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2012/08/01 All American Asphalt Certificate of Liability InsuranceAOC RO L? CERTI r°, • f N(VVV-F` 07/25/2012 THIS CERTIFICATE IS ISSUED AS A MA I S PON kFf C ER`fl�l�i>iTE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVE I L ERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURA HE IS 1�1(a,l.81Wg%S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. Yii ��// 1411 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 CONTACT NAME: Certificate Department Edgewood Partners Insurance Centers (EPIC) PHONE (g25) 244-7700 aC No; (925) 901-0671 [Irvine Branch] A/C No Ext: P.O. Box 5003 Ai RIESS: EPICeerts@Edgewoodlns.com San Ramon, CA 94583 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: ARCH SPECIALTY INS CO 21199 INSURED INSURER B : ZURICH AMR INS CO 16535 All American Asphalt INSURER CNATIONAL UNION FIRE INS CO OF PITTS 19445 P.O. Box 2229 INSURERD: SEABRIGHT INS CO 15563 INSURER E : Corona, CA 92878-2229 INSURER F I�f•�T 11 I1�ATC kn IRA MOM. 1aRF\/IRUIN NIIMRPR- vTHIS 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/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY GPP002265804 08/01/1 08/01/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100, 000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS -MADE Fil OCCUR PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 $ POLICY I 1 jEC PRO- n LOC B AUTOMOBILE LIABILITY BAP557108800 OS Ol 1 08/01/13 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOAUTOS X HIRED SAUTOS X AUTOSNON-O (Per PROPERTY Pena accident) $ C UMBRELLA LIAB OCCUR BE14505355 08/01/1 08/01/13 EACH OCCURRENCE $ 101 000, 000 �{ N AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10, 000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N/A BB1120243 08/01/1 08/01/13 X I TOCS IIT OR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under 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 (;EK I WIGA I It HL)LUtK l+A1Y l'CLLN I IV111 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 1 USA O 1yt$ti-ZU1U AGUKU GUKYUKAI IUIV. Au ngn15 FUbUI VCu. t@IC(,R9. 91VIM 3000 executivETR99§ML�aj2YPYLRgr&f?f8f#e&,:099"f"aq�$nse OB29370 edgewoodins.com 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 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 the preparation of the policy.) Policy Number. GPP0022658-04 Named Insured: All American Asphalt Endorsement Effective Dale: 8/1/12 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: GPP0022658-04 Named Insured: All American Asphalt Endorsement Effective Date: 8/1/12 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: GPP0022658-04 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/12 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 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 City of Menifee, Its officers, fficials, employees, agents and RE: Bradley Road and Encanto Road Street 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 Califomia, 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 8/1/12 Policy No. BB1120243 Endorsement No. Insured All American Asphalt Policy Effective Date 8/1/12 Insurance Company Seabright Insurance Company Countersigned By �^_D WC 04 03 06 / (Ed. 4-84) ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. 2451