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2019/08/01 All American Asphalt Certificate of Liability Insurancec Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 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 NA E T Certificates Department P.O. Box 5003 PHONE FAX San Ramon, CA 94583 AIC No 925-244-7700 Arc No : 925-901-0671 www.epicbrokers.com CA LICENSE #OB29370 INSURED All American Asphalt P.O. Box 2229 Corona CA 92878 INSURER(5) AFFORDING COVERAGE NAIC # INSURERA: Arch Specialty Insurance Company 21199 INSURERB: Zurich American Insurance COm an 16535 INSURERC: American Guarantee and Liability Ins Co 26247 INSURER D: INSURER E : INSURER F : COVERAGES CFRTIFICOTF N[ IMRI-P- DC1101r%K1 K11 iaaoE7e. 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 I NSD WVQ POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS A ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DPC1005856-03 8/1/2019 8/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTE15— PREMISES Eao=urrtnce $ 100,000 MED EXP (Any one person) $ PERSONAL &ADV INJURY $1,000,000 GEMLAGGREGATELIMIT APPLIES PER: POLICY ✓❑ JECT ❑ LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG 52,000000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY ✓ AUTOS ONLY BAP5571088-07 8/1/2019 8/1/2020 Ea COMBIBcadenNED I.N LE LIMIT $2000000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ ✓ PRO RTY Per aod�t DAMAGE $ $ C UMBRELLA LIAB EXCESS LIAB IOCCUR CLAIMS -MADE SXS019797003 8/1/2019 8/1/2020 EACH OCCURRENCE $5.000.000 AGGREGATE $ 5,000,000 DED I ✓ [ RETENTION $10,000 Following -Form $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC593206706 8/1/2019 8/1/2020 ,/ STATUTE ERH E L EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $ E,L. DISEASE - POLICY LIMIT $1,000,000 t DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) PMP 17-01 / RE: Sun City Street Resurfacing / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation CITY OT eni e Cityy Of Menifee City C e rk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 9714 Haun Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Menifee CA 92586 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P a t i e" Certificates Department tJ 1IRRS-ZU15 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 50056249 1 19 [01) Standard with $5= XS I Kris Stubbs 1 7/18/2019 1:09:52 PM (PDT) I Page 1 of 11 191200 PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901-0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: Cit of Menifee 974 Haun Road Menifee CA 92586 To: Whom it may concern Regarding: Notice of Cancellation Date Issued: 7/18/2019 Named Insured(s): All American Asphalt Policy Number(s): DPC1005856-03 BAP5571088-07 WC593205706 SXS019797003 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, Dan Ryan, Managing Principal epicbrokers.com edgewood partners insurance center ca license OB29370 50056249 1 19 [01] Standard with $5mm XS I Kris Stubbs 17/18/2019 1:09:52 PM (PDT) I Page 2 of 11 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s) Of Covered Operations Or Organization(s): Any person or organization where the Named Any location where required by written contract or Insured has agreed to add as an additional insured agreement, provided the contract or agreement is by written contract or agreement, provided the executed prior to any 'occurrence" or offense. 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 II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of 2. If coverage provided to the which the injury or damage arises additional insured is required by a has been put to its intended use by contract or agreement, the any person or organization other insurance afforded to such than another contractor or additional insured will not be subcontractor engaged in CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 50056249 1 19 [01] Standard with $5m XS I Kris Stubbs 1 7/18/2019 1:09:52 PM (PDT) I Page 3 of 11 performing operations for a principal as a part of the same project. C. 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: All other terms and conditions of this policy remain unchanged. 1. Required by the contract or agreement; or 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. 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: DPC1005856-03 Named Insured: All American Asphalt Endorsement Effective Date: 08/01/2019 REFERENCE: PMP 17-01 / RE: Sun City Street Resurfacing / CG20100413 SCHEDULE: City of Menifee and its elected official, officers, employees, agents, representatives. consultants. contract employees and volunteers 1 © Insurance Services Office, Inc., 2012 Page 2 of 2 50056249 1 19 [01] Standard with $5= XS I Kris Stubbs 1 7/18/2019 1:09:52 PM (PDT) I Page 4 of 11 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization where the Named Insured All locations where required by contract. has agreed to add as 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 II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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 CG 20 37 04 13 additional insured- 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 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 50056249 1 19 [01] Standard with $5m XS I Kris Stubbs 1 7/18/2019 1:09:52 PM (PDT) I Page 5 of 11