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2016/08/01 All American Asphalt Certificate of Liability InsuranceALCC>R�® �../ CERTIFICATE OF LIABILITY I�I9URp►N�EE�) ee DATEI D,/12/212/201616 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 AL*WGTO -bCMVGE 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 ber SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on• {(GIs 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 - Branch ID 145421 P.O. Box 5003 CONTCONTACT Certificates Department PHONE FAX AI No Ex (925) 244-7700 (AIC No: (925) 901-0671 E-MAIL p'1 ADDRESS: EPICCerts@ecbrokers.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: ARCH SPECIALTY INS CO 21199 San Ramon, CA 94583 INSURED INSURERB: ZURICH AMER INS CO 16535 All American Asphalt INSURER C: AMERICAN GUAR & LIAB INS 26247 INSURER D: P.O. Box 2229 INSURER E : INSURERF: Corona, CA 92878-2229 COVERAGES CERTIFICATE NUMBER: 47374932 REVISION NUMBER: 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 ANDD SUED POLICY NUMBER MM DPOLIDIYYYY Y EFF CY EXP MMLDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY DPC100585600 08/01/16 08/01/17 EACH OCCURRENCE S 1,000,000 OCCUR DAMAGCLAIMS-MADE PREMISERENTED TO.occu" PREMISE S Ea occurrence S 100,000 MED EXP (Any one person) S PERSONAL & ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I S 2,000,000 POLICY a PEA LOC PRODUCTS - COMP/OPAGG I S 2,000,000 S OTHER: B AUTOMOBILE LIABILITY BAP557108804 08/01/16 08/01/17 COMBINEDSINGLE LIMIT Ea accident S 2,000,000 BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCAUTOS HEDULED AUTOS IHIRED BODILY INJURY (Per accident) S NON -OWNED AUTOS AUTOS PROPERTY DAMAGE Per accident S S C UMBRELLA LIAB X OCCUR SXS019797000 08/01/16 08/01/17 EACHOCCURRENCE $ 10,000,000 I AGGREGATE S 10, 000, 000 X EXCESS LIAB CLAIMS -MADE DED I X I RETENTIONS 10,000 Following -Form $ B ANDEMPSYERS'LIAILITTION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N NIA WC593205703 08/01/16 08/01/17 X STATUTE ERPER H E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE- FA EMPLOYE S 1, 000, 000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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] CERTIFICATE HOLDER CANCELLATION 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 CA- I USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) DCannon-ie 47374932 The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies Insurance provided under the folioving: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF -INSURED RETENTION COVERAGE FORM SECTION Il —'WIHO IS AN 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 adver6sIW Injury' caused, In whole or In part, by your acts or ornlssions 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 your 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 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 Movr Is required only when this endorsement Is Issued subsequent to preparation of the policy.) Policy Number DPC100585600 Named Insured: All American Asphalt et al Endorsement Effective Date: August 1, 2016 2451 00 CGL0006 00 05 07 Page 1 of 1 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 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 wilt be primary, but only If and to the extent required by thatwritten contract All other terms and conditions of this Policy remaln 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 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: DPC100585600 Named Insured: All American Asphalt at al Endorsement Effective Date August 1, 2016 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 SCHEDULE Name of Person or Organization: Where required by written contract. Under SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition IL Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the folloyng 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 Polley 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 policy.) PollcyNumber. DPC100585600 Named Insured: All American Asphalt et al Endorsement Effective Date: August 1, 2016 00 CGLO121 00 09 06 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with Its permission. 2451 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY i(tibC 04 43 06 (Ed, ±a WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT=- CALI FORNIA 'Ab have the right to recover Our 1 q(wents from anyone Iiiblo--a for an injury covere l by this polio;:.:^eke V.ill not enforce Off right against the person or nrganiDution nall,=i In the SchedLlle. iThls agnKenlent apples only to thin extent th._at youi perform iaork un.ler a v ritten contract that requires to obtain this agreement from us,) You must mwintain payroll records WCUrately segregating the remuneration of your enlplcyz~s v.hlle engaged i11 the,. ork described in the Schledule. Tile additional prenliuni for this eandrorsenrnt Shall be 0. GQ % of the California workers' compensation pre- mium otlyer'..,Jse due on SLICII 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 Schecklle Job Description ALL CA OPERATION City of Menifee, Its officers, fficials, employees, agents and volunteers All American Asphalt Policy #WC593205703 8/1/16 RE: Bradley Road and Encanto Road Street Rehabilitation Zurich American Ins. C''•o . WC 252 (4-8}) VvC 04 03 06 (Ed. 4-84) Page 1 of 1 2451