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2022/04/27 CT&T Concrete Paving, Inc. (3)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 THISCERTIFICATE 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 belowIf 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 HIREDAUTOS ONLY 1,000,000 2,000,000 50,000 1,000,000 B X X X CA 06/23/202275-1612-APP 1,000,000 p.mcrae@sbcglobal.net 06/23/2023 X X (714) 779-6999 X X 1000539473-01 91765 C 10725 06/09/2022 25151 SEO-118944 44520 324 S DIAMOND BAR BLVD. PMB 275 22136 06/09/2023 LICENSE NO. 0637431 X X x 10/26/2022 5,000,000 5,000,000 1265 N. MANASSERO SUITE 303 E DIAMOND BAR X CT & T CONCRETE PAVING INC. D MACE2289310201INLAND MARINE/PROPERTY 04/27/202304/27/2022 $129,692 SCHEDULED EQUIPMENT / $250,000 BUILDING $20,000 BPP/ LEASED & RENTED EQUIPMENT $15,000 PATRICK MCRAE LIBERTY SURPLUS INSURANCE CORPORATION STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY CRUM & FORSTER SPECIALTY INSURANCE GREAT AMERICAN INSURANCE CO. OF NY A X PATRICK MCRAE INSURANCE SERVICES THE CITY OF MENIFEE 29844 HAUN ROAD MENIFEE, CA 92586 THE CITY OF MENIFEE AND ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, CONSULTANTS, CONTRACT EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH RESPECTS TO THE ABOVE-MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT. * SHOULD ANY OF THE ABOVE-DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED. RE: CIP 22-20 & CIP 22-21 SUN CITY & LAZY CREEK COMMUNITY PEDESTRIAN PROJECT x X (714) 779-6903 ANAHEIM HILLS, CA 92807 X 06/09/202306/09/2022 2,000,000 DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTEDEACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe underDESCRIPTION OF OPERATIONS below (Mandatory in NH)OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED HIRED AUTOS ONLY NON-OWNEDAUTOS ONLY AUTOS AUTOS ONLY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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. INSDADDL WVDSUBR N / A $ $ (Ea accident) (Per accident) OTHER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Acct#:2699542 10/26/2022 Lockton Companies 844-290-4908444 W 47th Street, Suite 900 Kansas City, MO 64112-1906 BBSIcerts@locktonaffinity.com Ace American Insurance Co.22667 Barrett Business Services, Inc.L/C/F CT & T CONCRETE PAVING INC1054 E 3RD STPOMONA, CA 91767 A X C51267904 10/1/2022 10/1/2023 X 2,000,000 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Policy State = CA WAIVER OF SUBROGATION IN FAVOR OF: DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Policy Number Symbol: WLR Number: Policy Period TO Effective Date of Endorsement Issued By (Name of the 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 to which it is attached and is effective on the date issued unless otherwise stated. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1.( ) Specific Waiver Name of person or organization: ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2.Operations: 3. Premium: The premium charge for this endorsement shall be percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4.Minimum Premium: _______________________________________ Authorized Agent WC 90 03 75 (05/18) ALL CALIFORNIA OPERATIONS 1.0 $0 Barrett Business Services, Inc. L/C/F CT & T CONCRETE PAVING INC 1054 E 3RD ST POMONA, CA 91767 C51267904 10/1/2022 10/1/2023 10/1/2022 Ace American Insurance Co. X DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 #0..+1),’- $+/+1’- %,’(,-,23 58 ,* -0 *0 *._ ;B? @URSHUWLHV& ;QF(& ,**. ## 0/(+57; 6854086 /2685’2)+ )35435’7/32 $4 >HZ 9DPSVKLUH BWRFN ;QVXUDQFH 5RPSDQ[& KHUHLQDIWHU WKH "5RPSDQ["% 7>6?AB7=7>C >?( + +AA@>LDN@ *<L@& 4HED>O 2MF=@J& /KKM@? 7H& */)09/2022 1000539473-01 CT & T Concrete Paving, Inc. 7./6 +2*356+1+27 ).’2-+6 7.+ 430/);% 40+’6+ 5+’* /7 )’5+,800;% ADDITIONAL INSURED 6 OWNERS, LESSEES OR CONTRACTORS 6 COMPLETED OPERATIONS CKLV HQGRUVHPHQW PRGLILHV LQVXUDQFH SURYLGHG XQGHU WKH IROORZLQJ2 COMMERCIAL GENERAL LIABILITY COVERAGE PART 6).+*80+ 2<F@ 3A ’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’G /GKMJ@?LV DPHQGHG WR LQFOXGH DV DQ DGGLWLRQDO LQVXUHG WKH SHUVRQ$V% RU RUJDQL\DWLRQ$V% VKRZQ MR XLI CGLIHYPI’ FYX SRP\ [MXL VIWTIGX XS PMEFMPMX\ JSV _FSHMP\ MRNYV\‘ SV _TVSTIVX\ HEQEKI‘ GEYWIH’ MR [LSPI SV MR TEUW& E[ _\SYV [SVO‘ EX XLI PSGEXMSR HIWMKREXIH ERH HIWGVMFIH MR XLI WGLIHYPI SJ XLMW IRHSVWIQIRX TIVJSVQIH JSV XLEX EHHMXMSREP MRWYVIH ERH MRGPYHIH MR XLI _TVSHYGXW’GSQTPIXIH STIVEXMSRW LE]EVH‘) DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 #0..+1),’- $+/+1’- %,’(,-,23 58 ,* +* *0 *.a ;A> ?VSTIVXMIW& ;RG(& ,**. #$ 21*-79= 8;762;8 148;7)4+- +57657)9154 $4 =I[ 9EQTWLMVI AXSGO ;RWYVERGI 5SQTER]& LIVIMREJXIV XLI "5SQTER]"% 7=6>@A7<7=B =>( , -CCB@NFPB ,>NB( 6JGF@Q 4OH?BL( 1MMOBA 9J( */)09/2022 +000539473-01 CT & T Concrete Paving, Inc. 9018 -4,578-3-49 +0)4/-8 90- 6521+=% 62-)8- 7-), 19 +)7-.;22=% ADDITIONAL INSURED 9 OWNERS, LESSEES OR CONTRACTORS 9 SCHEDULED PERSON OR ORGANIZATION BLMW IRHSVWIQIRX QSHMJMIW MRWYVERGI TVSZMHIH YRHIV XLI JSPPS[MRK2 COMMERCIAL GENERAL LIABILITY COVERAGE PART 8+0-,;2- 4>HB 5C )AAFNFJI>G 1IMOLBA 6BLMJI#M$ 5L 5LD>IFR>NFJI#M$2J@>NFJI#M$ 5C +JPBLBA 5KBL>NFJIM +( 4R] TIVWSR SV SVKERM^EXMSR JSV [LSQ ]SY EVI TIVJSVQMRK STIVEXMSRW [LIR ]SY ERH WYGL ERH WYGL TIVWSR SV SVKERM^EXMSR LEZI EKVIIH MR [VMXMRK MR E GSRXVEGX SV EKVIIQIRX XLEX WYGL TIVWSR SV SVKERM^EXMSR FI EHHIH EW ER EHHMXMSREP MRWYVIH SR ]SYV TSPMG]3 ERH ,( 4R] SXLIV TIVWSR SV SVKERM^EXMSR ]SY EVI VIUYMVIH XS EHH EW ER EHHMXMSREP MRYVIH YRHIV XLI GSRXVEGX SV EKVIIQIRX HIWGVMFIH MR ?EVEKVETL +( EFSZI( 4PP PSGEXMSRW SJ GSZIVIH STIVEXMSRW( $;RJSVQEXMSR VIUYMVIH XS GSQTPIXI XLMW AGLIHYPI& MJ RSX WLS[R EFSZI& [MPP FI WLS[R MR XLI 6IGPEVEXMSRW% )% 8B@NFJI 11 T <EJ 1M )I 1IMOLBA MW EQIRHIH XS MRGPYHI EW ER EHHMXMSREP MRWYVIH XLI TIVWSR$W% SV SVKERM^EXMSR$W% XMT\S NS YMJ BHMJIZQJ’ GZY TSQ^ \NYM WJXUJHY YT QNFGNQNY^ KTW aGTINQ^ NSOZW^b’ aUWTUJWY^ IFRFLJb TW aUJWXTSFQ FSI FI[JWYNXNSL NSOZW^b HFZXJI’ NS \MTQI SV MR TEVX& F]2 &%DSYV EGXW SV SQMWWMSRW3 SV ’%BLI EGXW SV SQMWWMSRW SJ XLSWI EGXMRK SR ]SYV FILEPJ3 MR XLI TIVJSVQERGI SJ ]SYV SRKSMRK STIVEXMSRW JSV XLI EHHMXMSREP MRWYVIH$W% EX XLI PSGEXMSR$W% HIWMKREXIH EFSZI( *%CMXL VIWTIGX XS XLI MRWYVERGI EJJSVHIH XS XLIWI EHHMXMSREP MRWYVIHW& XLI JSPPS[MRK EHHMXMSREP I\GPYWMSRW ETTP]2 CMNX NSXZWFSHJ ITJX STY FUUQ^ YT aGTINQ^ NSOZW^b TW aUWTUJWY^ IFRFLJb THHZWWNSL FKYJW3 &%4PP [SVO& MRGPYHMRK QEXIVMEPW& TEVXW SV IUYMTQIRX JYVRMWLIH MR GSRRIGXMSR [MXL WYGL [SVO& SR XLI TVSNIGX $SXLIV XLER WIVZMGI& QEMRXIRERGI SV VITEMVW% XS FI TIVJSVQIH F] SV SR FILEPJ SJ XLI EHHMXMSREP MRWYVIH$W% EX XLI PSGEXMSR SJ XLI GSZIVIH STIVEXMSRW LEW FIIR GSQTPIXIH3 SV DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 #0..+1),’- $+/+1’- %,’(,-,23 369 +* -+ *. *- ## .-&)357 4632.64 -0463%0’) ’13213%5-10 $2 <CT 7?JMPFGOC =QLAH 8KPRO?KAC 3LJM?KV& FCOCGK?DQCO QFC "3LJM?KV"% ENDORSEMENT NO. 25 )>>=;E?G= (8E=$ 2B@?;H 0FA9=C$ -DDF=< 5B$ */)*9/2022 +000539473-01 CT & T Concrete Paving, Inc. 5,-4 )0(134)/)05 ’,%0+)4 5,) 21.-’7# 2.)%4) 3)%( -5 ’%3)*6..7# PRIMARY INSURANCE CLAUSE ENDORSEMENT >L QFC CUQCKQ QF?Q QFGP GKPRO?KAC GP ?DDLOBCB QL ?KV ?BBGQGLK?I GKPROCB RKBCO QFC MLIGAV& PRAF GKPRO?KAC PF?II ?MMIV ?P MOGJ?OV ?KB KLQ ALKQOG@RQGKE TGQF ?KV GKPRO?KAC A?OOGCB @V PRAF ?BBGQGLK?I GKPROCB& ?P OCNRGOCB @V TOGQQCK ALKQO?AQ( <LQFGKE FCOCGK ALKQ?GKCB PF?II @C FCIB QL T?GSC& S?OV& ?IQCO LO CUQCKB ?KV ALKBGQGLK LO MOLSGPGLK LD QFC MLIGAV LQFCO QF?K ?P ?@LSC PQ?QCB( DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 #0..+1),’- $+/+1’- %,’(,-,23 69 ,. *. */ *3 ‘ <RWYVERGI BIVZMGIW ?JJMGI& <RG(& ,**2 ## /.’*469 5743/75 .1574&1(* (24324&6.21 $5 >I[ ;EQTWLMVI BXSGO <RWYVERGI 6SQTER\& LIVIMREJXIV XLI "6SQTER\"% 8>7?AB8=8>C >?( -* *@@?=JCL? );J?% 3GDC=M 1KE<?H% .IIK?> 6G% *0)09/2022 1000539473-01 CT & T Concrete Paving, Inc. 6-.5 *1)245*0*16 (-&1,*5 6-* 32/.(9# 3/*&5* 4*&) .6 (&4*+7//9# WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CLMW IRHSVWIQIRX QSHMJMIW MRWYVERGI TVSZMHIH YRHIV XLI JSPPS[MRK4 COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART 5(-*)7/* 1;E? 2@ 3?HIGF 2H 2HA;FCN;JCGF% 6X WJVZNWJI G] \WNYYJS HTSYWFHY XNLSJI G] GTYM UFWYNJX UWNTW YT FS] ‘THHZWWJSHJa NS \MNHM HT[JWFLJ NX XTZLLX YRHIV XLMW TSPMG\( <RJSVQEXMSR VIUYMVIH XS GSQTPIXI XLMW BGLIHYPI& MJ RSX WLS[R EFSZI& [MPP FI WLS[R MR XLI 7IGPEVEXMSRW( CLI JSPPS[MRK MW EHHIH XS @EVEKVETL $# 6H;FI@?H 2@ 4CABJI 2@ 4?=GL?HM &A;CFIJ 2JB?HI 6G 7I G@ 5?=JCGF .8 P (GF>CJCGFI% DI [EMZI ER\ VMKLX SJ VIGSZIV\ [I QE\ LEZI EKEMRWX XLI TIVWSR SV SVKERM]EXMSR WLS[R MR XLI BGLIHYPI EFSZI FIGEYWI SJ UF]RJSYX \J RFPJ KTW NSOZW] TW IFRFLJ FWNXNSL TZY TK ]TZW TSLTNSL TUJWFYNTSX TW ‘]TZW \TWPa ITSJ ZSIJW F HTSYWFHY [MXL XLEX TIVWSR SV SVKERM]EXMSR ERH NSHQZIJI NS YMJ ‘UWTIZHYX’HTRUQJYJI TUJWFYNTSX MF^FWIa) DMNX \FN[JW FUUQNJX TSQ] XS XLI TIVWSR SV SVKERM]EXMSR WLS[R MR XLI BGLIHYPI EFSZI( DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 FE-6609 Printed in U.S.A. FE-6609 SECTION II ADDITIONAL INSURED ENDORSEMENT Policy No.: 75-1612-APP Named Insured: CT & T Concrete Paving, Inc. 324 S. Diamond Bar Blvd. Diamond Bar, Ca 91765 Additional Insured: All Persons or organizations where required by written contract with the named insured. WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED, is amended to include as an insured the Additional Insured shown above, but only to the extent that liability is imposed on that Additional Insured solely because of your work performed for that Additional Insured shown above. Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there is an "X" in the box. Primary Insurance. The insurance provided to the Additional Insured shown above shall be primary insurance. Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to you. All other policy provisions apply. DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235 FE-6671 Printed in U.S.A. (04/09) FE-6671 Page 1 of 1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 75-1612-APP Named Insured: CT & T Concrete Paving, Inc. 324 S. Diamond Bar Blvd.Diamond Bar, Ca 91765 Name and Address of Person or Organization: All Persons or organizations where required by written contract with the named insured. The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a.Your ongoing operations; or b. Your work done under 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. All other policy provisions apply. FE-6671 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DocuSign Envelope ID: 137B8A0C-1E54-46DE-95A9-F2B9F72A1235