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2019/08/11 Underground Solutions, Inc. Certificate of Liability InsuranceAo-f-QRE0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/13/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hope Zamichieli NAME: Michael Ehrenfeld Company PHONE (619) 814-3046 a1c (619) 683-9999 AA .No): 2655 Camino Del Rio North EMAIL hopez@ehrenfeldinsurance.com ADDRESS- #200 INSURERS AFFORDING COVERAGE NAIC # San Diego CA 92108 INSURERA• Crum & Forster Specialty Insurance Company 44520 INSURED INSURER B• The Ohio Casualty Insurance Company 24074 Underground Solutions, Inc. INSURER C : State Compensation Ins Fund of CA 35076 120 N. Andreasen Drive INSURER D : INSURER E ; Escondido CA 92029 INSURERF: COVERAGES CERTIFICATE NUMBER: 19-20 All Lines Renewal REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E 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. 1NSR LTR TYPE OF INSURANCE AWWL ZkUtSM POLICY NUMBER POLICYEFF MWDD/YYYY POLICYEXP MMIDD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 ❑OCCUR 50,000CLAIMS -MADE aCMe X MED EXP (Any one person) $ 5,000 BI/PD DEDUCTIBLE: $5,000 A EPK127826 08/11/2019 08/11/2020 X E&O/CPLDEDUCTIBLE: $5,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: GENERALAGGREGATE $ 5,000,000 POLICY PRO- JECT 7 LOC PRODUCTS-COMP/OPAGG $ 5.000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accldvrO $ 1,000,000 ANYAUTO x BODILY INJURY (Per person) $ B OWNED SCHEDULED AUTOS ONLY AUTOS BA056664452 08/11/2019 08/11/2020 BODILY INJURY (Per accident) $ HIRED NON -OWNED P PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY_[Per,accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1.000,000 x AGGREGATE $ 1,000.000 A EXCESSLIAB CLAIMS -MADE EFX113251 08/11/2019 08/11/2020 DED RETENTION $ 0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY Y/ N STATUTE ER E. L EACH ACCIDENT $ 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA 9109008-19 08/11/2019 08/11/2020 E.L DISEASE -EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.LDISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below POLLUTION LIABILITY - OCCUR EACH CONDITION: $1,000,000 A E&O LIABILITY -CLAIMS MADE EPK127826 08/11/2019 08/11/2020 EACH WRONGFULACT $5,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Encroachment Permit for Potholing services - As respects General Liability, the Certificate Holder is Additional Insured per attached form EN0145-1111. "_^ 4ANULLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE t I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Underground Solutions, Inc. Policy # EPK127826 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS 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 COVER PART ONSITE CLEANUP COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Where Required By Written Contract. Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. Under the Common Provisions, Section III — 2. Who Is An Insured is amended to include as an insured any state or governmental agency or Subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your be- half for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: a. "Bodily injury", "property damage" "per- sonal and advertising injury", a "pollution condition" or a "wrongful act" arising out of operations performed for the federal gov- ernment, state or municipality; or b. "Bodily injury" or "property damage" in- cluded within the "products -completed op- erations hazard". EN0145-1111 Page 1 of 1 ❑ Includes copyrighted material of Insurance Service Office, Inc. with its permission