2021/11/15 NPG, Inc AKA: Nelson Paving & Grading, Goldstar Asphalt Products,aconif
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
CERTIFICATE NUMBER: 633372578 REVISION NUMBER:
DATE ( iI/DD/YYYN
11t10t2021
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, EXTENO 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: lf the cortlflcate holder is an ADOITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provl6lon6 or be endorsed.
lf SUBROGATION lS WAIVED, sublect to the terms and condltlons of the pollcy, ce aln pollcles may requlre an cndorsement. A statcmont on
thls certificate does not confer rlghts to tho certlflcate holder ln ll6u of such endorsement(s).
PROOUCER
Newport Beach-Allianl lnsurance Services, lnc
1301 Dove St Ste 200
Newport Beach CA 92660
License#:0C36461
CONTACT Soham Naik
li3',5" .,,,, 949-528-2891
soham nai lliant.com
rNsuRER(S) AFFORDll{G COVERAGE
TNSURERA: Executive Risk lndemnity lnc 35181
INSUREO
NPG, lnc dba: Nelson Paving & Grading, Goldslar Asphalt Products
P.O. Box 1515
Peffis CA.92572
rNsuRER B: Federal lnsurance Company 20241
rNsuRERc I ML Hawley lnsurance Company 37974
INSURER D
INSURER F
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE AEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REOUIREI\,{ENT, 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. LI[.ltITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSRLTR TYPE OF INSURAIICE SUAR POLiCYNUMBER POLICY EFF POLICY EXP LIlllITS
x COMMERCIAL GENERAL LIABILITY
CLAIMS.MAOE x OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER
POL CY
OTHER:
JECT LOCX
54310347 11t15t2021 't't 115t2422 E*CH OCCURRENCE $ 1,000,000
PREMISES lEa M!rEncal $ '100.000
MED ExP (Any one person)$ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,000
PRODUCTS. COMPIOP AGG $ 2,000,000
$
B AUTOMOEILELIABITITY
X
OWNEOAUTOS ONLYHIRED
AUTOS ONLY
SCHEDULEDAI]TOS
NON-OWNEOXX
1111512021 1111512022 COMBINED SINGLE LIMIT $ 1,000,000
BoDTLY NJURY (Psl p€6on)$
BOO LY INJURY (Per accid€nl)$
$
$
UI{BRELLA LIAB
EXCESS LIAB
X OCCUR 5671-7269 11t1512021 1115t2422 EACH OCCURRENCE s 5,000,000
AGGREGATE $ 5,000,000
DED RETENT ON $$
a WORKERSCOMPENSATION
ANO EMPIOYERS' LIASILITY
ANYPROPRIETOFI/PARTNEfu EXECUTIVE
OFFICEF'MEMAEREXCLUDED?
DESCRIPTION OF OPERATIoNS b€low
54310348 'v'v2021 1t112022 X PERSTATUTE OTH.
E,L EACH ACC DENT $ 1,000,000
E L OISEASE. EA EMPLOYEE $ 1,000,000
E,L, DISEASE, POTICY LIMIT s 1,000,000
c EG10009070 1111512021 1111512022 $1,000,000
$2,000,000
OESCRIPTIOI{ OF OPERATIOIIS/ LOCATIONS /VEHICLES (ACORO 101, Additiotrll R.m.rt Sch.dul., m.y b. rh.ch.d lfmo6.p.c.l. rcquir.d}
City oJ Menifee is named as Additional lnsured per attached endorsements. (30) Days Notice of Cancellation / Non-Renewal - Ten ('10) Days Notice For
Non-Payment of Premium.
CERTIFICATE HOLDER CANCELLATION
City of Menifee
29714 Huan Rd.
Menifee CA 92586
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CAIICELLED BEFORE
THE EXPIRATION DATE THEREOF, I{OTICE wlLL BE DELIVERED I
ACCORDANCE wlTH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATTVE
fu;t;p .4-z?-
@ 1988-2015ACORD CORPORATION. All ghts reserved
The ACORD name and logo are registered marks of ACORDACORD 2s (2016/03)
I
I
54310346
B
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
GONTRACTORS . AUTOMATIC STATUS FOR OTHER
PARTIES WHEN REQUIRED IN WRITTEN
CONSTRUCTION AGREEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
polrcyNUMBEp. 54310347
A. Section ll - Who ls An lnsured is amended to
include as an additional insured:
1. Any person or organization for whom you are
performing operations when you and such
person or organization have agreed in writing
in a contract or agreement that such person or
organization be added as an additional insured
on your policy; and
2. Any other person or organization you are
required to add as an additional insured underthe contract or agreement described in
Paragraph 1. above.
Such person(s) or organization(s) is an additional
insured only with respect to liability for "bodily
iniury", "property damage" or "personal and
advertising injury" caused, in whole or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on
your behalf;
in the performance of your ongoing operations for
the additional insured.
However, the insurance afforded to such
additional insured described above:
a. Only applies to the extent permitted by law;
and
b. Will not be broader than that which you are
required by the contract or agreement lo
provide for such additional insured.
A person's or organization's status as an
additional insured under this endorsement ends
when your operations for the person or
organization described in Paragraph '1. above are
completed.
COMMERCIAL GENERAL LIABILITY
cG 20 38 04 13
B. With respect to the insurance atforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal
and advertising injury" arising out of the
rendering of, or the failure to render, any
professional architectural, engineering or
surveying services, including:
a. The preparing, approving, or failing to
prepare or approve, maps, shop drawings,
opinions, reports, surveys, field orders,change orders or drawings and
specifications; or
b. Supervisory, inspection, architectural or
engineering activities.
This exclusion applies even if the claims against
any insured allege negligence or other wrongdoing
in the supervision, hiring, employment, training or
monitoring of others by that insured, if the
"occurrence" which caused the "bodily inJury" or
"property damage", or the offense which caused
the "personal and advertising injury", involved the
rendering of, or the failure to render, anyprofessional architectural. engineering or
surveying services.
2. 'Bodily injury" or "property damage'' occurring
after:
a. All work, including materials, parts or
equipment furnished in connection wilh
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
cG 20 38 04 13 O lnsurance Services Office, lnc., 2012 Page 't of 2
b. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organizationother than another contractor or
subcontractor engaged in 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
Soction lll - Limits Of lnsurance:
The most we will pay on behalf of the additional
insured is the amount of insurance:
1. Required by the contract or agreement
described in Paragraph A.1,; or
2. Available under the applicable Limits
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase
applicable Limits of lnsurance shown in
Declarations.
of
the
the
Page 2 ot 2 @ lnsurance Services Office, lnc.,2012 cG 20 38 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 pro\,ided under the following
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
POLTCY NUMBER. 54310347
A- Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability br "bodily injury", "property
damage" or "personal and ad\Ertising lniury"
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 perbrmance of your ongoing operations forthe additional insured(s) at the location(s)
designated abo\e.
Howe\er:
'1. The insurance afforded to such additional
insured only applies to the extent permitted by
law: and
2. tf corerage 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 contracl or agreement lo
pro\ide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 10 12 19
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" occuning after:
1. All work, including materials, parts or
equipment fumished in conneclion with such
work, on the project (other than senice,
maintenance or repairs) to be perbrmed by or
on behalf of the additional insured(s) at the
location of the co\,ered 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 anolher contractor or subcontractor
engaged in perbrming operations for a
principal as a part of the same project.
Name Of Additional lnsured Person(s)
Or Organization(s)Location(s) Of Cover6d Operations
WITERE REQUIRED BY }'R]TTEN CONTRtrCT.AI.L LOCATIONS IIITERE REQUIRED BY IIRITTEN
CONTR.trCT
lnbrmation required to complete this Schedule, if not shown abo\e, will be shown in the Declarations.
cG 20 10 12 't9 O lnsurance Senices Omce, lnc., 2018 Page 1 of 2
C. With respect to the insurance afiorded to these
additional insureds, the bllowing is added to
Sec{ion lll - Limits Of ln$rance:
lf cowrage 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 agreemenU or
2. A\ailable under the applicable limits of
insurance;
whiche\€r is less.
This endorssment shall not increase the
applicable limits of insurance.
O lnsurance Sen,ices Offce, lnc., 2018 cG 20 r0 12 19Page 2 ol 2
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETE D OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
A. Section ll - Who ls An lnsrred is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability br "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 op€rations
hazard".
Howe\,er:
l. The insurance afiorded to such additional
insured only applies to the extent permitted
by law; and
2. lf cowrage pro\,ided to the additional insured
is required by a contract or agreement, the
insurance afurded to such additional insured
will nol be broader than that which you are
required by the contract or agreement lo
pro\ide for such additional insured.
COMMERCIAL GENERAL LIABILITY
cG 20 37 '.tz 19
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf corerage prolided to lhe 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. A\Bilable under the applicable Limits of
lnsurance shown in the Declarations;
whiche\€r is less.
This endorsement shall not increase the applicable
Limits of lnsurance shown in the Declarations.
Name Of Additional ln$red Psr$n(s)
Or Organization(s)Location And Description Of Completed Operations
I|HERE REQUIRED BY I{RITTEN CONTR.ACT, BIII
ONLY 9IITEN TEE CONTRACT SPEC]FIES COVERAGE
FOR COUPI.ETED OPERATIONS
AII, LOCATIONS 9IITERE REQUIRED BY IIRITTEN
CONTR,ACT
lnbrmation required to complete this Schedule, if not showlr abo\e, will be shown in the Declarations
cG 20 37 12 19 O lnsurance Senices Offce, lnc.,2012 Page I of 'l
This endorsement modifies insurance provided under the fcllowing:
PoLICY NUMBER: 543'10347
POLTCY NUMBER 54310347 COTI/IMERCIAL GENERAL LIABILITY
1042-24f1 (Ed.7-rs)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY INSURANCE FOR
SCHEDULED ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Addilional lnsursd:
Per written contract
SCHEDULE
Location Of Covered Operations:
(lf no enlry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
With respecl only to the Additional lnsured and at the
Location Of Covered Operations shown in the
Schedule, the following is added to SECTION lV -
COMMERCIAL GENERAL LIABILITY CONDITIONS.
Paragraph 4. Othor lnsurance and supersedes any
provision to the contrary:
Primary And Noncontributory lnsuranco
This insurance is primary to and will nol seek
contribution from any other insurance available to
the Additional lnsured with respect to the Location
Of Covered Operations shown in the Schedule
under this policy provided that:
(1) The Additional lnsured 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 lnsured.
10-02-2461 (Ed. 7-15) lncludes copyrighted material of lnsurance Services Office, lnc.,
with its permission.
Page 1 of 1
POLICYNUMBER: 54310347
b. Those statemenls are based upon
representations you made to us; and
c. We have issued this policy in reliance upon
your representations.
7. Separation Of lnsureds
Except with respect to the Limits of lnsurance, and
any rights or duties specifically assigned in this
Coverage Part to the first Named lnsured, this
insurance applies:
a. As if each Named lnsured were the only
Named lnsured; and
b. Separately to each insured against whom
claim is made or "suit" is brought.
8. Transfer Or Waiver Of Rights Of Recovery
Against Others To Us
We will waive the right of recovery we would
otherwise have had against another person or
organization, for loss to which this insurance
applies, provided the insured has waived their
rights of recovery against such person or
organization in a contract or agreement that is
executed before such loss.
To the extent that the insured's rights to recover
all or part of any payment made under this
Coverage Part have not been waived, those rights
are transferred to us. The insured must do nothing
after loss to impair them. At our requesl, the
insured will bring "suit" or transfer those rights to
us and help us enforce them.
This condition does not apply to Coverage C.
9. When We Do Not Renew
lf we decide not lo renew this Coverage Part, we
will mail or deliver to the first Named lnsured
shown in the Declarations written notice of the
nonrenewal not less than 30 days before the
expiration date.
lf notice is mailed, proof of mailing will be sufflcient
proof of notice,
SECTION V - DEFINITIONS
1. "Advertisement" means an electronic, oral, written
or other notice, about goods, products or services,
designed for the specific purpose of attracting the
general public or a specific market segment to use
such goods, products or services.
"Advertisement" does not include any e-mail
address, lnternet domain name or other electronic
address or metalanguage.
2. "Advertising injury' means injury, other than
"bodily iniury', "property damage" or "personal
injury", sustained by a person or organization and
caused by an offense of infringing, in that
particular part of your "advertisement" about your
goods, products or services, upon their:
C'OMMERCIAL GENERAL LIABILITY
a. Copyrighted''advertisement"; or
b. Registered collective mark, registered service
mark or other registered trad6marked name,
slogan, symbol or title.
3. "Asbestos" means asbestos in any form, including
its presence or use in any alloy, by-product,
compound or other material or waste. Waste
includes materials to be recycled, reconditioned or
reclaimed.
4. "Auto" means:
a. A land motor vehicle, trailer or semitrailer
designed for travel on public roads, including
any attached machinery or equipment; or
b, Any other land vehicle that is subject to a
compulsory or financial responsibility law or
other motor vehicle insurance law where it is
licensed or principally garaged.
However, "auto" does not include "mobile
equipment".
5."Bodily injury" means physical:
a. lniury;
b. Sickness; or
c. Disease;
sustained by a person, including resulting death,
humiliation, mental anguish, mental injury or shock
at any time. All such loss shall be deemed to
occur at the time of the physical injury, sickness or
disease that caused it.
6. "Coverage territory" means:
a. The United States of America (including its
territories and possessions), Puerto Rico and
Canada;
b. lnternational waters or airspace, but only if the
injury or damage occurs in the course of travel
or transportation between any places included
in Paragraph a. above; or
c. All other parts of the world if the injury or
damage arises out of:
(1) Goods or products made or sold by you in
the tenitory described in Paragraph a.
above;
(2) The activities of a person whose home is in
the tenitory described in Paragraph a.
above, but is away for a short time on your
business; or
(3) 'Advertising injury'' or "personal injury"
offenses that take place through the
lnternet or similar electronic means of
communication
Form 10-02-1800 (Rev. 09-
'l7l
lncludes copyrighted material of ISO Properties, lnc., with
its permission
Page 13 of 17
POLTCYNUMBER: 54310347 COMMERCIAL GENERAL LIABILITY
cG 25 03 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESTGNATED CONSTRUCTTON PROJECT(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Oesignated Construction Project(s):
Per written contract.
lnformation required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. For all sums which the insured becomes legally
obligated to pay as damages caused by "occur-
rences" under Section I - Coverage A, and for all
medical expenses caused by accidents under
Section I - Coverage C, which can be attributed
only to ongoing operations at a single designated
construction project shown in the Schedule
above:
1. A separate Designated Construction Pro.iect
General Aggregate Limit applies to each des-
ignated construction pro.lect, and that limit is
equal to the amount of the General Aggregate
Limit shown in the Declarations.
2. The Designated Construction Project General
Aggregate Limit is the most we will pay for the
sum of all damages under Coverage A, ex-
cept damages because of "bodily injury" or
"property damage" included in the "products-
completed operations hazard", and for medi-
cal expenses under Coverage C regardless of
the number of:
a. lnsureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or
bringing "suits".
3. Any payments made under Coverage A for
damages or under Coverage C for medical
expenses shall reduce the Designated Con-
struction Project General Aggregate Limit for
that designated construction project. Such
payments shall not reduce the General Ag-
gregate Limit shown in the Declarations nor
shall they reduce any other Designated Con-
struction Project General Aggregate Limit for
any other designated construction project
shown in the Schedule above.
4. The limits shown in the Declarations for Each
Occurrence, Damage To Premises Rented To
You and Medical Expense continue to apply.
However, instead of being subJect to the
General Aggregate Limit shown in the Decla-
rations, such limits will be subject to the appli-
cable Designated Construction Project Gen-
eral Aggregate Limit.
cG 25 03 05 09 O lnsurance Services Otfice, lnc., 2008 Page 1 of 2 tr
B. For all sums which the insured becomes legally
obligated to pay as damages caused by "occur-
rences" under Section I - Coverage A, and for all
medical expenses caused by accidents under
Section I - Coverage C, which cannot be attrib-
uted only to ongoing operations at a single des-
ignated construction project shown in the Sched-
ule above:
1. Any payments made under Coverage A for
damages or under Coverage C for medical
expenses shall reduce the amount available
under the General Aggregate Limit or the
Products-completed Operations Aggr€gate
Limit, whichever is applicable; and
2. Such payments shall not reduce any Desig-
nated Construction Project General Aggre-
gate Limit.
C. When coverage for liability arising out of the
"products-completed operations hazard' is pro-
vided, any payments for damages because of
"bodily injury" or "property damage" included in
the "products-completed operations hazard" will
reduce the Products-completed Operations Ag-
gregate Limit, and not reduce the General Ag-
gregate Limit nor the Designated Construction
Project General Aggregate Limit.
D. lf the applicable designated construction project
has been abandoned, delayed, or abandoned
and then restarted, or if the authorized contract
ing parties deviate from plans, blueprints, de-
signs, specifications or timetables, the project will
still be deemed to be the same construction pro-
ject.
E. The provisions of Section lll - Limits Of lnsur-
ance not othenvise modified by this endorsement
shall continue to apply as stipulated.
Page 2 ol 2 @ lnsurance Services Office, lnc., 2008 cG25030509 tr
POLICY NUMBER: 54310346 COMM ERCIAL AUTO]\TOBI LE
-I.HIS ENDORSE}TENT CHAT-GES THE POLICY. PLEASE READ I.I.CAREF.ULL\,.
COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
This endorsenrent modifies insurance provided undcr thc following
BUSINESS AUTO COVERAGE FORM
This endorsement modifies the Business Auto Coverage Form1. EXTENDED CANCELLATION CONDITION
Paragraph A.2.b. - CANCELLATION - of the
COMMON POLICY CONDITIONS form lL 00 17 is
deleted and replaced with the following:b. 60 days befiore the effective date of cancella[on if
\n e cancel for any other reason.2. BROAO FORM INSUREDA Subsidiaries and Newly Acquired or Formed
Organizations A6 ln3ureds
The Named lnsured sho,vn in the Declarations is
amended to include:
1. Any legally incorporaled subsidiary in which
you own more than 50% of the votng stock on
the effective date of the Coverage Form.
Ho\ivever. the Named lnsured does not include
any subsidiary that is an "insured" under any
other automobile policy or would be an
"insured" under such a policy but for its
termination or the exhaustion of its Limit of
lnsurance.2. Any organization that is acquired or brmed by
you and over which you maintain majority
o/vnership. However, the Named lnsured
does nol include any newly formed or acquired
organization:
(a) That is an "insured" under any other
a:tomobile policy;
(b) That has exhausted its Limil of lnsurance
l'rlder any other policy; or
(c) 180 days or more after its acquisition or
formation by you, unless you have given
us written notice of the acquisition or
brmation.
Coverage does not apply to "bodily iniury" or
"property damage" that recJlts from an "accidenl"
hat occurred before you formed or acquired the
trganization.
B. Employees as lnsureds
Paragraph A.1 . - WHO lS AN INSURED - of
SECTION II - LIABILITY COVERAGE is amended to
add the bllo/ving:d. Any "employee" of yours while using a
covered "auto" you don't own, hire or
borro\ry in your business or your personal
dfairs.C. Lessors ao Insuleda
Paragraph A.1. -WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:e. The lessor of a covered "auto" while the
'auto" is leased to you under a written
agreement if:
(1) The agreement requires you to
proviJe direcl primary insurance for
he lessor: and
(2) The "auto" is loased without a driver.
Such leased .auto" will be considered a
covered 'aulo" you own and nol a covered
"auto" you hire.
Flolryever, the lessor is an "insured" only
br "bodily iniury" or "property damage"
resulting from he acts or omissions by:1. You:2. Any of your "employees" or agents;
or3. Any person, except the lessor or
any "employee" or agent of the
lessor, operating an "auto" with the
permission of any of 1. andlor 2.
D. Porsons And OrgEnizations As lnsursds
Under A Written lnsurod Contrac{
Paragraph A.1 - WHO lS AN INSURED - of
SECTION ll - LIABILITY COVERAGE is
amended to add the following:f. Any person or organization with respect to
he operation, maintenance or use of a
covered "auto", provided that you and
such person or organization have agreed
mder an express provision in a written
"insured @ntract", writlen agreement or a
written permit issued to you by a
governmental or public authority to add
s:ch person or organization to this policy
as an "insured".
l-lowever, such person or o€anization is
ar "insured" only:
Form: 16-02-0292 (Rcv.4-l l) Pagc I of3
"lncludes copyrighted material of lnsurance Services Office, lnc. with its permission"
(1) with respecl to the operation,
maintenance or use of a mvered
"auto"; and
(2) for "bodily injury" or "property damage"
caused by an 'accidenf' which takes
place after:
(a) You executed the "insured
@ntracl" or written agreement; or
(b) The permit has been issued to
3. FELLOW EMPLOYEE COVERAGE
EXCLUSION 8.5. - FELLOW EMPLOYEE - of
SECTION ll - LIABILITY COVERAGE does not apply.4. PHYSICAL DAMAGE - ADOITIONAL TEMPORARY
TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a. - TRANSPORTATION EXPENSES
- of SECTION lll - PHYSICAL DAMAGE
COVERAGE is amended to provide a limil of $50 per
day br temporary transportation expense, subjoct lo a
maximum limit of $1,000.5. AUTO LOAN/LEASE GAP COVERAGE
Paragraph A. 4. - COVERAGE EXTENSIONS - of
SECTION lll - PHYSICAL DAMAGE COVERAGE is
amended to add he following:
c. Unpaid Loan or Lease Amounts
ln the event of a total "loss" to a mvered "auto", we will
pay any unpaid amount due on the loan or lease for a
@vered "auto" minus:1. The amount paid under the Physical Darnage
Coverage Seclion of the policy; and2. Any:a. Overdue loarylease payments at the lime of
the 'loss":b. Financial penalties imposed under a lease for
excessive use, abnormal wear and tear or
high mileage;c. Security deposits not returned by the lessor:d. Costs for extended warranties, Credit Life
lnsurance, Health, Accident or Disability
lnsurance purchased with the loan or lease;
ande. Carry-over balances from previous loans or
leases.
We will pay for any unpaid amount due on the loan or
lease if caused by:
1 . Other than Collision Coverage only if the
Declaratons indicate that Comprehensive
Coverage is provided for any covered 'aulo";2. Specified Causes of Loss Coverage only if the
Oedarations indicate that Specilled Causes of
Loss Coverage is provided for any covered .aulo";
or3. Collision Coverage only if the Declarations indicate
hat Collision Coverage is provided for any
covered "aulo.6, RENTAL AGENCY EXPENSE
Paragraph A.4. - COVERAGE EXTENSIONS - of
SECTION III - PHYSICAL DAMAGE COVERAGE
is amended to add the ficllowing:
d. Rental Expense
We will pay the following expenses thal you or
any of your "enployees" are legally obligated
to pay because of a written @ntract or
agreemenl entered into for use of a rental
vehicle in the conducl of your business:
MAXIMUM WE WILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:1. 52,500 for loss of inmme incuned by the
rental agency during the period of time that
vehicle is oul of use because of actual
damage to, or "loss" of, that vehicle, including
income losl due to absence of that vehicle for
use as a replacement:2. $2,500 for decrease in trade-in value of the
rental vehicle because of actual damage to
that vehicle arising out of a mvered "loss"; and3. $2,500 for administrative expenses incurred
by the rental agenry, as stated in the contracl
or agreement.4. 57,500 maxinum total amount for paragraphs
1.,2. and 3. combined.7. EfiRA EXPENSE - BROADENED COVERAGE
Paragraph A.4. - COVERAGE EXTENSIONS - of
SECTION III _ PHYSICAL DAMAGE COVERAGE
is amended to add the bllowing:e. Recovery Erpense
We will pay for the expense of returnirE a
stolen @vered "auto" to you.
8. AIRBAG COVERAGE
Paragraph B.3.a. - EXCLUSIONS - of SECTION
lll - PHYSICAL DAMAGE COVERAGE does not
eply to the accidenlal or unintended discharge of
an airbag. Coverage is excess over any other
colleclible insurance or warranly specifi cally
desrgned to provide this coverage.9. AUOIO, VISUAL AND OATA ELECTRONIC
EQUIPMENT . BROADENEO COVERAG E
Paragraph C.2. - LIMIT OF INSURACE - of
SECTION lll - PHYSICAL DAMAGE is deleted
ld redaced with the following:
2. $2,000 is the most we will pay for "loss" in any
one "accident" to all eleclronic equipment that
rcproduces, receives or transmits audio, visual
or data signals which, at the time of 'loss", is:a. Permanently installed in or upon the
covered "auto" in a housing, opening or
cther location that is not normally used by
he 'auto' manufac{urer for the installalion
c, such equipment;b. Removable from a permanently instdled
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipment: orc. An integral part of sudr equipment.
Form: 16-02-0292 (Rcv. 4- I I ) Pagc 2 of3
"lncludes mpyrighted material of lnsurance Services Office, lnc. wih its permission"
10. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of
SECTION III_ PHYSICAL DAMAGE COVERAGE
the frcllowing is added:
t,,lo deductible applies tc glass damage if the glass
is repdred rather than replaced..I1. TWO OR MORE DEDUCTIBLES
Paragraph D.- DEDUCTIBLE - of SECTION lll -
PHYSICAL DAMAGE COVERAGE is amended lo
dd the follo\ /ing:
lf this Coverage Form and any other Coverage
Form or policy issued to you by us that is nol an
artomobile policy or Coverage Form applies to the
same "accidenl". the following applies:'1. lf he deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible. it wlll be waived: or2. lf the deductible under this Business Auto
Coverage Form is not the smaller (or smallest)
dedudible, it will be reduced by the amount of
he smaller (or smallest) deduclible.
12. AMENDED DUTIES IN THE EVENT OF
ACCIDETT, CLAIM, SUIT OR LOSS
Paragraph A.2.a. - DUTIES lN THE EVENT OF
AN ACCIDENT, CLAIM, SUIT OR LOSS of
SECTION lV - BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:a. ln the event of "accident", claim, "suit" or
"loss", you must promptly nolify us when the
"accident" is known to:
(1) You or your authorized representative, if
)ou are an individual;
(2) A parher, or any authorized
representative, if you are a partnership;
(3) A member, if you are a limited liability
company: or
(4) An executive offic€r, insurance manager,q authorized represenlative, if you are an
qganization oher than a padnership or
limited liability company.
Knowledge of an "accident", claim, "suit" or
"loss" by other persons does not imply that the
persons listed above have such knowledge.
Notice lo us should include:
(1 ) How, when and where the "accident" or
"loss" occuned;
(2) The'insured's" name and address: and
(3) To the eldent possible, the names and
addresses of any injured persons or
applies, provrded the "insured" has waived
heir rights of recovery against such person or
organization under a contract or agreement
hat is entered inlo before such "loss".
To the extent that the "insured's" rights to
recover damages for all or part of any
payment made under this insurance has not
been waived, hose rights are transferred to
us. That person or organization must do
everything necessary to secure our rights and
must do nothing after "accident" or "loss" to
impair them. At our request, the insured will
bring suit or transfer those rights to us and
h€lp us enforce them.
15. AUTOS RENTED BY EMPLOYEES
Paragraph 8.5. - OTHER INSURANCE of
SECTION IV - BUSINESS AUTO CONDITIONS .
is amended to add the following:e. Any "auto" hired or rented by your "employee"
on your betElf and al your direction will be
considered an "auto" you hire. lf an
"employee's" personal insurance also applies
on an excess basis to a covered "auto" hired
or rented by your "employee" on your behalf
and at your direclion, this insurance will be
primary to the "employee's" personal
insurance.
16. HIRED AUTO - COVERAGE TERRITORY
Paragraph 8.7.b.(5).(a) - POLICY PERIOD,
COVERAGE TERRITORY c, SECTION lV -
BUSINESS AUTO CONDITIONS is deleted and
replaced with the following:
(a) A covered "auto" of the private passenger
type is leased, hired, rented or borrowed
without a driver for a period of 45 days or
less: and
I7. RESULTAIIT MENTAL ANGUISH COVERAGE
Paragraph C. of - SECTION V - DEFINITIONS is
deleted and replaced by the following:
"Bodily injury" means bodily iniury, sickness or
disease sustained by any person, including
nEntal anguish or death as a result of the "bodily
hjury" sustained by that person.
Form: 16-02-0292 (Rev.4-l l) Page 3 of3
'lncludes copyrighted material of lnsurance Services Office, lnc. wilh its permission"
13. WAIVER OF SUBROGATION
Paragraph A.5. - TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US of
SECTION lV - BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:5. We will waive the right of recovery we would
otherwise have against another person or
organization for "loss" to which lhis insurance
14. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
Paragraph 8.2. - CONCEALMENT,
MISREPRESENTATION or FRAUD of SECTION
rV - BUSINESS AUTO CONDITIONS - is deleted
and redaced wih the following:
lf you unintentionally fail to disclose any hazards
existing al the inception date of your policy, we will
rpt void coverage under this Coverage Form
because of such failure.
PoLICYNUMBER: 54310346 COMTI/IERCIAL AUTO
16-02-0316 Ed. 10 14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NON-CONTRIBUTORY LIABILITY
!NSURANCE
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modilied by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named tnsured: NPG, Inc aka: Nelson Paving & Grading, Goldstar Asphalt Products
Endorcement Effective Oale: 1 1 11512021
SCHEDULE
Name(s) O, Person(s) Or Organization(s):
WHERE REQUIRED BY WRITTEN CONTRACT.
lnformation required to complete this Schedule, if nol shown above, will be shown in the Declarations
The following is added to ltem 5. - "Other
lnsuranco' of ltem B. - "General Conditions" under
Section lV - 'Business Auto Conditions":
e. Regardless of the provisions of Paragraph 5.a.
through d. above, for any liability arising out of the
ownership, maintenance, use, rental, lease, loan, hire
or borrowing by an "insured" of a covered "auto" for
which an "insured" is contractually obligated to
provide primary insurance coverage to a client, this
Coverage Form will be primary and non-contributory
with respect to the Persons or Organizations ln the
schedule, regardless of the availability or existence of
other collectible insurance under any other Coverage
Form or policy that applies on a primary basis.
16-02-0316 Ed. 't0 14 Page 1 of 1
Workers' Compensation and Employerc' Liability Policy
tlpq'th'd'8fl., Nelson Paving & Grading, Gotdstar
Asphalt Products
Endorsem6nt Number
Policy Number
Symbol: WCF Number:54310348
Policv Period
01 101 12021 to 01 101 12022
EffectiY8 Data of Endorsemenl
01t01t20?1
lssued By (Name ol lnsurance Company)
FEDERAL INSURANCE
lnsert lhe r€ma is lo be com leted on wh6n this sndorsoment is uent lo
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 ltem 3.A. of
the lnformation 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
( ) Specific Waiver
Name of person or organization:
( X) Blanket Waiver
Any person or organization for whom the Named lnsured has agreed by written contract to furnish this
waiver.
2. Operations:
ALL OPERATIONS
3. Premium:
The premium charge for this endorsement shall be 1.0 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: $0
wc 90 03 7s (05/18)
Authorized Representative