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2019/01/31 VCI Utility Services, LLC Certificate of Liability InsuranceATE (MMID AtIC"RhIF Ill CERTIFICATE OF LIABILITY INSURANCE D01/09/2019D/YYVY► 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 Marsh USA Inc 1560 Sawgrass Corporate Pkwy, Suite 300 City of Menifee Sunrise, FL 33323 City Clerk CONTACT NAME: HOE P{ N 1. FAX Nol: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # CN102986923-upl-GAWU-19-20 Y AAN 2 3 2M INSURER A : Liberty Mutual Fire Insurance Company 23035 INSURED VCI Utility Services, LLC INSURER B : LM Insurance Corporation 33600 INSURER C : Westchester Fire Insurance Company 10030 dba Vantage Utility Services 1369 W. 9th St. Received Upland, CA 91786 INSURER D INSURERE:_ INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-004780242-07 REVISION NUMBER: 10 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 TYPE OF INSURANCE ADDL -S BR POLICY EFF POLICY P-XP LTR POLICY NUMBER MM/DDIYYYY MMMDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY + CLAIMS -MADE Fx] OCCUR TB2-631-004260-019 01/31/2019 01/31/2020 EACH OCCURRENCE $ 5,000,000 $ 1,000,000 PR MISES fEa occurrence MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ 5,000,000 GI 4 AGGREGATE LIMIT APPLIES PER: POLICY � PE� El LOC GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $ 10,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea a ent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY _. AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Par acxiZ' $ X UMBRELLA LIAR X OCCUR G22049860013 01/31/2019 01/31/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS -MADE DED X RETENTION $10 000 $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A WA5-63D-004260-039(AOS) WC5-631-004260-049 (MN.WI) J 0113112019 01/31/ 020 0113112020 X PER - SIT ER E. L EACH ACCIDENT $ 1,000,000 E. L- DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Menifee is/are included as additional insured where required by written contract with respect to general liability This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured subject to policy terms and conditions with respect to general liability Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions CERTIFICATE HOLDER CANCELLATION City of Menifee 29714 Haun Road Menifee, CA 92586 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 of Marsh USA Inc. Manashi Mukherjee 14��� ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modified insurance provided under the following: BUSINESS AUTO 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 this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form This endorsement does not alter coverage provided in the Coverage Form SCHEDULE Name of Person(s) or Organization(s): Any Person(s) or Oiganization(s) as required by written cont7act prior to loss on file with the broker Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form, Policy No: AS2-631-004260-029 Issued By: Liberty Mutual Fire Insurance Company Effective Date: 01/31/2019 Expiration Date: 01/31/2020 Sales Office: 0390 Endt Serial No. CA 20 48 02 99 Copyright, Insurance Services Office, Inc, 1998 Page 1 of 1 Policy Number AS2-631-004260-029 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY— UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) ! Email Address or mailing address: Number Days Notice: Organ izations : Per schedule on file with Per schedule on file with Company ** Company **75 days or as required by written contract, whichever is less, per the schedule on file with the company" A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged. LIM 99 01 0511 © 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc, with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM Premium: INCL SCHEDULE Name of Person or Organization : Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out or your operations of a covered auto done under contract with that person or organization This waiver applies only to the person or organization shown in the Schedule above. Policy No: AS2-631-004260-029 Effective Date: 01/31/2019 Expiration Date: 01/31/2020 Sales Office: 0390 Issued By: Liberty Mutual Fire Insurance Company AX 1210 02 05 Page 1 of 1 POLICY NUMBER: TB2-631-004260-019 COMMERCIAL GENERAL LIABILITY CG20100413 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 A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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, B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement, or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations CG 20 10 04 13 © ISO Properties, Inc., 2012 Page 1 of 2 ❑ SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Operations All persons or organizations for whom you have I All locations as required by a written contract or agreed in a written contract or agreement, prior to an agreement entered into prior to an 'occurrence" "occurrence" or offense, to provide additional or offense. insured status. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I CG 2010 0413 0 Insurance Services Office, Inc, 2012 Page 2 of 2 POLICY NUMBER: TB2-631-004260-019 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 Organization(s) Location And Description Of Completed Operations All persons or organizations for whom you have agreed in a written contract or agreement, prior to an "occurrence" or offense, to provide additional insured status All locations as required by a written contract or agreement entered into prior to an "occurrence" or offense. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by ..your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 O Insurance Services Office, Inc.; 2012 Page 1 of 1 Policy Number TB2-631-004260-019 Issued by LIBERTY MUTUAL FIRE INSURANCE, COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABILITY INDEMNITY COVERAGE PART SELF -INSURED TRUCKER EXCESS LIABILITY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL LIABILITY —UMBRELLA COVERAGE FORM Schedule Name of Other Person(s) ! Or anization s : Email Address or mailing address: Number Days Notice: Per Schedule on File With The Company Per Schedule on File With The Company 75 or as required by written contract, whichever is less, per the schedule on file with the company A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule above. We will send notice to the email or mailing address listed above at least 10 days, or the number of days listed above, if any, before the cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. All other terms and conditions of this policy remain unchanged LIM 99 01 0611 ® 2011 Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy Number TB2-631-004260-019 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY — OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Section IV — Conditions 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed prior to a loss, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. (3) This insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence", claim or "suit". LD 24 153 08 16 © 2016 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: TB2-631-004260-019 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: As required by agreement entered into prior to loss. 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 Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or ..your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 0 NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium; we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective. In no event does the notice to the third party exceed the notice to the first named insured. B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. SCHEDULE Name of Other Person(s) / Email Address or mailing address: Number Days Notice: Organization(s): List on File 30 with the broker All other terms and conditions of this policy remain unchanged. Issued by LM Insurance Corporation For attachment to Policy No. WA5-63D-004260-039 Effective Date 01/31/2019 Premium $ Issued toDycom Industires, Inc. WC 99 20 75 © 2016 Liberty Mutual Insurance Page 1 of 1 Ed 12/01/2016 NOTICE OF CANCELLATION TO THIRD PARTIES A. If we cancel this policy for any reason other than nonpayment of premium, we will notify the persons or organizations shown in the Schedule below. We will send notice to the email or mailing address listed below at least 10 days, or the number of days listed below, if any, before cancellation becomes effective In no event does the notice to the third party exceed the notice to the first named insured B. This advance notification of a pending cancellation of coverage is intended as a courtesy only. Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy. Name of Other Person(s) / Organization(s): List on File with the broker SCHEDULE Email Address or mailing address All other terms and conditions of this policy remain unchanged Issued by LM Insurance Corporation For attachment to Policy No. WC5-63D-004260-049 Effective Date 01/31/2019 Issued toDycom Industires, Inc. WC 99 20 75 © 2016 Liberty Mutual Insurance Ed. 12/01 /2016 Number Days Notice: .e Premium $ Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Alaska, Kentucky, New Hampshire, New Jersey This waiver is NOT APPLICABLE Schedule Where Required By Contract Or Written Agreement Prior To Loss And Allowed By Law Alabama, Arizona, Arkansas, Colorado, Delaware, Dist. Of Col, Georgia, Idaho, Illinois, Indiana, Kansas, Maine, Michigan, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Vermont, West Virginia The premium charge is 2% of the total manual premium, subject to a minimum premium of $100 per policy. Connecticut, Florida, Iowa, Maryland, Nebraska, Oregon The premium charge is 1 % of the total manual premium, subject to a minimum premium of $250 per policy. Hawaii The premium charge is $250 and determined as follows: The premium charge for this endorsement is 1 % of the total manual premium, subject to a minimum premium of $250 per policy Louisiana The premium charge is 2% of the total standard premium, subject to a minimum premium of $250 per policy Massachusetts The premium charge is 1 % of the total manual premium New York, Tennessee The premium charge is 2% of the total manual premium, subject to a minimum premium of $250 per policy. Virginia The premium charge is 5% of the total manual premium, subject to a minimum premium of $250 per policy Issued by: LM Insurance Corporation 27243 For attachment to Policy No WA5-63D-004260-039 Effective Date: 1131/19 Issued to: Dycom Industries, Inc WC 00 03 13 01983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1 /1984 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. This waiver does not apply to any right to recover payments which the Minnesota Workers Compensation Reinsurance Association may have or pursue under M.S 79.36 Schedule Where Required By Contract Or Written Agreement Prior To Loss And Allowed By Law. Minnesota The premium charge is 2% of the total manual premium, subject to a minimum premium of $100 per policy. Wisconsin The premium charge is 2% of the total manual premium, subject to a minimum premium of $50 per policy. Issued by: LM Insurance Corporation For attachment to Policy No WC5-631-004260-049 Effective Date Premium $ Issued to: Dycom Industires, Inc WC 00 0313 © 1983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1 /1984 Policy Number TB2-631-004260-019 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY — OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Section IV —Conditions 4. Other Insurance and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance, and (2) You have agreed prior to a loss, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. (3) This insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same 'occurrence", claim or "suit'. LID 24 153 08 16 O 2016 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission POLICY NUMBER: TB2-631-004260-019 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: As required by agreement entered into prior to loss. 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 Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above CG 24 04 05 09 © Insurance Services Office, Inc , 2008 Page 1 of 1 O WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Alaska, Kentucky, New Hampshire, New Jersey This waiver is NOT APPLICABLE Schedule Where Required By Contract Or Written Agreement Prior To Loss And Allowed By Law. Alabama, Arizona, Arkansas, Colorado, Delaware, Dist. Of Col, Georgia, Idaho, Illinois, Indiana, Kansas, Maine, Michigan, Mississippi, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Vermont, West Virginia The premium charge is 2% of the total manual premium, subject to a minimum premium of $100 per policy. Connecticut, Florida, Iowa, Maryland, Nebraska, Oregon The premium charge is 1 % of the total manual premium, subject to a minimum premium of $250 per policy. Hawaii The premium charge is $250 and determined as follows: The premium charge for this endorsement is 1 % of the total manual premium, subject to a minimum premium of $250 per policy Louisiana The premium charge is 2% of the total standard premium, subject to a minimum premium of $250 per policy. Massachusetts The premium charge is 1 % of the total manual premium New York, Tennessee The premium charge is 2% of the total manual premium, subject to a minimum premium of $250 per policy. Virginia The premium charge is 5% of the total manual premium, subject to a minimum premium of $250 per policy Issued by: LIN Insurance Corporation 27243 For attachment to Policy No WA5-63D-004260-039 Effective Date: 1131/19 Issued to: Dycom Industries, Inc WC 00 0313 ©1983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1 /1984 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. This waiver does not apply to any right to recover payments which the Minnesota Workers Compensation Reinsurance Association may have or pursue under M.S. 79.36, Schedule Where Required By Contract Or Written Agreement Prior To Loss And Allowed By Law Minnesota The premium charge is 2% of the total manual premium, subject to a minimum premium of $100 per policy. Wisconsin The premium charge is 2% of the total manual premium, subject to a minimum premium of $50 per policy Issued by: LM Insurance Corporation For attachment to Policy No WC5-631-004260-049 Effective Date Premium $ Issued to: Dycom Industlres, Inc WC 00 03 13 © 1983 National Council on Compensation Insurance, Inc. Page 1 of 1 Ed. 4/1 /1984 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 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium Subject to a minimum premium charge of $ Person or Organization Where Required By Contract Or Written Agreement Prior To Loss And Allowed By Law Issued by LM Insurance Corporation For attachment to Policy No. WA5-63D-004260-039 Issued to Dycom Industires, Inc. Job Description Effective Date Premium $ WC 04 03 06 Page 1 of 1 Ed. 04/1984 TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( )Specific Waiver Name of person or organization (X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver 2. Operations: All Texas Operations 3. Premium: The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4 Advance Premium. Issued by LM Insurance Corporation For attachment to Policy No. WA5-63D-004260-039 Effective Date Premium $ Issued to Dycom Industires, Inc. WC 42 03 04 B © Copyright 2014 National Council on Compensation Insurance, Inc. Page 1 of 1 All Rights Reserved. POLICY NUMBER: TB2-631-004260-019 Effective Dates: 01/31/2019 — 01/31/2020 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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 Organization(s) I Location(s) Of Covered Operations City Of Men ifee All operations performed by the Named Insured within the City of Menifee 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project CG 2010 04 13 0 ISO Properties, Inc, 2012 Page 1 of 2 ❑ 0000139 SP 0037-0O2-P00139-1 City of Menifee 29714 Haun Road Menifee, CA 92586