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2020/09/30 LSA Associates, Inc. Certificate of Liability Insurance (4) Client#:583018 LSAASSOCIA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/02/2020 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 pollcy(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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER hONIAOT T Simson Soetanto Marsh&McLennan Agency LLC pH4 949-900-1211 No; 858-452-7530 Marsh&McLennan Ins.Agency LLC AnOFiE ; simson.soetanto@marshmma.com 1 Polaris Way#300 ^W INSURER{S)AFFORDING COVERAGE NAIC# Aliso Viejo,CA 92656 _�f INSURER A;National Fire Insurance Co of Hartford 20478_ INSURED LSAINSURER B:The Continental Insurance Company 35289 20 E xecutive Park,Suite 200 Associates,Inc. INSURER C:Valley Forge Insurance Company 20508 E Irvine,CA 92614 INSURER D: 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 CONTRACTOR 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, MR' AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDLSUBR POLICY EFF pPapl 'Y��jj(( (CIS NVD POLICY NUMBER MM/DD/YYY MAAIOIYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 6081697256 09/30/2020 09/30/2021 ppEAgqCCMHHp OCCURRENCE $1 000.000 CLAIMS-MADE �OCCUR PRE+f6%E5 Eap o%Erence $1 000 000 _ MED EXP Any one person $15 000 PERSONAL&ADV INJURY $1 OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 PRO- Lil POLICY FI JECT LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ C AUTOMOBILE LIABILITY 6081697225 09/30/2020 09/30/2021 Est'VINE15SINGLE%IiN�T 1 000,000 X ANY AUTO _ BODILY INJURY(Per person) $ AUT OW SC OS ONLY AUTOSULED BODILY INJURY(Per accident) $ X HIRED NON-OWNED PROPERTYCIAMAGE $ AUTOS ONLY X Id Par silt B X UMBRELLA LIAB X OCCUR 6081697273 09/30/2020 09/30/2021 EACH OCCURRENCE $5 00O 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $�J OOO O00 _ DEL X 4 ENTI2NE10000 $ A WORKERS COMPENSATION 6081697239 09/30/2020 09/30/2021 X PER OTH- AHD EMPLOYERS'LIABILITY Y/N •U ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT $1 OOO OOO CFFICERIMEMSER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Goetz Road Widening Project/CIM1601B.City of Menifee,and its officers,employees,agents,and authorized volunteers are included as additional insured as respects to General Liability and Auto Liability per attached endorsements.Primary and Non Contributory Wording applies per attached endorsement.Waiver of Subrogation applies to Workers Compensation per attached endorsement.Cancellation provisions apply per the attached. CERTIFICATE HOLIER CANCELLATION City of Menifee SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Carlos Geronimo ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road Sun City,CA 92586-0000 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6521300/M6470006 WSPXD INSURED: LSAAssociates,Inc. POLICY#: 6081697256 POLICY PERIOD: 09/30/2020 TO 09/30/2021 CIVA CNA PARAMOUNT General Liability Extension Endorsement It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows, If any other endorsement attached to this policy amends any provision also amended by this endorsement, then that other endorsement controls with respect to such provision, and the changes made by this endorsement with respect to such provision do not apply, TABLE OF CONTENTS 1. Additional Insureds 2. Additional Insured-Primary And Non-Contributory To Additional Insured's Insurance 3. Bodily Injury—Expanded Definition 4. Broad Knowledge of Occurrence/Notice of Occurrence 5. Broad Named Insured 6. Estates,Legal Representatives and Spouses 7. Expected Or Intended Injury—Exception for Reasonable Force 8. In Rem Actions 9. Incidental Health Care Malpractice Coverage 10. Joint Ventures/Partnership/Limited Liability Companies 11. Legal Liability—Damage To Premises 12. Medical Payments 13, Non-owned Aircraft Coverage 14. Non-owned Watercraft 15. Personal And Advertising Injury—Discrimination or Humiliation 16. Personal And Advertising Injury-Contractual Liability 17. Property Damage-Elevators 18. Supplementary Payments 19. Unintentional Failure To Disclose Hazards 20. Waiver of Subrogation—Blanket CNA74879XX(1-15) Page 1 of 13 Copyright CNA All Rlghls Reserved. Includes copyrighted nmleriel of Insurance Services Office,Inc.,with its penrisdon, CNA CNA PARAMOUNT General Liability Extension Endorsement 1. ADDITIONAL INSUREDS a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs A.through K.below whom a Named Insured is required to add as an additional insured on this Coverage Part under a written contract or written agreement,provided such contract or agreement: (1) is currently in effect or becomes effective during the term of this Coverage Part;and (2) was executed prior to: (a) the bodily injury or property damage;or (b) the offense that caused the personal and advertising injury, for which such additional insured seeks coverage. b. However,subject always to the terms and conditions of this policy, including the limits of insurance,the insurer will not provide such additional insured with: (1) a higher limit of insurance than required by such contract or agreement;or (2) coverage broader than required by such contract or agreement,and in no event broader than that described by the applicable paragraph A.through K.below, Any coverage granted by this endorsement shall apply only to the extent permissible by law. A. Controlling Interest Any person or organization with a controlling interest in a Named Insured,but only with respect to such person or organization's liability for bodily injury,property damage or personal and advertising injury arising out of. 1. such person or organization's financial control of a Named Insured;or 2. premises such person or organization owns, maintains or controls while a Named Insured leases or occupies such premises; provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. B. Co-owner of Insured Premises A co-owner of a premises co-owned by a Named Insured and covered under this insurance but only with respect to such co-owner's liability for bodily injury,property damage or personal and advertising injury as co-owner of such premises. C. Grantor of Franchise Any person or organization that has granted a franchise to a Named Insured, but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury as grantor of a franchise to the Named Insured, D. Lessor of Equipment Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for bodily injury,property damage or personal and advertising injury caused, in whole or in part, by the Named Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such bodily injury,property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. E. Lessor of Land CNA74879XX(1-15) Page 2 of 13 Copyrifihl CNA All Rights Reserved. Includes oopyrighled maledal of Insurance Servicos Office,Inc.,wilh its permission. CNA CNA PARAMOUNT General Liability Extension Endorsement Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily injury,property damage or personal and advertising injury arising out of the ownership, maintenance or use of such land,provided that the occurrence giving rise to such bodily injury or property damage, or the offense giving rise to such personal and advertising injury, takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. P. Lessor of Premises An owner or lessor of premises leased to the Named Insured,or such owner or lessors real estate manager,but only with respect to liability for bodily injury,property damage or personal and advertising injury arising out of the ownership, maintenance or use of such part of the premises leased to the Named Insured,and provided that the occurrence giving rise to such bodily injury, property damage or the offense giving rise to such personal and advertising injury takes place prior to the termination of such lease. The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by, on behalf of,or for such additional insured. G. Mortgagee,Assignee or Receiver A mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's liability for bodily injury, property damage or personal and advertising injury arising out of the Named Insured's ownership,maintenance,or use of a premises by a Named Insured, The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition operations performed by,on behalf of,or for such additional insured. H. State or Governmental Agency or Subdivision or Political subdivisions—Permits A state or governmental agency or subdivision or political subdivision that has issued a permit or authorization, but only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily injury,property damage or personal and advertising injury arising out of: 1, the following hazards in connection with premises a Named Insured owns, rents, or controls and to which this insurance applies: a. the existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults,street banners,or decorations and similar exposures;or b. the construction,erection,or removal of elevators;or c. the ownership,maintenance or use of any elevators covered by this insurance;or 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury,property damage or personal and advertising injury arising out of operations performed for the state or governmental agency or subdivision or political subdivision;or b. Bodily injury or property damage included within the products-completed operations hazard, With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. I. Trade Show Event Lessor 1, With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer, any person or organization whom the Named Insured is required to include as an additional CNA74879XX(1-15) Page 3 of 13 Ccpyrighr CNA All R�jhts Reserved. Includes copyrighted material of Insurance Services Orrice,Inc.,vAth Its permission. CNA CNA PARAMOUNT General Liability Extension Endorsement insured,but only with respect to such person or organizations liability for bodily injury,property damage or personal and advertising injury caused by: a. the Named Insured's acts or omissions;or b. the acts or omissions of those acting on the Named Insured's behalf, in the performance of the Named Insured's ongoing operations at the trade show event premises during the trade show event. 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. J. Vendor Any person or organization but only with respect to such person or organization's liability for bodily injury or property damage arising out of your products which are distributed or sold in the regular course of such person or organization's business,provided that: 1, The coverage granted by this paragraph does not apply to: a. bodily injury or property damage for which such person or organization is obligated to pay damages by reason of the assumption of liability in a contract or agreement unless such liability exists in the absence of the contract or agreement; b, any express warranty unauthorized by the Named Insured; c. any physical or chemical change in any product made intentionally by such person or organization; d. repackaging,except when unpacked solely for the purpose of inspection, demonstration,testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. any failure to make any inspections,adjustments,tests or servicing that such person or organization has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. demonstration,installation,servicing or repair operations,except such operations performed at the such person or organization's premises in connection with the sale of a product; g. products which,after distribution or sale by the Named Insured,have been labeled or relabeled or used as a container,part or ingredient of any other thing or substance by or for such person or organization;or h, bodily injury or property damage arising out of the sole negligence of such person or organization for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (1) the exceptions contained in Subparagraphs d>or f.above;or (2) such inspections,adjustments,tests or servicing as such person or organization has agreed with the Named Insured to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products, 2. This Paragraph J.does not apply to any insured person or organization,from whom the Named Insured has acquired such products, nor to any ingredient, part or container, entering into, accompanying or containing such products, 3. This Paragraph J.also does not apply: a, to any vendor specifically scheduled as an additional insured by endorsement to this Coverage Part; b. to any of your products for which coverage is excluded by endorsement to this Coverage Part;nor CNA74879XX(1-15) Page 4of13 Copyright CNA All Rghis Roserved. Includes copyrighted material of Insurance Services Office,Inc„Mh its pemdssion, CNA CNA PARAMOUNT General Liability Extension Endorsement C. if bodily injury or property damage included within the products-completed operations hazard is excluded by endorsement to this Coverage Part. K. Other Person Or Organization Any person or organization who is not an additional insured under Paragraphs A. through J. above. Such additional insured is an Insured solely for bodily injury,property damage or personal and advertising injury for which such additional insured is liable because of the Named Insured's acts or omissions. The coverage granted by this paragraph does not apply to any person or organization: 1. for bodily injury, property damage, or personal and advertising injury arising out of the rendering or failure to render any professional service; 2. for bodily injury or property damage included within the products-completed operations hazard;nor 3. who is specifically scheduled as an additional insured on another endorsement to this Coverage Part. 2. ADDITIONAL INSURED-PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE A. The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional insured's own insurance,then this insurance is primary, and the Insurer will not seek contribution from that other insurance. For the purpose of this Provision 2.,the additional insured's own insurance means insurance on which the additional insured is a named insured. B. With respect to persons or organizations that qualify as additional insureds pursuant to paragraph I.K. of this endorsement,the following sentence is added to the paragraph above: Otherwise, and notwithstanding anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess of any other insurance available to such person or organization. 3. BODILY INJURY—EXPANDED DEFINITION Lender DEFINITIONS the definition of bodily Injury is deleted and replaced by the following: Bodily injury means physical injury,sickness or disease sustained by a person, including death, humiliation,shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical injury,sickness or disease. 4. BROAD KNOWLEDGE OF OCCURRENCE!NOTICE OF OCCURRENCE Under CONDITIONS,the condition entitled Duties in The Event of Occurrence,Offense,Claim or Suit is amended to add the following: A. BROAD KNOWLEDGE OF OCCURRENCE The Named Insured must give the insurer or the Insurer's authorized representative notice of an occurrence, offense or claim only when the occurrence,offense or claim is known to a natural person Named Insured,to a partner, executive officer, manager or member of a Named Insured,or to an employee designated by any of the above to give such notice. B. NOTICE OF OCCURRENCE The Named Insured's rights under this Coverage Part will not be prejudiced if the Named Insured fails to give the Insurer notice of an occurrence, offense or claim and that failure is solely due to the Named Insured's reasonable belief that the bodily injury or property damage is not covered under this Coverage Part. However, the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the Named Insured is aware that this insurance may apply to such occurrence,offense or claim. CNA74879XX(1-15) Page 5 of 13 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Orrice,]no,,wish Ns perrerissiow INSURED: LSA Associates,Inc. POLICY#: 6081697225 POLICY PERIOD: 09/30/2020 TO 09/30/2021 AVAIA sCA 23 500D (Ed. 10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT-- BA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE 1. Which are no longer in force;or A. Who Is An Insured 2. Whose limits have been exhausted. The following is added to Section 11, Paragraph B. Bail Bonds and Loss of Earnings A.1.,Who Is An Insured: Section It,Paragraphs A.2.a.(2)and A.2.a.(4)are 1. a. Any incorporated entity of which the revised as follows: Named Insured owns a majority of the cost 1. In a.(2), the limit for the c of bail bonds is Coverage Form;provided that, voting stock on the date of inception of this increased from t 000 to cost ,and b. The insurance afforded by this provision 2. In a.(4), the limit for the loss of earnings is A.I. does not apply to any such entity that increased from$250 to$500 a day. is an "Insured" under any other liability C. Fellow Employee "policy"providing"auto"coverage. Section II,Paragraph 6.5 does not apply. 2. Any organization you newly acquire or form, other than a limited liability company, Such coverage as is afforded by this provision C.is partnership or joint venture, and over which excess over any other collectible insurance. you maintain majority ownership interest. !I. PHYSICAL DAMAGE COVERAGE The insurance afforded by this provision A.2.: A. Towing a. is effective on the acquisition or formation Section III, Paragraph A.2., is revised to include date, and Is afforded only until the end of Light Trucks up to 10,000 pounds G.V.W. the policy period of this Coverage Form,or the next anniversary of its inception date, B. Glass Breakage — Hitting A Bird Or Animal — whichever is earlier. Falling Objects Or Missiles b. Does not apply to: The following Is added to Section III, Paragraph (1) "Bodily Injury"-or "property damage" A.3.: caused by an "accident" that occurred With respect to any covered "auto,"any deductible before you acquired or formed the sho+roil in the Declarations will not apply to glass organization;or brcakage if such glass is repaired, in a manner (2) Any such organization that is an acceptable to us,rather than replaced. "insured" under any other liability C. Transportation Expenses "policy"providing"auto"coverage. Section III, Paragraph A.4.a. is revised, with 3. Any person or organization that you are respeo to transportation expense incurred by you, obligated to provide Insurance where required to provide: by a written contract or agreement is an a. $60 per day,in lieu of$20;subject to insured, but only with respect to legal responsibility for acts or omissions of a person b. $1,800 maximum,in lieu of$600. for whom Liability Coverage is afforded under this policy. D. Loss of Use Expenses 4. An "employee" of yours is an "insured" while Section III, Paragraph A.4.b. is revised, with operating an "auto" hired or rented under a respect to loss of use expenses incurred by you,to contract or agreement in that "employee's" provide: name, with your permission. while performing a. $1,000 maximum,in lieu of$600. duties related to the conduct of your business. E. Personal Property "Policy," as used in this provision A. Who Is An The following is added to Section III, Paragraph Insured, includes those policies that were in force A a on the inception date of this Coverage Form but; SCA 23 500D Copyright,CNA Corporation,2000 Page 1 of 3 (Ed. 10/11) includes copyrighted material of the Insurance Services Office used with its permission SCA 23 500D CNA (Ed. 10/11) c. We will pay up to $500 for loss to Personal to Hired Autos, then Physical Damage Property which is: coverage is extended to: (1) Owned by an"insured";and a. Any covered "auto" you lease, hire, rent or (2) In or on the covered"auto." borrow without a driver;and This coverage applies only in the event of a b. Any covered "auto" hired or rented by your total theft of your covered"auto." "employee" without a driver, under a contract in that individual "employee's" This insurance is excess over any other name, with your permission, while collectible insurance and no deductible applies. performing duties related to the conduct of F. Rental Reimbursement your business. c. The most we will pay for any one"accident" The following is added to Section ill, Paragraph or "loss" is the actual cash value, cost of AA.: repair, cost of replacement or $75,000 d. We will pay for rental reimbursement expenses whichever is less minus a $500 deductible incurred by you for the rental of an "auto" for each covered auto. No deductible because of"loss"to a covered"auto."Payment applies to"loss"caused by fire or lightning. applies in addition to the otherwise applicable amount of each coverage you have on a d. The physical damage coverage as is covered "auto." No deductibles apply to this provided by this provision will be limited to coverage. the types of physical damage coverage(s) 1. We will pay only for those expenses provided on your owned"autos," incurred during the policy period beginning e. Such physical damage coverage for hired 24 hours after the loss" and ending, "autos"will: regardless of the policy's expiration, with the lesser of the following number of days: (1) Include loss of use, provided it is the consequence of an"accident"for which (a) The number of days reasonably the Named Insured is legally liable. and required to repair or replace the as a result of which a monetary loss is covered"auto";or, sustained by the leasing or rental (b) 15 days, concern. 2. Our payment is limited to the lesser of the (2) Such coverage as is provided by this following amounts: provision G.e.(1) will be subject to a (a) Necessary and actual expenses limit of$750 per"accident." incurred;or, H. Airbag Coverage (b) $25 per day subject to a maximum of The following is added to Section III, Paragraph $375. B.3. 3. This coverage does not apply while there The accidental discharge of an airbag shall not be are spare or reserve "autos" available to considered mechanical breakdown. you for your operations. I. Electronic Equipment 4. If "loss" results from the total theft of a Section III, Paragraphs B.4.c and B.4.d. are covered auto" of the private passenger deleted and replaced by the following: type, we will pay under this coverage only that amount of your rental reimbursement c. Physical Damage Coverage on a covered expenses which is not already provided for "auto" also applies to "loss" to any under the Physical Damage Coverage permanently installed electronic equipment Extension, including its antennas and other G. Hired"Autos" accessories d. A $100 per occurrence deductible applies The following is added to Section III. Paragraph to the coverage provided by this provision. A.. 5. Hired"Autos" J. Diminution In Value If Physical Damage coverage is provided under The following is added to Section III, Paragraph B.6. this policy, and such coverage does not extend SCA 23 5000 Copyright,CNA Corporation,2000 Page 2 of 3 (Ed. 10/11) Includes copyrighted material of the Insurance Services Office used with its permission. SCA 23 500D CNA (Ed. 10/11) Subject to the following, the "diminution in value" officer positions created by your charter, exclusion does not apply to: constitution, by-laws or any other similar a. Any covered "auto" of the private governing document, and, while a resident of passenger type you lease, hire, rent or the same household, includes that person's borrow, without a driver for a period of 30 spouse. days or less, while performing duties Such "executive officers" are "insureds" while related to the conduct of your business; using a covered "auto" described in this and provision. b. Any covered "auto" of the private IV. BUSINESS AUTO CONDITIONS passenger type hired or rented by your employee" without a driver for a period of A Duties In The Event Of Accident,Claim, Suit Or 30 days or less, under a contract in that Loss individual "employee's" name, with your The following is added to Section IV, Paragraph permission, while performing duties related A.2,a. to the conduct of your business. (4) Your "employees" may know of an c, Such coverage as is provided by this "accident" or"loss."This will not mean that provision is limited to a "diminution in you have such knowledge, unless such value"loss arising directly out of accidental "accident" or "loss" is known to you or if damage and not as a result of the failure to you are not an individual, to any of your make repairs; faulty or incomplete executive officers or partners or your maintenance or repairs; or the installation insurance manager, of substandard parts, The following is added to Section IV, Paragraph d. The most we will pay for"loss"to a covered A.2.b. "auto"in any one accident is the lesser of: (6) Your"employees" may know of documents (1) $5,000;or received concerning a claim or"suit." This (2) 20% of the "auto's" actual cash value will not mean that you have such (ACV) knowledge, unless receipt of such documents is known to you or if you are not Ill. Drive Other Car Coverage—Executive Officers an individual, to any of your executive The following is added to Sections II and III., officers or partners or your insurance manager. 1. Any "auto" you don't own, hire or borrow is a B. Concealment,Misrepresentation or Fraud covered 'auto" for Liability Coverage while being used by, and for Physical Damage The following is added to Section IV, Paragraph Coverage while in the care, custody or control B.2. of, any of your"executive officers,"except: Your failure to disclose all hazards existing on the a. An "auto" owned by that"executive officer' date of inception of this Coverage Form shall not or a member of that person's household;or prejudice you with respect to the coverage afforded b. An "auto" used by that "executive officer" provided such failure or omission is not intentional. while working in a business of selling, C. Policy Period,Coverage Territory servicing,repairing or parking"autos." Section IV, Paragraphs 7.(5).(a). is revised to Such Liability and/or Physical Damage provide: Coverage as is afforded by this provision will be: a. 45 days of coverage in lieu of 30 days (1) Equal to the greatest of those V. DEFINITIONS coverages afforded any covered"auto"; Section V. Paragraph C. is deleted and replaced and by the following: (2) Excess over any other collectible "Bodily injury" means bodily injury, sickness or insurance. disease sustained by a person, including mental 2. For purposes of this provision, "executive anguish, mental injury or death resulting from any officer" means a person holding any of the of these SCA 23 500D Copyright,CNA Corporation,2000 Page 3 of 3 (Ed- 10111) Includes copyrighted material of the Insurance Services Office used with its permission. INSURED: LSA Associates,Inc. POLICY#: 6081697239 POLICY PERIOD: 09/30/2020 TO 09/30/2021 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) 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. Schedule Where required by written contract signed prior to loss 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 Insurance Company Countersigned by WC 00 03 13 (Ed.4-84) ©1983 National Council on Compensation Insurance. INSURED: LSA Associates,Inc. POLICY#:6081697225 POLICY PERIOD: 09/30/2020 TO 09/30/2021 CNA NOTICEOFCANCE"TION OR DESIGNATED P +r . • ORGANIZATION It is understood and agreed that this endorsement amends the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM In the event of cancellation or material change that reduces or restricts the insurance provided by this Coverage Form, we agree to send prior notice of cancellation or material change to the person or organization scheduled below at the address scheduled below. This endorsement does not amend our obligation to notify the Named Insured of cancellation as described in the Common Policy Conditions or in another endorsement attached to this policy. SCHEDULE 1. Numberof days advance notice: 10 Days if we cancel for non-payment of premium. 30 Days if the policy is cancelled for any other reason, or if coverage is restricted or reduced by endorsement. 2 Person or Organization's Name and Address Name: City of Menifee Attention: Street Address: Attn:Carlos Geronimo City,State, ZIP: 29714 Haun Road e- mail address: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA72315XX(04-2019) Endorsement Effective Date:6/24/2020 Endorsement No: Underwriting Company:Continental Casualty Company © Copyright CNA All Rights Reserved. INSURED: LSA Associates,Inc. POLICY PERIOD: 09/30/2020 POLICY#:6081697256 TO: 09/30/2021 DIVA CNA PARAMOUNT Changes - Notice of Cancellation or Material Restriction Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EMPLOYEE BENEFITS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART STOP GAP LIABILITY COVERAGE PART TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART SPECIAL PROTECTIVE AND HIGHWAY LIABILITY POLICY—NEW YORK DEPARTMENT OF TRANSPORTATION SCHEDULE Number of days notice(other than for nonpayment of premium): 30 Number of days notice for nonpayment of premium: 10 Name of person or organization to whom notice will be sent: City of Menifee Address: Attn: Carlos Geronimo 29714 Haun Road Sun City,CA 92586-0000 If no entry appears above,the number of days notice for nonpayment of premium will be 10 days. It is understood and agreed that in the event of cancellation or any material restrictions in coverage during the policy period, the Insurer also agrees to mail prior written notice of cancellation or material restriction to the person or organization listed in the above Schedule. Such notice will be sent prior to such cancellation in the manner prescribed in the above Schedule. All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy, CNA74702XX(1-15) Policy No: 4012918880 Page 1 of 1 VALLEY FORGE INSURANCE COMPANY Insured Name: ELECTROLURGY MANUFACTURING INC. Copyright CNA All Rights Reserved. INSURED: LSA Associates,Inc. POLICY#: 6081697239 POLICY PERIOD: 09/30/2020 CNA NOTICE OF CANCELLATION OR MATERIAL CHANCE ENDORSEMENT This endorsement modifies insurance provided under the WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY: In the event of cancellation or material change that reduces or restricts coverage during the policy period, we agree to send prior written notice in the manner prescribed, to the person or organization listed in the Schedule. SCHEDULE 1. Number of days advance notice: For nonpayment of premium: 30 For any other reason: 30 2. Name & Address of Person or Organization: City of Menifee Attn:Carlos Geronimo All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective fate) is shown below, and expires concurrently with said policy. Form No: CNA8738OXX(11-2016) Underwriting Company: UWCOMP, UWADDRI UWADDR2, UWCITY, UWSTATE UwzlP © Copyright CNA All Rights Reserved. INSURED: LSA Associates,Inc. POLICY#: 6081697273 POLICY PERIOD: 09/30/2020 TO 09/30/2021 CNA CHANCES-NOTICE OF . ENDORSEMENT This endorsement modifies insurance provided under the following: PARAMOUNT EXCESS AND UMBRELLA LIABILITY POLICY PARAMOUNT UMBRELLA LIABILITY POLICY PARAMOUNT EXCESS LIABILITY POLICY It is understood and agreed as follows: I. In the event of cancellation of this coverage during the policy period for a reason other than nonpayment of premium, the Insurer agrees to mail prior written notice of cancellation to: SCHEDULE Numberof Days Name Address Advanced Notice Cl of Menifee t]' _ _ Attn:Carlos Geronimo � II. If this Endorsement is attached to the PARAMOUNT EXCESS LIABILITY POLICY, then the bolded term "policy period"is deleted in its entirety and replaced with the term "policy period". All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. Form No: CNA75525XX(03-2015) Underwriting Company:UWCOMP,UWADDRI UWADDR2,UWCITY,UWSTATE UWZIP 0 Copyright CNA All Rights Reserved. MARSH & MCLENNAN AGENCY LLC CO 1 POLARIS WAY STE 300 ALISO VIEJO CA 92656-5358 CITY OF MENIFEE ATTN CARLOS GERONIMO 29714 HAUN RD SUN CITY CA 92586-6540 I