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Home My WebLink AboutLD23-0278Permit Number: LD23-0278 LD - Utilities/ Access to Utility Agency Facilities Issued: 05/08/2023 Expired: 05/28/2024 Job Address: 41463 Margarita Rd Legal Description: City of Temecula - Land Development Division 41000 Main Street - Temecula, CA 92590 Mailing Address: P.O. Box 9033 Temecula, CA 92589-9033 Phone: (951) 308-6395 Fax: (951) 694-6475 Jayson Pratt 120 N Andreasen Dr Escondido, CA 92029 Applicant: Underground Solutions Inc 120 N Andreason Dr Escondido, CA 92029 Contractor: Utility Work Order Number: D2151 Description: POT HOLING - RCWD D2151 WORK HOURS SHALL BE SUNDAY – THURSDAY, NO HOLIDAYS, 9:00pm – 5:00am Location: Promenade Way W/S and intersection at Overland Dr Proposed work: Pothole to locate utilities as shown on plans "PRELIMINARY WELL No.240 DISCHARGE PIPELINE REPAIRS/RELOCATION (PROJECT No. D2151), LD23-0278" Traffic Control shall be in accordance with approved Traffic Control Plan LD23-0278. Safe pedestrian/bicycle traffic and driveway access shall be maintained at all times. Concrete repair shall be in accordance with City Standards and the Greenbook. Trench repair shall be in accordance with City Standard Drawing 407. Final compaction test results shall be provided by a soils engineer. All disturbed landscaping and other improvements shall be removed or repaired and replaced to the satisfaction of Public Works Inspector. Permittee shall contact LDInspections@temeculaca.gov a minimum of two (2) business days prior to any work. Permittee must also request a final inspection, via LDInspections@temeculaca.gov, to verify completion of project. Page 1 of 2 Permit Number: LD23-0278 LD - Utilities/ Access to Utility Agency Facilities Permittee Responsibilities This Permittee agrees to indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. Trench repair shall be pursuant to City of Temecula Standard Drawing No. 407. 3.Traffic control devices shall be utilized to protect and control pedestrian and vehicular traffic in the construction area in accordance with the latest revision of the “Manual of Uniform Traffic Control Devices for Streets and Highways” (MUTCD). The contractor shall submit a specific traffic control plan for review and approval by the City in accordance with City “Traffic Control Plan Guidelines” for all work within Major Circulation Element streets. 2.BEFORE YOU DIG - CALL (TOLL FREE) 800-422-4133 A pre-construction meeting is required two (2) business days prior to any scheduled work. Permittee shall contact LDInspections@TemeculaCA.gov to schedule a meeting. 1. 4. Water Quality: Contractor shall remain in compliance with the City Water Pollution Control Ordinance. Contractor is required to provide protection of the City storm drain system. 5. Work hours shall be limited between 7:30 AM and 4:30 PM, Monday through Friday, unless otherwise noted. No work shall be allowed during City-recognized holidays." 6. THIS PERMIT IS ISSUED AND ACCEPTED SUBJECT TO THE FOLLOWING CONDITIONS AND ANY ATTACHED PROVISIONS: All U.S.A. mark outs shall be removed prior to completion of project.7. 8.All contractors and subcontractors shall have a valid City of Temecula business license and valid Certificate of Liability prior to start of work. 9.Should there be any claim against the City and the property owner with the encroachment being the proximate cause, the property owner shall be notified in writing to remove the encroachment within 30 days or the City will remove and bill the owner. 10.Permission is hereby requested to encroach into public right of way to perform work as set forth above. It is understood that this permit is limited to the work described herein and that all work is to be done in compliance with the provisions attached to this permit and with all other applicable rules. Permittee shall be responsible for said compliance, for acceptability of the work, for repair or replacement thereof if defective, and for repair or replacement of any existing improvement damaged by the doing of the work I hereby certify and agree on behalf of the Permittee that all laws, regulations and ordinances of the City of Temecula and the State of California and the terms and conditions of the Permit shall be complied with whether herein stated or not. 11. 12.I hereby warrant and represent to the City that I am authorized to execute this Permit Application on behalf of the Permittee and bind the Permittee to the agreements contained herein and any conditions of the Permit. ******Contractor and all subcontractors shall be present at the pre-construction meeting; otherwise, the meeting will be rescheduled to a later date****** Any work commencing within the City right-of-way before permit issuance or a pre-construction meeting shall be subject to a 72-Hour suspension of said work and an assessment of double permit fees.13. Permitee Date City Engineer or Authorized Representative Date 05/08/2023 Page 2 of 2 Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 1 of 2 Revised: 06/16/2020 APPLICATION INFORMATION PERMIT NO.: Type of Encroachment:  Street/Storm Drain  Sewer/Water  Utility Trenching  Signing & Striping  Traffic Signal  Miscellaneous (SPECIFY BELOW) The undersigned hereby applies to excavate, construct and otherwise encroach on City street right-of-way, as follows: Name(s) of street(s) and/or street address: Utility Work Order #: Start Date: End Date: In consideration of granting this application, all applicants including utility companies hereby agree to: 1. If applicable, submit a set of Construction Drawings, Traffic Control Plans, proof of City Business License for all parties involved, proof of Contractor’s License along with this application at the time of submittal. See the Traffic Control Plan Checklist for details. 2. Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application. (See below for specific liability insurance requirements.) 3. Remove/relocate any encroachment installed/maintained under this permit, upon written notice from the City Engineer. 4. Notify the Land Development Inspection Division via email at LDInspections@temeculaca.gov at least two (2) working days prior to commencing construction. Hold a pre-construction meeting prior to the start of construction. The developer/general contractor must be present for the timely request of inspections. 5. Comply with the Standard Specifications, most current Improvement Standard Drawings for Public Works Construction, City of Temecula Municipal Code Chapters 13.04 and 18.12, terms and conditions of the permit and all applicable rules and regulations for the City of Temecula and other public agencies having jurisdiction. LIABILITY INSURANCE REQUIREMENTS PROVIDE PROOF OF INSURANCE COVERAGE MEETING THE REQURIEMENTS STATED BELOW OR A CITY ATTORNEY APPROVED EQUIVALENT WITH THE CITY NAMED AS ADDITIONAL INSURED. IN THE EVENT THAT THE INSURANCE IS PROVIDED BY THE CONTRACTOR, THE CITY AND THE OWNER/DEVELOPER MUST BE NAMED AS ADDITIONAL INSURED. THIS REQUREMENT SHALL BE MET BY EITHER THE APPLICANT (DEVELOPER, OWNER, PUBLIC UTILITY AGENCY OR FRANCHISE) OR BY THE CONTRACTOR PERFORMING THE SUBJECT WORK, PRIOR TO BEGININNG ANY WORK PROPOSED UNDER THE SUBJECT ENCROACHMENT PERMIT. x TO CONDUCT EXPLORATORY UTILITY POTHOLING TO VERIFY DEPTH AND LOCATION ONLY. THIS IS A RCWD WELL No.240 DISCHARGE PIPELINE REPAIRS/ RELOCATION PROJECT NO. D2151 PROMENADE WAY & OVERLAND AVE 2/6/23 2/10/23 LD23-0278 CLEARED BY CITY OF TEMECULA PUBLIC WORKS tricia.ortega 02/02/2023 02/02/2023 02/02/2023 02/02/20 Land Development Encroachment Permit 41000 Main Street Temecula, Ca 92590 Phone: 951-694-6444 www.temeculaca.gov R:\LAND DEVELOPMENT DIVISION\Forms\Permit Applications\Word\Encroachment Permit App.docx Page 2 of 2 Revised: 06/16/2020 Proof of coverage shall be by certificate (Accord or equivalent) naming the City of Temecula as certificate holder and the minimum limits of insurance coverage shall be as follows: a. General Liability: One million dollars ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate lim it shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. b. Automobile Liability: One million dollars ($1,000,000) per accident for bodily injury and property damage. c. Worker’s Compensation as required by the State of California; Employer’s Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. d. Course of Construction: Completed value of the project. There is a limited exception to this requirement. Owners of single family homes doing work on the home’s driveway approac h located in the public right-of-way, may use their homeowners insurance with public liability and property damage coverage in at least the following minimum limits and which will name the City of Temecula as an additional insured for the duration of the encroachment permit: BODILY INJURY $250,000.00 EACH PERSON $500,000.00 EACH OCCURANCE $500,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS PROPERTY DAMAGE $100,000.00 EACH OCCURANCE $250,000.00 AGGREGATE PRODUCTS AND COMPLETED OPERATIONS A combined single limit homeowner’s policy with aggregate limits in the amount of $1,000,000.00 will be considered equivalent to the required minimum limits. Homeowners: a copy of the required homeowners insurance and a Certificate of Insurance showing the City named as an additional insured shall be attached to the application. The undersigned applicant and/or contractor states that they have read and agrees to meet all the conditions on this application, including provisions of required liability insurance or a City Attorney approved equivalent, and acknowledges that this application will be made a part of the encroachment permit. APPLICANT’S INFORMATION (THIS SECTION MUST BE COMPLETED) Company Name: Mailing Address: Contact: Phone #: E-mail: I hereby warrant and represent to the City that I am authorized to execute this permit application on behalf of the permittee and bind the permittee to the agreements contained herein and any conditions of the permit. Authorized Signature: Date Applied: CONTRACTOR’S INFORMATION Company Name: Mailing Address: Contact: Phone #: 24-HR Emergency #: State Contractor’s License #: Class: City Business License #: UNDERGROUND SOLUTIONS INC. 120 N. ANDREASEN DR ESCONDIDO CA 92029 JAYSON PRATT 760-703-1153 JAYSON@USIPOTHOLE.COM 1/10/23 JAYSONPRATT UNDERGROUND SOLUTIONS INC. 120 N. ANDREASEN DR ESCONDIDO CA 92029 JAYSON PRATT 760-703-1153 760-703-1153 826001 A 031862 01/10/2023 Michael Ehrenfeld Company Insurance Agents An Acrisure Agency CA 0K07568 2655 Camino Del Rio North #200 San Diego CA 92108 Hope Zamichieli (619) 814-3046 (619) 683-9999 hopez@ehrenfeldinsurance.com Underground Solutions, Inc. 120 N. Andreasen Drive Escondido CA 92029 Crum & Forster Specialty Insurance Company 44520 Nationwide Mutual Insurance Co 23787 State Compensation Ins Fund of CA 35076 22-23 LIABILITY All Lines A DEDUCTIBLE: $5,000 Y Y EPK140664 08/11/2022 08/11/2023 5,000,000 50,000 5,000 5,000,000 5,000,000 5,000,000 POLLUTION LIABILITY 1,000,000 B Y Y ACP3100201204 08/11/2022 08/11/2023 1,000,000 Comp/Coll Deductibles 2,000 A 0 EFX120876 08/11/2022 08/11/2023 5,000,000 5,000,000 C Y Y 9109008-22 08/11/2022 08/11/2023 1,000,000 1,000,000 1,000,000 A ERRORS & OMISSIONS LIABIILITY EPK140664 08/11/2022 08/11/2023 EACH WRONGFUL ACT $5,000,000 EACH CLAIM DED:$5,000 [Job #: Job Type: ROW/Traffic Control/Encroachment Permit] Certificate Holder is afforded Additional Insured, Primary Non-contributory and Waiver of Subrogation where required by written contract per attached Endorsements. Excess Liability extends coverage of General Liability, Pollution Liability, Professional Liability, Automobile Liability, and Employer's Liability only. Should any of the above coverage be provided by an OCIP/Wrap insurance program, the above policies will apply for off-site coverage only. City of Temecula 41000 Main Street Temecula CA 92590 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 Underground Solutions, Inc.Michael Ehrenfeld Company Insurance Agents 25 Certificate of Liability Insurance: Notes LEASED/RENTED EQUIPMENT: - Nationwide Mutual Insurance Co. Policy #ACP3100201204; Policy Term: 8/11/2022 to 8/11/2023; Leased/Rented Equipment; Limit $100,000; Deductible $500 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:                      EPK140664       POLICY NUMBER: EPK140664 POLICY NUMBER: EPK140664                          POLICY NUMBER: EPK140664 (13DJHRI 7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< $0(1'(':$,9(52)75$16)(52)5,*+76 2)5(&29(5<$*$,16727+(567286 7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ &200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57 &2175$&725632//87,21/,$%,/,7<&29(5$*(3$57 (55256$1'20,66,216/,$%,/,7<&29(5$*(3$57 7+,5'3$57<32//87,21/,$%,/,7<&29(5$*(3$57 216,7(&/($183&29(5$*(3$57 6&+('8/( EĂŵĞŽĨWĞƌƐŽŶ;ƐͿŽƌKƌŐĂŶŝǌĂƚŝŽŶ;ƐͿ ůĂŶŬĞƚǁŚĞŶƐƉĞĐŝĨŝĐĂůůǇƌĞƋƵŝƌĞĚŝŶĂǁƌŝƚƚĞŶĐŽŶƚƌĂĐƚǁŝƚŚƚŚĞŶĂŵĞĚŝŶƐƵƌĞĚ͘ 6(&7,219,±&20021&21',7,216LWHP7UDQVIHU2I5LJKWVRI5HFRYHU\$JDLQVW2WKHUV7R8V ZLWKLQWKH&RPPRQ3URYLVLRQVLVDPHQGHGE\WKHDGGLWLRQRIWKHIROORZLQJ 6ROHO\DVUHVSHFWVWKHSHUVRQVRURUJDQL]DWLRQVLQGLFDWHGLQWKH6FKHGXOHVKRZQDERYHZHZDLYHDQ\ ULJKWRIUHFRYHU\ZHPD\KDYHDJDLQVWWKHSHUVRQVRURUJDQL]DWLRQVLQGLFDWHGLQWKH6FKHGXOHVKRZQ DERYHEHFDXVHRISD\PHQWVZHPDNHIRU³GDPDJHV´DULVLQJRXWRI\RXURQJRLQJRSHUDWLRQVRU³\RXUZRUN´ SHUIRUPHGXQGHUDZULWWHQFRQWUDFWZLWKWKDWSHUVRQVRURUJDQL]DWLRQVDQGLQFOXGHGLQWKH³SURGXFWV FRPSOHWHGRSHUDWLRQVKD]DUG´ +RZHYHUWKLVZDLYHUVKDOOQRWDSSO\WR³GDPDJHV´UHVXOWLQJIURPWKHVROHQHJOLJHQFHRIWKHSHUVRQVRU RUJDQL]DWLRQVLQGLFDWHGLQWKH6FKHGXOHVKRZQDERYH $//27+(57(506$1'&21',7,2162)7+(32/,&<5(0$,181&+$1*(' POLICY NUMBER: EPK140664 POLICY NUMBER: EPK140664 POLICY NUMBER: EPK140664 COMMERCIAL AUTO AC 70 05 03 16 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BUSINESS AUTO PROTECTION -GOLD This endorsement modifies insuranceprovided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A.Effect of This Endorsement B.Newly Acquired or Formed Entities C.Employees as Insureds –Nonowned Autos D.Additional Insured by Contract,Permit or Agreement E.SupplementaryPayments –Bail Bonds F.SupplementaryPayments –Loss of Earnings G.Personal Effects and Property of Others Extension H.Prejudgment Interest Coverage I.Fellow Employee –Officer,Managers and Supervisors J.Hired Auto Physical Damage K.Temporary Substitute Autos –Physical Damage Coverage L.Expanded Towing Coverage M.Auto Loan or Lease Coverage N.Original Equipment Manufacturer Parts –Leased Private Passenger Types O.Deductible Amendments P.Rental Reimbursement Coverage Q.Expanded Transportation Expense R.Extra Expense –Stolen Autos S.Physical Damage Limit of Insurance T.New Vehicle Replacement Cost U.Physical Damage Coverage Extension V.Transfer of Rights of Recovery Against Others To Us W.Section IV –Business Auto Conditions –Notice of and Knowledge of Occurrence X.Hired Car Coverage Territory Y.Emergency Lock Out Z.Cancellation Condition AC 70 05 03 16 Page 1 of 7Includes copyrighted material of Insurance Services Office,Inc. with its permission ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000171 POLICY NUMBER: ACP3100201204 COMMERCIAL AUTO AC 70 05 03 16 If specifically required by the written contract orA.EFFECT OF THIS ENDORSEMENT agreement referenced in the paragraph above,Coverage provided under this policy is modified any coverage provided by this endorsement tobytheprovisionsofthisendorsement.If there an additional insured shall be primary andisanyconflictbetweentheprovisionsofthisanyothervalidandcollectibleinsuranceavail-endorsement and the provision(s)of any state-able to the additional insured shall be non-specific endorsement also attached to this poli-contributory with this insurance.If the writtency,then the provision(s)of the state-specific contract does not require this coverage to beendorsementshallapplyinsteadoftheprovi-primary and the additional insured’s coverage tosionsofthisendorsementthatareinconflict,be non-contributory,then this insurance will bebutonlytotheextentoftheconflict,and only to excess over any other valid and collectible insur-the extent necessary to bring such provisions ance available to the additional insured.into conformance with the state requirement(s) contained in the provision(s)of the state-specific endorsement.E.SUPPLEMENTARY PAYMENTS –BAIL BONDSB.NEWLY ACQUIRED OR FORMED ENTITIES Supplementary Payments of SECTION II –The Named Insured shown in the Declarations is COVERED AUTOS LIABILITY COVERAGE isamendedtoincludeanyorganizationyounewly revised as follows:acquire or form,other than a partnership,joint venture,or limited liability company,and over (2)Up to $2,500 for cost of bail bonds (including which you maintain ownership or majority (more bonds for related traffic law violations) than 50%)interest;if there is no other similar in-required because of an “accident” we cover. surance available to that organization.Coverage We do not have to furnish these bonds.thunderthisprovisionisaffordeduntilthe180 F.SUPPLEMENTARY PAYMENTS –LOSS OFdayafteryouacquireorformtheorganizationorEARNINGStheendofthepolicyperiod,whichever is later. Supplementary Payments of the SECTION II –C.EMPLOYEES AS INSUREDS –NONOWNED COVERED AUTOS LIABILITY COVERAGE isAUTOSrevisedasfollows: The following is added to paragraph A.1.Who Is (4)All reasonable expenses incurred by the “in-An Insured of SECTION II –COVERED AUTOS sured”at our request,including actual lossLIABILITYCOVERAGE:of earnings up to $500 a day because of d.Any "employee"of yours is an "insured"time off from work. while using a covered "auto"you don't own,G PERSONAL EFFECTS AND PROPERTY OF.hire or borrow in your business or your per-OTHERS EXTENSIONsonalaffairs. 1.The.Care,Custody or Control Exclusion ofD. ADDITIONAL INSURED BY CONTRACT,SECTION II –COVERED AUTOSPERMITORAGREEMENTLIABILITYCOVERAGE,does not apply to The following is added to A.1.Who Is An In-"property damage"to property,other than sured of SECTION II –COVERED AUTOS your property,up to an amount not exceed- LIABILITY COVERAGE:ing $250 in any one "accident".Coverage is excess over any other valid and collectibleAnypersonororganizationthatyouarere- insurance.quired to name as an additional insured in a written contract or agreement that is executed 2.The following paragraph is added to A.4. or signed by you prior to a “bodily injury”or Coverage Extensions of SECTION III – “property damage”occurrence is an “insured”PHYSICAL DAMAGE COVERAGE: for Covered Auto L iability coverage.How-c.We will pay up to $500 for your propertyever,with respect to covered “autos”,such that is lost or damaged as a result of apersonororganizationisaninsuredonlytocovered“loss”,without applying a de-the extent that person or organization qualifies ductible.Coverage is excess over anyasan“insured”under A.1.Who is an Insured of other valid and collectible insurance.SECTION II –COVERED AUTOS LIABILITY COVERAGE: Page 2 of 7 AC 70 05 03 16Includes copyrighted material of Insurance Services Office,Inc. with its permission ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000172 COMMERCIAL AUTO AC 70 05 03 16 H.PREJUDGMENT INTEREST COVERAGE substitute for a covered "auto"you own that is out of service because of its:The following paragraph is added to SECTION II –COVERED AUTOS LIABILITY COVERAGE,a.Breakdown; 2.Coverage Extensions,a.Supplementary b.Repair; Payments:c.Servicing; (7)Prejudgment interest awarded against the d."Loss";or“insured”on that part of the judgment we e.Destructionpay.If we make an offer to pay the appli- cable limit of insurance,we will not pay The coverage that applies is the same as any prejudgment interest based on that the coverage provided for the vehicle being period of time after the offer.replaced. I FELLOW EMPLOYEE –OFFICERS,. MANAGERS, AND SUPERVISORS L EXPANDED TOWING COVERAGE. The Fellow Employee Exclusion in SECTION II 1.We will pay up to: –COVERED AUTOS LIABILITY COVERAGE is a.$100 for a covered "auto"you own ofreplacedasfollows;the private passenger type,or A."Bodily injury"to any fellow "employee"of b.$500 for a covered "auto"you own thatthe "insured"arising out of and in the course is not of the private passenger type,of the fellow "employee's" employment or for towing and labor costs incurred eachwhileperforming duties related to the con- time the covered "auto"is disabled.Howev-duct of your business.This exclusion does er,the labor must be performed at the placenotapplytoan"insured"who occupies a of disablement.position as an officer,manager,or supervi- sor.2.This coverage applies only for an "auto" covered on this policy for Comprehensive orJHIREDAUTOPHYSICALDAMAGE. Specified Causes of Loss Coverage andIfcovered"auto" designation symbols 1 or 8 ap-Collision Coverages.ply to Liability Coverage and if at least one "au- 3.Payment applies in addition to the otherwiseto"you own is covered by this policy for Com- applicable amount of each coverage youprehensive,Specified Causes of Loss,or Colli- have on a covered “auto”.sion coverages,then the Physical Damage coverages provided are extended to "autos"you M AUTO LOAN OR LEASE COVERAGE. lease,hire,rent or borrow without a driver;and 1. In the event of a total "loss"to a coveredprovisionsintheBusinessAutoCoverageForm"auto", we will pay any unpaid amount dueapplicabletoHiredAuto Physical Damage apply on the loan or lease, including up to a max- up to a limit of $100,000.The deductible will be imum of $500 for early termination fees orequaltothelargestdeductible applicable to any penalties,for your covered "auto"less:owned "auto"for that coverage.Any Compre-a.The amount paid under SECTION III –hensive deductible does not apply to fire or PHYSICAL DAMAGE COVERAGE oflightning.this policy;andK.TEMPORARY SUBSTITUTE AUTOS –b.Any:PHYSICAL DAMAGE COVERAGE 1)Overdue lease/loan payments at theThefollowingisaddedtoparagraphC.Certain time of the "loss";Trailers,Mobile Equipment And Temporary 2)Financial penalties imposed under aSubstituteAutosofSECTIONI-COVERED lease for excessive use, abnormalAUTOS: wear and tear or high mileage;If Physical Damage Coverage is provided by 3)Security deposits not refunded by athisCoverageForm,the following types of lessor;vehicles are also covered "autos"for Physi- cal Damage Coverage:4) Costs of extended warranties,Credit Life insurance,Health,Accident,orAny"auto"you do not own while used with Disability insurance purchased withthepermissionofitsownerasatemporary the lease;and AC 70 05 03 16 Page 3 of 7Includes copyrighted material of Insurance Services Office,Inc., with its permission ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000173 COMMERCIAL AUTO AC 70 05 03 16 5)Carry-over balances from previous No deductible applies to glass if the glass is re- leases.paired,in a manner acceptable to us,rather than replaced.2.This coverage only applies to a "loss"which is also covered under this policy for Com-P.RENTAL REIMBURSEMENT COVERAGE prehensive,Specified Causes of Loss,or 1.This coverage applies only to a covered "au- Collision coverage.to"for which Physical Damage Coverage is 3.Coverage does not apply to any unpaid provided on this policy. amount due on a loan for which the covered 2.We will pay for rental reimbursement ex- “auto”is not the sole collateral.penses incurred by you for the rental of an N.ORIGINAL EQUIPMENT MANUFACTURER "auto"because of "loss"to a covered "auto". PARTS –LEASED PRIVATE PASSENGER Payment applies in addition to the otherwise TYPES applicable amount of each coverage you have on a covered "auto."No deductiblesUnderParagraphC.Limit of Insurance of apply to this coverage.SECTION III –PHYSICAL DAMAGE COVERAGE,Section 4 is added as follows:3.We will pay only for those expenses incurred during the policy period beginning 24 hours4.We will use new original equipment vehicle after the "loss"and ending,regardless of themanufacturerpartsforanyprivatepassen- policy's expiration,with the lesser of thegertypecovered“auto”where required by following number of days:the lease agreement which has a term of at least six months.If a new original equip-a.The number of days reasonably ment vehicle manufacturer part is not in pro-required to repair or replace the covered duction or distribution we may use a like,"auto".If "loss"is caused by theft,this kind and quality replacement part.number of days is added to the number of days it takes to locate the coveredO.DEDUCTIBLE AMENDMENTS "auto"and return it to you.The following are added to the Deductible provi- b.The number of days shown in thesionofSECTIONIII–PHYSICAL DAMAGE Schedule.COVERAGE: 4.Our payment is limited to the lesser of theIfanotherpolicyorcoverageformthatisnotan following amounts:automobile policy or coverage form issued by this company applies to the same “accident”,the a.Necessary and actual expenses following applies:incurred. 1.If the deductible under this coverage is the b.$75 for any one day or for a maximum smaller (or smallest)deductible,it will be of 30 days. waived:5.This coverage does not apply while there 2.If the deductible under this coverage is not are spare or reserve "autos"available to you the smaller (or smallest)deductible,it will be for your operations. reduced by the amount of the smaller (or 6.If "loss"results from the total theft of a cov- smallest)deductible.ered "auto"of the private passenger type, If a Comprehensive or Specified Causes of Loss we will pay under this coverage only that Coverage “loss”from one “accident”involves amount of your rental reimbursement ex- two or more covered “autos”,only the highest penses which is not already provided for un- deductible applicable to those coverages will be der SECTION III –PHYSICAL DAMAGE applied to the “accident,”if the cause of the loss COVERAGE Coverage Extension. is covered for those vehicles.This provision only Q EXPANDED TRANSPORTATION EXPENSE. applies if you carry Comprehensive or Specified Paragraph A.4.a.of SECTION III –PHYSICALCausesofLossCoverageforthosevehicles,DAMAGE COVERAGE is replaced by the follow-and does not extend coverage to any covered ing:“autos”for which you do not carry such We will pay up to $50 per day to a maximum ofcoverage. $1500 for temporary transportation expense in- curred by you because of the total theft of a Page 4 of 7 AC 70 05 03 16IncludescopyrightedmaterialofInsuranceServicesOffice,Inc with its permission. ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000174 COMMERCIAL AUTO AC 70 05 03 16 covered "auto"of the private passenger type.ment manufacturer or other sources in- We will only pay for those covered "autos"for cluding non-original equipment manu- which you carry Comprehensive or Specified facturers and Causes of Loss Coverage.We will pay for tem-b.If a repair or replacement results in bet- porary transportation expenses incurred during ter than like kind or quality,we will not the period beginning 24 hours after the theft and pay for the amount of the net improve- ending, regardless of the policy's expiration,ment. when the covered "auto"is returned to use or we 5.If we offer to pay the actual cash value ofpayforits"loss".the damaged or stolen property, we will R.EXTRA EXPENSE –STOLEN AUTOS value auto advertising wraps, paint customi- The following paragraph is added to Coverage zation,and similar business related advertis- Extensions of SECTION III –PHYSICAL ing modifications,in addition to the actual DAMAGE COVERAGE:cash value of the property.Auto advertising wraps, paint customization,and similarc.We will pay for up to $5,000 for the expense business related advertising modificationsofreturningastolencovered“auto”to you. will be valued at the cost to replace themWewillpayonlyforthosecovered“autos” with an adjustment made for depreciationforwhichyoucarryComprehensiveorSpec- and physical condition.ified Causes of Loss Coverage T.NEW VEHICLE REPLACEMENT COSTS.PHYSICAL DAMAGE LIMIT OF INSURANCE The following is added to the Limit of InsuranceUnderSECTIONIII–PHYSICAL DAMAGE provision of SECTION III –PHYSICALCOVERAGE,Paragraph C.,Limit of Insurance DAMAGE COVERAGE:is replaced by the following: 5.The provisions of paragraphs 1.and 3.doC.Limit Of Insurance not apply to a covered “auto“of the private1.The most we will pay for “loss”in any one passenger type or a vehicle with a gross“accident”is the lesser of:vehicle weight rating of 20,000 pounds or a.The actual cash value of the damaged less which is a “new vehicle.” or stolen property as of the time of the In the event of a total “loss” to your new ve-“loss”,or hicle to which this coverage applies,we will b.The cost of repairing or replacing the pay at your option: damaged or stolen property.a.The verifiable “new vehicle”purchase 2.$1500 is the most we will pay for “loss”in price you paid for your damaged vehi- any one “accident”to all electronic equip-cle,not including any insurance or war- ment that reproduces,receives or transmits ranties purchased; audio,visual or data signals which, at the b.If it is available,the purchase price,astimeof“loss”,is:negotiated by us,of a “new vehicle”of a.Permanently installed in or upon the the same make,model,and equipment covered “auto”in a housing,opening or or the most similar model available,not other location that is not normally used including any furnishings,parts,or by the “auto”manufacturer for the in-equipment not installed by the manufac- stallation of such equipment.turer or manufacturers’ dealership; or . b.Removable from a permanently installed c.The market value of your damaged ve- housing unit as described in Paragraph hicle,not including any furnishings, 2.a.above or is an integral part of that parts,or equipment not installed by the equipment;or manufacturer or manufacturer’s dealer- c.An integral part of such equipment.ship. 3. An adjustment for depreciation and physical We will not pay for initiation or set up costs condition will be made in determining actual associated with loans or leases cash value in the event of a total “loss”.As used in this endorsement,a “new 4.The cost of repairing or replacing may:vehicle”means an “auto”of which you are the original owner that has not been previ-a. Be based on an estimate which includes parts furnished by the original equip- AC 70 05 03 16 Page 5 of 7Includes copyrighted material of Insurance Services Office,Inc., with its permission ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000175 COMMERCIAL AUTO AC 70 05 03 16 ously titled and which you purchased less a.Your obligation in the Duties in the Event than 365 days before the date of the “loss”.of Accident,Claim,Suit or Loss Condi- tion relative to notification requirements applies only when the “accident” orU.PHYSICAL DAMAGE COVERAGE “loss”is known to:EXTENSIONS (1) You,if you are an individual;Under SECTION III –PHYSICAL DAMAGE (2)A partner,if you are a partnership;COVERAGE,A.Coverage,Coverage Exten- sions,b.Loss of Use Expenses is replaced by (3)A member,if you are a limited liability the following:company;or b.Loss of Use Expenses (4) An executive officer or insurance manager,if you are a corporation.For Hired Auto Physical Damage,we will pay expenses for which an “insured”be-b.Your obligation in the. Duties in the Event comes legally responsible to pay for loss of of Accident,Claim,Suit or Loss Condition use of a vehicle rented or hired without a relative to providing us with documents driver,under a written rental contract or concerning a claim or “suit”will not be agreement.We will pay for loss of use ex-considered breached unless the breach penses if caused by:occurs after such claim or “suit”is known to:(1)Other than collision if the Declarations indicate that Comprehensive Coverage (1) You,if you are an individual; is provided for any covered “auto”;(2)A partner,if you are a partnership; (2) Specified Causes of Loss only if the (3)A member,if you are a limited Declarations indicate that Specified liability company;or Causes of Loss Coverage is provided (4) An executive officer or insuranceforanycovered“auto”;or manager,if you are a corporation. (3)Collision only if the Declarations indicate that Collision Coverage is provided for X.HIRED CAR –COVERAGE TERRITORYanycovered“auto.” Item (5) of the Policy Period,Coverage TerritoryHowever,the most we will pay for any GeneralConditionss replaced by the following:expenses for loss of use is $50 per day,to a maximum of $1,500.The insurance provided (5)Anywheren the worldif a covered “auto”is by this provision is excess over any other leased,hired,rented or borrowed without a collectible insurance.driver for a period of 30 days or less;and V.TRANSFER OF RIGHTS OF RECOVERY Y.EMERGENCY LOCKOUT AGAINST OTHERS TO US We will reimburse you up to $100 for reasonable The following is added to the Transfer Of Rights expense incurred for the services of a locksmith Of Recovery Against Others To Us Condition:to gain entry into your covered “auto”subject to these provisions:We waive any right of recovery we may have against any person or organization to 1.Your door key,electronic key or key entry the extent required of you by a written con-pad has been lost,stolen or locked in your tract executed prior to any “accident”be-covered “auto”and you are unable to enter cause of payments we make for damages such “auto”,or under this coverage form.2.Your keyless entry device battery dies and W.NOTICE OF AND KNOWLEDGE OF you are unable to enter such "auto"as a re- OCCURRENCE sult, 3.Your key,electronic key or key entry padSECTIONIV–BUSINESS AUTO has been lost or stolen and you haveCONDITIONS,Paragraph A is amended as changed the lock to prevent an unauthorizedfollows: entry;and 6.NOTICE OF AND KNOWLEDGE OF OCCURRENCE Page 6 of 7 AC 70 05 03 16Includes copyrighted material of Insurance Services Office,Inc with its permission. ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000176 COMMERCIAL AUTO AC 70 05 03 16 4.Original copies of receipts for services of a If we cancel for any reason other than non- locksmith must be provided before reim-payment of premium,we will mail or deliver bursement is payable.to the First Named Insured written notice of cancellation at least 60 days before the ef-Z.CANCELLATION CONDITION fective date of cancellation.This provision Paragraph A.2.of the COMMON POLICY does not apply in those states that require CONDITION –CANCELLATION applies more than 60 days prior notice of cancella- except as follows:tion. AC 70 05 03 16 Page 7 of 7Includes copyrighted material of Insurance Services Office,Inc., with its permission ACP BA 31-0-0201204 LK4B 21230 INSURED COPY AC7005031600 0001 42 0000177 9109008-22 EFFECTIVE AUGUST 11, 2022 AT 12.01 A.M. AND EXPIRING AUGUST 11, 2023 AT 12.01 A.M. RECOMMENDED BY: DATE: ACCEPTED BY: DATE: 5/4/2023 NICOLAS M. MINICILLI TRAFFIC ENGINEER R.T.E. NO: 2647 05/04/23 RECOMMENDED BY: DATE: ACCEPTED BY: DATE: 5/4/2023 NICOLAS M. MINICILLI TRAFFIC ENGINEER R.T.E. NO: 2647 05/04/23 RECOMMENDED BY: DATE: ACCEPTED BY: DATE: 5/4/2023 NICOLAS M. MINICILLI TRAFFIC ENGINEER R.T.E. NO: 2647 05/04/23 RECOMMENDED BY: DATE: ACCEPTED BY: DATE: 5/4/2023 NICOLAS M. MINICILLI TRAFFIC ENGINEER R.T.E. NO: 2647 05/04/23 RECOMMENDED BY: DATE: ACCEPTED BY: DATE: 5/4/2023 NICOLAS M. MINICILLI TRAFFIC ENGINEER R.T.E. NO: 2647 05/04/23