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2022/03/01 Roadway Engineering and Construction Corp (3)ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION$ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/28/2022 License # 0C36861 (909) 886-9861 (909) 886-2013 22322 Roadway Engineering & Construction Corp 3121 Indian Ave. Perris, CA 92571-3208 37885 16045 A 1,000,000 X NPC100450901 3/1/2022 3/1/2023 100,000 $5,000 PD ded/Occ 5,000 1,000,000 2,000,000 2,000,000 EBL AGGREGATE 1,000,000 1,000,000B X NBA-1004510-01 3/1/2022 3/1/2023 $1,000 Comp Ded $1,000 Coll Ded 5,000,000A NEC-6006403-01 3/1/2022 3/1/2023 5,000,000 0 C 7600017355221 3/1/2022 3/1/2023 1,000,000 N 1,000,000 1,000,000 Re: 1214 – Evans Park Pump Track Expansion, CIP 17-01 City of Menifee, its officers, agents and employees are additional insureds as respects to general liability per endorsements attached; additional insureds as respects to auto liability per endorsements attached. City of Menifee 29844 Haun Road Menifee, CA 92586 ROADENG-01 MAXU Inland Empire-Alliant Insurance Services, Inc. 685 E. Carnegie Dr Ste 265 San Bernardino, CA 92408 Christina M Mountz cmountz@alliant.com Greenwich Insurance Company XL Specialty Insurance Company Everest Premier Insurance Company Over GL/AL/EL X X X X X X X X X X X X X DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 1 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. " " ! ! This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM COVERAGE DESCRIPTION '.103#3:6$45+565' 650*:4+%#-#.#)' *04 //463'& 30#&03./463'& .1-0:''4 4/463'&4 &&+5+0/#-/463'&:0/53#%5 )3''.'/503'3.+5 .1-0:''+3'& 6504 611-'.'/5#3:#:.'/54 .'/&'&'--08.1-0:''9%-64+0/ *:4+%#-#.#)'07'3#)' '/5#-'+.$634'.'/5 953#91'/4'<30#&'/'&07'3#)' '340/#-(('%5407'3#)' '#4'#1 -#44'1#+3< #+7'3('&6%5+$-' *:4+%#-#.#)'07'3#)'95'/4+0/4 &&+5+0/#-3#/41035#5+0/91'/4' +3'& 650*:4+%#-#.#)' 64+/'44 6500/&+5+0/4 05+%'(%%633'/%' #+7'3(6$30)#5+0/ /+/5'/5+0/#-#+-63'0+4%-04'#;#3&4 3+.#3:/463#/%' 0&+-:/,63:'&'(+/'& 95'/&'&#/%'--#5+0/0/&+5+0/ POLICY NUMBER: NBA-1004510-01 XIC 421 1013 DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 2 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. '.103#3:6$45+565' 650*:4+%#-#.#)' < ,'35#+/3#+-'340$+-'26+1.'/5 /&'.103#3:6$45+565' 6504 is changed by adding the following: If Physical Damage coverage is provided by this Coverage Form, the following types of vehicles are also covered “autos” for Physical Damage coverage: Any “auto” you do not own while used with the permission of its owner as a temporary substitute for a covered “auto” you own that is out of service because of its: # Breakdown; $ Repair; % Servicing; & “Loss”; or ' Destruction. *04 //463'& < " 07'3#)' *0 4 / /463'& is changed by adding the following: 30#&03./463'& For any covered “auto”, any subsidiary, affiliate or organization, other than a partnership or joint venture, as may now exist or hereafter be constituted over which you assume active management or maintain ownership or majority interest, provided that you notify us within ninety (90) days from the date that any such subsidiary or affiliate is acquired or formed and that there is no similar insurance available to that organization. However, coverage does not apply to “bodily injury” or “property damage” that occurred before you acquired or formed the organization. .1-0:''4 4/463'&4 Any “employee” of yours is an “insured” while using a covered “auto” you don’t own, hire or borrow, in your business or your personal affairs. &&+5+0/#-/463'&:0/53#%5 )3''.'/53'3.+5 Any person or organization with whom you have agreed in writing in a contract, agreement or permit, to provide insurance such as is provided under this policy, provided that the “bodily injury” or “property damage” occurs subsequent to the execution of the written contract, agreement or permit. .1-0:''+3'& 6504 An “employee” of yours is an “insured” while operating an “auto” hired or rented under a contract or agreement in that “employee’s” name, with your permission, while performing duties related to the conduct of your business. DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 3 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. < '/'3#-0/&+5+0/45*'3/463#/%'$ is replaced with the following: $For Hired Auto Physical Damage Coverage, the following are deemed to be covered “autos” you own: Any covered “auto” you lease, hire, rent or borrow; and Any covered “auto” hired or rented by your “employee” under a contract in that individual “employee’s” name, with your permission, while performing duties related to the conduct of your business. However, any “auto” that is leased, hired, rented or borrowed with a driver is not a covered “auto”. 611-'.'/5#3:#:.'/54 < " 07'3#)'07'3#)'95'/4+0/4# 611-'.'/5#3:#:.'/54 is changed as follows: Item is deleted and replaced by the following: Up to $3,500 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. Item is deleted and replaced by the following: All reasonable expenses incurred by the “insured” at our request, including actual loss of earnings up to $500 a day because of time off from work. .'/&'&'--08.1-0:''9%-64+0/ < " 9%-64+0/4'--08.1-0:'' does not apply. The insurance provided under this Provision is excess over any other collectible insurance. *:4+%#-#.#)'07'3#)' <" 07'3#)'is changed by adding the following: '/5#-'+.$634'.'/5 # We will pay for rental reimbursement expenses incurred by you for the rental of an “auto” because of “loss” to a covered “auto”. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered “auto”. No deductibles apply to this coverage. $ We will pay only for those expenses incurred during the policy period beginning twenty-four (24) hours after the “loss” and ending, regardless of the policy’s expiration, with the lesser of the following number of days: DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 4 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. The number of days reasonably required to repair or replace the covered “auto”. If “loss” is caused by theft, this number of days is added to the number of days it takes to locate the covered “auto” and return it to you. Thirty (30) days. % Our payment is limited to the lesser of the following amounts: Necessary and actual expenses incurred. $50 any one day per private passenger “auto”; $100 any one day per truck; $1,500 any one period per private passenger “auto”; $3,000 any one period per truck; or Higher limits if shown elsewhere in this policy. & This coverage does not apply while there are spare or reserve “autos” available to you for your operations. ' If “loss” results from the total theft of a covered “auto” of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided for under the Physical Damage Coverage Extension. 953#91'/4'<30#&'/'&07'3#)' We will pay for the expense of returning a stolen covered “auto” to you. '340/#-(('%5407'3#)' If you have purchased Comprehensive Coverage on this policy for an “auto” you own and that “auto” is stolen, we will pay, without application of a deductible, up to $500 for “personal effects” stolen from the “auto”. As used in this endorsement, “personal effects” means tangible property that is worn or carried by an “insured”. “Personal effects” does not include tools, jewelry, money or securities. '#4'#1 In the event of a total “loss” to a covered “auto” shown in the Declarations, we will pay any unpaid amount due on the lease or loan for a covered “auto”, less: # The amount paid under the Physical Damage Coverage Section of the policy; and $ Any: Overdue lease/loan payments at the time of the “loss”; Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; Security deposits not returned by the lessor; Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchases with the loan or lease; and Carry-over balances from previous loans or leases. DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 5 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. -#44'1#+3< #+7'3('&6%5+$-' No deductible applies to glass damage if the glass is repaired rather than replaced. *:4+%#-#.#)'07'3#)'95'/4+0/4 <" 07'3#)' 07'3#)'95'/4+0/4 is amended by the following: &&+5+0/#-3#/41035#5+0/91'/4' '%5+0/4 #and$ are amended to provide a limit of $50 per day and a maximum limit of $1,000. +3'& 650*:4+%#-#.#)' The following section is added: Any “auto” you lease, hire, rent or borrow is deemed to be a covered “auto” for physical damage coverage. The most we will pay for each covered “auto” is the lesser of: the actual cash value; the cost for repair or replacement; or $50,000, or higher limit if shown on the Declarations for Hired Auto Physical Damage Coverage. For each covered “auto” a deductible of $100 for Comprehensive Coverage and $1,000 for Collision Coverage will apply. 64+/'44 6500/&+5+0/4 < 0440/&+5+0/4 is changed by the following: 05+%'(%%633'/%' '%5+0/<65+'4/*'7'/5( %%+&'/5-#+.6+53044# is changed by adding the following: If you report an injury to an “employee” to your workers’ compensation carrier and if it is subsequently determined that the injury is one to which this insurance may apply, any failure to comply with this condition will be waived if you provide us with the required notice as soon thereafter as practicable after you know or reasonably should have known that this insurance may apply. #+7'3(6$30)#5+0/ '%5+0/3#/4('3(+)*54('%07'3: )#+/455*'3404 is changed by adding the following: However, this Condition does not apply to any person(s) or organization(s) with whom you have a written contract, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under such contract with that person or organization. DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 XIC 421 1013 © 2013 X.L. America, Inc. All Rights Reserved. Page 6 of 6 May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. < '/'3#-0/&+5+0/4 is changed by the following: /+/5'/5+0/#-#+-63'0+4%-04'#;#3&4 The following condition is added: Your unintentional failure to disclose all hazards as of the inception date of the policy shall not prejudice any insured with respect to the coverage afforded by this policy. 3+.#3:/463#/%' 0/&+5+0/5*'3/463#/%' is changed by adding the following: For any covered “auto” this insurance shall apply as primary and not contribute with any other insurance where such requirement is agreed in a written contract executed prior to a “loss”. 0&+-:/,63:'&'(+/'& < “Bodily injury” is replaced by the following: “Bodily injury” means bodily injury, sickness or disease sustained by a person including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. 95'/&'&#/%'--#5+0/0/&+5+0/ "03. #/%'--#5+0/$ is replaced by the following: The greater of sixty (60) days or the time required by any applicable state amendatory endorsement before the effective date of cancellation if we cancel for any other reason. All other terms and conditions of this policy remain unchanged. DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 POLICY NUMBER: © Insurance Services Office, Inc., 2018 Page of CG 20 10 12 19 ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 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. Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Name Of Additional Insured Person(s) Or Organization(s) Blanket as required by written contract Blanket as required by written contract 12 NPC100450901 DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 © Insurance Services Office, Inc., 2018 CG 20 10 12 19Page of 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. 22 DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY CG 20 37 12 19 POLICY NUMBER: © Insurance Services Office, Inc., 2018 Page ofCG 20 37 12 19 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 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 theseadditional 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Name Of Additional Insured Person(s) Or Organization(s) Blanket as required by written contract Blanket as required by written contract 11 NPC100450901 DocuSign Envelope ID: 4A324842-EACE-473B-9D1A-526797BD4BD8