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2019/01/05 TKE Engineering, Inc. Certificate of Liability InsuranceTKEENGI-01 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) l 9/24/2019 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 riahts to the certificate holder in lieu of such endorsement/sl_ PRODUCER License # OC36861 San Die? Insurance Services, Inc. 701 B St 6th FI San Diego, CA 92101 INSURED TKE Engineering Inc 2305 Chicago Ave Ste#100 Riverside, CA 92507-6948 cR�ITACT Tana Schelling 01i4 OF hIF.14IFEE PHONE E; HONE I FAX FINA14CE 9VC, No, ExtL i (NC, No): A E-MAILORESS; lliTana.Schen g'C �e lliartt.cam AO ' ?-) ,'!1 INSURER(S) AFFORDING COVERAGE NAICI wSURERA: Travelers Property Casualty Company of America_ 25674. R(► C ���D INSURER B : California Automobile Insurance Company 38342 l� C INSURER C.- INSURER D. - INSURER E : INSURER F : 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. ,R TYPE OF INSURANCE ,ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS L X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ 2,000,0 CLAIMS -MADE [X:] OCCUR X X 16806H13841819 1/5/2019 1/5/2020 DAMAGEEST REnNT erica) $ 1,000,0 GE1J'LAGGREGATE LIMIT APPLIES PER: X POLICY I JEOT LOC —I OTHER- B AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY I X AUTOSULED X AUTOS ONLY X . AUTOS ONLYY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE MED EXP.JAny one_person) $ PERSONAL &ADV INJURY $ GENERAL A_ GGGRGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT !Ea accident) _ .$ 9/18/2019 9/18/2020 BODILY INJURY (Perpersyn) $ p�BFROeDILY INJURY CPer accident) $. Pi gIOPU' nt]_AMAGE $ EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY X S7AILITI_... Eli ANY PROPRIETOR/PARTNER/EXECUTIVE YIN X UB-9J213184-19�7-G 7l5/2019 1/5/2020 1,000,000 @ E.L. EACH ACCIDENT (Mande ory in NH EXCLUDED? I ' N / A E.L_DISEASE EAEMPLO__. 1,000,000 Y_ If yes, describe under 1,000 000 DESCRIPTION OF OPERATIONS below F I ni.gF:ARF - Pr1I Ir.V I IMIT A DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Project: On Call Services (INSPECTION SERVICES) City of Menifee and its officers, officials, employees, and volunteers are Additional Insured with respect to General Liability for the Ongoing Operations of the named insured as required by written contract, Waiver of Subrogation applies. Waiver of Subrogation applies to Workers Compensation. Forms attached. FE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Steven Glynn, Public Works Manager 29714 Haun Road - Menifee, CA 92586 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ARCHITECTS, ENGINEERS AND SURVEYORS COVERAGE XTEND ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Broadened Named Insured B. Incidental Medical Malpractice C. Reasonable Force — Bodily Injury Or Property Damage D. Non -Owned Watercraft — Increased To Up To 75 feet E. Aircraft Chartered With Crew F. Damage To Premises Rented To You G. Malicious Prosecution — Exception To Knowing Violation Of Rights Of Another Exclusion H. Medical Payments — Increased Limit I. Increased Supplementary Payments J. Additional Insured — Owner, Manager Or Lessor Of Premises PROVISIONS A. BROADENED NAMED INSURED 1. The following is added to SECTION II — WHO IS AN INSURED: Any organization, other than a partnership or joint venture, over which you maintain ownership or majority interest on the effective date of the policy qualifies as a Named Insured. However, coverage for any such additional organization will cease as of the date during the policy period that you no longer maintain ownership of, or majority interest in, such organization. B. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the definition of "occurrence" in the DEFINITIONS Section: K. Additional Insured — Lessor Of Leased Equipment L. Additional Insured — State Or Political Subdivisions — Permits Relating To Premises M. Additional Insured — State Or Political Subdivisions — Permits Relating To Operations N. Who Is An Insured — Newly Acquired Or Formed Organizations O. Knowledge And Notice Of Occurrence Or Offense P. Unintentional Omission Q. Waiver Of Transfer Of Rights Of Recovery Against Others To Us When Required By Written Contract R. Amended Insured Contract Definition — Railroad Easement Unless you are in the business or occupation of providing professional health care services, "occurrence" also means an act or omission committed in providing or failing to provide first aid or "Good Samaritan services" to a person. 2. The following is added to the DEFINITIONS Section: "Good Samaritan services" means any emergency medical services for which no compensation is demanded or received. 3. The following is added to Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above CG D3 79 01 16 0 2016 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY (b) Not owned by any insured; and (c) Not being used to carry any person or property for a charge. 2. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured for use of an aircraft that is: (a) Chartered with crew to any insured; (b) Not owned by any insured; and (c) Not being used to carry any person or property for a charge. F. DAMAGE TO PREMISES RENTED TO YOU 1. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY in COVERAGES: Exclusions c. through n. do not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. A separate limit of insurance applies to such damage to premises as described in Paragraph 6. of Section III — Limits Of Insurance. This insurance does not apply to damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: a. Rupture, bursting, or operation of pressure relief devices; b. Rupture or bursting due to expansion or swelling of the contents of any building or structure, caused by or resulting from water; or c. Explosion of steam boilers, steam pipes, steam engines, or steam turbines. 2. The following replaces Paragraph 6. of SECTION III — LIMITS OF INSURANCE: Subject to S. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or temporarily occupied by you with permission of the owner, caused by fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water. The Damage To Premises Rented To You Limit will apply to all damage proximately caused by the same "occurrence", whether such damage results from: fire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water; or any combination of any of these. The Damage To Premises Rented To You Limit will be the higher of: a. $1,000,000; or b. The amount shown on the Declarations of this Coverage Part for Damage To Premises Rented To You Limit. 3. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINITIONS Section: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permission of the owner, caused by: (1) Fire; (2) Explosion; (3) Lightning; (4) Smoke resulting from such fire, explosion, or lightning; or (5) Water, is not an "insured contract'; 4. The following replaces Paragraph 4.b.(1)(b) of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: (b) That is insurance for premises rented to you, or temporarily occupied by you with the permission of the owner; CG D3 79 01 16 0 2016 The Travelers Indemnity Company. All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY committed, after you have signed that written contract; and b. Is caused, in whole or in part, by acts or omissions of you or any person or organization performing operations on your behalf, in the maintenance, operation or use of equipment leased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the following provisions: a. The limits of insurance provided to such equipment lessor will be the limits which you agreed to provide in the written contract, or the limits shown on the Declarations of this Coverage Part, whichever are less; and b. The insurance provided to such equipment lessor does not apply: (1) To any "bodily injury" or "property damage" caused by an 'occurrence" that takes place, or "personal injury" caused by an offense that is committed, after the equipment lease expires; or (2) If the equipment is leased with an operator. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, unless you have agreed in a written contract for this insurance to apply on a primary or contributory basis. L. ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS — PERMITS RELATING T O PREMISES The following is added to Paragraph 2. of SECTION II — WHO IS 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, is an insured, but only with respect to "bodily injury", "property damage", "personal injury" or "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. M. ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS — PERMITS RELATING TO OPERATIONS The following is added to Paragraph 2. of SECTION II — WHO IS AN INSURED: Any state or political subdivision that has issued a permit with respect to operations performed by you or on your behalf is an insured, but only with respect to "bodily injury", "property damage", "personal injury" or "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: (1) "Bodily injury", "property damage", "personal injury" or "advertising injury" arising out of operations performed for that state or political subdivision; or (2) "Bodily injury" or "property damage" included within the "products — completed operations hazard". N. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4.a. of SECTION II — WHO IS AN INSURED: a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 days after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 days after you acquire or form such organizations, if you report such organization in writing to us within 180 days after you acquire or form it. O. KNOWLEDGE AND NOTICE OF OCCURRENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim Or Suit, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: e. The following provisions apply to Paragraph a. above, but only for the purposes of the insurance provided under this Coverage Part to you or any insured listed in Paragraph 1. or 2. of Section II — Who Is An Insured: CG D3 79 01 16 © 2016 The Travelers Indemnity Company. All rights reserved. Page 5 of 6 TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-9J213184-19-47-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) 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 this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Job Description ENGINEERS 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 Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 11-16-18 ST ASSIGN: Page 1 of 1