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2019/04/01 American Asphalt South, Inc. Certificate of Liability Insurance A400R a> CERTIFICATE OF LIABILITY INSURANCE DATz/z1/zo2o ) 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(tes)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 CONTACT InterWest Insurance Services NAME: Joanne Cadarette License#01301094 PHOHE 916-609-8362 Arc No:91B-979-7562 P.O. Box 255188 n,DRl,ss; cadarette iwlns.com Sacramento CA 95865-5188 INSURERS AFFORDING COVERAGE NAIC# 1094 INSURER A: Financial Pacific Ins Company 31453 INSURED AMERI26 INSURERB:Arch Insurance Company 11150 American Asphalt South, Inc 14436 Santa Ana Avenue INSURER C:Travelers Prop Cas Co of Amer 25674 Fontana CA 92337 INSURER D:Westchester Surplus Lines Ins 10172 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:492239752 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I POLICYNUMBER I IMMIDDJYYYY) MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 60423382 12/31/2019 12/31/2020 EACH OCCURRENCE $2.000.000 CLAIMS-MADE u OCCUR PREMISES Ea occurrence $100.000 X Contractual Liab MED EXP(Any one person) $5,000 X Ded$5.000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY JECT LOC PRODUCTS-COMP/OPAGG $4,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y 60423382 12/31/2019 12/31/2020 C�NlauJdaR 1 $1,000,000 Ix ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLYN AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLYAUTOS ONLY Per accident $ C X UMBRELLA LIAR X OCCUR ZUP71 M8933019 12/31/2019 12/31/2020 EACH OCCURRENCE $6,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s 6.000,000 DED I X RETENTION$ $ B WORKERS COMPENSATION Y ZAWC19413902 4/1/2019 4/1/2020 X I gTATUTE FOR AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1.000,000 OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1.000 000 D POLLUTION LIABILITY G70915613002 8/27/2019 8/27I2020 LIMIT/EA OCC $2,000,000 LIMT/AGG $2,000,000 DEDUCTIBLE $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re:PMP#20-02,Quail Valley Street Resurfacing Project,Quail Valley,City of Menifee,CA. Additional Insured Status applies if required by wrilten contract per endorsement attached.City of Menifee,its officers,agents and employees. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Menifee 29844 Haun Road AUTHORIZED REPRESENTATIVE Menifee CA 92586 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Policy#60423382 COMMERCIAL GENERAL LIABILITY CG 20 21 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VOLUNTEER WORKERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to c. For which there is any obligation to share include as an insured any person(s) who are volun- damages with or repay someone else who teer worker(s) for you, but only while acting at the must pay damages because of the injury direction of, and within the scope of their duties for described in paragraphs 1.a. or b. above; you. However, none of these volunteer worker(s) are or insureds for: d. Arising out of his or her providing or failing 1. 'Bodily injury" or"personal injury": to provide professional health care serv- a. To you, to your partners or members (if you ices. are a partnership or joint venture), to your 2. 'Property damage"to property: members (if you are a limited liability com- a. Owned, occupied, or used by, pany), to your other volunteer worker(s) or to your "employees" arising out of and in b. Rented to, in the care, custody or control the course of their duties for you; of, or over which physical control is being b. To the spouse, child, parent, brother or exercised for any purpose by sister of your volunteer worker(s) or your you, any of your other volunteer workers, your "employees" as a consequence of para- "employees", any partner or member (if you graph 1.a. above; are a partnership or joint venture), or any member(if you are a limited liability company). CG 20 21 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑ Policy#60423382 COMMERCIAL GENERAL LIABILITY CG 20 32 07 98 Modified THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED - ENGINEERS, ARCHITECTS OR SURVEYORS NOT ENGAGED BY THE NAMED INSURED This endorsement modifies insurance provided under the following. COMMERCIAL CEnIERAL LIABILITY COVERAGE PART SCHEDULE Name Of Engineers,Architects Or Surveyors Not Engaged By The Named Insured: AS PE ACORD25 CERT114ICATE OF INSURANCE (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II -- Who Is An Insured is amended to This insurance does not apply to "bodily injury" include as an insured the architects, engineers or "property damage" or "personal and advertising surveyors shown in the Schedule, but only to the injury" arising out of the rendering of or the failure extent such arohitect, engineer, ur 5urvcyur iv Held to render uny prufeasiunul s�rvice�, including: liable for your ongoing operations performed by 1. The preparing, approving, or failing to prepare you or on your behalf. Such architects, engineers or approve maps, drawings, opinions, reports, or surveyors, while not engaged by you, are con- surveys, change orders, dpsions or spar_ifioa- tractually required to be added as an additional in- tions; and sured to your policy, B. With respect to such architects, engineers or sur- 2. Supervisory, inspection or engineering serv- veyuls sllUwn In Me 6ullWule alluvt, llle lalluwifig ices. exclusion is added to Paragraph 2., Exclusions of Section I — Coverage A — Bodily Injury And Property Damage Liability and Section I —Cov- erage B — Personal And Advertising Injury Li- ability: CG 20 32 07 98 Modified Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: 60423382 COMMERCIAL GENERAL LIABILITY CG25030397 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: ALL PROJECTS WITH THE POLICY PERIOD. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the insured becomes legally 4. The limits shown in the Declarations for Each obligated to pay as damages caused by Occurrence, Fire Damage and Medical Ex- "occurrences"under COVERAGE A(SECTION pense continue to apply. However, instead of 1), and for all medical expenses caused by acci- being subject to the General Aggregate Limit dents under COVERAGE C(SECTION 1),which shown in the Declarations, such limits will be can be attributed only to ongoing operations at a subject to the applicable Designated Con- single designated construction project shown in struction Project General Aggregate Limit. the Schedule above: B. For all sums which the insured becomes legally 1. A separate Designated Construction Project obligated to pay as damages caused by General Aggregate Limit applies to each "occurrences"under COVERAGE A(SECTION designated construction project, and that limit 1),and for all medical expenses caused by acci- is equal to the amount of the General Aggre- dents under COVERAGE C(SECTION 1), which gate Limit shown in the Declarations cannot be attributed only to ongoing operations 2. The Designated Construction Project General at a single designated construction project shown Aggregate Limit is the most we will pay for In the Schedule above: the sum of all damages under COVERAGE 1. Any payments made under COVERAGE A A,except damages because of"bodily injury" for damages or under COVERAGE C for or"property damage" included in the medical expenses shall reduce the amount "products-completed operations hazard",and available under the General Aggregate Limil for medical expenses under COVERAGE C or the Products-Completed Operations Ag- regardless of the number of: gregate Limit,whichever is applicable;and a. Insureds; 2. Such payments shall not reduce any Desig- b. Claims made or"suits" brought;or nated Construction Project General Aggre- c. Persons or organizations making claims gate Limit. or bringing "suits". C. When coverage for liability arising out of the 3. Any payments made under COVERAGE A "products-completed operations hazard"is pro- for damages or under COVERAGE C for vided, any payments for damages because of medical expenses shall reduce the Desig- "bodily injury"or"property damage" included in nated Construction Project General Aggre- the "products-completed operations hazard"will gate Limit for that designated construction reduce the Products-Completed Operations Ag- project. Such payments shall not reduce the gregate Limii, and not reduce the General Ag- General Aggregate Limit shown in the Decla- gregate Limit nor the Designated Construction rations nor shall they reduce any other Des- Project General Aggregate Limit. ignated Construction Project General Aggre- gate Limit for any other designated construc- tion project shown in the Schedule above. CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Paae 1 of 2 Q. If the applicable designated construction project E. The provisions of Limits Of Insurance(SECTION has been abandoned,delayed,or abandoned III)not otherwise modified by this endorsement and then restated,or if the authorized contract- shall continue to apply as stipulated. ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction project. Pnnp 2 of 2 Cnnvrinht Insurance Services Office. Inc.. 1996 CG 25 03 03 97 POLICY NUMBER: 60423382 CG 24 17 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTUAL LIABILITY - RAILROADS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Scheduled Railroad: Designated Job Site: ALL JOB5ZTE5 (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to operations performed for, or affecting, a Tort liability means a liability that would be Scheduled Railroad at a designated Job Site, the imposed by law In the absence of any definition of"insured contract" in the Definitions section is contract or agreement. replaced by the following: Paragraph f. does not include that part of any 8. "Insured Contract" means: contract or agreement: a. A contract for a lease of premises. However, (1) That indemnifies an architect, engineer or that portion of the contract for a lease of surveyor for injury or damage arising out premises that indemnifies any person or of: organization for damage by fire to premises while rented to you or temporarily occupied by (a) Preparing, approving or failing to you with permission of the owner is not an prepare or approve maps, shop "insured contract"; drawings, opinions, reports, surreys, b. A sidetrack agreement; field orders, change orders or c. Any easement or license agreement; drawings and specifications; or d. An obligation, as required by ordinance, to (b) Giving directions or instructions, or indemnify a municipality, except in connection failing to give them, If that Is the with work for a municipality; primary cause of the injury or damage; e. An elevator maintenance agreement; (2) Under which the insured, if an architect, f. That part of any other contract or agreement engineer or surveyor, assumes liability for pertaining to your business (including an an injury or damage arising out of the indemnification of a municipality in connection insured's rendering or failure to render with work performed for a municipality) under professional services, including those listed which you assume the tort liability of another in Paragraph (1) above and supervisory, party to pay for "bodily injury" or "property inspection, architectural or engineering damage" to a third person or organization. activities. CG 2417 10 01 0 130 Properties, Inc., 2000 Page 1 of 1 *48006550* 111111111111111111111111111 111�1 111I 1111 14le iche4er A Chubh Company ADDITIONAL INSURED ENDORSEMENT—ONGOING WORK OR OPERATIONS Named Insured Endorsement Number American Asphalt South,Inc. Policy Symbol Palley Numl or Polley Period Effective Date of Endorsement CPW G70915613 002 8/27/2019 To 8/27/2020 8/27/2019 Issued By(Name of Insurance Companyy Westchester Surplus Lines Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE: Nanienf lS%suu(sl ur()mcm{tttti4tr{s3. As required by written contract or agreement signed by both parties prior to a loss to which this insurance applies. (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. SECTION II-WHO IS AN INSURED is amended to include as an additional insured the persons or organizations shown in the Schedule,but only with respect to liability for injury or damage,to which this insurance applies,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 insureds. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law;and 2. I£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. B.With respect to the insurance afforded to these additional insureds,the following exclusion is added: Exclusions This insurance does not apply to injury or damage occurring after: a. All work or operations,including materials,parts or equipment furnished in connection with such work or operations, on the project(other than service, maintenance or repairs) to be performed by you or on your behalf at the site of the covered operations has been completed;or ENV-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc.with its petrnission Page 1 of 2 (221012.1) Westchester ,1 C:hubi,Company b. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for the additional insured 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: 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. All other terms and conditions of this policy remain unchanged. ENV-3250(12/18) Includes copyrighted material of Insurance Services Office,Inc,with its permission Page 2 of 2 (221012.1) Westchester 1 Chubb Company ADDITIONAL INSURED ENDORSEMENT—PRODUCTS-COMPLETED OPERATIONS HAZARD Named Insured Endorsement Number American Asphalt South,Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G70915613 002 8/27/2019 To 8/27/2020 8/27/2019 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number.The remainder of the information is to be completed roily when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE N+l!11S'!L1' t �trittJ%� n' As required by written contract or agreement signed by both parties prior to a loss to which this insurance applies. (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 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 injury or damage, to which this insurance applies, caused by or resulting from your work performed for that additional insured and included in the products-completed operations hazard, and only to the extent that such injury or damage is caused,in whole or in part,by your negligence or the negligence of those acting on your behalf. 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 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. All other terms and conditions of this policy remain unchanged. ENV-3251(12/1 S) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 1 (221012.2) Westchester A(Ambf]compaaq PRIMARY AND NONCONTRIBUTORY—OTHER INSURANCE CONDITION Named Insured Endorsement Number American Asphalt South,Inc. Policy Symbol Policy Number Policy Period Effeplve Data of Endorsement CPW G70915613 002 8/27/2019 To 8/27/2020 8/27/2019 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary and Noncontributory Insurance This policy is primary to,and will not seek contribution from,any other insurance available to an additional insured under this policy,provided that: a. The additional insured is a named insured under such other insurance;and b. The named insured has agreed in a written contract or agreement that this insurance would: (i) act as primary insurance;and (2)would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. ENV-3253(12-18) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page r of r (266562.2) WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Named Insured Endorsement Number American Asphalt South, Inc. Policy Symbol Policy Number Policy Period Effective Date of Endorsement CPW G70915613 002 8/27/2019 To 8/2712020 8/27/2019 Issued By(Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Nave of Person or Organization; Any person or organization that is an owner of real property or personal property on which you are pei trafoituort operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you. wherein such request is made prior to commencement of operations. i (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: 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 ongoing operations or your work done under a contract with that person or organization and included in the products-completed operations hazard This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV-3143(03-05) Includes copyrighted material of Insurance Services Office,Inc.with its permission Page 1 of 1 POLICY NUMBER:60423382 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Re: PMP#20-02, Quail Valley Street Resurfacing Project, Quail Valley, City of Menifee, CA. Additional Insured Status applies if required by written contract per endorsement attached. City of Menifee, its officers, agents and employees. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization is held liable for"your work" for that person or organization by or for you. This endorsement applies to the following work: Description of Job: See Above Location of Job: see Above Al only Effective from: Effective Date: 12/31/2019 Expiration Date: 12/31/2020 When this endorsement applies, such insurance as is afforded by the general liability policy is primary and any other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. CG 20 10 11 85 Modified (07-01) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER:60423382 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Re: PMP#20-02, Quail Valley Street Resurfacing Project, Quail Valley, City of Menifee, CA. Additional Insured Status applies if required by written contract per endorsement attached. City of Menifee, its officers, agents and employees. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 POLICY NUMBER: 60423382 ASDA AU 07 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE NAMED INSURED:American Asphalt South,Inc 14436 Santa Ana Avenue Fontana CA 92337 ADDITIONAL INSURED:Re:PMP#20-02,Quail Valley Street Resurfacing Project,Quail Valley,City of Menifee,CA. Additional Insured Status applies if required by written contract per endorsement attached.City of Menifee,its officers,agents and employees. WHO IS AN INSURED (SECTION II) is amended to include as an insured the organization shown in the Schedule above, but only with respect to the operation of vehicles owned by the named insured and operated on behalf of the named insured. This endorsement does not apply to any operations for other than the named insured. Each person or organization named above is an insured for liability coverage, but only to the extent that person or organization qualifies as an insured under the Who Is An Insured provision of Section II Liability Coverage. The additional insured is not required to pay for any premiums stated in the policy or earned from the policy. Any return premium, if applicable, declared by us shall be paid to you. You are authorized to act for the additional insured in all mailers pertaining to this insurance. We will mail the additional insured notice of any cancellation of this policy. If the cancellation is by us, we will give thirty days notice to the additional insured. The additional insured will retain any right of recovery as a claimant under this policy. ASDA AU 07 01 Page 1 of 1 POLICY NUMBER:60423382 ASDA AU 07 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE Name of Person or Organization: Re: PMP#20-02, Quail Valley Street Resurfacing Project, Quail Valley, City of Menifee, CA. Additional Insured Status applies if required by written contract per The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV BUSINESS AUTO CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above be- cause of payments we make for bodily injury or property damage arising out of losses or accidents which occur during the policy period. This waiver applies only to liability you assume pursuant to a contract with the person or organization shown in the schedule. ASDA AU 07 02 Page 1 of 1 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 2/21/2020 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. ZAWC19413902 Endorsement No. of the Arch Insurance Company (NAME OF INSURANCE COMPANY) issued to American Asphalt South, Inc Premium (if any) $ Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named 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 endorsement shall be *% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description ALL PERSONS AND/OR ORGANIZATIONS THAT REQUIRE A 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 WC 252(4-84) WC 04 03 06(Ed.4-84) Page 1 of 1