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2023/01/14 SouthStar Engineering and Consulting, Inc.ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: 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 1/17/2023 11000 SouthStar Engineering & Consulting, Inc. 1945 Chicago Avenue Suite C-2 Riverside, CA 92507 38342 27847 A1122J A 1,000,000 72SBABE7952 1/14/2023 1/14/2024 1,000,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000B BA040000063415 11/17/2022 11/17/2023 5,000,000A 72SBABE7952 1/14/2023 1/14/2024 5,000,000 C WSD 5064219 01 2/9/2023 2/9/2024 1,000,000 1,000,000 1,000,000 D E&O/Professional Lia PF00048A22 12/1/2022 Ded $75,000 3,000,000 Project #: CIP 13-03 Holland Road Overpass Project Excess Liability policy is follow form to underlying General Liability, Business Auto and Worker's Compensation policies. City of Menifee 29844 Haun Road Sun City, CA 92586 SOUTENG-05 MICHELLELYON NFP Property & Casualty Services, Inc. 1551 North Tustin Avenue Suite 500 Santa Ana, CA 92705 Suzanne Okafor suzanne.okafor@nfp.com Sentinel Insurance Company Ltd California Automobile Insurance Company Insurance Company of the West Lloyds of London X 12/1/2023 X X X X X X X X DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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% of the total California Workers’ Compensation premium otherwise due. Schedule Person or Organization Job Description Policy Number: WSD 5064219 01 Insured: SouthStar Engineering & Consulting Inc. Endorsement Effective: 2/09/2023 Coverage Provided by: Insurance Company of the West Issue Date: 1/13/2023 Countersigned by: WC 99 06 34 (Ed. 8-00) Any person or organization when required by written contract. All California operations DocuSign Envelope ID: 80164A45-E8B8-4403-8628-950ADF7D3168