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2013/08/01 All American Asphalt Certificate of Liability InsuranceACi?RhIP CERTIFICATE OF LIABILITY INSURANCE D07/22IDDIY 07/22/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT& UPON' THE I ERTIFICATE 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 BETWE NTH IV, INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. tf @ebl� 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 LIC #OB29370 1-925-244-7700 Edgewood Partners insurance Centers (EPIC) [Irvine Branch] CONTACT Certificate Department p PHONE FAX c No Ell, (925) 244-7700 AIc No: (925) 901-0671 E-MAADDRESS: EPICcerts@EdgewoodIns.com P.O. Box 5003 INSURERS AFFORDING COVERAGE NAIC # San Ramon, CA 94583 INSURER A: ARCH SPECIALTY INS CO 21199 INSURED All American Asphalt INSURER B : ZURICH AMER INS CO 16535 INSURER CNATIONAL UNION FIRE INS CO OF PITTS 19445 INSURERD: P.O. Box 2229 INSURERE: Corona, CA 92878-2229 INSURER F : COVERAGES CERTIFICATE NUMRFR- 34851846 RFVISION 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 MMIDD/YYYY POLICY EXP MM/DDIYYW LIMBS A GENERAL LIABILITY GPP002265805- 08/01/1 08/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rTI OCCUR DAMAGE T RENTED PREMISES RENT occurrence) $ 100,000 MED EXP (Any one person) $ PERSONAL BADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG S 2,000,000 POLICY M PRO- LOC I I S B AUTOMOBILE LIABILITY BAP557108801 08 Ol 1 08/01/14 COMBINED SINGLE LIMIT Ea accident $ 2, 000, 000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS Ix BODILY INJURY (Per accident) S PROPERTY DAMAGEHIRED Per accident $ NON -OWNED AUTOS X AUTOS(Fare $ C UMBRELLA LIAB X OCCUR BE11665540 08/01/1 08/01/14 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DIED I X I RETENTION$ 10, 0 00 Following -Form $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORRARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN] N / A WC593205700 08/01/1 08/01/14 X WC ITORYLIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE S 1,000,000 (Mandatory In NH) if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 (:tK I Itl(:A1 t HULULK 'City of Menifee 29714 Haun Road Menifee, CA 92586 ACORD 25 (2010/05) AHilgen-IRV 34851846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE USA CA- ©1988-2010 ACORD CORPORATION. All rights reserved. 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 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 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 slated herein (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Policy Number: GPP0022658-05 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/13 00 CGL0006 00 05 07 Page 1 of 1 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 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: GPP0022658-05 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/13 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 Project City of Menifee, Its officers, fficials, employees, agents and RE: Bradley Road and Encanto Road Street volunteers Rehabilitation 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: GPP0022658-05 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/13 00 CGL0121 00 09 06 Includes Copyright Material from Insurance Services Office, Inc., with its permission. Page 1 of 1 2451 WORKERS' COMPENSATION AND EMPLOYERS` LIABILITY INSURANCE POLICY :1C 04 L13'0'u (Ed. 4•81 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 belota. r-i= , cr.-&_ "at=- �Tr7 C e" ne-_7 -- -o�:,etad o-y �n_n tn.� _r.=r. _..� ._ .S3:.i•d aibB .-_-.„0 3 _pa-��jjn of --- pn :Zy.) This endorsement, effective on t15;i11?pt Policy No. :^<<C 5932057-00 of the Zurich American Insurance Company issued to all American Asphalt at 12:U i A.fvl. standard time, fors a part of NA%iE DF 1`J5UR4NCE CO!.1PANY1 We have the right to recover our payments from arn;one 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 mium otherwise due on such remuneration. Schedule Person or Organization City of Menifee, Its officers, fficials, employees, agents and volunteers W-- 25 {4-51 ) WC CW Qs 06 -Zd. 4-5,1) % of the California workers' compensation pre - Job Description RE: Bradley Road and Encanto Road Street Rehabilitation ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACTOR 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. Fare Gi ? 2451