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2020/02/18 L.C. Paving & Sealing, Inc. Insurance Endorsement Policy Number:ATN2035914 COMMERCIAL GENERAL LIABII= CG 20 38 0413 THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS --AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COIv IMaAL GENERAL LIABILITY COVERAGE PART A. Section H—Who b An Insured is amended to include B. With respect to the insurance afforded to these as an additional insured: additional insureds,the following additional exclusions 1. Any person or organization for whom you are apply: performing operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or 1. "Bodil injury" agreement that such person or organization be Y . property damage" or "personal added as an additional insured on your policy,and and or the advertising injury"arising out y the rendering Z, other person or o� or the failure to render, any professional Any p organization you are required architecamd, engineering or surveying services, to add as an additional insured under the contract or including: agreement described in Paragraph L above. a. Such persons) or organizations) is an additional or a eve, ma��& odrawin sr ftiling PnP� insured only with respect to liability for PTO �, drawings, opinions, s'Iriy edits injury", reports,surveys, field orders. change orders or "property damage"or"personal and advertising injury" drawings and specifications;or caused,in whole or in part,by: b. Supervisory, inspection, architectural or a. Your acts or omissions;or engineering activities. b. The acts or omissions of those acting on your This exclusion applies even if the claims against any behalf insured allege negligence or other wrongdoing in the in the performance of your ongoing operations for the of ervisso b ghat employment,training or monitoring additional insured. Y msured, if the "occurimcer which caused the"bodily injury"or"property damage",or the However, the insurance afforded to such additional offense which caused the "personal and advertising insured described above: injury involved the rendering of, or the failure to a. Only applies to the extentpermitted by law;and render, any professional architectural, engineering or b. Will not be broader than that which you are surveying services. required by the corildd or agreement to provide 2. "Bodily injury" or "property damage" occurring far such additional insured. after: A person's or organizations status as an additional a. All work, including materials, parts or insured under this endorsement ends when your equipment furnished in connection with such operations for the person or organization described in work, on the project (other than service, Paragraph 1.above are completed. 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 CG 20 38 0413 0 Insurance Services Office,Inc..2012 Page 1 of 2 injury or damage arises has been put to its shown in the Declarations; intended use by any person or organization whichever is less. other than another contractor or subcontractor engaged in performing operations for a principal This endorsement shall not increase the applicable as a part of the same project Limits of I mumce shown in the Declarations. C. With respect to the iasurance afforded to these additional insureds, the following is added to Section III—I mils Of Insurance: The most we will pay on behalf of the additional insured is the amount of inmrance: 1. Required by the contract or agreement described in Paragraph A.L;or M ility endorsement needshe carrier or from aner representative.he required signature. Page 2 of 2 0 Insurance Services Office,Inc.,2012 CG 2a.36 0413 POLICY NUMBER: ATN2035914 COMMERCIAL.GENERAL LIABILITY CG 2010 0413 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) Or O anization s Locations Of Covered Operations As Required y en Contract, Fully As Required By written contract, Fumy- Executed Prior To The Named Insured's Work Executed Prior To The Named Insured's Work Information required to complete this Schedule,if not shown above will be shown In the Declarations. A. Section it —Who Is An insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with dame spe Otto liability for"bodily injury", "property This Insurance does not apply to "bodily injury'or age" "personal and advertising Injury" "property damage"occurring after. caused,In whole or in part,by: 1. Your acts or omissions;or 1• All work, Including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs)to be performed by or In the performance of your ongoing operations for on behalf of the additional Insured(s) at the the additional Insured(s) at the location(s) location of the covered operations has been designated above completed;or However. 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to i4 intended use th any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law'and engaged in performing operations for a 2. if coverage provided to the additional insured Is principal as a part of the same project 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. CG 2010 0413 0 Insurance Services Office,Inc.,2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following Is added to insurance shown in the Declarations; Section III—Un lts Of Insurance: whichever is less if coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement,the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations amount of insurance 1. Required by the contract or agreement;or This General Liability end&13 Signature from the carrie authorized Broker repres Please provide the requi Page 2 of 2 0 Insurance Services office, Inc,2012 C POLICY NUMBER ATN2035914 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTSICOMPLEfED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional insured Person(s) Or O snizatlon a Ltication And RMSI 'on Of Com leted O rations As Required By Written Contract,Fully Executed Prior As Required By Written Contract Fully Executed Prior To The Named Insured's Work To The Named Insured's Work information required to com lete this Schedule,If not shown above,will be shown in the Declarations. A. Section It—Who Is An Insured Is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s)or additional insureds, the following is added to organkdon(s) shown In the Schedule, but only Section 10—Limits Of insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is property damage"caused,in whole or In part by required by a contract or agreement, the most we"your work` at the location designated and chedule of this endorsement wig pay on behalf of the additional Insured is the descn'bed in the S performed for that additional insured and amount of Insurance: included In the "products-completed operations I• Required by the contract or agreement or hazard" 2. Available under the applicable Limits of However insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not Increase the applicable by law;and Limits of insurance shown In the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement; the This Ge:pr:ov:idethe y endorsement needs Insurance afforded to such additional Insured will not be broader than that which you are Signatucarrier or from an authorized Broker required by the contract or agreement to , repres provide for such additional insured. Please equired signature. CG 20 37 0413 Insurance services Office,Ina,2012 page 1 of 1 Policy Number:ATN2035914 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 06100 (CIM5) PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Any coverage provided to an Additional Insured shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless: 9) a written contract or written agreement specifically requires that this insurance apply on a primary and non-contributory basis, or 2) prior to a loss, you request in writing and we agree that this insurance shall apply on a primary and non-contributory basis. Name Of Persons Or Organization s As Required By Wriften Contract, Fully Executed Prior To The Named Insured's Work. All other terms, conditions and exclusions under this policy are applicable to this Endorsement and remain unchanged. VEN 05100(0911�) This G:provide :the ty endorsement needs Signat carrier or from an authorized Broker page 1 of 1 repres Pleaserequired signature. POLICY NUMBER.ATN2035914 COMMERCIAL GENERAL LIABILITY CO?h 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART Ls SCHEDULE: As Re Ofr deB W tt O anization: q My Written Fully Executed Prior To The Named Insured's Work information required to complete this Schedule If not shown above,will be shown in the Declarations, The following is added to Paragraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: 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. This General Liability endorsement needs Signature from the carrier or from an authorized Broker representative. Please provide the required signature. CO 24 04 05 09 0 Insurance Services Office,Inc.,2008 Page 1 of t] Policy Number:ATN2035914 United Specialty Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VEN 084 00(01116) THIRD PARTY CANCELLATION NOTICE ENDORSEMENT This endorsement modifies the Conditions provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART If we cancel this policy for any reason other than nonpayment of premium,we will mall notification to the persons or organizations shown in the schedule below(according to the number of days listed below) once the Named Insured has been notified. If we cancel this coverage for nonpayment of premium, we will marl a copy of such written notice of cancellation to the name and address below at least 10 days prior to the effective date of such cancellation Our failure to provide such advance notification will not extend the policy cancellation date nor negate cancellation of the policy SCHEDULE Name and Address of Other PersonfOrQanizatlon Number of Days Notice Per schedule on file with the company 30 x E Li="y ent needs mom an authorized Brokerveenature.All other terms,conditions and exclusions under this policy ar and remain unchanged. VEN 064 00(01/15) Page 7 of 1 � UNITED SPECIALTY INSURANCE COMPANY SCHEDULE OF FORMS AND ENDORSEMENTS Forms and endorsements applying to the Coverage Parts listed below and made a part of this policy at the time of issue: POLICYNO.. ATN2035914 EFFECTNEDATE`02/18/20 to 02/18/21 At 12.01 A.K Standard Time NAMED INSURED:L.C.Paving&Sealing,Inc. Forms AmXcable: VBN D1 (04/07)-Common Policy Declarations VBN D2(04/07)-Commercial General Liability Coverage Declarations VEN D3(04/07)-Schedule Of Forms And Endorsements CO 00 01 (12107)-Commercial General Liability Coverage Form CO 2010(04/13)-Additional Insured-Owners,Lessees or Contractors CO 20 11 (04/13)-Additional Insured-Managers or Lessors of Premises CG 2012(04/13)-Additional Insured-State or Political Subdivisions-Permits CG 20 34(04/13)-Additional Insured-Lessor of Leased Equipment CG 20 37(04/13)-Additional Insured-Owners,Lessees or Contractors-Completed Operations CG 20 38(041" -Additional Insured-Owners,Lessees or Contractors-Automatic Status for Other Parties CG 2107(05/14 -Exclusion-Access or Disclosure of Confidential or Personal Information CG 2147(12107 -Employment-Related Practices Exclusion CG 2167(04/02 -Fungi or Bacteria Exclusion CG 2186(12104)-Exclusion-Exterior Insulation and Finish Systems CO 2190(01106)-Exclusion of Terrorism CO 24 04(05/09)-Waiver of Transfer of Rights of Recovery Against Others To Us CG 24 26(07/04)-Amendment of Insured Contract Definition IL 0017(11/98)-Common Policy Conditions IL 00 21 (09/08)-Nuclear Energy Liability Exclusion Endorsement VEN 00100(05/18)-Absolute Asbestos&Lead Exclusion VEN 008 00(05/18)-CGL Changes-A(Practice) VEN 013 00(05/18)-Composite Rate Endorsement VEN 015 01 (05/18)-Condo,Townhome,Tract House Exclusion(Residential condo) VEN 024 03(05/18)-Deductible Endorsement(Med Pay) VEN 045 01 (02/16)-Minimum Audit Premium Endorsement VEN 047 00(01115)-New York Operations Exclusion VEN 05100(01/15 -Primary and Non-Contributing Insurance Endorsement VEN 053 0001181-Professional Liability Exclusion VEN 059 01 /15Service of Suit Endorsement VEN 062 05(04/18 -Contractors Warranty VEN 064 00(01/15)-Third Party Cancellation Notice Endorsement VEN 069 02(04/18)-Wrap-Up Exclusion(Limited Off-Site Exception) VEN 079 01(03/18)-Policy Limitation-Total Aggregate Limit for All Construction Projects VEN M 04107 WORKERS'COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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_0_%of the California workers'compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description L.C. Paving&Sealing 620 Alpine Way Escondido, CA 92029 This endorsement changes the policy to which it is attached effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to prepa n of the policy.) Endorsement Effective 09/12/2019 Policy No, CS-WK-000000267-0 knaorse000Insured L.C.Paving&Sealing,Inc. Insurance Company Countersigned by Clear Spring Property and Casualty Company WC 04 03 06 (Ed.4-84)