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HomeMy WebLinkAboutLD24-4654Permit Number: LD24-4654 LD - Utilities/ Utility Maintenance Issued: 10/23/2024 Expired: 04/23/2025 Job Address: Moraga Rd E/S 130' S/O Rancho California Rd Legal Description: City of Temecula - Land Development Division 41000 Main Street - Temecula, CA 92590 Mailing Address: P.O. Box 9033 Temecula, CA 92589-9033 Phone: (951) 308-6395 Fax: (951) 694-6475 Southern California Edison (Utility Billing) 24487 Prielipp Wildomar, CA 92595 (951) 440-9074 Applicant: Pino Tree Service, Inc. Po Box 2370 Idyllwild, CA 92549 (951) 973-8525 Contractor: Utility Work Order Number: Tree Maintenance Description: SCE Tree Maintenance: Moraga Rd E/S 130' S/O Rancho California Rd WORK HOURS SHALL BE MONDAY – FRIDAY, NO HOLIDAYS, 8:30am - 3:30pm Proposed work: Tree maintenance, fire safety compliance Permitee Date City Engineer or Authorized Representative Date 10/23/2024 Page 1 of 1 BUSINESS LICENSE CERTIFICATE Finance Department 41000 Main Street Temecula, CA 92590 CITY OF TEMECULAThe person, firm or corporation named below is hereby granted this certificate (pursuant to the provisions of the City Business License Ordinances of the City of Temecula, California) to engage in, carry on or conduct, in the City of Temecula, California, the business, trade, calling, profession, exhibition or occupation described below for the period indicated. This license is permission only, and is issued without verification that the license is subject to or exempt from licensing by the State of California; nor shall such issuance be deemed a waiver of the City of Temecula of past or future violations of such laws or ordinances. BUSINESS NAME:Pino Tree Service, Inc. BUSINESS LOCATION:54960 Pine Crest Ave., 5, Idyllwild, CA 92549 DESCRIPTION: Contractor - Specialty BUSINESS OWNER:Business License Number: 058050 Effective Date: January 31, 2025Expiration Date: Jacobus Pino License Fee: $35.00 Fees paid in accordance with City Ordinance NOT TRANSFERABLE and NON-REFUNDABLETO BE POSTED IN A CONSPICUOUS PLACE August 22, 2024PINO TREE SERVICE, INC. PO BOX 2370 IDYLLWILD, CA 92549 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 8/26/2024 (951) 246-4003 1305 16823 Pino Tree Service, Inc. 686 E Mill 2nd Flr San Bernardino, CA 92408 22322 37257 A 5,000,000 UTT1000031-01 8/20/2024 8/20/2025 100,000 CONTRACTUAL LIAB 10,000 WILDFIRE INCLUDED 5,000,000 5,000,000 5,000,000 X LOGGERS LIABILITY LOGGERS LIAB 1,000,000 1,000,000B NBA100633502 8/20/2024 8/20/2025 AUTO EXCESS 4,000,000 C P0014-WF241938404C 6/1/2024 6/1/2025 1,000,000 Y 1,000,000 1,000,000 Certificate holder is named as Additional Insured for General Liability per forms CG2010 1219 and CG2037 1219. Primary/Non-Contributory wording applies per form CG2001 1219. Waiver of Subrogation applies per form CG2404 1219. Additional Insured applies to Business Auto per form XIC421 1013; Primary/Non-Contributory wording and Waiver of Subrogation included. Waiver of Subrogation applies to Workers Compensation per form WC040306. *30 days notice of cancellation applies to all liability; 10 days notice for non-payment of premium. City of Temecula 41000 Main St Temecula, CA 92590 PINOTRE-01 MGAINES Leo Rodriguez Insurance Agency 27174 Newport Rd Suite 3 and 4 Menifee, CA 92584 Michele Gaines Mgaines@acrisure.com Fortegra Specialty Insurance Company Greenwich Insurance Company Praetorian Insurance Company X X X X X X X X X POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations 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 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. As Required by Written Contract Various Location(s) UTT1000031-01 Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 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 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 37 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 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 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". 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 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 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. UTT1000031-01 As Required By Written Contract Various Location(s) POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page1of 1 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 Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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 (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. UTT1000031-01 POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. As Required By Written Contract UTT1000031-01 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER1%$633502 XIC 421 1013  "   " ! ! This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE DESCRIPTION  '.103#3:6$45+565' 650*:4+%#-#.#)'  *04 //463'&  30#&03./463'&  .1-0:''4 4/463'&4  &&+5+0/#-/463'&:0/53#%5 )3''.'/503'3.+5  .1-0:''+3'& 6504  611-'.'/5#3:#:.'/54  .'/&'&'--08.1-0:''9%-64+0/  *:4+%#-#.#)'07'3#)'  '/5#-'+.$634'.'/5  953#91'/4'<30#&'/'&07'3#)'  '340/#-(('%5407'3#)'  '#4'#1  -#44'1#+3< #+7'3('&6%5+$-'  *:4+%#-#.#)'07'3#)'95'/4+0/4  &&+5+0/#-3#/41035#5+0/91'/4'  +3'& 650*:4+%#-#.#)'  64+/'44 6500/&+5+0/4  05+%'(%%633'/%'  #+7'3(6$30)#5+0/  /+/5'/5+0/#-#+-63'0+4%-04'#;#3&4  3+.#3:/463#/%'  0&+-:/,63:'&'(+/'&  95'/&'&#/%'--#5+0/0/&+5+0/ XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 2 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission.  '.103#3:6$45+565' 650*:4+%#-#.#)' < ,'35#+/3#+-'340$+-'26+1.'/5 /&'.103#3:6$45+565' 6504 is changed by adding the following: If Physical Damage coverage is provided by this Coverage Form, the following types of vehicles are also covered “autos” for Physical Damage coverage:  Any “auto” you do not own while used with the permission of its owner as a temporary substitute for a covered “auto” you own that is out of service because of its: # Breakdown; $ Repair; % Servicing; & “Loss”; or ' Destruction.  *04 //463'&   <    "    07'3#)'  *0 4 / /463'& is changed by adding the following:  30#&03./463'& For any covered “auto”, any subsidiary, affiliate or organization, other than a partnership or joint venture, as may now exist or hereafter be constituted over which you assume active management or maintain ownership or majority interest, provided that you notify us within ninety (90) days from the date that any such subsidiary or affiliate is acquired or formed and that there is no similar insurance available to that organization. However, coverage does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization.  .1-0:''4 4/463'&4 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.  &&+5+0/#-/463'&:0/53#%5 )3''.'/53'3.+5 Any person or organization with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is provided under this policy, provided that the “bodily injury” or “property damage” occurs subsequent to the execution of the written contract, agreement or permit.  .1-0:''+3'& 6504 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. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. < '/'3#-0/&+5+0/4 5*'3/463#/%'$ is replaced with the following: $For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos” you own:  Any covered “auto” you lease, hire, rent or borrow; and  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”.  611-'.'/5#3:#:.'/54 <  "  07'3#)'07'3#)'95'/4+0/4# 611-'.'/5#3:#:.'/54 is changed as follows: Item  is deleted and replaced by the following:  Up to $3,500 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. Item   is deleted and replaced by the following:   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.  .'/&'&'--08.1-0:''9%-64+0/ <  " 9%-64+0/4 '--08.1-0:'' does not apply. The insurance provided under this Provision  is excess over any other collectible insurance.  *:4+%#-#.#)'07'3#)' <"     07'3#)'is changed by adding the following:  '/5#-'+.$634'.'/5 # 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. $ We will pay only for those expenses incurred during the policy period beginning twenty-four (24) hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the following number of days: XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 4 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission.  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.  Thirty (30) days. % Our payment is limited to the lesser of the following amounts:  Necessary and actual expenses incurred.  $50 any one day per private passenger “auto”; $100 any one day per truck; $1,500 any one period per private passenger “auto”; $3,000 any one period per truck; or Higher limits if shown elsewhere in this policy. & This coverage does not apply while there are spare or reserve “autos” available to you for your operations. ' 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 Physical Damage Coverage Extension.  953#91'/4'<30#&'/'&07'3#)' We will pay for the expense of returning a stolen covered “auto” to you.  '340/#-(('%5407'3#)' If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that “auto” is stolen, we will pay, without application of a deductible, up to $500 for “personal effects” stolen from the “auto”. As used in this endorsement, “personal effects” means tangible property that is worn or carried by an “insured”. “Personal effects” does not include tools, jewelry, money or securities.  '#4'#1 In the event of a total “loss” to a covered “auto” shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered “auto”, less: # The amount paid under the Physical Damage Coverage Section of the policy; and $ Any:  Overdue lease/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 purchases with the loan or lease; and   Carry-over balances from previous loans or leases. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission.  -#44'1#+3< #+7'3('&6%5+$-' No deductible applies to glass damage if the glass is repaired rather than replaced.  *:4+%#-#.#)'07'3#)'95'/4+0/4 <"     07'3#)' 07'3#)'95'/4+0/4 is amended by the following:  &&+5+0/#-3#/41035#5+0/91'/4' '%5+0/4 #and$ are amended to provide a limit of $50 per day and a maximum limit of $1,000.  +3'& 650*:4+%#-#.#)' The following section is added: Any “auto” you lease, hire, rent or borrow is deemed to be a covered “auto” for physical damage coverage. The most we will pay for each covered “auto” is the lesser of:  the actual cash value;  the cost for repair or replacement; or   $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage. For each covered “auto” a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply.  64+/'44 6500/&+5+0/4 <  0440/&+5+0/4 is changed by the following:  05+%'(%%633'/%' '%5+0/<65+'4/*'7'/5( %%+&'/5-#+.6+53044# is changed by adding the following: If you report an injury to an “employee” to your workers’ compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable after you know or reasonably should have known that this insurance may apply.  #+7'3(6$30)#5+0/ '%5+0/ 3#/4('3(+)*54('%07'3: )#+/455*'3404 is changed by adding the following: However, this Condition does not apply to any person(s) or organization(s) with whom you have a written contract, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under such contract with that person or organization. XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 6 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. < '/'3#-0/&+5+0/4 is changed by the following:  /+/5'/5+0/#-#+-63'0+4%-04'#;#3&4 The following condition is added: Your unintentional failure to disclose all hazards as of the inception date of the policy shall not prejudice any insured with respect to the coverage afforded by this policy.  3+.#3:/463#/%' 0/&+5+0/ 5*'3/463#/%' is changed by adding the following: For any covered “auto” this insurance shall apply as primary and not contribute with any other insurance where such requirement is agreed in a written contract executed prior to a “loss”.  0&+-:/,63:'&'(+/'& < “Bodily injury” is replaced by the following: “Bodily injury” means bodily injury, sickness or disease sustained by a person including mental anguish, mental injury, shock, fright or death resulting from any of these at any time.  95'/&'&#/%'--#5+0/0/&+5+0/ "03.  #/%'--#5+0/$ is replaced by the following: The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before the effective date of cancellation if we cancel for any other reason. All other terms and conditions of this policy remain unchanged. WORKERWORKERS COMPS COMPENSATIENSATION ANDON AND EMPLOYEMPLOYERS LIERS LIABILITABILITY INSUY INSURANCERANCE POLICYPOLICY WC 04WC 04 03 0603 06 (Ed. 4(Ed. 4-84)-84) WAIVEWAIVER OFR OF OUROUR RIGHRIGHT TOT TO RECOVRECOVER FER FROM OROM OTHERTHERS ENS ENDORSDORSEMENEMENT -T -CALICALIFORNFORNIAIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _2__% of the California workers' compensation premium otherwise due on such remuneration. Schedule Minimum premium per person or organization is $500 Person or OPerson or Organizatiorganizationn Job DescriptJob Descriptionion BLANKET WBLANKET WAIVER EFFAIVER EFFECTIVE:ECTIVE:06/01/2006/01/202424 ALL OPERAALL OPERATIONS ASTIONS AS REQUIREDREQUIRED BY WRITTEBY WRITTEN CONTRACN CONTRACTT IN APPLICIN APPLICABLE STATABLE STATESES 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 endorsemen(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)t is issued subsequent to preparation of the policy.) Policy No. P0014-WF241938404C Insured PINO TREE SERVICE INC Insurance Company: PRAETORIAN INSURANCE COMPANY Countersigned By