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2010/08/01 All American Asphalt Certificate of Liability InsuranceDDFYY ACORD,, CERTIFICATE OF LIABILITY INSURANCE 1 D 0/246/24 /011 /2011 Y) PRODUCER LIC #OB29370 1-925-244-7700 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edgewdod Partners Insurance Centers (EPIC) ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE [orange Branch] tag s ;� ? �a J HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 5003 oT r �` I E I ' �' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Ramon, CA 94583 EPICcerts®edgewoodins.com JUN 2 0 ^�j+ E t( INSURERS AFFORDING COVERAGE NAIC# INSURED All American Asphalt �� �)/�is, e c oe iVd' P.O. Box 2229 Corona, CA 92878-2229 INSURERA:ARCH SPECIALTY INS CO 21199 INSURER B: HARTFORD FIRE IN CO 19682 INSURER C: NATIONAL 'UNION FIRE INS CO OF PITTS 19445 INSURER D: SEABRIGHT INS CO 15563 INSURER E: rOVFRArFS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPEOFINSURANCEpOLICYNUMBER POLICOATEY EFFECTIVE ID POLICY1 EXPIRATION NYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FKOCCUR GPP002265802 08/01/10 08/01/12 EACH OCCURRENCE 1$100,000 $1,000,000 DAMAGE To RENTED PRFMIS _I E.occurence MED EXP (Anyone person) $ PERSONAL& ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIESPER: POLICY X PRO-- LOC PRODUCTS-COMP/OPAGG $2,000,000 B AUTOMOBILE LIABILITY ANYAUTO ALL OW NED AUTOS SCHEDULEDAUTOS HIREDAUTOS NON-OWNEDAUTOS 72UENGK5491 08/01/10 08/01/11 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X BODILY I NJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT $ OTHERTHAN EAACC AUTOONLY: AGG $ $ C EXCESS/UMBRELLA LIABILITY X I OCCUR CLAIMSMADE HXDEDUCTIBLE RETENTION $ 10, 000 7521507 08/01/10 08/01/11 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $10,000,000 $ $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? If yes, describe under SPECIAL PROVISIONS below BB1100243 08/01/10 08/01/11 X WCYTAIT- OTR- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: Bradley Road and Encanto Road Street Rehabilitation [1] Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation L;hKTIFIGAI E HULDEK GANGtLLA I IUN Ten Day Notice for Non-rayment oz rremium SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Menifee DATE THEREOF, THE ISSUING INSURER WILL i(V6 MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, �ll_�(1yf�il�4.X 29714 Haun Road Menifee, CA 92586 XptmmmXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX� AUTHORIZED REPRESENTATIVE — n USA ACORD 25 (2001/08) KQuinn-ORG ©ACORD CORPORATION 1988 21938587 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF -INSURED RETENTION COVERAGE FORM SECTION II — WHO IS INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with you to be named as an additional insured, but only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: A. In the performance of your ongoing operations or "your work", including "your work" that has been completed; or B. In connection with premises owned by or rented to you. As used in this endorsement, the words "you" and "your" refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Schedule The City of Menifee, Its officers, fficials, employees, agents and volunteers Endorsement Number: Project RE: Bradley Road and Encanto Road Street Rehabilitation This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: GPP002265802 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/10 00 CGL0006 00 05 07 2451 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE — BROAD FORM, CGL POLICY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF -INSURED RETENTION COVERAGE FORM Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, the following paragraph is added to Condition 4. Other Insurance: Where the Named Insured is required by a written contract to provide insurance that is primary and non-contributory, and the written contract so requiring is executed by the Named Insured before any "occurrence" or offense, this insurance will be primary, but only if and to the extent required by that written contract. All other terms and conditions of this Policy remain unchanged. Schedule The City of Menifee, Its officers, fficials, employees, agents and volunteers Endorsement Number: Project RE: Bradley Road and Encanto Road Street Rehabilitation This endorsement is effective on the inception date of this policy unless otherwise stated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: GPP002265802 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/10 00 CGL0130 00 09 06 Page 1 of 1 2451 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF -INSURED RETENTION COVERAGE FORM Project Schedule The City of Menifee, Its officers, fficials, employees, agents RE: Bradley Road and Encanto Road Street Rehabilitation and volunteers Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 8. Transfer Of Rights of Recovery Against Others to Us is amended by the addition of the following provision: 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 operations or "your work" done under a written contract with that person or organization. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: GPP002265802 Named Insured: All American Asphalt Endorsement Effective Date: 08/01110 terial from Insurance Services Office, Inc. Page 1 of 1 00 CGLO121 00 09 06 Includes Copyright Ma 2451 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 premium otherwise due on such remuneration. Schedule Person or Organization Job Description The City of Menifee, Its officers, fficiais, employees, RE: Bradley Road and Encanto Road Street agents and volunteers Rehabilitation WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 8/1/10 Policy No. BB1100243 Endorsement No. 12 Insured All American Asphalt Policy Effective Date 8/1/10 Insurance Company Seabright Insurance Company Countersigned By i' WC 04 03 06 (Ed. 4-84) ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. 2451