payments at the time of the "loss"; Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; Security deposits not returned by the lessor; Costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with theloan or lease; and Carry-over balances from previous leases or loans. F. G. H. Towing and Labor Paragraph A.2. of the Physical Damage Coverage Section is replaced by the following: We will pay up to $75 for towing and labor costs incurred each time a covered "auto" that is a "private passenger type", light truck or medium truck is disabled. However, the labor must be performed at the place of disablement. As used in this provision, "private passenger type" means a private passenger or station wagon type "auto" and includes an "auto" of the pickup or van type if not used for business purposes. Extended Glass Coverage The following is added to Paragraph A.3.a. of the Physical Damage Coverage Section: If glass must be replaced, the deductible shown in the Declarations will apply. However, if glass can be repaired andis actually repaired rather than replaced, the deductible will be waived. You have the option of having the glass repaired rather than replaced. Hired Auto Physical Damage – Increased Loss of Use Expenses The Coverage Extension for Loss Of Use Expenses in the Physical Damage Coverage Section is replaced by thefollowing: Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay forloss of use of a vehicle rented or hired without a driver under a written rental contract or written rental agreement. We will pay for loss of use expenses if caused by: (1)Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto"; U-CA-424-H AK (10/21)Page 2 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. (2) (3) Specified Causes Of Loss only if the Declarations indicate that Specified Causes Of Loss Coverage is provided for any covered "auto"; or Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". I. However, the most we will pay for any expenses for loss of use is $100 per day, to a maximum of $3000. Personal Effects Coverage The following is added to the Coverage Provision of the Physical Damage Coverage Section: Personal Effects Coverage a.We will pay up to $750 for "loss" to personal effects which are: (1) (2) Personal property owned by an "insured"; and In or on a covered "auto". b. Subject to Paragraph a. above, the amount to be paid for "loss" to personal effects will be based on the lesser of: (1) (2) The reasonable cost to replace; or The actual cash value. c.The coverage provided in Paragraphs a. and b. above, only applies in the event of a total theft of a covered "auto".No deductible applies to this coverage. However, we will not pay for "loss" to personal effects of any of the following: (1) (2) (3) (4) (5) Accounts, bills, currency, deeds, evidence of debt, money, notes, securities, or commercial paper or otherdocuments of value. Bullion, gold, silver, platinum, or other precious alloys or metals; furs or fur garments; jewelry, watches, preciousor semi-precious stones. Paintings, statuary and other works of art. Contraband or property in the course of illegal transportation or trade. Tapes, records, discs or other similar devices used with audio, visual or data electronic equipment. J. K. L. Coverage shall be in excess of other available primary insurance coverage. Tapes, Records and Discs Coverage 1. The Exclusion in Paragraph B.4.a. of Section III – Physical Damage Coverage in the Business Auto Coverage Form and the Exclusion in Paragraph B.2.c. of Section IV – Physical Damage Coverage in the Motor CarrierCoverage Form does not apply. 2. The following is added to Paragraph 1.a. Comprehensive Coverage under the Coverage Provision of the Physical Damage Coverage Section: We will pay for "loss" to tapes, records, discs or other similar devices used with audio, visual or data electronicequipment. We will pay only if the tapes, records, discs or other similar audio, visual or data electronic devices: (a) Are the property of an "insured"; and (b) Are in a covered "auto" at the time of "loss". The most we will pay for such "loss" to tapes, records, discs or other similar devices is $500. The PhysicalDamageCoverage Deductible Provision does not apply to such "loss". Airbag Coverage The Exclusion in Paragraph B.3.a. of Section III – Physical Damage Coverage in the Business Auto Coverage Formand the Exclusion in Paragraph B.4.a. of Section IV – Physical Damage Coverage in the Motor Carrier CoverageFormdoes not apply to the accidental discharge of an airbag. Two or More Deductibles The following is added to the Deductible Provision of the Physical Damage Coverage Section: U-CA-424-H AK (10/21)Page 3 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. If an accident is covered both by this policy or Coverage Form and by another policy or Coverage Form issued to youby us, the following applies for each covered "auto" on a per vehicle basis: 1. 2. If the deductible on this policy or Coverage Form is the smaller (or smallest) deductible, it will be waived; or If the deductible on this policy or Coverage Form is not the smaller (or smallest) deductible, it will be reduced by theamount of the smaller (or smallest) deductible. M.Temporary Substitute Autos – Physical Damage 1. The following is added to Section I – Covered Autos: Temporary Substitute Autos – Physical Damage If Physical Damage Coverage is provided by this Coverage Form on your owned covered "autos", the followingtypes of vehicles are also covered "autos" for Physical Damage Coverage: Any "auto" you do not own when used with the permission of its owner as a temporary substitute for a covered"auto" you do own but is out of service because of its: 1. 2. 3. 4. 5. Breakdown; Repair; Servicing; "Loss"; or Destruction. 2.The following is added to the Paragraph A. Coverage Provision of the Physical Damage Coverage Section: N. Temporary Substitute Autos – Physical Damage We will pay the owner for "loss" to the temporary substitute "auto" unless the "loss" results from fraudulent acts or omissions on your part. If we make any payment to the owner, we will obtain the owner's rights against any otherparty. The deductible for the temporary substitute "auto" will be the same as the deductible for the covered "auto" itreplaces. Amended Duties In The Event Of Accident, Claim, Suit Or Loss Paragraph a. of the Duties In The Event Of Accident, Claim, Suit Or Loss Condition is replaced by the following: a. In the event of "accident", claim, "suit" or "loss", you must give us or our authorized representative prompt notice of the "accident", claim, "suit" or "loss". However, these duties only apply when the "accident", claim, "suit" or "loss" is known to you (if you are an individual), a partner (if you are a partnership), a member (if you are a limited liabilitycompany) or an executive officer or insurance manager (if you are a corporation). The failure of any agent, servant or employee of the "insured" to notify us of any "accident", claim, "suit" or "loss" shall not invalidate the insuranceafforded by this policy. Include, as soon as practicable: (1) (2) (3) How, when and where the "accident" or "loss" occurred and if a claim is made or "suit" is brought, written noticeof the claim or "suit" including, but not limited to, the date and details of such claim or "suit"; The "insured’s" name and address; and To the extent possible, the names and addresses of any injured persons and witnesses. O. If you report an "accident", claim, "suit" or "loss" to another insurer when you should have reported to us, your failure to report to us will not be seen as a violation of these amended duties provided you give us notice as soon aspracticable after the fact of the delay becomes known to you. Waiver of Transfer Of Rights Of Recovery Against Others To Us The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: U-CA-424-H AK (10/21)Page 4 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. P. This Condition does not apply to the extent required of you by a written contract, executed prior to any "accident" or"loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. This waiver onlyapplies to the person or organization designated in the contract. Employee Hired Autos – Physical Damage Paragraph b.of the Other Insurance Condition in the Business Auto Coverage Form and Paragraph f. of the Other Insurance – Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form are replacedby the following: For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) (2) Any covered "auto" you lease, hire, rent or borrow; and Any covered "auto" hired or rented under a written contract or written agreement entered into by an "employee" orelected or appointed official with your permission while being operated within the course and scope of that "employee's" employment by you or that elected or appointed official’s duties as respect their obligations to you. Q. R. S. T. U. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". Unintentional Failure to Disclose Hazards The following is added to the Concealment, Misrepresentation Or Fraud Condition: However, we will not deny coverage under this Coverage Form if you unintentionally: (1) Fail to disclose any hazards existing at the inception date of this Coverage Form; or (2) Make an error, omission, improper description of "autos" or other misstatement of information. You must notify us as soon as possible after the discovery of any hazards or any other information that was not providedto us prior to the acceptance of this policy. Hired Auto – World Wide Coverage Paragraph 7.b.(5) of the Policy Period, Coverage Territory Condition is replaced by the following: (5) Anywhere else in the world if a covered "auto" is leased, hired, rented or borrowed for a period of 60 days or less, Bodily Injury Redefined The definition of "bodily injury" in the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease, sustained by a person including death or mental anguish,resulting from any of these at any time. Mental anguish means any type of mental or emotional illness or disease. Expected Or Intended Injury The Expected Or Intended Injury Exclusion in Paragraph B. Exclusions under Section II – Covered Auto LiabilityCoverage is replaced by the following: Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the "insured". This exclusion does notapply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Physical Damage – Additional Temporary Transportation Expense Coverage Paragraph A.4.a. of Section III – Physical Damage Coverage is replaced by the following: 4.Coverage Extensions a.Transportation Expenses We will pay up to $50 per day to a maximum of $1,000 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". U-CA-424-H AK (10/21) Page 5 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. V. W. Replacement of a Private Passenger Auto with a Hybrid or Alternative Fuel Source Auto The following is added to Paragraph A. Coverage of the Physical Damage Coverage Section: In the event of a total "loss" to a covered "auto" of the private passenger type that is replaced with a hybrid "auto" or "auto" powered by an alternative fuel source of the private passenger type, we will pay an additional 10% of the cost ofthe replacement "auto", excluding tax, title, license, other fees and any aftermarket vehicle upgrades, up to a maximum of $2500. The covered "auto" must be replaced by a hybrid "auto" or an "auto" powered by an alternative fuel sourcewithin 60 calendar days of the payment of the "loss" and evidenced by a bill of sale or new vehicle lease agreement. To qualify as a hybrid "auto", the "auto" must be powered by a conventional gasoline engine and another source ofpropulsion power. The other source of propulsion power must be electric, hydrogen, propane, solar or natural gas,either compressed or liquefied. To qualify as an "auto" powered by an alternative fuel source, the "auto" must bepowered by a source of propulsion power other than a conventional gasoline engine. An "auto" solely propelled bybiofuel, gasoline or diesel fuel or any blend thereof is not an "auto" powered by an alternative fuel source. Return of Stolen Automobile The following is added to the Coverage Extension Provision of the Physical Damage Coverage Section: If a covered “auto” is stolen and recovered, we will pay the cost of transport to return the “auto” to you. We will payonlyfor those covered “autos" for which you carry either Comprehensive or Specified Causes of Loss Coverage. All other terms, conditions, provisions and exclusions of this policy remain the same. U-CA-424-H AK (10/21) Page 6 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. NAV-EXC-348A (01/11)Page 1 of 1Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office, Inc. with its permission. COMMERCIAL EXCESS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS OTHER INSURANCE PRIMARY AND NON-CONTRIBUTING This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS LIABILITY COVERAGE PART SCHEDULE When required by written contract executed before the "loss." A. Section IV - Conditions, 9. Other Insurance is deleted and replaced by the following: 9. This insurance is excess over any other insurance available to the insured except: a. insurance that is purchased specifically to apply in excess of this policy; or b. insurance available to the person or organization shown in the Schedule of this endorsement as an additional insured on the “controlling underlying insurance.” B. When this insurance applies on a primary and non-contributing basis, the Limits of Insurance available for the additional insured will be the lesser of: 1. the amounts shown in item 3 of the Declarations of this policy; or 2. the amount of insurance you are required to provide the additional insured in the written contract or agreement. All other terms of the policy remain unchanged. INSURED: POLICY #: POLICY PERIOD: TO: PetroCard,Inc. 04/01/202704/01/2026LA26EXC725167IC © Insurance Services Office, Inc., 2008 Page 1 of 1 CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 POLICY NUMBER: MKLV5ENV105077 Where required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Name Of Person Or Organization: INSURED: POLICY PERIOD: TO PetroCard,Inc. MKLV5ENV105568 04/01/202704/01/2026