Common use of Submittal Clause in Contracts

Submittal. The original insurance policy (s) shall be submitted to: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx Xxxxxx, XX 00000 Attn: Xx. Xxxxxxxx Xxxxxxxxx - ROW Crossings Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx, Xxxxxx, XX 00000 Additionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority (SBCTA) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER THIS COVERAGE AFFORDED BY THE POLICY BELOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTS, 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  COMMERCIAL GENERAL LIABILITY  CLAIMS MADE  OCCUR.  OWNER'S & CONTRACTOR'S PROT.  OTHER GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED. EXPENSE (Any one person) $ $ $ $ $ $ AUTOMOBILE LIABILITY  ANY AUTO  ALL OWNED AUTO  SCHEDULED AUTOS  HIRED AUTOS  NON-OWNED AUTOS  GARAGE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  UMBRELLA FORM  OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ PROPERTY INSURANCE  COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY STATUARY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

Submittal. The original insurance policy (s) shall be submitted to: Assistant Director, Standards and Design Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx Xxxxxx000 Xxxx Xxxxx Xxxxxxx, XX 00000 Xxxxx 000 San Dimas, California 91773 Attn: Xx. Xxxxxxxx Xxxxxxxxx - ROW Crossings Encroachments Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx000 X. Xxxxx Xxxxxxx, XxxxxxXxxxx 000, Xxx Xxxxx, XX 00000 Additionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority Associated Governments (SBCTASANBAG) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER THIS COVERAGE AFFORDED BY THE POLICY BELOW. INSURED COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTS, 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  GENERAL AGGREGATE $ □ COMMERCIAL GENERAL LIABILITY  CLAIMS MADE  OCCUR.  OWNER'S & CONTRACTOR'S PROT.  OTHER GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. $ LIABILITY PERSONAL & ADV. INJURY $ □ CLAIMS MADE □ OCCUR. EACH OCCURRENCE $ □ OWNER'S & CONTRACTOR'S FIRE DAMAGE (Any one fire) $ PROT. □ OTHER MED. EXPENSE (Any one person) $ $ $ $ $ $ AUTOMOBILE LIABILITY  □ ANY AUTO  □ ALL OWNED AUTO  □ SCHEDULED AUTOS  □ HIRED AUTOS  □ NON-OWNED AUTOS  □ GARAGE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ $ PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  □ UMBRELLA FORM  □ OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ PROPERTY INSURANCE  □ COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION STATUARY LIMITS AND EACH ACCIDENT $ EMPLOYER'S LIABILITY STATUARY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

Submittal. The original insurance policy (s) shall be submitted to: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx Xxxxxx, XX 00000 Attn: Xx. Xxxxxxxx Xxxxxxxxx - ROW Crossings Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx, Xxxxxx, XX 00000 Additionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority (SBCTA) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER THIS COVERAGE AFFORDED BY THE POLICY BELOW. INSURED COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTS, 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  GENERAL AGGREGATE $ □ COMMERCIAL GENERAL LIABILITY  CLAIMS MADE  OCCUR.  OWNER'S & CONTRACTOR'S PROT.  OTHER GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. $ LIABILITY PERSONAL & ADV. INJURY $ □ CLAIMS MADE □ OCCUR. EACH OCCURRENCE $ □ OWNER'S & CONTRACTOR'S FIRE DAMAGE (Any one fire) $ PROT. □ OTHER MED. EXPENSE (Any one person) $ $ $ $ $ $ AUTOMOBILE LIABILITY  □ ANY AUTO  □ ALL OWNED AUTO  □ SCHEDULED AUTOS  □ HIRED AUTOS  □ NON-OWNED AUTOS  □ GARAGE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ $ PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  □ UMBRELLA FORM  □ OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ PROPERTY INSURANCE  □ COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION STATUARY LIMITS AND EACH ACCIDENT $ EMPLOYER'S LIABILITY STATUARY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

Submittal. The original insurance policy (s) shall be submitted to: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx Xxxxxxxxx Xxx Xxxxxx, XX 00000 Attn: Xx. Xxxxxxxx Xxxxxxxxx - Xxxx Xxxxx- ROW Crossings Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx xxxxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: SCRRA Project #: 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx XxxxxxXxxxxxxxx Xxx, Xxxxxx, XX 00000 Additionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority (SBCTA) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER THIS COVERAGE AFFORDED BY THE POLICY BELOW. INSURED COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTS, 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. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  GENERAL AGGREGATE $ □ COMMERCIAL GENERAL LIABILITY  CLAIMS MADE  OCCUR.  OWNER'S & CONTRACTOR'S PROT.  OTHER GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. $ LIABILITY PERSONAL & ADV. INJURY $ □ CLAIMS MADE □ OCCUR. EACH OCCURRENCE $ □ OWNER'S & CONTRACTOR'S FIRE DAMAGE (Any one fire) $ PROT. □ OTHER MED. EXPENSE (Any one person) $ $ $ $ $ $ AUTOMOBILE LIABILITY  □ ANY AUTO  □ ALL OWNED AUTO  □ SCHEDULED AUTOS  □ HIRED AUTOS  □ NON-OWNED AUTOS  □ GARAGE LIABILITY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) $ $ $ PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  □ UMBRELLA FORM  □ OTHER THAN UMBRELLA FORM EACH OCCURRENCE AGGREGATE $ $ PROPERTY INSURANCE  □ COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION STATUARY LIMITS AND EACH ACCIDENT $ EMPLOYER'S LIABILITY STATUARY LIMITS EACH ACCIDENT DISEASE-POLICY LIMIT DISEASE-EACH EMPLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

Submittal. The original insurance policy (s) shall be submitted to: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx Xxxxxx2700 Xxxxxxxxx Xxx Xxmona, XX 00000 CA 91767 Attn: Xx. Xxxxxxxx Xxxxxxxxx - Xxxx Xxxxx- ROW Crossings Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx xxxxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" B"‌ RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: SCRRA Project #: 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 2558 Xxxxxx Xxxxxx, Xxxxxx, XX 00000 Additionally Xxxitionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority (SBCTA) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE INSUR- ANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER AL- TER THIS COVERAGE AFFORDED BY THE POLICY BELOWBE- LOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTSREQUIRE- MENTS, 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 CONDI- TIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE INSUR- ANCE POLICY NUMBER NUM- BER POLICY EFFECTIVE EF- FECTIVE DATE (MM/DD/YY) POLICY EXPIRATION EX- PIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  LIABIL- ITY □ COMMERCIAL GENERAL LIABILITY  □ CLAIMS MADE  OCCUR□ OC- CUR.  □ OWNER'S & CONTRACTORCON- TRACTOR'S PROT.  □ OTHER GENERAL AGGREGATE PRODUCTS-AG- GREGATE PRODUCTS- COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE OCCUR- RENCE FIRE DAMAGE (Any one fire) MED. EXPENSE (Any one person) EX- PENSE $ $ $ $ $ $ (Any one per- son) AUTOMOBILE LIABILITY  XXX- XXXXXX □ ANY AUTO  □ ALL OWNED AUTO  □ SCHEDULED AUTOS  AU- TOS □ HIRED AUTOS  □ NON-OWNED AUTOS  □ GARAGE LIABILITY LIABIL- ITY COMBINED SINGLE LIMIT BODILY INJURY IN- JURY (Per person) BODILY INJURY IN- JURY (Per accident) PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  □ UMBRELLA FORM  □ OTHER THAN UMBRELLA FORM EACH OCCURRENCE OCCUR- RENCE AGGREGATE $ $ PROPERTY INSURANCE  INSUR- ANCE □ COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION COM- PENSATION AND EMPLOYER'S LIABILITY LIA- BILITY STATUARY LIMITS EACH ACCIDENT ACCI- DENT DISEASE-POLICY POL- ICY LIMIT DISEASE-DISEASE- EACH EMPLOYEE EM- PLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS

Submittal. The original insurance policy (s) shall be submitted to: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx XxxxxxXxxxxxxxx Xxx Pomona, XX 00000 CA 91767 Attn: Xx. Xxxxxxxx Xxxxxxxxx - Xxxx Xxxxx- ROW Crossings Coordinator E-mail: xxxxxxxxxx@xxxxx.xxx xxxxxxxxxxxx@xxxxx.xxx Office Number: (000) 000-0000 EXHIBIT "B" B"‌ RAILROAD PROTECTIVE LIABILITY POLICY DECLARATION POLICY Insurance Company: Policy Number: Policy Period: From: To: SCRRA Project : 12:01am Standard time at location CERTIFICATE HOLDER AND ADDITIONALLY INSURED Certificate Holder/Insured: Southern California Regional Rail Authority (SCRRA) 0000 Xxxxxx Xxxxxx, Xxxxxx, XX 00000 Additionally Insured: Los Angeles County Metropolitan Transportation Authority (MTA) Burlington Northern Santa Fe Corporation (BNSF) Orange County Transportation Authority (OCTA) Union Pacific Railroad Company (UPRR) Riverside County Transportation Commission (RCTC) National Railroad Passenger Corp. (AMTRAK) San Bernardino County Transportation Authority (SBCTA) Ventura County Transportation Commission (VCTC) LIMITS OF INSURANCE Aggregate Limit $6,000,000 Each Occurrence Limit $2,000,000 DESCRIPTION OF WORK AND JOB LOCATION(S) NAME AND ADDRESS OF DESIGNATED CONTRACTOR NAME AND ADDRESS OF INVOLVED GOVERNMENT AUTHORITY OR OTHER CONTRACTING PARTY PREMIUM Contract Cost Premium Base Rate per 1,000 of Advance Premium FORM OF ENDORSEMENT Title Number COUNTERSIGNATURE Countersigned by Date (Authorized Representative) EXHIBIT "B CERTIFICATE OF INSURANCE Southern California Regional Rail Authority (SCRRA) ISSUE DATE (MM/DD/YY) PRODUCER INSURED THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE INSUR- ANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER AL- TER THIS COVERAGE AFFORDED BY THE POLICY BELOWBE- LOW. COMPANIES AFFORDING COVERAGE COMPANY A LETTER COMPANY B LETTER COMPANY C LETTER COMPANY D LETTER COMPANY E LETTER COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENTSREQUIRE- MENTS, 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 CONDI- TIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE INSUR- ANCE POLICY NUMBER NUM- BER POLICY EFFECTIVE EF- FECTIVE DATE (MM/DD/YY) POLICY EXPIRATION EX- PIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY  LIABIL- ITY □ COMMERCIAL GENERAL LIABILITY  □ CLAIMS MADE  OCCUR□ OC- CUR.  □ OWNER'S & CONTRACTORCON- TRACTOR'S PROT.  □ OTHER GENERAL AGGREGATE PRODUCTS-AG- GREGATE PRODUCTS- COMP/OP AGG. PERSONAL & ADV. INJURY EACH OCCURRENCE OCCUR- RENCE FIRE DAMAGE (Any one fire) MED. EXPENSE (Any one person) EX- PENSE $ $ $ $ $ $ (Any one per- son) AUTOMOBILE LIABILITY  LIA- BILITY □ ANY AUTO  □ ALL OWNED AUTO  □ SCHEDULED AUTOS  AU- TOS □ HIRED AUTOS  □ NON-OWNED AUTOS  □ GARAGE LIABILITY LIABIL- ITY COMBINED SINGLE LIMIT BODILY INJURY IN- JURY (Per person) BODILY INJURY IN- JURY (Per accident) PROPERTY DAMAGE $ $ $ $ EXCESS LIABILITY  □ UMBRELLA FORM  □ OTHER THAN UMBRELLA FORM EACH OCCURRENCE OCCUR- RENCE AGGREGATE $ $ PROPERTY INSURANCE  INSUR- ANCE □ COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $ WORKER'S COMPENSATION COM- PENSATION AND EMPLOYER'S LIABILITY LIA- BILITY STATUARY LIMITS EACH ACCIDENT ACCI- DENT DISEASE-POLICY POL- ICY LIMIT DISEASE-DISEASE- EACH EMPLOYEE EM- PLOYEE $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS