CERTIFICATE OF LIABILITY INSURANCESHEHNER
ACC)R
C CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
04/02/2018
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 License # OD28764
Orion Risk Management Insurance Services, Inc.
1800 Quail Street Suite 110
Newport Beach, CA 92660
near
jac No, Ext): (949) 263-8850 j
C H U B B® Liability Insurance
Endorsement
Policy Period FEBRUARY 1, 2018 TO FEBRUARY 1, 2019
Effective Date FEBRUARY 1, 2018
Policy Number 3603-11-49 NBO
Insured INFOSEND INC
Name of Company FEDERAL INSURANCE COMPANY
Date Issued
This Endorsement applies to the following forms:
GENERAL LIABILITY
Who Is An Insured
Additional Insured -
Scheduled Person
Or Organization
FEBRUARY 14, 2018
Under Who Is An Insured, the following provision is added.
Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are
obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by
this policy.
However, the person or organization is an insured only:
• if and then only to the extent the person or organization is described in the Schedule;
• to the extent such contract or agreement requires the person or organization to be afforded
status as an insured;
• for activities that did not occur, in whole or in part, before the execution of the contract or
agreement; and
• with respect to damages, loss, cost or expense for injury or damage to which this insurance
applies.
No person or organization is an insured under this provision:
• that is more specifically identified under any other provision of the Who Is An Insured
section (regardless of any limitation applicable thereto).
• with respect to any assumption of liability (of another person or organization) by them in a
contract or agreement. This limitation does not apply to the liability for damages, loss, cost or
expense for injury or damage, to which this insurance applies, that the person or organization
would have in the absence of such contract or agreement.
Liability Insurance Additional Insured - Scheduled Person Or Organization
continued
Form 80-02-2367 (Rev. 5-07) Endorsement
Page 1
CHUBB®
Liability Endorsement
(continued)
Conditions
Other Insurance —
Primary, Noncontributory
Insurance — Scheduled
Person Or Organization
Liability Insurance
Under Conditions, the following provision is added to the condition titled Other Insurance.
If you are obligated, pursuant to a contract or agreement, to provide the person or organization
shown in the Schedule with primary insurance such as is afforded by this policy, then in such case
this insurance is primary and we will not seek contribution from insurance available to such person
or organization.
Schedule
Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with
such insurance as is afforded by this policy.
All other terms and conditions remain unchanged.
Authorized Representative
Additional Insured - Scheduled Person Or Organization last page
Form 80-02-2367 (Rev. 5-07)
Endorsement
Page 2
WORKERS' COMPENSATION AND EMPLOYERS' UABILITY INSURANCE POLICY
WC 99 03 04 (Ed. 7-08)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -
CALIFORNIA
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a
different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on 02/01/17 at 12:01 A. M. standard time, forms a part of
(DATE)
Policy No. (18)7174-98-12 of the FEDERAL INSURANCE COMPANY
(NAME OF INSURANCE COMPANY)
issued to INFOSEND INC
Endorsement No.
Authorized Representative
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. The additional premium for the blanket waiver
offered by this endorsement shall be 1.00 % of total California premium.
Scheduis
Person or Organization Job Description
COUNTY OF TULARE, ITS OFFICERS, AGENTS
OFFICIALS, EMPLOYEES AND VOLUNTEERS
221 S. MOONEY BLVD.
VISALIA, CA 93291
WC 99 0304 (Ed. 7-09)
ALL CALIFORNIA OPERATIONS