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LD24-4338
Permit Number: LD24-4338 LD - Utilities/ Excavation - Parallel Issued: 10/30/2024 Expired: 08/04/2025 Job Address: 33395 Wolf Store 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 Cynthia Fearn 321 Hunter St Ramona, CA 92065 Applicant: Rsvc Company 891 Iowa Ave. Riverside, CA 92507 (909) 664-4791 Contractor: Utility Work Order Number: (24-1424) Description: Wet Utilities (RCWD) - Ralph's Fuel Center WORK HOURS SHALL BE MONDAY – FRIDAY, NO HOLIDAYS, 7:00am - 4:30pm Location: Wolf Store S/S 200' W/O Butterfield Stage Rd Proposed work: Rancho California Water District (RCWD) connections per approved plans "RCWD 1305 PRESSURE ZONE, H1940P, LD24-4338" All facilities shall be installed in accordance with City Standard Drawing 117. Traffic Control shall be in accordance with approved Traffic Control Plan LD24-4338 Permittee shall comply with all applicable Traffic Control General Notes. 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. Concrete curbs, walks, gutters, cross gutters and driveway approaches damaged during construction shall be removed from joint to joint and reconstructed in accordance with City Standards and the Greenbook. All disturbed landscaping and other improvements shall be removed/repaired and replaced to the satisfaction of the City Engineer or their designated assignee. Permittee shall contact LDInspections@temeculaca.gov a minimum of two (2) business days prior to any work. Page 1 of 3*****See Page 2 of this Permit for Permittee Responsibilities***** Permit Number: LD24-4338 LD - Utilities/ Excavation - Parallel Permittee must also request a final inspection to verify completion of project. 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 Page 2 of 3 Permit Number: LD24-4338 LD - Utilities/ Excavation - Parallel City Engineer or Authorized Representative Date 10/30/2024 Page 3 of 3 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD NOT TO SCALE FLASHING ARROW SIGN TRAILER (TYP.) (FAS) (HLWD) HIGH LEVEL WARNING DEVICE TRAFFIC CONE POST TUBE (CMS) CHANGEABLE MESSAGE SIGN TRAILER (TYP.) TYPE II BARRICADE PERMIT NO. 1. ALL TRAFFIC CONTROL DEVICES SHALL CONFORM TO THE LATEST EDITION OF THE CALIFORNIA MANUAL ON UNIFORM TRAFFIC CONTROL DEVICES (CALIFORNIA MUTCD) AND THE STANDARD SPECIFICATIONS FOR PUBLIC WORKS CONSTRUCTION. 2. THE CITY ENGINEER OR HIS REPRESENTATIVE HAS THE AUTHORITY TO INITIATE FIELD CHANGES TO ASSURE PUBLIC SAFETY. 3. ALL TRAFFIC CONTROL DEVICES SHALL BE REMOVED FROM VIEW WHEN NOT IN USE. 4. WORK HOURS SHALL BE RESTRICTED TO THE PERIOD BETWEEN 8:30 A.M. AND 3:30 P.M., MONDAY THROUGH FRIDAY, UNLESS APPROVED OTHERWISE. WHEN NIGHT WORK IS REQUIRED, WORK HOURS SHALL BE 9 P.M. TO 5 A.M., SUNDAY THROUGH THURSDAY. 5. TRENCHES MUST BE BACK FILLED OR PLATED DURING NON-WORKING HOURS. STEEL PLATES SHALL HAVE ASPHALTIC CONCRETE BERM ON ALL EDGES. ALL DIRT, DUST, AND DEBRIS SHALL BE REMOVED FROM STREET AT END OF EACH DAY AND AT THE END OF THE JOB. THE STREET SHALL BE IN DRIVABLE CONDITION AT ALL TIMES. 6. PEDESTRIAN CONTROLS SHALL BE PROVIDED AS SHOWN ON THE PLANS. 7. TEMPORARY "NO PARKING" SIGNS WILL BE POSTED 24 HOURS PRIOR TO COMMENCING WORK. 8. ACCESS TO DRIVEWAYS WILL BE MAINTAINED AT ALL TIMES UNLESS OTHER ARRANGEMENTS ARE MADE. 9. THE CONTRACTOR SHALL REPLACE WITHIN 72 HOURS ALL TRAFFIC SIGNAL LOOP DETECTORS DAMAGED DURING CONSTRUCTION. 10. THE CONTRACTOR SHALL REPLACE WITHIN 24 HOURS, ALL STRIPING REMOVED OR DAMAGED BY CONSTRUCTION WORK. (STRIPING MAY BE REPLACED TEMPORARILY WITH TAPE.) 11. ALL WORKERS SHALL BE EQUIPPED WITH AN ORANGE VEST (OR A REFLECTIVE VEST AT NIGHT). ALL FLAGGERS SHALL ALSO BE EQUIPPED WITH A HARD HAT, C28 "STOP/SLOW" PADDLE AND SHALL BE TRAINED IN THE PROPER FUNDAMENTALS OF FLAGGING TRAFFIC. 12. ANY WORK THAT DISTURBS NORMAL TRAFFIC SIGNAL OPERATIONS SHALL BE COORDINATED WITH THE CITY OF TEMECULA'S TRAFFIC DIVISION, 48 HOURS PRIOR TO BEGINNING CONSTRUCTION. CONTACT THE CITY'S TRAFFIC DIVISION AT (951) 694 -6411. 13. THE CONTRACTOR SHALL MAINTAIN ALL TRAFFIC CONTROL DEVICES 24 HOURS PER DAY AND 7 DAYS PER WEEK. 14. A MINIMUM OF TWELVE (12) FOOT TRAVEL LANES MUST BE MAINTAINED UNLESS OTHERWISE APPROVED BY THE DEPARTMENT OF PUBLIC WORKS. 15. ALL NIGHT WORK WILL REQUIRE WRITTEN APPROVAL FROM THE DEPARTMENT OF PUBLIC WORKS. LANE CLOSURES, ROAD DETOURS, ROAD CLOSURES, AND TRAFFIC SIGNAL MODIFICATIONS ASSOCIATED WITH OVERNIGHT CONSTRUCTION ACTIVITIES WILL REQUIRE WARNING SIGNS BE PLACED AT LEAST ONE WEEK IN ADVANCE OF STARTING CONSTRUCTION. 16. A SOLAR POWERED FLASHING ARROW BOARD SHALL BE REQUIRED ON ALL ARTERIAL STREET LANE CLOSURES. 17. IF THE PERMIT APPLICANT DETERMINES THAT CONDUIT INSTALLATION WILL BE BY THE BORING MACHINE METHOD, THE TRENCH PATCH FOR THE UTILITY OBSERVATION EXCAVATION WILL BE THE SAME AS FOR OPEN TRENCH EXCAVATION METHOD. THIS WILL PROVIDE A SINGLE CONTINUOUS SURFACE RESTORATION ELIMINATING THE MULTIPLE PENETRATION INTO THE PUBLIC ROADWAY TO ALL REQUIREMENTS IN CITY STANDARD DRAWING # 407 (ALL SHEETS) FOR TRENCH PATCH. 18. ANY WORK THAT CREATES AN UNDUE SAFETY RISK OR CREATES SEVERE CONGESTION MAY BE SHUT DOWN BY CITY TRAFFIC ENGINEERS, CITY FIELD INSPECTION, OR THE POLICE DEPARTMENT. 19. CONES AND DELINEATORS SHALL HAVE REFLECTORIZED SLEEVES FOR NIGHT WORK. 20. IF PARKING IS ALLOWED IN ADVANCE WARNING AREA, ADVANCE WARNING SIGNS SHALL BE MOUNTED ON HIGH LEVEL DEVICES. APPLICANT IS RESPONSIBLE FOR FULL AND COMPLETE REPRESENTATION OF THE ACTUAL ROAD CONDITIONS SHOWN ON THIS PLAN INCLUDING, BUT NOT LIMITED TO EXISTING STRIPING, SIGNING, SIDEWALKS, AND BIKE LANES. 1 6 LD24-4338 ERICK ESCOBEDO 10/29/24 10/29/ 24 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD PROPOSED TRENCH WOLF STORE RD (NO MPH POSTED) BUTTERFIELD STAGE RD 45 MPH BUTTERFIELD STAGE RD 45 MPH SHOPPING CENTER DWY ADDITIONAL NOTES: 35 SPEED LIMIT SPEED LIMIT 45 2 6 10/29/24 10/29/ 24 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD BUTTERFIELD STAGE RD 45 MPH BUTTERFIELD STAGE RD 45 MPH SHOPPING CENTER DWY WOLF STORE RD (NO MPH POSTED) 35 SPEED LIMIT SPEED LIMIT 45 WOLF STORE RD (NO MPH POSTED) WOLF S T O R E R D (NO M P H P O S T E D ) LO W E R R I G H T MA T C H L I N E - 3 6 MA T C H L I N E - UP P E R L E F T 10/29/24 10/29/ 24 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD WOLF S T O R E R D (NO M P H P O S T E D ) BUTTERFIELD STAGE RD 45 MPH SHOPPING CENTER DWY BUTTERFIELD STAGE RD 45 MPH 35 SPEED LIMIT SPEED LIMIT 45 PROPOSED TRENCH ADDITIONAL NOTES: 4 6 10/29/24 10/29/ 24 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD BUTTERFIELD STAGE RD 45 MPH BUTTERFIELD STAGE RD 45 MPH SHOPPING CENTER DWY 35 SPEED LIMIT SPEED LIMIT 45 WOLF STORE RD (NO MPH POSTED) WOLF S T O R E R D (NO M P H P O S T E D ) LO W E R R I G H T MA T C H L I N E - 5 6 UP P E R L E F T MA T C H L I N E - 10/29/24 10/29/ 24 PUBLIC WORKS - TRAFFIC ENGINEERING DIVISION CITY OF TEMECULAENGINEER'S INFORMATIONENGINEER'S SEAL FOR TRAFFIC CONTROL PLANS RALPHS 686 FUEL CENTER WOLF STORE RD & CONTRACTOR: RECOMMENDED BY:DATE: ACCEPTED BY:DATE: R.T.E. NO. NICOLAS M. MINICILLI TRAFFIC ENGINEER 3002 RSVC COMPANY PRO TRAFFIC SERVICES & SO CAL ELITE TRAFFIC UNION & NON-UNION OPERATED WBE LIC.# 978979 SAN MARCOS, COLTON ORANGE & IRWINDALE 760-744-7056 909-370-4000 714-288-9385 PLANS DESIGNED BY: ENGINEERS NAME: RCE #:DATE: TCP NO. 1424-RSVC-24PM BUTTERFIELD STAGE RD BUTTERFIELD STAGE RD 45 MPH SHOPPING CENTER DWY BUTTERFIELD STAGE RD 45 MPH 35 SPEED LIMIT SPEED LIMIT 45 WOLF STORE RD (NO MPH POSTED) WOLF S T O R E R D (NO M P H P O S T E D ) LO W E R R I G H T MA T C H L I N E - 6 6 UP P E R L E F T MA T C H L I N E - 10/29/24 10/29/ 24 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 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. LD24-4338 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 limit 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.One million dollars ($1,000,000) per accident for bodily injury or disease. d.Course of Construction:Completed value of the project. 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 $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. (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: Company Name: Mailing Address: Contact:Phone #:24-HR Emergency #: Class:City Business License #:961558 B C-7 C-8 C36 C10 055461 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 10/2/2024 Burnham WGB Insurance Solutions CA Insurance License 0F69771 15901 Red Hill Avenue Tustin CA 92780 Brittany Andrakowicz 714-439-3582 714-573-1770 brittany.andrakowicz@wgbib.com Zurich American Insurance Comp 16535 RSVCC-1 American Guarantee and Liabili 26247RSVCCompany 3051 Myers St.,Suite B Riverside CA 92503 412742842 A X 1,000,000 X 500,000 5,000 1,000,000 3,000,000 X GLO 3083674 -01 9/1/2024 9/1/2025 2,000,000 A 1,000,000 X X X BAP 2398195 -01 9/1/2024 9/1/2025 B X 5,000,000 X SXS 2512144-01 9/1/2024 9/1/2025 5,000,000 A XWC2398190-01 9/1/2024 9/1/2025 1,000,000 1,000,000 1,000,000 When required by written contract,General Liability Additional Insured in favor of Certificate Holder applies per attached endorsement UGL2162,and Waiver of Subrogation applies per endorsement CG 24 04 05 09,and Primary,Noncontributory applies per attached endorsement UGL2162.Auto Additional Insured in favor of Certificate Holder applies per attached endorsement UCA424,waiver of subrogation applies per endorsement UCA424,primary and noncontributory applies per attached endorsement UCA424.Workers Compensation waiver of subrogation applies in favor of Certificate Holder per attached endorsement WC040306. RE:RAL6863 Fuel -City of Temecula Certificate Holder Vesting:City of Temecula City of Temecula 41000 Main Street Temecula CA 92590 ZURICH Producer No.Add’l.Prem Return Prem. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Business Auto Coverage Form Motor Carrier Coverage Form A.Amended Who Is An Insured 1.The following is added to the Who Is An Insured Provision in Section II -Covered Autos Liability Coverage: The following are also "insureds": a.Any "employee"of yours is an "insured"while using a covered "auto"you don't own,hire or borrow for acts performed within the scope of employment by you.Any “employee”of yours is also an “insured”while operating an “auto”hired or rented under a contract or agreement in an “employee’s”name,with your permission,while performing duties related to the conduct of your business. b.Anyone volunteering services to you is an "insured"while using a covered "auto"you don’t own,hire or borrow to transport your clients or other persons in activities necessary to your business. c.Anyone else who furnishes an "auto"referenced in Paragraphs A.1.a.and A.1.b.in this endorsement. d.Where and to the extent permitted by law,any person(s)or organization(s)where required by written contract or written agreement with you executed prior to any "accident",including those person(s)or organization(s) directing your work pursuant to such written contract or written agreement with you,provided the "accident" arises out of operations governed by such contract or agreement and only up to the limits required in the written contract or written agreement,or the Limits of Insurance shown in the Declarations,whichever is less. 2.The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance -Primary and Excess Insurance Provisions Condition in the Motor Carrier Coverage Form: Coverage for any person(s)or organization(s),where required by written contract or written agreement with you executed prior to any "accident",will apply on a primary and non-contributory basis and any insurance maintained by the additional "insured"will apply on an excess basis.However,in no event will this coverage extend beyond the terms and conditions of the Coverage Form. B.Amendment -Supplementary Payments Paragraphs a.(2)and a.(4)of the Coverage Extensions Provision in Section II -Covered Autos Liability Coverage are replaced by the following: (2)Up to $5,000 for the 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. INTERNAL USE ONLY Includes copyrighted material of Insurance Services Office,Inc.,with its permission. U-CA-424-F CW (04/14) Page 1 of 6 Coverage Extension Endorsement Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. BAP2398195- 0• 1 09/01/2024 09/01/2025 09/01/2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. Additional Insured – Automatic – Owners, Lessees Or Contractors This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A.Section II – Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured under a written contract or written agreement executed by you, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" and subject to the following: 1.If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a.The Insurance Services Office (ISO) ISO CG 20 10 (10/01 edition); or b.The ISO CG 20 37 (10/01 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" arises out of: (1)Your ongoing operations, with respect to Paragraph 1.a. above; or (2)"Your work", with respect to Paragraph 1.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 1., insurance afforded to such additional insured: (a)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (b)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 2.If such written contract or written agreement specifically requires that you provide that the person or organization be named as an additional insured under one or both of the following endorsements: a.The Insurance Services Office (ISO) ISO CG 20 10 (07/04 edition); or b.The ISO CG 20 37 (07/04 edition), such person or organization is then an additional insured with respect to such endorsement(s), but only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is caused, in whole or in part, by: (1)Your acts or omissions; or (2)The acts or omissions of those acting on your behalf, U-GL-2162-A CW (02/19) Page 1 of 4Includes copyrighted material of Insurance Services Office, Inc., with its permission. GLO 3083674 - 01 Effective Date: 09/01/2024 in the performance of: (a)Your ongoing operations, with respect to Paragraph 2.a. above; or (b)"Your work" and included in the "products-completed operations hazard", with respect to Paragraph 2.b. above, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 2., insurance afforded to such additional insured: (i)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement; and (ii)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. 3.If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a.Under the ISO CG 20 10 (04/13 edition, any subsequent edition or if no edition date is specified); or b.With respect to ongoing operations (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury", "property damage" or "personal and advertising injury" is 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, which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 3., insurance afforded to such additional insured: (a)Only applies to the extent permitted by law; (b)Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; and (c)Only applies if the "bodily injury", "property damage" or "personal and advertising injury" offense occurs during the policy period and subsequent to your execution of the written contract or written agreement. 4.If neither Paragraph 1. nor Paragraph 2. above apply and such written contract or written agreement requires that you provide that the person or organization be named as an additional insured: a.Under the ISO CG 20 37 (04/13 edition, any subsequent edition or if no edition date is specified); or b.With respect to the "products-completed operations hazard" (if no form is specified), such person or organization is then an additional insured only to the extent that "bodily injury" or "property damage" is caused, in whole or in part by "your work" and included in the "products-completed operations hazard", which is the subject of the written contract or written agreement. However, solely with respect to this Paragraph 4., insurance afforded to such additional insured: (1)Only applies to the extent permitted by law; (2)Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured; (3)Only applies if the "bodily injury" or "property damage" occurs during the policy period and subsequent to your execution of the written contract or written agreement; and U-GL-2162-A CW (02/19) Page 2 of 4Includes copyrighted material of Insurance Services Office, Inc., with its permission. (4)Does not apply to "bodily injury" or "property damage" caused by "your work" and included within the "products-completed operations hazard" unless the written contract or written agreement specifically requires that you provide such coverage to such additional insured. B.Solely with respect to the insurance afforded to any additional insured referenced in Section A. of this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: 1.The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or 2.Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. C.Solely with respect to the coverage provided by this endorsement, the following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions: The additional insured must see to it that: (1)We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; (2)We receive written notice of a claim or "suit" as soon as practicable; and (3)A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D.Solely with respect to the coverage provided by this endorsement: 1.The following is added to the Other Insurance Condition of Section IV – Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a.The additional insured is a Named Insured under such other insurance; and b.You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2.The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition under Section IV – Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. E.This endorsement does not apply to an additional insured which has been added to this Coverage Part by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. U-GL-2162-A CW (02/19) Page 3 of 4Includes copyrighted material of Insurance Services Office, Inc., with its permission. F.Solely with respect to the insurance afforded to an additional insured under Paragraph A.3. or Paragraph A.4. of this endorsement, the following is added to Section III – Limits Of Insurance: Additional Insured – Automatic – Owners, Lessees Or Contractors Limit The most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the written contract or written agreement referenced in Section A. of this endorsement; or 2.Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-2162-A CW (02/19) Page 4 of 4Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy No. Contractors Liability Supplemental Coverages and Conditions This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A.Non-owned Watercraft Liability Extended Coverage Paragraph (2) of Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by the following: (2)A watercraft you do not own that is: (a)Less than the length shown in the Non-Owned Watercraft Schedule of this endorsement; and (b)Not being used to carry persons or property for a charge; B.Damage To Premises Rented Or Occupied By You 1.The last paragraph under Paragraph 2. Exclusions of Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by the following: Exclusions c. through n. do not apply to damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner. A separate Damage to Premises Rented To You Limit of Insurance applies to this coverage as described in Section III – Limits Of Insurance. 2.The paragraph directly following Paragraph (6) in Exclusion j. of Section I – Coverage A – Bodily Injury And Property Damage Liability is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to premises (other than damage by "specific perils"), including "property damage" to the contents of such premises, rented to you under a rental agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to Premises Rented to You as described in Section III – Limits Of Insurance. 3.Paragraph 6. of Section III – Limits Of Insurance is replaced by the following: 6.Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises while rented to you, or in the case of damage by one or more "specific perils" to any one premises, while rented to you or temporarily occupied by you with permission of the owner. 4.Paragraph a. of the "insured contract" definition under the Definitions Section is replaced by the following: NON-OWNED WATERCRAFT SCHEDULE Watercraft Length: 51 feet (If no amount is shown above, 51 feet applies.) U-GL-1060-F CW (05/22) Page 1 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. GLO 3083674 - 01 Effective Date: 09/01/2024 C. 1. 2. 3. a. b. D. 1. a. b. a.A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by "specific perils" to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; 5.Paragraph (ii) under Paragraph 4.b.(1) of the Other Insurance Condition under Section IV – Commercial General Liability Conditions is replaced by the following: (ii)That is property insurance providing coverage for "specific perils" for premises rented to you or temporarily occupied by you with permission of the owner; 6.The following definitions are added to the Definitions Section: "Specific perils" means fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil commotion, vandalism, leakage from fire extinguishing equipment, weight of snow, ice or sleet or "water damage". "Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking or cracking of any part of a system or appliance containing water or steam. Additional Insured – Lessor Of Leased Equipment – Automatic Status When Required In Lease Agreement With You Section II – Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). However, the insurance afforded to such additional insured: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person’s or organization’s status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: Required by the written contract or written agreement you have entered into with the additional insured; or Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph C. shall not increase the applicable Limits of Insurance shown in the Declarations. Additional Insured – Managers Or Lessors Of Premises Section II – Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) that you have agreed in a written contract or written agreement to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of premises leased to you and subject to the following additional exclusions: This insurance does not apply to: Any "occurrence" which takes place after you cease to be a tenant in that premises. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured manager or lessor of the premises leased to you. However, the insurance afforded to such additional insured: a.Only applies to the extent permitted by law; and U-GL-1060-F CW (05/22) Page 2 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2. a. b. E. 1. a. b. (1) (2) 2. a. b. b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: Required by the written contract or written agreement you have entered into with the additional insured; or Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph D. shall not increase the applicable Limits of Insurance shown in the Declarations. Additional Insured – State Or Governmental Agency Or subdivision Or Political Subdivision – Permits Or Authorizations Section II – Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision that you have agreed in a written contract or written agreement or that you are required by statute, ordinance or regulation to name as an additional insured, subject to the following provisions: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or "Bodily injury" or "property damage included within the "products-completed operations hazard". However, the insurance afforded to such additional insured: a.Only applies to the extent permitted by law; and b.Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: Required by the written contract or written agreement you have entered into with the additional insured; or Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. The insurance provided by this Paragraph E. shall not increase the applicable Limits of Insurance shown in the Declarations. F.Personal And Advertising Injury Coverage – Assumed Under Contract Or Agreement 1.Exclusion e. of Section I – Coverage B – Personal And Advertising Injury Liability is replaced by the following: 2.Exclusions This insurance does not apply to: e.Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to: (1)Liability for damages that the insured would have in the absence of the contract or agreement; or (2)Liability for "personal and advertising injury" if: U-GL-1060-F CW (05/22) Page 3 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. (1) (2) (a) (b) (3) (4) (a) (b) (5) (a)The liability pertains to your business and is assumed in a contract or agreement that is an "insured contract"; and (b)The "personal and advertising injury" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability so assumed in such "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "personal and advertising injury", provided: (i)Liability to such party for, or for the cost of, that party’s defense has also been assumed in the same contract or agreement; and (ii)Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this insurance applies are alleged. 2.For purposes of this "personal and advertising injury" coverage only: Paragraph d. and the second to last paragraph under Paragraph 2. of Supplementary Payments – Coverages A and B are replaced by the following: d.The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no conflict appears to exist between the interests of the insured and the interest of the indemnitee; So long as the above conditions are met, attorneys’ fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Such payments will not be deemed to be damages for "bodily injury", "property damage" or "personal and advertising injury" and will not reduce the limits of insurance. G.Insured Contract Amendment Paragraph f. and f.(1) through f.(3) of the "insured contract" definition under the Definitions Section is replaced by the following: f.That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: That indemnifies a railroad for "bodily injury", "property damage" or "personal and advertising injury" arising out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road-beds, tunnel, underpass or crossing; That indemnifies an architect, engineer or surveyor for injury or damage arising out of: Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured’s rendering or failure to render professional services, including those listed in (2) above and supervisory, inspection, architectural or engineering activities; That indemnifies a person or organization for "personal and advertising injury": Arising out of advertising, publishing, broadcasting or telecasting done for you or on your behalf; or To an "employee" of such person or organization that does advertising, publishing, broadcasting or telecasting for you or on your behalf; or That indemnifies a labor leasing firm for "bodily injury" to "leased workers". U-GL-1060-F CW (05/22) Page 4 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. H.Medical Payments – Increased Reporting Period Paragraph a. of Section I – Coverage C – Medical Payments is replaced by the following: a.We will pay medical expenses as described below for "bodily injury" caused by an accident: (1)On premises you own or rent; (2)On ways next to premises you own or rent; or (3)Because of your operations; provided that: (a)The accident takes place in the "coverage territory" and during the policy period; (b)The expenses are incurred and reported to us within three years of the date of the accident; and (c)The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. I.Broad Bail Bond Coverage Paragraph 1.b. under Supplementary Payments – Coverages A And B is replaced by the following: b.The cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. J.Amendment – Duties In The Event of Occurrence, Offense, Claim or Suit The following paragraphs are added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV – Commercial General Liability Conditions: Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or "suit" shall be given to us as soon as practicable after knowledge of the "occurrence", offense, claim or "suit" has been reported to your officer, manager, partner or an "employee" authorized by you to give or receive such notice. Knowledge by "employees" other than your officer, manager, partner or "employee" authorized by you to give or receive such notice of an "occurrence", offense, claim or "suit" does not imply that you also have such knowledge. In the event that an insured reports an "occurrence" to your workers compensation carrier and this "occurrence" later develops into a General Liability claim, covered by this Coverage Part, the insured’s failure to report such "occurrence" to us at the time of the "occurrence" shall not be deemed to be a violation of this Condition. You must, however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability rather than a Workers Compensation claim. K.Unintentional Failure To Disclose Or Describe Hazards Paragraph 6. Representations of Section IV – Commercial General Liability Conditions is replaced by the following: 6.Representations By accepting this policy, you agree: a.The statements in the Declarations are accurate and complete; b.Those statements are based upon representations you made to us; and c.We have issued this policy in reliance upon your representations. Coverage will continue to apply if you unintentionally: (1)Fail to disclose all hazards existing at the inception of this policy; or (2)Make an error, omission or improper description of premises or other statement of information stated in this policy. You must notify us in writing as soon as possible after the discovery of any hazards or any other information that was not provided to us prior to inception of this Coverage Part. L.Bodily Injury Redefined The "bodily injury" definition under the Definitions Section is replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of these at any time. This includes mental anguish, mental injury, shock or fright resulting from bodily injury, sickness or disease. U-GL-1060-F CW (05/22) Page 5 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. 1. M.Two Or More Of Our Coverage Parts/Policies The following is added to Section III – Limits of Insurance: Subject to Paragraph 2. or 3. above, whichever applies, if this Coverage Part and any other Commercial General Liability Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same "occurrence", only the highest available Each Occurrence Limit under any such Coverage Part or policy applies to such "occurrence". 2.Subject to Paragraph 2. above, if this Coverage Part and any other Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply to the same offense, only the highest available Personal And Advertising Injury Limit under any such Coverage Part or policy applies to such offense. 3.Under this Coverage Part and all other Zurich underwriting company Coverage Parts or policies to which Paragraphs 1. and 2. above combined apply, the most we will pay for all injury or damage because of "bodily injury" or "property damage" "occurrences", "personal and advertising injury" offenses and medical expenses is: a.The single highest Coverage Part or policy General Aggregate Limit; or b.The single highest Coverage Part or policy Products-Completed Operations Aggregate Limit, whichever applies, whether such "occurrence", offenses or medical expenses are covered by one or more than one Zurich underwriting company policy. 4.Any existing provisions under Paragraph 4. Other Insurance under Section IV – Commercial General Liability Conditions that may be contrary to the provisions of this endorsement are amended to comply with the changes in coverage as stipulated in Paragraphs 1., 2., and 3. above. This provision does not apply to any Coverage Part or policy issued by us or any other Zurich underwriting company affiliated with us specifically to apply as excess insurance over this Coverage Part or to any endorsement to this policy which specifically provides any coverage for a wrap-up or other consolidated insurance program project if this policy is not for a wrap-up or other consolidated insurance program. All other terms, conditions, provisions and exclusions of this policy remain the same. U-GL-1060-F CW (05/22) Page 6 of 6Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART GLO 3083674 - 01 SCHEDULE Name Of Person Or Organization: ANY INSURED WHEN REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Sec- tion IV – Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Endorsement No. (NAME OF INSURANCE COMPANY) issued to RSVC COMPANY Premium (if any)$ Authorized Representative 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 %of the California workers’compensation pre¬ mium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED,EXECUTED PRIOR TO THE ACCIDENT OR LOSS,THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND/OR ORGANIZATION WC 252 (4-84) WC 04 03 06 (Ed.4-84)Page 1 of 1 Policy No. WC 2398190 — 01 of the Zurich American Insurance Company WORKERS’ COMPENSATION AND EMPLOYERS’ LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following “attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 09/01/2024 at 12:01 A.M. standard time, forms a part of (DATE) LD24-4338 LD24-4338