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2020/10/05 Von Euw Backhoe, Inc.ACURa' LBURNS DATE (MMIDDIYYYY) 21212a21 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. VONEUWB-01 CERTIFICATE OF LIABILITY INSURANCE 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 Laura Burns NAME: Lea Rodriguez Insurance Agency PHONE FAX 27174 Newport Rd {aac, Nc, Ext)T�951 j 246-4003 212 WC. NO Suite 3 and 4 am lL Laura LeoRodri uezIns.com Menifee, CA 92584 ADr�'REss: 9 -_ INSURER(S) AFFORDING COVERAGE NAIC 0 Icial Pacific Insurance Company 31453 INSURED INSURER a: Travelers Casualty Insurance Co of America 19046 Von Euw Backhoe, Inc. wsuRERc:State Compensation Insurance Fund of California 35076 P.O. Box 693 INSURERD: Winchester, CA 92596 - msuRER E: INSURER F : COVERAGES CSRTIFICATF AI11MRER- RFVIRfCIN NI IMRFR 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._ INSRTYPE OF INSURANCE ADDL;SUBRj POLICY EFF POLICY EXP LTR POLICY NUMBER f LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR �j �� X X EACH OCCURRENCE _ 60437848 10/5/2020 10/5/2021 DAMAGE TO RENTED PREMISES [Ea.cccur[ence) g 1,000,000 $ 100,000 $ 5,000 MED EXP (Any one person) _ $ 1,000,000 I PERSONAL & ADV INJURY ti;�EjiFLAGGREGATVLIMITAPPLIESPER: POLICY X I PP8f L—] LOC $ 2,000,000 GENERAL AGGREGATE PRODUCTS _ GrQN1P/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X IBAON694947 2/21/2021 2/21/2022 - COMSINEDSIHGLIE LIMIT - $ 1,000,000 . [Es_a�fd�LtO _ I BODILY INJURY Perpersc $ BODILY INJURY Per acciden $ pp ALTODS ONLY 1 W M MAGE $ _ UMBRELLA LIAR E,4LH OCCURRENCE $ AGGREGATE �EXESS LIAB CLAIMS -MADE $ ECI RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y N OFFIC,E(iAuIEMBER EXCLUDED? �. 9 an a ory in NH) 11 yyes, describe under DESCRIPTI N OF OPERATIO1vS lelcw NIA X 1863518-21 2/1/2021 2/1/2022 X I PEIRTUf k OTH- - _ E.L EACH ACCIDENT —__ $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ _ 1,000,000 ' E-L- DISEASE - P L1CY LIMIT $ 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Menifee, 29844 Haun Rd Certificate holder is named as additional insured per blanket form CG201OR 12 11. Primary and Non -Contributory and Waiver of Subrogation applies as required per written contract. BA Additional Insured and Waiver of Subrogation applies per blanket form CAT420 0215. WC Waiver of Subrogation applies as required per written contract per blanket form 10217 (Rev. 7-2014). *30 Days notice of cancellation applies to all liability; 10 days notice for non-payment of premium. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of MenifeeTHE EXPIRATION DATE THEREOF, ACCORDANCE WITH THE POLICY PROVISIONS. WILL 29844 Haun Road Menifee, CA 92586 — AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. The ACORD name and logo are registered marks of ACORD BE DELIVERED IN All rights reserved. POLICY NUMBER; 60437848 CG 20 10R 1211 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ rr CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAM OF P R30N--Qa QR_GAN1Z& N Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract, the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then ro coverage applies. WHQ 6 AN INSURED: (Section II) This section is amended to include as an insured the person or organization within the scope of the qualifying language above, but only to the extent that the person or organization is held liable for your acts or omissions In the course of "your work " for that person or organization by or for you. The "products - completed operations hazard" portion of the policy coverage as respects the additional insured does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments) . This clause does not affect the "products - completed operations" coverage provided to the named insured(s,) WALVEROF.SUBROGAT.ION:. We waive any right of recovery, when required by written contract, that we may have against the person or organization within the scope of the qualifying language above because of payments we make for injury. The job location must be within the State of domicile of the named insured, or within any contiguous State thereto. DESB,RIPTI.ON-OF-WORK:, The type of work performed must be that as described under classifications h the CGL Coverage Part Declarations, Water Mains Repair and Installation PRIMARY.CLAUSE:, When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. ExcLusinN This insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's , engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2 Supervisory, inspection, architectural or engineering activities. EFFECTIVE DATE: 10/5/2020 EXPIRATION DATE: 10/5/2021 CG 20 IOR 12 11 Page 1 of I Includes copyrighted material of Insurance Services Office, Ina, with its permission .r POLICY NUMBER: BAON694947 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION CIF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described "n any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing -is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A B. C D E F. G A B. BLANKET ADDITIONAL INSURED EMPLOYEE HIRED AUTO EMPLOYEES AS INSURED SUPPLEMENTARY PAYMENTS - INCREASED LIMITS TRAILERS - INCREASED LOAD CAPACITY HIRED AUTO PHYSICAL DAMAGE PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT BLANKET ADDITIONAL INSURED The following is added to Paragraph Al., Who Is An Insured, of SECTION II - COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II, EMPLOYEE HIRED AUTO 1. The following is added to Paragraph Al., Who Is An Insured, of SECTION II - COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - INCREASED LIMIT I WAIVER OF DEDUCTIBLE - GLASS J. PERSONALPROPERTY K AIRBAGS L AUTO LOAN LEASE GAP M BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b, in B.S., Other Insurance, of SECTION IV - BUSI- NESS AUTO CONDITIONS: b, For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own; (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C EMPLOYEES ASINSURED The following is added to Paragraph Al., Who Is An Insured, of SECTION II - COVERED AUTOS LIABILITY COVERAGE: CA T4 23 C12 15 © 2015 The TIavdlers Indemnity Company. Al rights reserved. Page 1 of 3 Includes copyrighted malarial of Insurance Services Office, Inc, with Its permission. COMMERCIAL AUTO C E F Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS t The following 1•eplaces Paragraph A.2.a.(2) of SECTION 11- COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2 The following replaces Paragraph A.2.a.(4) of SECTION I - COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. TRAILERS - INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I - COVERED AUTOS: 1 "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph AA., Cover- age Extensions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of; (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss" or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" t11at is hired, rented or bor- rowed from your "employee G PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT The following replaces the first sentence n Para- graph A.4.a., Transportation Expenses, of SECTION III - PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - INCREASED LIMIT Paragraph C.1.b. of SECTION III - PHYSICAL DAMAGE COVERAGE is deleted. I WAIVER OF DEDUCTIBLE - GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III - PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. I PERSONAL PROPERTY The following 's added to Paragraph A4., Cover- age Extensions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and (2) In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. Page 2 of 3 © 2015 The Travelers Indemnity Company. All rights reserved. CA T4 20 02 15 Includes copyrighted material of Insurance Services Office, Inc. with [is permission. K AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Exclusion 3.a, does not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.l.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss". L AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total 'loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage I. provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the 'loss' (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor, (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (a) Carry-over balances from previous loans or leases. M BLANKET WAIVER CF SUBROGATION The following replaces Paragraph A.5. Transfer Of Rights Of Recovery Against others To Us, of SECTION IV - BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Ls We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or 'loss", pro- vided that the "accident' or "loss" arises out of the operations contemplated by such col1- tract. The waiver applies only to the person or organization designated In such contract. CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved, Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 1, 2021 AT 12.01 A.M. ALLEFFECTIVE DATESARE AND EXPIRING FEBRUARY 1, 2022 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME VON EUW BACKHOE, INC. PO BOX 693 WINCHESTER, CA 92596 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 ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 1863518-21 RENEWAL SP 7-13-88-06 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 SA�NFRFRANCISCO: FEBRUARY 3, 2021 AUTHORIZED REPRESENT /IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) 2572 OLD OF 217