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2019/10/25 Reliable Concrete Accessories Certificate of Liability Insurance ACC ME)")" CERTIFICATE OF LIABILITY INSURANCE 7DAT913 012 0 2 0 YI 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). CONTACT PRODUCER Ed ewood Partners Insurance Center(EPIC) NAME:_ 19000 MacArthur Blvd. PH Floor PHONE 949 263-0606 FAX No: 949 263-0906 Irvine, CA 92612 , M��' xf, ADDRESS: INSURERS AFFORDING COVERAGE NAIC# www.edgewoodins.com INSURER A: Pennsylvania Lumbermens Mutual Insurance Co. 14974 INSURED INSURER B: Berkshire Hathaway Homestate Insurance Company 004207 Reliable Concrete Accessories INSURER c, 7600 Redondo Circle Huntington Beach CA 92648 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 57910572 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 TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMJDD1YWY LTR LIMITS A COMMERCIAL GENERAL LIABILITY / 04-RO13-01-19 10/25/2019 10/25/2020 EACH OCCURRENCE $1 000X0 ' CLAIMS-MADE ,/. OCCUR P0RE J E oc en $10Q 000 MED EXP(Any oneperson) s5,000 PERSONAL&ADV INJURY $1 00Q 000 CdENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY❑ PRO- ❑ LOC PRODUCTS-COMP/OP AGG $2 000 000 JECT OTHER $ A AUTOMOBILE LIABILITY ✓ 04-R013-02-19 10/25/2019 10/25/2020 (CET!cdd. INaLE LIMIT $1 000 000 I✓ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY ✓ AUTOS HIRED NON-OWNE✓ PROPFRTYDAMAGE AUTOS ONLY ✓ AUTOS ONLDY Parr a A 11 $ ✓ D $ A �/ UMBRELLA LIAB ,/ OCCUR 04-R013-03-19 10/25/2019 10/25/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED I ✓I RETENTION$10,000 $ B WORKERS COMPENSATION ✓ REVIC123399 10/1/2020 10/1/2021 ✓ P A T OTH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E-L EACH ACCIDENT $1 00Q 000 OFFICER/MEMBER EXCLUDED? El NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1 00Q 000 A Inland Marine-Scheduled Equipment 04-RO13-01-19 10/25/2019 10/25/2020 $2,500 Deductible;ACV DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) The City of Menifee,The City of Menifee Community Services,the Menifee Housing Authority and each of their officers,officals employees,agents and volunteers are included as Additional Insureds as respects General Liability and Automobile Liability insurance per attached endorsements.Primary and Non-Contributory Wording applies per attached endorsement(s).Waiver of Subrogation on Workers Compensation and Employefs Liability insurance as respects to the City of Menifee,the City of Menifee Community Services District,the Minifee Housing Authority and each of their officers,employees,agents and volunteers per attached endorsement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityy of Menifee THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 29844 Haun Road ACCORDANCE WITH THE POLICY PROVISIONS. Menifee CA 92583 AUTHORIZED REPRESENTATIVE r Anthony D'Asaro ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 57910572 1 19/20 GL, Auto, IM , Umb, WC I Jennifer Youngberg 1 9/30/2020 3:57:03 PM (PDT) I Page 1 of 6 This certificate cancels and supersedes ALL previously issued certificates. Reliable Concrete Accessories 9/30/2020 04-RO13-01-19 COMMERCIAL GENERAL LIABILITY LUM-145 02 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Broad Form Additional Insured Paragraph 2. of Section II —Who Is An Insured of Commercial General Liability Coverage Form CG 00 01 is amended to add the following: e. Additional Insured by Written Contract or Written Agreement The following are insureds under the policy when you have agreed in a written contract or agreement to provide them coverage as additional insureds under your policy: (1) Lessors of Leased Equipment: person(s) or organization(s) who lease equipment to you, but only with respect to their liability for"bodily injury", "property damage"or"personal and advertising injury" arising out of or caused, in whole or in part, by the maintenance, operation or use of such equipment by you, your"employees", "temporary workers"or"volunteer workers". With respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence" which takes place after the equipment lease expires. (2) Owners, Managers or Lessors of Premises or Land: any owner, manager or lessor of premises or land, but only with respect to their liability ari ing out of or caused, in whole or in part, by ownership, maintenance or use of that part of such premises or land leased to you. This insurance does not apply to: (a) Any "occurrence" which takes place after you cease to be a tenant or lessee of such premises or land; or (b) Structural alterations, new construction or demolition operations performed by or on behalf of the owner, manager or lessor of such premises or land. (3) Mortgagees, Assignees or Receivers: any person(s) or organization(s) with respect to their liability as your mortgagee, assignee or receiver and arising out of their ownership, maintenance or use of your premises. This insurance does not apply to: Any structural alterations, new construction or demolition operations performed by you or others for such person or organization. (4) Any person or organization, other than a joint venture, for whom you have agreed by written contract to provide "bodily injury" or"property damage" liability insurance, but only for liability arising out of or caused, in whole or in part, by operation(s) performed by you or on your behalf, provided that: (a) This Subparagraph (4)does not apply to any agreement to provide insurance to: (1) Any"employee", association of"employees" or labor union, except with respect to work performed by or for you or for such "employee", association of "employees" or labor union under direct contract between you as contractor and such "employee", association of"employees" or labor union as owners; Pennsylvania Lumbermens Mutual Insurance Company LUM-145 02 06 Philadelphia, Pennsylvania Page 1 of 3 57910572 1 19/20 GL, Auto, IM , Umb, WC I Jennifer Youngberg 1 9/30/2020 3:57:03 PM (PDT) I Page 2 of 6 This certificate cancels and supersedes ALL previously issued certificates. (ii) Any railroad company except with respect to work performed by you or for you for such railroad company under direct contract or agreement between you and such railroad company; (III) Any person or organization whose profession, business or occupation is that of an architect, surveyor or engineer with respect to liability arising out of preparation or approval of maps, drawings, opinions, reports, surveys, change orders, designs or specifications; giving directions or instructions; failing to give directions or instructions; or the performance of any other professional services by such person or organization; (iv) Any of your contractors or subcontractors or any partner, officer, agent or"employee"of such contractors or subcontractors; and (v) Anyone described in Paragraphs e.(1)through (3)above. (b) If a vendor of "your products" is an additional insured under this Coverage Form, such insurance as provided to the additional insured applies only with respect to "bodily injury" or .'property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and subject to the following additional exclusions. This insurance does not apply to: (i) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of assumption of liability in a contract or agreement. This exclusion does not apply to liability that the vendor would have in the absence of the contract or agreement; (II) Any expressed warranty of your"products" unauthorized by you; (iii) Any physical or chemical change in "your products" made intentionally by such vendor; (iv) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from you or the manufacturer, and then such parts are repackaged in the original container; (v) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make, or normally undertakes to make in the normal course of business, in connection with the distribution or sale of"your products"; (vi) Demonstration, installation, servicing or repair operations except such operations performed at the vendor's premises in connection with the sale of"your products"; or (vii) Any of "your products" which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other item or substance by or for the vendor. This insurance afforded to the vendors in (4)(b) above does not apply to any person or organization from whom you have acquired such products, ingredients, parts or containers entering into, accompanying or containing "your products". No insurance is provided under this vendor's coverage in (4)(b) if"bodily injury" or "property damage" under the "products-completed operations hazard" is excluded by any exclusions or provisions of this Coverage Form or by any endorsement. (c) The insurance afforded to any person or organization as an insured under Paragraph 2.e.(1) through (4)above: (i) Shall include only that insurance required to be provided by the terms of such agreement, and then only to the extent that such insurance is included within the terms of this policy, and that person's or organization's status as an additional insured under this endorsement ends: (a) when your operations for that additional insured are completed or (b) when any written contract or agreement with such person or organization is terminated or expires. Pennsylvania Lumbermens Mutual Insurance Company LUM-145 02 06 Philadelphia, Pennsylvania Page 2 of 3 57910572 1 19/20 GL, Auto, IM , 0mb, WC I Jennifer Youngberg 1 9/30/2020 3:57:03 PM (PDT) I Page 3 of 6 This certificate cancels and supersedes ALL pXOviously issued certificates. (ii) Does not apply to "bodily injury" or "property damage" included within the "products- completed operations hazard" unless such coverage is required by an "insured contract" between you and the additional insured. (III) Is subject to all applicable exclusions of Paragraph 2. Exclusions, Coverage A (Section 1). (iv) Does not include any person or organization included as an insured under the provisions of Section II — Who Is An Insued or included as an additional insured by any other endorsement to this policy. (d) The limits of insurance afforded to such additional insureds shall be the lesser of the limits required by any contract or agreement between the parties or provided by this policy. (e) The insurance afforded to any person or organization as an additional insured under this Paragraph 2.e.(1) through (4) does not apply to "bodily injury" or "property damage" which occurs prior to the date of your contract or written agreement with such person or organization. 2. Other Insurance The insurance afforded to any additional insured under Paragraph 2.e.(1) through (4)will be primary and non- contributory if required by such contract or agreement with you. 3. Waiver of Right of Recovery by Written Contract or Agreement We waive any right of recovery to payments we make for injury or damages arising out of your ongoing operations or"your work" included in the "products-completed operations hazard". This applies to any person or organization with whom you have agreed in a written contract or agreement made prior to the date of the .,occurrence" to waive your rights of recovery from such person or organization, but only for payments made under this insurance as a consequence of such contract or agreement. Pennsylvania Lumbermens Mutual Insurance Company LUM-145 02 06 Philadelphia, Pennsylvania Page 3 of 3 57910572 1 19/20 GL, Auto, IM , Umb, WC I Jennifer Yatlpgberg 191301 020 3:57:03 PM (PDT) I Page 9 of 6 This certificate cancels and supersedes ALL pY@Viously issued certificates. i Reliable Concrete Accessories POLICY NUMBER: 04-RO13-02-19 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, FORM NAME: COMMERCIAL AUTOMOBILE EXTENSTION ENDORSEMENT This endorsement modifies insurance provided under the following- BUSINESS AUTO COVERAGE FORM A, Any person or organization whom you are required by contract to name as additional insured 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. B. For any person or organization for whom you are required by contract to provide a waiver of subrogation, the Loss Condition-TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US is not applicable. C. The insurance afforded to any additional insured whom you are required by contract to name as an additional insured will be PRIMARY AND NON-CONTRIBUTORY by such contract or agreement with you. 57910572 1 19/20 GL, Auto, IM , 0mb, WC I Jennifer YCungperg 1 9/30/2020 3:57:03 PM (PDT) I Page 5 of 6 ' This certificate cancels and supersedes ALL previously issued certificates. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10B (Ed.9-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS 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.) The additional premium for this endorsement shall be 2%of the total manual premium otherwise due on such remuneration. The minimum premium for this endorsement Is $350. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE BLANKET WAIVER Person/Organization Blanket Waiver— Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/01/2020 PolicyNo.REWC123399 Endorsement No, Insured Reliable Concrete Accessories Premium $ Insurance Company Countersigned by WC 99 04 10B (Ed.9-14) 57910572 1 19/20 GL, Auto, IM , Umb, WC I Jennifer.•YOU Q.berg 1 9/30/2020 3:57:03 PM (PDT) I Page 6 of 6 This certificate cancels and supersedes ALL=:p;ly'iously issued certificates.