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2015/11/15 NPG, Inc AKA: Nelson Paving & Grading, Goldstar Asphalt Products Certificate of Liability InsuranceOP ID: DB `A� �G' CERTIFICATE OF LIABILITY INSURANCE 09/08l2016 D09108/20Y6 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 endorsements . PRODUCER Crosby Insurance, Inc 8181 E. Kaiser Blvd CONTANAME: CT John Sheffield PHONE FAX A/c No E,� •714-221-5255 Arc No: 714-221-5210 E-MAIL sheffield crosb insurance.com ADDRESS: Anaheim Hills, CA 92808 John Sheffield PRODUCER NPGCO-J CUS INSURERS AFFORDING COVERAGE NAIC # INSURED NPG, Inc. aka: Nelson Paving & INSURER A:Ironshore Specialty Ins Co Grading, Goldstart Asphalt Products P.O. Box 1515 Perris, CA92572 INSURER B: General Ins Co of America INSURER c:Liberty Ins Underwriters INSURER D:ICW Group INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 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 INSURANCE ADDLSUBR INSR WVD POLICYNUMBER POLICY EFF MM/DDIY POLICYEXP MMIDD/Y LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX_1 OCCUR AGS0058702 11/15/2015 11/15/2016 EACH OCCURRENCE $ 1,000,000 PREMISES E6 aEoNccu rence 5 50,000 MED EXP (Anyone person) S 5,000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PR� 1-1 X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 I $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Hired Phys Dam 24-CC-206754-9 INCL PHYSICAL DAMAGE $50,000 MAXIMUM LIMIT 11/15/2016 11/15/2016 COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 X BODILY INJURY (Per person) s BODILY INJURY (Per accident) S PROPERTY DAMAGE (PER ACCIDENT) s X X Comprehensive Is $1,000 de X Collision s $1,000 de C UMBRELLA LIAB EXCESS LIAB CLAIMS -MADE 100002437206 11/15/2015 11/15/2016 EACH OCCURRENCE $ 5,000,00 X HOCCUR AGGREGATE s 5,000,000 DEDUCTIBLE RETENTION S s Is D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE [—Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WVE5028828 01 01/01/2016 01/01/2017 X I WCSTATU- I I OTH- TORY LIMITS ER E.L. EACH ACCIDENT s 1,000,000 E.L. DISEASE - EA EMPLOYE 5 1,000,000 E.L. DISEASE -POLICY LIMIT I 5 1,000,000 g EQUIPMENT RENTED FROM OTHERS 24-CC-316773-10 11/16/2015 11/15/2016 Limit 500,000 Ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) *If cancelled for non-payment of premium only 10 days notice will bepiven. Certificate Holder is named Additional Insured as respects Genenera Liabilityy only as per attached endorsements. Project: NPG Job 16431 Bailey Park Bfvd., Menifee, CA CITYM EN Cityof Menifee 29714 Haun Rd. Menifee, CA92586 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 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AGS0058702 commEkdlAL GENERAL LiAwLry :CG'20 119 �.04.1.3 THIS ENDORSEMENT CHANGES. THE. POLICY. PLEASE .READ IT. CAREFULLY. ADDITIONAL INSURED: -.OWNERS- LESSEES0R : WIN CONTRAGTORS SCHEDULED PERSON OR. ORGANIZATION th following: Thi's..:'en.d"orse.ment.Modif:ie-*si'nsurance..pr.oyi'd d e: undere CONIVIER.C.1-A.L.GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(sy I Or Orciarilzation1s) I Location(si Of Covered.OnerAtions As required. ..by written contract. If rNu.i.ried by yo written contract. or written agreement . yvit . h. su( Additional Insured'.: this jns.urarice is: primary ar 'nonrcGritributarv,, If anyone. -other than the Additional Insure4, provides similar: for the: Additional Insured then , hen this insurance: : urance. will apply :as outlined in SECTION ECT.110. N. .'IV.. COMMERICAL: LIAIAILITY- CONDITIONS paracrabh 4, Other Insuran6p subparagraph "t. Met h.od:of Sharing, Theinclusionof one or more Insured(s) : under -the terms of this endorsement does not increase our: limits of liability. 1AII otherterms and:.c.ondiiions: remain Any Location I Information required .tocompfete4his Schedule; if not shown -:above; will be -shown in the Declarations. I A. Se.cti6n 11 " Who -Is An. Insured. is amended to: 2. If::r-overag I e I provided td,the additional insured is include as an: additional insured the person(s) or required by a contract or. ,agreement, the '. organization(s) shown Jn: the Schedule, ..but:.only insurance afforded to such additional -insured opeiW- will that which you :are with respect to liability . ty.r _y pr., ...not be broader than "bodily damage" or "personal and advertising. 'injury" required the: contract or -agreement to ih' 'h cau ed vidlaorin: part; by> provide f6.r*'*'uch,a.dditioh6linsured. 1. Your acts.,or.,omissions., or Z 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) ddgighatdd above: However: C The insurance 'afforded to such additional insured: only applies to the. extent .permitted by law, and .CG.20.110-.0413 0 Insurance Services Office, Inc.; 2012 Page: 1 of 2 B. With rosiJect to the- insurance afforded to ,theseadditional insureds, the: fQllqrrtih g. additional exclusions apply: This i-MOr80pe does not apply "to."bodily- injury" r . y 0. ..property damage." occurring afte.r. 1. All war' including materials s: or equipment: furnished. in connection With such work, on the project (Other than service; maintenance or-repaifs);to be performed by.or on behalf of the additional ihsUrtd(�.). at the location of the �covered operations .. has been .completed,' or 2. That portion, of 'Your work" but of which. the injury or damage arises has. been put to.. -its intended.. use by any -pers on or organiz.a....- other than another contractor -or. . subcontractor engaged ed in performing 6.pera'tidns t6r a principal bsopart of the same project, .:C: With respect to the insurance afforded to: -these additional :Insureds,. the :following is added to Sedidiv Iff — UM' Its, Of : I nsurahee: If coverage :.provided 'to the additional :insured As required : bya contractor agreement, the m'dst:W0 Will 'pay. on .behalf of the additional insured is the amount of"insurance; Requi me red byth.e:cointractoragi-be . nt*:'Or 2. Available under the 8 .. p licablo Lim of P .. Insurance shown in thO.Declar.ation.5; whichever is less.. This endorsement shall hot increase the: .applicable. Limits of Insurance. shown in 'the Declarations. .Page 2:of 2 V Insurance Services Office. .1 nc. 2012 03 2010. Ot 13, POLICY -NUMBER: AGS0058702 :COMMERCIAL GENERAL LIABILITY CG 20 37 04-13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES :DR CONTRACTORS - COMPLETED OPERATIONS This endorsement dors-ement modifi.bs ih-s*'u'r'a'"n'ce'prov'jded.Uhd'e'r.*.thb following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS]COMPLETED OPERATIONS LIABILITY. COVERAGE PART -SCHEDULE Varne.OfAddifi'onail Insured .Person(s): Or 10rgahizatlion(s) Location And Description "Of Cornpl I eted Operat I i . ons As:required. by written contract.. If re by your The insurance :afforded. by this policy for the benefit of written: qu written contract: :or written. agreement with such: the additional. insured does.not apply to . .,. . . ... " ... .. . additional .. I... . , insured . .. I., ­. P, Additional Insured *this, insurance .is prim.ar .. ­ damage' to.anybuilding..: ... . Additional S .... y and. 'property, structure or non-mcontribufb.r appurtenant. structure intended.j.p W occupied as a 'Private residence':; The. term "private residence" If. anyone, other .than lhe. Additional. lns.ur.e.d;provides includes singlefamily homes or r residences, similar insurance for the Additional Insured,then fhi :.::...:.. ....is multi.7fami'l or residences.. Apartments are'not homes 'p :residences," .insurance will apply -outlined in SECTION IV'— considered rivate COMMERICAL LIABILITY CONDITIONS paragraph 4Other Insurance, . subparagraph :d. Method. of The inclusion': of one or: more lnsured.(s) under the terms of this bi1dotsernent does..not: increase out limits of liability. I All'other terms and: co.n.ditions-, remain unchanged. I Information required *td:bomplete.this Schedule, if hot shbWh above; Will biR�thb*wh in:theDeeldratibris. I A. Section If " Whols An insured is: -amended to include as an additional insured' the person(s). or organizatioh(s) shown. in the Schedule,. but :only with respect to liability or re�. ab.-W for ".bodily irij.dry" p roperty da . Mage" caused,, in:whole..o ' r in ' ..pa.t ,�.Oy 'your work'- at the location designated. and described in the Scheddle of thisendorsement PP_rf&.mbd for that additio"n-aillih!§uitbd and included in: the "pro'duots'-dornpleted operatio'ns hazard". However., -1. The insurance afforded to such additional insured :only applies to.. e,:,exen :th" t' permitted by law; and -:2. If coverage -provided to the additional Insured -is d . requireby- a. contract or agreement, the ins0-rah'ce.a'ff.dr.ded,to.s0c;h:.bddtional:'.insured :will: not: be broader. tha.h thart. Which you are r6qUirod by'the.co.nt . ract or agreement. to provide forsuch additional insured. Pq-20 37-04 13 Q Insurance'Services Office, Inc_.:201:2 Pa&: 1 'of 2 P. V\Ath respect to the insurance: afforded. to .these additional insureds, 'the following' , is 'added to Section Ill .". Limits .Of -Insurance:: If icoverage: provided.. to the additional insured is required by a contractor -agreement., the most:we Will pay on behalf of the -additional: insured is the am Uht f insurance: ... . , jG 1. Required by the- contract or agreement; or Z Available under the appliba - &(e Limits of Ins.urance:shbWn:in the Declarations; whichever'is less. This endorsement shall not increase the applicable. Limits of Insurance: shown in the Declarations. Page 2 of 2 CJSO-ProWrties. ]na.. 2004 CG 20 37 0413 ❑