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2011/08/01 All American Asphalt Certificate of Liability InsuranceACC) E ® CERTIFICATE OF LIABILITY INSURANCE D/DD/Y7/25 07/25/2011 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 LIC #OB29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [Orange Branch] CONTACT Certificate Department NAME: P AICNN. E (925) 244-7700 aC No): 901-0671 ADDRESS: EPICcerts@Edgewoodlns.com . P.O. Box 5003E-MAIL: INSURERS AFFORDING COVERAGE NAIC # San Ramon, CA 94583 A: ARCH SPECIALTY INS CO 21199 AUGINSURER INSURED B: HARTFORD FIRE IN CO 19682 All American Asphalt ' -INSURER INSURER CNATIONAL UNION FIRE INS CO OF PITTS 19445 INSURER D: SEABRIGHT INS CO 15563 P.O. Box 2229 INSURERE: Corona, CA 92878-2229 INSURER F : COVERAGES CERTIFICATE NUMBER: 22418742 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 ADDL SUBR POLICY NUMBER POLICY EFF JMMIDDffYYYI POLICY EXP I (MMIDDIYYYY)LIMITS A GENERAL LIABILITY GPP002265803 08/01/1 08/01/13 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FTI OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 100, 000 MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OPAGG 1 $ 2,000,000 X - LOC 1-1 POLICY PRO $ B AUTOMOBILE LIABILITY 72UENGK5491 08 Ol 1 08/01/12 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS IPeraccidenl BODILY INJURY (Per accident) S X PROPERTY DAMAGE S NON -OWNED HIRED AUTOS X AUTOS S C UMBRELLA LIAB X OCCUR BE21422933 08/01/1 08/01/12 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 10, 000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / NDRY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? FN NIA BB1110243 08/01/1 08/01/12 X WC STATU- OTH- LIMFP E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE 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 / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: Bradley Road and Encanto Road Street Rehabilitation Ill Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation 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 q j�j2 I USA 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) ztalebzadeh-org 22418742 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 orthe 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 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 the preparation of the policy.) Policy Number: GPP0022658-03 Named Insured: All American Asphalt Endorsement Effective Date:8/1/11 00 CGL0006 00 05 07 Project Page 1 of 1 2419