HWA Insurance Cert.pdf^ �®
A
l(�Jv/R CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDD/YYYY)
09/25/2018
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
CON ACT Ralph Taylor
NAME:
Orion Insurance Group
H No Ext ; (425) 771-5197 1C No): (425) 673-4427
E-MAIL s: rtaylor@orioninsgroup.com
ADDRE
3405 188th ST SW
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite #302
INSURERA: RLI Insurance
13056
Lynnwood WA 98037
INSURED
INSURER B : Admiral Insurance Company
24856
INSURER C :
H WA GeoSCI ences Inc.
INSURER D : r
21312 30th Drive SE, Suite 110
INSURER E :
INSURER F :
Bothell WA 98021-7010
COVERAGES CERTIFICATE NUMBER: CL1892502581 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 CONTRACTOR OTIdER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
iNSR
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
MWDD
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
�/
CLAIMS -MADE /� OCCUR
t Itu
PREMISES Ea occurrence
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL BADVINJURY
$ 1,000,000
A
PSB0002638
12/01/2017
12/01/2018
GEN'LAGGREGATE LIMITAPPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY O. PE ° LOG
PRODUCTS - COMP/OP AGG
$ 2,000,000
Employee Benefits
$
OTHER:
_
AUTOMOBILE LIABILITY
_
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
X ANYAUTO
A
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
F
PSA0001635
12/01/2017
12/01/2018
BODILY INJURY (Pe raccident)
$
PROPERTY DAMAGE
Par accident
$
$
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 5,000,000
A
EXCESS LIAB
HCLAIMS-MADE
PSE0001834
12/01/2017
12/01/2018
AGGREGATE
$ 5,000,000
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN N
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? �
(Mandatory In NH)
N/A
PSB0002638
12/01/2017
12/01/2018
PER OTN-
STATUTE ER
E.L.EACHACCIDENT
1,000,000
$
E L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 2,000,000
IF yes, describe under
DESCRIPTION OF OPERATIONS below
$3,000,000 Each Claim
$50,000
B
Professional Liability Claims Made
Including Pollution Liability
E000003589302
12/01/2017
12/01l2018
$3,000,000Aggregate
Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Project Name: 84th Ave West Overlay (between 220th SW and 212th SW); TETRA TECH, INC. JOB #: 1 00-RCE-1 8-021; Client: City of Edmonds.
All required parties including Tetra Tech, Inc. and City of Edmonds are listed as additional insureds with primary non-contributory wording except with
respect to professional liability and worker's compensation. 30-days notice of cancellation modification applies to certificate holder. A blanket waiver of
subrogation applies in favor of all required parties for all policies including the worker's compensation and professional liability where required by contract.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TETRA TECH, INC. ACCORDANCE WITH THE POLICY PROVISIONS.
1420 Fifth Avenue, Suite 550
AUTHORIZED REPRESENTATIVE
Seattle WA 98004 1_ � .SNP)\,-;Zl
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
Policy Number: PSB0002638 RLI Insurance Company
Named Insured: HWA GeoSciences, Inc.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° FOR PROFESSIONALS
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM - SECTION II — LIABILITY
C. WHO IS AN INSURED is amended to include as
an additional insured any person or organization that
you agree in a contract or agreement requiring
insurance to include as an additional insured on this
policy, but only with respect to liability for "bodily
injury", "property damage" or "personal and
advertising injury" caused in whole or in part by you
or those acting on your behalf:
a. In the performance of your ongoing operations;
b. In connection with premises owned by or rented
to you; or
c. In connection with "your work" and included
within the "product -completed operations
hazard".
2. The insurance provided to the additional insured by
this endorsement is limited as follows:
a. This insurance does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
b. This insurance does not apply to the rendering
of or failure to render any "professional
services".
c. This endorsement does not increase any of the
limits of insurance stated in D. Liability And
Medical Expenses Limits of Insurance.
3. The following is added to SECTION III H.2. Other
Insurance — COMMON POLICY CONDITIONS
(BUT APPLICABLE ONLY TO SECTION II —
LIABILITY)
However, if you specifically agree in a contract or
agreement that the insurance provided to an
additional insured under this policy must apply on a
primary basis, or a primary and non-contributory
basis, this insurance is primary to other insurance
that is available to such additional insured which
covers such additional insured as a named insured,
and we will not share with that other insurance,
provided that:
a. The "bodily injury" or "property damage" for
which coverage is sought occurs after you have
entered into that contract or agreement; or
b. The "personal and advertising injury" for which
coverage is sought arises out of an offense
committed after you have entered into that
contract or agreement.
4. The following is added to SECTION III K. 2.
Transfer of Rights of Recovery Against Others to
Us — COMMON POLICY CONDITIONS (BUT
APPLICABLE TO ONLY TO SECTION II —
LIABILITY)
We waive any rights of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage" or "personal and advertising injury" arising
out of "your work" performed by you, or on your
behalf, under a contract or agreement with that
person or organization. We waive these rights only
where you have agreed to do so as part of a
contract or agreement with such person or
organization entered into by you before the "bodily
injury" or "property damage" occurs, or the "personal
and advertising injury" offense is committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPB 304 02 12 Page 1 of 1
Policy Number: PSB0002638
RLI Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° FOR DESIGN PROFESSIONALS
LIABILITY ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A. First Aid And Good Samaritan Services
B. Supplementary Payments
C. Reasonable Force — Bodily Injury Or Property Damage
D. Non -Owned Watercraft
E. Canoes Or Rowboats
F. Damage To Premises Rented To You
G. Aircraft Chartered With Crew
H. Electronic Data Liability
I. Who Is An Insured — Newly Acquired Or Formed Organizations
J. Who Is An Insured — Unnamed Partnership Or Joint Venture
K. Additional Insured — Owner, Manager Or Lessor Of Premises Or Leased Equipment
L. Additional Insured — State Or Political Subdivisions — Permits Related To Premises Or Operations
M. General Aggregate Limit — Per Project Or Per Location
N. Knowledge And Notice Of Occurrence Or Offense
O. Amended Bodily Injury Definition
P. Amended Insured Contract Definition — Construction Or Demolition Operations Within 50' Of Railroad
Q. Amended Personal And Advertising Injury Definition — Electronic Material
R. Unintentional Omission
S. Waiver Of Transfer Of Rights Of Recovery Against Others To Us
PPB 316 02 11 Page 1 of 7
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM — SECTION II — LIABILITY AND SECTION III AS IT PERTAINS TO LIABILITY
ONLY
A. First Aid And Good Samaritan Services
1. The following is added to Section II A.I.
Business Liability Coverages
We will pay those sums that the insured
becomes legally obligated to pay as damages
because of "bodily injury" arising out of either the
rendering of or failure to render, "First Aid" or
"Good Samaritan Services" to any person. For
the purposes of this coverage grant, "First Aid"
or "Good Samaritan Services" will be deemed to
meet the definition of 'occurrence'. For the
purposes of determining the applicable limits of
insurance, any act or omission together with all
related acts or omissions in the rendering of
"First Aid" or "Good Samaritan Services" to any
one person will be deemed one `occurrence' .
a. "First Aid" means initial care for medical
attention immediately following a "bodily
injury'
b. "Good Samaritan Services" means medical
attention provided in an emergency and for
which no remuneration is demanded or
received.
2. The insurance provided by this provision shall
be excess over any valid and collectible other
insurance available to any insured whether
primary, excess, contingent or any other basis,
except for insurance purchased specifically by
you to apply in excess of the limits of Insurance
shown in the declarations for Business Liability.
B. Supplementary Payments
Section II A.1.f. Coverage Extension —
Supplementary Payments Paragraphs 1.(b) and
1.(d) are deleted and replaced with the following:
(b) Up to $2,500 for the cost of bail bonds required
because of accidents or traffic violations arising
out of any vehicle to which Business Liability
Coverage for "bodily injury' applies. We do not
have to furnish these bonds.
(d) All reasonable expenses incurred by the insured
at our request to assist in the investigation or
defense of the claim or "suit", including actual
loss of earnings up to $500 a day because of
time off work.
C. Reasonable Force — Bodily Injury Or Property
Damage
Section II B.1.a. Exclusions, Expected Or
Intended Injury, is deleted and replaced by the
following:
a. Expected or Intended Injury
"Bodily Injury" or "property damage"
expected or intended from the standpoint of
the insured. This exclusion does not apply
to "bodily injury' or "property damage'
resulting from the use of reasonable force to
protect persons or property.
D. Non -Owned Watercraft
1. Section II B.1.g. Exclusions, Aircraft, Auto Or
Watercraft Subparagraph (2) is deleted and
replaced by the following:
(2) A watercraft you do not own that is:
(a) Up to seventy-five (75) feet long; and
(b) Not being used to carry persons or
property for a charge;
2. Only as respects to the insurance provided by
this provision C. Who Is An Insured is
amended to include as an insured any person
who, with your express consent uses the
watercraft.
3. The insurance provided by this provision shall be
excess over any valid and collectible other
insurance available to the insured, whether
primary, excess, contingent or on any other
basis, except for the insurance purchased
specifically by you to apply in excess of the
Limits of Insurance shown in the declarations for
this Coverage Part.
E. Canoes Or Rowboats
The following is added to the exceptions contained
in Section II B.1.g. Exclusions, Aircraft, Auto Or
Watercraft:
(6) Any non -motorized canoe or rowboat owned by
the insured. Only as respects to the insurance
provided by this provision C. Who Is An
Insured is amended to include as an insured
any person who, with your express consent,
uses any such canoe or rowboat.
F. Damage to Premises Rented to You
1. The last paragraph of Section II B.1.
Exclusions — Applicable To Business
Liability Coverage is deleted and replaced by
the following:
PPB 316 02 11 Page 2 of 7
Exclusions c.,d.,e.,f.,g.,h.,i.,k.,l.,m.,n. and o. in
"Electronic data" means information, facts or
SECTION II — LIABILITY do not apply to
programs stored as or on, created or used on, or
damage by water, fire, explosion, lightning, or
transmitted to or from computer software
smoke resulting from fire to premises while
(including systems and applications software),
rented to you, or temporarily occupied by you
hard or floppy disks, CD-ROMS, tapes, drives,
with permission by the owner. A separate
cells, data processing devices or any other
Damage To Premises Rented To You Limit of
media which are used with electronically
Insurance applies to this coverage as described
controlled equipment.
in paragraph D. Liability And Medical
3. For the purposes of the coverage provided by
Expenses Limits of Insurance in SECTION II —
this endorsement, Section II F. Liability And
LIABILITY.
Medical Expenses Definitions, Paragraph 17.
2.
Section II F.9.a. Liability And Medical
is deleted and replaced by the following:
Expenses Definitions, is deleted and replaced
by the following:
17. "Property damage" means:
a. A contract for a lease of premises. However,
a. Physical injury to tangible property,
that portion of the contract for a lease of
including all resulting loss of use of that
premises that indemnifies any person or
property. All such loss of use shall be
organization for damage by water, fire,
deemed to occur at the time of the
explosion, lightning, or smoke resulting from
physical injury that caused it;
fire to premises while rented to you or
b. Loss of use of tangible property that is
temporarily occupied by you with permission
not physically injured. All such loss of
of the owner is not an "insured contract";
use shall be deemed to occur at the
3.
This provision does not apply if coverage for
time of the "occurrence" that caused it;
Damage To Premises Rented To You is
or
excluded by another endorsement to this policy.
c. Loss of, loss of use of, damage to,
G. Aircraft Chartered With Crew
corruption of, inability to access, or in-
ability to properly manipulate "electronic
1.
The following is added to the exceptions
data", resulting from physical injury to
contained in Section II B.1.g. Exclusions,
tangible property. All such loss of
Aircraft Auto or Watercraft:
"electronic data" shall be deemed to
(6) Any non -owned aircraft chartered to you
occur at the time of the "occurrence"
with a crew including a pilot.
that caused it.
2.
The insurance provided by this provision shall
For the purposes of this insurance,
be excess over any valid and collectible other
"electronic data" is not tangible property.
insurance available to the insured whether
I. Who Is An Insured — Newly Acquired Or Formed
primary, excess, contingent or on any other
Organizations
basis, except for insurance purchased
specifically by you to apply in excess of the
The following is added to Section II C. Who Is An
Limits of Insurance shown in Declarations.
Insured:
H. Electronic Data Liability
Any organization you newly acquire or form, other
1.
Section II B.1.q. Exclusions is deleted and
than a partnership, joint venture or limited liability
replaced by the following:
company, over which you maintain ownership or
majority interest, will qualify as a Named Insured if
q. Electronic Data
there is no other similar insurance available to that
Damages arising out of the loss of, loss of
organization. However:
use of, damage to, corruption of, inability to
1. Coverage under this provision is afforded only
access, or inability to manipulate "electronic
until the one hundred eightieth (1801") day after
data" that does not result from physical
you acquire or form the organization or the end
injury to tangible -property.
of the policy period, whichever is earlier;
2.
The following definition is added to Section II F.
2. Coverage does not apply for "bodily injury" or
Liability And Medical Expenses Definitions:
"property damage" that occurred before you
acquired or formed the organization.
PPB 316 02 11 Page 3 of 7
3. Coverage does not apply for "personal and
advertising injury" arising out of an offense
committed before you acquired or formed the
organization.
4. This provision does not apply to any
organization for which coverage is excluded by
another endorsement to this policy.
J. Who Is An Insured — Unnamed Partnership Or
Joint Venture
1. The last paragraph of Section II C. Who Is An
Insured: is deleted and replaced by the
following:
No person or organization is an insured with
respect to the conduct of any current or past
partnership, joint venture or limited liability
company that is not shown as a Named Insured
in the Declarations. However this limitation does
not apply to your liability with respect to your
conduct of the business of any current or past
partnership or joint venture:
a. That is not shown as a Named Insured in
the Declarations, and
b. In which you are a member or partner but
only if
(i) Each and every member or partner in
that joint venture or partnership is not a
construction contractor, and
(ii) The joint venture or partnership is not
providing construction contracting
services.
2. This provision does not apply to any person or
organization for which coverage is excluded by
another endorsement to this policy.
3. The insurance provided by this provision shall
be excess over any valid and collectible other
insurance, whether primary, excess, contingent
or on any other basis, which is available
covering your liability with respect to your
conduct of the business of any current or past
partnership or joint venture that is not shown as
a Named Insured in the Declarations and which
is issued to such partnership or joint venture.
K. Additional Insured — Owner, Manager Or Lessor
Of Premises Or Leased Equipment
Section II C. Who Is An Insured is amended to
include as an insured:
1. Any person or organization that you have
agreed in a contract or agreement to include as
an additional insured on this policy, but:
a. Only with respect to liability for "bodily injury"
or "property damage" that occurs, or
"personal and advertising injury" caused by
an offense committed, after you have
entered into that contract or agreement; and
(1) Only if the "bodily injury", "property dam-
age" or "personal and advertising injury
" is caused, in whole or in part, by you or
any person or organization performing
operations on your behalf, and arises
out of the ownership, maintenance or
use of that part of any premises leased
to you under that contract or agreement;
or
(2) The "bodily injury", "property damage" or
"personal and advertising injury " is
caused, in whole or in part, by you or
any person or organization performing
operations on your behalf, and arises
out of the maintenance, operation or use
of equipment leased to you by such
additional insured.
2. The insurance provided to such additional in-
sured under this provision is subject to the
following:
a. The limits of insurance afforded to such
additional insured shall be the limits which
you agreed to provide in the contract or
agreement, or the limits shown in the
Declarations, whichever are less; and
b. The insurance afforded to such additional
insured does not apply:
(1) To any "bodily injury" or "property dam-
age" that occurs, or "personal and
advertising injury" caused by an offense
committed, after you cease to be a
tenant in that premises;
(2) To any structural alterations, construc-
tion or demolition operations performed
by or on behalf of such additional
insured;
(3) To any premises for which coverage is
excluded by another endorsement to
this Coverage Part;
(4) To any "bodily injury" or "property dam-
age" that occurs, or "personal and
advertising injury" caused by an offense
committed, after the equipment lease
expires; or
(5) If the equipment is leased with an
operator.
3. This provision does not apply on any basis to
any person or organization for which coverage
as an additional insured specifically is added by
another endorsement to this policy.
PPB 316 02 11 Page 4 of 7
L. Additional Insured — State Or Political
Subdivisions — Permits Related To Premises Or
Operations
Section II C. Who Is An Insured is amended to
include as an insured:
Any state or political subdivision that has issued
a permit in connection with premises owned or
occupied by, or rented or loaned to, you, but
only with respect to "bodily injury", "property
damage", "personal and advertising injury"
arising out of the existence, ownership, use,
maintenance, repair, construction, erection or
removal of advertising signs, awnings, canopies,
cellar entrances, coal holes, driveways,
manholes, marquees, hoist away openings,
sidewalk vaults, elevators, street banners or
decorations for which that state or political
subdivision has issued such permit.
2. Any state or political subdivision that has issued
a permit, but only with respect to "bodily injury",
"property damage", "personal and advertising
injury" arising out of operations performed by
you or on your behalf for which that state or
political subdivision has issued such permit.
However, no such state or political subdivision is
an insured for:
a. 'Bodily injury", "property damage", "personal
and advertising injury" arising out of op-
erations performed for that state or political
subdivision; or
b. "Bodily injury" or "property damage"
included within the "products -completed
operations hazard".
M. General Aggregate Limit — Per Project Or Per
Location
Section II D. Liability And Medical Expenses
Limits of Insurance, Paragraph 4. Aggregate
Limits. is deleted and replaced by the following:
4. Aggregate Limits
The most we will pay for:
a. All "bodily injury" and "property damage"
that is included in the "products -completed
operations hazard" is twice the Liability and
Medical Expenses limit.
b. All:
(1) "Bodily injury" and "property damage"
except damages because of "bodily in-
jury" or "property damage" included in
the "products -completed operations
hazard";
(2) Plus medical expenses;
(3) Plus all "personal and advertising injury"
caused by offenses committed;
is twice the Liability and Medical Expenses
limit.
The aggregate limit for all "bodily injury" and
"property damage", medical expenses and
"personal and advertising injury" other than
"bodily injury" or "property damage" included in
the "products -completed operations hazard"
applies separately to each of your "projects"
away from premises owned by or occupied by
you or to each of your "locations" owned by or
occupied by you.
"Projects" mean an area away from premises
owned by or rented to you at which you are
performing operations pursuant to a contract or
agreement. For the purposes of determining the
applicable aggregate limit of insurance, each
"project" at the same "location" shall be
considered a single "project".
For the purposes of this provision, "location"
means
1. premises involving the same or connecting
lots;
2. premises where connection is interrupted
only by a street, roadway, waterway or right-
of-way of a railroad; or
3. premises where operations are performed in
sections, stages or phases as a continuation
of the same contract or agreement, even if
the premises do not involve connecting lots.
Subject to Paragraph a. or b. above, whichever
applies, the Damage To Premises Rented To
You Limit is the most we will pay for damages
because of "property damage" to any one
premises, while rented to you, or in the case of
fire; explosion; lightning; smoke resulting from
such fire, explosion or lightning; or water while
rented to you or temporarily occupied by you
with permission of the owner.
The Limits of Insurance of SECTION II —
LIABILITY apply separately to each consecutive
annual period and to any remaining period of
less than twelve (12) months, starting with the
beginning of the policy period shown in the
Declarations, unless the policy period is
extended after issuance for an additional period
of less than twelve (12) months. In that case, the
additional period will be deemed part of the last
preceding period for purposes of determining the
Limits of Insurance.
N. Knowledge And Notice Of Occurrence Or
Offense
The following is added to Section II E. 2. Liability
and Medical Expenses General Conditions,
Duties In The Event of Occurrence, Offense,
Claim Or Suit:
PPB 316 02 11 Page 5 of 7
Notice of an "occurrence" or of an offense which
may result in a claim must be given as soon as
practicable after knowledge of the "occurrence" or
offense has been reported to you, one of your
"executive officers" (if you are a corporation), one of
your partners who is an individual (if you are a
partnership), one of your managers (if you are a
limited liability company), one of your trustees who is
an individual (if you are a trust), or an "employee"
(such as an insurance, loss control or risk manager
or administrator) designated by you to give such
notice.
Knowledge by any other "employee" of an "occur-
rence" or offense does not imply that you also have
such knowledge.
Notice of an "occurrence" or of an offense which
may result in a claim will be deemed to be given as
soon as practicable to us if it is given in good faith as
soon as practicable to your workers' compensation,
accident, or health insurer. This applies only if you
subsequently give notice of the "occurrence" or
offense to us as soon as practicable after you, one
of your "executive officers" (if you are a corporation),
one of your partners who is an individual (if you are
a partnership), one of your managers (if you are a
limited liability company), one of your trustees who is
an individual (if you are a trust), or an "employee"
(such as an insurance, loss control or risk manager
or administrator) designated by you to give such
notice discovers that the "occurrence" or offense
may involve this policy.
O. Amended Bodily Injury Definition
The definition of "bodily injury" in Section II F.3.
Liability And Medical Expenses Definitions is
deleted and replaced by the following:
"Bodily injury" means injury to the body, sickness,
disease, or death. "Bodily injury" also means mental
injury, mental anguish, emotional distress, pain and
suffering, or shock resulting from injury to the body,
sickness, disease or death of any person.
P. Amended Insured Contract Definition —
Construction Or Demolition Operations Within
50' Of Railroad
1. The definition of "insured contract" in Section II
F.9.c. Liability And Medical Expenses
Definitions is deleted and replaced by the
following:
c. Any easement or license agreement
2. The definition of "insured contract" in Section II
F.9.f.(1) Liability And Medical Expenses
Definitions is deleted.
3. The insurance provided by this provision shall
be excess over any valid and collectible Railroad
Protective Liability insurance available to an
insured , whether primary, excess, contingent or
on any other basis, except for the insurance
purchased specifically by you to apply in excess
of the Limits of Insurance shown in the
declarations for this Coverage Part.
Q. Amended Personal And Advertising Injury
Definition — Electronic Material
1. The definition of "personal and advertising
injury" in Section II F.14.d. Liability And
Medical Expenses Definitions is deleted and
replaced by the following:
d. Oral, written or electronic publication, in any
manner, of material that slanders or libels a
person or organization or disparages a
person's or organization's goods, products
or services;
The definition of "personal and advertising
injury" in Section II F.14.e. Liability And
Medical Expenses Definitions is deleted and
replaced by the following:
e. Oral, written or electronic publication, in any
manner, of material that violates a person's
right of privacy;
3. Section II B.1.p.(2) Exclusions for Personal
And Advertising Injury is deleted and replaced
by the following:
(2) Arising out of oral, written or electronic
publication of material if done by or at the
direction of the insured with knowledge of its
falsity;
4. Section II B.1.p.(2) Exclusions for Personal
And Advertising Injury is deleted and replaced
by the following:
(3) Arising out of oral, written or electronic
publication of material whose first
publication took place before the beginning
of the policy period;
R. Unintentional Omission
The following is added to SECTION III — COMMON
POLICY CONDITIONS Paragraph C. Concealment,
Misrepresentation Or Fraud (BUT APPLICABLE
ONLY TO SECTION II — LIABILITY)
However as it pertains to Business Liability
Coverage only, the unintentional omission of, or
unintentional error in, any information provided by
you which we relied upon in issuing this policy shall
not prejudice your rights under this insurance. This
provision does not affect our right to collect
additional premium or to exercise our right of
cancellation or nonrenewal in accordance with
applicable insurance laws or regulations.
PPB 316 02 11 Page 6 of 7
S. Waiver Of Transfer Of Rights Of Recovery
Against Others To Us
SECTION III — COMMON POLICY CONDITIONS
Paragraph K.2. Transfer of Rights of Recovery
Against Others to Us (BUT APPLICABLE ONLY
TO SECTION II — LIABILITY) is deleted and
replaced by the following:
2. Applicable to Business Liability Coverage:
We waive any rights of recovery we may have
against any person or organization because of
payments we make for "bodily injury", "property
damage", "personal injury and advertising injury"
arising out of:
a. Premises owned by you, temporarily occu-
pied by you with permission of the owner, or
leased or rented to you;
b. Ongoing and completed operations
performed by you, or on your behalf, under a
contract or agreement with that person or
organization;
c. Your "work"; or
d. "Your products".
We waive these rights only where you have
agreed to do so as part of a contract or agree-
ment entered into by you before the "bodily
injury" or "property damage" occurs or the
"personal and advertising injury" offense is
committed.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPB 316 02 11 Page 7 of 7
Policy Number: PSA0001635
Named Insured: HWA GeoSciences, Inc.
RLI Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° BUSINESS AUTO ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A. Broad Form Named Insured
B. Employees As Insureds
C. Blanket Additional Insured
D. Blanket Waiver Of Subrogation
E. Employee Hired Autos
F. Fellow Employee Coverage
G. Auto Loan Lease Gap Coverage
H. Glass Repair — Waiver Of Deductible
I. Personal Effects Coverage
J. Hired Auto Physical Damage Coverage
K. Hired Auto Physical Damage — Loss Of Use
L. Hired Car — Worldwide Coverage
M. Temporary Transportation Expenses
N. Amended Bodily Injury Definition — Mental Anguish
O. Airbag Coverage
P. Amended Insured Contract Definition — Railroad Easement
Q. Coverage Extensions — Audio, Visual And Data Electronic Equipment Not Designed Solely For The
Production Of Sound
R. Notice Of And Knowledge Of Occurrence
S. Unintentional Errors Or Omissions
T. Towing Coverage
PPA 300WA 03 13 Page 1 of 5
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
A. Broad Form Named Insured
The following is added to the SECTION II —
COVERED AUTOS LIABILITY COVERAGE, Para-
graph A.I. Who Is An Insured Provision:
Any business entity newly acquired or formed by you
during the policy period, provided you own fifty
percent (50%) or more of the business entity and the
business entity is not separately insured for
Business Auto Coverage. Coverage is extended up
to a maximum of one hundred eighty (180) days
following the acquisition or formation of the business
entity.
This provision does not apply to any person or
organization for which coverage is excluded by
endorsement.
B. Employees As Insureds
The following is added to the SECTION II —
COVERED AUTOS LIABILITY COVERAGE, Para-
graph 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.
C. Blanket Additional Insured
The following is added to the SECTION II —
COVERED AUTOS LIABILITY COVERAGE, Para-
graph A.1. Who Is An Insured Provision:
Any person or organization that you are required to
include as an additional insured on this coverage
form in a contract or agreement that is executed by
you before the "bodily injury' or "property damage"
occurs is an "insured" for liability coverage, but only
for damages to which this insurance applies and
only to the extent that person or organization
qualifies as an "insured" under the Who Is An
Insured provision contained in SECTION II —
COVERED AUTOS LIABILITY COVERAGE.
The insurance provided to the additional insured will
be on a primary and non-contributory basis to the
additional insured's own business auto coverage if
you are required to do so in a contract or agreement
that is executed by you before the "bodily injury' or
"property damage" occurs.
D. Blanket Waiver Of Subrogation
The following is added to the SECTION IV —
BUSINESS AUTO CONDITIONS, A. Loss
Conditions, 5. Transfer Of Rights Of Recovery
Against Others To Us:
We waive any right of recovery we may have against
any person or organization to the extent required of
you by a contract executed prior to any "accident" or
"loss", provided that the "accident" or "loss" arises
out of the operations contemplated by such contract.
The waiver applies only to the person or
organization designated in such contract.
E. Employee Hired Autos
1. The following is added to the SECTION II —
COVERED AUTOS LIABILITY COVERAGE,
Paragraph A.I. 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 that "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
CONDITIONS is deleted and replaced with the
following:
b. For Hired Auto Physical Damage Coverage,
the following are deemed to be covered
"autos" you own:
(1) Any covered "auto" you lease, hire, rent
or borrow; and
(2) Any covered "auto" hired or rented by
your "employee" under a contract in that
individual "employee's" name, with your
permission, while 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. Fellow Employee Coverage
SECTION II — COVERED AUTOS LIABILITY
COVERAGE, Exclusion B.S. does not apply if you
have workers compensation insurance in -force
covering all of your employees.
G. Auto Loan Lease Gap Coverage
SECTION III — PHYSICAL DAMAGE COVERAGE,
C. Limit Of Insurance, is amended by the addition
of the following:
In the event of a total "loss" to a covered "auto"
shown in the Schedule of Declarations, we will pay
any unpaid amount due on the lease or loan for a
covered "auto", less:
PPA 300WA 03 13 Page 2 of 5
1. The amount paid under the PHYSICAL
DAMAGE COVERAGE section of the policy;
and
2. Any:
a. Overdue lease/loan payments at the time of
the "loss";
b. Financial penalties imposed under a lease
for excessive use, abnormal wear and tear
or high mileage.
c. Security deposits not returned by the lessor;
d. Costs for extended warranties, Credit Life
Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease;
and
e. Carry-over balances from previous loans or
leases.
H. Glass Repair— Waiver Of Deductible
SECTION III — PHYSICAL DAMAGE COVERAGE,
D. Deductible is amended by adding the following:
No deductible for a covered "auto" will apply to glass
damage if the glass is repaired rather than replaced.
I. Personal Effects Coverage
The following is added to SECTION III — PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
c. Personal Effects Coverage
In the event of a total theft loss of your covered
"auto we will pay up to $400 for "loss" to wearing
apparel and other personal effects which are:
(1) Owned by an "insured"; and
(2) In or on your covered "auto";
No deductible applies to Personal Effects
Coverage.
J. Hired Auto Physical Damage Coverage
The following is added to SECTION III — PHYSICAL
DAMAGE COVERAGE, A. Coverage, 4. Coverage
Extensions:
d. Hired Auto Physical Damage Coverage
If hired "autos" are covered "autos" for Liability
Coverage and this policy also provides Physical
Damage Coverage for an owned "auto", then the
Physical Damage Coverage is extended to
"autos" that you hire, rent or borrow subject to
the following:
(1) The most we will pay for "loss" in any one
"accident" to a hired, rented or borrowed
"auto" is the lesser of:
(a) $60,000
(b) The actual cash value of the damaged
or stolen property as of the time of the
"loss"; or
(c) The cost of repairing or replacing the
damaged or stolen property with other
property of like kind and quality.
(2) An adjustment for depreciation and physical
condition will be made in the event of a total
"loss".
(3) We may deduct for betterment for parts
normally subject to repair and replacement
during the useful life of the "auto". In this
event, deductions shall be limited to the
lesser of:
(a) An amount equal to the proportion that
the expired life of the part to be repaired
or replaced bears to the normal useful
life of the part; or
(b) The amount which the resale value of
the "auto" is increased from the repair or
replacement.
(4) A deductible equal to the highest Physical
Damage deductible applicable to any owned
auto will apply.
(5) This Coverage Extension will not apply to:
(a) Any "auto" that is hired, rented or
borrowed with a driver; or
(b) Any "auto" that is hired, rented or
borrowed from your "employee".
K. Hired Auto Physical Damage — Loss Of Use
The following is added to SECTION II — COVERED
AUTOS LIABILITY COVERAGE, A.2. Coverage
Extensions:
e. We will pay sums which you legally must pay to
the lessor of a covered "auto" which you have
leased without a driver for thirty (30) days or less
for the lessor's loss of use of the covered "auto",
provided:
(1) This insurance provides comprehensive,
specified causes of loss or collision covered
on the covered "auto";
(2) The loss of use results from the covered
"auto" being damaged in an "accident" while
you are leasing it.
We will pay up to a maximum limit of $1,500 for
this covered extension.
L. Hired Car —Worldwide Coverage
The following is added to SECTION II — COVERED
AUTOS LIABILITY COVERAGE, A.2. Coverage
Extensions:
PPA 300WA 03 13 Page 3 of 5
f.
Hired Car — Worldwide Coverage
(1) We will pay all sums an "insured" legally
must pay as damages because of "bodily
injury" or "property damage" to which this
insurance applies, caused by an "accident"
which occurs outside of the United States of
America, the territories and possessions of
the United States of America, Puerto Rico
and Canada resulting from the maintenance,
or use of any covered "auto" of the private
passenger type you lease, hire, rent or
borrow without a driver for thirty (30) days or
less.
(2) With respect to any claim made or "suit"
instituted outside the United States of
America, the territories and possessions of
the United States of America, Puerto Rico,
and Canada:
(a) You shall undertake the investigation,
settlement and defense of such claims
and "suits" and keep us advised of all
proceedings and actions.
(b) You will not make any settlement
without our consent.
(c) We will reimburse you:
(1) For the amount of damages be-
cause of liability imposed upon you
by law on account of "bodily' injury'
or "property damage" to which this
insurance applies, and
(ii) For all reasonable expenses incur-
red with our consent in connection
with the investigation, settlement or
defense of such claims or "suits".
Reimbursement for expenses will be
part of the Limit of Insurance for
liability coverage shown in the Busi-
ness Auto Coverage Declarations,
and not in addition to such limits.
(3) The limit of Insurance for Liability Coverage
shown in the Business Auto Coverage
Declarations is the most we will reimburse
you for the sum of all damages imposed on
you, as set forth in paragraph 2.c. above,
and all expenses incurred by you arising out
of any single "accident" or "loss".
(4) You must maintain the greater of the
following primary auto liability insurance
limits:
(a) Compulsory admitted insurance with
limits required to be in force to satisfy
the legal requirements of the jurisdiction
where the accident occurs; or
(b) Insurance limits required by law and
issued by a government entity or by an
insurer licensed or permitted by law to
do business in the jurisdiction where the
"accident" occurs; or
(c) Auto liability insurance limits of at least
$300,000 combined single limit or
$100,000 per person/$300,000 per acci-
dent Bodily Injury, $100,000 Property
Damage.
If you fail to comply with the above, this
insurance is not invalidated. However, in the
event of a "loss", we will pay only to the
extent that we would have been liable had
you so complied.
(5) The insurance provided by this coverage
extension is excess over any other
collectible insurance available to you
whether on a primary, excess contingent or
any other basis.
M. Temporary Transportation Expenses
SECTION III — PHYSICAL DAMAGE COVERAGE,
A.4. Coverage Extensions, subparagraph a.
Transportation Expenses is deleted and replaced
by the following:
a. Transportation Expenses
(1) We will pay up to a maximum of $1,500 for
temporary transportation expense incurred
by you because of Physical Damage to a
coverage "auto".
(2) We will pay only for those covered "autos"
for which you carry Comprehensive,
Collision or Specified Case of Loss
Coverage.
(3) We will pay only for those expenses incurred
by you during the period of time that begins
twenty-four (24) hours after the covered
"loss" and ends at the time when the
covered "auto" can be reasonable repaired
or replaced.
(4) This coverage does not apply while there
are spare or reserve "autos" available to you
for your operations.
N. Amended Bodily Injury Definition — Mental
Anguish
The following is added to SECTION V —
DEFINITIONS, Definition C.:
"Bodily injury" also includes mental anguish, but only
when the mental anguish arises from other bodily
injury, sickness or disease.
PPA 300WA 03 13 Page 4 of 5
O. Airbag Coverage
The following is added to SECTION III — PHYSICAL
DAMAGE COVERAGE B. Exclusions 3.a.:
However, this exclusion will not apply to accidental
discharge of an airbag due to mechanical or
electrical breakdown.
P. Amended Insured Contract Definition — Railroad
Easement
SECTION V — DEFINITIONS paragraph H. "Insured
contact" is modified as follows:
1. Paragraph H.3. is replaced by the following:
3. Any easement or license agreement.
2. Paragraph H.6.a. is deleted.
Q. Coverage Extensions — Audio, Visual And Data
Electronic Equipment Not Designed Solely For
The Production Of Sound
SECTION III — PHYSICAL DAMAGE COVERAGE
B. Exclusions, exception paragraph a. to exclusion
4.c. and 4.d. is deleted and replaced with the
following:
a. Equipment and accessories used with such
equipment, except for tapes, records, discs or
other electronic media device, provided such
equipment is permanently installed in the
covered "auto" at the time of the "loss" or is
removable from the housing unit which is
permanently installed in the covered "auto" at
the time of the "loss", and such equipment is
designed to be solely operated by use of the
power from the "autos" electrical system, in or
upon the covered "autos"; or
R. Notice Of An Knowledge Of Occurrence
SECTION IV — BUSINESS AUTO CONDITIONS,
A.2. Duties In The Event Of Accident, Claim Suit
Or Loss, subparagraph a. is deleted and replaced
with 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" or
"loss" including:
(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 person and
witnesses.
Your duty to give us or our authorized
representative prompt notice of the "accident" or
"loss" applies only when the "accident" or "loss"
is known to:
(1) You, if you are an individual;
(2) A partner if you are a partnership; or
(3) An executive officer or insurance manager, if
you are a corporation.
S. Unintentional Errors Or Omissions
SECTION IV — BUSINESS AUTO CONDITIONS, B.
General Conditions; 2. Concealment Misrepre-
sentation Or Fraud is amended by adding the
following:
The unintentional omission of, or unintentional error
in, any information given by you shall not prejudice
your rights under this insurance. However this pro-
vision does not affect our right to collect additional
premium or exercise our right of cancellation or
nonrenewal.
T. Towing Coverage
SECTION III — PHYSICAL DAMAGE COVERAGE,
A.2. Towing, is deleted and replaced by the
following:
2. We will pay up to $750 for towing and labor
costs incurred each time a covered "auto" is
disabled due to a covered cause of loss.
However:
a. All labor must be performed at the place of
disablement; and
b. If the covered auto is a private passenger
type no deductible applies; and
c. If the covered auto is not of the private
passenger type our obligation to pay will be
reduced by a $250 deductible per
disablement.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPA 300WA 03 13 Page 5 of 5
Policy Number: PSE0001834
RLI Insurance Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RLIPack° FOR DESIGN PROFESSIONALS
EXCESS LIABILITY ENHANCEMENT
SCHEDULE OF COVERAGES ADDRESSED BY THIS ENDORSEMENT
A. General Aggregate Limit — Per Project Or Per Location
B. Additional Insured — Primary/Non-contributory
C. Waiver Of Transfer Of Rights Of Recovery Against Others To Us
This endorsement modifies insurance provided under the following:
COMMERCIAL EXCESS LIABILITY COVERAGE FORM
A. General Aggregate Limit — Per Project Or Per
Location
Paragraph 2.a. of C. Limits of Liability of SECTION
I — INSURING AGREEMENT is deleted and
replaced by the following:
a. The limit of liability stated in the Declarations as
general aggregate is the most we will pay during
each policy period for all ultimate net loss,
except ultimate net loss because of:
(1) injury and damage included in the products -
completed operations hazard or;
(2) any coverage included in underlying
insurance to which no underlying aggregate
applies.
The general aggregate applies separately to
each of your "projects" away from premises
owned by or occupied by you or to each of your
locations owned by or occupied by you.
"Projects" mean an area away from premises
owned by or rented to you at which you are
performing operations pursuant to a contract or
agreement. For the purposes of determining the
applicable aggregate limit of insurance, each
"project" at the same "location" shall be
considered a single "project'.
For the purposes of this provision, "location"
means
(1) premises involving the same or connecting
lots;
(2) premises where connection is interrupted
only by a street, roadway, waterway or right-
of-way of a railroad; or
(3) premises where operations are performed in
sections, stages or phases as a continuation
of the same contract or agreement, even if
the premises do not involve connecting lots.
B. Additional Insured — Primary/Non-contributory
Paragraph K. Other Insurance of SECTION IV —
CONDITIONS is deleted and replaced by the
following:
K. Other Insurance
If other insurance, whether collectible or not, is
available to the insured covering a loss, also
covered by this policy, the insurance afforded by
this policy shall be in excess of, and shall not
contribute with, such other insurance. However,
if the underlying insurance provides coverage
to an additional insured on a primary basis, or a
primary and non-contributory basis, this insur-
ance shall be available to such additional
insured on an excess basis over the underlying
insurance. We will not share with other
insurance which covers such additional insured
as a named insured.
C. Waiver Of Transfer Of Rights Of Recovery
Against Others To Us
Paragraph L. Subrogation of SECTION IV —
CONDITIONS is deleted and replaced by the
following:
PPU 304 06 10 Page 1 of 2
L. Subrogation
In the event of any payment under this policy, the
insured must notify us of any of the insured's rights
of recovery against any person or organization. We
shall be subrogated to all such rights. The
insured shall execute and deliver instruments
and papers and do whatever else is necessary to
secure such rights. The insured shall do nothing
after loss to prejudice such rights. However we
waive any rights of recovery we may have
against any person or organization if the
underlying insurance also waives such rights.
Any amount recovered through subrogation or
otherwise shall be apportioned in the inverse order
of payment of the claim or claims involved to the
extent of actual payment thereof by all interests. The
expenses of all such recoveries and proceedings in
connection therewith shall be apportioned in the
ratio of respective recoveries. With respect to
proceedings conducted solely by us, if there is no
recovery, we will bear the expense thereof. If there
is a recovery, we shall be reimbursed in full from
such recovery for the amount of all expenses
incurred by us before apportionment of such
recovery as herein provided.
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED.
PPU 304 06 10 Page 2 of 2
POWER OF ATTORNEY Lx-9821918
Lexon Insurance Company
KNOW ALL MEN BY THESE PRESENTS, that LEXON INSURANCE COMPANY, a Texas Corporation, with its principal office in
Louisville, Kentucky, does hereby constitute and appoint Angel Lamar
true and lawful Attorneys) -In -Fact to make, execute, seal and deliver for, and on its behalf as
Street Opening/Street Obstruction Bond under bond or undertaking number 9821918
HWA GeoSciences Inc. as principal in the penal sum of $ $5,000.00
surety, and as its act and deed a
issued on behalf of
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of LEXON INSURANCE
COMPANY on the 1 st day of July, 2003 as follows:
Resolved, that the President of the Company is hereby authorized to appoint and empower any representative of the Company or other
person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other
writings obligatory in nature of a bond not to exceed $ $5.000.00 dollars, which the Company might execute through its duly
elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as binding
upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -
Fact, so appointed, may be removed for good cause and the authority so granted may be revoked as specified in the Power of Attorney.
Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of attorney
granted, and the signature of the Assistant Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such
power and any such power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such
power so executed and sealed and certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached,
continue to be valid and binding on the Company.
IN WITNESS THEREOF, LEXON INSURANCE COMPANY has caused this instrument to be signed by its President, and its Corporate
Seal to be affixed this 5th day of August, 2015.
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ACKNOWLEDGEMENT
LEXON INSURANCE COMPANY
BY
David E.'Campbell
President
On this 5th day of August, 2015, before me, personally came David E. Campbell to me known, who be duly sworn, did depose and say
that he is the President of LEXON INSURANCE COMPANY, the corporation described in and which executed the above instrument; that he
executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation.
AMY TAYLOR
Notary Public- State of Tennessee BY -
' Davidson County Amy Pylor
My Commission Expires 07-08-19 Notart Public
CERTIFICATE
I, the undersigned, Assistant Secretary of LEXON INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY
that the original Power of Attorney of which the forgoing is a true and correct copy, is in full force and effect and has not been revoked and the
resolutions as set forth are now in force.
Signed and Seal at Mount Juliet, Tennessee this 5th Day of July , 2018 .
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S E A L BY Andrew Smith
y�`''� •'d+� Assistant Secretary
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"WARNING: Any person who knowingly and with Intent to defraud any insurance company or other person, files and application for insurance of
claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto,
commits a fraudulent insurance act, which Is a crime and subjects such person to criminal and civil penalties."