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2018/08/01 All American Asphalt Certificate of Liability InsuranceACORN® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 9/13/2018 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 have ADDITIONAL INSURED provisions or 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 Edgewood Partners Insurance Center P.O. Box 5003 San Ramon, CA 94583 NAME: CT Certificates Department AICNNo EXt : 925-244-7700 FAAic No): 925-901-0671 E-MAIL ADDRESS: EPICcertS a icbrokers.com INSURERS AFFORDING COVERAGE NAIC # www.epicbrokers.com CA LICENSE #01329370 INSURERA: Arch Specialty Insurance Company 21199 INSURED All American Asphalt P.O. BOX 2229 INSURER B: Zurich American Insurance Companv 16535 INSURERC: American Guarantee and Liability Ins Co 26247 INSURERD: Corona CA 92878 INSURER E : INSURER F : GUVLKALitN CFRTIFICATF NIIMRFR• AA4RAR1R DF\/ICInK1 All IMRCD- 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A �/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR �/ �/ DPC1005856-02 City of Menifee City Clerk t S ^� 17 0 -„ _ 8/1/2018 8/1/2019 EACH OCCURRENCE S1,000,000 DAMAGE PREMISES Ea ON $100,000 MED EXP (Any one person) S PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ✓❑ JJECT LOC OTHER: GENERAL AGGREGATE 52,000,000 PRODUCTS - COMP/OP AGG 52,000,000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS NON -OWNED AUTOS ONLY ✓ AUTOS ONLY ✓ ✓ BAP5571088-06 .��.-� 8/1/2018 8/1/2019 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 ✓ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S ✓ Pe�IRED �ac PROPERTY S 5 C UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE ✓ V, SXS019797002 8/1/2018 8/1/2019 EACHOCCURRENCE 55,000,000 ✓ N AGGREGATE S 5,000,000 DED ✓ RETENTION$10,000 Following -Form Is B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMBER EXCLUDEANYPROPRIETORIPARTNERD? ECUTIVE � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A ✓ WC593205705 8/1/2018 8/1/2019 ,/ STATUTE EORH E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1 ,000,000 E.L. DISEASE - POLICY LIMIT S1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) #30709-2 / RE: Forterra Street Rehabilitation - City of Menifee / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation 11r_M 1 I1"IL1A I C NULUCh( UANULLLA I IUN Cityy of Menifee 29714 Haun Road Menifee CA 92586 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 Certificates Department ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 44184636 1 18 (011 Standard with $5= XS I Maritza Ornelas 1 9/13/2018 11:47:03 AM (PDT) I Page 1 of 4 1919HIM PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901-0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: Cityy of Menifee 29714 Haun Road Menifee CA 92586 To: Whom it may concern Regarding: Notice of Cancellation Date Issued: 9/13/2018 Named Insured(s): All American Asphalt Policy Number(s): DPC1005856-02 BAP5571088-06 WC593205705 SXS019797002 Should the above described policy be cancelled before the expiration date thereof, we will mail 30 days written notice to the above referenced Certificate Holder; except, 10 days notice for non-payment of premium. Sincerely, .4> 4--, Dan Ryan, Managing Principal epicbrokers.com edgewood partners insurance center ca license OB29370 44184636 1 18 (011 Standard with $5m XS I Maritza Ornelas 1 9/13/2018 11:47:03 AM (PDT) I Page 2 of 4 COMMERCIAL GENERAL LIABILITY CG20120413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Any State or Governmental Agency or Subdivision or Political Subdivision where the Named Insured has agreed to add as a an additional insured by written contract or agreement, provided the contract or agreement is executed prior to any occurrence or offense Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section If — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or CG20120413 © Insurance Services Office, Inc., 2012 Page 1 of 2 99184636 1 18 [01] Standard with $5= XS I Maritza Ornelas 1 9/13/2018 11:47:03 AM (PDT) I Page 3 of 4 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions of this policy remain unchanged. Endorsement Number: 19 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: DPC1005856-02 Named Insured: All American Asphalt et al Endorsement Effective Date: August 1, 2018 CG 20 12 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 44184636 1 18 [01] Standard with $5= XS I Maritza Ornelas 1 9/13/2018 11:47:03 AM (PDT) I Page 4 of 4 Edgewood Partners Insurance Center P.O. Box 5003 San Ramon, CA 94583 City of Menifee 29714 Haun Road Menifee CA 92586 MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonlineT'I Sender: Maritza Ornelas Phone: 925-244-7704 Subject: Cert.No. 44184636 -All American Asphalt - Certificate - City of Menifee Date: 9/13/2018 No. of Pages: 5 URL: www.epicbrokers.com This document has been brought to you by ecertsonline on behalf of Edgewood Partners Insurance Center. This document has been brought to you by ecertsonline on behalf of Edgewood Partners Insurance Center. For new certificate requests, changes to an existing certificate, or if you have any other questions, please forward the current certificate issued with requested changes via E-Mail: EPICcerts@epicbrokers.com or Facsimile: (925) 901-0671 PLEASE NOTE: Requests must be submitted or approved by the Named Insured. FREQUENTLY ASKED QUESTIONS: Q: What is a Certificate of Insurance? A: A written document verifying insurance coverage of the Named Insured listed in the top left corner. Q: Why am I receiving this? A: The Named Insured listed in the top left corner is performing or has performed operations for you where they have been required to show you evidence of their insurance. Q: What is this costing me? A: Certificates are issued as a service to our Named Insured. We will not be sending you an invoice for having received this document. THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPHONE,AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineTM Insurance Visions, Inc. All rights reserved.