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2017/08/01 All American Asphalt Certificate of Liability InsuranceACC)R0 CERTIFICATE OF LIABILITY INSURANCE rATE(MMIDDtYYYY) /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 Box 5003 CONTACT Certificates Department PHONE (925) 244-7700 FAX 925 901-0671 C No Ext: A/C No: ( ) E-MAIL EPICcerts@ep icbrokers.com ADDRESS: picbrokers.com 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 CAMERICAN GUAR & LIAB INS 26247 INSURERD: P.O. Box 2229 INSURER E : Corona, CA 92878-2229 INSURERF: 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 I TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY DPC100585601 08/01/17 08/01/18 EACH OCCURRENCE $ 1,000,000 CLAIMS a OCCUR DAMAGE TO RENT - Ea occurrence) $ 100,000 -PREMISES MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BAP557108805 08/01/17 08/01/18 COMBINED SINGLE LIMIT Ea .cadent $ 2,000,000 ANY AUTO X BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ C UMBRELLA LIAB X 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$ 10,000 Following -Form $ B ANDEMPS EMPLOYERTIONS' AND EMPLOYERS' LIABILITY WC593205704 08/01/17 08/01/18 X STATUTE ERH Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N / A E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in If yes, describe under and E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Murrieta Road Resurfacing (Rouse to Ethanac Road) Capital Improvements Project No. 18-02 Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation [21 '— — UJA1Vl•CLLJA I IUM 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�/,//��/,�. USA © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MBuck-ie 50760230 MEMO To: Whom it may concern From: Edgewood Partners Insurance Centers (EPIC) Named Insured: All American Asphalt, etal Policy Number(s): DPC100585601; BAP557108805; WC593205704; SXS019797001 RE: Notice of Cancellation Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, Kathy Lopek Account Manager tel: 925.244.7700 3000 executive parkway, suite 325, san ramon, ca 94583 ca license OB29370 epicbrokers.com THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the follo%img- COly MERCIAL GENERAL LIABiLiTY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF -INSURED RE'T`ENTiON COVERAGE FORM SECTION 11 — WHO 15 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 suocontractors: A. In the performance of your ongoing operations or "your vrork", including "your vrc-k" that has been completed; or B, In connection with your promises owned by or rented to you. As used in this endorsement, tie words you" and "your" refer to the Named Insured. All other terms: and conditions of this P6icyr remain unchanged, Schedule Project City of Menifee, and its elected officials, officers, employees, Murrieta Road Resurfacing (Rouse to Ethanac Road) agents, representatives, consultants, contract employees and Capital Improvements Project No. 18-02 volunteers. Endorsement Number: This endorsement is effeciive on the inception [Tall(: of this po'icy unless otherwise stated herein. (The infor.niation bela"s 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 4913 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 follo%Mncg- COMMERCIAL GENERAL LIABILITY COVERAGE FORMS 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-oontributory, and the written contract so requiring is executed by the Named Insured befom arty "occurrence" or offense, this insurance will be primary, tut ony if and to the extent required by that written contract All other terms and conditions of this Policy rernain unchanged. Schedule City of Menifee, and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers. Endorsement Number Project Murrieta Road Resurfacing (Rouse to Ethanac Road) Capital Improvements Project No. 18-02 This eryforsemeni is effective on the inception data of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy) Po'icy Number: DPC100585601 Named insured: All Amer can Asphalt et at Endorsement Effective Date August 1, 2017 00 CGL0130 00 09 06 Page 1 of 1 4913 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION ENDORSEMENT This endorsement modifies insurance provided under, tine follow=ng� COMMERCIAL GENERAL LiAB!LiIY COVERAGE FORM COMMERCIAL GENERAL LABILITY SELF -INSURED RETENTION COVERAGE FORM SCHEDULE Name of Person or Organization: VVnere 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 foptwing provision: We waive any right of recovery we may have against the person or organization shown in the SCHEDULE above because of payments m 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 terns and conditions of this Pdcy remain unchanged. Schedule Project City of Menifee, and its elected officials, officers, employees, Murrieta Road Resurfacing (Rouse to Ethanac Road) agents, representatives, consultants, contract employees and Capital Improvements Project No. 18-02 volunteers. Endorsement Number: This endorsement is effective on the inception date of this po!!cy unless otherwise. stated herein. (The 'info rmation below is required only wizen this endorsement is Issued subsequent to preparation of the policy.) Policy Number..* DPC100585601 Named Insured: All American Asphalt at al Endorsement Effective Date: August 1, 2017 00 CGLO121 00 09 06 Includes copyrighted material of insurance Services Office, tile., Page 1 of 1 with Its permission. 4913 POLICY NUMBER BAP557108805 COMMERCIAL AUTO CA20480299 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifier insurance provided under the following: BUSINESS AUTO COVERAGE FOR10 CzARAGE CO'ERAGE FORki IAOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM "ddh 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 organizations) who are 'insureds" under the 'Rho 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 elate is indicated below. Endorsement EffErtive: 8 / 1 / 17 Countersigned By: (Authorized Representative) Named Insured: All American Asphalt; SCHEDULE Naii-e of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TtiHICH YOU ARE REQUIRED TO PROVIDE ADDITI-0,NtL INSURED STATUS C,P. ADDITIONAL INSURED STATUS ON A PRIMARY, NON —CONTRIBUTORS BASIS, III WRITTEN CONTRACT CIR •iRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Schedule Project City of Menifee, and its elected officials, officers, employees, Murrieta Road Resurfacing (Rouse to Ethanac Road) agents, representatives, consultants, contract employees and Capital Improvements Project No. 18-02 volunteers. (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 organizeion shown in the Schedule is an 'insured" for Liability Coverage, but only to the extent th,,t person or organizlion qualifies as an 'insured" under the b49ao Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 48 02 99 Copyright. insurance Services Office. Inc., •19% Page 1 of 1 0 4913 POLICYNUMBER BAP557108805 COMMERCIAL AUTO CA 04 44 0310 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the folio,„ling: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FOPM TRUCKERS COVERAGE FORf.4 :Aldh respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on thein,eption date of the polivy unless another date is indi,ated below. Named Insumd: All American Asphalt Endorsement Effective Dafae: 8 / 1 / 17 SCHEDULE Name(s) Of Person(s) Or Organ¢ation(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE RED}UIRED BY WRITTEN CONTRACT OR AGREEMENT l'iITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT •7AITlER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above. will be shown in the Declarations. The Transfer Of Rights Of Recovery A.gaaast Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the ",-c- cident" or the "loss" Linder a contract with that person or organization. Schedule City of Menifee, and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers. Project Murrieta Road Resurfacing (Rouse to Ethanac Road) Capital Improvements Project No. 18-02 4913 CA 0444 0310 Q Insurance Services Off i,e. Inc., 2009 Page 1 of 1 0 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 0306 (Ed. 4,84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-- CALI FORNIA Vtiq have the right to ra,,over our payn>rnts from anyone liable for an injury covered by this poll>y. )P.t will not enforce our right against the person or organization nand 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 endorsen-ent shall be 0. fro % of the California workers' compensation pre- mium otherwise due on such 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 SCIWIule Join DescrkAon ALL CA OPERATION City of Menifee, and its elected officials, officers, employees, agents, representatives, consultants, contract employees and volunteers. All American Asphalt Policy #WC593205704 8/1/17 Murrieta Road Resurfacing (Rouse to Ethanac Road) Capital Improvements Project No. 18-02 Zurich American Ilis. Co. %NC 252 (3$4) 4913 WC 04 03 06 (Ed. 4-84) Page 1 of 1