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Ontario Refrigeration, Inc. A2015-261 A2Zt6 Sentices Agreement Below you will find a checklist relating to Insurance and other requirements that are required for doing business with the City of Chino Hills. Only those Items checked-off are MANDATORY,however if your standard policies exceed the minimum requirements please include. Commercial general liability insurance must meet or exceed the requirements of ISO-COL Form No,CG 00 01 11 85 or 88. The amount of Insurance set forth below will be a combined single limit per occurrence for bodily Injury,personal injury,and property damage for the policy coverage. Liability policies will be endorsed to name the City,its officials,and employees as "additional Insured's"under said insurance coverage and to state that such Insurance will be deemed"primary"such that any other Insurance that may be carried by the City will be excess thereto. Workers'Compensation policies shall waive all rights of subrogation against City,its officers,officials,employees and agents for losses arising from work performed by Consultant for City. Such insurance must be on an"occurrence,"not a"claims made,"basis and will not be cancelable or subject to reduction except upon thirty(30)days prior written notice to the City, Please find additional Terms and Conditions on the reverse side of this Services Agreement. This is not a Contract order or an authorization to begin work. ® Comprehensive General Liability. including coverage for premises, products and completed operations, independent contractors, personal injury and contractual obligations with combined single limits of coverage of at least$1,000,000 per occurrence. The City of Chino Hills is to be listed as an additionally insured party. ® Auto Liability,including owned,non-owned and hired vehicles with at least: $1,000,000 per occurrence. ❑ $100.000-300.000 per occurrence. ❑ As required by State Statutes. A copy of your current policy must be submitted naming yourself and or your company. ® Workers'Comoensation Insurance:as required by State Statutes including Waiver of Subrogation. (Not needed if Self-employed with no employees and CONTRACTOR signs statement to this effect.) ® Business License: The SERVICE PROVIDER shall agree to have a current City of Chino Hills license on file at City Hall or purchase said license(at no cost to the City). • Scone of Services and/or Compensation Attachments ® Total Compensation Not-to-Exceed: $15.000.00 ® Expiration Date: June 30.2016 PLEASE NOTE: ALL APPLICABLE INFORMATION LISTED ABOVE MUST BE OBTAINED AND ON FILE, PRIOR TO THE ISSUANCE OF A CITY CONTRACT BEING SENT TO YOU(VIA FAX OR HARD COPY)BY THE CONTRACT COMPLIANCE OFFICER,THUS AUTHORIZING COMMENCEMENT OF WORK FOR THE CITY. AGREEMENT IS EFFECTIVE AS OF DATE LAST SIGNED BELOW. Company Name: By(Print name& Ontario Refrigeration,Inc. David Bunnell Company Mailing Address: City,State,Zip: 635 S.Mountain Ave. Ontario,CA 91762 Phone: E-Mail Address: l 909.684.2771 I DBunneil@ontref.com Mall two copies of the original agreement along with proofof insurance to:City of Chino Hills-City Clerk,14000 City Center Drive,Chino Hills,CA 91709 Odglnalor/Department Contact: Deborah Hill I ® Date initiated: 12/11/15 Vendor's Authorized Signature' Date signed: t Z //'!It S er77`VV v Vendor's Authorized Signaturr' Date signed: D �, �9 Contract Compliance Approval: e� i ' 61- ��d�d.Gt Date Approved: funb1/45— Or Ad DepartmentDirector/CityManagerAroval. Date Approved: fiti 1.GENERALLY. The services ( "Contract') covered by this should any claim be brought against it by suit or otherwise, services agreement must be furnished by Contractor subject to all whether the same be groundless or not, arising out of the the terms and conditions contained in this contract which Contract or their performance, Contractor will defend City (at Contractor, in accepting this contract, agrees to be bound by and City's request and with counsel satisfactory to City)and indemnify comply with in all particulars. No other terms or conditions are City for any judgment rendered against it or any sums paid out in binding upon the parties unless subsequently agreed to in writing. settlement or otherwise. For purposes of this section "City" Written acceptance of all or any portion of the Contract covered includes City's officers, elected officials, and employees. It is by this contract constitutes unqualified acceptance of all terms expressly understood and agreed that the foregoing provisions and conditions in this contract. The terms of any proposal will survive termination of this contract. The requirements as to referred to in this contract are included and made a part of the the types and limits of insurance coverage to be maintained by contract only to the extent it specified the Contract, the price, and Contractor, and any approval of such insurance by City, are not the delivery, and then only to the extent that such terms are intended to and will not in any manner limit or qualify the liabilities consistent with the terms and conditions of this contract. and obligations otherwise assumed by Contractor pursuant to this 2.CHANGES. City may make changes within the general scope contract, including, without limitation, to the provisions concerning of this contract by giving notice to Contractor and subsequently indemnification. confirming such changes in writing. If such changes affect the 8.WARRANTY. Contractor agrees that the Contract is covered by cost of or the time required for performance of this contract, an the most favorable commercial warranties the Contractor gives to equitable adjustment in the price or delivery or both must be any customer for the same or substantially similar services, or made. No change by Contractor is allowed without City's written such other more favorable warranties as is specified in this approval. Any claim by Contractor for an adjustment under this contract. Warranties will be effective notwithstanding any section must be made in writing within thirty (30) days from the inspection or acceptance of the Contract by City. date of receipt by Contractor of notification of such change unless 9.ASSIGNMENT. City may assign this contract. Except as to any City waives this condition in writing. Nothing in this section payment due under this contract, Contractor may not assign or excuses Contractor from proceeding with performance of the subcontract the contract without City's written approval. Should contract as changed. City give consent, it will not relieve Contractor from any 3. TERMINATION. This agreement will terminate on the date obligations under this contract and any transferee or noted unless extended in advance and in writing by the City subcontractor will be considered Contractor's agent. Manager or Department Director, as applicable. City or 10.INSURANCE. Contractor must provide the insurance Contractor may terminate this contract at any time, either verbally indicated on the face sheet of this Services Agreement. or in writing,with or without cause. Should termination occur, City 11.PERMITS. Contractor must procure all necessary permits and will pay Contractor as full performance until such termination the licenses, and abide by all federal, state, and local laws, for unit or pro rata contract price for the performed and accepted performing this contract. portion of the Contract. City may provide written notice of 12.INDEPENDENT CONTRACTOR. City and Contractor agree termination for Contractor's default if Contractor refuses or fails to that Contractor will act as an independent contractor and will have comply with this contract. If Contractor does not cure such failure control of all work and the manner in which is it performed. within a reasonable time period, or fails to perform the Contract Contractor will be free to contract for similar service to be within the time specified (or allowed by extension), Contractor will performed for other employers while under contract with City. be liable to City for any excess costs incurred by City. Contractor is not an agent or employee of City and is not entitled 4. TIME EXTENSION. City may extend the time for completion if, to participate in any pension plan, insurance, bonus or similar in City's sole determination, Contractor was delayed because of benefits City provides for its employees. Any provision in this causes beyond Contractor's control and without Contractor's fault contract that may appear to give City the right to direct Contractor or negligence. In the event delay was caused by City, as to the details of doing the work or to exercise a measure of Contractor's sole remedy is limited to recovering money actually control over the work means that Contractor will follow the and necessarily expended by Contractor because of the delay; direction of the City as to end results of the work only. there is no right to recover anticipated profit. 13.WAIVER. City's review or acceptance of,or payment for,work 5.REMEDIES CUMULATIVE. City's rights and remedies under product prepared by Contractor under this contract will not be this contract are not exclusive and are in addition to any rights construed to operate as a waiver of any rights City may have and remedies provided by law. under this Agreement or of any cause of action arising from 6.PAYMENT. City will pay Contractor after receiving acceptable Contractor's performance. A waiver by City of any breach of any invoices for services rendered and accepted. Drafts will not be term, covenant, or condition contained in this contract will not be honored. deemed to be a waiver of any subsequent breach of the same or 7.INDEMNIFICATION. Contractor agrees to indemnify and hold any other term, covenant, or condition contained in this contract, City harmless from and against any claim,action, damages, costs whether of the same or different character. (including, without limitation, attorney's fees), injuries, or liability, 14.INTERPRETATION. This Agreement was drafted in,and will arising out of the Contract, or their performance, regardless of be construed in accordance with the laws of the State of City's passive negligence, but excepting such loss or damage California,and exclusive venue for any action involving this which is caused by the sole active negligence or willful agreement will be in San Bernardino County. misconduct of the City. Should City be named in any suit,or Exhibit A Scope of Work Contractor (Company): Name of Company: Ontario Refrigeration Service, Inc. Description of Service: ® HVAC System Repairs as needed Any one service/incident may not exceed $5,000. A ® CERTIFICATE C COT LIABILITY INSURANCE OU NCH ) 12/ATEi5/2o1 THIS CERTIFICATE IS ISSUED AS A MATTER INFORMATIONNLY AND ONFERSNR RIGHTS UPON 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 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 LIC #0H79377 1-949-222-0444 CONTACT NAME: ISU Insurance Services - ERM Insurance Brokers PHONE949_222_0444 FAX Noy: 949-222-0445 (AIC.Na.Ertl: 2101 Business Center Drive #150 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Irvine, CA 92612 INSURER A: STARR IND & LIAR CO 38318 INSURED INSURER B: ' Ontario Refrigeration Service, Inc. INSURER C: 635 So. Mountain Ave. INSURERD: INSURER E: Ontario, CA 91762 INSURER F: COVERAGES CERTIFICATE NUMBER: 45611695 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRRI TYPE OF INSURANCE SNSRI VABD� POLICY NUMBER I(MM/DD )EFF I IMMIOD/YYYY`I LIMITS A GENERAL LIABILITY X X 1000025363151 03/15/15 03/15/16 EACHOCCURRENCE $1,000,000 UAMAGt IU ReN I al 100,000 111 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 I I GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICYI X I TEA, I ILOC $ iI A AUTOMOBILE LIABILITY X X SISIPCA08323915 03/15/15 03/15/16 COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ I ANY AUTO BODILY INJURY(Per person) $ AOAUTOS LED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ A UMBRELLA LIAB X OCCUR X X 1000021628 03/15/1 03/15/16 EACH OCCURRENCE $ 10,000,000 ___ X EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I X I RETENTION$O $ A WORKERS COMPENSATION X 1000001650 03/15/1 03/15/16 XI WCSTATU- I I0TH- ANDEMPLOYERS'LIABILITY TORY LIMITS FR YIN 1,000,000 OFVCERRIPACLUDEXECUTIVE y NIA E.L.EACH ACCIDENT $ (Mandatory inNOFFICER/MEMBER EXCLUDED? 1,000,000 in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below { DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) The certificate holder is additional insured per CG2010 04 13/CG2037 04 13 attached; primary and non-contributory wording per form OG 107 (04/11); general liability waiver per form CG2404 0509; auto additional insured per form SICA 1016 (02/12); auto liability waiver of subrogation per from CA 0444 (0310); workers compensation waiver of subrogation per form WC 04 03 06 (ed 04-84) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Chino Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14000 City Center Drive AUTHORIZED REPRESENTATIVE ,r��'�'' �w,,_ t. Chino Hills, CA 91709 �y USA 0"R':...' '°°''° ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD terrierm 45611695 POLICY NUMBER: SISIPCA08323915 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below Named Insured:Ontario Refrigeration Service Inc Endorsement Effective Date:3/15/2015 SCHEDULE Name(s) Of 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. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 ©Insurance Services Office, Inc.,2009 Page 1 of 1 p efa \:J__-75 'Starr Indemnity & Liability Company Dallas,TX 1-666-S19-2522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number: SISIPCA08323915 Effective Date:03/15/2o15at 12:01 AM Named Insured: Ontario Refrigeration Service, Inc. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This policy is amended as follows: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON OR ORGANIZATIONS LIABILITY ARISING OUT OF THE USE OF A COVERED"AUTO" I. SECTION II — LIABILITY COVERAGE A. Coverage, 1. Who is Insured, is amended to add. d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. SICA 1016 (02/12) Page 1 of 2 Copy Fight 0C.V.Starr&Company and Stara Indemnity&Liability Company. All rights reserved. Includes copyrighted material of ISO Properties,Inc.,used with its permission. -)Starr Indemnity & Liability Company ster Dallas,TX 1-666-519-2522 Signed for STARR INDEMNITY&LIABILITY COMPANY Charles H.Dangelo;`President Nehemiah E.Ginsburg,General;Counsel SICA 1016 (02/12) Page 2 of 2 Copyright©C.V.Sian&Company and Stan Indemnity 8 Liability Company. All rights reserved. Includes copyrighted material of ISO Properties,Inc.,used with its permission. POLICY NUMBER: 1000025363151 COMMERCIAL GENERAL LIABILITY 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 Name Of Additional Insured Person(s)Or Location And Description Of Completed Organization(s): Operations Where Required By Written Contract I Where Required By Written Contract I Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less, If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: 1 00002 5363151 COMMERCIAL GENERAL LIABILITY 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 Name Of Person Or Organization: Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. I 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 above because of payments we make for injury or Rights Of Recovery Against Others To Us of damage arising out of your ongoing operations or Section IV—Conditions: "your work" done under a contract with that person or organization and included in the "products-completed We waive any right of recovery we may have against operations hazard". This waiver applies only to the the person or organization shown in the Schedule person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 yP. y —hi Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Primary and Non-Contributory Condition Policy Number: 1000025363151 Effective Date: March 15, 2015 at 12:01 A.M. Named Insured: Ontario Refrigeration Service, Inc. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV—CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following is added to paragraph 4.a.of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured,where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY& LIABILITY COMPANY Charles H. Darigelo, President Nehemiah E. Ginsburg, GenerauCounsel OG 107(04/11) Page 1 of 1 copy/into C.V.Starr&Company and Starr Indemnity&Liability Company. All rights reserved Includes copynghted material of ISO Properties,Inc.,used with Its permission. POLICY NUMBER: 1000025363151 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Location And Description Of Completed Organization(s): Operations Where Required By Written Contract Where Required By Written Contract I 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 required by the contract or agreement to include as an additional insured the person(s) or provide for such additional insured. organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or B. With respect to the insurance afforded to these "property damage" caused, in whole or in part, by additional insureds, the following is added to "your work" at the location designated and Section III—Limits Of Insurance: described in the Schedule of this endorsement If coverage provided to the additional insured is performed for that additional insured and included required by a contract or agreement, the most we in the"products-completed operations hazard". will pay on behalf of the additional insured is the However amount of insurance: 1. The insurance afforded to such additional 1. Required by the contract or agreement; or insured only applies to the extent permitted by 2. Available under the applicable Limits of law; and Insurance shown in the Declarations; 2. If coverage provided to the additional insured is whichever is less. required by a contract or agreement, the insurance afforded to such additional insured This endorsement shall not increase the applicable will not be broader than that which you are Limits of Insurance shown in the Declarations. CG 20 37 04 13 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA 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.o% of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Where required by contract Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. 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: 03/15/2015 Policy No.: 1000001650 Endorsement No• Insured: Ontario Refrigeration Service, Inc. Premium: Insurance Company: Countersigned by: WC 04 03 06 (Ed. 04-84) Page 1 of 1