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2018/08/11 Underground Solutions, Inc. Certificate of Liability InsuranceacoR6r CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DDNYYY) 8/9/2018 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 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 Michael Ehrenfeld Company Camino Del Rio North City of Menifee ACT NAME: Hope Zamichieli PHONE . (619)814-3046 A/C No:(619)683-9999 (AI2655 E-MAIL m ADDRESS: p ho ez@ehrenfeldinsurance.co #2OO City Clerk San Diego CA 92108 INSURERS AFFORDING COVERAGE NAIC # INSURERA:CrUM & Forster Specialty Insurance 44520 INSURED AUG 172018 Underground Solutions, Inc. INSURER B :The Ohio Casualty Insurance Company 24074 INSURERC:State Compensation Ins Fund of CA 35076 120 N. Andreasen Drive Escondido, CA 92029 Received INSURERD: INSURERE: Phone: (760) 294-9449 INSURERF: COVERAGES CERTIFICATE NUMBER-18-19 All Lines Renewal PF:%1ICInn1 KII InIIRCG. 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. INSR LTR I TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I S 5,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 50, 000 X IVIED EXP(Any one person) $ 5,000 BI/PD DEDUCTIBLE 5,000 EPK123726 8/11/2018 8/11/2019 X E&O/CPL DEDUCTIBLE 5,000 PERSONAL & ADV INJURY $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: [�] I GENERAL AGGREGATE S 51000,000 PRODUCTS - COMP/OPAGG S 5,000,000 POLICY JEO LOC I S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 X BODILY INJURY (Per person) S B ANY AUTO ALL OS SCHEDULED AUTOS AUTOS BA056664452 8/11/2018 8/11/2019 BODILY INJURY (Per ( ) S HIRED AUTOS X NON -OWNED AUTOS X PROPERTY DAMAGE Per accident S S UMBRELLA LAB I OCCUR EACH OCCURRENCE S 1, 000, 000 X AGGREGATE S 1,000,000 A EXCESS LABXCLAIMS -MADE DED I I RETENTIONS N/A s EFX111188 8/11/2018 8/11/2019 WORKERS COMPENSATION X I I AND EMPLOYERS' LIABILITY Y / N STATUTE ERH E.L. EACH ACCIDENT S 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. DISEASE - EA EMPLOYE S 1,000,000 C (Mandatory in NH) If yes, describe under 9109008-18 8/11/2018 8/11/2019 - E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS below A POLLUTION LIABILITY - Occur EPK123726 8/11/2018 8/11/2019 EACH CONDITION LIMIT: $ 1,000,000 E & 0 LIABILITY -Claims -Made EACH WRONGFUL ACT: $ 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) Encroachment Permit for Potholing Services - As respects General Liability, the Certificate Holder is Additional Insured including Primary Non-contributory Wording and Waiver of Subrogation per form EN0118 0211. Wrap -Up Exclusion per form EN0021 0211. As respects Automobile Liability, Additional Insured and Waiver of Subrogation per form CA8810 0113. As respects Workers' Compensation, Waiver of Our Rights to Recover From Others Endorsement - California per SCIF Form 10217. Excess Liability extends coverage of General Liability, Pollution Liability, Professional Liability, Automobile Liability, and Employer's Liability only. Attached forms only apply as required by written contract. City of Menifee 29714 Haun Road Menifee, CA 92586 I IVIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rob Kempa/HOPE�— ACORD 25 (2014/01) INS025 (201401) 91988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E Underground Solutions, Inc. Policy # EPK123726 a Forster part of the FAIRFA.Y group THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART ERRORS AND OMISSIONS LIABILITY COVERAGE PART THIRD PARTY POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Where Required by Written Contract A. SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional insured the person(s) or organization(s) indicated in the Schedule shown above, but solely as respects "claims" caused in whole or in part, by "your work" for that person or organization performed by you, or by those acting on your behalf. This insurance shall be primary and non-contributory, but only in the event of a named insured's sole negligence. B. We waive any right of recovery we may have against the person(s) or organization(s) indicated in the Schedule shown above because of payments we make for "damages" arising out of "your work" performed under a designated project or contract with that person(s) or organization(s). C. This Endorsement does not reinstate or increase the Limits of Insurance applicable to any "claim" to which the coverage afforded by this Endorsement applies. EN0118-0211 ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. Page 1 of 1 Underground Solutions, Inc. Policy # EPK123726 "Bodily injury" or "property damage" arising out of: (1) The transportation of "mobile equipment" by an "auto" owned or operated by or rented or loaned to any insured; or (2) The use of "mobile equipment" in, or while in practice for, or while being prepared for, any prearranged racing, speed, demolition, or stunting activity. h. Personal And Advertising Injury "Personal and advertising injury". i. War "Bodily injury" or "property damage", however caused, arising out of: (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. j. Wrap-up "Bodily injury" or "property damage" arising out of any project in which the insured participated for which a "Wrap-up or Owner Controlled Insurance Plan" was provided. 3. The following additional exclusions apply to Insuring Agreement B - Personal And Advertising Injury in E N 0021-0211 addition to those contained within the Common Provisions: Insuring Agreement B does not apply to "damages", "defense expenses", or any loss, cost or expense, or any "claim" or "suit": a. Breach Of Contract Based upon or arising out of a breach of contract, except an implied contract to use another's advertising idea in your "advertisement". b. Electronic Chatrooms Or Bulletin Boards Based upon or arising out of electronic chatroom or bulletin board that the insured hosts, owns, or over which the insured exercises control. c. Infringement Of Copyright, Patent, Trademark Or Trade Secret Based upon or arising out of the infringement of copyright, patent, trademark, trade secret or other intellectual property rights, including, without limitation, false patent marking and provisional or royalty rights from or during any period from the date of filing of the application for patent to the date of issuance as a patent. However, this exclusion does not apply to infringement, in your "advertisement", of copyright, trade dress or slogan. d. Insureds In Media And Internet Type Businesses Committed by an insured whose business is: (1) Advertising, broadcasting, publishing or telecasting; (2) Designing or determining content Page 8 of 10 © 2011 United States Fire Insurance Company, all rights reserved. Underground Solutions, Inc. Policy Number: BA056664452 COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ENDORSEMENT AGREEMENT HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WAIVER OF SUBROGATION BLANKET BASIS EFFECTIVE AUGUST 11, 2018 AT 12.01 A.M. AND EXPIRING AUGUST 11, 2019 AT 12.01 A.M. UNDERGROUND SOLUTIONS, INC. 120 N ANDREASEN DR STE A ESCONDIDO, CA 92029 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. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER 9109008-18 RENEWAL SP 5-86-40-17 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED, NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAWN FFRRANCISCO: v AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7-2014) JULY 19, 2018 2572 PRESIDENT AND CEO OLD DP 217