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2017/08/01 All American Asphalt Certificate of Liability Insurance (3)A� V� CERTIFICATE OF LIABILITY INSURANCE D 7/12 /DDn7 07/12/2017 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 - Branch ID 145421 P.O. Box 5003 CONTACT Certificates Department PHONE FAX c o (925) 244-7700 A/c No: (925) 901-0671 E-MAIL icbrokers.com EPICcerts@e ADDRESS: EPICcerts@epicbrokers.com AFFORDING COVERAGE NAIC # INSURER A: ARCH SPECIALTY INS CO 21199 San Ramon, CA 94583 INSURED All American Asphalt INSURERB: ZURICH AMER INS CO 16535 INSURER C: AMERICAN GUAR & LIAB INS 26247 INSURERD: P.O. Box 2229 INSURER E : INSURERF: Corona, CA 92878-2229 COVERAGES CERTIFICATE NUMBER: 50340801 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 INSURANCEINSD_WkPOLICY ADDL SUBR NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR DPC100585601 08/01/17 08/01/18 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occunence $ 100, 000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY PEI° LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG 1 $ 2,000,000 Is OTHER: B AUTOMOBILE LIABILITY BAP557108805 08/01/17 08/01/18 COMBINED SINGLE LIMIT Ea accident $ 2 000, 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS NON -OWNED AUTOS L PROPERTY DAMAGE Per accident $ $ C UMBRELLA LIAR NX OCCUR SXS019797001 08/01/17 08/01/18 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 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUI r N / A WC593205704 08/01/17 08/01/18 X STATUTE OERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Project #CIP 16-12 / RE: Briggs Road Resurfacing / Menifee, CA / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation [2] Ii M I IrlI. I G nvLUCR %,A1YliCLL11 I JUN 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 I USA ACORD 25 (2014/01) DCannon-ie 50340801 ©1988-2014 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-INSUREp RETENTION COVERAGE FORM SECTION II — WHO 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 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 your premises owned by or rented to you. As used in this endorsement, the wordsyou" and "your" refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Schedule Project City of Menifee Project #CIP 16-12 / Briggs Road Resurfacing / Menifee, CA 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 DPC100585601 Named Insured: All American Asphalt et al Endorsement Effective Date: August 1, 2017 4431 00 CGL0006 00 05 07 Page t 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 will be primary, but only If and to the extent required by that written contract. All other terms and conditions of this Policy remaln unchanged. Schedule Project City of Menifee Project #CIP 16-12 / Briggs Road Resurfacing / Menifee, CA 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: DPC100585601 Named Insured: All American Asphalt et al Endorsement Effective Date August 1, 2017 00 CGL0130 00 09 06 Page 1 of 1 4431 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided under the follovAng: 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 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. Schedule Project City of Menifee Project #CIP 16-12 / Briggs Road Resurfacing / Menifee, CA 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: DPC100585601 Named Insured: All American Asphalt et al Endorsement Effective Date: August 1, 2017 00 CGLO121 00 08 06 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with Its permission. 4431 POLICYNUMBER: BAP557108805 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORIO GARAGE COVERAGE FORIO MOTOR CARRIER COVERAGE FORIA TRUCKERS COVERAGE FOMI 'Nth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are 'Insureds" under the %Nbo Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorserrrnt Effective: 8/l/17 Countersigned By: (Authorized Re resentatitre) Named Insured: All American Asphalt 6?9:I41111" Nam of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR i'iHICH YOU ARE REQUIRED TO PR(YVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIPJARY, NON—CONTRIBUTORY BASIS, IN A ivRITTEN CONTRACT OR ►•iRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Schedule Project City of Menifee Project #CIP 16-12 / Briggs Road Resurfacing / Menifee, CA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an 'Insured" for Liability Coverage, but only to the extent that person or organization qualifies as an 'Insured" under the 'Alho Is An Insured Provision contained in Section II of the Coverage Form. CA 2048 02 99 Copyright, Insurance Services Office, Inc., 19%4 Page 1 of 1 ❑ 4431 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 44 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA 'Rt- have the right to recover our payments from anyone liable for an injury cover&J by this policy. 'Ale will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to tip 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 Scheduia. The additional premium for this endorsement shall be 0.00 % of the California workers' compensation pre- mium oti-erv.ise due on such remuneration. Schedule Person or Organizabon Job Descrk%on ALL PERSONS AND/OR ALL CA OPERATION 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 City of Menifee Project #CIP 16-12 / Briggs Road Resurfacing / Menifee, CA All American Asphalt Policy #WC593205704 8/1/17 Zurich American Ins. Co. WC 2-52 (4-M) VVC C4 03 06 (Ed. 4-84) Page 1 of 1 4431