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2022/01/01 RSG, Inc.10/06/2022 The Empire Company 550 North Park Center Drive Suite 205 Santa Ana CA 92705 Erica Hornaday ehornaday@empire-co.com RSG, Inc. 17872 Gillette Ave., Suite 350 Irvine CA 92614 Sentinel Insurance Company, LTD 11000 Trumbull Insurance Company 27120 Argonaut Insurance Company 19801 2022/2023 2nd Updt Master A 72SBAAQ7019 01/01/2022 01/01/2023 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A 72SBAAQ7019 01/01/2022 01/01/2023 1,000,000 A 10,000 72SBAAQ7019 01/01/2022 01/01/2023 2,000,000 2,000,000 B Y 72WECVK8727 01/01/2022 01/01/2023 1,000,000 1,000,000 1,000,000 C Errors & Omissions Cliams Made 121MPL0167514-02 03/01/2022 03/01/2023 AGGREGATE LIMIT $4,000,000 EACH CLAIM $2,000,000 DEDUCTIBLE $10,000 City of Menifee 29844 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. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE RSG, Inc. 00017900 The Empire Company 25 Certificate of Liability Insurance: Notes Certificate Holder continued: The City of Menifee, its council members, officers, agents, employees and authorized volunteers ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE Ø ˝ ˇØ ææ ææ ˝ ˚˛ ˛ ˝ ˚˛ ˛ —˙ ¸˛ ˝ ˛˝ ˝ —˙ —˝ ˛ ˛¸˙ –ﬁ‡ ˝˝ Ø Œ —ﬁ–‰»›› ¿‹» —¿„» –” —–·•‰§ ¤•ﬁ¿‹•–† ¿‹» w ‚» ¿ﬁ‹”–ﬁ… ł†‰·«…»› ‰–§ﬁ•„‚‹»… ‡¿‹»ﬁ•¿· –” †›«ﬁ¿†‰» ˝»ﬁ“•‰»› ””•‰» †‰ '•‹‚ •‹› »ﬁ‡•››•–† ˝¸˛ ˛˝ ˝˝˝ ˛ ˛˛˝ ˝¸ —˛˝ ˛ ˛˘ ‚•› »†…–ﬁ›»‡»†‹ ‡–…•”•»› •†›«ﬁ¿†‰» ﬁ–“•…»… «†…»ﬁ ‹‚» ”–··–'•†„ ¸˝˝˝ ˙ ˚˛ ˛ ˝¸ ¿‡» ” ……•‹•–†¿· †›«ﬁ»… —»ﬁ›–†ł› ﬁ ﬁ„¿†•ƒ¿‹•–†ł› –‰¿‹•–†ł› ” –“»ﬁ»… »ﬁ¿‹•–†› †”–ﬁ‡¿‹•–† ﬁ»ﬂ«•ﬁ»… ‹– ‰–‡·»‹» ‹‚•› ˝‰‚»…«·» •” †–‹ ›‚–'† ¿–“» '•·· » ›‚–'† •† ‹‚» »‰·¿ﬁ¿‹•–†› ßò Í»½¬·±²Ýò É¸±×ß²×²«®»¼•› ¿‡»†…»… ‹– •†‰·«…» ¿› ¿† ¿……•‹•–†¿· •†›«ﬁ»… ‹‚» »ﬁ›–†ł› –ﬁ –ﬁ„¿†•ƒ¿‹•–†ł› ›‚–'† •† ‹‚» ˝‰‚»…«·» «‹ –†·§ '•‹‚ ﬁ»›»‰‹ ‹– ·•¿•·•‹§ ”–ﬁ –…•·§ •†¶«ﬁ§ ﬁ–»ﬁ‹§ …¿‡¿„» –ﬁ »ﬁ›–†¿· ¿†… ¿…“»ﬁ‹•›•†„ •†¶«ﬁ§ ‰¿«›»… •† '‚–·» –ﬁ •† ¿ﬁ‹ § ˙–«ﬁ ¿‰‹› –ﬁ –‡•››•–†› –ﬁ ‚» ¿‰‹› –ﬁ –‡•››•–†› –” ‹‚–›» ¿‰‹•†„ –† §–«ﬁ »‚¿·” •† ‹‚» »ﬁ”–ﬁ‡¿†‰» –” §–«ﬁ –†„–•†„ –»ﬁ¿‹•–†› ”–ﬁ ‹‚» ¿……•‹•–†¿· •†›«ﬁ»…ł› ¿‹ ‹‚» ·–‰¿‹•–†ł› …»›•„†¿‹»… ¿–“» •‹‚ ﬁ»›»‰‹ ‹– ‹‚» •†›«ﬁ¿†‰» ¿””–ﬁ…»… ‹– ‹‚»›» ¿……•‹•–†¿· •†›«ﬁ»…› ‹‚» ”–··–'•†„ ¿……•‹•–†¿· »¤‰·«›•–†› ¿·§ ‚•› •†›«ﬁ¿†‰» …–»› †–‹ ¿·§ ‹– –…•·§ •†¶«ﬁ§ –ﬁ ﬁ–»ﬁ‹§ …¿‡¿„» –‰‰«ﬁﬁ•†„ ¿”‹»ﬁ ·· '–ﬁ •†‰·«…•†„ ‡¿‹»ﬁ•¿·› ¿ﬁ‹› –ﬁ »ﬂ«•‡»†‹ ”«ﬁ†•›‚»… •† ‰–††»‰‹•–† '•‹‚ ›«‰‚ '–ﬁ –† ‹‚» ﬁ–¶»‰‹ ł–‹‚»ﬁ ‹‚¿† ›»ﬁ“•‰» ‡¿•†‹»†¿†‰» –ﬁ ﬁ»¿•ﬁ› ‹– » »ﬁ”–ﬁ‡»… § –ﬁ –† »‚¿·” –” ‹‚» ¿……•‹•–†¿· •†›«ﬁ»…ł› ¿‹ ‹‚» ·–‰¿‹•–† –” ‹‚» ‰–“»ﬁ»… –»ﬁ¿‹•–†› ‚¿› »»† ‰–‡·»‹»… –ﬁ ‚¿‹ –ﬁ‹•–† –” §–«ﬁ '–ﬁ –«‹ –” '‚•‰‚ ‹‚» •†¶«ﬁ§ –ﬁ …¿‡¿„» ¿ﬁ•›»› ‚¿› »»† «‹ ‹– •‹› •†‹»†…»… «›» § ¿†§ »ﬁ›–† –ﬁ –ﬁ„¿†•ƒ¿‹•–† –‹‚»ﬁ ‹‚¿† ¿†–‹‚»ﬁ ‰–†‹ﬁ¿‰‹–ﬁ –ﬁ ›«‰–†‹ﬁ¿‰‹–ﬁ »†„¿„»… •† »ﬁ”–ﬁ‡•†„ –»ﬁ¿‹•–†› ”–ﬁ ¿ ﬁ•†‰•¿· ¿› ¿ ¿ﬁ‹ –” ‹‚» ›¿‡» ﬁ–¶»‰‹ DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date:11/22/21 Policy Expiration Date:01/01/23 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number:72 WEC VK8727 Endorsement Number: Effective Date:01/01/22 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address:RSG, INC. 17872 GILLETTE AVE STE 350 IRVINE CA 92614 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 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us DocuSign Envelope ID: 17F07D35-E577-4B2F-86D2-39ABE9B261FE