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2020/08/01 All American Asphalt Certificate of Liability Insurance (4)Subject: Date: No. of Pages: Phone: Sender: URL: MAIL DOCUMENT Certificate of Insurance Delivery by ecertsonline™ THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BY TELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonline™ Insurance Visions, Inc. All rights reserved. Edgewood Partners Insurance Center P.O. Box 5003 San Ramon, CA 94583 925-244-7704 www.epicbrokers.com 7/20/2020 This document has been brought to you by ecertsonline on behalf of Edgewood Partners Insurance Center. For new certificate requests, changes to an existing certificate, or if you have any other questions, please forward the current certificate issued with requested changes via E-Mail: EPICcerts@epicbrokers.com or Facsimile: (925) 901-0671 PLEASE NOTE: Requests must be submitted or approved by the Named Insured. FREQUENTLY ASKED QUESTIONS: Q: What is a Certificate of Insurance? A: A written document verifying insurance coverage of the Named Insured listed in the top left corner. Q: Why am I receiving this? A: The Named Insured listed in the top left corner is performing or has performed operations for you where they have been required to show you evidence of their insurance. Q: What is this costing me? A: Certificates are issued as a service to our Named Insured. We will not be sending you an invoice for having received this document. City of Menifee 29844 Haun Road Menifee CA 92586 Seta Ho 12 Cert No. 56638744 - All American Asphalt -Certificate - Renewal COI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 7/20/2020 Edgewood Partners Insurance Center P.O. Box 5003 San Ramon, CA 94583 925-244-7700 925-901-0671 www.epicbrokers.com CA LICENSE #0B29370 Certificates Department Certificates Department EPICcerts@epicbrokers.com All American Asphalt P.O. Box 2229 Corona CA 92878 56638744 City of Menifee 29844 Haun Road Menifee CA 92586 #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / Certificate Holder is Additional Insured if Required by Written Contract Excluding Workers Compensation 1,000,000 100,000 1,000,000 2,000,000 2,000,000 5,000,000 5,000,000 2,000,000 1,000,000 1,000,000 1,000,000 Following-Form A DPC1005856-04 8/1/2020 8/1/20213 3 3 B BAP5571088-08 8/1/2020 8/1/2021 3 3 3 C TUE347483600 8/1/2020 8/1/20213 3 3 10,000 B WC593205707 8/1/2020 8/1/2021 3 N Arch Specialty Insurance Company 21199 Zurich American Insurance Company 16535 Great American Insurance Company 16691 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 1 of 11 epicbrokers.com edgewood partners insurance center ca license 0B29370 PO Box 5003 San Ramon, CA 94583 Phone: 925.244.7700 Fax: 925.901‐0244 Email: EPICcerts@epicbrokers.com CERTIFICATE HOLDER: 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, _____________________________ Date Issued: To: Whom it may concern Regarding: Notice of Cancellation Named Insured(s): Policy Number(s): 7/20/2020 All American Asphalt City of Menifee 29844 Haun Road Menifee CA 92586 DPC1005856-04 WC593205707 BAP5571088-08 TUE347483600 Dan Ryan, Managing Principal 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 2 of 11 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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) Or Organization(s): Location(s) Of Covered Operations Any person or organization where the Named Insured 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 Any location where required 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”, “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 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 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 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 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 3 of 11 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 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: 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. 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: Named Insured: Endorsement Effective Date: All American Asphalt DPC1005856-04 SCHEDULE: City of Menifee 08/01/2020 REFERENCE: #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 4 of 11 CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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 All locations where required by contract. 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 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. 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 5 of 11 CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 All other terms and conditions of this Policy remain unchanged. 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: Named Insured: Endorsement Effective Date: All American Asphalt DPC1005856-04 SCHEDULE: City of Menifee 08/01/2020 REFERENCE: #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 6 of 11 CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1)The additional insured is a Named Insured under such other insurance; and (2)You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. All other terms and conditions of this policy remain unchanged. 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: Named Insured: Endorsement Effective Date: All American Asphalt DPC1005856-04 SCHEDULE: City of Menifee 08/01/2020 REFERENCE: #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 7 of 11 CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization where the waiver of our right to recover is permitted by law and is required 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. 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 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. Schedule above because of payments we make All other terms and conditions of this policy remain unchanged. 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: Named Insured: Endorsement Effective Date: All American Asphalt DPC1005856-04 SCHEDULE: City of Menifee 08/01/2020 REFERENCE: #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 8 of 11 7/20/2020 All American Asphalt SCHEDULE: City of Menifee BAP5571088-08 08/01/2020 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 9 of 11 CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the “accident” or the “loss” under a contract with that person or organization. 7/20/2020 All American Asphalt SCHEDULE: City of Menifee BAP5571088-08 08/01/2020 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 10 of 11 WC 252 (4-84) WC 04 03 06 (Ed. 4-84) 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 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 pre- mium otherwise due on such remuneration. Schedule Person or Organization Job Description 0.00 ALL PERSONS AND/OR ALL CA OPERATIONS ORGANIZATIONS THAT ARE REQUIRED BY 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 Policy Number: Named Insured: Endorsement Effective Date: All American Asphalt SCHEDULE: City of Menifee WC593205707 All American Asphalt 08/01/2020 REFERENCE: #32335 / RE: CIP 20-02 Ethanac Road & Sherman Road Street Resurfacing Project / 56638744 | 20 [01] Standard with $5mm XS | Seta Ho | 7/20/2020 2:21:04 PM (PDT) | Page 11 of 11