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2014/08/01 All American Asphalt Certificate of Liability Insurance
,a ©� CERTIFICATE OF LIABILITY INSURANCE D06/30/2014/DD/Y6/30 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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). PRODUCER CA LIC #OB29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Inland Empire/Ontario Branch] �, P.O. Box 5003 G t:a�,,y ) R i�r P ('1 ��yC,;, `e-� !! �f CONTACTME: Certificate Department PHCNNo , (925) 244-7700 aC No: (925) 901-0671 E-MAIL ADDRESS: EPICcerta@EdgewoodIna.com INSURERS AFFORDING COVERAGE NAIC# San Ramon, CA 94583 INSURERA: ARCH SPECIALTY INS CO 21199 INSURED AUG 84 All American Asphalt P.O. Box 2229 INSURER B: ZURICH AMER INS CO 16535 INSURER CNATIONAL UNION FIRE INS CO OF PITTS 19445 INSURERD: INSURERE: Corona, CA 92878-2229 INSURER F : COVERAGES CERTIFICATE NUMBER: 40503575 RFVI.glnN NIIMRFR• 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A GENERAL LIABILITY GPP002265806 08/01/1 08/01/15 EACH OCCURRENCE S 1,000,000 MMERCIAL GENERAL Lri�IABILITY PLI CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 100,000 MED EXP (Any one person) S PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY T PRO- JECTLOC $ B AUTOMOBILE LIABILITY BAPS57108802 08 Ol 1 08/01/15 COMBINED SINGLE LIMIT Ea accident 2,000,000 BODILYINJURY(Perperson) S ANY AUTO ALL OWNED SCHEDULEDBODILY AUTOS AUTOS Ix INJURY Per accident ( )HIRED S AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident S S C UMBRELLA LIAB X OCCUR BE11665589 08/01/1 08/01/15 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10, 0 0 0 Following -Form S 1 B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ N / A WC593205701 08/01/1 08/O1/15 X WCSTATU- OTH- E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) RE: Bradley Road and Encanto Road Street Rehabilitation [1] Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation [2] v�r� rrwM r c nvw�rc L ANUr LLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 29714 Haun Road AUTHORIZED REPRESENTATIVE �` //�� Menifee, CA 92586 C � USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ahilgen-ont 40503575 MEMO To: Whom it may concern From: Edgewood Partners Insurance Centers (EPIC) Named Insured: All American Asphalt et al Policy Number(s): GPP0022658-06, BAP5571088-02, WC5932057-01, BE11665589 RE: Notice of Cancellation Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Kathy Lopes Account Manager tel: 925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license OB29370 edgewoodins.com t7�""'-�--R-•a^..-..-F-r--+•r�5-x-+�..�r^^^xF-'�^�-T-,-�n -�-�.^y-� :_:..,�¢.m..'�.�.'.. �':.y.._-.b:,;..x ._,...,.tA.-,-,�-_._-,. 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 AN INSURED is amended to include as an additional insured these persons or organizations who are required under a written contract with you to be named as an additional insured, but only with respect to flablilty for "bodlty injury, 'property damage". or "personal and advertising injury" caused, in whole or in part, by your acts or omissions o- the acts or omissions of you: subcontractors: A, 'n the performance of your ongoing operations car "your woo, including "your work" that has been completed; or B. In ccn riection Wth ycur premises owned by or rented to you. As used in this endorsennent, the words "you' and "your" refer to they Named insured. All other tarns and conditions ofrhis Policy remain unchanged. Schedule Project City of Menifee, Its officers, fficials, employees, agents and RE: Bradley Road and Encanto Road Street volunteers Rehabilitation Endorsement Number. This endcrser,nent is effective on the inception date ofilhis pcHey unless otherwise stated herein. ;7he information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Policy Number- GPP0022658-0 Named insured: Ali ,American Asphalt et al Endorsement Effective Date: August 1, 2014 2451 00 CGLOOO6 GO 0, 07 Page 1 of t THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. {OTHER INSURANCE - BROAD FORM, CGL POLICY ENDORSEMENT This enclorsoment modifies insurance provided under1;,w folioWng7 COMMERCIAL GENERAL LIABILITY COVERAGE FORM Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, the foilov.ing paragraph is added to Condition 4.Other Insurance: Where the Named insured is required by a written contract to provide insurance that is prirrarj and non-contribLdc;ry, and the written contract so requiring is executed by tree Named Insured beiore any "occurrence" or offense, th.s insurance will, be primary, but only if arri to the extent required by 1hatwrttten contract. All other terms and conditions of this Policy remain unchanged. Schedule 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 an the inception date of this policy unless otherwise stated herein. tThe information helm-i is required only when this endorsement is issued subsequent to preparation of the policy,) Policy Number- GPP0022658-06 Named Insured: All American Asphalt et al Endorsement Effective fate Aucrust 1, 2014 OG' CGI-0130 00 09 t16 Page 1 of 1 2451 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided urAertne foliovoing- COhr MERCIAL GENERAL LIABILITY COVERAGE. FORM, COMI%lERCIAL GENERAL LIABILITY SELF -INSURED RETENTION COVERAGE FORM SCHEDULE Name of Person or Organization: inhere-equired by written cunt.act. Under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Condikion 8. Transfer Of Rights Of Recovery Against Others To Us is armended by the addition of tine faiiorving provision: ?tire 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 pen on or organization. All ether terms and condltlons of this Policy remain unchanged. Schedule Project City of Menifee, Its officers, fficials, employees, agents and RE: Bradley Road and Encanto Road Street volunteers Rehabilitation 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 c-ollcy,) Policy Number- GPP0022658-06 Named insured: M American Asphalt at al Endwsernent Effective Date: Aucrust 1, 2014 00 C,GLO1211 00 00 06 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with Its permission. 2451 WORKERS' COMPENSATION AND, EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 W ( Ed . 4-a4) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-- CALIFORNIA 'At have the right to recover our paynl✓nts from anyone liable for in injury covereJ by this policy. t- v4ll not enforce our right against the r-rs•on or on7ani7,ation nan-►--d in the Schedule. (This agreement apl?Ii�--s Only to tl)r-- Extent tllat YOU �lerfofni work under a .vritten contract that require: you to obtain this agreement from us.) You must maintain 1xivroll rdcordS accurately se;1regating the remuneration of your employees while engaged in the .vork described in the Schedule. The additional prenliUrn for this endorselrent shall be 0. 00 of the California workers' compensation pre- miunl otl-P-l" ise due nil SUCK remuneration. Person or Organization 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 Scliedules Job Desct-q)tion ALL CA OPERATION City of Menifee, Its officers, fficials, employees, agents and volunteers All Aineric,aii Asplialr P,-lic_y 4WC593205;-01 1,''14 i°iC 2`2 (4-P.41 W*': N 03 Od iEd. 4-84 ) RE: Bradley Road and Encanto Road Street Rehabilitation Zliricli Anieric 3Ii In-s, . Co. . Page 1 of 1 2451