2020/01/08 Superior Ready Mix Concrete, LP Self-Insurance for Workers' Compensation PlanSUPERIOR READY MIX CONCRETE, L.P.
1508 WEST MISSION ROAD
ESCONDIDO, CALIFORNIA, 92029
(760) 745-0556
FAX (760) 740-9556
January 8, 2020
City of Menifee
29844 Haun Road
Menifee; CA 92586
Re: Superior Ready Mix Concrete, L.P.,
Letter of Self-insurance for Workers' Compensation Plan
To Customer:
The purpose of this letter is to provide documentation regarding Superior Ready Mix Concrete's Self -Insured
Workers' Compensation Plan. Superior has been a qualified self -insured employer for workers' compensation
continuously in California since 2003. Our claims are managed by our third -party administrator, Tri Star Risk
Management.
Our state certification can be verified at www.dir.ca.gov/sip/sij2.htrnl; under Self Insured Employers/Roster. The
Self -Insurance Certification Number is 2286.
Waiver of Subrop-ation: Superior agrees to waive its right of subrogation for workers compensation payments
from City of Menifee, its respective elected officials and each of their representatives, consultants, officers,
agents, employees, volunteers, and assigns as additional insureds.
CERTIFICATE HOLDER
City of Menifee
29844 Haun Road
Menifee, CA 92586
Superior will notify City of Menifee 30 days in advance of a cancellation of coverage.
Our Excess Workers' Compensation Insurance Carrier is as follows: Safety National Casualty Corporation,
policy No. SP 4061506, effective date November 1, 2019 through November 1, 2020.
For additional information, please contact your local Superior Ready Mix office.
Sincerely,
Arnold L. Veldkamp