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2019/07/13 Taber Drilling Certicate of Liability Insurance TABEDRI-01 KRAMSTA❑ ACQ�O" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y-YYY) `•� 8/1312019 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 endorsements . PRODUCER License#OB50501 COPTRCT m$trong&ASSOCIateS PHONE FAX Ar st Court St,Bldg 530 668-2777 A/C,No,(530 668.-2779 Woodland,CA 95695 E-lgiLE .tgaiart@armstrongprofiessional.com INSURERS AFFORDING COVERAGE NAIC# _ INSURER A.Admiral Insurance Company 24856 INSURED INSURER B:Wesco Insurance Company Inc. 25011 Taber Drilling INSURERC-State Compensation Insurance Fund 35076 536 Galveston St. INSURER D:Allianz Global Corporate&Sl3ecialty 35300 West Sacramento,CA 95691 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SUB VdVD POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR X X IIFEIECC1719506 8/15/2019 8/15/2020 DAMAGE TO RENTED 100,000 MED EXP fAny oneperson) $ 5,000 PERSONAL&ADV INJURY 1,000,000 GEWLAGsGREGATE LIMIT APPLIES PER: GENERAL AGGRE GATE $ 2,000,000 POLICY PRO-- LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: Pollution Liab $ 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LMMIT $ 1,000,000 ANY AUTO _ X X 111PP1150513-05 8/15/2019 8/1512020 BODILYINJU Y Per arson $ OWNED SCHEDULED AUTOS ONLY -X AUTOS BODILY INJURY Per acciden $ X AUTOS ONLY X AUTOS ONLY (PerrzcEcldent)AMAGE $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS LIAB CLAIMS-MADE IFEIEXS1719606 8/15/2019 8/15/2020 AGGREGATE $ 4,000,000 DED 1 1 RETENTION$ I $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITYSTAJUIE ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 197243319 7/13/2019 7/13/2020 1,000,000 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE 11000,000. If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ D Equipment Floater IMZ193084157 8/5/2019 8/5/2020 Rented/Leased Equip 250,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Re Project#2014.0038 Bradley Road Bridge over Salt Creek.The City of Menifee is named as additionally insured as per the attached endorsement. CERTIFICATE HOLDER CANCELLATION City of Menifee City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Menifee Engineering Department ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road Sun City,CA 92586 AUTHORIZED REPRESENTATIVE h in -ram-= f_ !* 1 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Automatic Additional Insured — Owners, Lessees or Contractors This endorsement,effective e/15/2019attaches to and forms apart of Policy Number FEIECC1719506 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 SCHEDULE Name of Person or Organization: Any person(s)or organization(s)whom the Named Insured agrees,in a written contract,to name as an additional insured. However,this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured,but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC-319-0712 1 Automatic Waiver of Subrogation Endorsement This endorsement,effective$�15/19dttaches to and farms'a part of Policy Number F E I E C C 1719506 This endorsement changes the Policy. Please road it carefUlly. This endorsement modifies insurance provided under the following: C0lVX1VIERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR$POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any persons)or organization(s)to whom the Named Insured agrees,in a written contract,to provide a waiver of subrogation. However,this status exists only for the project specified itx that contract. The Corppany waives anyright ofrecovery it may have against the person or organization shown in the above Schedule because ofpayments the Company makes for injury or damage arising out of the insured's work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement actto extend the policy period, change the scope of covorage or inorease the Agg;cgate Limits of insurance shown in the Declarations. ECC-320-0712 D. Limited Automatic Towing Coverage G. "Personal Effects"Coverage Item 2.Towing, of Paragraph A. Coverage, Item 4.Coverage Extensions of Paragraph under SECTION III—PHYSICAL DAMAGE A. Coverage, under SECTION III- COVERAGE is amended to read: PHYSICAL DAMAGE COVERAGE, is 2. Towing amended to add: We will pay for towing and labor costs "Personal Effects"Coverage each time that a covered"auto" is We will pay actual cash value for"loss"to disabled. All labor must be performed at "personal effects"of the"insured"while in the place of disablement of the covered a covered"auto"subject to a maximum "auto". limit of$2,500 per"loss", for that covered "auto"caused by the same"accident". No a. The limit for towing and labor for each disablement is$500; deductible will apply to this coverage,b. No deductible applies to this cover- H. "Downtime Loss" Coverage age Item 4. Coverage Extensions, of E. Item 3. Glass Breakage—Witting A Bird Paragraph A.Coverage, under SECTIONIII. PHYSICAL DAMAGE COVERAGE, is Or Animal—Falling Objects or Missiles of amended to add; Paragraph A. Coverage under SECTION III e"Covera —PHYSICAL DAMAGE COVERAGE, is "Downtime Loss g amended to add: We will pay any resulting"downtime loss" Glass Repair Coverage expenses you sustain as a result of a We will waive the Comprehensive covered physical damage"loss"to a covered "auto"up to a maximum of$100 deductible for Glass, if one is indicated on per day,for a maximum of 30 days for the your covered"auto", for glass repairs. We same physical damage"loss", subject to will repair at no cost to you, any glass that the following conditions: can be repaired without replacement, provided the"loss"arises from a covered a• We will provide"downtime loss" beginning Comprehensive"loss"to your"auto", on the 51hday after we have given you F. Increase Of Transportation Expense our agreement to pay for repairs to acovered "auto" and you have given the Coverage repair facility your authorization to make Subpart a.Transportation Expenses of repairs; Item 4. Coverage Extensions of Paragraph b. Coverage for"downtime loss" expenses A. Coverage under SECTION III— will end when any of the following occur: PHYSICAL DAMAGE COVERAGE is amended to read: (1) You have a spare or reserve"auto" available to you to continue your a. Transportation Expenses operations. We will pay up to$50 per day to a (2) You purchase a replacement"auto". maximum of$1,000 for temporary transportation expense incurred by you (3) Repairs to your covered "auto" have because of the total theft of a covered been completed by the repair facility "auto" of the private passenger type. and they determine the covered We will pay only for those covered "auto" is road-worthy. "autos"for which you carry either (4) You reach the 30 day maximum Comprehensive or Specified Causes of coverage. Loss Coverage or Theft Coverage. We will pay for temporary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration,when the covered"auto"is returned to use or we pay for its"loss". CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 2 of 5 Used with permission M. Aggregate Deductible (3) An "executive officer"or director, if Paragraph D. Deductible under SECTION you are a corporation; III—PHYSICAL DAMAGE COVERAGE is (4) A manager or member, if you are a amended to add: limited liability company; Regardless of the number of covered (5) Your insurance manager; or "autos"involved in the same"loss", only (6) Your legal representative. one deductible will apply to that"loss". If the deductible amounts vary by"autos", P. Waiver Of Subrogation For Auto Liability then only the highest applicable deductible Losses Assumed Under Insured Contract will apply to that"loss". Item 5.Transfer Of Rights Of Recovery N. Diminishing Deductible Against Others To Us of Paragraph A. Paragraph D. Deductible under SECTION Loss Conditions under SECTION IV— BUSINESS AUTO CONDITIONS is III—PHYSICAL DAMAGE COVERAGE is amended to read: amended to add: Any deductible will be reduced by the 5. Transfer of Rights of Recovery Against Others To Us percentage indicated below on the first "loss" reported during the corresponding If any person or organization to or for policy period: whom we make payments under this Coverage Form has rights to recover damages from another, those rights are Loss Free Policy Periods Deductible transferred to us. That person or With the Expansion Reduction on the organization must do everything Endorsement first"loss" necessary to secure our rights and must 1 0% do nothing after an"accident"or"loss" 2 25% to impair them. However, if the insured has waived those rights to recover 3 _ 5o�i" _ .__ through a written contract,we will waive 4 75% any right to recovery we may have 5 000% under this Coverage Form. If we pay a Physical Damage"loss"during Q. Insurance is Primary and the policy period under any BUSINESS Noncontributory AUTO COVERAGE FORM you have with Subpart a. of Item 5. Other Insurance of us,your deductible stated in the Paragraph B. General Conditions under Declarations page of each such SECTION IV—BUSINESS AUTO COVERAGE FORM will not be reduced on CONDITIONS is amended to read: any subsequent claims during the remainder a. This insurance is primary and of your policy period and your deductible reduction will revert back to 0%for each noncontributory, respects any other such COVERAGE FORM if coverage is insurance, if required in a written contract with you. renewed. O. Knowledge of Loss and Notice To Us R. Other Insurance—Hired Auto Physical Damage Subsection a. of Item 2. Duties In the Event Subpart b. of Item 5..Other Insurance of of Accident, Claim, Suit or Loss of paragraph B.General Conditions under Paragraph A. Loss Conditions under SECTION 1V—BUSINESS AUTO SECTION IV--BUSINESS AUTO CONDITIONS is amended to add: CONDITIONS is amended to read: However, prompt notice of the"accident", b. For Hired Auto Physical Damage claim "suit"or"loss" to us or our Coverage, the following are deemed authorized representative only applies to be covered "autos" you own: after the"accident", claim, "suit"or"loss" is (1) Any covered"auto"you lease, known to: hire, rent or borrow; and (1) You, if you are an individual; (2) A partner, if you are a partnership; CA990187 0715 Includes Copyrighted Material of Insurance Services Offices, Inc. Page 4 of 5 Used with permission ENDORSEMENT AGREEMENT BROKER COPY STATE COMPENSATION WAIVER OF SUBROGATION REP A5 BLANKET BASIS 1972433-19 FUND RENEWAL NF HOME OFFICE 5-00-38-17 SAN FRANCISCO EFFECTIVE JULY 13 , 2019 AT 12.01 A.M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING JULY 13, 2020 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME TABER DRILLING 536 GALVESTON ST WEST SACRAMENTO, CA 95691 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 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 SAANFRFRANCISCO: JULY 2, 2019 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO 2572 SCIF FORM 10217 (REV.7-2014) OLD DP 217